AIIMS NOV 2012 DENTAL Paper MCQS

Discussion in 'Dental PG MDS IQE MFDS ADC Exams' started by guest2011, Nov 22, 2012.

  1. guest2011

    guest2011 Moderator

    1. Gate control theory was given by
    Descartes
    Goldshieder
    Mezlack and wall

    2. Bone modeling theory of craniofacial growth was given by
    John hunter
    Van der claw
    Melvin and Sicher

    3. Cardiac dysrythmias occurs due to stimulation of
    3 C N.
    4 C N.
    5C N.
    7C N.

    4. Excessive pressure at angle of mandible during establishment of patent airway damages the
    5 cranial n.
    7 cranial n.
    8 cranial n
    9 cranial n.

    5. The nerve commonly seen to be simultaneously anaesthesized along with anesthesia of V n.
    Optic
    Occulomotor
    Abducent
    Facial

    6. Excessive bleeding occurring during oral surgery under GA can be minimized by maintaining the patient at
    Head up
    head down
    Prone
    Supine

    7. Patient with chronic ACTH insufficiency requires extraction under GA . patient requires premedications with ( 2 times in paper )
    Antibiotics

    8. A tooth bud splitting into 2 resulting in formation of 2 incompletely separated crown with single root and root canal is
    Germination
    Fusion
    Concrescence

    9. Patient with panfacial injuries presenting at emergency which of the following sud be 1st managed
    Mandible #
    Orbital rim #
    Zygomatic arch #
    Le fort dysjunction

    10. India annual health expenditure of its total national GDP is
    15%
    10%
    1.2%
    2%

    11. Disadvantage of tipping canine using a finger spring is
    The canine root tips in the direction opp. to the direction of crown


    12. Patient with head injury and cervical # can not be ruled out , best method of intubation is
    Laryngoscopy and intubation
    Fiberoptic intubation
    Combitube
    LMA

    13. BEST method of inubation in patient with orofacial injury undergoing RX for oral surgery under GA
    LMA
    Laryngeal mask airway
    Oro tracheal tube
    Naso endo tube

    14. A child with 5yr 4mths with narrow maxilla , SNA normal , SNB reduced and distal step deci. molar arrangement , RX of choice ( 2 times in papper )
    Wait and watch at 6yr
    FR II APPLIANCE
    TWIN BLOCK THERAPY
    KLOEN EXTRA ORAL HEAD GEAR


    15. TENSOR PALATI is supplied by
    VII N.
    Trigeminal
    Vagus
    Hypoglossal


    16. Facial n . is located
    Superficial to SMAS and parotidomasseteric fascia
    Superficial to SMAS and deep to parotidomasseteric fascia
    Deep to SMAS and deep to parotidomasseteric fascia
    Deep to SMAS and buccal pad of fat


    17. Moyers D type CLASS II malocclusion is
    Orthognathic Mx / orthognathic Mn
    retrognathic Mx / retrognathic Mn
    prognathic Mx / retrognathic Mn
    orthognathic Mx / retrognathic Mn


    18. Most resistant to antiseptics
    Bacteria
    Viruses
    Spores
    Prions


    19. Antibiotic associated colits is commonly caused by
    Clindamycin
    Vancomycin (DOC)
    Metronidazole
    Chloramphenicol


    20. Drug not seen to cross BBB
    NETILIMYCIN
    Penicillin
    Clindamycin
    Ceftazidime


    21. Latent period in distraction osteogenesis is
    0-2 days
    4-7 days
    21 days
    4-6weeks


    22. Class 3 development with mandibular deviation , developing cross bite , enlargement of condyle with inc. radioopacity pointing towards lateral pterygoid muscle , most likely
    Osteoma
    Osteoid osteoma
    Osteochondroma
    Condylar hyperplasia


    23. The graft histologically and morphologically similar to
    5th costochondral graft
    Sternoclavicular joint
    3rd tarsal bone graft


    24. Most common site of zygomatic arch # is
    Ant to ZT suture
    Post to ZT suture
    Zygomatictemporal suture
    No specific location


    25. Serum alk . PO4 IS raised in al except
    Paget’s disease
    Fibrous dysplasia
    Osteomyelitis
    Hyperparathyroidism


    26. Contrast agent used to study joint space , procedure is called as
    Arthroscopy
    Arthrography
    Orthopantomogram
    Arthroplasty


    27. Most common method is used in detection of primary herpes
    Culture with giemsa stain
    Culture with giemsa stain
    Routine cytology
    Fluroscent stain for cytology


    28. Most common type of hereditary malocclusion is
    Class I type 1
    Class II div 1
    Class II div 2
    Functional class III


    29. CSF rhinorrhoea can be identified by all except
    High CSF protein
    High glucose
    Tramline pattern
    β 2 transferrin


    30. Not used as abrasive in dentrifice ( doubt bout dis 1 )
    Calcium carbonate
    Sodium chloride
    Silicate
    Amylase


    31. Oxygen supply of free graft is best confirmed by ( aipg 2012)
    Pulse oximetry
    Laser Flowmetry
    Prick test<<<<<<<<<<
    Fluorocin and fluorophotometer


    32. Exogeneous sucrose metabolizing organisms are considered as etiologic agents for dental caries as
    They are capable of producing extracellular dextan like glucan


    33. Patient with prosthetic cardiac valve needs oral surgical procedure under GA. Antibiotic prophylaxis of choice is ( nov 2011 aiims )
    2gm amoxicillin 1hr prior to GA
    1gm amoxicillin 2hr prior to GA<<<<<<<<<
    500 mg before 1hr to GA
    600 MG Clindamycin 15 min before surgery


    34. ETCHING of enamel with 37% orthophosphoric acid for 30 sec creates microporous layer of depth
    5- 10µ m<<<<<<<<
    10- 20µ m
    21- 30µ m
    50- 60µ m


    35. Etching of enamel surface with H2(PO4)3 creates a microporous etched surface of 15-25 µm . how much of this thickness is contributed by enamel
    5-10
    1-5
    10-15
    >15


    36. Gingival lesions are unusual findings in
    Primary herpes
    Recurrent apthae<<<<<<<<<<<
    Pyogenic granuloma
    Erythema multiforme


    37. Causative agent for AIDS was established in
    1969
    1972
    1983<<<<<<<<<<
    1994


    38. Bony swelling in mandibular swelling 2cm in size painful and susceptible to salicyclate therapy is (nov 2011 aiims)
    Osteoma
    Osteoid osteoma<<<<<<
    Osteochondroma
    Osteoblastoma


    39. Obstructive apnea is most commonly seen to develop in
    B/L TMJ ankylosis<<<<<<<<
    Orbital floor #
    Mandibular ameloblastoma


    40. Rx of choice in patient presenting with LUDWIG’S ANGINA at emergency
    Incision and drainage
    Tracheostomy ↓GA
    Cricothyrotomy
    Tracheostomy ↓LA<<<<<<<<


    41. Drug administration to be stopped in patient prior to patient ↓ GA
    METFORMIN


    42. NOT true about METFORMIN
    ↓ cellular oxidation of glucose
    ↓ glucose synthesis in liver
    Excreted unchaned in urine
    Safely administered in decompensated cadiac failure<<<<<<


    43. Not true about Piperacillin
    Rx for P.aeroginosa
    Related to blood dyscrasias
    Resistant to β LACTAMASES<<<<<<


    44. Brittle bone disease defect lies in ( osteogenesis imperfect )
    Procollagen formation<<<<<<
    Collagen polymerization<<<<<<<
    ↑osteoclastic activity
    ↑ immature collagen and osteoblastic activity

    Defect lies in collagen 1 formation

    45. NK CELL acts on viruses because
    Expression of MHC I on cell surface receptor<<<<<<<
    Non Expression of MHC I on cell surface receptor
    Expression of MHC II on cell surface receptor
    NON Expression of MHC II on cell surface receptor


    46. Twinning effect is seen in
    Stainless Steel
    Ni – Ti
    Co- Cr
    All of the above<<<<<<<<<<<


    47. Clasp adjustment in a RPD is a property of ( doubt bout dis 1)
    Elongation


    48. A Patient with class II modification partial edentulous space with opposing full complement of natural teeth in Mx Arch, occlusion to be given is
    Canine guided occlusion
    Unilateral balanced occlusion
    Bilateral balanced occlusion
    Canine guided or unilateral balanced depending on total no.of missing teeth



    49. Teeth in CD in patient with Parkinsonism
    Anatomic
    Non anatomic<<<<<<<<<
    Semi anatomic
    Sezary


    50. Hashimoto’s thyroiditis all are seen except ( doubt bout dis 1)
    Orphan annie eyed nuclei
  2. guest2011

    guest2011 Moderator

    51. 33degree bending of head forward or touching the chin to the sternum while recording PPS is done in order to
    Prevent entry of the material into the phaynx
    Activation of muscles of soft palate<<<<<<
    Activation of muscles of soft palate + post wall of pharynx


    52. While recording 2 ⁰ impression using custom tray the tray should be 1st seated in
    Ant region<<<<<<<<<<
    Post region
    Ant and post simultaneously depending upon operators choice



    53. Most mucostatic impression material is ( doubt bout dis 1)
    Pop<<<<<<
    ZoE
    Impression compound
    Alginate


    54. Patient experiencing sensitivity immediately after seating of FPD is most commonly due to
    Carious abutment
    Thin margins<<<<<<<<
    Exposed cementum



    55. Highest interfacial surface tension exists between tooth and orthodontic bracket made up of material
    Porcelain alumina
    Polycarbonate
    Stainless steel
    Ni Ti


    56. Amalgam bonding agents used to bond to amalgam restored teeth is
    TEGDMA
    UDMA
    4- META<<<<<<<
    Cyanoacrylates


    57. Salt of gontrez are used as
    Denture adhesives


    58. Temp at which tertiary amine activates benzoyl peroxide to split and initiate chemical polymerization is
    25⁰ C
    37⁰C
    60⁰C<<<<<<<<<<
    80⁰C


    59. Lingually locked Mx 2⁰ CI in an other wise normal occlusion . most propable cause is
    Prolong retention of Mx 1⁰ CI


    60. Which of the following technique is not used for cleft lip repair ( or cleftlip+ palate repair)
    Millard tech
    Tenninson randall tech
    Langenback tech<<<<<<<<
    De trossreau tech


    61. Disease seen to involve both the bone and the intervertebral space of the spinal cord
    Multiple myeloma
    Tuberculosis<<<<<<<
    Lymphoma
    Metastasis


    62. # of porcelain can be prevented by
    Group function occlusion
    Canine guided occlusion
    Preventing balancing side contact
    Highly glazed porcelain


    63. Submandibular gland is separated from sublingual gland via
    Fibres of mylohyoid muscle


    64. Anticoagulant added to blood sample at PHC FOR blood glucose estimation
    EDTA
    Na citrate
    K oxalate
    K oxalate + NaF<<<<<<<<


    65. RADIOGRAPHIC CONSTRAST can be governed by montitoring
    KVp<<<<<<<<
    mA
    Time
    Fsfd


    66. True hinge axis is compulsorly be recorded for
    CD
    RPD<<<<<<<
    FPD
    Change in vertical dimension<<<<<<<<<


    67. DEPTH AT which impacted bone is located is measured by
    White line
    Amber line
    Red line<<<<<<<<


    68. Most common type of H/P seen under microscopy for ameloblastoma
    Nests strands cords of epithelium in fibrous connective tissue stroma (follicular variant)


    69. Hair on end appearance on a skull xray is seen in
    Thalassemia


    70. White plaque on buccal mucosa with pseudomycelia seen under light microscopy is
    Candida albicans<<<<<<<<<<
    Histoplasma
    Sporothrix


    71. Linear curve running from anterior to posterior teeth is
    Curve of spee<<<<<<<
    Curve of monsoon
    Curve of monsoon
    Bonwill curve

    72. Topical anesthetic is effective upto depth of ( doubt bout dis 1)
    0.5 – 1 mm
    1- 2 mm
    2- 3 mm
    3- 3.5 mm



    73. Sterilization of hand piece is not done by
    Dry heat
    Auto clave
    Ethylene oxide


    74. Antiflux material is
    Graphite


    75. Karyotyping is done for
    Chromosomal abnormalities


    76. Important fatty acid present in breast milk is
    Docosa hexanoic acid (DHA)<<<<<<<<<
    Linoleic acid
    Palmitic acid

    77. Diplopia in a patient with maxillofacial injuries is best assessed by
    HESS chart


    78. Rx for patent with gingivitis ANUG
    Metronidazole+ penicillin


    79. Most common site of BCC ( doubt bout dis 1 )
    Upper ⅓ face
    middle⅓face<<<<<<<
    side of nose
    lower ⅓ face


    80. Last resort of anesthesia
    Intrapulpal<<<<<<
    Intraligamentary
    Supraperiosteal
    Infilteration


    81. Blood supply to free flap is best assessed by
    Prick test<<<<<<<<<
    Laser Doppler flometry
    Oxygen saturation


    82. Bilateral mandibular expansion is seen in
    Cherubism<<<<<<<<<
    Fibrous dysplasia
    Pagets disease
    CGCG


    83. Most common malignant tumor arising in parotid gland
    Mucoepidermoid CA<<<<<<<
    Pleomorphic adenoma
    Odontogenic myxoma


    84. Yellow bag waste is best managed by
    Incineration<<<<<<<
    Burial
    Autoclave


    85. Hypodontia is seen in
    Ectodermal dysplasia


    86. Hypogonadism , failure to thrive , loss of taste , inability to maintain stability . the deficiency is suggestive of
    Zn<<<<<<<<<<
    Cr
    Cu
    K


    87. All the following muscles are supplied by cranial accessory except
    Stylophayngeus ( GLOSSOPHARYNGEAL N.)<<<<<<<<<<
    Saplingopharyngeus
    Palatophayngeus
    cricopharyngeus


    88. Patient is a vertical grower with ↑ lower ant facial height which of the following is seen in maxilla of the patient as compensation for this inc
    Rotates ant downwards
    Post downwards<<<<<<
    Post upwards


    89. Stage II tumor in oral cavity ( doubt bout dis 1)
    T1N0M0
    T2N0M0<<<<<
    T2N1M0
    T2N1M1


    90. Lag phase in orthodontic tooth movement is about
    2-3sec
    2-3min
    2-3days
    2-3weeks<<<<<<<<<<<


    91. BAKERS anchorage is
    Intermaxillary anchorage<<<<<<<
    Intramaxillary anchorage
    extraoral anchorage
    reciprocal anchorage


    92. Genial tubercle prominent on lower edentulous arch Rx is
    Cover the genial tubercle and relief on intaglio surface
  3. guest2011

    guest2011 Moderator

    Fiberoptic endotracheal intubation is a useful technique in a number of situations. It can be used when the patient's neck cannot be manipulated, as when the cervical spine is not stable. It can also be used when it is not possible to visualize the vocal cords because a straight line view cannot be established from the mouth to the larynx. Fiberoptic intubation can be performed either awake or under general anesthesia and it can be performed either as the initial management of a patient known to have a difficult airway, or as a backup technique after direct laryngoscopy has been unsuccessful.
  4. guest2011

    guest2011 Moderator

    In recent years, there have been many advances in difficult airway management. The introduction of the laryngeal mask airway, and later the intubating laryngeal mask airway have changed the American Society of Anesthesiologists’ difficult airway algorithm significantly.5 Despite new devices and techniques being added to the arsenal daily, the mainstay of difficult airway management remains flexible fiberoptic laryngobronchoscopic intubation. Fiberoptic intubation can be performed under a variety of conditions. However, one major decision must be made with every procedure will the patient be intubated while under general anesthesia, or does the patient need to be awake during intubation?6 Intubation under general anesthesia (even with inhalational induction and spontaneous respiration) carries the inherent risk of losing control of the difficult airway. For this reason, many anesthesiologists, on recognition of a difficult airway, elect to perform an awake intubation using either fiber optic laryngobronchoscopy or awake direct laryngoscopy.
    Direct laryngoscopy in an awake, unprepared patient can be extremely challenging. Excessive salivation and gag and cough reflexes can make intubation difficult, if not impossible, under awake conditions. In addition, the stress and discomfort may lead to undesirable elevations in the patient’s sympathetic and parasympathetic outflow. Several highly effective topical and regional anesthesia techniques have been developed to subdue these reflexes and facilitate intubation. Each of these techniques has the common goal of reducing sensation over the specific regions that will be encountered by the fiber optic bronchoscope and endotracheal tube.
  5. guest2011

    guest2011 Moderator

    Amongst the horizontal subgroups, Group A represented the “pseudo Class II”
    which had normal skeletal relations but had maxillary dental protrusion. Group B
    displayed maxillary skeletal and dental protrusion and normal mandibular positioning and
    size. Group C had bimaxillary retrusion, maxillary dental protrusion and mandibular
    dental protrusion. Both the maxilla and mandible were smaller in size. Group D was
    similar to Group C, but did not include mandibular dental protrusion. Group E was
    maxillary prognathic with bimaxillary dental protrusion. Group F was the largest and
    least well-defined group and displayed mandibular retrusion
  6. guest2011

    guest2011 Moderator

    Microorganisms vary greatly in their resistance to chemical germicides and sterilization processes (Figure 1) 342 Intrinsic resistance mechanisms in microorganisms to disinfectants vary. For example, spores are resistant to disinfectants because the spore coat and cortex act as a barrier, mycobacteria have a waxy cell wall that prevents disinfectant entry, and gram-negative bacteria possess an outer membrane that acts as a barrier to the uptake of disinfectants Implicit in all disinfection strategies is the consideration that the most resistant microbial subpopulation controls the sterilization or disinfection time.
  7. guest2011

    guest2011 Moderator

    Skin Prick Testing

    Skin prick testing measures specific IgE attached to cells in the skin. This is probably the most commonly used allergy test and is appropriate for both inhaled and ingested (eaten) allergies.

    Skin prick testing is usually the first test recommended when an allergy is suspected. The advantages are that it is a simple, quick (providing results within 15-20 minutes) and inexpensive form of testing.

    It can give useful information in all forms of allergy, and is appropriate for inhaled and ingested (eaten) allergies. The test is conducted within a hospital or GP surgery by specially trained nurses or doctors.

    The skin prick test introduces such a tiny amount of allergen into the skin that testing is quite safe. These tests can be carried out on all age groups, including babies, although the response will be considerably smaller than in an adult.

    Skin testing is usually carried out on the inner forearm, but if the patient has bad eczema the test can be performed on the back
    The test allergens are selected in accordance with the patient’s history
    As few as 3 or 4 or up to about 25 allergens can be tested
    The arm is coded with a marker pen for the allergens to be tested
    A drop of the allergen (extract) solution is placed by the relevant name or number
    The skin is then pricked through the drop using the tip of a lancet – this can feel a little uncomfortable but should not be painful
    The patient needs to avoid taking anti-histamines and certain other medications for 48 hours before the test

    If the test is positive, the skin becomes itchy within a few minutes and then becomes red and swollen with a “wheal” in the centre (very much like the reaction to a nettle sting). The wheal has a raised edge which slowly expands to reach its maximum size in about 15 minutes, clearing for most people within an hour. However, having a reaction is not in itself a signal that someone has an allergy to that substance. The wheal needs to be over a certain size to suggest an allergy, although the size of the wheal is not an indication of how severe an allergic reaction may be.

    Two control samples are included to make sure that the test has worked; one of the controls will cause a reaction in all people, and the other should not cause a reaction in anyone. This helps the nurses and doctors ensure the test has been conducted properly.

    A negative response to skin prick testing usually indicates that the patient is not sensitive to that allergen. Negative reactions may occur if the patient is taking anti-histamines or medications that block the effect of histamine. For reasons which we do not yet fully understand skin prick testing with food allergens is less reliable than with some other allergens such as dust and pollens, so false negative reactions can occur. Also, in some people, the test may be negative for other reasons, which is why it is important for the results to be interpreted by a healthcare professional experienced in allergy. In some cases, the doctor may request a blood test to help clarify the results.

    The person having the test is usually asked to stop taking any anti-histamine medication some days beforehand, since the results will not be reliable if anti-histamines are still in the body when the test is performed. If the patient has not stopped taking anti-histamines before their appointment they may not be able to have the skin prick test.
  8. guest2011

    guest2011 Moderator

    The history of virology – the scientific study of viruses and the infections they cause – begins in the closing years of the 19th century. Although Louis Pasteur and Edward Jenner developed the first vaccines to protect against viral infections, they did not know that viruses existed. The first evidence of the existence of viruses came from experiments with filters that had pores small enough to retain bacteria. In 1892, Dmitry Ivanovsky used one of these filters to show that sap from a diseased tobacco plant remained infectious to healthy tobacco plants despite having been filtered. Martinus Beijerinck called the filtered, infectious substance a "virus" and this discovery is considered to be the beginning of virology. In the 20th century many viruses were discovered
  9. guest2011

    guest2011 Moderator

    A CASE OF ACYCLOVIR-INDUCED RESPIRATORY DEPRESSION IN PATIENT WITH END-STAGE RENAL DISEASE

    W. Hester1; V.T. Martin1; S. Bansil1; C.J. Fichtenbaum1. 1University of Cincinnati, Cincinnati, OH. (Tracking ID #115632)

    LEARNING OBJECTIVES

    1. Recognize the clinical setting of acyclovir-induced neurotoxicity. 2. Diagnose and manage acyclovir-induced neuroxicity.

    CASE

    A 46 year-old woman with AIDS (recent CD 4 + lymphocyte count 145 per mL & plasma HIV RNA level <400 copies per mL) and ESRD on continuous ambulatory peritoneal dialysis (CAPD) presented with pain in her right thigh for three months. Doppler ultrasounds were negative for deep venous thrombosis on two different tests. She had been in stable health without recent opportunistic infections. Her past medical history was significant for a history of shingles, orolabial herpes simplex disease, pancreatitis secondary to nucleosides, Candida esophagitis, and asthma. Her physical exam revealed an edematous right thigh and a tender 3 × 5 cm irregular ecchymotic area present on her lateral thigh near a small shallow ulcer. A small vesicle has preceded the ulcer. Laboratory data included a white blood cell count of 8.1K with 74% neutrophils; blood urea nitrogen of 74 mg/dL; creatinine of 15.7 mg/dL; and creatinine kinase 1,303 U/L. The Alveolar-arterial gradient was 71053.25 mmHg. Computerized Tomography of the right lower extremity with contrast and multiplanar 3D reconstructions revealed no abscess. Empiric therapy with intravenous acyclovir 5 mg/kg/day was empirically started on hospital day 2. The next day the patient developed delirium and hypoxemia. The arterial blood gas revealed a pH 7.21, PaCO2 67 mmHg, PaO2 163, HCO3 27 mmol/L, O2 saturation 97.8% on 100% oxygen via a non-rebreathable mask. Chest radiography demonstrated pulmonary edema. Cultures of the peritoneal fluid, bronchoalveolar lavage, blood, and spinal fluid, were all negative. The skin biopsy demonstrated findings consistent with calciphylaxis and pressure necrosis and the absence of viral inclusions. Acyclovir was discontinued on the sixth hospital day and a serum acyclovir level 12 hours after stopping the acyclovir was 5.5 mcg/mL (reported therapeutic peak range of 0.40–2.0 mcg/mL). Twenty-four hours after stopping the acyclovir the patient became alert and was extubated within 48 hours. Given all of these findings, the patient was diagnosed with acyclovir-induced respiratory depression.

    DISCUSSION

    Neurotoxicities such as lethargy, confusion, and delirium have been reported with acyclovir and seem to be more prevalent in the setting of kidney dysfunction, but have been identified in otherwise healthy individuals. To our knowledge, this is the first case report of acyclovir leading to respiratory failure in a patient with chronic renal disease. As demonstrated in this case, acyclovir should be used cautiously in those with renal failure to prevent neurotoxicities.
    A CASE OF AMIODARONE-INDUCED THYROTOXICOSIS

    J.E. Adams1. 1University of California, San Francisco, San Francisco, CA. (Tracking ID #115759)

    LEARNING OBJECTIVES

    1. Review Amiodarone's effects on thyroid function. 2. Diagnose and treat thyrotoxic effects of Amiodarone.

    CASE

    62 y/o male presented to his primary medical doctor complaining of a several month history of weakness, fatigue, hand tremor, and a ten pound weight loss. The patient was started on Amiodarone 2 years ago for paroxysmal atrial fibrillation and had remained in sinus rhythm without further complications. Upon initial work-up patient was found to have an undetectable TSH, and an elevated free T4.

    DISCUSSION

    Up to 20% of patients on long-term therapy will develop hypothyroidism as a result of toxic effects of Amiodarone, and 3% will develop hyperthyroidism. Hypothyroidism occurs by several mechanisms, the most common being a destructive thyroiditis which is often preceded by a hyperthyroid phase. Additionally, Amiodarone decreases the peripheral conversion of T4 to T3 and acts to directly block the T3 receptor. Lastly, synthesis of thyroid hormone is inhibited by high levels of iodine in Amiodarone (Wolff-Chaikoff effect). Treatment of hypothyroidism is with replacement therapy and is rarely an indication to discontinue therapy. Hyperthyroidism secondary to Amiodarone toxicity also occurs by a variety of mechanisms. In Type 1, synthesis of T4 is increased due to iodine load in a patient with underlying autonomy secondary to a nodule or goiter. In Type 2, patients develop a destructive thyroiditis often followed by hypothyroidism. Clinically, determining the mechanism of hyperthyroidism can be challenging but can direct therapy. Detectable uptake on thyroid scan or nodules on exam suggest Type 1. Patients with Type 2 sometimes have elevated IL-6 levels. Doppler sonography to assess vascularity and diagnose small nodules is successful in classifying 80% of cases. Type 1 disease is treated with anti-thyroid drugs such as Methimazole and response may be slow. Patients with Type 2 are treated with steroids and often respond quickly. In clinical practice, patients are often treated with both, with the rapidity of response guiding further treatment. In considering stopping therapy, it is important to weigh the risks of chronic hyperthyroidism against the risk of arrhythmia. Amiodarone has a very long half-life which prevents any immediate benefit in stopping the drug, and symptoms may actually be exacerbated when the beta-blocking effects of Amiodarone are lost. In general, thyrotoxicity is not an absolute contraindication for continuation of Amiodarone and risks and benefits must be weighed carefully. In monitoring patients on long-term therapy, TSH and FT4 should be followed every six months.
    A CASE OF AMNESIA RESPONSIVE TO PHLEBOTOMY

    H.A. Younes1; R. Parker1. 1University of Pittsburgh, Pittsburgh, PA. (Tracking ID #116839)

    LEARNING OBJECTIVES

    1) To diagnose and recognize the different kinds of erythrocytosis and polycythemia, 2) To learn about the complications of erythrocytosis, 3) To learn about the treatment options of different kinds of erythrocytosis.

    CASE

    A 63 y.o. gentleman, with a past medical history significant for CAD, hypertension, and recurrent DVT's, presented to his PCP office complaining of frequent forgetfulness for 2 weeks. He reported the problem starting while he was on a plane trip from Denver to Pittsburgh where he felt some shortness of breath with mild headache. When he reached Pittsburgh, he couldn't tell where he came from, or the time of the day. He was even somewhat confused about his personal belongings. This episode was followed with several incidences of forgetfulness in his daily tasks, such as forgetting the water tap was open and forgetting his daily schedule of activities. Physical exam revealed no localized neurological deficit. An MRI of brain showed no evidence of a new ischemic or hemorrhagic stroke, although it showed an old right MCA occipital lobe infarct. A hypercoagulable workup was negative. A CBC showed a Hgb of 18 g/dL, a Hct of 54.3, and an RBC mass of 5.83 × 10 to power 12 per L. WBC count was 6.6, and platelet count 147,000. A repeat CBC confirmed above values. Serum viscosity and erythropoitin level proved normal. A blood volume study showed normal RBC volume, with a low plasma volume, and a low normal total blood volume; all findings consistent with a relative polycythemia. In view of the persistent neurological findings, therapeutic phlebotomy of the patient was done, with 500 ml removed each time. After a few sessions, the patient reported his symptoms improving significantly, with a decrease in his hemoglobin and hematocrit levels.

    DISCUSSION

    As opposed to absolute polycythemia (polycythemia vera or PV) where there is an absolute increase in red cell mass, ‘relative’, ‘stress’, or ‘apparent’ polycythemia is defined as an increase in hematocrit with normal red cell mass. Approximately 25% of cases have reduced plasma volume. Possible causes of this relative polycythemia include dehydration, alcohol, smoking, obesity, hypoxia, acute MI, and hypertension. PV is known to cause both microvascular disturbances, such as peripheral ischemia and atypical cerebral ischemic attacks, as well as major arterial and venous thromboembolism. However, the risk of vascular occlusive episodes in relative polycythemia is not well known. A study by Schwartz et al. comparing relative polycythemia with PV revealed significantly more thromboembolic events (DVT/PE) in PV, but equal risk of cardiac and cerebrovascular events. The fact that our patient's symptoms improved after phlebotomy as his hematocrit decreased, suggests that his symptoms were atypical cerebral attacks. Although phlebotomy is not considered a typical treatment modality of relative polycythemia, it worked well with our patient.
  10. guest2011

    guest2011 Moderator

    Obstructive apnea is most commonly seen to develop in B/L TMJ ankylosis
    Orbital floor #
    Mandibular ameloblastoma Adult patients with severe mandibular asymmetry are often treated with a combination of surgery and orthodontic treatment to improve facial esthetics and occlusion. Intraoral vertical ramus osteotomy is a useful surgical procedure for mandibular setback in patients with mandibular prognathism or mandibular asymmetry. A 17-year-old woman presented with a Class III malocclusion with facial asymmetry and a unilateral posterior crossbite. The patient was treated orthodontically with edgewise appliances and surgically with intraoral vertical ramus osteotomy and sagittal split ramus osteotomy. The combined surgical-orthodontic treatment resulted in facial symmetry and optimal occlusion
  11. guest2011

    guest2011 Moderator

    Rx of choice in patient presenting with LUDWIG’S ANGINA at emergency Incision and drainage
    Tracheostomy under GA
    normal Cricothyrotomy
    Tracheostomy under la

    Patients with Ludwig's angina may die as a result of the inability to effectively manage the ... This is an Open Access article distributed under the terms of the Creative ... of a 45-year-old man with Ludwig's angina scheduled for emergency drainage. ...
  12. guest2011

    guest2011 Moderator

    The finding that Galega officinalis (goat’s rue or
    French lilac), historically used as a traditional treatment
    for diabetes in Europe, was rich in guanidine
    led to the introduction of several glucose-lowering
    Table V. Metabolic and vascular effects of metformin
    Anti-hyperglycaemic action
    suppresses hepatic glucose output
    increases insulin-mediated glucose utilisation
    decreases fatty acid oxidation
    increases splanchnic glucose turnover
    Weight stabilisation or reduction
    Improves lipid profile
    reduces hypertriglyceridaemia
    lowers plasma fatty acids and LDL-cholesterol; raises HDLcholesterol
    in some patients
    No risk of serious hypoglycaemia
    Counters insulin resistance
    decreases endogenous or exogenous insulin requirements
    reduces basal plasma insulin concentrations
    Vascular effects
    increased fibrinolysis
    decreases PAI-1 levels
    improved endothelial function
    HDL = high-density lipoprotein; LDL = low-density lipoprotein;
    PAI-1 = plasminogen activator inhibitor-1.
  13. guest2011

    guest2011 Moderator

    1. Tumor marker of glioma – cd113
    2. M.C. complication of long term HAART – optic neuritis
    3. Organism in which endotoxin is not involved in pathophysiology - vibrio cholera
    4. anaesthestic drug to be given for the total body weight rather than ideal body weight-
    atracurium
    5. ciliary muscle derivative – neural ectoderm
    6. True of post tonsillectomy grisels syndrome A/E- neurosurgeon consultation not required
    7. 70yr old retired military man with bitemporal headache that reduced on bitemporal massage and lying down for weeks, due to – chronic tension type headache
    8. Patient with ICD misplacement, IOC – chest Xray
    9. Fixative used in Electron Microscopy – glutaraldehyde (DNB rpt)
    10. Rt axis deviation seen in – tall and thin individual
    11. Self Stimulation of Brain – median forebrain bundle
    12. M.C complication following lens extraction in PHPV – retinal detachment
    13. Postmortem estimation of gestational age of fetus 2cm in length and 10 gram in weight – 6 weeks (indirect rpt)
    14. Indication for laser uvulopalatoplasty - snoring (old rpt)
    15. Denis classification involves – three column
    16. Lymphoma marker – Common leukocyte antigen
    17. What percentage of disability in an individual with V/A 4/60 – 75%
    18. Fixed number of vertebral column found in - thoracic
    19. Population of yearly patients with cervical cancer based on present incidence - ?1 million
    20. Viriable tonometer used in – ?
    21. Millenium Development Goals – two/thirds of under 5 mortality rate
    22. Enzymes present in CSF examination – CK and LDH
    23. Nanotechnology application in medicine, A/E - ?
    24. Transition from infectious diseases to manmade and non communicable disease – pidemiological transition
    25. Leukemic patient with dry tap and myelofibrosis – megakaryocytic leukemia
    26. With absence of brain involvement, CNS directed treatment is not required in – ?burkitt’s
    27. Causative agent of SARS – coronavirus (rpt)
    28. One parent with balanced translocation of 15/21, advice given
    29. Lady with progressive loss of vision with photopic vision – Stargradts Disease )
    30. B/L proximal clamping of carotid bodies – increase in vasomotor centre (indirect
    31. Chronic high dose alcoholic now acheieves the same effect with lower quantity of alcohol – reverse tolerance
    1. Third window effect- superior semicircular canal dehiscence
    2. Epiglottis derived from – fourth arch
    3. Comparative chromosomal analysis of normal cell genetics with neoplastic cell – comparative genomic hybridization
    4. Amphoterecin B therapy with hypokalemia K+=2.3meq- supplement with 40meq over 24 ours?
    5. stereotactic radiotherapy - brain tumor/lung tumour (rpt aims)
    6. Preterm babies with PDA, true A/E – narrow pulse pressure
    7. DOC for ESBL E. coli - piperacillin
    8. Child with precocious puberty and uncontrollable laughter – hypothalamic hemartoma
    9. True about testis – gubernaculums attached to caudal end
    10. Nerve root of long thoracic nerve of bell-c567
    11. Silverman scoring – 4 (rpt )
    12. Child with tibia swelling, elevated ESR and periosteal reaction, Investigation - MRI
    13. RCT to asses dating in adolescents, random school chosen, random class choses, random
    students chosen method of sampling - multistage sampling/stratified sampling
    14. Lesion in bullous skin lesion with ,oral ulceration - ?suprabasal
    15. Child can say her name, knows her sex and can dress under supervision - ?4yrs
    16. GDP expenditure on healthsector in India – 1.4%
    17. Cognitive impairment due to aging due to – homocysteine (aipg rpt)
    18. Age for trachoma screening – 1 to 9 yrs
    19. Patient with heroin addiction comes with pinpoint pupin and coma, doc – IV Naloxone
    20. Not helpful in diagnosis of ectopic pregnancy – beta HCG estimation
    21. Blink reflex –pons
    22. person had a fight with a neighbour where he assaulted him,he can be booked under ipc-351
    23. Gait apraxia due to involvement of which artery – ACA
    24. wilson's disease-serum copper low
    25. type1 rta A/E - daily hco3 supplementation >4mmol (aipg 2012 rpt)
    26. Seen in Burger’s Disease – neural involvement present (indirect rpt
    27. Roll back malaria A/E – ? develop new insecticide/insecticide nets
    28. Corrective surgery adviced in child with rickets when – serum phosphate is normal
    29. Which of the following is seen during heart disease in pregnancy and not during normal pregnancy: neck veins
    30. A/E true about Lidocaine – most cardiotoxic lethal antiarrhythmic
    31. Gravid female at 37 weeks gestation comes with visual disturbance, headache and elevated BP, TOC – start antihypertensive, magnesium sulphate and terminate pregnancy
    32. 70yo lady on long term alendronate treatment for severe osteoporosis comes with hip and thigh pain, IOC – x-ray
    33. Patient with increased serum cysteine, with multiple renal stones, treatment plan A/E –
    cystamine
    34. No nerve regeneration occurs in spinal cord due to – mio inh protein other(indirect rpt)
    35. Radiographical diagnosis of intestinal obstruction – small bowel dilatation of more than 3cm
    36. Flow cytometry done in – lymphocytes
    37. drug design not very much successful reason is :receptor
    38. 68/ M after 40 years what is true : diastolic more impo than systolic/hyperlipidemia more risk than hypertension
    39. HIV sentinal surveillance used to calculate;;;;high risk/trend
    40. Shock Index [Hearyt rate/BP] in pregnancy...critical value-.9-1.1/.7-.9
    41. pt with TBME taking Rx well, at end of 1 month detorioration,which Ix not req ?ncct
    42. Principle of MRCP –
    43. Child intubated and after 2 mins bellows collapse, next step - ?
    44. Next investigation in generalized lymphadenopathy with 70%lymphocytes and TLC 20,000 – peripheral blood cytological analysis


    1. Pt with open wound & S/O nerve injury, Next step-surgery
    2. Property not shared by t cell and b cell
    3. Rashtriya Bima Suraksha Yojna – applies to BPL only
    4. Blue white stain on uv light – semen

    5. bacteriodes fragilis –not causes shock

    6. Epidemic cause of pneumonia spread by aerosol- legionella

    7. Sub Himalayan resident with multiple ulcers in lower limb – sporothrix

    8. True about bacillus anthrax –mcfaydean reaction (rpt)

    9. Child presents with seizures, hypopigmented macule, subnormal iq-tuberous sclerosis (rpt)

    10. All cause acute anal pain A/E- (ans)anal fistula, (other options)
    thrombosed external hemorrhoids,perianal abcess, fissure in ano

    11. Child a fussy eater, mother decides to reward child with chocolate
    verytime he finishes his meal – operant condition (indirect rpt)

    12. Treatment of choice for ca cx 3B-concurrent chemoradiotherapy

    13. Total birth 4050 with still birth 50 and neonatal birth 200 NMR 50-rpt

    14. Child with hypoglycemia unable utilize glucose from glycogenolysis, gluconeogenesis- G6phosphatase defy

    15. Not a second messenger-guanyl cyclase (rpt)

    16. Old male with history of loss of consciousness and hence injured
    imself, on waking pt with both shoulders adducted internally rotated-B/l posterior dislocation

    17. Blood supply to sternomastoid A/E-post auricular (rpt)
  14. guest2011

    guest2011 Moderator

    18. not used in erectile dysfunction - phenylephrine (rpt)

    19. Diabetic with clinical picture of mucormycosis, DOC- amphotericin B (rpt)

    20. rho kinase inhi bitor – fasudil (dnb rpt)



    21. Infant with respiratory distress was intubated, the fastest and accurate test to confirme intubation is - normal capnography

    22. child presented with volvulus, small intestinal lesion incised, path evaluation revealed presence of what tumor in lesion - adenoma

    23. Causes of calcification of pinna A/E - gout

    24. Patient develops urticaria following hot bath and sun exposure - cholinergic utricaria (rpt)

    25. All seen in syringomyelia except – hypertrophy of adductor pollicis

    26. Drug contraindicated in glaucoma with systemic beta blocker – brimonidine

    27. True about NPCDCS – subcentre has facility for DM and HTN diagnosis and treatment



    28. True about Prions – long incubation period

    29. screening for hearing in neonates- Otoacoustic Emission

    30. Absolute requirement for cochlear implant - presence of auditory nerve

    31. knowledge of illness in MMSE - insight

    32. Frontotemporal dementia A/E- insight present

    33. Treatment advice for patient with recurrent stone A/E –calcium restriction (rpt)

    34. structures cut during vasectomy A/E - ilioinguinal nerve

    35. EEG monitoring during anaesthesia helps in assessing - depth of anesthesia (rpt)

    36. EEG figure-absence seizures (rpt without image)

    37. M/C cause of neonatal sepsis- Group Beta streptococcus or E.coli (indirect repeat)
    38. Malignancy with B/l proptosis is the commonest presentation of - Leukemia

    39. lateral force on knee causing valgus deformity - ? Medial collateral
    40. Double base smokeless powder- nitroglycerin, nitrocellulose

    41. End diastolic volume increases - increase in negative intrathoracic pressure

    42. 14 yr old boy unable ot get good grades, was assessed and deemed smart and intelligent, best to diagnose his problem – specific learning disability test

    43. Ligament connecting menisci – coronary ligament

    44. 14 y/o female presents with normal breast and hair, with absent uterus and vagina but normal aries – Mullerian Agenesis (rpt)

    45. Young man with asymptomatic macules over trunk, erythematous painless lesion over glans, generalized lymphadenopathy, TOC – Benzathine penicillin (rpt)

    46. Follow up for recurrence of Prostatic Cancer in elderly – PSA (rpt)

    47. Site of extravasation of urine in rupture of urethra above deep perineal pouch – true pelvis (indirect rpt)

    48. Forced inversion of plantar flexed foot causes damage to which ligament - ?

    49. Atrophy of hypothenar muscle with numbness of little and ring finger lesion in –ulner

    50. CD 95 marker of – extrinsic apoptosis pathway )

    51. Liver enzyme dephosphorlated to phosphorylated form true is – seen in fasting state than fed ate

    52. Ocular manifestation of trisomy 13- B/L microphthlmia


    53. Blood supply to muscle is increased by all except – inhibitor to b2 receptor

    54. Female with 2 month amenorrhoea,with sudden abdominal pain with adnexal mass, upt
    positive - ectopic pregnancy
    55. Ovulation common on rt side A/E - right handedness (rpt)
    56. choking seen in - shotgun
    57. Penicillin g - Rat bite fever
    58. lady with RA with sudden quadriperesis with increased tone with exaggerated reflex, no ladder/bowel involvement Investigation to be done-xray
    59. Multigravida with previous 2 normal pregnancy now with unstable lie – placenta previa
    60. Trial of labour c/I after previous caeserian section – if previous CS is for CPD (rpt)
    61. BI-RADS - breast imaging reporting and data system
    62. Recurrent amoebic abscess drained thrice, now with empty cavity given luminal amoebicide, ---plan of follow up – USG or CT monthly with Stool Test weekly
    63. RHO kinase inhibitor – fasudil (dnb rpt)
    64. Antiepileptic of choice in infant with refractory epilepsy at 6hr and 10hr – phenobarbitone
    65. Most common cause of neonatal mortality in India - ? infection
    66. DOC for premenstrual syndrome – SSRI (rpt)
    67. Not a second generation antihistaminic – cyclizine and fexofenadine
    68. 24 y/o male with CKD with positive family history of dead brother with similar CKD and
    lenticonous – Alport’s Syndrom
    69. Lady presents with painful palpable lump, next test – USG
    70. Rt hypochondrial pain with elevated diaphragm on xra, A/E – acute cholecystitis
    71. Lady with multiple facial abrasion with broken teeth – grievous injury (rpt)
    72. Biliary obstruction following infected fish consumption – Clonorchis sinensis
    73. Reversal of shunt not possible in natural progression of which – TOF
    74. In insomnia sleep accurately assessed by – actigraphy
    75. All seen in polymyositis except – ophthalmoplegia
    76. Cholimimmetics not used in – bradycardia
    77. Structure that doesn’t develop in mesentry of stomach – kidney (rpt
    78. Mechanism of action of intratympanic gentamycin – hair cell destruction.
    79. Gas ideal for analgesia – Nitrous Oxide
    1. Fixed dilated pupil with Iris Atrophy and Secondary glaucoma - ? poshner syn
    2. Which of the following is seen in association with membrane raft—gp1
    3. True A/E – omeprazole affects acid reducing
    4. Which is not seen in megaloblastic anaemia – increased reticulocyte
    5. high frequency waves used in ...ototoxicity.
    6. pt with hep c, hypocomplimentemia, 2g/day proteinuria, hematuria present, most probabale diagnosis-mpgn
    7. 200 population, (range 70-90) at 1 SD how many.........136
    8. what is feature of tempoarteritis: gaint cell
    9. kinomyograph
    10. Ribozyme-peptidyl transferase
    11. DNA repair defective-thymidine dimmers
    12. kidney fibrinoid necrosis,onion peel
    13. not true of hernia-conser mx
    14. Consumption of fish leading to gall bladder carcinoma
    15. dopamine ,NE,Epi effect on renal circulation
    95.......Hyperacute transplant rejection due to – preformed antibodies in recipient
    96. child seborhehic dermatitis.........langerhans
    97. dz with high incidence/low prevalenc........fatal/highly curable
    1. A pt with surgical obstructive jaundice can be evaluated by USG A/E – peritoneal deposits

    2. Nerve doesn’t supply gluteus region – sciatica

    3. Contraindicated in corneal ulcer – flurometholone
    4. Lady with scant vaginal discharge, foul smelling with no cells, syndromic management is – tronidazole and fluconazole (rpt)

    5. Curve with mean > mode – right positive skew (rpt)

    6. Mass prophylaxis not done in – scabies (rpt)

    7. Population of 10lakh with 30% under 16yrs, with prevalence of blindness 0.8 per 1000 in that ge group, population affected – 240

    8. True about tetanus toxoid A/E – ?passed from mother to foetus/useless in a pt with no

    9. Population 5000 with myopic prevalence of 500. New cases of 90, incidence is – 1.8% (don’t emember the question values but answer is correct)
    10. Child with mass in upperhumerus with cortical thinning and periosteal reaction, toc A/E – bone radiotherapy

    11. Patient with first metatarsophal jt involvement with CKD – gout

    12. Least likely to occur in uterine leiomyoma – fatty degeneration

    13. Seen in ARDS – airbronchogram on Xray (rpt)
    14. Modified allen test – at wrist (rpt)

    15. Pseudosulcus seen in – laryngopharyngeal reflux

    16. Sternomastoid muscle supplied by A/E – Post auricular (rpt)

    17. Ionizing radiation affects which cell cycle – M phase
    18. ASS grade of patient with controlled HTN – ASA 2

    19. Protozoa that affects the eye – toxoplasma

    20. Associated with membrane raft – GPI anchored protein

    21. Seen in pregnancy with heart disease – systemic hypotension

    22. Child with Hb 3.4g% with history of transufion 3months back, with microcytic hypochoromic cells with target cells and erythroid expansion changes in bone – beta thalassemia major
    23. In HIV pregnancy true A/E – forceps preferred to vacuum delivery
    24. Difficulty in dorsiflexion of distal phalanx if index finger, mngmt is- splint
    25. Stain used in sebaceous cell carcinoma of eye lid – Oil Red O stain


    123....... IOC for lady with dysmenorrhoea with cyclical pain and infertility – diagnostic laparascopy

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