AIIMS NOV 2013 Discussion-OPERATION HARRI CAPSULE-OHC 4 based

Discussion in 'AIIMS Nov 2013' started by Santosh Jadhav, Nov 11, 2013.

  1. Santosh Jadhav

    Santosh Jadhav Active Member

    Regarding ESI ACT WHICH IS CORRECT AIIMS NOV-2013
    A)Funeral benefit is Rs 50000
    b) The State Government’s share of expenditure on medical care is 1/8 ; the ESI Corporation’s share of expenditure on medical care is 7/8 of total cost
    C)Person with daily wages of Rs 70 has to contribute Rs 300 towards ESI
    d)Employee has to contribute 4.75% and employer contributes 8.75%

    ans b


    The Employees State Insurance Act, 1948(REF-OHC BOOK PAGE 452)
    FINANCE
    * The scheme is run by contributions by employees and employers and grants from Central and State Governments.
    * The employer contributes 4.75 % of total wage bill; the employee contributes 1.75 % of wages.
    * The State Government’s share of expenditure on medical care is 1/8 of total cost of medical care; the ESI Corporation’s share of expenditure on medical care is 7/8 of total cost of medical care.
    Maternity benefit
    * For confinement, the duration of benefit is 12 weeks (84 days), for miscarriage 6 weeks.
    * The benefit is allowed at about full wages.
    Disablement benefit
    * The rate of temporary disblement benefit is about 70 % of the wages.
    Dependant’s benefit
    * Pension at the rate of 70 % of wages is payable.
    * An eligible son or daughter is entitled to dependant’s benefit up to the age of 18; the benefit is withdrawn if the daughter marries earlier.
    Funeral expenses
    * Amount not exceeding Rs. 5000.



    In assessing the literacy rate the parameter which is utilized(AIIMS NOV-2013)
    a)age above 7 years
    b)schooling upto 10th class
    c)schooling upto 15years
    d)all population

    ans A

    Literacy and education (ref OHC BOOK PAGE 354)
    * A person is deemed as literate if he or she can read and write with understanding in any language. A person who can merely read but cannot write is not considered literate.
    * The literacy rate taking in account the total population in the denominator has now been termed as “crude literacy rateâ€, while the literacy rate calculated taking into account the 7 years and above population in the denominator is called the effective literacy rate.



    Percentage of literates – 74.04***
    * The national percentage of literates in the population above 7 years of age is about 74.04 males about 82.14% and females 65.46%.
    * Kerala - 93.91% literates.


    What is true regarding Polio(AIIMS NOV-2013)
    a)India is the only country which could not eradicate polio
    b)last case was reported in JAN 13 2011(WILD POLIO)
    c)India is currently using IPV
    d)Vaccine borne case in 2012

    ref OHC BOOK-Page 296
    * India has been considered polio-free since February 2012.
    * As of 25th February 2012, India was removed from the list of polio endemic countries by the WHO.
    * It has to remain polio free for another 2 years to achieve the goal of polio eradication.

    Regarding disaster management high priority is given for AIIMS NOV-2013)
    a)Green
    b)Red
    c)Black
    d)yellow

    ans b

    Disaster impact and response (REF-OHC BOOK PAGE 447)
    Triage
    * The principle of “first come, first treatedâ€, is not followed in mass emergencies. Triage consists of rapidly classifying the injured on the basis of the severity of their injuries and the likelyhood of their survival with prompt medical intervention.
    * Triage is the only approach that can provide. maximum benefit to the greatest number of injured in a major disaster situation.
    * The most common classification uses the internationally accepted four colour code system.
    * Red indicates high priority treatment or transfer, yellow signals medium priority, green indicates ambulatory patients and black for dead or moribund patients.



    Screw feed technology-all except(AIIMS NOV-2013)
    A)NON BURN
    B)VOLUME reduction more than 50%
    c)weight reduction 20-35%
    d)ideal for pathological waste

    ans d
    ref- page-444 OPERATION HARRI CAPSULE book
    A non-burn, dry thermal disinfection process in which waste is shredded and heated in a rotating auger.
    * Waste is reduced by 80% in volume and by 20-35 % in weight.
    * This process is suitable for treating infectious waste and sharps.


    % of GDP allotted to health in India(AIIMS NOV 2013)
    a).12
    b).012
    c)0.5
    d)0.05


    ANS B



    Burden of under 5 mortality in the world in 2010 is (AIIMS NOV 2013)
    a)6 million
    b)8 million
    c)10 million
    d)12 million

    ANS D(7.6 MILLION)



    Regarding measles vaccination strategy in 9-14 yrs is called as(AIIMS NOV-2013)
    a)Catch up
    b)keep up
    c)mop up
    d)follow up

    ans a(Ref-OHC SPM class)-similair question was asked in POLES-AIIMS MODEL EXAM SERIES

    Immunisation of 5 year old by NIS(AIIMS NOV 2013)
    a)pentavalent vaccine –Vitamin A
    b)booster DT
    c)DT,OPV,Vitamin A
    d)DPT ,Vitamin A

    ANS C



    True regarding Q test
    a) comparing the proportion of means of 2 groups
    b)to determine outliars
    c)to determine normality distribution
    d) comparing the proportion of means of MORE THAN 2 groups

    ans b (ref-OHC 4 SPM Consultant class)

    Indoor air pollution will cause all except AIIMS NOV-2013)
    A)adverse pregnancy outcome
    b)neurological complications
    c)child pneumonia
    d)chronic lung disease

    ans B


    REF-OHC BOOK
    Indoor air pollution
    Monitoring of air pollution
    * The best indicators of air pollution are sulphur dioxide, smoke and suspended particies.
    a. Sulphur dioxide:
    b. Smoke or soiling index:(1992-JIP***).
    * A known volume of air is filtered through a white filter paper.
    * Smoke concetration is estimated and expressed as micrograms/cubic metre of air.
    c. Grit and dust measurement.
    d. Coefficient of haze.
    e. Air pollution index.
    Health aspects
    Major air pollutants, their sources and adverse effects
    Respiratory tract irritation, bronchial hyperactivity, impaired lung defences, bronchiolitis obliterans
    Lung cancer
    Cough, substernal discomfort, bronchoconstriction, decreased exercise performance, respiratory tract irritation
    Exacerbation of asthma and COPD, respiratory tract irritation, hospitalization may be necessary, and death may occur in severe exposure
    OUTDOOR air pollution
    Lead Automobile exhaust using leaded gasoline Impaired neuropsychological development in children


    ROLL BACK MALARIA-all except
    a)strengthening health system
    b)insecticide treated bed nets
    c)development of insecticides
    d)training health personal

    and c) (ref OHC 4 SPM CONSULTANT CLASS)


    MEAN IN HB of 2000 population is 13.5 gm.How much proportion of patients are above mean
    a)o.5%
    b)0.25
    c)0.75
    d)0.1

    ans a (OHC 4 SPM CONSULTANT CLASS)


    The % of people lying between mean and mean + 1.standard deviation
    a)0.68
    b)0.34
    c)o.12
    d)0.15

    ans b(OHC SPM CONSULTANT CLASS)
  2. Santosh Jadhav

    Santosh Jadhav Active Member

    AIIMS NOV 2013 Discussion-OPERATION HARRI CAPSULE-OHC 4 based-2
    True about pterygium – (AIIMS NOV-2013)
    1.exposure to infra red rays
    2.probe can be passed underneath the pterygium at the limbus
    3.elastic degeneration in the descemets membrane
    4.resection via bare sclera technique cause recurrence of 30-70%
    Ans d

    REF-OHC OPHTHAL

    *bare sclera technique had a recurrence rate of 66.7%. (NET)
    *Ultra violet rays may cause
    *elastotic degeneration of conjunctiva
    Stocker’s line - presence of a pigment line in front of the pterygium , suggestive of long standing non-progressive pterygium.

    SURGICAL

    1. Excision with simple closure of the wound.
    2. Mc Gavics bare sclera method:
    • pterygium is excised and the conjunctival defect is left as it is.
    • High rates of recurrence and granuloma formation .
    3. Transplantation of the pterygium : Pterygium excision with auto-conjunctival graft / amniotic membrane graft. Done in recurrent pterygium / large pterygium.
    4. Mac Reynold’s operation: head is sutured to the body itself.
    5. Kehr’s operation: head is sutured to the inferior fornix.






    Most common type of NHL Worldwide(AIIMS NOV 2013)
    a)Diffuse large B cell lymphoma
    b)Follicular lymphoma
    c)Small cell lymphoma
    d)Diffuse small lymphocytic lymphoma




    Ref-OPERATION HARRI BOOK-PAGE 509
    Diffuse Large B Cell Lymphoma
    * Most common type of non-Hodgkin's lymphoma.*
    * Cytogenetic and molecular genetic studies are not necessary for diagnosis.
    * Primary mediastinal diffuse large B cell lymphoma- younger median age (i.e., 37 years) and a female predominance .
    * Neoplastic cells are heterogeneous but predominantly large cells with vesicular chromatin and prominent nucleoli.
    * More than 50% of patients will have extranodal involvement at diagnosis, with the most common sites being the gastrointestinal tract and bone marrow.
    * Other unusual subtypes of diffuse large B cell lymphoma such as pleural effusion lymphoma(AI-2006***) and intravascular lymphoma - very poor prognosis.

    Follicular Lymphoma
    *Females
    22% of non-Hodgkin's lymphomas
    *Treatment-one of the malignancies most responsive to chemotherapy and radiotherapy-25% of the patients undergo spontaneous regression


    Which is false with regarding megaloblastic anemia (AIIMS NOV-2013)(AIIMS NOV 2012 RPT)
    a)reticulocyte increased
    b)nucleated RBCs
    c) increased bilirubin
    d)mild splenomegaly

    ans a

    REF-OPERATION HARRI CAPSULE -4 Discusssion
    MEGALOBLASTIC ANEMIA
    MCV > 100 FL
    * WBC, Platelets ¯
    * PS – Anisopioiklocytosis, macrocytosis
    * Low retic index(AIIMS NOV-2012***)
    * Basophillic stippling (in RBC), normoblast
    * Neutrophils – Hypersegmentation of nucleus (characteristic)
    * Bone marrow
    - Hyper cellular
    - ¯ myeloid/erythroid ratio
    - Abundant iron
    - Nuclear chromatin – a peculiar fenestrated pattern very characteristic
    - ¯ megakaryocytes
    * * LDH, bilirubin
    * Cobalamin level
    - 160-200ng/ml
    - < 100 – deficiency
    * Folate level – 6-20 micro/ml < 4 microg – deficiency

    • Ineffective Hemopoiesis
    • * Unconjugated bilirubin , raised urine urobilinogen, reduced haptoglobins and positive urine hemosiderin, and a raised serum lactate dehydrogenase&a weakly positive direct antiglobulin test




    All are true about Fe def anemia except (AIIMS NOV 2013)
    A. Transferrin saturation <16%
    B. Is detected by serum ferritin levels even in earlier states
    C. Is mostly presented without any symptoms
    D. Latent anemia is most prevalent in india

    ANS A

    Ref-OPERATION HARRI BOOK-PAGE-462

    Iron deficiency Anemia
    3 Stages
    Negative iron balance - Iron stores are decreased, ferritin Decreased
    - All other paramaters – normal

    TABLE in OPERATION HARRI BOOK

    Parameter Normal IDA
    *Sr.Iron(microgm/dl) 50-150 <30
    *Sr.Ferritin(microgm/dl) 50-200 <15
    *TIBC 300-360 >400
    * TSAT 30-50 <10






    Which of the following is not a cause of acquired pure red cell aplasia(AIIMS NOV-2013)
    A)ABO incompatability in BMT
    b)Drug induced-NSAIDS
    c)5Q-MONOSOMY
    D)LYMPHOMA
    ANS B
    REF-OPERATION HARRI BOOK PAGE-484

    In adults, PRCA is acquired.
    * Immunologic-Systemic lupus erythematosus, juvenile rheumatoid arthritis, rheumatoid arthritis.
    * Virus-Persistent B19 parvovirus, hepatitis, adult T cell leukemia virus, Epstein-Barr virus.
    * Drugs-phenytoin, azathioprine, chloramphenicol, procainamide, isoniazid, Erythropoietin.*
    * Parvo virus B19
    Lymphoma

    REF-NET
    • Thymoma (1-15%)
    • Hematological malignancies (eg, B- and T-cell chronic lymphocytic leukemia)
    • T-cell large granular lymphocyte leukemia and solid tumors
    • Infections
    • Drugs
    • Pregnancy[7]
    • Systemic lupus erythematosus
    • Renal failure
    • Good syndrome (thymoma with combined B- and T-cell deficiency)
    PRCA can occur following ABO mismatched marrow transplantation
  3. samuel

    samuel New Member

    Dear all,
    As anticipated(5-7),6 questions in AIIMS NOV-2013 were based on new facts(NEW TO HARRISON) in the 18th edition of HARRISON.Evidences given with below with references


    1 WHICH IS NOT TRUE REGARDING hemoptysis (AIIMS NOV 2013)
    a) massive hemoptysis is more than 600ml/24 hrs
    b) 90% bleed from bronchial artery
    c) CT chest is done as the 1st investigation
    d) In an unstable patient rigid bronchoscope is done to identify the lesion
    Ans a
    This question underlines the fact which we have been emphasising in the exams-what is new in the 18 TH ALONE is not asked in the exams.whatever is tampered in the 18th edition is asked with razor sharp precision in the exams!!!
    Kindly note the subtle change in the definition of massive hemoptysis in the 17th EDITION & in the 18th EDITION-which became a stem and the answer!!!
    This point was highlighted in the OHC Book seperately!!!
    Ref OHC book-page 29
    The most common etiology of hemoptysis is infection of the medium-sized airways.
    * Massive hemoptysis - greater than 200–600 cc in 24 h
    Operation Harri book page-140
    Fiberoptic bronchoscopy is particularly useful for localizing the site of bleeding and for visualization of endobronchial lesions. When bleeding is massive, rigid bronchoscopy is often preferable.
    * In patients with suspected bronchiectasis, HRCT is the diagnostic procedure of choice.
    Massive hemoptysis - >100–600 mL over a 24-h period(17thEDITION)
    Hemoptysis: Treatment
    * Selectively intubating the nonbleeding lung. (often with bronchoscopic guidance)
    * Other available techniques - laser phototherapy, electrocautery, bronchial artery embolization, and surgical resection of the involved area of lung.
    * With bleeding from an endobronchial tumor- argon plasma coagulation or the neodymium:yttrium-aluminum-garnet (Nd:YAG) laser
    * Bronchial artery embolization - a vessel proximal to the bleeding site is cannulated, and Gelfoam is injected to occlude the bleeding vessel.

    REF-JOURNAL
    Bronchial and nonbronchial systemic artery embolization for life-threatening hemoptysis: a comprehensive review.
    *Massive hemoptysis is one of the most dreaded of all respiratory emergencies and can have a variety of underlying causes.
    * In 90% of cases, the source of massive hemoptysis is the bronchial circulation. ***
    *Diagnostic studies for massive hemoptysis include radiography, bronchoscopy, and computed tomography (CT) of the chest.***
    *. Many researchers currently suggest that CT should be performed prior to bronchoscopy in all cases of massive hemoptysis.
    * Bronchial artery embolization (BAE) is a safe and effective nonsurgical treatment for patients with massive hemoptysis.
  4. samuel

    samuel New Member

    AIIMS NOV 2013 Discussion-OPERATION HARRI CAPSULE-OHC 4 basedMEDICINE

    MEDICINE
    1. A Lady brought her husband to the casuality.Patient is an alcohoholic who not consumed alchol for 2 days for religious reasons. Developed nausea vomiting on day 1 and day 2 developed seizures.What is the most likely treatment (AIIMS NOV-2013) (AIIMS MAY 2013 RPT)

    a) Diazepam
    b) Sodium valproate
    c) Phenytoin
    d) clonidine
    Ans a
    Ref-OHC4-POSIGOLD(Booklet with collection of 2007-2012 AIIMS/AIPG questions&answers)
    Ref-Consultant-POZITIVE Psychiatry hand out-page44, 18
    • Most severe Alcohol withdrawal syndrome
    • Within 2-4 days of abstinence
    • in 5%
    • Recovers within 3-7 days
    • An acute organic brain syndrome
    Features
    • Clouding of consciousness
    • Poor attention span
    Hallucinations
    • Visual (common)
    • Auditory
    • Tactile
    • Autonomic disturbance
    • Psychomotor agitation and ataxia
    Drug of Choice
    • Benzodiazepines
    • Chlordiazepoxide or Diazepam
    2. In glassgow coma scale withdrawal to pain stimulus comes under ( AIIMS NOV-2013)
    a) M4
    b) M3
    c) M2
    d) M5
    ans-A
    ref-OHC-MKT(Must Know Tables-important tables from All subjects)

    3 True about Kluver bucy syndrome are all expect: (AIIMS NOV-2013)
    a. hypersexuality
    b. hypermetamorphosis
    c. hyperactivity
    d. Placidity
    Ans c
    Ref-,POSIGOLD,OHC PSYCHIATRY-handout page 3
    Kluver Bucy syndrome- (Bilat medial temporal destruction) – hyperorality, hypersexuality, hypermetamorphosis, placidity, Visual Agnosia



    Similair question in AIIMS MAY 2013
    Kluver Bucy syndrome in young children. All except [AIIMS MAY 2013]
    A) hypermetamorphosis
    B) Hypersexuality
    C) visual agnosia
    D) refractory seizures
    Ans (d)[/B]

    MEDICINE
    4) All are true regarding METHANOL poisoning except [AIIMS NOV 2013]
    a) critical level is 1.25
    b) fomipazole-inhibits with aldehyde dehydrogenase
    c) Formic acid is responsible for toxicity
    d) snowfield vision is seen in Methyl alcohol poisoning
    ans b
    ref-POSIGOLD,OPERATION HARRI Book-page 200
    Methanol
    * The ingestion of methanol (wood alcohol) causes metabolic acidosis, and its metabolites formaldehyde and formic acid cause severe optic nerve and central nervous system damage.
    Treatment- saline or osmotic diuresis, thiamine and pyridoxine supplements, fomepizole or ethanol, and hemodialysis - alcohol dehydrogenase inhibitor fomepizole (4-methylpyrazole).


    * Posm = 2Na+ + Glu/18 + BUN/2.8.
    * When the measured osmolality exceeds the calculated osmolality by >15–20 mmol/kg H2O, one of two circumstances prevails. Either the serum sodium is spuriously low, as with hyperlipidemia or hyperproteinemia (pseudohyponatremia), or osmolytes other than sodium salts, glucose, or urea have accumulated in plasma. Examples include mannitol, radiocontrast media, isopropyl alcohol, ethylene glycol, propylene glycol, ethanol, methanol, and acetone.
    * Three alcohols may cause fatal intoxications: ethylene glycol, methanol, and isopropyl alcohol. All cause an elevated osmolal gap, but only the first two cause a high-AG acidosis.
    Ethylene Glycol
    * Ingestion of ethylene glycol (commonly used in antifreeze) leads to a metabolic acidosis and severe damage to the central nervous system, heart, lungs, and kidneys.
    * Diagnosis is by recognizing oxalate crystals in the urine, the presence of an osmolar gap in serum, and a high-AG acidosis. If antifreeze containing a fluorescent dye is ingested, a Wood's lamp applied to the urine may be revealing.
    * Treatment- similar to that for methyl alcohol

    5 Recently approved by FDA for treatment of lennox- gestaut SYNDROME (AIIMS NOV2013)
    A. lacosamide
    B. rufinamide
    C. zonisamide
    D. levetiracetam
    And b
    REF-OHC book page-160(Exciting 18th)
    Rufinamide used in Lennox-Gastaut syndrome
    * Side effects
    * Sedation
    * Fatigue
    * Dizziness
    * Ataxia
    * Headache
    * Diplopia,(QT interval prolongation)
    * Rufinamide-interactions
    * Level increased by valproic acid
    * May increase phenytoin
  5. samuel

    samuel New Member

    1)OPERATION HARRI BOOK(OH BOOK)
    -it is an extract of entrance examination oriented points from Harrison(17th-I)
    -it covered around 35-40 questions from AIIMS NOV-2013
    2)OPERATION HARRI CAPSULE Book(OHC Book)(covered around 40 questions from AIIMS NOV-2013))
    This has 4 parts
    a)Exciting 18th-all new points from the 18th has been pooled and given.For continuity some points from 17th also is given.To differentiate, both are given in different colours(Covered 9 questions from AIIMS NOV 2013 -pleased to know that didnot miss a single question from those new topics in the 18th)
    b)SPM extract(covered 15 questions in AIIMS NOV 2013)
    c)Physiology extract(10 questions from AIIMS NOV 2013)
    d)POZININE(Entrance oriented points from most subjects-covered 4 questions)

    The other question from DNB- NOV 2013 which was very satisfactory
    Incidence of suicide in India(DNB-NOV 2013)
    a)12 per lakh population
    b)24 per lakh population
    c)36 per lakh population
    d)8 per lakh population
    ans c(OHC Book-page-339)
  6. samuel

    samuel New Member

    Regarding the question on Methanol toxicity


    *Methanol has a high toxicity in humans
    *30 mL is potentially fatal, although the median lethal dose is typically 100 mL (i.e. 1–2 mL/kg body weight of pure methano).
    *Reference dose-( maximum acceptable oral dose of a toxic substance)for methanol is 0.5 mg/kg/day

    If it was given just as "dehydrogenase" then the toxic level might be the answer,but this question was repeated from AIIMS MAY -2013 in which the answer quoted was aldehyde dehydrogenase
  7. samuel

    samuel New Member

    MEDICINE

    Uniparenral disomy not seen in (AIIMS NOV-2013) [/b]
    a. Bloom syndrome
    b. Angelman syndrome
    c. Silver Russell syndrome
    d. Prader willi syndrome
    ans a
    REF-OHC CLASS
    REF-OH book-page-285,499
    Genomic imprinting- Two classic examples are the Prader-Willi syndrome and Angelman syndrome.
    * Prader-Willi syndrome(AIIMS-NOV-2010***) - characterized by diminished fetal activity, obesity, hypotonia, mental retardation, short stature, and hypogonadotropic hypogonadism. Deletions of the paternal copy of the Prader-Willi locus located on the short arm of chromosome 15 result in a contiguous gene syndrome involving missing paternal copies of the necdin and SNRPN genes.
    * Angelman syndrome- characterized by mental retardation, seizures, ataxia, and hypotonia, have deletions involving the maternal copy of this region on chromosome 15.
    * These two syndromes may also result from uniparental disomy. In this case, the syndromes are not caused by deletions on chromosome 15 but by the inheritance of either two maternal chromosomes (Prader-Willi syndrome(AIIMS-NOV-2010***)) or two paternal chromosomes (Angelman syndrome).
    *Defective DNA repair-Fanconi’s, Bloom’s, Ataxia Telengiectasia

    Severe malaria all except (AIIMS NOV2013)[/b ]
    a) Hypoglycemia –less than 40mg
    b) creatinine more than 3mg
    c) LDH more than 45
    d) Hct more than 15
    ans D
    Ref-Operation Harri book-page-page 891
    Indicating a Poor Prognosis in Severe Falciparum Malaria


    Hypoglycemia Leukocytosis >20% of parasites identified as pigment-containing trophozoites and schizonts
    Hyperlactatemia Severe anemia, >5% of neutrophils with visible pigment
    Acidosis Coagulopathy
    Elevated serum creatinine
    Elevated total bilirubin,enzymes
    Elevated urate



    A female with excess consumption of junk food presented with gum bleed, echymosis, hemarthrosis and perifollicular bleeds-Problem lies with(AIIMS NOV2013)
    a) glumate carboxylation
    b) carboxylation of coagulation factors
    c) Hydroxylation of proline and lysine
    d)
    ans a
    ref-OHC discussion OHC Book-page-57
    VIT-C

    Functions-antioxidant activity, promotion of nonheme iron absorption, carnitine biosynthesis, the conversion of dopamine to norepinephrine.
    * good dietary sources of vitamin C include citrus fruits, green vegetables.
    * smoking, hemodialysis, pregnancy, and stress appear to increase vitamin C requirements.
    * vitamin C deficiency causes scurvy- (petechiae, ecchymoses,perifollicular hemorrhages ); inflamed and bleeding gums; - In children, vitamin C deficiency may cause impaired bone growth.
    * laboratory diagnosis of vitamin C deficiency is made by low plasma or leukocyte levels.
    * useful in Chédiak-Higashi syndrome and osteogenesis imperfecta .
    * lower the incidence of certain cancers, particularly esophageal and gastric cancers.
    * toxicity-?kidney stones, promote iron overload in patients taking supplemental iron , hemolysis in patients with glucose-6-phosphate dehydrogenase deficiency, false-negative guaiac reactions as well as interfere with tests for urinary glucose.



    45 year old lady presents with painless supraclavicular lymphadenopathy.Biopsy revealed binucleated acidophilic owl eye appearance with floating lymphocytes in empty space which was CD 15,CD 30 positive.The probable diagnosis (AIIMS N0V-2013) (AIIMS NOV2013)
    a) Nodular sclerosing lymphoma
    b) lymphocyte predominant lymphoma
    c) Anaplastic large cell lymphoma
    d)
    ansA
    REF-OHC discusssion,OPERATION HARRI-BOOK page-502
  8. samuel

    samuel New Member

    30 yr old with hirsutism,infertility and obesity- diagnosed to be PCOS .what is the NOT the treatment option (AIIMS NOV-2013)
    a) Oral contraceptive pills
    b) Tamoxifen
    c) clomiphene citrate
    d) spironolactone
    ANS b
    REF-OPERATION HARRI BOOK-Page-216

    Polycystic Ovarian Syndrome (PCOS)(AI-2011***)
    * Hyperandrogenism in association with amenorrhea or oligomenorrhea.
    * Lean patients with PCOS generally have high LH levels in the presence of normal to low levels of FSH(elevated LH/FSH ratio) and estradiol.
    * The LH/FSH abnormality is less pronounced in obese patients in whom insulin resistance is a more prominent feature.
    Treatment
    * These patients are at risk for the development of dysfunctional bleeding and endometrial hyperplasia.
    * Endometrial protection can be achieved with the use of oral contraceptives or progestins (medroxyprogesterone acetate prometrium).
    * Spironolactone, which functions as a weak androgen receptor antagonist.
    * Clomiphene citrate is highly effective as first-line treatment, with or without the addition of metformin.

    Fertilised ovum reaches the uterine cavity by :- (AIIMS NOV2013)
    A. 6-7 days
    B. 5- 6
    C. 7-8
    D. 4-5 days
    ANS –D
    REF-OHC-MKT-OG-Page 52

    ‘0’hour – Fertilization (D-15 from LMP)
    30 hrs – 2 cell stage (Blastomeres)
    40-50 hrs – 12 cell stage
    72 hrs – 12 cell stage
    96 hrs – 16 cell stage. Morula enters the uterine cavity(AIIMS NOV-2013***)
    5th day – Blastocyst


    All are physiological changes during pregnancy except (AIIMS NOV2013)
    a) distended neck veins
    b) systemic hypotension
    c) pedal edema
    d) dyspnoea
    ANS B
    REF-POSIGOLD-AIIMS NOV-2012 [/b]



    Blood testis barrier is between (AIIMS NOV2013)
    a. Sertoli and sertoli cells
    b. Leydig and myoid cells
    c. Sertoli and germ cells
    d. Sertoli and spermatid
    ans a
    REF-OHC BOOK-PAGE 620
    Blood–Testis Barrier-Tight junctions between adjacent Sertoli cells near the basal lamina form a blood–testis barrier that prevents many large molecules from passing from the interstitial tissue and the part of the tubule near the basal lamina (basal compartment) to the region near the tubular lumen (adluminal compartment) and the lumen.
    * The fluid in the lumen of the seminiferous tubules is quite different from plasma; it contains very little protein and glucose but is rich in androgens, estrogens, K+, inositol, and glutamic and aspartic acids.



    Long collagen fibres with wide spacing between them found in (AIIMS NOV2013)
    A.cornea
    B.tympanic membrane
    C.basement membrane
    D.diaphragm
    ANS A
    REF-OHC-OPHTHAL handout-page-18
    • Corneal Stroma
    • - occupies about 90% of the total corneal thickness, is composed of collagen fibrils, keratocytes and extracellular ground substances.
    • - Collagen fibers are highly uniform in diameter (25-35 nm) .
    • -The distance between two corneal fibers is also highly uniform (41.5nm) .Corneal transparency is mainly dependent on the arrangement of these collagen fibers in stroma.
    • - It is continuous with the sclera and limbus.

    Cause of corneal transparency:
    1. Anatomical factors:
    a. Cornea does not contain opaque structures:
    - No keratin in the epithelium.
    - No blood vessels.
    - No myelin sheath around nerve fibers.
    b. Regular arrangement of collagenous bundles in the stroma.
    c. Smooth anterior surface.
    2. Physical factors:
    - The spacing between the collagenous fibrils is uniform and less than half the wavelength of visible light (400-700 nm). So that the scattered light rays destroy each other allowing clear vision.
    3. Physiological factors - (deturgescence of the cornea):
  9. samuel

    samuel New Member

    The External anal sphincter is supplied by (AIIMS NOV 2013)
    A) S2,S3,S4
    B) S2,S3
    C) L5,S1
    D) S1,S2
    Ans a
    Ref-OHC Book-Chapter-physiology-page-589

    Transit Time in the Small Intestine & Colon
    * The first part of a test meal reaches the cecum in about 4 h, and all the undigested portions have entered the colon in 8 or 9 h.
    * Defecation- the sympathetic nerve supply to the internal (involuntary) anal sphincter is excitatory, whereas the parasympathetic supply is inhibitory.
    * The nerve supply to the external anal sphincter, a skeletal muscle, comes from the pudendal nerve. (AIIMS NOV-2013***)
    * The urge to defecate first occurs when rectal pressure increases to about 18 mm Hg.
    * When this pressure reaches 55 mm Hg, the external as well as the internal sphincter relaxes and there is reflex expulsion of the contents of the rectum.
    * Distention of the stomach by food initiates contractions of the rectum and, frequently, a desire to defecate. The response is called the gastrocolic reflex, and may be amplified by an action of gastrin.


    Percentage of death in emergency AAA operation [AIIMS NOV 2013]
    a) 40%
    b) 10%
    c) 5%
    d) 1-2%
    Ans a
    REF-POSIGOLD
    Percentage of death in emergency AAA operation [AIIMS MAY 2013]
    a ) 40%
    b)10%
    c)5%
    D)1-2%
    Ans a
    REF-OPERATION HARRI CAPSULE-4-discussion
    Aortic aneurysm
    Operative repair with placement of a prosthetic graft is indicated in patients with symptomatic thoracic aortic aneurysms, those in whom the ascending aortic diameter is >5.5–6 cm or the descending thoracic aortic diameter is >6.5-7 cm, and those with an aneurysm that has increased by >1 cm per year.
    In patients with Marfan syndrome or bicuspid aortic valve, ascending thoracic aortic aneurysms >5 cm should be considered for surgery.
    Abdominal Aortic Aneurysms
    Abdominal aortic aneurysms occur more frequently in males
    At least 90% of all abdominal aortic aneurysms - below the level of the renal arteries.
    The risk of rupture increases with the size of the aneurysm: the 5-year risk for aneurysms <5 cm is 1–2%, whereas it is 20–40% for aneurysms >5 cm in diameter.
    With careful preoperative cardiac evaluation and postoperative care, the operative mortality rate approximates 1–2%.
    After acute rupture, the mortality rate of emergent operation is 45–50%



    The ability of the body to eliminate the drug is called as (AIIMS NOV2013)
    a) rate of elimination
    b) clearance
    c) steady state
    d) volume of distribution
    ANS B
    REF-OH Book-page-11
    Clearance
    * Includes both metabolism and excretion.
    * For a drug administered as an IV infusion
  10. samuel

    samuel New Member

    Which of the following is false regarding treatment of osteoporosis (AIIMS NOV 2013)
    a) IV PTH is the treatment for severe osteoporosis
    b) calcitonin decreases bone pain
    c) Bisphonates are work horse for treatment
    d) T score 1.5 indicates osteopenia
    ANS D
    REF-OHC Discussion,OHC BOOK -Exciting 18th page-234


    • Endogenous PTH is an 84-amino-acid peptide that is largely responsible for calcium homeostasis
    • Although chronic elevation of PTH, as occurs in hyperparathyroidism, is associated with bone loss (particularly cortical bone), PTH also can exert anabolic effects on bone
    • exogenous PTH analogue (1-34hPTH; teriparatide) that has been approved for the treatment of established osteoporosis in both men and women. (AIIMS NOV-2013***)
    • Calcitonin might have an analgesic activity***
    • Calcitonin suppresses osteoclast activity by direct action on the osteoclast calcitonin receptor


    Measurement of Bone Mass
    • dual-energy x-ray absorptiometry (DXA),
    • single-energy x-ray absorptiometry (SXA),
    • quantitative CT,
    • ultrasound (US).

    • T-scores, which compare individual results to those in a young population that is matched for race and sex.
    • Z-scores compare individual results to those of an age-matched population that also is matched for race and sex.
    • A T-score below –2.5 in the lumbar spine, femoral neck, or total hip is taken as a diagnosis of osteoporosis

    • Risedronate and alendronate are approved for the treatment of steroid-induced osteoporosis, and
    • risedronate also is approved for prevention of steroid-induced osteoporosis.
    • Both alendronate and risedronate are approved for treatment of osteoporosis in men.

    Osteopenia-T – Score-< - 1 & >-2.5


    Platelet adhesion to collagen via (AIIMS NOV2013)
    a. F viii
    b. Fix
    c. VWF
    d. Fibronectin
    ans c
    REF-OHC BOOK page-93
    Platelet Adhesion
    * Certain proteins are expressed on the platelet surface that subsequently regulate collagen-induced platelet adhesion, particularly under flow conditions, and include glycoprotein (GP) IV, GPVI, and the integrin alfa 2, beta 1.
    * The GPIb-IX-V complex binds to the exposed von Willebrand factor, causing platelets to adhere
    * Von Willebrand factor–bound GPIb-IX-V promotes a calcium-dependent conformational change in the GPIIb/IIIa receptor, transforming it from an inactive low-affinity state to an active high-affinity receptor for fibrinogen.

    Factors that promote platelet aggregation :
    • ADP
    • Epinephrine
    • TXA2
    • Serotonin
    • vWF
    • Fibrinogen
    • Thrombospondin
    • collagen
    • Immune complex
    • Thrombin

    [/bThe ability of the body to eliminate the drug is called as (AIIMS NOV2013)[/b]
    a) rate of elimination
    b) clearance
    c) steady state
    d) volume of distribution
    ANS B
    REF-OH Book-page-11


    Compared to unfractionated heparin,LMWH has reliable anticoagulant action because (AIIMS NOV2013)
    A) it interferes with thrombin and antithrombin III simultaneously
    b) It is less protein bound
    c) It is given subcutaneously
    d) It is cleared by macrophages
    ans b
    ref-OH BOOK page 685




    HEPARIN
    Clearance
    * Includes both metabolism and excretion.
    * For a drug administered as an IV infusion

    Dose-dependent clearance- due to Binding to macrophages.
    * Activated platelets release platelet factor 4 (PF4), a highly cationic protein that binds heparin with high affinity.
    * Monitored by APTT, or anti-factor Xa level.
    * Heparin resistant- require >35,000 units/d to achieve a therapeutic aPTT.
    * Dissociation- many will have a therapeutic anti-factor Xa level despite a subtherapeutic aPTT- patients who exhibit this phenomenon is best monitored using anti-factor Xa levels instead of the aPTT.***
    * Side Effects- thrombocytopenia, osteoporosis(30%), and elevated levels of transaminases. Symptomatic vertebral fractures occur in 2–3%.
    * Heparin affects the activity of both osteoblasts and osteoclasts.
    * 1 mg of protamine sulfate neutralizes 100 units of heparin.
    Low-Molecular-Weight Heparin
    * Prepared from unfractionated heparin by controlled enzymatic or chemical depolymerization-molecular weight of LMWH is 5000.
    LMWH catalyzes factor Xa inhibition by antithrombin.
    * Bind less avidly to endothelial cells, macrophages, and heparin-binding plasma proteins.(AIIMS NOV-2013)
    * Plasma half-life of ~4 h- cleared almost exclusively by the kidneys.
    * 90% bioavailability after SC injection.
    * Does not require coagulation monitoring. If monitoring is necessary, anti-factor Xa levels must be measured.***

    Insulin :glucagon ratio is low favouring wich enzyme? (AIIMS NOV-2013)
    a. Pyruvate kinase
    b. glucokinase
    c. hexokinase
    d. glucose 6phosphatase
    ans d

    ref-OHC BOOK PAGE – 502,601
    Insulin
    Protein Metabolism
    * The supply of amino acids is increased for gluconeogenesis because, in the absence of insulin, less protein synthesis occurs in muscle and hence blood amino acid levels rise.
    * Alanine is particularly easily converted to glucose.
    * The activity of the enzymes increased- phosphoenolpyruvate carboxykinase, which facilitates the conversion of oxaloacetate to phosphoenolpyruvate ;also include fructose 1,6-diphosphatase, which catalyzes the conversion of fructose diphosphate to fructose 6-phosphate, and glucose 6-phosphatase,
    Insulin–Glucagon Molar Ratios
    * Insulin is glycogenic, antigluconeogenetic, antilipolytic, and antiketotic - "hormone of energy storage."
    * Glucagon- glycogenolytic, gluconeogenetic, lipolytic, and ketogenic. It mobilizes energy stores and is a "hormone of energy release."

    *At low insulin glucagon ratio,gluconeogenesis is increased


    Insulin–glucagon molar ratio
    Situation Value
    Balanced diet 2.3
    Infusion of arginine 3.0
    3 days of starvation 0.4
    constant infusion of glucose 25
    ingestion of a protein meal during the infusion 170




    Trans cutaneoeus nerve stimulation to relieve pain acts by (AIIMS NOV2013)
    a) Gate way theorey of pain
    b) central pain
    c) allodynia
    d) Refered pain
    ANS A
    REF-OPERATION HARRI CAPSULE book –page- 656
    Stress-Induced Analgesia
    * It is well known that soldiers wounded in the heat of battle often feel no pain until the battle is over (stress-induced analgesia).
    * The relief may result from inhibition of pain pathways in the dorsal horn gate by stimulation of large-diameter touch-pressure afferents.
    * Collaterals from these myelinated afferent fibers synapse in the dorsal horn. These collaterals may modify the input from nociceptive afferent terminals that also synapse in the dorsal horn. This is called the gate-control hypothesis.

    Acupuncture at the site of the pain appears to act primarily in the same way as touching or shaking (gate-control mechanism).

    Worker of asbestos factory with mass in the apical lobe .which is true regarding the HPE (AIIMS NOV2013)
    1] Melanosomes
    2] Desmosomes
    3] neurosecretory granules
    4] Tubular microvilli
    Ans -2
    Ref-OHC-MKT-Page-65


    Squamous cell carcinoma-Cells united by well-developed cell junctions (desmosomes), intercellular bridges, tonofilaments
  11. samuel

    samuel New Member

    Contrast related nephropathy (AIIMS NOV 2013)
    a) increased creatinine
    b) decreased sr.creatinine
    c) increased bilirubin
    d) decreased bilirubin
    Ans a
    Category-New
    Type-Superficial basics
    REF-OHC Book- Chapter-Cardiology-page 154,189
    CONTRAST NEPHROPATHY-PREVENTION
    • an increase in creatinine >0.5 mg/dL or 25% above baseline that occurs 48–72 hours after contrast administration
    • Diabetic patients -metformin should stop 48 hours prior
    • sodium bicarbonate, low- or iso-osmolar contrast agents
    • volume of contrast to <100 mL per procedure

    Contrast nephropathy
    • Characteristic course is rise in SCr within 1–2 d, peak within 3–5 d, recovery within 7 d
    • A reduction in urine output (oliguria, defined as <400 mL/24
    • If the dipstick is positive for hemoglobin but few red blood cells are evident in the urine sediment, then rhabdomyolysis or hemolysis should be suspected.


    Uniparenral disomy not seen in (AIIMS NOV 2013)

    a. Bloom syndrome
    b. Angelman syndrome
    c. Silver Russell syndrome
    d. Prader willi syndrome
    Ans a

    Category-New
    Type-Basics in depth
    REF-OPERATION HARRI CAPSULE book-page-203
    Primary Immunodeficiencies of the Innate Immune System
    • Bloom syndrome (helicase deficiency) combines a typical dysmorphic syndrome with growth retardation, skin lesions, and a mild immunodeficiency

    Sweling of great toe with shaggy surrounding tissue with overhanging marigins with punched out lesions-the diagnosis (AIIMS NOV 2013)
    a) Reiters syndrome
    b) Psoariasis
    c) Rheumatoid arthritis
    d) Gouty arthritis
    Ans D
    Category-New
    Type- Exciting 18th based,Basics in depth


    REF-OPERATION HARRI CAPSULE BOOK-PAGE-237
    Gout
    • Gout is a metabolic disease that most often affects middle-aged to elderly men and postmenopausal women.
    • It results from an increased body pool of urate with hyperuricemia
    • The metatarsophalangeal joint of the first toe often is involved, but tarsal joints, ankles, and knees also are affected commonly
    • During acute gouty attacks, needle-shaped MSU crystals typically are seen both intracellularly and extracellularly
    • With compensated polarized light these crystals are brightly birefringent with negative elongation
    • Serum uric acid levels can be normal or low at the time of an acute attack, as inflammatory cytokines can be uricosuric and effective initiation of hypouricemic therapy can precipitate attacks
    • Cystic changes, well-defined erosions with sclerotic margins (often with overhanging bony edges)(AIIMS NOV-2013***), and soft tissue masses are characteristic features of advanced chronic tophaceous gout

    Not derived from neurectoderm (AIIMS NOV02013)
    a.retina
    b.ciliary muscle
    c.dilator pupillae
    d.sphincter pupillae
    Ans b

    Category-Repeat (AIIMS Nov-2012)
    Ref-OHC book-page 493

    Structure Origin
    * Conjuctiva Ectoderm
    * Lacrimal sac, Naso lacrimal duct Ectoderm of naso optic furrow
    * Lens Ectoderm (lens placode)
    * Vitreous Ectoderm + mesoderm
    * Choroid Mesoderm
    * Ciliary body and iris Mesoderm
    * Iris musculature (Sphincter & Dilator pupillae) Ectoderm
    * Ciliary muscle (AIIMS NOV-2012***) Mesoderm
    * sclera Mesoderm


    Spermatogenesis division of chromosomes occurs in which step (AIIMS NOV-2013)
    a) Spermatogonia to primary spermatocyte
    B)Primary spermatocyte to secondary spermatocyte
    c)secondary spermatocyte to spermatogonia
    d)
    ans b
    Category-Modified repeat
    Discussion

    Ref-OHC Book-page-499

    Diploid 46 a) Male
    - Spermatogonia
    -Primary spermato cyte*
    b) Females
    - Oogonia
    - Primary oocyte
    Haploid 23 a) Male
    *Secondary spermatocyte*
    *Spermatid *
    * Spermatazoa
    b) Females
    * Secondary oocyte
    * Mature Ovum*
    * Polar body

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