AIIMS Q & A (Nov. 2008)

Discussion in 'AIIMS Nov 2013' started by Guest, Nov 10, 2008.

  1. kavish.

    kavish. Guest

    Q. M/C site for peripheral arterial aneurysm is [/size]
    a. Radial A
    b. Subclavian A
    c. Popliteal A
    d. Femoral A


    Ans: c.Popliteal A

    REF: Sabiston 1908 18th,Schwartz 8th ed, Schwartz, 7/e, pp 949–950, Bailey 24th edp.no.950

    • Dilatations of localised segments of the arterial system are called aneurysms.
    • They can either be true aneurysms, con­taining the three layers of the arterial wall in the aneurysm sac, or false aneurysms, having a single layer of fibrous tissue as the wall of the sac, e.g. aneurysm following trauma.
    • The term mycotic is a misnomer because, while it indicates infection as a causal element in the formation of the aneurysm, this is hardly ever due to a fungus. In general, mycotic aneurysms are due to bacteria.
    • Aneurysms occur all over the body in major vessels such as the aorta, femoral, popliteal, subclavian and carotid arteries, or in smaller vessels, such as the cerebral, mesenteric, splenic and renal arteries. The majority is true fusiform atherosclerotic aneurysms.


    Popliteal artery aneurysms Defined as a popliteal artery diameter greater than 2 cm
     Popliteal aneurysms are usually due to atherosclerosis
     Account for 80% of all peripheral aneurysms
     50% are bilateral. 50% are associated with an abdominal aortic aneurysm. 50% are asymptomatic
     Symptomatic aneurysms present with features of:
    o Compression of adjacent structures (veins or nerves)
    o Rupture
    o Limb iscahemia due to emboli or acute thrombosis
     NOTE Popliteal aneurysms require excision even if asymptomatic. Because of the risk of embolization (60–70%) and thrombosis with resultant gangrene, as well as the lesser risk of rupture, all of which lead to substantial likelihood of limb loss, even relatively small, asymptomatic aneurysms should be excised when discovered.
    _________________
    DR.KAVISH CHOUHAN,MGMMC,INDORE Batch02
    Doing MD Dermatology from AIIMS (Rank24 in May AIIMS '08)
    AUTHOR OF DAMS MAY AIIMS 08 SOL. BOOK BY PEEPEE PUBLISHERS
  2. kavish.

    kavish. Guest

    Q. Wiskott Aldrich syndrome is characterized by all except?
    a. Autosomal recessive
    b. Platelet agregation defect
    c. Thrombocytopenia
    d. Eczema

    Ans is a. Autosomal recessive
    REF: Harrison's Principles of Internal Medicine, 17th Edition/p.no.2060

    Wiskott Aldrich syndrome is an X-linked disease(XR) & NOT AR

    Wiskott-Aldrich Syndrome
    • X-linked disease
    • Characterized by
    a. eczema,
    b. thrombocytopenia,
    c. repeated infections
    • Caused by mutations in the WASP gene.
    • WASP deficient platelets are small and have a shortened half-life.
    • Affected male infants often present with bleeding, and most do not survive childhood, dying of complications of bleeding, infection, or lymphoreticular malignancy.
    • The immunologic defects are:
    a. Low serum concentrations of IgM
    b. IgA and IgG are normal and
    c. IgE is frequently increased.
    • These patients fail to make antibodies to polysaccharide antigens normally,Most patients eventually acquire severe T cell deficiency, rendering them vulnerable to overwhelming infections with herpes simplex virus and other infectious agents.
    • TREATMENT
    a. Transplantation of histocompatible bone marrow from a sibling donor following myeloablative therapy can correct both the hematologic and immunologic abnormalities.
    b. intravenous immunoglobulin infusions
    c. splenectomy.
    d. prophylactic penicillin(Because of the increased risk of pneumococcal bacteremia)
  3. kavish.

    kavish. Guest

    Q. 2 month old female Infant with linear verrucous lesion on the abdomen. On HPE epidermal cell degeration, Stratum spinosum and S.granulose show epidermal cell vacuolation ,diagnosis is ?
    a. linear darier’s disease
    b. incontenentia pigmenti
    c. verrucous epidermal nevus

    ANS: C verrucous epidermal nevus
    Ref: Lever's textbook of Histopathology of skin. page 686,& section on localized melanocyte proliferation, 8th edition. Fitzpatric’s Dermatology 7th ed p.1057,432,Neene khanna 1st ed. P.27(for incontenentia pigmenti)


    The H/P picture that is given in the question of vacuolation in stratum granulosum and spinosum is the clincher. It is also referred to as epidermolytic hyperkeratosis or granular degeneration of the epidermis

    Epidermal Nevus• Epidermal nevi, or verrucous nevi, may be either localized or systematized.
    • localized type- present usually but not invariably at birth, only one linear
    lesion is present, often referred to as nevus unius lateris. It consists of closely set,papillomatous, hyperkeratotic papules • systematized type, papillomatous hyperkeratotic papules, often in a linear configuration, are present as many lesions.
    • These lesions are often linear in a parallel arrangement, particularly on the trunk.• They may also be associated with the distinctive pattern of epidermolytic
    hyperkeratosis
    What is Epidermolytic Hyperkeratosis
    (granulardegeneration of the epidermis)

    It is seen in some linear epidermal nevi and in [bleep] congenital ichthyosiform erythroderma.
    The salient histologic features are (a) perinuclear vacuolization of the cells in the stratum spinosum and the stratum granulosum; (b) irregular cellular boundaries peripheral to the vacuolization; (3) an increased number of irregularly shaped, large keratohyalin granules; and (4) compact hyperkeratosis in the stratum corneum.



    DARIER-WHITE DISEASE (KERATOSIS FOLLICULARIS)
    (Fitzpatric’s Dermatology 7th ed p.432)

    • Autosomal dominant disorder
    • Altered keratinization of the epidermis, nails, and mucous membranes.
    • Mutations in a sarcoplasmic endoreticulum ca2+-atpase isoform 2 (serca2)
    • Dwd is not present at birth and usually begins in the first or second decade. • Males and females are equally affected.
    • Characteristic sites of predilection are the face, forehead, scalp, chest, and the back(seborrheic sites).
    • C/f consists of warty papules & plaques in seborrheic areas, specific nail changes , palmoplantar pits & papules on the dorsum of hand & feet.
    • Histology shows suprabasal acantholysis in epidermis with dyskeratotic cells((Corps grains and ronds)


    Incontinentia pigmentii: X linked disease seen in Females as it is lethal for males in-utero. Initially vesicular eruption along the Blaschko lines give rise to verrucous lesions and finally hyper/ hypopigmented patches. Biopsy usually varies with stages: vesicular, verrucous and hyperpigmented stages. Prominent featues include hyperkeratosis, eosinophilic spongiosis of epidermis, basal cell degeneration, pigment incontinence etc.
  4. bluffer.

    bluffer. Guest

    2 yr old child comin 2 u in er at 3 am wid fever 39.5, rr 36/min , stridor only on lying down and crying. no difficulty in drinkin. he is consolable. wat will be d next step?

    give adose of dexamethasone
    send nasal and throat washin 4 culture
    send blood counts and culture
    nebulization wid epinephrine
  5. esenthil.

    esenthil. Guest

    a 54 year old male patient presenting with hemoptysis, oligo arthritis , fever and weight loss for past 6 months & a known smoker with serial chest radiographs showing fleeting opacities . what is the most likely dignosis ?

    1. ABPA
    2. TB
    3. wegeners
    4.Ca lung
  6. tulio.

    tulio. Guest

    20 YR. FEMALE with VI N. palsy with hyperintense lesion on T2 MRI. On giving contrast, homogenous lesion on contrast. Diagnosis?

    a) Schwannoma
    b) Cav. hemangioma
    c) Meningioma
    d) Astrocytoma
  7. raghavendra.

    raghavendra. Guest

    Here are some questions from my side:

    Well differented serous cystadenocarcinoma discovered after histopathology of ovarian cystectomy specimen. Management:
    1) follow-up
    2) surgery with serial CA 125
    3) salpino-oopherectomy
    4) TAH + BSO

    Spleen projects into:
    1) Greater OMENTUM
    2) LEFT subhepatic space
    3) Left paracolic gutter
    4) Infracolic ?? (cant remember)

    Primigravida at 37 wks gestational age, has hypotonic uterine contractions for 10 hrs with only 1cm dilation. Management:
    1) wait and watch
    2) Syntocinon
    3) Amniotomy
    4) LSCS

    Glycogen phosphorylase b is kept in inhibited state in MUSCLE by
    1) ATP
    2) Ca2+
    3) Glucose 6 phosphate
    4) 5'AMP
  8. lives4ever.

    lives4ever. Guest

    vasopressor used in preg is.......
    methoxamine
    phenyephrine
    ephidrine



    Name: EPHEDRINE
    Class: Sympathomimetic (Adrenergic)
    Risk Factor: C
    Fetal Risk Summary

    Ephedrine is a sympathomimetic used widely for bronchial asthma, allergic disorders, hypotension, and the alleviation of symptoms caused by upper respiratory infections. It is a common component of proprietary mixtures containing antihistamines, bronchodilators, and other ingredients. Thus it is difficult to separate the effects of ephedrine on the fetus from other drugs, disease states and viruses. Ephedrine-like drugs are teratogenic in some animal species, but human teratogenicity has not been suspected (1,2).

    The Collaborative Perinatal Project monitored 50,282 mother-child pairs, 373 of whom had 1st trimester exposure to ephedrine (3, pp. 345–56). For use anytime during pregnancy, 873 exposures were recorded (3, p. 439). No evidence for a relationship to large categories of major or minor malformations or to individual defects was found. However, an association in the 1st trimester was found between the sympathomimetic class of drugs as a whole and minor malformations (not life-threatening or major cosmetic defects), inguinal hernia, and clubfoot (3, pp. 345–56).

    Ephedrine is routinely used to treat or prevent maternal hypotension following spinal anesthesia (4,5,6 and 7). Significant increases in fetal heart rate and beat-to-beat variability may occur, but these effects may have been the result of normal reflexes following hypotension-associated bradycardias. A recent study, however, has demonstrated the placental passage of ephedrine with fetal levels at delivery approximately 70% of the maternal concentration (8). The presence of ephedrine in the fetal circulation is probably a major cause of the fetal heart rate changes.


    SO ANS MAY BE EPHEDRINE
  9. lives4ever.

    lives4ever. Guest

    risser's localiser cast is used in
    1.idiopathic scoliasis
    2.kyphoscoliasis
    4.thoracolumbar scoliasis
    4.????????

    1: Singapore Med J. 1988 Jun;29(3):219-21.Links
    Idiopathic scoliosis--treatment by pre-operative Risser's localiser cast followed by Harrington rodding and posterior spinal fusion.
    Koh KT, Low BY, Balachandran N.

    PMID: 3187572 [PubMed - indexed for MEDLINE]

    ANS- IDIOPATHIC SCOLIOSIS
  10. jonty19

    jonty19 Guest

    DOC FOR REFRACTORY HISTIOCYTOSIS?
    A. CLADARABINE
    B. FLUDARABINE
    C. HIGH DOSE CYTOSINE ARABINOSIDE
    D.HIGH DOSE METHOTREXATE
  11. jonty19

    jonty19 Guest

    ANS TO TO THIS QTN IS MOST PROBABLY .....
    .........CLADARBINE(2-chlorodeoxyadenosine)

    to support my ans are the 10 out of 10 search result on google for treatment of refractory histiocytosis.....one of which i am posting here ....


    ABSTRACT

    Abstract: Langerhans cell histiocytosis (LCH) is a rare disorder which frequently involves the lungs of affected adults. Recent evidence suggests it is a clonal neoplastic disorder. Prognosis in this disease is variable, but in its multisystem form or when associated with progressive respiratory dysfunction, prognosis is poor. Recent case reports and a phase II trial of the antimonocyte drug 2-chlorodeoxyadenosine (2CDA) have described success in treating LCH. We used 2CDA to treat a young Australian man with LCH involving lungs and bone. A complete symptomatic remission was achieved with no evidence of recurrence some 5 years after completion of chemotherapy.
  12. jonty19

    jonty19 Guest

    4.WHICH OF THE FOLLOWING BRAINSTEM NUCLEI IS NOT DERIVED FROM ALAR PLATE?
    A. HYPOGLOSSAL NUCLEI
    B. INFERIOR OLIVARY NUCLEUS
    C. DENTATE NUCLEUS
    D. SUBSTANTIA NIGRA
    Ans. a HYPOGLOSSAL NUCLEI ref IB SINGH EMBRYOLOGY PAGE 308 6TH EDITION

    SUBSTANTIA NIGRA-DEVELOPS FROM ALAR PLATE ..ref IB SINGH EMBRYOLOGY PAGE 313 6TH EDITION
  13. jonty19

    jonty19 Guest

    20 YR. FEMALE with VI N. palsy with hyperintense lesion on T2 MRI. On giving contrast, homogenous lesion on contrast. Diagnosis?

    a) Schwannoma
    b) Cav. hemangioma
    c) Meningioma
    d) Astrocytoma


    Answer-B) Cavernous hemangioma
    Reference-
    Characteristic MR Imaging Findings of Cavernous Hemangiomas in the Cavernous Sinus. American Journal of Neuroradiology 24:1148-1151,

    Extraaxial cavernous hemangiomas Rare and very rarely arise in the cavernous sinus.
     Although this malformation is categorized as a vascular malformation and has well-defined histologic characteristics, it sometimes presents tumorlike behavior, including mass effects, enclosure of neurovascular structures, and proliferation during pregnancy.
     The lesions are found predominately among women,.
     The onset of symptoms is usually insidious, and symptoms are caused by the large size of the lesions.
     Patients usually present with headaches and dysfunction of the cranial nerves passing through the cavernous sinus, manifesting particularly as ptosis and diplopia.  Mr imaging reveals well-defined masses that are hypointense or isointense on t1-weighted images and markedly hyperintense on t2-weighted images, which indicates the relationship between the lesion and the intracavernous ica.
     The marked hyperintensity on t2-weighted images and homogeneous enhancement seem to distinguish these lesions from other types. Meningiomas often give similar signal intensity to gray matter on both t1- and t2-weighted images.
    schwannomas tend to give lower signal intensity than gray matter on t1-weighted images and almost uniformly give higher signal intensity on t2-wighted images.
    Both schwannomas and meningiomas show prominent contrast enhancement, which tends to be a slightly heterogeneneous pattern
  14. Jenny

    Jenny Guest

    Which of the following is most sensitive diagnostic test for Dengue?
    a) IgM Elisa
    b) Tissue Culture
    c) Electron Microscopy
    d) CFT

    Answer : (a) IgM Elisa
  15. Jenny

    Jenny Guest

    Which of the following is incorrect about hybridoma technique?
    a) normal activated B-cell and myeloma cell
    b) myeloma cells - selective mutation in salvage pathway, vigorous proliferation in HAT medium
    c) Aminopterin, a folic blocker, inhib. denovo nucleotide synthesis
    d) Thymidine Kinase and HGPRT catalyse salvage pathway
  16. Jenny

    Jenny Guest

    All are true about carbohydrate antigen except
    a) less antigenic
    b) memory response seen
    c) does no stim. T-cell
    d) causes polyclonal B-cell stimulation
  17. Jenny

    Jenny Guest

    Which of the following organisms cause Reactive Arthritis?
    a) Ureaplasma urealyticum
    b) Gr.A beta hemolytic Streptococci
    c) Borrelia bugdorfi
  18. Jenny

    Jenny Guest

    Lady from Shimla has fever, malaise, axillary and inguinal lymphadenopathy. Culture shows stalacite growth. Likely organism is ?
    a) Yersinia pestis
    b) Francisella
    c) Pseudomonas
  19. Jenny

    Jenny Guest

    40yr old gardner gets trauma to his hand while gardening. He has multiple vesicles on hand and eruptions along lymphatic. Most likely organism is
    a) Sporothrix shenkii
    b) Cladosporium
    c) Histoplasma
    d) Candida
  20. Jenny

    Jenny Guest

    Which of the following is not a RNA virus?
    a) Rabies
    b) Rubella
    c) Simian40
    d) Ebola
  21. Jenny

    Jenny Guest

    True about bacteriophage is
    a) imparts toxigenicity to bacteria
    b) transfers chromosome to bacteria
    c) helps in transduction of bacteria
  22. Jenny

    Jenny Guest

    Which of the following explains mechanism of action of Pertussis toxin?
    a) ADP Ribosylation
    b) acts through G-alpha subunit
  23. Jenny

    Jenny Guest

    Which of the following is responsible for isotyping in immunoglobulins?
    a) changes in aminoacid heavy and light chain in variable region
    b) changes in aminoacid heavy and light chain in constant region responsible for class and subtype
    c) these are areas in antigen that bind to antibody
    d) subtle aminoacid changes due to allelic differences
  24. Jenny

    Jenny Guest

    True about bacteriophage is
    a) imparts toxigenicity to bacteria
    b) transfers chromosome to bacteria
    c) helps in transduction of bacteria
  25. Jenny

    Jenny Guest

    Which of the following Pseudomonas is responsible for infections through intravenous catheter ?
    a) Pseudomonas aeruginosa
    b) Pseudomonas cepacia
    c) Pseudomonas maltiphilia
    d) Pseudomonas mallei
  26. Jenny

    Jenny Guest

    Primi with obstructed labour and exhaustion has fetal demise. Appropriate step would be to do
    a) Caesarean section
    b) Craniotomy
    c) Decapitation
    d) Forceps Delivery
  27. Jenny

    Jenny Guest

    Which of the following is not found in PCOD?
    a) increased DHEA
    b) increased Prolactin
    c) increased LH
    d) increased LH:FSH ratio
  28. Jenny

    Jenny Guest

    Q199) Investigation of choice in Cholestosis of pregnancy?
    a) Bilirubin
    b) Bile Acid
    c) Alkaline Phosphatase
    d) ALT, AST
  29. Jenny

    Jenny Guest

    Which of the following is not used in FIGO staging of Ca.Cervix ?
    a) IVP
    b) Sigmoidoscopy
    c) CT scan
    d) Cystoscopy
  30. Jenny

    Jenny Guest

    45yr old female with DUB has 8mm thick endometrium. Next step is
    a) Hysterectomy
    b) Histopathology of endometrium
    c) Progesterone
    d) Follow up with USG
  31. Jenny

    Jenny Guest

    Vasopressor used in pregnancy?
    a) Phenylephrine
    b) Ephedrine
    c0 Methoxamine
    d) Mephenteramine
  32. Jenny

    Jenny Guest

    Female with history of amenorrhoea for 6 weeks, USG shows empty sac, serum beta HCG-1000 IU. Next step would be ?
    a) Medical management
    b) Repeat HCG after 1 week
    c) Repeat HCG after 48hrs
  33. Jenny

    Jenny Guest

    ) Primi 37wk with Cervix 1cm after 10hrs and having mild uterine contractions. Next step would be
    a) Syntocinon drip and augment
    b) Amniotomy
    c) Caesarean section
    d) Sedation and wait
  34. Jenny

    Jenny Guest

    Earliest to be diagnosed on USG ?
    a) Spina bifida
    b) Anencephaly
    c) Meningocoele
    d) Cystic Hygroma
  35. Jenny

    Jenny Guest

    Pregnant lady got infected with chickenpox in last three days of delivery. Appropriate step would be
    a) Both baby and mother are safe
    b) Give antiviral treatment to mother before delivery
    c) Give antiviral treatment to baby after delivery
    d) Baby will develop congenital varicella syndrome
  36. Jenny

    Jenny Guest

    ) Which of the following measures are not done to prevent materno-fetal transmission of Hiv from mother to child ?
    a) AZT to mother
    b) Vaginal delivery
    c) No breast feeding by mother
    d) Vitamin 'A' to mother
  37. Jenny

    Jenny Guest

    Which of the following structures is most likely to get damaged if Robert's maneuvre (flexing hip against mother's abdomen) is performed?
    a) Lumbosacral plexus
    b) Femoral n.
    c) Obturator n.
    d) Lat. cut. n. of thigh
  38. Jenny

    Jenny Guest

    In which of the following disorders is tube motility affected?
    a) Marfan Syndrome
    b) Turner Syndrome
    c) Noonan Syndrome
    d) Kartagner Syndrome
  39. Jenny

    Jenny Guest

    Which of the following is an Ovarian reserve indicator?
    a) LH
    b) FSH
    c) LH:FSH ratio
    d) Estradiol
  40. Jenny

    Jenny Guest

    Cue cells are found in ?
    a) Candidiasis (vaginal)
    b) Bacterial Vaginosis
    c) Trichomoniasis
  41. Jenny

    Jenny Guest

    Which of the following is not done in shoulder dystocia?
    a) Suprapubic pressure
    b) Fundal Pressure
    c) Robert's Maneuvre
    d) Wood's procedure
  42. Jenny

    Jenny Guest

    Adult with proptosis and abucent nerve palsy. Homogeneous mass with high contrast enhancement. Most likely diagnosis is ?
    a) Cavernous Hemangioma
    b) Glioma
    c) Astrocytoma
    d) Meningioma
  43. Jenny

    Jenny Guest

    Which of the following is not part of SAFE strategy?
    a) Safe excreta disposal
    b) Oral Azithromycin
    c) Vitamin 'A' supplementation
    d) Frequent face wash
  44. Jenny

    Jenny Guest

    Which of the following is not a component of Horner's Syndrome?
    a) Miosis
    b) Apparent Exopthalmos
    c) Ptosis
    d) Heterochromia Iridis
  45. Jenny

    Jenny Guest

    ) Which of the following is present in left abducent nerve palsy?
    a) Ptosis of left eye
    b) Accomodative paresis of left eye
    c) Diplopia in left gaze
    d) Weakness of left adduction
  46. Jenny

    Jenny Guest

    Maximum refractive index
    a) Cornea
    b) Anterior surface of lens
    c) Posterior surface of lens
    d) Centrum of Lens
  47. Jenny

    Jenny Guest

    Which of the following cause Inclusion Conjunctivitis?
    a) Chlamydia trachomatis
    b) Chlamydia Psittaci
  48. Jenny

    Jenny Guest

    Which of the following cause Inclusion Conjunctivitis?
    a) Chlamydia trachomatis
    b) Chlamydia Psittaci
  49. Jenny

    Jenny Guest

    Glomus tumor is found in
    a) Fingers
    b) Liver
    c) Adrenal
    d) Pituitary
  50. Jenny

    Jenny Guest

    Which of the following drugs used in Osteoporosis has both bone forming and bone resorption property?
    a) Calcitonin
    b) Strontium ranelate
    c) Bisphosphonate
    d) Terapeptide

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