AIIMS Q & A (Nov. 2008)

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

  1. Jenny

    Jenny Guest

    A patient with multiple injuries develops tachycardia, tachypnoea, fever, increased TLC and periumbilical rash on day 2. Diagnosis is?
    a) Pulmonary Embolism
    b) Fat Embolism
  2. Jenny

    Jenny Guest

    Which of the following leads to Insertional type Achilles Tendinitis?
    a) Steroid use
    b) Chronic strain
    c) Improper shoes
    d) runners or jumpers
  3. Jenny

    Jenny Guest

    Which of the following joints is not involved in Rheumatoid Arthritis?
    a) Elbow
    b) Ankle
    c) Tarso-metatarsal
    d) Metatarso-phalangeal

    Answer : (c) Tarso-Metatarsal joint
  4. Jenny

    Jenny Guest

    Post radical neck dissection shoulder syndrome does not have one of the following
    a) Shoulder pain
    b) Limited shoulder movements
    c) normal EMG findings
    d) Shoulder drooping
  5. Jenny

    Jenny Guest

    Post radical neck dissection shoulder syndrome does not have one of the following
    a) Shoulder pain
    b) Limited shoulder movements
    c) normal EMG findings
    d) Shoulder drooping

    Velpau and Sling-Swathe bandages are used in
    a) # clavicle
    b) # scapula
    c) Acromio-clavicular dislocation
    d) Shoulder dislocation
  6. Jenny

    Jenny Guest

    Risser-localizer cast is used in?
    a) Kyphosis
    b) Dorsolumbar scoliosis
    c) Lumbar scoliosis
    d) Spondylolisthesis
  7. Jenny

    Jenny Guest

    Watson-Jones operation is performed for
    a) neglected clubfoot
    b) muscle paralysis
    c) valgus deformity
    d) hip
  8. Jenny

    Jenny Guest

    In deep posterior compartment syndrome which passive movement causes pain?
    a) Toe flexion
    b) Toe extension
    c) Foot dorsiflexion
    d) Foot inversion
  9. Jenny

    Jenny Guest

    Injury to which of the following is cause of positive "Trendlenberg Test"?
    a) Superior Gluteal nerve
    b) Inferior Gluteal nerve
    c) Obturator nerve
    d) Femoral nerve
  10. jonty19

    jonty19 Guest

    Acute Achilles tendonitis(insertional tendonitis)

    Acute Achilles tendonitis (also known as Albert's Disease) typically has a abrupt onset with moderate to severe pain found at either the insertion of the tendon in the back of the heel (insertional tendonitis) or in a location 2-3 cm proximal to the tendons' insertion. Many individuals who suffer from acute Achilles tendonitis can describe an injury or single event that initiated the pain. Symptoms of acute Achilles tendonitis occur at the beginning of an activity and are typically described as sharp pain. As the activity continues and the Achilles tendon 'warms up', the Achilles tendon pain begins to feel a bit better. With excessive use, the Achilles tendon again becomes painful at the end of activity. For example, runners with Achilles tendonitis experience pain as they begin their run. The pain subsides during their run only to recur near the end of their normal running distance.

    Chronic Achilles tendonitis (tendonosis)

    Chronic Achilles tendonitis is also called Achilles tendonosis. Chronic Achilles tendonitis can also cause hypertrophy (enlargement) of the posterior heel. When viewed on x-ray, this finding is called an increased Phillip-Fowler angle.

    In cases of chronic Achilles tendonitis it's important to differentiate between pain strictly due to the pull of the Achilles tendon and pain due to the enlargement of the posterior heel rubbing against the shoe called a pump bump or Haglund's deformity.
    The difference between Achilles tendonitis(insertional tendonitis) and a pump bump(chronic) can be understood by evaluating the pain while barefoot (suggestive of acute Achilles tendonitis ie insertional tendonitis) compared to pain while wearing shoes with an enclosed heel in pump bump ie chronic Achilles tendonitis (tendonosis)....
  11. Dilpreet.

    Dilpreet. Guest

    In bone, PTH increases the activity and number of osteoclasts, the cells responsible for bone resorption. However, this stimulation of osteoclasts is not a direct effect. Rather, PTH acts on the osteoblast (the bone-forming cell) to induce a membrane-bound protein called RANK ligand (RANKL). This factor acts on osteoclasts and osteoclast precursors to increase both the numbers and the activity of osteoclasts. This action increases bone turnover or bone remodeling, a specific sequence of cellular events initiated by osteoclastic bone resorption and followed by osteoblastic bone formation. Although both bone resorption and bone formation are enhanced by PTH, the net effect of excess PTH is to increase bone resorption. PTH in low and intermittent doses increases bone formation without first stimulating bone resorption. This action appears to be indirect, involving other growth factors such as IGF-1. This has led to the recent approval of recombinant PTH 1-34 (teriparatide) for the treatment of osteoporosis
  12. drctvs.

    drctvs. Guest

    The skeletal effects of teriparatide depend upon the pattern of systemic exposure. Once–daily administration of teriparatide stimulates new bone formation on trabecular and cortical (periosteal and/or endosteal) bone surfaces by preferential stimulation of osteoblastic activity over osteoclastic activity. In monkey studies, teriparatide improved trabecular microarchitecture and increased bone mass and strength by stimulating new bone formation in both cancellous and cortical bone. In humans, the anabolic effects of teriparatide manifest as an increase in skeletal mass, an increase in markers of bone formation and resorption, and an increase in bone strength. By contrast, continuous excess of endogenous PTH, as occurs in hyperparathyroidism, may be detrimental to the skeleton because bone resorption may be stimulated more than bone formation.
    it is endogenous pth responsible for resorption.....
  13. kavish.

    kavish. Guest

    Q. 1995 parliament recent update on 'seventh disability' is which of the following?
    a. mental illness
    b. drug abuse
    c. road traffic accidents

    Ans is c. Mental illness

    The Persons with Disabilities (Equal Opportunities, Protection of Rights and Full Participation) Act was passed by both the Houses of our Parliament in a single day in December 1995. The law was notified on 7th February 1996.
    The Disability Act of 1995 defines 'disability' to mean (i) blindness; (ii) low vision; (iii) leprosy-cured; (iv) hearing impairment; (v) locomotor disability; (vi) mental retardation, and (vii) mental illness.
    The Disability Act of 1995 not only included mental illness under the definition of 'disability' but also mandates that its Central Coordination Committee (which has representation at the 'Secretary to the Government of India' level of the Health Ministry!) will: (1) review and coordinate the activities of all Governmental and Non-Governmental Organisations which are dealing with matters relating to persons with disabilities; (2) develop a national policy to address issues faced by persons with disabilities; (3) advise on the formulation of policies, programmes, legislations and projects with respect to disability.
    In a tragic incident at Erwadi in TamilNadu during August 2001, 25 people, including 11 women, were charred to death. A devastating fire broke out at 5 a.m. in the thatched hostel housing them. Out of the 46 hostel inmates, 40 were chained to their beds. They kept screaming for help but no one came to their rescue. The 46 hostel inmates were mentally ill. The Erwadi tragedy of Aug 2001 attracted international attention. That it happened is indicative of a deep-rooted apathy towards people with mental illness.
  14. arun.

    arun. Guest

    Lot of you people quote online articles and journals as explanations for whatever you feel is the answer to AIIMS or other questions. the important point is that these journal articles are merely citations and need not necessarily represent accepted clinical practices. even review articles merely represent somebody's viewpoint. clinical recommendations come forth during periodic audit by experts in the respective fields of old practices and recent research on topics.

    i don't suggest that you stop quoting online articles. it is quite a good way to keep onself and others apprised of new ideas and future trends and ongoing research. refer standard PG levels text books for answers to questions. a highly condensed form, difficlult to interpret in one sighting/ reading, is available in UG level standard text books.

    and please don't have any ego issues with anybody. this medical field is riddled with differences of opinion. accept others opinions as opinions if you want your's to be heard and respected too. all you people can take a leaf from kavish's book. he was so good in solving questions and was equally adept at managing differences in opinion. make healthy discussions. don't fight like cats and dogs.

    take care all of you.

    all the best to you all for AIPGMEE 2009. study hard and do well.
  15. jonty19

    jonty19 Guest

    Splenic macrophages in Gaucher's ds differ from those in ceroid histiocytosis by staining positive for:

    a) lipids
    b) phospholipids
    c) acid fast stain
    d) iron
  16. tulio.

    tulio. Guest

    20 YR. old with ENHANCING LESION in HILUM of kidney..focal areas of necrosis....on imaging....diagnosis?
    a) Mets. Germ cell tumour
    b) Lymphoma
    c) ..................
    d) ...................
  17. kavish.

    kavish. Guest

    Q.M/C cause of mononeuritis multiplex in India ?
    a. TB
    b. RA
    c. Hansen’s disease
    d. PAN

    Ans is C. Hansen’s disease
    REF Harrison's Principles of Internal Medicine, 17th Edition/p.no.2656,2661,1022,

    • Leprosy is the most common cause of treatable peripheral neuropathy in India (REF: Kumar S, Alexander M, Gnanamuthu C. Cranial nerve involvement in patients with leprous neuropathy. Neurol India 2006;54:283-5)
    • Diabetes mellitus is the most common cause of mononeuropathy multiplex. In this disorder, individual nerves are transiently disabled. The neuropathy usually develops over the course of minutes to days, and the recovery of function may require weeks to months. ( Victor, pp 1396–1399.)
    • Leprous neuropathy is characterized by the involvement of superficial peripheral nerve trunks in cooler body regions such as ulnar, median, radial, common peroneal, supraorbital and great auricular nerves.
    • Leprous neuropathy can take any of the three forms: mononeuropathy, mononeuritis multiplex or symmetric polyneuropathy.
    • Cranial nerve involvement is also commonly seen in patients with leprosy

    Mononeuropathy Multiplex (Harrison's Principles of Internal Medicine, 17th Edition/p.no.2656)
    • Mononeuropathy multiplex refers to the multifocal involvement of individual peripheral nerves.
    • Although multiple compressive neuropathies can present in this manner, more often an inflammatory cause is responsible, and in such cases the disorder is referred to as mononeuritis multiplex.
    • Both systemic (67%) and nonsystemic (33%) vasculitis may present as mononeuritis multiplex; less commonly, vasculitic neuropathy can present as an asymmetric or distal symmetric neuropathy.
    • Among the systemic vasculitides, polyarteritis nodosa, rheumatoid arthritis, systemic lupus erythematosus (SLE), Churg-Strauss syndrome, Wegener's granulomatosis, and hypersensitivity vasculitis should be considered; these are often associated with constitutional symptoms such as fever and weight loss .The common fibular nerve (previously called the common peroneal nerve) is affected in ~75% of patients with vasculitic neuropathy; symptoms consist of a painful foot drop. The ulnar, median, and radial nerves may also be involved.

    Leprous Neuritis(Harrison's Principles of Internal Medicine, 17th Edition/p.no2661)
    • Mycobacterium leprae causes mononeuropathy multiplex affecting peripheral nerves in cooler regions of the body, reflecting the predilection for this bacterium to thrive at cooler temperatures.
    • Although the incidence of leprous neuritis has declined, it remains a leading cause of neuropathy worldwide.
    • Leprosy is classified into tuberculoid, lepromatous, and borderline types; peripheral nerves may be affected in all three types, and involved nerves are often palpably thickened.
    • In tuberculoid leprosy, a single patch of hypesthetic or anesthetic skin may occur in any location. The area is generally hypopigmented, thickened, or red. A mononeuropathy involving a nearby superficial nerve may occur.
    • Lepromatous leprosy produces more widespread skin thickening, hypesthesia, and anhidrosis affecting the pinnae of ears, dorsum of hands or feet, dorsomedial surfaces of the forearm, and anteromedial aspects of the legs.
    • The fifth and seventh cranial nerves, greater auricular nerve in the neck, median and ulnar nerves, and peroneal nerves can all be involved.
  18. kavish.

    kavish. Guest

    Q. 20 years old female with VI nerve palsy shows a hyper intense lesion on T2W MRI of cavernous sinus that homogenously brightens up with contrast. Probable diagnosis is-

    a. Astrocytoma
    b. Cavernous haemangioma
    c. Glioma
    d. Meningioma


    was this the actual Q?
    schwannoma was present in options or not?
  19. lives4ever.

    lives4ever. Guest

    then schwannoma is the right answer

    in schwannoma

    MRI
    heterogenous mass of high signal intensity on T2W1,heterogenous enhancement

    AGE:20-30 yrs

    DD:may apperar similar to meningioma on MRI

    ans is schwannoma if its in choice,but unable to recall
    this option
    others pleaseopine regarding recall of this option
  20. lives4ever.

    lives4ever. Guest

    regarding meningioma

    Definition

    Meningioma is a tumor that arises from the meninges — the membranes that surround your brain and spinal cord. The majority of meningioma cases are noncancerous (benign), though rarely a meningioma can be cancerous (malignant).

    Meningioma occurs most commonly in women. Most people develop meningioma as adults, after age 40. But meningioma can occur at any age, including childhood.

    Even if a meningioma is benign, it isn't harmless. A meningioma can press on the brain and spinal cord, causing complications such as vision loss or paralysis. The signs and symptoms you experience depend on the size and location of the meningioma and what parts of the nervous system are affected. Meningioma treatment options include surgery and radiation, though sometimes immediate treatment isn't necessary
  21. genius.

    genius. Guest

    most common nerve to b damaged in mc roberts maneouvre is lumbosacral trunk
    ref;williams22nd..pg520......wong & colleagues have reviewed neurological injury involving the lower extremities in assoc with labor & delivery.such injuries may manifest as footdrop,which can b secondary to injury at the level of the lumbosacral root,lumbosacral plexus,sciatic nerve,or common peroneal nerve.components of the lumbosacral plexus cross the pelvic brim & can b compressed by the fetal head or by the forceps.
    pt. to b noted-the most common mechanism of injury however is external compression of the peroneal nervesusaully caused by inappropriate leg positioning in stirrups especially during a prolonged 2nd stage of labor[but mc roberts maneuovre consists of removing the legs from the stirrup sharply flexing the pages up onto the abdomen
  22. byju.

    byju. Guest

    maneuvers for the alleviation of shoulder dystocia-ref JAMES:HIGH RISK PREGNANCY 3RD ED.pg 1445
    mcroberts maneuvre
    suprapubic pressure
    rotational maneuvers: woods and rubins maneuver
    delivery of the post arm:barnum maneuver and gaskin maneeuver
    cephalic replacement:zavanelli
    symphysiotomy
    abdominal rescue through hysterotomy


    attentandts should refrain from applying fundal pressure as a maneuver bcoz pushing on the fundus simply duplicates a maternal directional expulsive force tht has already failed to deliver the fetal shoulder & serves only to further impact the ant shoulder behind the symphysis pubis.in addition the use of fundal pressure has been assoc with an increased risk of erb-duchhene palsy& thoracic spinal cord injury in the neonate.
  23. byku.

    byku. Guest

    BEST INDICATOR OF OVARIAN RESERVE?
    ans:FSH.
    REF:NOVAK 14TH ED...PG NO.1203 & 1204.

    ovarian reserve refers to the size of the nongrowing,or resting,primordial follicle population which presumably determines the no. of growing follicles & the "quality" or reproductive potential of their oocytes.

    although AGE is the best predictor of ovarian reserve,approximately 10% of women hav an accelerated loss of ovarian reserve by their mid-30s,whereas others respond well to COH[controlled ovarian hyperstimulation].bcoz of this imperfect correlation bwn chronological age & ovarian biological age,assays hav been developed to assist in the prediction of ovarian responsiveness to COH.

    screening tests used for this include SERUM DAY 3 FSH,SERUM INHIBIN B,SERUM MULLERIAN INHIBITING SUBSTANCE,THE CLOMIPHENE CITRATE CHALLENGE TEST,& TRANSVAGINAL ULTRASOUND PARAMETERS SUCH AS ANTRAL FOLLICLE COUNT AND MEAN OVARIAN VOLUME MEASUREMENT.

    for IVF treatment following pituitary desensitisation,basal FSH assesment proved to b a better predictor of ovarian response than age.
  24. byku.

    byku. Guest

    investigation of choice in cholestasis of pregnancy?
    ans....bile acids.
    REF:JAMES-HIGH RISK PREG 3RD ED...PG 1037

    Measurement of bile acids is the most useful test for the diagnosis of OBSTETRIC CHOLESTASIS.in unaffected pregnancies the levels of serum bile acids change little.the extent of the rise in OC pregnancies is variable & can b marked.

    serum ALT & AST also rise in the majority of cases but the extent of rise may not b marked.

    Raised bilirubin can occur in OC but it is not commonly seen& should not b used alone to make the diagnosis.

    Alkaline phosphatase rises in the 3rd trimester of normal pregnancies,mainly as a consequence of the placental isoenzyme,& is therefore not of value in the diagnosis of OC.
  25. byku.

    byku. Guest

    female with 37 weeks gestation with mild labor pain,with progressively 1cm dilated & noneffaced cervix.next step in management?
    ans....sedation & wait.
    ref:fernando arias-high risk preg 3rd ed...pg 376.

    the most frequent problem with the diagnosis of prolonged latent phase of labor is the distinction bwn FALSE LABOR& LATENT PHASE OF LABOR.a common method to make this differentiationis by observing the patient for a period of atleast 2hrs. pts in false labor will show a pattern of irregular contractionstht eventually decrease in frequency & intensity,& will hav no cervical changes during the observation period.pts in latent phase will show persistant regular uterine contractionsusually increasing in intensity& freq. & will show sum cervical changes like softening & effacement.
    Another method to differentiate false labor from latent phase of labor is by "therapeutic rest".for this purpose ,the pt is given a 15mg dose of morphine sulphate.pts in false labor sleep for a few hrs awake without contractions while pts in latent phase continue contracting& show cervical changes following the rest period.
  26. kavish.

    kavish. Guest

    Q- 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

    ANS -1. ABPA

    Read this Case report from PGIMER ,
    Ritesh Agarwal, Chandana Reddy, D Gupta,Assistant Professor, Senior Resident, Additional Professor, Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh (India).


    ABSTRACT:-
    Allergic bronchopulmonary aspergillosis is an uncommon condition characterized by hypersensitivity to aspergillus antigen. It commonly presents as refractory asthma, fleeting pulmonary opacities and bronchiectasis. The authors describe an unusual presentation of allergic bronchopulmonary aspergillosis, when it was mistaken as bronchogenic carcinoma and review the current literature on the diagnosis and management of this rare condition.



    INTRODUCTION
    Allergic bronchopulmonary aspergillosis (ABPA) is a pulmonary disorder characterized by hypersensitivity to fungi most commonly Aspergillus fumigatus, a fungus which colonizes the bronchial mucus of patients with asthma and cystic fibrosis. It occurs in 1-2% of patients with bronchial asthma and 2-15% of patients with cystic fibrosis1. The immunological substrate of this hypersensitivity includes a TH2 CD4+ lymphocyte response, IgE mediated (type 1) and IgG mediated (type 3) hypersensitivity. Patients often present with unremitting asthma and other systemic complaints like fever, anorexia, weight loss and hemoptysis. Common radiological manifestations include fleeting pulmonary infiltrates, bronchoceles (mucus filled bronchi), consolidation, nodules and bronchiectasis. The diagnosis is often missed and infact many patients are misdiagnosed as pulmonary tuberculosis, because of the upper lobe opacities and bronchiectasis. We describe an uncommon presentation of ABPA, wherein the patient was initially diagnosed as bronchogenic carcinoma and even underwent fiberoptic bronchoscopy in the diagnostic evaluation. Proper clinical suspicion and serology confirmed the diagnosis.
    CASE REPORT
    A 60 year-old female, presented with history of cough with minimal mucoid expectoration and exertional breathlessness of six years duration. She also had history of winter exacerbations associated with wheezing. She was a post-menopausal lady, non-smoker, with history of exposure of biomass fuel. For the last six months, she complained of increasing dyspnea, dull aching left sided chest pain, anorexia and weight loss of 5kg. There was no history of fever or hemoptysis. On examination she had pallor. Rest of the physical examination was unremarkable. A general practitioner had investigated her and a chest radiograph was obtained (Figure 1). The chest radiography showed left hilar prominence, and nonhomogenous opacities in left middle and lower zone. A flexible fiberoptic bronchoscopy examination performed at another center, suspecting a bronchogenic carcinoma, was normal. She was referred to our center, where a review of chest radiograph showed left hilar prominence and pulmonary opacities confirming to the morphology of glove-in-finger suggesting the presence of bronchiectasis and mucus filled bronchi. With the history suggesting bronchial asthma, and the presence of bronchiectasis, a diagnosis of allergic bronchopulmonary aspergillosis (ABPA) was made. High-resolution computed tomography (HRCT) confirmed the presence of bronchiectasis and also shows numerous bronchoceles (mucus filled bronchi) which appear as hilar lymphadenopathy (Figure 2). A skin test for Aspergillus fumigatus was positive; her total IgE count was 11098 IU/mL, IgE specific to Aspergillus fumigatus 42 U/L, absolute eosinophil count was 2000/mL, and there were presence of aspergillus precipitins. The final diagnosis made was allergic bronchopulmonary aspergillosis.

    DISCUSSION
    Allergic bronchopulmonary aspergillosis is one of the common causes of eosinophilic lung disease and probably the most common cause of eosinophilic pneumonia in the developed countries2. Patients may present with recurrent asthma exacerbations, expectoration of dark brown mucus plugs, hemoptysis of systemic features such as fever, anorexia, malaise and weight-loss. There is no specific physical finding associated with ABPA. The radiological findings include “gloved-finger”, “tooth-paste” shadows, airfluid levels from dilated bronchi and tramline shadows from edematous bronchial walls3. HRCT characteristically shows central bronchiectasis, mucusfilled bronchi (also called bronchoceles), consolidation and centrilobular nodules4. Bronchoceles are usually proximal, often inseparable from the hilum and may simulate hilar lymphadenopathy and is probably thecause of left hilar mass in our patient5. The Rosenberg criteria are most widely used for diagnosis (Box 1)6. Patients may also present with less than the full complement of diagnostic criteria. Greenberger7 proposed the use of clinical designations ABPA-S (seropositive) and ABPA-CB (central bronchiectasis) and emphasized that bronchiectasis is not an essential criteria.
    The natural history of ABPA is characterized by clinical, immunological and radiologic episodes of remission and relapse. Five stages are commonly described which do not necessarily progress in a sequential fashion. Stage I is the acute stage in which patients fulfil the Rosenberg criteria; with treatment the abnormalities subside, and if resolution persists for six months, the patient is considered to be in stage II (remission). Traditionally, patient is said to be in remission, if the IgE levels decline by atleast 35% before they plateau. Stage II may persist indefinitely or the patient may have recurrence, classically defined as doubling of total IgE levels-stage III (relapse). Stage IV (glucorticoid-dependent asthma) represents those patients with or without infiltrates on chest radiograph, who continue to have persistently raised IgE levels despite ongoing glucorticoid use and withdrawal of the drug results in exacerbation of the disease. Stage V includes patients with widespread fibrosis and bronchiectasis.
    Glucocorticoids are the cornerstone of therapy. They have to be given at a dose of 0.5mg/kg/day oral prednisolone for 1-2 weeks, then on alternate days for 6-8 weeks and tapered at 5-10mg every 2 weeks and discontinued. The aim is to decrease the inflammation and attenuate the fungal antigen burden. Patients are followed up with serum IgE levels repeated every 6-8 weeks until remission and then annually with serial chest radiographs, pulmonary function tests and IgE levels. Importantly the treatment is not aimed at normalizing the IgE levels, but only to decrease it by 35%. The role of itraconazole is still not clear; however most authorities would give it as corticosteroid-sparing agent at doses of 200mg twice a day for 16 weeks and then once a day for 16 weeks. It has been shown to decrease the corticosteroid requirement and airway inflammation, and can be given as a corticosteroid-sparing agent.


    Diagnostic criteria for ABPA (Rosenberg criteria)

    1-Asthma or cystic fibrosis

    2- Peripheral blood eosinophilia

    3- Immediate cutaneous reactivity to aspergillus antigen

    4- Precipitins against aspergillus antigen.

    5- Elevated total serum IgE (> 1000 IU/mL)

    6- Fleeting pulmonary infiltrates.

    7- Central bronchiectasis

    8- Elevated specific IgE and IgG to aspergillus antigen
  27. Guest

    Guest Guest

    REM Sleep

    The high-amplitude slow waves seen in the EEG during sleep are sometimes replaced by rapid, low-voltage EEG activity, which in primates, including humans, resembles that seen in stage 1 sleep.
    However, sleep is not interrupted; indeed, the threshold for arousal by sensory stimuli and by stimulation of the reticular formation is elevated.
    This condition is sometimes called paradoxical sleep,
    since the EEG activity is rapid. Rapid, roving movements of the eyes occur during paradoxical sleep, and it is for this reason that it is also called REM sleep.
    No such movements are present in slow-wave sleep, which consequently is often called NREM sleep.
    Another characteristic of REM sleep is the occurrence of large phasic potentials, in groups of three to five, that originate in the pons and pass rapidly to the lateral geniculate body and from there to the occipital cortex. For this reason, they are called pontogeniculo-occipital (PGO) spikes. The tone of the skeletal muscles in the neck
    is markedly reduced during REM sleep. Other muscles keep their tone, but there is a locus ceruleus-dependent relative paralysis of voluntary activity. In cats with locus ceruleus lesions, REM sleep is associated with thrashing about, as if they were acting out their dreams.

    Types of rhythm
    In adult humans who are awake but at rest with the mind wandering and the eyes closed, the most prominent component of the EEG is fairly regular pattern of waves at a frequency of 8–12 Hz and an amplitude of 50–100 V when recorded from the scalp. This pattern is the alpha rhythm
    In addition to the dominant rhythm, 18- to 30-Hz patterns of lower amplitude are sometimes seen over the frontal regions. This beta rhythm may be a harmonic of the alpha.
    Gamma oscillations at 30–80 Hz are often seen when an individual is aroused and focuses attention on something. This is often replaced by irregular fast activity as the individual initiates motor activity in response to the stimulus.
    A pattern of large-amplitude, regular 4- to 7-Hz waves called the theta rhythm occurs in children and is generated in the hippocampus in experimental animals (see below).
    Large, slow waves with a frequency of less than 4 Hz are sometimes called delta waves.
  28. geny.

    geny. Guest

    the most common cause of mononeuritis multiplex in india
    a)rheumatoid arthritis
    b)SLE
    c)hansens disease
    d)PAN

    the ans has to be hansens disease.as it is stated in the park.till any latest survey occurs i think it has to be the ideal ans.if anyone finds any new reference please state.
  29. karan.

    karan. Guest

    MICROWICK MICROCATHETER SUSTAINED RELEASE PREPARATION IS USED IN?
    A. MEDICATION TO ROUND WINDOW
    B. CONTROL OF EPISTXIS
    C. FREIS SYNDROME
    D. DROOLING OF SALIVA

    A. MEDICATION TO ROUND WINDOW
    Cummings: Otolaryngology: Head & Neck Surgery, 4th ed. Chapter 131 - PHARMACOLOGIC TREATMENT OF THE COCHLEA AND LABYRINTH- ROUND WINDOW MEMBRANE


    The ultimate degree of pharmacokinetic control is achieved with the use of mechanical sustained-release devices. These devices allow researchers to reliably manipulate inner ear kinetic curves by changing the rate and amount of dose delivered to the RWM(round window membrane). There are two devices that are currently approved for use in humans and have been studied in clinical trials: the Silverstein MicroWick (Micromedics, Eaton, MN) and the IntraEar Microcatheter (Durect, Cupertino, CA). The Silverstein MicroWick is made from polyvinyl acetate and measures 1- × 9-mm long, small enough to fit through a tympanostomy tube. The wick absorbs medication (which can be administered by the patient at home) that has been applied to the external ear canal and delvers it to the RWM. The advantage of this system is that fitting the device is a very simple and minimally invasive procedure (only nominally more invasive than tympanostomy tube placement) and can be removed without anesthesia. Long-term use is not advised, because the wick material may become adherent to the mucosa of the round window niche. This device has been used to deliver both steroids and gentamicin treatments in human clinical trials
  30. karan.

    karan. Guest

    VELPEAU SLING AND SWATH BANDAGE IS USED IN?
    A. ACROMIO C LAVICULAR DISLOCATION
    B. SHOULDER DISLOCATION
    C. FRACTURE SCAPULA
    D. FRACTURE CLAVICLE

    A. ACROMIO C LAVICULAR DISLOCATION
    Campbell's Operative Orthopaedics, 11th ed. Chap 57 Acute dislocations
    Acromioclavicular Pin Fixation
    Phemister, Modified

    • Expose the acromioclavicular joint, the lateral end of the clavicle, and the coracoid through an anterior curved incision.
    • Examine the acromioclavicular joint. Often the articular disc is rotated and locked within the joint, so it prevents reduction of the dislocation. Remove the disc or any other offending structure.
    • Place mattress sutures in the ruptured coracoclavicular ligaments, but do not tie them.
    • Insert two Kirschner wires the size of a guidewire about 2 cm apart through the lateral border of the acromion so that they enter the center of the articular facet of the acromion (Fig. 57-17). This can be simplified by first passing the wires retrograde from the articular surface of the acromion out through the skin.
    • Reduce the dislocation, and advance the wires across the joint and into the clavicle for 2.5 to 4 cm.
    • Check the position of the wires and the accuracy of reduction by anteroposterior and lateral (axillary) radiographs. If both are satisfactory, bend the wires 90 degrees at the lateral border of the acromion, and cut them off, leaving 0.6 cm as a hook on the end of each wire to prevent proximal migration.
    • Rotate the wires so that the hooks are buried in the soft tissue next to the acromion.
    • Repair the capsule and ligaments of the acromioclavicular joint, and tie the sutures previously placed in the coracoclavicular ligaments.
    • Repair any damage to the clavicular insertions of the trapezius and deltoid muscles.
    • Apply a Velpeau dressing or a sling-and-swath bandage.wath bandage.
  31. karan.

    karan. Guest

    MOST COMMON CAUSE OF MONONEURITIS MULTIPLEX IN INDIA IS?
    A. HANSENS DISEASE
    B. RA
    C. TB
    D. PAN

    HANSENS DISEASE
    Harrison's Internal Medicine > Chapter 379. Peripheral Neuropathy >

    Mononeuropathy Multiplex
    A. Mononeuropathy multiplex refers to the multifocal involvement of individual peripheral nerves. Although multiple compressive neuropathies can present in this manner, more often an inflammatory cause is responsible, and in such cases the disorder is referred to as mononeuritis multiplex. Both systemic (67%) and nonsystemic (33%) vasculitis may present as mononeuritis multiplex; less commonly, vasculitic neuropathy can present as an asymmetric or distal symmetric neuropathy. Among the systemic vasculitides, polyarteritis nodosa, rheumatoid arthritis, systemic lupus erythematosus (SLE), Churg-Strauss syndrome, Wegener's granulomatosis, and hypersensitivity vasculitis should be considered; these are often associated with constitutional symptoms such as fever and weight loss (Chap. 319). The common fibular nerve (previously called the common peroneal nerve) is affected in ~75% of patients with vasculitic neuropathy; symptoms consist of a painful foot drop. The ulnar, median, and radial nerves may also be involved.
    Mycobacterium leprae causes mononeuropathy multiplex affecting peripheral nerves in cooler regions of the body, reflecting the predilection for this bacterium to thrive at cooler temperatures
    Prevalence 1.34/10000 as on april 1st 2005 –Park’s Textbook of preventive and social medicine 19th edition page 265.
    The prevalence of R A is much lower..
    Read the lines from harrison-The prevalence of RA is ~0.8% of the population (range 0.3–2.1%); women are affected approximately three times more often than men. The prevalence increases with age, and sex differences diminish in the older age group. RA is seen throughout the world and affects all races. However, the incidence and severity seem to be less in rural sub-Saharan Africa and in Caribbean blacks..

    see the answer is supposed to be either of these 2 only..
    And combined reference from both these yeilds hansens as answer-- even though i agree that Hansen's prevalence in Park is old- but we have to follow these figures till newer surveys are done..
  32. Rajiv2314

    Rajiv2314 Guest

    Last rank at which one got a PG seat

    Can anyone tell me what was the last rank at which one got an AIIMS seat in the July session counseling for the General category?
  33. karan.

    karan. Guest

    FISH IS A POOR SOURCE OF?
    A. IRON
    B. PHOSPHORUS
    C. IODINE
    D. VIT A

    A. IRON park 19th edition,page 500

    The fat of fish is rich in unsaturated fatty acids and vitamin A and D vitamins.fish bones when eaten are excellent source of calcium ,phosphorus and fluorides.fresh water fish do not contain iodine but sea water fish do.of all the sea foods oysters and lobsters are the richest source of iodine.fish are less rich in iron(0.7 to 3 mg per 100 gram)then meat.
  34. kavish.

    kavish. Guest

    Q2. N2O use is C/I in A/E ?
    a. Exentration
    b. Vitroretinal surgery
    c. Cochlear implant
    d. Microlaryngeal surgery

    Ans is a. Exentration
    REF: *Miller’s anesthesia 6th ed.
    Goodman & gillman 12th ed, SECTION III Drugs Acting on the Central Nervous System, Chapter 13 general anaesthetics
    • Ajay yadav,p.61
    • Goodman gilmann

    First read this lines from G&G, so that u will understand the basic concept behind the q

    One major problem with N2O is that it will exchange with N2 in any air-containing cavity in the body. Moreover, because of their differential blood:gas partition coefficients, nitrous oxide will enter the cavity faster than nitrogen escapes, thereby increasing the volume and/or pressure in this cavity. Examples of air collections that can be expanded by nitrous oxide include a
     pneumothorax,
     an obstructed middle ear,  an air embolus,
     an obstructed loop of bowel,
     an intraocular air bubble,  a pulmonary [bleep],
     and intracranial air.
    Nitrous oxide should be avoided in these clinical settings.(REF: Goodman & gillman 12th ed, SECTION III Drugs Acting on the Central Nervous System, Chapter 13 general anaesthetics)


    Now let’s disscuss each option one by one

    Option B Gas bubbles such as air, sulfur hexafluoride (SF6 ) or carbon octofluorine (C3 F8 ) are used in vitreoretinal surgery. Nitrous oxide will enter gas bubbles and cause a dangerous increase in intraocular pressure. Nitrous oxide should be avoided when a gas bubble is to be placed and for 4 weeks afterward or until the bubble has been absorbed.
    So Nitrous oxide can’t be used for vitreoretinal surgery

    Option a
    Exenteration is a major operation during which all the contents of a body cavity are removed. Pelvic exenteration refers to the removal of the pelvic organs and adjacent structures; orbital exenteration refers to the removal of the entire eyeball, orbital soft tissues, and some or all of the eyelids

    NOTE EXENTERATION IS NOT AN INTRAOCULAR SURGERY, SO NITROUS OXIDE CAN BE USED IN IT

    Option D
     CO2 and neodymium:yttrium aluminum garnet (Nd:YAG) lasers are frequently used for microsurgery on the upper airway and trachea
     Lasers can ignite materials used in anesthesia practice. The CO2 laser can penetrate an endotracheal tube and ignite a fire, supported by oxygen and N2 O.  Nitrous oxide should not be used to dilute the FIO2 during airway surgery. Nitrous oxide supports combustion just like oxygen.
     During laser surgery on the airway, not more than 30% oxygen in nitrogen or helium should be used. Protected endotracheal tubes reduce the risk of fire.
    So Nitrous oxide should not be used in MLS

    Option C
    Nitrous Oxide and Middle Ear Pressure
     The middle ear space is vented intermittently when the eustachian tube is opened.
     When inhaled in high concentrations, N2 O enters the air cavities faster than nitrogen can leave. The result is an increase in pressure.
     After discontinuation of N2 O, the gas is rapidly reabsorbed. Sustained, marked, negative middle ear pressure may develop.
     Such pressure may contribute to the development of
    o serous otitis,
    o disarticulation of the stapes,
    o and impaired hearing
     N2 O anesthesia may be hazardous to hearing in patients who have
    previously undergone reconstructive middle ear surgery.
    .
     Susceptible patients include those with previous otologic surgery, acute or chronic otitis media,
    sinusitis, upper respiratory tract infection, enlarged adenoids, and pathologic conditions of the
    nasopharynx.
    so Nitrous oxide can't be used for cochlear implants




    Extra info
     There is no evidence that using N2 O (50%) for general anesthesia for type 1
    tympanoplasties will interfere with graft placement or outcome of the surgical procedure. The
    anesthetist should limit the concentration of N2 O to 50% and discontinue administration 15 minutes before closure of the middle ear. The decrease in pressure can be avoided by flushing the middle ear cavity with air before closure of the tympanic membrane.

     Nitrous oxide can interact with vitamin B12 resulting in vitamin B12 deficiency (megaloblastic anemia and peripheral neuropathy) following long-term nitrous oxide administration.
  35. kavish.

    kavish. Guest

    Q.26. All are true except ?
    a. Zinc deficiency causes pulmonary fibrosis
    b. Selenium causes cardiomyopathy
    c. increased Calcium causes iron deficiency
    d. Chromium can lead to impaired glucose tolerance

    In this q thr is confusion in options i wud advice u to understand the basic concept behind the q so that u cn attempt even a twisted one
    REF: Harrison's Internal Medicine, 17th ed. , Chapter 71. Vitamin and Trace Mineral Deficiency and Excess , table 71.2, page no.443
    Harper ch44 p.478

    IF THIS WAS THE CORRECT Q & OPTIONS THEN ANS IS
    a. Zinc deficiency causes pulmonary fibrosis

    Zinc toxicity causes pulmonary fibrosis NOT deficiency

    Manifestaion of zinc deficiency Growth retardation, taste and smell, alopecia, dermatitis, diarrhea, immune dysfunction, failure to thrive, gonadal atrophy, congenital malformations

    Manifestaion of zinc toxicity General: Reduced copper absorption, gastritis, sweating, fever, nausea, vomiting, Occupational: Respiratory distress, pulmonary fibrosis

    option c• Inorganic iron is absorbed only in the Fe2+ (reduced)
    state, and for that reason the presence of reducing agents
    will enhance absorption.

    • The most effective compound
    is vitamin C, and while intakes of 40–60 mg of vitamin
    C per day are more than adequate to meet requirements,
    an intake of 25–50 mg per meal will enhance iron absorption,
    especially when iron salts are used to treat iron deficiency anemia.

    • Ethanol and fructose also enhance iron absorption.
    • Heme iron from meat is absorbed separately
    and is considerably more available than inorganic
    iron.
    • However, the absorption of both inorganic and
    heme iron is impaired by calcium—a glass of milk with
    a meal significantly reduces availability.(REF:harper ch.44)

    so remember increased calcium intake impairs iron absorption

    Option b
    Selenium deficiency can lead to Cardiomyopathy, heart failure, striated muscle degeneration
  36. kavish.

    kavish. Guest

    Q.3. Bacteriophage : All are true except a. Promotes toxigenicity to bacteria
    b. Transformation
    c. Virus incorporates DNA of virus into host DNA
    d.

    ans is b. Transformation (ref. Ananthnarayan 7th ed. P. 55, 461-467 chapter on bacteriophage)

    TRANSFORMATION :- Naked DNA fragments from one bacterium, released during cell lysis, bind to the cell wall of another bacterium. The recipient bacterium must be competent, which means that it has structures on its cell wall that can bind the DNA and take it up intracellularly. Recipient competent bacteria are usually of the same species as the donor.(so it does not involve virus{bacteriophage})
  37. Bond.

    Bond. Guest

    Kindly have a look at following questions and help us in them.

    1. WHICH OF THE FOLLOWING IS THE TERMINAL GROUP OF LYMPH NODE IN COELIAC AXIS?
    A. PREAORTIC
    B. LATERAL SACRAL
    C. PARA COLIC
    D. INTERMEDIATE GP

    2. MAXIMUM POST PRANDIAL MOTILITY IS SEEN IN?
    A. ASCENDING COLON
    B. DESCENDING COLON
    C. SIGMOID COLON
    D. TRANSEVERSE COLON

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

    4. PHOSPHORLASE B IS INHIBITED BY?
    A. ATP
    B. AMP
    C. GLUCOSE
    D. CALCIUM

    5. COMMON COMPLEMENT COMPONENT FOR BOTH PATHWAYS IS? ???????????????
    A. C3
    B. C5
    C. C1q
    D. C8

    6. MOST SENSITIVE DIAGNOSTIC TEST FOR DENGUE IS?
    A. IgM ELISA
    B. CFT
    C. TISSUE CULTURE
    D. ELECTRON MICROSCOPY

    7. TRUE ABOUT CARBOHYDRATE ANTIGEN ARE ALL EXCEPT?
    A. HAS LOW IMMUNOGENICITY
    B. MEMORY RESPONSE SEEN
    C. CAUSES POLYCLONAL B CELL STIMULATION
    D. DOES NOT STIMULATE T CELL

    8. FISH IS A POOR SOURCE OF?
    A. IRON
    B. PHOSPHORUS
    C. IODINE
    D. VIT A

    9. USE OF NITROUS OXIDE IS CONTRAINDICATED IN?
    A. COCHLEAR IMPLANT
    B. MICROLARYNGEAL SURGERY
    C. VITREO-RETINAL SURGERY
    D. EXENTRATION OPERATION

    10. ALL ARE TRUE ABOUT progressive multifocal lecoencephalopathy EXCEPT?
    A. FOLLOWS AN INDOLENT COURSE AND SLOW TO PROGRESS
    B. TISSUE BIOPSY IS DIAGNOSTIC
    C. PRESENTS AS VISUAL LOSS AND SPEECH ABNORMALITY
    D. INVOLVES DEEP CORTICAL NEURONS

    11. SPONTANEOUS CSF LEAK is associated with ALL EXCEPT?
    A. INCREASED ICT
    B. PARTIAL OR COMPLETE EMPTY SELLA SYNDROME
    C. PSEUDOTUMOUR CEREBRI
    D. LOW RISK of formation of ENCEPHALOCOELE

    12. MICROANGIOPATHIC HEMOLYTIC ANAEMIA IS SEEN IN A/E?
    A. ANTIPHOSPHPLIPID ANTIBODY SYN
    B.TTP
    C. MICROSCOPIC POLYANGITIS
    D. METALLIC CARDIAC VALVES

    13. WHICH OF THESE IS NOT A MARKER OF ACTIVE REPLICATIVE PHASE OF CHRONIC HEPATITIS B?
    A. HBV DNA
    B. HBV DNA POLYMERASE
    C. ANTI Hbc
    D. AST &ALT

    14. A 29 YR OLD UNMARRIED FEMALE PRESENTS WITH DYSPNEA, HER CHEST X RAY IS NORMAL, FVC-92% FEVI/FVC-89% DLCO-59%. ON EXERCISE HER OXYGEN SATURATION DROPS FROM 92% TO 86%.WHAT IS THE DIAGNOSIS?
    A. ALVEOLAR HYPOVENTILLATION
    B. PRIMARY PULMONARY HYPERTENSION
    C. INTERSTITIAL LUNG DISEASE
    D. ANXIETY

    15. WHICH OF THE FOLLOWING FEATURES OF UREMIA WILL NOT IMPROVE WITH HEMODIALYSIS?
    A. PERIPHERAL NEUROPATHY
    B. PERCARDITIS
    C. SEIZURES
    D. Hyperphosphatemia

    16. IN A MALE AFTER LAPROSCOPIC CHOLECYSTECTOMY CARCINOMA GALL BLADDER STAGE Ia WAS DETECTED ON HISTOPATH. WHAT IS THE NEXT APPROPRIAT MANAGEMENT?
    A. CONSERVATIVE AND FOLLOW UP
    B. RADICAL PORTAL LYMPHADENECTOMY
    C. RADIOTHERAPY
    D.

    17. A 10 YR OLD CHILD IS ALWAYS RESTLESS INATTENTIVE TO STUDY AND ALWAYS WANTS TO PLAY OUTSIDE.PARENTS ARE EXTREMELY DISTRESSED.WHAT WOULD YOU ADVISE?
    A. IT’S A NORMALBEHAVIOUR
    B. BEHAVIOUR THERAPY
    C. IT’S A SERIOUS ILLNESS REQUIRES MEDICAL TREATMENT
    D. NEEDS CHANGE IN ENVIRONMENT

    18. ALL ARE TRUE ABOUT PCOD EXCEPT?
    A. PERSISTENTLY ELEVATED LH
    B. INCREASED LH/FSH RATIO
    C. INCREASED DHEAS
    D. increased prolactin level

    19. INVESTIGATION OF CHOICE IN CHOLESTASIS OF PREGNANCY?
    A. BILIRUBIN
    B. BILE ACIDS
    C. ALK PHOSPHATASE
    D. ALT&AST

    20. RISSER’S LOCALISER CAST IS USED IN THE CONSERVATIVE MANAGEMENT OF?
    A. DORSOLUMBAR SCOLIOSIS
    B. dorsal SCOLIOSIS
    C. KYPHOSIS
    D. SPONDYLOLISTHESIS GRADE III

    21. WATSON JONES OPERATION IS DONE FOR?
    A. VALGUS DEFORMITY
    B. MUSCLE PARALYSIS
    C. NEGLECTED CLUBFOOT
    D. peroneal tendon repair

    22. A PT COMES WITH PROPTOSIS AND ABDUCENT N PALSY. A DARK HOMOGENOUS MASS ON T2W MRI IS SEEN WHICH SHOWS INTENSE ENHANCEMENT WITH CONTRAST.DIAGNOSIS IS?
    A. CAVERNOUS HEMANGIOMA
    B. MENINGIOMA
    C. ASTROCYTOMA
    D. GLIOMA

    23. FASTEST ROUTE OF ABSORPTION OF LOCAL ANAESTHETIC IS?
    A. INTERCOSTAL
    B. EPIDURAL
    C. BRACHIAL
    D. CAUDAL
  38. Guest

    Guest 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
    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)
    • 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.

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