Aipgmee2011part1

Q1. Which is a branch from trunk of brachial plexus ?
1. SupraScapular Nerve
2. Long Thoracic Nerve
3. Axillary Nerve
4. Nerve to Subclavius Muscle

Answer 1. SUPRASCAPULAR NERVE

Q2. Autorikshaw run over an 8-year-old, tyre mark over leg is called?
A. Patterned bruise
B. Imprint abrasion
C. Contusion
D. Pressure bruise
References : Given below

Answer is B Imprint abrasion

Krishan Vij ,Text Book of Forensic Medicine and Toxicology, Principles and Practice, 2008,
4thEdn, Pages 282-283.
Pressure Abrasions (Crushing Abrasions / Imprint Abrasions): When the impact is vertical to
the skin surface, the epidermis gets crushed and pressure type of abrasions result and the
imprint of the impacting object may be produced. These may be seen in manual strangulation
(abrasions produced by fingernails) and in hanging, where the weave of the ligature material
may be reproduced.
Patterned Abrasions: Patterned abrasions occur when the force is applied at or around right
angle to the surface of skin, as already mentioned……The classical example of this is seen in
traffic accidents when tyre of a motor car passes over the skin leaving the pattern when the
skin has been squeezed into the grooves of the rubber tread.
Reddy.K.S.N,The Essentials of Forensic Medicine and Toxicology, 2006, 25th Edn, Pages 156-
157.
Patterned bruising is also seen in motor car accidents.
Answer: Imprint Abrasion is to be preferred as most appropriate alternate to Patterned Bruise,
since,
1. Imprint abrasion and patterned abrasion are the same.
2. Patterned abrasion (imprint abrasion) is the classical example of tyre mark
3. Tyre will produce patterned bruise usually, if in association with abrasions

Q3. Mineralocorticoid receptors are present in all except ( REPEAT )

1) Hippocampus
2) Brain
3) Liver
4) Kidney

Answer 3) Liver

Q4. Which is not autoimmune disease?

1. SLE
2. Grave’s Disease
3. Myasthenia Gravis
4. Sickle Cell Disease

Answer 4. Sickle Cell Disease

Q5. A 40 year female underwent surgery. Post operatively she told the anaesthetist that she
was aware of per-operative agents. Individual intraoperative awareness is evaluated by

1. Bispectral Index

2.

Answer 1. Bispectral Index

Bispectral index (BIS) is one of several recently developed technologies which purport to
monitor depth of anesthesia. BIS monitors can replace or supplement Guedel's classification
system for determining depth of anesthesia. Titrating anesthetic agents to a specific bispectral
index during general anesthesia in adults (and children over 1 year old) allows the anesthetist
to adjust the amount of anesthetic agent to the needs of the patient, possibly resulting in a
more rapid emergence from anesthesia. Use of the BIS monitor may reduce the incidence of
intraoperative awareness in high risk procedures or patients[1] and may also have a role in
predicting recovery from severe brain injury

Q6. Most common cause of death in schizophrenia patient
1. Homicide
2. Depression
3. Suicide
4. Due to Antipsychotic side effects

Answer C ) Suicide

Q7. All are pneumatic bones except
1) Frontal
2) Mandible
3) Ethmoidal
4) Mastoid

Answer 2 ) Mandible

Q8. Clue Cells are found in
A) Candida
B) Bacterial Vaginosis
C) Trichomonas Vaginalis
D) Chlamydial infection


Q9. Nerve involved in supracondylar fracture

1. Radial nerve
2. Median nerve
3. Ulnar nerve
4. Ant int nerve

Ans- AIIMS CONTROVERSIAL QUESTION

Q11. Punett Square is used for
1. Genotype
2. Collecting datas in one group
3.
4.

1. Genotype
The Punnett square is a diagram that is used to predict an outcome of a particular cross or
breeding experiment. It is named after Reginald C. Punnett, who devised the approach, and is
used by biologists to determine the probability of an offspring having a particular genotype.

Q12. A teenage girl complaints of pain over the knee. The pain increase while starting to stand
from sitting position and while walking upstairs. What is the likely diagnosis?

1. Chondromalacia of patella
2. Patellar Fracture
3. Torn Meniscus
4. Bipartite Patella

Answer ) 1. Chondromalacia of patella
Chondromalacia patellae means "soft cartilage under the knee cap," a presumed cause of pain
at the front of the knee. This condition often affects young .The pain of chondromalacia
patellae is typically felt after prolonged sitting, like for a movie, and so is also called "movie
sign" or "theater sign".

Q13. Blount’s disease is present as

1. Genu recurvatum
2. Genu varum
3. Genu Valgum
4.
Answer 3. Genu Valgum

Blount's Disease is one which affects the bone development of toddlers and older children.
Most often, it starts as bow-leggedness which does not improve in a child between two and
four years of age.

DEAR DOCTORS TIBIA VARA is other name for BLOUNT'S DISEASE and it presents as GENU
VALGUM

Radiographic Appearance

Physiologic bowing typically show flaring and bowing of tibia and femur in a symmetric fashion
and is normal in children < 2 years of age (maximal at about 18 mo);
- physiologic genu valgum, or knock knees, develops next, w/ maximal deformity occurring at
3 years of age;
- gradual correction to ultimate alignment of slight genu valgum occurs by 9 years of age in
the great majority of patients

Q14. Which is not a neural tumor ?

1. Ependymoma
2.Neuroblastoma
3. Gangliocytoma
4. Ganglioglioma

Answer. CONTROVERSIAL As Usual AIIMS ROCKS with dummy Questions

REF Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso Fausto; Robbins, Stanley L.;
Abbas, Abul K. (2005). Robbins and Cotran pathologic basis of disease. St. Louis, Mo: Elsevier
Saunders. pp. 1406.
Ganglioglioma is a tumour that arises from ganglion cells in the central nervous system.
The term "gangliocytoma" is sometimes equated with ganglioglioma. However, it is also
sometimes equated with ganglioneuroma. The term "gangliocytoma" is sometimes used to
imply that the tumor is entirely neuronal.

Q15. Cadeveric transplant is done for A/E

1. blood vessels
2. liver
3. lung
4. bladder

Answer 4. Bladder

The major donor organs and tissues are heart, lungs, liver, pancreas, kidneys, eyes, heart
valves, skin, bones, bone marrow, connective tissues, middle ear, blood vessels. Therefore
one donor can possibly give gift of life to many terminally ill patients who would not survive
otherwise.

Q16. 32 yr male a known hypertensive planned for cholecystectomy . which of following is
contraindicated
1. propofol
2. ketamine
3. midazolam
4.

ANS 2. Ketamine

Ketamine causes a rise in intracranial pressure and should not be used in patients who have
sustained a recent head injury.
The blood pressure rises by about 25% (on average the systolic pressure rises by 20-30
mmHg) and the heart rate is increased by about 20% - the overall effect is therefore to
increase the workload of the heart.
The pressure within the eyeball (intra-ocular pressure) rises for a short time following
administration.

All pressures are increased.

Q17. . One of the drug is contraindicated in Patients with lithium toxicity
1.diuretics
2. beta blocker
3. ccb
4.

Answer 1. Diuretics

Diuretics acting distally to the proximal tubule, such as thiazides and spironolactone, do not
directly affect the fractional excretion of lithium (although they may affect serum lithium levels
indirectly through their effects on volume status). Reabsorption of lithium is increased and
toxicity is more likely in patients who are hyponatremic or volume depleted, both of which are
possible consequences of diuretic therapy.

Q18. Which virus crosses placenta least likely

1. rubella
2. herpes simplex
3. HIV
4. Hepatitis B

ANS Hepatitis B

HBV is a large virus and does not cross the placenta, hence it cannot infect the fetus unless
there have been breaks in the maternal-fetal barrier, e.g. via amniocentesis.

Q19. Which is present in Pentology of fallot :
1. ASD
2. VSD
3. Right Ventricular Hypertrophy
4. Pulmonary stenosis

Answer 1. ASD

Q20. All are true about Nesidioblastosis except ?

1. Hypoglycemic Episodes are seen
2. Occurs in adults more than child
3. Histopathology shows Hyperplasia of Islet cells
4. Diazoxide is used in treatment

Answer 2. Occurs in adults more than child

Nesidioblastosis is hyperinsulinemic hypoglycemia attributed to excessive function of
pancreatic beta cells with an abnormal microscopic appearance. The abnormal histologic
aspects of the tissue included the presence of islet cell enlargement, islet cell dysplasia, beta
cells budding from ductal epithelium, and islets in apposition to ducts.Most common age group
2 – 3 years.

Q21. Epileptogenic

1. Desflurane
2. Sevoflurane
3. Ether
4. Halothane

Answer 2. Sevoflurane
Ref : A practice of anesthesia for infants and children By Charles J. Coté

Q22. Most common tumor causing superior Vena cava syndrome.

1. Lymphoma
2. Small cell carcinoma
3. Non small cell carcinoma.
4.

ANS Small cell Carcinoma

Nearly 95% of superior vena cava syndrome cases are attributed to cancer, with the most
common cause being small cell lung cancer, followed by squamous cell lung cancer,
adenocarcinoma of the lung, non-Hodgkin's lymphoma, and large cell lung cancer.

Q23. Most common tumor causing superior Vena cava syndrome.

1. Lymphoma
4.

ANS 3. Small cell Carcinoma

Nearly 95% of superior vena cava syndrome cases are attributed to cancer, with the most
common cause being small cell lung cancer, followed by squamous cell lung cancer,
adenocarcinoma of the lung, non-Hodgkin's lymphoma, and large cell lung cancer.

Q23. Not a cause of primary amoenorrhoea

1. kallman syndrome
2. turner syndrome

3. sheehan syndrome
4. rokitansky syndrome

Answer 3. sheehan syndrome

Q24. All are indoor air pollutants except

1.CO
2. Chloroflurocarbons
3. Nitrogen oxide
4. Mercury

Answer 3) Nitrogen Oxide

Q25. Denominator in Maternal Mortality rate
1. Total Number of Live birth
2. Total Number of Married Women
3. Total Number of Birth
4.

Answer 1. 1. Total Number of Live birth

Q26.Contraceptive to be avoided in epilepsy

1. OCP
2. Condoms
3. IUD
4. Post Coital Pill

ANSWER 1. OCP

Confusion Lies Between OCP and POST COITAL PILL .

But Check this standard reference from

The morning after pill can be used in women with epilepsy after unprotected sexual
intercourse. A higher dose is recommended in patients taking hepatic enzyme inducing drugs
- 1st dose – Levenorgestrol 1.5mgs (2 tablets)
- 2nd dose 12 hours later – Levenorgestrol 0.75mgs (1 tablet)

Q27. People are separated into certain sub groups. People are selected randomly from sub
groups. What type of sampling is done?
1. Random sampling
2. Stratified Sampling
3. Quota Sampling
4.

Answer 2. Stratified Sampling

Q28. NARP syndrome is seen in

1. mitochondrial
2. glycogen storage
3. lysosomal
4. lipid storage

Answer 1. Mitochondrial Disorder

Neuropathy, ataxia, and retinitis pigmentosa, is a condition related to changes in

mitochondrial DNA.
Mutations in the MT-ATP6 gene cause neuropathy, ataxia, and retinitis pigmentosa.
The MT-ATP6 gene is contained in mitochondrial DNA. Mitochondria are structures within cells
that convert the energy from food into a form that cells can use. Although most DNA is
packaged in chromosomes within the nucleus, mitochondria also have a small amount of their
own DNA (known as mitochondrial DNA or mtDNA).

Q29. Which pass through Jugular foramen ?

1. Vertebral artery
2. Hypoglossal Nerve
3. Internal Carotid artery
4. Sympathetic chain

CN IX, X, XI(descending), jugular vein passes through jugular foramen

Jugular Foramen or Vernet's syndrome is characterized by the paresis of 9th–11th (with or
without 12th) cranial nerves together.

Q30. Necrotizing lymphadenitis is seen in

1.Kimura disease
2. kikuchi disease
3. hodgkin disease
4. castelman disease

Answer 2. Kikuchi Disease

Kikuchi disease ai also called histiocytic necrotizing lymphadenitis or Kikuchi-Fujimoto disease,
is an uncommon, idiopathic, generally self-limited cause of lymphadenitis. The most common
clinical manifestation of Kikuchi disease is cervical lymphadenopathy. Several viral candidates
have been proposed, including cytomegalovirus, Epstein-Barr virus,16 human herpesvirus,
varicella-zoster virus, parainfluenza virus, parvovirus B19, and paramyxovirus.

Q31. Which is rave drug?

1. Cannabis
2. Cocaine
3. Heroin
4.

Answer 2. Cocaine

Yet another one from AIIMS Board

"RAVE drugs - MDMA, cocaine, amphetamines and ketamine.

Superior vena cava syndrome MOST common cause
a)metastasis
b)nonsmall cell lung carcinoma
c)small cell carcinoma

ANS-B
William Hunter first described the syndrome in 1757 in a patient with syphilitic aortic
aneurysm. In 1954, Schechter reviewed 274 well-documented cases of superior vena cava
syndrome (SVCS) reported in the literature; 40% of them were due to syphilitic aneurysms or
tuberculous mediastinitis. In more recent times, these infections have gradually decreased as
the primary cause of superior vena cava (SVC) obstruction. Lung cancer, particularly

adenocarcinoma, is now the underlying process in approximately 70% of the patients with
superior vena cava syndrome (SVCS). However, up to 40% of the causes are due to
nonmalignant causes.

Q. 32. Aprepitant is all except
1. Agonist at NK1
2. Crosses Blood Brain Barrier
3. Ameliorate Nausea Vomiting of chemotherapy
4. Metabolized by CYP450

Answer 1. Agonist at NK1

Aprepitant is an antiemetic chemical compound that belongs to a class of drugs called
substance P antagonists (SPA). It mediates its effect by blocking the neurokinin 1 (NK1)
receptor.

Q. 33. Buprenorphine is a
1. Partial agonist at MU Receptor
2. Partial agonist at Kappa Receptor
3. Full Agonist at Mu Receptor
4. It is antagonist at Kappa receptor

Answer 1. . Partial agonist at MU Receptor

Q. 34. Local Anaesthetic agent with vasoconstrictor is not used in
1. Spinal
2. Epidural
3. Digital finger block
4. Skin Anaesthesia

Answer 3. Digital Finger Block

The toxicity of LA is related to the amount and speed of their absorption into the systemic
circulation !
Vasoconstrictor ingredient (e.g., adrenaline, felypressin) is often added to LA with the aim to
reduce the absorption of LA into the systemic circulation.
Effects of vasoconstrictors:
- increase in the effect of LA (increased concentration)
- decrease in the toxicity of LA (decreased absorption)
- increase in the duration of the effect of LA
Vasoconstrictors must not be used for producing ring-block of an extremity (e.g. finger or toe)
because they may cause prolonged ischaemia and gangrene.

Q. 35. All are true about Erlotinib except
1. Used in Non Small Cell Carcinoma
2. It is a small peptide acting as EGRF antagonist
3. Food decreases absorption
4. It causes skin rashes

Answer 3. Food decreases absorption

Explanation : Food enhances the oral absorption and bioavailability of erlotinib.

Q36. Specific Compliance of lung is decreased by all except

1. Chronic Bronchitis
2. Pulmonary fibrosis

3. Pulmonary Congestion
4. Decreased Surfactant
Answer 1. Chronic Bronchitis

Emphysema / COPD may be associated with an increase in pulmonary compliance due to the
loss of alveolar and elastic tissue.

Q37. Sparrow marks are seen in following condition

1. gunshot injuries
2. stab injry of face
3 vitriolage
4 windshield glass injury

Answer 4 windshield glass injury

Q. Blount’s disease is a cause of?
1. Coax vara
2. Coax magna
3. Genu valgum
4. Genu varum

Ans: 4 it is a typical disorder affecting the postero-medial epiphysis of proximal tibia (due to
avascular necrosis) thereby leading to over growth of the lateral epiphysis resulting in agene /
tibia vara deformity. It is common in West Indies & Africans.

Q. 1. Which is a branch from trunk of brachial plexus ?
3. Axillary Nerve

Answer 1. SUPRASCAPULAR NERVE or NERVE TO SUBCLAVIUS ????

The nerve to the Subclavius Muscle

This nerve is from the anterior aspect of the superior trunk, from C5, with occasional additions
from C4 and C6.
It descends posterior to the clavicle and anterior to the brachial plexus to supply the
subclavius muscle.

The Suprascapular Nerve

This nerve arises from the posterior aspect of the superior trunk, fibres from the ventral rami
of C5 and C6 and often C4 (50% of people).
It supplies the supraspinatus and infraspinatus muscles and the shoulder joint.
It passes laterally across the posterior triangle of the neck, superior to the brachial plexus and
then through the scapular notch.

1. Which is a branch from trunk of brachial plexus ?
3. Axillary Nerve
Answer 1. SUPRASCAPULAR NERVE

2. Autorikshaw run over an 8-year-old, tyre mark over leg is called?
A. Patterned bruise
B. Imprint abrasion
C. Contusion
D. Ectopic bruise
References : Given below
Answer is B. Imprint abrasion
Krishan Vij ,Text Book of Forensic Medicine and Toxicology, Principles and Practice,
2008, 4thEdn, Pages 282-283.
Pressure Abrasions (Crushing Abrasions / Imprint Abrasions): When the impact is
vertical to the skin surface, the epidermis gets crushed and pressure type of abrasions
result and the imprint of the impacting object may be produced. These may be seen in
manual strangulation (abrasions produced by fingernails) and in hanging, where the
weave of the ligature material may be reproduced.
Patterned Abrasions: Patterned abrasions occur when the force is applied at or around
right angle to the surface of skin, as already mentioned……The classical example of
this is seen in traffic accidents when tyre of a motor car passes over the skin leaving
the pattern when the skin has been squeezed into the grooves of the rubber tread.
Reddy.K.S.N,The Essentials of Forensic Medicine and Toxicology, 2006, 25th Edn,
Pages 156-157.
Patterned bruising is also seen in motor car accidents.
Answer: Imprint Abrasion is to be preferred as most appropriate alternate to Patterned
Bruise, since,
1. Imprint abrasion and patterned abrasion are the same.
2. Patterned abrasion (imprint abrasion) is the classical example of tyre mark
3. Tyre will produce patterned bruise usually, if in association with abrasions

3. Mineralocorticoid receptors are present in all except ( REPEAT )
1) Hippocampus
2) Brain
3) Liver
4) Kidney
Answer 3) Liver

4. Which is not autoimmune disease?
1. SLE
2. Grave’s Disease
3. Myasthenia Gravis
4. Sickle Cell Disease
Answer 4. Sickle Cell Disease

5. A 40 year female underwent surgery. Post operatively she told the anaesthetist that
she was aware of per-operative agents. Individual intraoperative awareness is
evaluated by
1. Bispectral Index
2.
Answer 1. Bispectral Index
Bispectral index (BIS) is one of several recently developed technologies which purport
to monitor depth of anesthesia. BIS monitors can replace or supplement Guedel's
classification system for determining depth of anesthesia. Titrating anesthetic agents
to a specific bispectral index during general anesthesia in adults (and children over 1

year old) allows the anesthetist to adjust the amount of anesthetic agent to the needs
of the patient, possibly resulting in a more rapid emergence from anesthesia. Use of
the BIS monitor may reduce the incidence of intraoperative awareness in high risk
procedures or patients[1] and may also have a role in predicting recovery from severe
brain injury

6. Most common cause of death in schizophrenia patient
1. Homicide
2. Depression
3. Suicide
4. Due to Antipsychotic side effects
Answer C ) Suicide

7. All are pneumatic bones except
1) Frontal
2) Mandible
3) Ethmoidal
4) Mastoid
Answer 2 ) Mandible

8. Clue Cells are found in
A) Candida
C) Trichomonas Vaginalis
D) Chlamydial infection

9. Nerve involved in supracondylar fracture
1. Radial nerve
2. Median nerve
3. Ulnar nerve
4. Anterior interosseous nerve
Answer 4. Anterior interosseous nerve

10. Pain in ethmoidal disease travels through
1. Nasociliary Nerve
2. Lacrimal Nerve
3. Frontal Nerve

11. Punett Square is used for
1. Genotype
2. Collecting datas in one group
3.
4.Inheritance pattern
1. Genotype
The Punnett square is a diagram that is used to predict an outcome of a particular
cross or breeding experiment. It is named after Reginald C. Punnett, who devised the
approach, and is used by biologists to determine the probability of an offspring having
a particular genotype.

12. A teenage girl complaints of pain over the knee. The pain increase while starting to
stand from sitting position and while walking upstairs. What is the likely diagnosis?
1. Chondromalacia of patella
2. Patellar Fracture
3. Torn Meniscus
4. Bipartite Patella
Answer ) 1. Chondromalacia of patella
Chondromalacia patellae means "soft cartilage under the knee cap," a presumed cause
of pain at the front of the knee. This condition often affects young .The pain of

chondromalacia patellae is typically felt after prolonged sitting, like for a movie, and so
is also called "movie sign" or "theater sign".

13. Blount’s disease is present as (Repeat from ADrPlexus Mock series 3 on Dec
30,2010 ) Q.No 107
1. Genu recurvatum
2. Genu varum
3. Genu Valgum
4.
Answer 3. Genu Varum

14. Diet Recommendations all except
1. Cholesterol intake should be 100 gm/1000 kcal/day
2. To avoid alcohol consumption
3. Salt intake should be less than 5gm/day
4. Saturated fat is about 10% of whole diet
Answer 4. Saturated fat is about 10% of whole diet

15. People are separated into certain sub groups. People are selected randomly from
sub groups. What type of sampling is done?
1. Random sampling
3. Quota Sampling
4. Cluster Sampling
Answer 2. Stratified Sampling

16. Which pass through Foramen Magnum ?
1. Vertebral artery
2. Hypoglossal Nerve
3. Internal Carotid artery
4. Sympathetic chain
Answer 1. Vertebral artery
Spinal roots of CN XI(ascending), brainstem, vertebral arteries.
Jugular Foramen or Vernet's syndrome is characterized by the paresis of 9th–11th
(with or without 12th) cranial nerves together.
1- HYPOGLOSSAL CANAL - hypoglossal nerve

2- INTERNAL CAROTID ARTERY - passes thru both carotid canal and foramen lacerum

3- GREATER PALATINE FORAMEN - anterior palatine nerve

4- LESSER PALATINE FORAMEN - posterior palatine nerve

5- NASOPALATINE NERVE - incisive foramen

6- SUPRA ORBITAL FORAMEN OR NOTCH - supraorbital nerve

7- SUPRA ORBITAL FISSURE - inferior opthalmic vein

8- INFRA ORBITAL FORAMEN - infra orbital nerve

9- ZYGOMATIC NERVE - infra orbital fissure

10- ZYGOMATICO FACIAL FORAMEN - zygomatico facial branch of the sixth nerve

11- OPTIC CANAL - central retinal vein

12 - FORAMEN ROTUNDUM - maxillary division of the trigeminal nerve

13- FORAMEN OVALE - Mandibular nerve, Accessory meningeal artery, Lesser petrosal
nerve and Emissary veins (mnemonic : MALE).

14- FORAMEN SPINOSUM - middle meningeal artery

15- JUGULAR FORAMEN - 9 , 10 , 11 th cranial nerves

16- MASTOID FORAMEN - meningeal branch of occipital artery

17- TYMPANO MASTOID FISSURE - auricular branch of vagus ( vidian r alderman n )

18- FACIAL NERVE - stylomastoid foramen

19- CHORDA TYMPANI NERVE - petro tympanic fissure.

17. Which is not a neural tumor ?
1. Ependymoma
2.Neuroblastoma
3. Gangliocytoma
4. Ganglioglioma
Answer CONTROVERSIAL
REF Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso Fausto; Robbins, Stanley
L.; Abbas, Abul K. (2005). Robbins and Cotran pathologic basis of disease. St. Louis,
Mo: Elsevier Saunders. pp. 1406.
Ganglioglioma is a tumour that arises from ganglion cells in the central nervous
system.
The term "gangliocytoma" is sometimes equated with ganglioglioma. However, it is
also sometimes equated with ganglioneuroma. The term "gangliocytoma" is sometimes
used to imply that the tumor is entirely neuronal.

18. Which is rave drug?
1. Cannabis
2. Cocaine
3. Heroin
4. Ecstacy
Answer 4. Ecstasy
There are a variety of substances that have been connected with Rave Clubs. This is a
brief list of some of the drugs by slang names and some of their effects:
Ecstasy – Hallucinogen/Stimulant Ecstasy is a synthetic drug that is similar to
methamphetamine and the hallucinogen mescaline. Ecstasy can produce a significant
increase in heart rate and blood pressure and a sense of alertness. The stimulant
effects, which enable users to dance for extended periods, may also lead to
dehydration, hypertension, and heart or kidney failure. Ecstasy can cause brain
damage. It is one of the most widely used of the club drugs.
Ephedrine – Stimulant This substance is sold over-the-counter at convenience stores,
some food stores, and mail order. It is sold often as ‘Herbal Ecstasy’ and is touted as a
‘safe’ and ‘legal’ form of Ecstasy. Ephedrine is in the Amphetamine family and can
cause heart attacks, seizures, agitation, palpitations, and other health problems.
Ephedrine is a common weight-loss substance. The FDA has proposed restrictions on
ephedrine after it received more than 800 reports of harmful effects to people, among
them coronary problems that could put patients at risk for heart attacks, strokes and
death.
Ketamine – Hallucinogen Ketamine is an animal tranquilizer used by vets in pet
surgery. Users say the effects of Ketamine are similar to PCP. Ketamine is usually
snorted and is frequently used in combination with other drugs like ecstasy, heroin
and cocaine. The high lasts anywhere from 30-minutes to about 2-hours. Special K or
powdered Ketamine, emerged as a recreational drug in the 1970s and was known as
“Vitamin K’ in the underground club scene in the 1980s. It has since resurfaced as
“Special K” in the 1990s rave scene.

GHB – Depressant This substance comes in a liquid form and looks like water and has
a salty taste. GHB is used as a “club drug” for effects similar to those of Rohypnol,
also known as “date rape drugs.” Coma and seizures can occur following of GHB and
when combined with methamphetamine.
Mixing GHB with alcohol could be a deadly combination. Excessive use of GHB can
result in loss of consciousness (G-hole), tremors, irregular and depressed respiration
and coma.
Methcathinone – Stimulant Known on the street as Khat or cat it produces an
amphetamine like effect. The drug produces a burst of energy and feeling of
invincibility, accompanied by a state of well being and euphoria. Effects include
paranoia, hallucinations, nervousness and anxiety. Physical effects can be pounding
heart, headaches stomachaches, and shakes. Khat is most often snorted, but may also
be injected with a needle or taken orally by mixing with a beverage such as a soft
drink.
LSD – Hallucinogen LSD induces abnormalities in sensory perceptions. Effects are
unpredictable depending on the amount taken, on the surroundings in which the drug
is used, and on the user’s personality, mood, and expectations. It can be in the form
of a tablet, capsule, liquid, or on pieces of blotter paper that have absorbed the drug
and is typically taken by mouth. Effects come on within 30 to 90 minutes after taking
and can include physical effects of dilated pupils, higher body temperature, increased
heart rate and blood pressure, sweating, loss of appetite, sleeplessness, dry mouth,
and tremors.
Magic Mushrooms – Hallucinogen The effects of Mushrooms or “Shrooms” are similar
to LSD. They include illusions and hallucinations, distorted perception of time and
distance. It is ingested orally in the form of tablets or powder. Trips or episodes can
consist of psychosis, convulsions, flashbacks, and possible death.
Methamphetamine – Stimulant Methamphetamine affects many areas of the central
nervous system. The drug is often made in clandestine laboratories from relatively
inexpensive over-the-counter ingredients. Diverse groups, including young adults who
attend raves, in many regions of the country, are using it. It is available in many
forms, and can be smoked, snorted, injected, or orally ingested. Methamphetamine
use is associated with serious health consequences, including memory loss,
aggression, violence, psychotic behavior, and potential cardiac and neurological
damage. Abusers typically are agitated, have excited speech, decreased appetite, and
increased physical activity levels.

19. All are indoor air pollutants except
1. Radon
2. Carbon Monoxide
3. Nitrogen oxide
4. Mercury
Answer 3) Nitrogen Oxide

20. Denominator in Maternal Mortality rate
4.
Answer 1. 1. Total Number of Live birth

21. Cadeveric transplant is done for A/E
1. blood vessels
2. liver
3. lung
4. bladder
Answer 4. Bladder
and this is why you have to read prospectus back page with specific links
The major donor organs and tissues are heart, lungs, liver, pancreas, kidneys, eyes,
heart valves, skin, bones, bone marrow, connective tissues, middle ear, blood vessels.

Therefore one donor can possibly give gift of life to many terminally ill patients who
would not survive otherwise.

22. Not a cause of primary amoenorrhoea
1. kallman syndrome
2. turner syndrome
3. sheehan syndrome
4. rokitansky syndrome
Answer 3. sheehan syndrome

23. 32 yr male a known hypertensive planned for cholecystectomy . which of following
is contraindicated
1. propofol
2. ketamine
3. midazolam
4.
ANS 2. Ketamine
Ketamine causes a rise in intracranial pressure and should not be used in patients who
have sustained a recent head injury.
The blood pressure rises by about 25% (on average the systolic pressure rises by 20-
30 mmHg) and the heart rate is increased by about 20% - the overall effect is
therefore to increase the workload of the heart.
The pressure within the eyeball (intra-ocular pressure) rises for a short time following
administration.
All pressures are increased.

24. One of the drug is contraindicated in Patients with lithium toxicity
1.diuretics
2. beta blocker
3. ccb
4.
Answer 1. Diuretics
Diuretics acting distally to the proximal tubule, such as thiazides and spironolactone,
do not directly affect the fractional excretion of lithium (although they may affect
serum lithium levels indirectly through their effects on volume status). Reabsorption of
lithium is increased and toxicity is more likely in patients who are hyponatremic or
volume depleted, both of which are possible consequences of diuretic therapy.

25. Most common tumor causing superior Vena cava syndrome.
1. Malignant Lymphoma
4.
ANS Small cell Carcinoma
Nearly 95% of superior vena cava syndrome cases are attributed to cancer, with the
most common cause being small cell lung cancer, followed by squamous cell lung
cancer, adenocarcinoma of the lung, non-Hodgkin's lymphoma, and large cell lung
cancer.

26. Which virus crosses placenta least likely ( ADrPlexus Q )
1. rubella
2. herpes simplex
3. HIV
4. Hepatitis B
ANS 4. Hepatitis B
HBV is a large virus and does not cross the placenta, hence it cannot infect the fetus
unless there have been breaks in the maternal-fetal barrier, e.g. via amniocentesis.

27. Deoxygenated Blood is carried in all blood vessels except

1. umbilical artery
2. umbilical vein
3. pulmonary artery
4. right ventricle
Answer 2. Umbilical vein

28. A patient with Solitary kidney having 4 cm solitary exophytic mass in lower pole.
Management is
1.Partial nephrectomy
2. Radical nephrectmy with dialysis
3. Radical nephrectomy with immediate renal transplant
4. Observation
ANS. Partial nephrectomy

29. Which is present in Pentology of fallot :
1. ASD
2. VSD
3. Right Ventricular Hypertrophy
4. Pulmonary stenosis
Answer 1. ASD

30. All are true about Nesidioblastosis except ?
1. Hypoglycemic Episodes are seen
2. Occurs in adults more than child
3. Histopathology shows Hyperplasia of Islet cells
4. Diazoxide is used in treatment
Answer 2. Occurs in adults more than child
Nesidioblastosis is hyperinsulinemic hypoglycemia attributed to excessive function of
pancreatic beta cells with an abnormal microscopic appearance. The abnormal
histologic aspects of the tissue included the presence of islet cell enlargement, islet
cell dysplasia, beta cells budding from ductal epithelium, and islets in apposition to
ducts.Most common age group 2 – 3 years.

31. Epileptogenic
1. Desflurane
2. Sevoflurane
3. Ether
4. Halothane
Ref : A practice of anesthesia for infants and children By Charles J. Coté
Answer 2. Sevoflurane

32. Contraceptive to be avoided in epilepsy
1. OCP
2. Condoms
3. IUD
4. Post Coital Pill
ANS. OCP
The morning after pill can be used in women with epilepsy after unprotected sexual
intercourse. A higher dose is recommended in patients taking hepatic enzyme inducing
drugs
- 1st dose – Levenorgestrol 1.5mgs (2 tablets)
- 2nd dose 12 hours later – Levenorgestrol 0.75mgs (1 tablet)

33. NARP syndrome is seen in
1. mitochondrial
2. glycogen storage
3. lysosomal
4. lipid storage
Answer 1. Mitochondrial Disorder

Neuropathy, ataxia, and retinitis pigmentosa, is a condition related to changes in
mitochondrial DNA.
Mutations in the MT-ATP6 gene cause neuropathy, ataxia, and retinitis pigmentosa.
The MT-ATP6 gene is contained in mitochondrial DNA. Mitochondria are structures
within cells that convert the energy from food into a form that cells can use. Although
most DNA is packaged in chromosomes within the nucleus, mitochondria also have a
small amount of their own DNA (known as mitochondrial DNA or mtDNA).

34. Necrotizing lymphadenitis is seen in
1. Kimura disease
2. kikuchi disease
3. hodgkin disease
4. castelman disease
Answer 2. Kikuchi Disease
Kikuchi disease ai also called histiocytic necrotizing lymphadenitis or Kikuchi-Fujimoto
disease, is an uncommon, idiopathic, generally self-limited cause of lymphadenitis.
The most common clinical manifestation of Kikuchi disease is cervical
lymphadenopathy. Several viral candidates have been proposed, including
cytomegalovirus, Epstein-Barr virus,16 human herpesvirus, varicella-zoster virus,
parainfluenza virus, parvovirus B19, and paramyxovirus.

35. A tennis player gets hurt by a ball in his eye, he complaints of decreased vision?
what may be the cause for the condition?
1 optic neuritis
2 pars planitis
3 . Avulsion of the Vitreous base
4 . equatorial edema
Shall Discuss Most Probable 3. Avulsion of the Vitreous base
Chapter 12 BLUNT INJURY OF THE EYE
Blunt injuries: the eye wall does not have a full thickness wound. Open globe or
penetrating injuries: the eye wall has a full thickness wound. A blunt force causes a
globe rupture and a sharp object causes a laceration at the site of impact. Lacerations
may be penetrating with a single entrance wound, or a perforating with an entrance
and exit wound.
Symptoms and signs suggestive of globe rupture include pain, deceased visual acuity
(a normal visual acuity is rarely present in a globe rupture), extensive subconjunctival
haemorrhage (often involving 360 degrees of bulbar conjuctiva), a deep or shallow
anterior chamber, hyphaema, low IOP (however IOP can be normal or high), irregular
pupil, iridodialysis, cyclodialysis, lens subluxation, commotio retinae, retinal tears,
vitreous haemorrhages, obvious corneal or scleral lacerations or intraocular contents
may be outside the orbit.
Direct blows to the eye transmit energy to the adjacent tissues as they produce
compression,
shearing, and tensile strains. The resultant great shearing forces are usually strongest
at the posterior border of the vitreous base, and a linear tear of the retina may result.
If traction is strongest at the anterior border of the vitreous base, the nonpigmented
ciliary epithelium is torn. Strong traction at both the anterior and posterior borders
may produce vitreous base avulsion, which is pathognomic of ocular

36. Aprepitant is all except
1. Agonist at Neurokinin receptor
Answer 1. Agonist at NK1
Aprepitant is an antiemetic chemical compound that belongs to a class of drugs called
substance P antagonists (SPA). It mediates its effect by blocking the neurokinin 1
(NK1) receptor.

37. Buprenorphine is a
4. It is antagonist at Kappa receptor
Answer 1. . Partial agonist at MU Receptor

38. Local Anaesthetic agent with vasoconstrictor is not used in
1. Spinal
2. Epidural
3. Digital finger block
4. Skin Anaesthesia
Answer 3. Digital Finger Block
The toxicity of LA is related to the amount and speed of their absorption into the
systemic circulation !
Vasoconstrictor ingredient (e.g., adrenaline, felypressin) is often added to LA with the
aim to reduce the absorption of LA into the systemic circulation.
Effects of vasoconstrictors:
- increase in the effect of LA (increased concentration)
- decrease in the toxicity of LA (decreased absorption)
- increase in the duration of the effect of LA
Vasoconstrictors must not be used for producing ring-block of an extremity (e.g. finger
or toe) because they may cause prolonged ischaemia and gangrene.

39. All are true about Erlotinib except
1. Used in Non Small Cell Carcinoma
2. It is a small peptide acting as EGRF antagonist
3. Food decreases absorption
4. It causes skin rashes
Answer 3. Food decreases absorption
Explanation : Food enhances the oral absorption and bioavailability of erlotinib.

40. Sparrow marks are seen in following condition
1. gunshot injuries
2. stab injry of face
3 vitriolage
4 windshield glass injury
Answer 4 windshield glass injury

41. All are supplied by the anterior division of Mandibular nerve except:
1. lateral pterygoid
2. medial pterygoid
3. temporalis
4. masseter
Answer 2: medial pterygoid
The nerve to medial pterygoid is a direct branch of the mandibular trunk.

42. 39. All of the following decrease bone resorption in osteoporosis except?
1.Alendronate
2.Etidronate
3.Strontium
4.Teriparatide
Answer 4. Teriparatide
Teriparatide increases both bone formation and bone resorption

43. Onodi Cells & Haller Cells are associated with the following structures
respectively?
1.Optic Nerve & Orbital floor
2.OPTIC NERVE & INTERAL CAROTID ARTERY

3.ICA & optic Nerve
4.ORBITAL FLOOR & ICA
Answer 1. OPTIC NERVE & ORBITAL FLOOR

44. Posterior relations of head of pancreas are all except
1) Common Bile Duct
2) duodenum first part
3) Aorta
4) IVC
Answer 2. Duodenum First part
Posterior Surface.—The posterior surface is in relation with the inferior vena cava, the
common bile duct, the renal veins, the right crus of the diaphragm, and the aorta.

45. About yaws all are true except
1. caused by t. pertenue
2. transmitted non-venerally
3. Secondary yaw can involve bones
4. Last stages involve heart & nerves
Answer 4. Last stages involve heart & nerves
Yaws, like syphilis, has been classified into the following 4 stages:
Primary stage: The initial yaws lesion develops at the inoculation site.
Secondary stage: Widespread dissemination of treponemes results in multiple skin
lesions similar to the primary yaws lesion.
Latent stage: Symptoms are usually absent, but skin lesions can relapse.
Tertiary stage: Bone, joint, and soft tissue deformities may occur.

46. Mifepristone is used in
1. Hydatiform Mole
2. Abortion
3. Ectopic
4.
Answer 2. Abortion
Medical abortion using mifepristone plus prostaglandin is the most effective method of
abortion at gestations of less than 7 weeks. Mifepristone is contraindicated in the
presence of an intrauterine device (IUD), as well as with ectopic pregnancy, adrenal
failure, hemorrhagic disorders, inherited porphyria, and anticoagulant or long-term
corticosteroid therapy.

47. Patient had cicatrical alopecia with grey pigmentation around hair follicles.What
will you look for?
1. Whitish lesion in the buccal mucosa
2. Nail dystrophy
3. Arthritis
4. Discoid Plaques in the face
Answer 1. Whitish lesion in the buccal mucosa

48. How to differentiate ASD from VSD in X-ray
1. Enlarged Left atrium
2. Pulmonary congestion
3. Aortic shadow
Answer 1. Enlarged Left atrium

49. Specific Compliance of lung is decreased by all except
1. Chronic Bronchitis
2. Pulmonary fibrosis
3. Pulmonary Congestion
4. Decreased Surfactant
Answer 1. Chronic Bronchitis
Emphysema / COPD may be associated with an increase in pulmonary compliance due

to the loss of alveolar and elastic tissue

50. All are features of digitalis toxicity except
1. Ventricular Bigeminy
2. Regularisation of AF
3. Delayed conduction across AV
4. Biventricular tachycardia
Answer CONTROVERSIAL AIIMS. HELP US WITH OPTIONS
Digoxin toxicity is especially suggested by paroxysmal atrial tachycardia with AV block
and accelerated junctional rhythm in the presence of atrial fibrillation, so-called
“regularization of atrial fibrillation. Prolonged PR intervals (greater than 0.20 second)
may represent a conduction delay through the atria or AV junction due to digitalis
toxicity or heart block.Bidirectional ventricular tachycardia is particularly characteristic
of severe digitalis toxicity. The combination of increased (atrial) arrhythmogenesis and
inhibited atrio-ventricular conduction (for example paroxysmal atrial tachycardia with
A-V block - so-called "PAT with block") is said to be pathognomonic (i.e. diagnostic) of
digoxin toxicity.

51. A patient was started haloperidol for schizophrenia before four days. Now the
patient complaints of severe spasm of neck on one sidefor the past 2 hours. what is
the likely diagnosis?
1. akathisia
2. Acute dystonia
3. malignant hyperthermia
4. tardive dyskinesia.
Answer: 2. Acute dystonia

52. Diaphragm develops from all except
1.pleuroperitoneal membrane
2.septum transversum
3.musculature of dorsal wall
4.cervical somites
Answer: 4.cervical somites

53. Sterile pyuria is seen in
1.chronic pyelonephritis
2.wilms”s tumour
3.tuberculosis
4.cystitis
Answer: tuberculosis

54. Haematological syndromes is seen in radiation doses of
1.5 rad
2.100 rad
3. 200 rad
4.
Answer: 3. 200
The hematologic syndrome is associated with radiation doses in the range of 150 to
600 rad (1 .5 to 6 Gy).

55. Best test to identify metastatic bone lesion is
1.ct scan
2.mri
3.bone scan
4.x ray
Answer. Bone scan

56. Which is the commonly used fixative in histopathological specimen
1.glutaraldehyde

2.formaldehyde
3.alcohol
4.picric acid
Answer: 2.formaldehyde
The most common fixative for light microscopy is 10% neutral buffered formalin (4%
formaldehyde in phosphate buffered saline).

57. All are given in total parenteral nutrition except
1.carbohydrates
2.fat
3.fibre
4.micronutrients
Answer:fibre

58. About parvovirus B19 all are true except
1. spread by respiratory route
2.has affinity for erythrocyte p antigen
3.causes transient aplastic crisis
4.about only 10%of cases it crosses the placenta
Answer: Ref Harrison 17th edition p 1116/1117 , Greenwood microbiology 6th e p
452
The risk of transplacental infection is 30%

59. In patients receiving isoniazid theraphy which of the following micronutrients to be
supplemented
1. Vitamin B12
2. pyridoxine
3.
4.
Answer.pyridoxine

60. Which of the following is used to diagnose intraoperative myocardial infarction
1.
2.
3.transesophagial echocardiogram
4.ecg
Answer: Please Help us with correct options

71 pt with solitary kidney hving 4 cm exophytic mass in lower pole. best management
partial nephrectomy
rdical nephrctmy with dialysis
radical witth immediate renal transplant
observation

72 NARP syndrome is seen in
mitochondrial
glycogen storage
lysosomal
lipid storage

73 hallmark of acute inflammation ??
vasoconstriction
stasis
vasodilation and increase in permeability
leucocytic margination

74 ONODI CELLS & HALLER CELLS are associated with the following structures
respectively?
a.OPTIC NERVE & ORBITAL FLOOR

b.OPTIC NERVE & INTERAL CAROTID ARTERY
c.INTERNAL CAROTID ARTERY& OPTIC NERVE
d.ORBITAL FLOOR & INTERNAL CAROTID ARTERY

75 amp b causes def of
na
ca
k
mg

76 injury to common peronel n all except ??
loss of senstion over sole
foot drop
injury to neck of fibula
loss of dorsiflex of toe

77 Nerve involved most commonly in supracondylar fracture
Radial nerve
Median nerve
Ulnar nerve
Ant int nerve

78 definitive airway a/e:
nasotracheal tube
orotracheal tube
lma
cricothyroidectomy

76 not a cause of primary amoenorrhoea
kallman syndrome
turner syndrome
sheehan syndrome
rokitansky syndrome

79 a 65 yrs old lady presenting wth swollen n painful knee...having grade III osteoarthritic
changes..wats the best management for her
1.conservative
2.arthroscopic washing
3.partial knee replacement
4.total knee replacement

80 which is the integrase inhibitor used in treatment of hiv??
raltegrase
indinavir
lopinavir

81 A 6 year old child presents with pain in hip in femoral triangle region. X-ray does not reveal
any abnormality. What is the next step?
A. USG
B. MRI
C. Aspiration
D. Traction

82 Pasteurised milk is tested mostl commonly by:

a. phosphatase test
b. coliform test
c. catalase test

84 Anaesthetic agent with vasoconstrictor C/I in:
a. finger block
b. spinal block
c. epidural block
d. regional Anaesthesia

85 a rickshaw runover thigh of child ..tyre marks over thigh represents ??
patterned bruise
imprint abrasion
ectopic abrasion

86 prophylaxis of migraine a/e
propranolol
flunarizine
topiramate
levacetarem

87 early sign of magnesium toxicity
1.depression of deep tendon reflexes
2.respiratory depression
3.cardiac arrest
4.decrease urine output

88 all are actions of muscarinic antagonist except.
a. decreses gastric secretion
b. prolongs a-v conduction
c. decreses resp secretions
d.contraction of radial muscles of iris

89 all are seen in argyl robertson pupil except.
near reflex normal
direct reflex absent
consensual reflex normal
vision normal

89 Branch of trunk of brachial plexus
a. suprascalpur
b. long thoracic n
c.ant. Thoracic
d. nerve to sub clavius.

90 tolerance in opioids develops to all except
miosis
analgesia
euphoria
??

91 diaphragm develops from a/e:
septum transversum
dorsal mesocardium
pleuroperitoneal membrane
cervical myotomes
2 ecg is poor in detecting ischaemia in areas supplied by
lad
lt circumflex
lca
rca

93 The primary action of NO in git is?
A. Vasodilatation
B. Vasoconstriction
C. GI smooth muscle relaxation
D. Secretomotor

94 Which is not seen in digoxin toxicity?
A. Biventricular tachycardia
B. Proxysmal atrial tachycardia with ectopics
C. Ventricular bigeminy
D. Regularisation of AF

95 Which of the following does not cause indoor air pollution?
A. CO
B. Nitrogen dioxide
C. Radon
D. Mercury vapor

96 All are true about pheochromacytoma except?
A. 90% are malignant
B. 95% occur in the abdomen
C. They secrete catecholamines
D. They arise from sympathetic ganglions

Q 97 Most important and hazardous agent that can be used in bioterrorism:
A. Plague
B. Small pox
C. TB
D. Clostridium botulinum

[snip] True about epidural opioids are all except?
A. Acts on dorsal horn cell
B. Itching
C. Nausea & vomiting
D. Respiratory depression

Q99 Most common site of stricture formation after TURP?
A. Navicullar foss
B. Bulb
C. Prostatic membranous urethra
D. Bladder neck

Q100 Intraoperative myocardial infarction is best diagnosed by:
A. ECG
B. Invasive arterial pressure
C. Central venous pressure
D. Trans esophageal echocardiogram

Q101 Pseudoisomorphic phenomenon seen in
A. Psoriasis
B. Lichen planus
C. Vitiligo
D. Plane warts

1 02 ova albumin antigen was injected into a rabbit. What antibody will it produce initially?
A. IgG
B. IgM
C. IgE
D. IgD

103 a 50 yr lady has history of sprained ankle 2 months back followed by recovery. She now
complains of severe pain in that ankle with inability to flex that foot. Physician notes edema
and shiny skin in local examination. What is the probable diagnosis:
a. Fibromyalgia
b. Complex regional pain syndrome 1
c. Complex regi...

104 About yaws all are true except:
A. Caused by Treponema pertenue
B. Transmitted non-venerally
C. Secondary yaws can involve bones
D. Last stages involve heart and nerves

105 Weight gain in pregnancy is related to all except?
A. Ethnicity
B. Smoking
C. Socioeconomic status
D. Pre conceptional weight

106 Which virus among the following is least likely to cross placenta?
A. Rubella
B. Herpes simplex
C. HIV
D. HBV

107 A fire breaks out during laser vocal cord surgery. What is not to be done?
A. Pouring sterile water
B. Removing endotracheal tube
C. 100% oxygen after discontinuing anesthetic gases
D. Treatment with steroid & antibiotic

108 A patient with history of discharge from right ear for past 1 year presented with severe
ear ache. The discharge was cultured and the organism was found to be gram positive cocci.
The least likely cause is?
A. Psuedomonas
B. Streptococcus pneumoniae
C. Staphylococcus
D. Haemophilus influenzae

109 Which among the following is the most common tumour associated with
neurofibromatosis in a child?
A. Juvenile myelomonocytic leukemia
B. Acute lymphoblastic leukemia
C. Acute monocytic leukemia
D. Acute myeloid leukemia

110 Common carotid artery is palpated at which site?
A. Upper border of cricoid cartilage
B. Upper border of thyroid cartilage
C. Hyoid bone
D. ???

111 A 5 year old boy while having dinner suddenly becomes aphonic and is brought to the
casulty for the complaint of respiratory difficulty. What should be the appropriate
management?
A. Cricothyroidotomy
B. Emergency tracheostomy
C. Humidified oxygen

D. Heimlich maneuver

112 Which among the following is the most common fungal infection seen in immuno
competent patients?
A. Aspergillus
B. Candida
C. Cryptococcus
D. Mucor

113 A teenaged girl complains of pain in knee on climbing stairs and on getting up after sitting
for a long time. What is the probable diagnosis?
A. Chondromalacia
B. Plica syndrome
C. Bipartite patella
D. Patello-femoral osteoarthritis

114 cause of premature death in schizophrenia?
a)homicide
b)suicide
c)toxicity of antipsychotic drug
d)hospital acquired infection

115 Which of the following is not an adverse effect of thalidomide?
A. Diarrhoea
B. Teratogenicity
C. DVT
D. Peripheral neuropathy

116 Superior vena caval syndrome is most commonly caused by?
A. Lymphoma
B. Small cell lung ca
C. Non small cell lung ca
D. Secondary tumours

117 Which of the following is a contraindication for medical treatment in gallstones?
A. Radio opaque stones
B. Radiolucent stones
C. Normal functioning gall bladder
D. Small stones

18 lines of blashchko --
lymphatic
blood vessel
nerve
line of development

119 deoxy blood flow thru a/e:
umbilical a
umbilical vein
pulm a
right ventricle

120 best test for hcg ?
radioimmunoassay
elisa
latex test

121 aortic knuckle shadow on pa x ray..obliterated by consolidation of which portion of lung?
upper lingula

lower lingula
apex of lower lobe
post part ofupper lobe

122 Tetracycline used in prophylaxis of ?
cholera
brucellosis
leptospirosis

123 basal matabolic closely associated with ?
a.lean body mass
b.body surface area
c.body mass index
d.

124 maximal water absorption of water in git?
a jejunum
b colon
c ileum
d ??

125 pentology of fallot has which one of following extra entities:
a. asd
b. vsd
c. rvh
d. pulmonary stenosis

126 free radicals in cells produced by a/e
glut peroxidase
NO synthase
superoxide dismutase

127 all of done in management of shoulder dystocia except
a. fundal pressure
b. suprapubic press
c. mc roberts
d. woods

128 Which one of the following is not neuron tumour
a.ependymoma
b.gangliocytoma
c.ganglioglioma
d.??

129 In L5 root involvement, which among the following is not affected?
A. Thigh adduction
B. Knee flexion
C. Knee extension
D.great Toe extension

Q130 Which among the following is not a cause of fasting hypoglycemia?
A. Glucagon excess
B. Glucose 6 phospatase deficiency
C. Ureamia
D. Glycogen synthase deficiency

131 McKeon's theory on reduced prevalence of TB?
A. Increased awareness and knowledge
B. Medical advancement

C. Behavioural modification
D. Social and environmental factor

132 A child presents with abdominal pain only during passage of stools. No other symptoms
like vomiting or blood in stools. There are no signs of intestinal obstruction. Most probable
diagnosis is?
A. Rectal polyp
B. Intusseception
C. Meckels diverticulum
D. NEC

Q133 A man presents with a maculopapular rash. He gives a history of previous painless rash.
Infection is due to?
A. Treponema pallidum
B. Chlamydia
C. Calymmatobacterium granulomatis
D. Haemophilus ducreyi

Q134 Meglitinides - all are true except:
a. decreases post parendial hyperglycemia
b. hypoglycemia less common than sulfonylureas
c. it decreases insulin resistance
d. it acts by releasing insulin

Q135 Cleavage of which complement is involved in both -classical and alternate pathway a.
C1
b. C2
c. C3
d. C4

Q136 what is not asso. with mestruation..?
1. hormone
2. vaginal cytology
3. estrus profile
4. cervical changes

Q137 best treatment option for genuine stress incontinence?
a. burch colposuspenssion
b. kelly's
c. sling operation
d.free vaginal tapping

Q138 Xanthogranulomatous inflammation all are true except ?
A. presence of foamy macrophage
B. presence of tuberculous infection
C. multinucleatd giant cell
D. yellow nodule

Q139 Posterior relations of head of pancreas are all except?
A. Common bile duct
B. First part of duodenum
C. right crus of diaphragm
D. Inferior vena cava

140 All are true about blood coagulation except.
1 factor 10 in doth intrinsic and extrinsic
2 extrinsic is activated by contact with plasma and -fly charged protein ans
3 calcium is very important ion for coagulation
4 intrinsic can be activated in vitro.

Q141 Late onset endophthalmitis after intraocular lens implantation caused by
a)staph epidrmidis
b)pseudomonas
c) strptococcus pyogenes
propionibacter acne

142 Which of the following is not a contraindication for pregnancy?
A. WPW syndrome
B. Pulmonary hypertension
C. Eisenmenger syndrome
D. Marfan syndrome with aortic root dilatation

Q143 which one of the following is a cardio protective fattyacid
a.stearic,
b.palmitic
c.oleic
d.w3 fatty acids

Q144 Which one of the following is not seen in floor of 3rd ventricle
a.optic stalk
b.mammilary body
C.occulomotor nerve
d.infundibulum

145 Which among the following not a component of hypogastric sheth?
A. Broad ligament
B. Transverse cervical ligament
C. lateral ligament
d.??

146 Child brought to casualty with reports of violent shaking by parents. Most likely injury?
A. Long bone #
B. Ruptured spleen
C.subdural hematoma
D.skull bone #

147 arthropod transmitted virus diseases not found in india
1.west nile fever
2.dengue
3.yellow fever
4.

148 open neural tube defects detected by increase in which of the following –

acetylcholinesterase
pseudocholinestrase
AFP

149 Which of the following is true abt HDI A/E?
a) LIFE EXPECTANCY AT BIRTH
b) LIFE EXPECTANCY AT 1 YEAR
c) EDUCATION
d) GDP in us $

150 most potent activator of T cells?
1. B cells
2. follicular dendritic cells
3. mature dendritic cells

4. macrophages

151 Following abt Phagocytosis all true A/e
a.<0.5 mcm
b.>0.5 mcm
c.Phagosome+lysosome=phagolysosome
d. d.amoeba n other unicellular org make their living out of it

152 APL Ab syndrome which Ab seen?
a.beta 1 microglobulin
b.ANA
c. anti centromere
d.

153 poor prognostic factor for ALL?
a.hyperdiploidy
b.t(9;22) t(4;11)
c.2-8 yrs
d.tlc <50000

154 Pearson's skewness coefficients
a.(Mean-median)/sd
b.Median-mean/sd
c.Sd/mean-median
d.Sd/median-mean

155 scarring alopecia with perifollicular greying .wth mucous mem n facial rashes /annular
plaques?
1.d l e
2.lichen planus
3.psorisis
4.

156 With delirium tremens,not seen:
a.visual hallucination
b.unconsciousness
c.coarse tremors
d.opthalmoplegia

157 A patient wth intestinal infection 7 days later presented with amoebic liver
abscess..5cmX5cmX6cm deep liver abscess on right side Rx of choice
a.Mz and antibiotics is choice
b.Repeated aspiration and antibiotics
c.Surgical drainage is best for above mentioned patient wth antibiotics
d.Resection of liver

158 drug of choice for central Diab insipidus?
a.desmopressin
b.leuprolide
c.thiazide

159 first structure to b fixed after Amputation is
a.Bone fixing
b.arterial repair
c.venous repair
d.nerve repair

160 fallopian tube immotility seen in:

a.churg strauss syndr
b.kartaganers syndr
c.noonans syndr
d.turner syndrome

161 Epileptic potential is present in
A. Desflurane
B. Halothane
C. Sevoflurane
D. Ether

162 which one is known as signature fracture?
1.depressed skull fracture
2.penetrating fracture
3.counter coup
4. # along the suture line

163 A 7 yr old child with craniopharyngioma got cranial surgery done following which pituitary
got damaged.which hormone shld b replaced first-
1.hydrocort
2.thyroxine
3.growth hormone
4.

164 A 45 yr old lady presented with dub & usg finding of 8mm endometrium.which is next
best investigation to conclude diagnosis?
1.endometrial histopathology
2.hysterectomy
3.ocp
4.follow up

Q165 Which one of the following is earliest to be diagnosed by USG?
a.anencephaly
b.prosencephaly
c.meningocele
d.spina bifida

166 .A 5 yr ol child presented wth ballooning of perpuce while micturationperpuce adhesion
were there.whts the best treatment for him
a.adhesiolysis and dilatation
b.circumscision
c.dorsal slit
d.conservative

167 False about HDL?
a.can oxidise LDL
b.decreased levels fail to clear LDL
c.best predictor for CAD
d

168 A poison Illuminous, translucent, waxy
1. Yellow phosphorus
2.arsenic
3.thalium
4.?

170 Gene for expession of protein.yield max production of enzyme.is ensured by introduction
of following gene by virus

a.Promoter gene
b.Initiator signal
c.transln and transcription termination signal
d.

171 Body plethysmography pressure findings when pt breathes aginst closed glottis in lungs n
recordings respectively
1.bothdecreased
2.both increased
3.lungs increases n recording decreased
4.in boxincrease lung decrease

172. cartilage for growth plate is:
a.fibrous
b.prim cartilagenous
c.sec cartilagenous
d.plane jt

173 Not a predisposer for atherosclerotic plaque formation?
a.ApoE
b.alpha-macroglobulin
c.oxidised LDL
d.?

174. 7 mo child with cough ending in spasm.which is best way to sample?
a.Nasophayngeal swab
b.Cough sputum culture
c.tracheal aspirate
d.??

175 Unilateral undescended testis . ideal age of operation
a.6 months
b.12 months
c.24 months
d.36 months

176Following are true Carbohydrate antigen
a.Memory
b.poly clonal response
c.?
d. t cell stimulation

177 Aflatoxin produced by which of the fungal species?
a.aspergillus flavus
b.aspergillus niger
c. candida
d??

178 A 3.8 kg baby of a diabetic mother developed seizure 16 hr after birth ...
1.hypoglycemia
2.hypocalcemia
3. intraventricular hemorrhage
4. ??

179 girl presenting with occipital headache assoc wid ataxia vertigo.also similar complaints in
mother ?

a.vestibular neuronitis
b.basillar migraine
c.
d.
180 18yr male with hemetemesis & melena and splenomegaly ....
1.NCPF
2.CIRRHOSIS
3.MALARIA with dic
4.extra hepatic portal venous obstruction

181 Pregnancy induced cholestasis marker... is
a.Bilirubin
b.Bile salts
c.Sgot or sgpt
d.Alp

182 ph 7.5 pco2 30.po2 102 is partially ,compensated by
met acidosis
met alkalosis
resp acidosis
resp alkalosis

183 pulmonary toxicity is seen with
1. bleomycin
2.cisplatin
3.methotrexate
4.actinomycin d

184 A female wid depressed mood,loss of appetite n no interest in surrounding wid insomnia
specially wid time lag in iniating n wakes up 1 hr early for 1 yr aftr her husband death is
diagnosed as a case of depression..most appropiate treatment
a.start wid a SSRI
b.two antideprassant combined therapy
c.no treatmnt as
D start antidepressant according to side affect profile

Q185 A pt comes with history of unresponsive fever n cough. xray pneumonia, gram positiv
and partially acid fast branchin filaments 'grows on sheep blood agar'
1.actinomycosis
2.nocardiosis
3.aspergillus
4.

186 not a disorder of protein misfolding?
1.alzeimer
2.TB
3.cystic fibrosis
4.cjd

Q187 70yr old with intemittent jerks of recent origin, EEG showing b/L periodic spikes,
diagnosis?
a)Hepes simplex encephalitis
b)Lewy body dementia
c)Alzheimer's
d)CJD

Q188 15 DAYS old baby comes with ca: 5 po4 :9 pth 30 (n=10-60) & seizures
1.psuedo hypo para thyroid
2.Vit d def

3.Hyperparathyroidism
4.HIE

Q189 most common cause of meningoencephalitis in children
1.hsv
2.enterovirus
3.mumps
4.listeria

q is pulm compliance decreased in all except
A)pulm congestion
B)pulm fibrosis
C)decreased surfactant
D)chronic bronchitis

191 all of the following true abt erlotinib except
1. tyrosine kinase inhibitor
2. food delays its absorption
3. rashes s/e
4. used in non small cell ca lung when not responded to other chemotherapeutic agents

192 People are separated into certain sub groups. People are selected randomly from sub
groups. What type of sampling is done?
1. Random sampling
3.cluster sampling
4.systemic sampling

Q194 capsule virulence in a/e -
1.nisseria memingitis
2.pneumococcus
3.bordetella pertussis
4.streptococcus

Q195 superior oblique palsy-
a.horizontal and down
b.horizontal and up
c.vertical and dwn
d.vertical and up

Q196 muscle of dorsal aorta develops frm
a.paraxial
b.intermediate
c.lateral plate
d.

197 Uretheral Crest is seen in
a. bulbar urtehera
b. prostatic urethera
c. membranous urethera

198 Site not affected in posterior cerebral artery infarct is?
A. Midbrain
B. Pons
C. Thalamus
D. Cortex

199 Visceral larva migrans seen in
1.strongyloides

2.ancylostoma
3.toxocara canis

200. psammoma bodies seen in all except
1.follicular ca thyroin
2.papillary ca thyroid
3.cystadenoca
4.meningioma

201 Denominator in Maternal Mortality rate
4.

202 a tennis player gets hurt by a ball, he complaints of decreased vision.what may be finding
s/o this trauma
1 optic neuritis
2 pars planitis
3 vitrious detachment/ avulsion
4 equatorial edema

203 A 35 year old female has proximal weakness of muscles, repeated ptosis and east
fatiguability. The best test to diagnose her condition is:
1) Muscle biopsy
2) CPK
3) Edrophonium test
4) EMG

204 For Pcod all r true except
1 high lh/fsh
2 high dheas
3 very high prolactin
4 raised lh
205 most imp prognostic factor in Cong Dia Hernia

a.pulmonary ht
b.timing of surgery
c.size

206 dental numbering is done by all except
a.FDI two digit system
b.anatomic n diagramatic charting
c.pamer notation
d.??

207 Sterile Pyuria present in...
a.Tb
b. Chronic hydronephrosis??
c. Wilm's tumour
d. Neuroblastoma

208 parvovirus b19 a/e
a.<10 % transmitted by blood/placenta
b.Resp route
c.its a dna virus
d.affects erythroid progenitor cells

209 a mother with 33weeks gestation with sle. drugs not to be administered

1. sulfadiazine
2. hydroxychloroquine
3.prednisolone
4.methotrexate

209 mifepristone used in

a.molar
b.threatened abortion
c.fibroid
Ectopic pregnancy

210 hematuria in 55 yr old man for past 5 years.. 5 episodes lasting for 4 -5 days.wat will b
next best inv to come to diagnosis?
a.urine exam nd microscopy
b.x ray kub
c.abdominal usg
d.

211 during TURP surgeon takes care to dissect above verumontenum so as not to injure the
1.external urethral sphincter
2.urethral crest
3.prostatic utricle
4.? d is sphincter vesicae

212 least common cause of ambiguous genitalia in female child---
a.placental steroid sulfatase
b.fetal aromatase
c.wt4 mutation
d.cah

213 medical treatment for variceal bleed
a.octreotide
b.pantaprazole
c.
d.
214 lady 25 yr old presents with high tsh and low t4 .which is most common cause for her
illness
1.hashimotos
2.graves
3. pit macroadenoma
4. pseudohypothyroidism...

215 vit k carboxylates
1.aspartate
2.glutamate
3.
4.
216 false about C.diphtheriae:
a.toxin producn chromosome mediated
b.org cnfd by toxin production
c? toxic to heart and neuron
d?

217 stab injury with omentum protrusion in umbilical area ,vitals stable.immediate next step
1.fast
2.laparotomy
3.suturing with wound exploration
4.cect

218 The shaded area in graph (showing diabetic cut off n diabetic n non diabetic distribution)
is
a] true +ve
b] true –ve
c] false +ve
d] false –ve

219 man with maculopapular rash with prev h/o painless rash n genital painless ulcer.diagn
is:
a.treponema pallidum
b.chlamydia
c.c.granulomatis
d.H.ducreyi

220 false about strep pneumoniae?
a.capsule aids in infection
b.commonest cause of o.media and pneumonia
c. least likely cause of meningitis
d.bile sensitive

221 a schizophrenic pt started on haloperidol since 2 days comes with c/o
torticollis,orofaciolingual movements. what is the diagnosis
1. acute dystonia
2.tardive dyskinesia
3.parkinsonism
4.akithisia

222 no carrier state is seen in?
1.measels
2.typhoid
3. diptheria.
4.polio

223 Pt. wt hypothyrodism wt IHD . Wt's d Rx ?
1.low dose of levothyroxin
2. normal dose
3.no levothyroxin
4.thyroid extract

224 a primigravida in 1st trimester had sputum positive 4 afb..treatment
a) deferred to 2nd trimester
b) cat1
c)cat2
d)cat3

225 A patient had head injury with opening of eyes with stimulation to pain, inappropriate
words, and moving limbs what is the score:
a. 10
b. 8
c. 12
d. 14

226 Which of the following is true?

a. Acetylcholinesterase inhibited by malathion can be reversed with increasing levels of
acetylcholinesterase
b. Sulphonilamide inhibits folate reductase irrevesibly.
c. flouoroacetate competetively inhibits aconitase

ethenol inhibit aldehd dehydrogenase when used in methanol poisoning

227 Secondary hemorrhage after how many days of tonsillectomy?
1: 24 hrs
2: 6 days
3: 12 days
4:12 hrs
228 Aprepitant is all except
1. Agonist at NK1

229 Buprenorphine is a

... antagonist at mu..

230 blood chimerism is maintained by??
a) monochorionin dizygotic
b)dichorionic dizygotic
c) vaninshin twins
d) singleton preganancy
231 crp stands for??
1.capsular polysaccharide in pneumococcus
2.
3.
4.
232 features of bstructive azoospermia??
1.high fsh high testosterone
2.low fsh high testosterone
3.normal fsh normal testosterone
4.

233 principle mediator of apoptosis?
1.nucleus
2.lysosome
3.mitochondria
4.?

234 regarding Leptospirosis.true is
a.rats only reservoir
b.fluroquinolones r doc
c.person to person transmission
d. oro fecal transmission

235 5 year old child and burned are of the size of palm is equal to
1. 1%
2. 5%
3. 10%
4.

236 Q:All are true about ranalozine except?
a)causes hypotension
b)1st line antianginal
c)hyoglycemic
D?

237 true abt sodium fluoride in treatment of otosclerosis?
1.inhibits osteblastic activity
2.used in active phase of otosclerosis when schwartz sign positive
3. has proteolytic activity(bone enzymes)
4.
238 wat is true abt ranula
1.epulis
2.swelling in floor of mouth
3.
4.
239 A 6 week old male infant was brought in a state of dehydration and shock . Na levels were
low 124 k levels 7 meq per l , hyper pigmentation present with normal genitalia . Diagnosis ?
1.Congenital adrenal hyperplasia
2.adrenal hmg n shock
3.Acute gastroenteritis with dehydration
4.

240 In pseudohyperparathyroidism what is true ?
1.Gain of function mutation
2.Decreased conversion of gtp to gmp
3.Decreased inositol tri phosph production
4.no response due to increase c amp

241 all true except selective estrogen receptor downregulator (serd), fulvestrant
1. Used for breast cancer
2. is selective oestrogen antagonist
3. Is slower acting, safer, more effective than SERM
4.given as once a month dose

242 which drug not used to control bleeding while delivery of a woman with heart disease ?
1.methylergometrime
2.carboprost
3.syntocin
4.misoprostol

243 not a autoimmune disease outta following??
1.sle
2.myasthenia fravis
3.sickle cell disease
4.graves disease

244 treatment wth INH leads to deficiency of ?
1.thiamine
2.niacin
3.pyridoxine
4.pantothenic acid

245 surgeon removes a part of liver to the left of falciform legiment. which segment the
surgeon has removed
1. 1 & 4a
2. 2 & 3
3. 1 & 4b
4.
246 diminished kidney function which is done

1.N acetylcysteine
2.fenoldopam
3.low osmolar contrast

...
247 a patient had running nost and pain over medical aspect of eye foll that the patient
developed, chemosis,protosis,diplopia of right eye on abduction with congestion of optic disc.
what is the prbable diagnosis?
1.acute ethmoidal sinusitis
2.orbital cellulitis
3.cavernous sinus thrombosis
4.orbital apex syndrome

248 which one of the folloeing not used in diagnosis of insulinoma ?
1.fasting glucose test
2. d xylose
3. c peptide levels
4. insulin /glucose ratio

249 A young lady presents with fever , dysuria and pain abdomen . Uncomplicated acute
cystitis was diagnosed . Which of these is false ?
1.Nitrate test positive
2.e coli ct was < 10 power 3
3.1 pus cell per 7 field
4.1 bacilli per field

250 pt with malaria, given primaquine develops hemolysis, diagnosis?
1.g 6 pd def
2.glucose 6 phosphate
3.
4.

251. Best investigation for bone metastases?
a.MRI
b.CT
c.bone scan
d. x ray

252. CT least accurate for:
a. 1 cm of aneurysm in hepatic artery
b.1 cm of lymph node inpara-aortic region
c.1 cm of pancreas mass in tail

251 anaesthesia avoided in sickle cell patient...
a. iv anaesthesia
b. regional anaes

252 Pregnancy induced cholestasis marker... is
a. Bilirubin
b. Bile salts
c. Sgot/sgpt
d. Alp

253 pt with b/l central loss of vision, normal retinogram.no systemic features. no history of
similar complaints in any family members.
which condition?
a) best's disease
b) stargardt's disease
c) Retinitis pigmentosa
d) macualr hole

254 poor prognostic factor for ALL?
a.hyperdiploidy
b.t(9;22).....ans
c.2-8 yrs
d.?

255 commonest cause for b/l proptosis in children?
a.cavernous haemangioma
b.rhabdomyosarcoma
c,d?

256 most reliable radiological sign of pulmonary hypertension-----
a. descending branch of right pulmonary artery > 16mm
b. desc of lt pul a. >16mm
c. lt. Pul a. >16 mm
d. pul a. >16mm

257 primi in labour with uterine contractions since last 10 hrs,cx not effaced?;next step?
a.sedate n observe
b.syntocin induction
c.c.s.
d.?

258 earliest to be diagnosed by USG?
a.anencephaly
b.prosencephaly
c.meningocele
d.

259 An amoebic liver abscess..5cm-5cm Rx of choice
a. Mz amd antibiotics is choice
b. Repeated aspiration and antibio
c. Surgical drainage
d. Resection of liver

260 perpuce adhasion 2yr child.rx
a. adhesiolysis and dilatation
b. circumscision
c. dorsal slit

261 all true except:
a.human anatomical waste disposed in yellow bag
b.red bag contents can be source of contamination
c.black bag for incineration ash
d.blue bag contents always disposed in secure landfill

262 not a c/i for pregnancy - wpw syndrome

263 no carrier state – measels

264 man with maculopapular rash with prev h/o painless rash.diagn is:
a.treponema pallidum
b.chlamydia
.C.granulomatis
d.H.ducreyi

265 false about strep pneumoniae?
a.capsule aids in infection
b.commonest cause of o.media and pneumonia

c.??

266 Amputation 1st done is
a. Bone fixing

267 mineralocorticoid receptor not present in
a.liver
b.colon
c.hippocampus
d.kidney

268 pasteurised milk is tested mostly by:
a.phosphatase test
b.coliform test

269 d/o/c for central Diab insipidus?
a.vasopressin
b.leuprolide
c.thiazide

270 fallopian tube immotility seen in:
a.churg strauss syndr
b.kartaganer;s
c.?d.?

271 child got cranial sx done ... pituitary got damaged.. which hormone shld b replaced first-
hydrocort
thyroxine
growth hormone

272 delirium tremens,not seen:
a.visual hallucination
b.unconsciousness
c.coarse tremors
a. opthalmoplegia

273 pnt with low Ca,high phosphorus,raised PTH..inv not to be done:
a.urine microscopy
b.PTH levels
c.vit D levels
d.??

274 miglitinides all are true except
1decreases post parendial hyperglycemia
2 hypoglycemia less than sulfonylurease
3 it decreases insulin resistance ans it's (thiazolidinedions acts as insulin sensitizer)
4 it acts by releasing insulin (yes just like sulfonylurease but less hypoglycemia)

275 Pearson's skewness coefficients
a. (Mean-median)/sd
b. Median-mean/sd
c. Sd/mean-median
d. Sd/median-mean

276.Question about contrast used in imaging
Test dose to be given

277.Test for milk
phospatase test

indole test

278.child with seizure within 16hrs of birth
hypoglycemia
hypocalcemia

279. Gun powder can
UV lightANS
IR light

A 5 year old boy while having dinner suddenly becomes aphonic and is brought to the casulty
for the complaint of respiratory difficulty. what should be the next appropriate treatment:-
1) cricothyroidotomy
2) emergency tracheostomy
3) humidified oxygen
4) Hemlich maneouvre

Ans is Emergency tracheostomy

heimlich's maneuver is not tried in partial or incomplete obstruction as it can cause complete
obstruction.
Cricothyrotomy is performed as an intervention of choice in complete obstruction and when
there are no or minimal surgical instruments available.

Emergency tracheostomy followed by removal of foriegn body by direct laryngoscopy is the
procedure to be followed.

there is no point of doing tracheostomy if the thing can be managed with lessor invasive
procedure

"Chocking" redirects here. For the mechanical tool, see Wheel chock.
For the act of compressing someone's neck, see Strangling. For other uses, see Choke.
Choking
Classification and external resources
ICD-10 F41.0, R06.8, T17, W78-W80
ICD-9 784.9, 933.1
MeSH D000402

Choking is the mechanical obstruction of the flow of air from the environment into the lungs.
Choking prevents breathing, and can be partial or complete, with partial choking allowing
some, although inadequate, flow of air into the lungs. Prolonged or complete choking results in
asphyxia which leads to anoxia and is potentially fatal. Oxygen stores in the blood and lungs
keep the victim alive for several minutes after breathing is stopped completely.

Choking can be caused by:

* Physical obstruction of the airway by a foreign body.
* Respiratory diseases that involve obstruction of the airway.
* Compression of the laryngopharynx, larynx or trachea in strangulation.

Contents

* 1 Choking in non-humans
* 2 Foreign objects
* 3 Symptoms and clinical signs
* 4 Treatment
o 4.1 Encouraging the victim to cough

o 4.2 Back slaps
o 4.3 Abdominal thrusts
+ 4.3.1 Self treatment with abdominal thrusts
o 4.4 Modified chest thrusts
o 4.5 Finger sweeping
o 4.6 Direct vision removal
* 5 CPR
* 6 Notable victims
* 7 Other uses of abdominal thrusts
* 8 References
* 9 External links

Choking in non-humans
Wiki letter w.svg This section is empty. You can help by adding to it.
Foreign objects

The type of choking most commonly recognised as such by the public is the lodging of foreign
objects (also known as foreign bodies, but consisting of any object which comes from outside
the body itself, including food, toys or household objects) in the airway.

This type of choking is often suffered by small children, who are unable to appreciate the
hazard inherent in putting small objects in their mouth. In adults, it mostly occurs whilst the
patient is eating. In one study, peanuts were the most common obstruction.

Symptoms and clinical signs

* The person cannot speak or cry out, or has great difficulty and limited ability to do so.
* Breathing, if possible, is labored, producing gasping or wheezing.
* The person has a violent and largely involuntary cough, gurgle, or vomiting noise, though
more serious choking victims will have a limited (if any) ability to produce these symptoms
since they require at least some air movement.
* The person desperately clutches his or her throat or mouth, or attempts to induce vomiting
by putting their fingers down their throat.
* If breathing is not restored, the person's face turns blue (cyanosis) from lack of oxygen.
* The person does any or all of the above, and if breathing is not restored, then becomes
unconscious.

Treatment

Choking can be treated with a number of different procedures, with both basic techniques
available for first aiders and more advanced techniques available for health professionals.

Many members of the public associate abdominal thrusts, also known as the Heimlich
Maneuver with the correct procedure for choking, which is partly due to the widespread use of
this technique in movies, which in turn was based on the widespread adoption of this
technique in the United States at the time.

Most modern protocols (including those of the American Heart Association and the American
Red Cross, who changed policy in 2006[5] from recommending only abdominal thrusts)
involve several stages, designed to apply increasingly more pressure.

The key stages in most modern protocols include:
Encouraging the victim to cough

This stage was introduced in many protocols as it was found that many people were too quick
to undertake potentially dangerous interventions, such as abdominal thrusts, for items which
could have been dislodged without intervention. Also, if the choking is caused by an irritating
substance rather than an obstructing one, and if conscious, the patient should be allowed to
drink water on their own to try to clear the throat. Since the airway is already closed, there is

very little danger of water entering the lungs. Coughing is normal after most of the irritant has
cleared, and at this point the patient will probably refuse any additional water for a short
time.
Back slaps

The majority of protocols now advocate the use of hard blows with the heel of the hand on the
upper back of the victim. The number to be used varies by training organization, but is usually
between five and twenty.

The back slap is designed to use percussion to create pressure behind the blockage, assisting
the patient in dislodging the article. In some cases the physical vibration of the action may
also be enough to cause movement of the article sufficient to allow clearance of the airway.

Almost all protocols give back slaps as a technique to be used prior to the consideration of
potentially damaging interventions such as abdominal thrusts, but Henry Heimlich, noted for
promulgating abdominal thrusts, wrote in a letter to the New York Times that back slaps were
proven to cause death by lodging foreign objects in to the windpipe.

The findings of a 1982 Yale study by Day, DuBois, and Crelin that "persuaded the American
Heart Association to stop recommending back blows for dealing with choking...was partially
funded by Heimlich's own foundation." According to Roger White MD of the Mayo Clinic and
American Heart Association (AHA), "There was never any science here. Heimlich overpowered
science all along the way with his slick tactics and intimidation, and everyone, including us at
the AHA, caved in."

Abdominal thrusts
A demonstration of abdominal thrusts

Abdominal thrusts, also known as the Heimlich Maneuver (after Henry Heimlich, who first
described the procedure in a June 1974 informal article entitled "Pop Goes the Cafe Coronary",
published in the journal Emergency Medicine). Edward A. Patrick, MD, PhD, an associate of
Heimlich, has claimed to be the uncredited co-developer of the procedure. Heimlich has
objected to the name "abdominal thrusts" on the grounds that the vagueness of the term
"abdomen" could cause the rescuer to exert force at the wrong site.

Performing abdominal thrusts involves a rescuer standing behind a patient and using their
hands to exert pressure on the bottom of the diaphragm. This compresses the lungs and
exerts pressure on any object lodged in the trachea, hopefully expelling it. This amounts to an
artificial cough.

Due to the forceful nature of the procedure, even when done correctly it can injure the person
on whom it is performed. Bruising to the abdomen is highly likely and more serious injuries
can occur, including fracture of the xiphoid process or ribs.

In some areas, such as Australia, authorities believe that there is not enough scientific
evidence to support the use of Abdominal thrusts and their use is not recommended in first
aid.

Self treatment with abdominal thrusts

A person may also perform abdominal thrusts on themselves by using a fixed object such as a
railing or the back of a chair to apply pressure where a rescuer's hands would normally do so.
As with other forms of the procedure, it is possible that internal injuries may result.
[edit] Modified chest thrusts

A modified version of the technique is sometimes taught for use with pregnant and/or obese
patients. The rescuer places their hand in the center of the chest to compress, rather than in
the abdomen.

Finger sweeping

The American Medical Association advocates sweeping the fingers across the back of the
throat to attempt to dislodge airway obstructions, once the choking victim becomes
unconscious

Some protocols advocate the use of the rescuer's finger to 'sweep' foreign objects away once
they have reached the mouth.[citation needed] However, many modern protocols recommend
against the use of the finger sweep as if the patient is conscious, they will be able to remove
the foreign object themselves, or if they are unconscious the rescuer should simply place them
in the recovery position (where the object should fall out due to gravity). There is also a risk
of causing further damage (for instance inducing vomiting) by using a finger sweep
technique.

Direct vision removal

The advanced medical procedure to remove such objects is inspection of the airway with a
laryngoscope or bronchoscope, and removal of the object under direct vision, followed by CPR
if the patient does not start breathing on their own. Severe cases where there is an inability to
remove the object may require cricothyrotomy.

CPR

In most protocols, once the patient has become unconscious, the emphasis switches to
performing CPR, involving both chest compressions and artificial respiration. These actions are
often enough to dislodge the item sufficiently for air to pass it, allowing gaseous exchange in
the lungs.

Notable victims

* United States President George W. Bush survived choking on a pretzel on January 13, 2002,
receiving major media coverage.
* Jimmie Foxx, a famous Major League Baseball player, died by choking on a bone.
* Tennessee Williams, the playwright, died after choking on a bottle cap.
* An urban legend states that obese singer Mama Cass choked to death on a ham sandwich.
This was borne out of a quickly discarded speculation by the coroner, who noted a partly eaten
ham sandwich and figured she may have choked to death. In fact, she died of a heart
condition, often wrongly referred to in the media as heart failure but specified on her death
certificate as fatty myocardial degeneration.
* The Queen Mother was admitted to a UK Hospital for an operation in May 1993 after choking
on a fish bone.

Other uses of abdominal thrusts

Dr. Heimlich also advocates the use of the technique as a treatment for drowning and asthma
attacks, but Heimlich's promotion to use the maneuver to treat these conditions resulted in
marginal acceptance. Criticism of these uses has been the subject of numerous print and
television reports which resulted from an internet and media campaign by his son, Peter M.
Heimlich, who alleges that in August 1974 his father published the first of a series of
fraudulent case reports in order to promote the use of abdominal thrusts for near-drowning
rescue.

A 35 year old female has proximal weakness of muscles, repeated ptosis and east fatiguability.
The best test to diagnose her condition is:
1) Muscle biopsy
2) CPK
3) Edrophonium test

4) EMG
Answer: Edrophonium test.
Explanation: Muscle biops, EMG and CPK are primarily used for diagnosis of inflammatory
myopathies e.g. polymyositis, inclusion body myositis. Here the clinical picture is clearly of
MG, which most common presentataion is extraocular muscle palsies. Plus inflammtory
myopathies usually spare extraocular muscles. BUT proximal muscle weakness is included in
the syndrome of myapthic muscle weakness. Anyways, I think what they wanted is to focus on
how to distinguish between MG and inflammatory myopathies using a single test and not a
diagnostic test. So the answer is Edrophonium which will help us to clarify it in a split
second( figuratively) Edrophonium Positive=MG, negative, test further for myopathies.

What are the methods for diagnosing Myasthenia Gravis and how long do they take to
perform?

The initial diagnostic exam for Myasthenia Gravis includes the following:

* Evaluation begins with examination by a neurologist. 1 hour.
* " Tensilon test. (A Tensilon test is positive in many patients who have MG, but may actually
be negative in 20-30% patients with MG diagnosed by other methods.) 15-30 minutes in the
physician's office.
* Acetylcholine receptor antibodies (a blood test). Acetylcholine receptor antibodies are
positive in 90% of patients with general myasthenia. The results usually take a week to return
from the laboratory.
* EMG (electromyogram) is a test to determine the electrical response from the muscle after
stimulation of the nerve. 1 hour.

ans: EMG

An additional test is:

* Single-fiber EMG. This test is only performed at specialized centers. The exam itself takes 1-
3 hours to perform. A single fiber EMG is considered the best test, being positive in 95-99% of
MG patients.

In rare patients all these tests are normal, but examination by a neurologist suggest
Myasthenia Gravis. If the disease is mild or purely ocular (symptoms of the eye muscles), then
the tests are more frequently negative then in the case of the generalized disease.

Q: which is NOT a definite airway
a. nasotracheal tube
b. orotracheal tube
c. LMA......ANS
d. cricothyroidtomy..

Ref:
A definitive airway can be: an endotracheal tube, an nasotracheal tube, or a surgical airway
(cricothroidotomy).

The need for a definitive airway is based upon a number of clinical findings:
the presence of apnea
inability to maintain a patent airway by less invasive means
need to protect the lower airway from aspiration of blood or vomitus
impending or potential airway compromise (following inhalational injury, facial fractures,
retroparygeal hematoma or sustained seizure activity)
presence of a closed head injury requiring assisted ventilation

inability to maintain adequate oxygenation by face mask oxygen supplementation
any patient with a Glasgow coma score of 8 or less

17. Which is not a neural tumor ?
1. Ependymoma
2. Neuroblastoma
3. Gangliocytoma
4. Ganglioglioma
Answer CONTROVERSIAL (cant ans be neuroblastoma,neuroendocrine tumor)

Neuroblastoma is the most common extracranial solid cancer in childhood and the most
common cancer in infancy, with an annual incidence of about 650 new cases per year in the
US. Close to 50 percent of neuroblastoma cases occur in children younger than two years old.
It is a neuroendocrine tumor, arising from any neural crest element of the sympathetic
nervous system or SNS.

REF Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso Fausto; Robbins, Stanley L.;
Abbas, Abul K. (2005). Robbins and Cotran pathologic basis of disease. St. Louis, Mo: Elsevier
Saunders. pp. 1406.
Ganglioglioma is a tumour that arises from ganglion cells in the central nervous system.
The term "gangliocytoma" is sometimes equated with ganglioglioma. However, it is also
sometimes equated with ganglioneuroma. The term "gangliocytoma" is sometimes used to
imply that the tumor is entirely neuronal.

Q-Epileptic potential is present in
A. Desflurane
B. Halothane
C. Sevoflurane
D. Ether
Best Ans-Sevoflurane

• SEVOFLURANE, ISOFLURANE, ENFLURANE Have epileptic potential.

• "ISOLATED EPILEPTIFORM PATTERNS SOMETIMES CAN BE SEEN DURING
INTERSUPPRESSION ACTIVITY AT 1.5 TO 2 MAC ISOFLURANE. SEVOFLURANE CAUSES
SIMILAR DOSE-DEPENDENT EEG EFFECTS. EQUI-MAC CONCENTRATIONS OF SEVOFLURANE
AND ISOFLURANE CAUSE SIMILAR EEG CHANGES.
• EPILEPTIFORM ACTIVITY HAS BEEN INDUCED BY ADMINISTRATION OF SEVOFLURANE IN
PATIENTS WITHOUT EPILEPSY, AND SEIZURE ACTIVITY ON EEG, BUT NOT CLINICAL SEIZURE
ACTIVITY, HAS BEEN REPORTED IN PEDIATRIC PATIENTS WITH A HISTORY OF EPILEPSY
DURING INDUCTION OF ANESTHESIA WITH SEVOFLURANE.
• DESPITE THESE OBSERVATIONS, SEVOFLURANE, SIMILAR TO OTHER INHALATION AGENTS,
IS NOT SUITABLE FOR USE DURING ELECTROCORTICOGRAPHY FOR LOCALIZATION OF
SEIZURE FOCI.
• EEG PATTERNS SEEN WITH ENFLURANE ARE SIMILAR TO THE PATTERNS SEEN WITH
ISOFLURANE EXCEPT THAT EPILEPTIFORM ACTIVITY IS CONSIDERABLY MORE PROMINENT.
• At 2 to 3 MAC, burst suppression is seen, but virtually all intersuppression activity consists of
large spike/wave pattern discharges. Hyperventilation with high concentrations of enflurane
increases the length of suppression, decreases the duration of bursts, but increases the
amplitude and main frequency component of the intersuppression epileptiform activity. Frank
EEG seizures also may occur with enflurane that produce the same cerebral metabolic effects
as pentylenetetrazol, a known convulsant.

• Halothane also produces EEG patterns similar to those of isoflurane, but dosages of
halothane that would produce burst suppression in the EEG (3 to 4 MAC) are associated with
profound cardiovascular toxicity.
• Desflurane produces EEG changes similar in nature to equi-MAC concentrations of isoflurane.
In limited clinical studies,
• THERE HAS BEEN NO EVIDENCE OF EPILEPTIFORM ACTIVITY WITH DESFLURANE, DESPITE
HYPERVENTILATION AND 1.6 MAC DOSAGE,[219] AND DESFLURANE HAS BEEN USED AS A
TREATMENT OF REFRACTORY STATUS EPILEPTICUS.

• “SEIZURES OCCUR DURING INDUCTION OF ANESTHESIA WITH HIGH CONCENTRATIONS OF
SEVOFLURANE IN CHILDREN, INCLUDING THOSE WITHOUT A RECOGNIZED SEIZURE
DIATHESIS.
• IN TWO HEALTHY HUMAN SUBJECTS, EEG BURST SUPPRESSION WITH 2 MAC
SEVOFLURANE WAS ACCOMPANIED BY EPILEPTIFORM DISCHARGES THAT WERE OBSERVED
DURING EEG MONITORING.
• These discharges were associated with a significant increase in CBF, thus demonstrating that
flow-metabolism coupling was preserved. In patients with temporal lobe epilepsy,
administration of 1.5 MAC sevoflurane elicited widespread paroxysmal interictal EEG activity.
Of note was the observation that paroxysmal activity was not restricted to the ictal focus and
that the administration of sevoflurane was not of any assistance in localization of the
epileptogenic region of the brain.
• The development of tonic-clonic movements indicative of seizure activity has also been
reported in otherwise healthy patients on emergence from sevoflurane anesthesia. In all of the
reported cases of seizure activity attributable to sevoflurane anesthesia, untoward sequelae
have not been documented. These reports highlight sevoflurane's ability, albeit small, to evoke
epileptiform activity, and accordingly, the use of sevoflurane in patients with epilepsy should
be undertaken with appropriate caution.”
----------------- Miller's Anesthesia

• “Potential for cerebral toxicity has been studied for sevoflurane as compared to halothane.
At
• normal CO2 and blood pressure no evidence of sevoflurane toxicity exists.

• With extreme hyperventilation to decrease cerebral blood flow by half, brain lactate levels
increase, but significantly less than with halothane. There are conflicting data as to whether
sevoflurane has a proconvulsant effect.
• High, long-lasting concentrations of sevoflurane (1.5 to 2.0 MAC), a sudden increase in
cerebral sevoflurane concentrations, and hypocapnia can trigger EEG abnormalities that often
are associated with increases in heart rate in both adults and
• children. This has raised the question as to the appropriateness of sevoflurane in patients
with epilepsy.”

• “Sevoflurane has the potential for toxicity, since it can be converted to toxic agents;
however, the concentration of these agents is normally below
• the toxic threshold. Sevoflurane has been shown to be a useful alternative to halothane for
• p ediatric induction, however there are reports of epileptiform discharges in patients given
sevoflurane at induction doses (1.5 to 2 MAC).”
---------- Barash, Paul G.; Cullen, Bruce F.; Stoelting, Robert K.
Clinical Anesthesia, 5th Edition
Lippincott Williams & Wilkins

Drug issues
The following anaesthetic and allied drugs should be used with caution in epileptics:
-----oxford anesthesia

1. Most common nerve injured in supracondylar fracture humerus?
a. Median

b. Radial
c. Ulnar
d. Anterior interosseus nerve
Ans: D
The Mnemonic for the order of nerves injured in Supracondylar fracture is AMRU
That is:
Ant . Interosseus Nerve> Median > Radial >Ulnar

2. Earliest symptom of GERD in an infant is?
A. Respiratory distress answer
B. Upper GI bleed
C. regurgitation
D.obstruction

Ans: C REGURGITATION....
Reference from Nelson Pediatrics
Infantile reflux manifests more often with regurgitation (especially postprandially),
signs of esophagitis (irritability, arching, choking, gagging, feeding aversion), and
resulting failure to thrive; symptoms resolve spontaneously in the majority by 12–24
mo. Older children, in contrast, may have regurgitation during the preschool years;
complaints of abdominal and chest pain supervene in later childhood and adolescence.
Occasional children present with neck contortions (arching, turning of head)
designated Sandifer syndrome. The respiratory presentations are also age dependent:
GERD in infants may manifest as obstructive apnea or as stridor or lower airway
disease in which reflux complicates primary airway disease such as laryngomalacia or
bronchopulmonary dysplasia. Otitis media, sinusitis, lymphoid hyperplasia,
hoarseness, vocal cord nodules, and laryngeal edema have all been associated with
GERD. In contrast, airway manifestations in older children are more frequently related
to asthma or to otolaryngologic disease such as laryngitis or sinusitis.

3. Basal metabolic rate is closely associated with?
A. Lean body mass
B. Body surface area
C. Body mass index
D. Body weight
Ans: A Lean Body mass (REPEAT...shall not spend much time on repeats)

4. A girl presented with recurrent occipital headache associated with ataxia and
vertigo. Mother also has similar complaints. Most probable diagnosis is?
A. Vestibular neuronitis
B. Basillar migraine
C. TIA
D. –
Ans: b Basilar migraine(REPEAT)

5. Drug of choice for central Diabetes Insipidus is?
a. Desmopressin
b. Leuperolide
c. Thiazide diuretics
d. –
Ans: A Desmopressin
Reference: Harrispn 17th ed
The signs and symptoms of uncomplicated pituitary DI can be eliminated completely
by treatment with desmopressin (DDAVP), a synthetic analogue of AVP (Fig. 334-1). It
acts selectively at V2 receptors to increase urine concentration and decrease urine
flow in a dose-dependent manner (Fig. 334-4). It is also more resistant to degradation
than AVP and has a three- to fourfold longer duration of action. Desmopressin
(DDAVP) can be given by IV or SC injection, nasal inhalation, or oral tablet.

6. A 32 year old mountaineer has a hematocrit of 70%. What is the possible
explanation?
A. Polycythemia with relative dehydration
B. High altitude cerebral oedema
C. High altitude pulmonary oedema
D. Hemodilution

Ans.A Polycythemia and relative dehydration

Reference:Harrison 17th ed
Polycythemia can be spurious (related to a decrease in plasma volume; Gaisbock's
syndrome), primary, or secondary in origin. The secondary causes are all associated
with increases in EPO levels: either a physiologically adapted appropriate elevation
based on tissue hypoxia (lung disease, high altitude, CO poisoning, high-affinity
hemoglobinopathy) or an abnormal overproduction (renal cysts, renal artery stenosis,
tumors with ectopic EPO production). A rare familial form of polycythemia is
associated with normal EPO levels but hyperresponsive EPO receptors due to
mutations

7. Tetracycline is used in the prophylaxis of which of the following diseases?
a. Cholera
b. Brucellosis
c. Leptospirosis
d. Meningitis
Ans: a Cholera
Reference:Goodman Gilman and Harrison 17th ed
Doxycycline (300 mg as a single dose) is effective in reducing stool volume and
eradicating Vibrio cholerae from the stool within 48 hours. Antimicrobial agents,
however, are not substitutes for fluid and electrolyte replacement in this disease. In
addition, some strains of V. cholerae are resistant to tetracyclines.

8. A 7 month old child has bouts of cough ending with a whoop. What is the best way
to confirm the diagnosis?
A. Nasophayngeal swab
B. Cough plate culture
C. Tracheal aspirate
D. –

Ans: a Nasopharyngeal swab
Harrison 17th ed

The diagnosis is Pertusis and we have to find the best specimen to confirm the
diagnosis.

Culture of nasopharyngeal secretions remains the gold standard of diagnosis, although
DNA detection by polymerase chain reaction (PCR) is replacing culture in many
laboratories because of increased sensitivity and quicker results. The best specimen is
collected by nasopharyngeal aspiration, in which a fine flexible plastic catheter
attached to a 10-mL syringe is passed into the nasopharynx and withdrawn while
gentle suction is applied.

9. Aflatoxin is produced by?
A. Aspergillus flavus
B. Aspergillus niger
C. Candida
D. –

Ans: a Aspergillus Flavus

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