AIIMS May 2013 Medicine 1 A patient presented with alcohol withdrawl syndrome now having seizure..

DOC is AIIMS MAY 2013 a) Diazepam b) valproate Ans (a) Ref-Consultant-POZITIVE Psychiatry hand out-page 18 Withdrawal tremors (shakes/jitters) 6-8 hours after cessation Psychotic/perceptual disturbance 8-12 hours after cessation Seizure (Rum fits) 12-24 hours Delirium Tremens within 72 hours. Detoxification is first step done by Benzodiazepines (chlordiazepoxide) Delirium Tremens confusion, disorientation, VH, dangerous exhaustion Black out discrete episodes of anterograde amnesia during intoxication Fetal alcohol syndrome Microcephaly, Craniofacial malformation, limb,heart defects Disulfiram inhibits aldehyde dehydrogenase, DA reaction characterised by flushing, tachycardia, palpitation, headache, hot flushes. Alcoholic anonymous self help group of recovering alcoholics AL anon Spouses of alcohol Al Ateen children of alcoholics Deterrants agents Disulfiram, metronidazole, citrated calcium carbamide Anticraving agents Naltrexone, Fluoxetine, Acamprosate 2 Bells palsy which is not correct AIIMS MAY 2013 a) steroid is mandatory b) unilateral facial deafness c) immediate surgical decompression Ans (c) REFERENCE OHC-2,3 POZITIVE Consultant BELLS PALSY Symptomatic measures include (1) the use of paper tape to depress the upper eyelid during sleep and prevent corneal drying, and (2) massage of the weakened muscles. A course of glucocorticoids, given as prednisone 6080 mg daily during the first 5 days and then tapered over the next 5 days, appears to shorten the recovery period and modestly improve the functional outcome A recently published randomized trial found no added benefit of acyclovir (400 mg five times daily for 10 days) compared to prednisolone alone for treatment of acute Bells palsy; (17TH EDITI0N HARRISON) the overall weight of evidence suggests that the combination therapy with prednisone plus valacyclovir may be marginally be tter than prednisone alone(18TH EDITI0N HARRISON) 3 chromosome dividing perpendicular to usual axis of division forms.. AIIMS MAY 2013 a.ring chromosome b.isochromosome c)acrochromosome d)subtelomeric chromosome Ans (b) Ref-OHC Book,POZITIVE consultant * Dysgerminomas mutations in c-Kit oncogenes [as seen in gastrointestinal stromal tumors (GIST)], whereas a subset of germ cell tumors have isochromosome 12 4 Embryonic hemoglobin is composed of _____chains AIIMS MAY 2013 a)Alpha&beta b)epsilon& gamma c).gamma &beta d)zeta &epsilon Ans (d) REFERENCE -POZITIVE-OHC2,3-Hematology OPERATION HARRI- BOOK PAGE 464 CONSULTANT MKT Human Heamoglobins Embryonic hemoglobins Fetal hemoglobin Adult hemoglobins gower 1- zeta(2), epsilon(2) gower 2- alpha(2), epsilon (2) Portland- zeta(2), gamma (2) hemoglobin F- alpha(2), gamma(2) hemoglobin A- alpha(2), beta(2) hemoglobin A2- alpha(2), delta(2) 5) Slow growing tumor affecting cerebellum, spinal cord in chidren is AIIMS MAY 2013 a) Pilocytic astrocytoma b)Meningioma c)medulloblastoma Ans (a) REF-POZITIVE OHC-2,3,CONSULTANT OHC 3-Class discussion Low Grade Astrocytoma 6 More common in children Pilocytic Astrocytoma - Most common childhood brain Tumor

- Cerebellum - Cystic, well demarcated - Spindle shaped cells 6) A young male with genital , oralulcers, and visual disturbance AIIMS MAY 2013 a) bechets syndrome b)Reiters syndrome c) Oculocutaneous aphthous ulceration syndrome d). Epidermolysis bullosa Ans (a) REFERENCE POZITIVE-OHC 2,3 CONSULTANT Discussion fron OHC3 DAY 8 Recurrent oral ulceration plus two of the following: Recurrent genital ulceration Eye lesions Skin lesions Pathergy test The syndrome affects young males and females Males and females are affected equally, but males often have more severe disease. Blacks are very infrequently affected. ANTIBODIES????? Circulating autoantibodies against -enolase of endothelial cells and antiSaccharomyces cerevisiae antibodies (ASCAcharacteristic of Crohns disease) are found to be present in the later stages of the disease. A tendency toward venous thrombus formation accounts for many of the consequences of Behets syndrome the strong association with HLA-B5 (B51) alloantigen Eye involvement with scarring and bilateral panuveitis is the most dreaded complication, since it occasionally progress es rapidly to blindness The arthritis of Behets syndrome is not deforming and affects the knees and ankles PATHERGY TEST In more serious cases, thalidomide (100 mg/d) is effective Early initiation of azathioprine tends to favorably affect the long-term prognosis of Behets syndrome Colchicine can be beneficial for the mucocutaneous manifestations of the syndrome glucocorticoid therapy Bechets syndrome Diagnostic criteria- Recurrent oral ulceration + 2 a) Recurrent genital ulcers b) Eye lesions c) Skin lesions d) Pathergy Test M:F 1:1, but males severe disease HLA B5 Genital ulcers, less common but more specific Pathergy Test - Non specific skin inflammatory reaction to scratch or Intradermal saline injection. Eye Panuveitis most dreaded complication Nondeforming arthritis knees Arterial and venous Thrombosis Tt steroids The syndrome affects young males and females from the Mediterranean region, the Middle East, and the Far East, suggesting a link with the ancient Silk Route 7. sudden onset lbbb seen in all AIIMS MAY 2013 excpt a.MI.. b.ASHMAN syndrorme. c.hypokalemia d. hyperkalemia Ans ()-NOT Discussed 8 asymptomatic child with delta wave short PR interval which drug not to be given AIIMS MAY 2013 a) beta blocker b)amiodarone c)adenosine Ans (A) REFERENCE OHC 2,3 CONSULTANT 9) bilateral babinski sign? AIIMS MAY-2013 a. pons hemorrhage b. basal ganglia hemorrhage c. cerebellar hemorrhage Ans (a) REFERNCE-OHC 3,POZITIVE CONSULTANT 10)Which of the ulcer is painless AIIMS MAY 2013 A) syphilis

B) Herpes C)Chancroid D) Ans (a) Reference OHC 2,3 OPERATION HARRI BOOK PAGE 715 Primary Syphilis * Primary chancre a single painless * In women, common primary sites are the cervix and labia * Inguinal lymphadenopathy is bilateral Consultant The genus Treponema includes T. pallidum subspecies pallidum, which causes venereal syphilis; T. pallidum subspecies pertenue, which causes yaws; T. pallidum subspecies endemicum, which causes endemic syphilis or bejel; T. carateum, which causes pinta. The primary lesion appears at the site of inoculation, usually persists for 46 weeks, and then heals spontaneously Approximately 15% of patients with secondary syphilis still have persisting or healing chancres There are four stages of syphilis in adults primary, secondary, latent and tertiary syphilis. Manifestations of primary syphilis include a hard painless chancre and regional lymphadenitis They can occur on the palms and the soles. The patient may also have patchy alopecia, c ondyloma lata (moist, flat, confluent plaques), or mucous patches. Systemic manifestations include malaise, anorexia, headache, sore throat, arthralgia, low grade fever, and generalized lymphadenopathy lues maligna????? lues maligna, a rare form of secondary syphilis, The criteria for diagnosis of lues maligna include strongly positive serological test results, a severe Herxheimer reaction , and an excellent response to antibiotic therapy CORONA VENERIS????? PAPULAR LESIONS OF SEC.SYPHILIS,ALONG THE ANTERIOR MARIGIN OF SCALP Tertiary or late syphilis is a noncontagious but highly destructive phase of syphilis, which may take many years to develop ; it can manifest itself in several forms. 11) child with mental retardation , seizures and angiomylipoma in kidney diagnosis is AIIMS MAY 2013 a)tuberosclerosis B) von hipple lindau c) Ans (a) REF OHC 2,3 OH book-page 351 consultant Exiting 18th Neurofibromatosis type 1 NF1 17 Neurofibroma, neurofibrosarcoma, brain tumor Neurofibromatosis type 2 NF2 22 Vestibular schwannoma, meningioma, spine Nevoid basal cell carcinoma syndrome (Gorlins syndrome) 9 Basal cell carcinoma, medulloblastoma, jaw cysts Tuberous sclerosis 1 9 Angiofibroma, renal angiomyolipoma 2 16 Von HippelLindau VHL 3 Kidney, cerebellum, pheochromocytoma Multiple Endocrine Neoplasia 1 (Werners syndrome) AD Mutations in Menin (ch11q13) Pituitary adenoma, malignant schwannomas Parathyroid and pancreatic islet cell tumors Neurofibromatosistype 1 (NF1) AD Mutations inNF1/Neurofibromin (ch17q12-22) Schwannomas, astrocytomas, optic nerve gliomas, meningiomas Neurofibromas, neurofibrosarcomas, others Neurofibromatosis type 2 (NF2) AD Mutations in NF2/Merlin (ch22q12) Bilateral vestibular schwannomas, astrocytomas, multiple meningiomas, ependymomas Tuberous sclerosis (TSC) (Bournevilles disease) AD Mutations in TSC1/TSC2 (ch9q34/16) Subependymal giant cell astrocytoma, ependymomas, glioma, ganglioneuroma, hamartoma Turcots syndrome AD AR Mutations in APCa (ch5) hMLH1 (ch3p21) Gliomas, medulloblastomas Adenomatous colon polyps, adenocarcinoma Von HippelLindau (VHL) AD Mutations in VHL gene (ch3p25) Hemangioblastomas Retinal angiomas, renal cell carcinoma, pheochromocytoma, pancreatic tumors and cysts, endolymphatic sac tumors of the middle ear Neurofibromatosis 2 S Bilateral vestibular schwannomas

S NF2 gene chr.22 S Neurofibromin 2 or merlin Juvenile postr.subcapsular opacity Multiple caf au lait spots and peripheral neurofibromas occur rarely Tuberous sclerosis S Adenoma Sebaceum Ash leat macule shagreen patch S Subependymal giant cell Astrocytoma S Rhabdomyomas of myocardium S Angiomyomas of kidney, liver, adrenals S TSC 1 chr 9 S TSC 2 chr 16 S Tuberin 12)all are major criteria for rheumatic fever except AIIMS MAY 2013 a. carditis b. subcutaneous nodule c. polyarthralgia d. chorea Ans (c) Reference OHC POZIGOLD CONSULTANTS C. Rheumatic fever Rheumatogenic serotypes - 1,3,5,6,18 Criterias Five major Carditis - Pancarditis - 40 60% - Mitral - No constrictive pericarditis * Migratory Arthritis - 75% Syndenhams chorea - < 10% Nodules, Erythema marignatum <10% 13. Forgotten muscle in Rotator cuff AIIMS MAY 2013 A)supraspinatus B)subscapularis C)teres minor D) infraspinatus Ans () NOT DISCUSSED 14) Which of the following type of hip dislocation is characterised by, internal rotation of limb, limb shortening and restriction of abduction ? AIIMS MAY 2013 A. Anterior B. Posterior C. Lateral D. Medial Ans (b) REF MKT-OHC CONSULTANT Typical deformities in dislocations Joint (dislocation) Deformity Shoulder (anterior) Abduction Elbow (posterior) Flexion Hip Posterior Flexion adduction internal rotation Anterior Abduction external rotation Knee Flexion, external rotation Ankle Varus Pharmacology 15)Priapism is caused by poison of AIIMS MAY 2013 a) Sea snake b) Spanish fly c) Scorpion d) Rattle snake Ans () 16)Ritonavir inhibits metabolism of all except AIIMS MAY 2013 a) midazolam b) amiadarone c) cisapride

d) phenytoin Ans (a) REF OHC OH BOOK-PAGE 6 CONSULTANT Molecule Substrates Inhibitors CYP3A Calcium channel blockers Amiodarone Anti Arrythmics Ketoconazole, Itraconazole Statins Erythro, Clarithro Indinavir, Saquinavir, Ritonavir(AIIMS2010***) Antiviral ritonavir is a very potent CYP3A4 inhibitor added to anti-HIV regimens, not because of its antiviral effects but because it decreases clearance, and hence increases efficacy, of other anti-HIV agents 17)Time dependent killing,post antibiotic effect is seen in AIIMS MAY 2013 A)aminoglycosides B)Beta lactams C)Quinolones D)Macrolides Ans (b) REF POZIGOLD OPERATION HARRI BOOK-PAGE-750 OHC Antibiotic class is characterized as either concentration dependent (fluoroquinolones, aminoglycosides), such that an incre ase in antibiotic concentration leads to a more rapid rate of bacterial death, or time dependent(beta lactams). Absorption bioavailability ranges from as little as 1020% (erythromycin and penicillin G) -100% [amoxicillin, clindamycin, metronidazole, doxycycline, trimethoprim-sulfamethoxazole (TMPSMX), linezolid, and most fluoroquinolones]. 18)Drug for juvenile myoclonic epilepsy in pregnant female? AIIMS MAY 2013 a. levetiracetam b. lacosamide c. phenytoin d. carbamazepine Ans (a) 19)which do not cause SLE? AIIMS MAY-2013 a. penicillin b. isoniazid c. hydralazine Ans (a) REF OHC,CONSULTANT POZIGOLD Drug induced lupus ANA +ve Anti Histone + HLA DR4 Spares CNS, Renal Involves joint, skin Less female Predilection Drugs - Pneumonic HIPMCQ Hydralazine INH procainamide methyl Dopa chlorpromazine Quinidine Others - Phenytoin, carbamazepine, lithium. Moderate to low risk Isoniazid (antibiotic) Minocycline (antibiotic) Pyrazinamide (antibiotic) Quinidine (antiarrhythmic) D-Penicillamine (anti-inflammatory) Carbamazepine (anticonvulsant) Oxcarbazepine (anticonvulsant) Phenytoin (anticonvulsant) Propafenone (antiarrhythmic) Biologics such as interleukins (eg, interleukin -2 [IL-2]), interferons (eg, alfa, gamma, beta), and tumor necrosis factor alpha (TNF-) inhibitors are associated with musculoskeletal symptoms and antibody production suggestive of a lupuslike autoimmune disorder Antiarrhythmics Procainamide and quinidine Antibiotics Minocycline[10] and isoniazid Antifungals Griseofulvin and voriconazole Anticonvulsants Valproate, ethosuximide, carbamazepine,[11] and hydantoins Hormonal therapy Leuprolide acetate Antihypertensives Hydralazine, methyldopa, and captopril Anti-inflammatories Penicillamine and sulfasalazine[12]

 Antipsychotics Chlorpromazine Cholesterol-lowering agents Lovastatin, simvastatin, and gemfibrozil Biologics Interleukins (eg, IL-2), interferons (eg, alfa, beta, gamma), and TNF- (etanercept, infliximab, adalimubab)[5] Inhalers Tiotropium bromide inhaler[13] Other drug categories Ophthalmic timolol 20)vasopressin antagonist acts on? AIIMS MAY 2013 a. cortical collecting duct b. medullary collecting duct c. pct d. Dct Ans (a) Reference OHC CONSULTANT Physiology 21)ficks law? AIIMS MAY 2013 a. passive diffusion b. active movement Ans (a) REF MODEL EXAM POZITIVE CONSULTANT Discussion from POZITIVE MODEL exam A simple Diffussion * From high concentration to low concentration * Ficks law of diffussion - Net rate of diffussion = Diffusion co efficient X Area of membrane X (cin cout) Thickness of membrane * Diffussion by - distance - size - Temp - Lipid solubility * Gated channels - Voltage gated - Ligand gated - Open or close when they bind an ion or a specific molecule - Extracellular ligands 1st messenger - Intracellular ligands 2nd messenger B. Facilitated Diffussion * Carrier mediated eg. Glucose III Active Transport a) Primary active b) Secondary active c) Carrier type process d) Vesicular Transport process Primary active * Directly use energy from ATP eg. Na+ K+ Pump - Ca2 Pump - K+ H+ Pump Na+ K+ Pump Most common pump in the body * Three 1, 2, 3 and 3 1, 2, 3 subunits * Na, K+ transport occurs through sub unit * Mode of Function Phosphorylation dephosphorylation * An Electrogenic pump with a coupling ratio of 3:2 * 3 Na+ out * 2 K+ in * Major energy consumer * Inhibitors - Too low Na+, K+ - Hypothermia - 02 - Poisons dinitro phenol Promotors Inhibitors * Insulin * Na, K+

* Thyroid * Hypothermia * Aldosterone * 02 * G actin * Poisons dinitrophenol 22)dysphoria occurs due to AIIMS MAY-2013 A)kappa receptor b)mu receptor c)delta receptor d) ans a REF POZIGOLD MKT-OHC-PAGE 55 CONSULTANT 10. Classification of opioid receptors.1 Receptor Clinical Effect Agonists * Supraspinal analgesia (-1) * Respiratory depression (-2) * Physical dependence * Muscle rigidity * Morphine * Met-enkephalin * -endorphin * Fentanyl * Sedation * Spinal analgesia *Dysphoria * Morphine * Nalbuphine * Butorphanol * Dynorphin * Oxycodone * Analgesia * Behavioral * Epileptogenic * Leu-enkephalin2 *-endorphin2 * Hallucinations * Dysphoria * Respiratory stimulation * Pentazocine * Nalorphine * Ketamine? 23) Ovulation occurs due to AIIMS MAY 2013 A)before oestrogen surge B)bithermal raise of temperature C)FSH causes rupture of follicle D)cervisal mucus disappears Ans () Ophthal 24)Which of the following is not the risk factor for Rhegmatogenous retinal detachment ? AIIMS MAY 2013 A. Pseudophakia B. Hyperopia C. Trauma D. Lattice degeneration Ans (b) REF OHC CONSULTANT-page 89-opthal Rhegmatogenous retinal detachment A rhegmatogenous retinal detachment occurs due to a break in the retina that allows fluid to pass from the vitreous space into the subretinal space between the sensory retina and the retinal pigment epithelium. Retinal breaks are divided into three types holes, tears and dialyses. Predisposing factors for retinal detachment: - High myopia is the commonest predisposing factor. - Lattice degeneration. - Trauma. - Intracapsular cataract extraction (ICCE). - Posterior vitreous face detachment (PVD) leading to acute vitreous traction to an area of abnormally strong vitreo-retinal adhesion causing retinal tears. symptoms: Flashes of light (photopsia) Increase in floaters

Signs: 1. V.A. is affected only if the macula is detached. 2. Marcus Gun pupillary reaction if the retina is totally detached. 3. Red reflex appears gray in the detached sectors. 4. Fundus examination shows that RD may be total, sectorial or macular. The detached retina shows; - The detached retina appears grey, wavy and tremulous. - The tear appears red (the colour of underlying choroid). - The retinal blood vessels appear dark and wavy. 5. IOP is usually decreased. Complications of neglected cases: 1. total detachment of the retina. 2. Iridocyclitis. 3. Complicated cataract. 4. Proliferative vitreo-retinopathy (PVR): migration of RPE cells through the retinal break into the vitreous where they acquire fibroblastic activity. It is necessary to do vitrectomy in order to be able to flatten the retina. After vitrectomy we may fill the vitreous cavity by silicon oil. 5. Retinal atrophy and consecutive optic atrophy and no PL if detachment is neglected. Treatment of Rhegmatogenous Retinal Detachment three general principles: Find all retinal breaks Seal all retinal breaks Relieve present (and future) vitreoretinal traction OH BOOK-PAGE 99 Separation of sensory retina from retinal pigment epithelium Causes Spontaneous in elderly Trauma Myopia After cataract extraction Lattice degeneration Simple Detachment or Uncomplicated Type It is MC type also known as rhegmatogenous retinal detachment due to development of hole in retina. Retinal detachment has convex surface which does not resolve spontaneously; surgery is the TOC. Treatment: Aim is to close the retinal tears and to reattach the retina. Laser photocoagulation Cryotherapy (for sealing the hole) Scleral buckling encirclage Drainage of subretinal fluid (can be treated by pneumatic retinopexy) 25)Which of the following pair regarding drug and its mechanism is correctly matched ? AIIMS MAY 2013 A. Pilocarpine increases uveoscleral outflow B. Brimonidine decreases synthesis of aqueous humor C. Latanprost carbonic anhydrase inhibitor D. Betaxolol Decreases trabecular outflow Ans (b,A) REF OHC CONSULTANT BRIMONIDINE-ALFA A2 AGONIST-increases aqueous flow and decrease aqueous production Carbonic anhydrase inhibitors-brinzolamide-decreases aqeous production Pilocarpine-miotic-increase outflow Betaxolol-cardioselective beta 1 blocker-decrease aqeous production 26)Ocreoplasmin is the newer drug used in which of the following ? AIIMS MAY 2013 a. Retinal break b. Vitreomacular traction c. Submacular bleed d. Diabetic macular bleed Ans (b)-NOT DISCUSSED 27)Pigmentatory changes between posterior pole and equator , [salt and paper retinopathy] are seen in all of following except ? AIIMS MAY 2013 A. Resolving retinal detachment B. Rubella C. Phenothiazine toxicity D. Fundus flavimaculatus Ans () REF OHC OPHTHAL CONSULTANT salt and pepper fundus ocular fundus characterized by a stippling of dark pigmented spots and yellowish-red spots of atrophy, as is found in congenital syphilis, Choroideremia

 Lebers congenital amaurosis, rubeola, poliomyelitis,. Salt and pepper fundusconditions are Rubella, cystinosis, congenital syphilis 28)Which of the following classically does not have calcified foci ? A. Retinoblastoma B. Persistent hyperplastic primary vitreous C. Optic disc Drusens D. Intraocular melanoma Ans () REF OHC CONSULTANT OH BOOK-PAGE99 Enlargment of the orbit Symmetrical : in intra-conal lesion (optic nerve glioma, haemangioma, ect) Asymmetrical : in extra-conal lesions (rhabdomyosarcoma, dermoid cyst, etc.,) Change in bony density : Increased : in meningioma, Pagets disease, fibrous dysplasia and osteoblastic metastasis. Decreased or destruction : in malignant tumours. Intraorbital calcification : in orbital varix, optic nerve-sheath meningioma, retinoblastoma, etc., Superior orbital fissure enlargement : in infraclinoid carotid aneurysm intracavernous aneurysm, intracranial extension of orbital tumours etc. Optic canal enlargement : in optic nerve glioma Optic N Drusen * Refractile deposits within the substance of optic N he ad. * Glittering particles in the surface of optic disc. *Ultrasound or CT scanning is sensitive for detection of buried optic disc drusen because they contain calcium. * Pseudo papilloedema* * Enlarged blind spot arcuate scotomas. 29)Which of the following is not related to conjuctivitis ? AIIMS MAY 2013 A. Visual function is spared B. Pupil is spared C. Corneal infilteration D. Ans (c) REF OHC Consultant 30)An ophthalmologist working in district hospital is likely to perform following surgical procedure most commonly ? AIIMS MAY 2013 A. Phacoemulcification B. DCR C. Bilateral Lamellar Tarsus Rotation D. Pars plana vitrectomy Ans (b) REF OHC POSIGOLD 31)Most common presentation of retinoblastoma ? AIIMS MAY 2013 A. Leukocoria with pseudohypopyon B. Leucokoria with Hyphema C. Leucokoria with Heterochromia Iridis D. Leukocoria with strabismus Ans (d) REF OHC Ophthal hand out Consultant MC intraocular malignancy of childhood * Types: HeritableB/L, Multiple Non heritable solitary * Etiology: Absense of RB genes (due to mutation) as it is a tumor suppressor gene (TSG). * MC symptom is leukocoria * MC Sign is In small lesions: simulates endophthalmitis specially when endophytic

 In large lesions: exophytic simulate Coats disease. 32)Most common intraocular metastasis in females are from which of the following primary tumor ? AIIMS MAY 2013 A. Breast B. Ovary C. Cervix D. Endometrium Ans (a) REF OHC OH BOOK PAGE 101 Tumors of the orbit cause painless, progressive proptosis. * The most common primary tumors are hemangioma, lymphangioma, neuro -fibroma, dermoid cyst, adenoid cystic carcinoma, optic nerve glioma, optic nerve meningioma, and benign mixed tumor of the lacrimal gland. * Metastatic tumor to the orbit occurs frequently in breast carcinoma, lung carcinoma, and lymphoma. 33)Which of the following bone does not form floor of the orbit ? AIIMS MAY 2013 A. Zygomatic B. Maxilla C. Ethmoid D. Palatine Ans (c) REF OHC CONSULTANT MKT POZIGOLD The roof (superior wall) orbital plate frontal bone and the lesser wing of sphenoid. The floor (inferior wall) orbital surface of maxilla, the orbital surface of zygomatic bone and the orbital process of palatine bone. The medial wall frontal process of maxilla, lacrimal bone, orbital plate of ethmoid and a small part of the body of the sphenoid. The Lateral wall -orbital process of zygomatic and the orbital plate of greater wing of sphenoid. 34)A 60 year old male with history of Diabetes complained of gradual diminution of vision over 2-3 days followed by sudden loss of vision. which of the following will be the most important investigation in this scenario ? AIIMS MAY 2013 A. Serum ACE levels B. Serum Homocysteine levels C. . Quantiferon TB assay D. Serum Creatinine levels Ans (B ) 35)Regarding Myopic degeneration which of the following is True AIIMS MAY 2013 A. It is seen more commonly in males than in females B. Myopic degeneration can lead to retinal detachment C. It is seen in < 6 D myopia D. Ans (b) REF OHC CONSULTANT-PAGE 104 OPHTHAL BOOK MYOPIA OF ATLEAST 6D Choroidal neovascularisation Tigroid fundus Posterior retinal detachment 36)Biopsy taken from chalazion showsAIIMS MAY 2013 A) lipogranulomatous B) inflammatory C) suppurative granulomatous Ans ( a) REF OHC CONSULTANT POZIGOLD A chalazion also known as a meibomian gland lipogranuloma, is a cyst in the eyelid that is caused by inflammation of a blocked meibomian gland, usually on the upper eyelid. Initial treatment for a chalazion in the acute stage is hot compresses .However, in chronic cases, the chalazion does not respond to this conservative treatment and must be inc ised and curettage. Recurring chalazia in the same area may sometimes be a symptom of sebaceous cell carcinoma. POZIGOLD- Chalazion of lid is (AIIMS MAY 2008) a) Caseous necrosis b) Chronic nonspecific inflammation c) Chronic lipogranulomatous inflammation d) Liposarcoma Ans (c) Biochemistry 37 Suicidal enzyme is AIIMS MAY 2013 A)5 lipoxygenase B) cycloxygenase C) D) Ans () Pathology 38)Which is not seen in Apoptosis AIIMS MAY 2013 a) Cell shrinkage b) Nuclear condensation c) Inflammation Ans (c) REF OHC,OH BOOK POZIGOLD CONSULTANT OG 39)End product of progesterone metabolism found in urine is AIIMS MAY 2013 A) pregnanediol B) C) D) Ans (A) REF-POZITIVE CONSULTANT 40)30 yr old Poor patient from hilly area with h/o low grade fever, infertility diagnosis is AIIMS MAY 2013 a) TB endometritis b) c) d) Ans (a) 41)shock after normal labour..cause? AIIMS MAY-2013 a. uterine inversion b. PPH c)amniotic fluid embolism d) ans-a REF OHC POSIGOLD 42)Female presented with 3X3 cm relatively painless lesion on vulva. Diagnosis is AIIMS MAY 2013 a) Treponemal infection b) Chlamydia c)Gonococcal d) ans REF- 43)HRT in Post menopausal women is given fir A/E AIIMS MAY 2013 a) vasomotor symptom b) prevention of CAD c) Prevention of Osteoporosis ANs (b) Reference OHC,OH BOOK,CONSULTANT,POZIGOLD POZIGOLD- HRT is helpful in all of the following except: [AIIMS Nov 2006] a) Vaginal atrophy b) Flushing c) Osteoporosis d) Coronary heart disease Ans (d) 44)All are done to prevent maternal to fetal transmission of HIV except AIIMS MAY 2013 a) prenatal Ziduvudine b) Vaginal delivery c) Avoid breast feeding Ans (b) REF OHC,POZIGOLD CONSULTANT OPERATION HARRI BOOK PAGE 20 HIV infections * Transmission during perinatal period predominant cause of HIV in children Risk of mother to child Transmission * Vaginal Delivery * Preterm Delivery * Trauma to foetal skin * Maternal bleeding * High viral load * Low CD4 count * PROM * Other genital infections * Treatment Zidovidine reduces vertical Transmission by 70%. Cesarian in women with viral load > 1000 copies/ml. 45)Which is not included in 3rd stage in labour to prevent PPH AIIMS MAY 2013 a) oxytocin injection with delivery of sh0ulder b) Immediate cutting n cord clamping c) misoprostol d) controlled n sustained cord traction Ans () REF CONSULTANT 46) The following is true regarding duncans method of seperation of placenta AIIMS MAY 2013 A) peripheral seperation B) blood is collected between placenta and membranesand escapes out of vagina C) maternal part of placenta present at the vulva after delivery D) Ans () Surgery

47)true about COELIAC plexus block AIIMS MAY 2013 A) given for lower abdominal malignancy B) usually given unilateral C) diarrehoea and hypotension are common side effects D) given in retroperitoneum at L3 level Ans (c) REF OHC POZIGOLD 48)Percentage of death in emergency AAA operation AIIMS MAY 2013 a ) 40% b)10% c)5% D) ans 49)A 5yr child burnt with boiling water. method used to calculate burnt area AIIMS MAY 2013 a) lund and browder b) rule of 9 c) palm method ANs (a) REF OHC-RECENT ADVANCES Lund and browder chart chart used to estimate the percentage of skin burnt to the total body surface area in children 50)A child had circumferential burn ofBOTH thighs, buttock,face n scalp. AIIMS MAY-2013 Percentage of burn is a) 0.37 b) 0.47 c) 0.27 d) 0.64 Ans (b) REF OHC CONSULTANT 51)A neonate with meningomyelocele awaiting surgery.Solution to cover meningomyelocele is sterile gauze soaked in AIIMS MAY-2013 a) Normal saline b) Betadine c) d) Ans (a) REF OHC POZIGOLD 52)19 yr old femal with primary amenorrhoea with axillary n pubic hair but absent vagina n uterus. AIIMS MAY-2013 a) Mullerian agenesis b) XYY syndrome c) Androgen insensitivity syndrome d) Ans (a) REF OHC CONSULTANT POZIGOLD OH BOOK PAGE 212 Mllerian agenesis is a congenital malformation in women characterised by a failure of the Mllerian ducts to develop, resu lting in a missing uterus and variable malformations of the vagina. It is the second most common cause of primary amenorrhea she will enter puberty with development of secondary sexual characteristics including thelarche (breasts) and adrenarche (p ubic hair). Her chromosome constellation will be 46,XX. Ovulation usually occurs. Typically, the vagina is shortened and intercourse may in some cases be difficult and painful. Medical examination supported by gynecologic ultrasonography demonstrates a complete or partial absence of the cerv ix, uterus, and vagina. Renal anomalies occur in 25-35% of females with mullerian agenesis. The Vecchietti procedure????? The Vecchietti procedure is a procedure that has been shown to result in a vagina that is comparable to a normal vagina in patients with Mllerian agenesis ??????? androgen insensitivity syndrome (AIS) which is an X-linked recessive disorder 10% of all cases of primary amenorrhea. 46,XY karyotype, lack of androgen receptor responsiveness severe underandrogenization and fema le external genitalia.

 A person with complete androgen insensitivity syndrome (CAIS) has a female external appearance despite a 46XY karyotype and undescended testes, a condition once called testicular feminization a person with Androgen Insensitivity Syndrome is a phenotypic female with a chromosomal genotype of 46,XY. 1. Complete AIS (CAIS): completely female body except no uterus, fallopian tubes or ovaries; testes in the abdomen; minimal androgenic (pubic or axillary) hair at puberty Childhood growth is normal and the karyotypic incongruity remains unsuspected unless an inguinal lump is discovered to be a testis during surgical repair of an inguinal hernia, Patients with AIS have a 46, XY karyotype, but because of the lack of androgen recepto r responsiveness, they have severe underandrogenization and female external genitalia. The absence of pubic and axillary hair distinguishes them clinically from patients with mllerian agenesis.. Androgen resistance syndrome requires gonadectomy because there is risk of gonadoblastoma in the dysgenetic gonads. Whether this should be performed in early childhood or after completion of breast development is controversial. 53)Earliest complication of Ileostomy AIIMS MAY-2013 a) Obstruction b) Necrosis c) d) ans b REF OHC POZITIVE POZIGOLD 54)Which of the following has Osteoblastic metastasis rate AIIMS MAY 2013 A) Ca prostate B) Ca lung C) Ca breast D) Ans (a) REF MKT-RD OHC ,CONSULTANT Osteoblastic Bone Metastases = Evidence of slow growing neoplasm Primary Prostate, breast, lymphoma, malignant carcinoid, medulloblastoma, mucinous adenocarcinoma of GI tract, of bladder, pancreas, neuroblastoma Most common cause Prostate cancer (in adult male); breast cancer (in adult female) Osteolytic bone Metastases Most common cause : Neuroblastoma (in childhood); lung cancer (in adult male); breast cancer (in adult female), thyroid cancer; kidney; colon May begin in spongy bone (associated with soft tissue mass in ribs) Vertebral pedicles often involved (not in multiple myeloma) SPM 55)A patient presented with corneal ulcer n later on perforation..on gram staining Gram negative coccoid seen. Diagnosis is AIIMS MAY 2013 a) Moraxella b) Neisseria c)Gonococci d) REF B CONSULTANT 56)Meningitis is considered hyperendemic if AIIMS MAY 2013 a) 2 cases b) 2-10 cases c) more than 10 cases d) more than 100 cases Ans () REF OHC OH BOOK PAGE PAGE 645 Community-based outbreak-Mass vaccination occurrence of three or more cases within 3 months in persons who have a common affiliation or reside in the same area but who are not close contacts of one another Structure of the Polysaccharide Capsule of Common Disease-Causing Meningococci EXCITING 18TH Meningococcal Serogroup Chemical Structure of Oligosaccharide Current Disease Epidemiology A 2-Acetamido-2-deoxy-D-mannopyranosyl phosphate sporadic cases worldwide B alfa-2,8-N-acetylneuraminic acid propensity to cause hyperendemic disease C alfa-2,9-O-acetylneuraminic acid Small outbreaks and sporadic disease Y 4-O-alfa-D-glucopyranosyl-N-acetylneuraminic acid Sporadic disease W135 4-O-alfa-D-galactopyranosyl-N-acetylneuraminic acid Sporadic disease; outbreaks of disease associated with mass gatherings; Microbiology 57)Boggy swelling with easily pluckable hair. How to diagnose AIIMS MAY 2013 a)KOH mount

b)pus culture c)biopsy d) Ans (a) REF OHC CONSULTANT POZIGOLD OH BOOK PAGE 237 POZIGOLD- A 7 year old boy with boggy swelling of the scalp with multiple discharging sinuses with cervical lymphadenopathy with easily pluckable hair. What would be done for diagnosis? [AIIMS NOV 2009] a) Pus for culture b) KOH mount c) Biopsy Ans (b) 58)which is a slow grower AIIMS MAY-2013 a) m.kansassi b) chenolae c) fortuitum d) abcessicum Ans (A) Reference-OHC,OPERATION HARRI BOOK PAGE-732,730 ,Consultant,POZIGOLD Runyon classification-based on colony pigmentation-replaced by the use of DNA probes *NTM are broadly differentiated into rapidly growing (11 years of age. ENT 64)Father of neurootology AIIMS MAY 2013 a)House b)lempard c) d) Ans (a)NOT DISCUSSED 65)use of Bone anchoring hearing aid-BAHA AIIMS MAY 2013 a) person with acousticneuroma in NF 2 b)child with microtia c). old person with profound hearing loss Ans (b) POZITIVE-RECENT ADVANCES-ENT A Bone-Anchored Hearing Aid( TN 2009&AIIMS MAY-2013***) is a type of hearing aid based on bone conduction. It is primarily suited to people who have conductive hearing losses, unilateral hearing loss and people with mixed hearing losses who cannot otherwise wear in the ear or behind the ear heari ng aids Bone-anchored hearing aids use a surgically implanted abutment to transmit sound by direct conduction through bone to the inner ear, bypassing the external auditory canal and middle ear. A titanium post is surgically embedded into the skull with a small a butment exposed outside the skin The titanium fixture bonds with the surrounding tissue in a process called osseointegration. The hearing aid can be used on ce osseointegration is complete, usually two to six months after implantation The Baha must be positioned so that it does not touch the pinna of the ear POSIGOLD BAHA is useful in [TN PGEE 2009] a) Sensory neural deafness b) Congenital ear canal atresia c) Meningitis with ossification d) All of the above Ans (b) 66)Patient complains of left ear pain.On examinationtympanic membrane normal.Right ear normal.Lef ear masss coming the posterior part-diagnosis AIIMS MAY 2013 A)CSOM B)Keratosis obturans C) D) Ans (b) Ref-Consultant 67)Which of the following cartilage forms complete cartilagenous ring ? AIIMS MAY 2013 A. Epiglottis B. Cricoid C. Cuineform D. Thyroid Ans (b) REF OHC POZIGOLD Ortho 68) 2 years old child with rickets is on calcium supplements and has a foot deformity. When should a decision to undertake corrective surgery be undertaken? AIIMS MAY 2013 A. When vitamin D levels turn to normal B. When growth plate healing is seen radio-graphically

C. When bone specific alkaline phosphatase is normal D. When serum calcium becomes normal Ans (c) REF OHC POZIGOLD-NOV-AIIMS 2012 69)hockey player..injury to? AIIMS MAY 2013 a. medial meniscus b. ACL posterior part c. ACL anterior part Ans () 70)Gallows traction in child- AIIMS MAY 2013 A) for fracture of femur shaft B)for tibial fracture C) D) Ans (A) REF POZIGOLD-AIIMS NOV-2009 OHC MKT MKT- Traction systems and their uses. Name Use * Gallows traction(AIIMS-NOV-2009***) Fracture shaft of the femur in children below 2 years * Bryants traction Same * Russells traction Trochanteric fractures * Bucks traction Conventional skin traction * Perkins traction Fracture shaft femur in adults * 90o-90o traction Fracture shaft of femur in children * Agnes-Hunt traction Correction of hip deformity * Well-leg traction Correction of adduction or abduction deformity of hip * Dunlop traction Supracondylar fracture of humerus * Smiths traction Supracondylar fracture of humerus * Calcaneal traction Open fractures of ankle or leg * Metacarpal traction Open forearm fractures * Head-halter traction Cervical spine injuries * Crutchfield traction Cervical spine injuries * Halo-pelvic traction Scoliosis Psychiatry 71)all r true in retts syndrome except? AIIMS MAY 2013 a. macrocephaly b. mental retardation C)Seizures. Ans (a) REF-CONSULTANT OHC POZITIVE RECENT ADVANCES similair question A 2 year old girl child is brought to OPD with features of hand ringing stereotype movements, impaired language and communication skills. Her HC is 42 cm. Her birth record shows HC of 35 cm. What is the most likely diagnosis? a) Asperger syndrome b) Rett syndrome c) Fragile x syndrome d) Colarad syndrome Ans (b) Asperger syndrome or Aspergers syndrome or Asperger disorder is an autism spectrum disorder that is characterized by signi ficant difficulties in social interaction It differs from other autism spectrum disorders by its relative preservat ion of linguistic and cognitive development Asperger syndrome (AS) is one of the autism spectrum disorders (ASD) or pervasive developmental disorders (PDD), which are a spectrum of psychological conditions that are characterized by abnormalities of social interaction and communication that pervade the individuals functioning, and by restricted and repetitive interests and beh avior Children with AS may have an unusually sophisticated vocabulary at a young age and have been colloquially called little professors, but have difficulty understanding figurative language and tend to use language literally Individuals with AS often have excellent auditory and visual perception AS is also associated with high levels of alexithymia, which is difficulty in identifying and describing ones emotions Rett syndrome is a neurodevelopmental disorder of the grey matter of the brain that affects females more commonly than male s. The clinical features include small hands and feet and a deceleration of the rate of head growth (including microcephaly in some). People with Rett syndrome are prone to gastrointestinal disorders and up to 80% have seizures. They typically have no verbal skills, and about 50% of individuals affected are not ambulatory. Scoliosis, growth failure, and constipation are very common and can be problematic. Genetically Rett syndrome (symbolized RTT) is caused by mutations in the gene MECP2 located on the X chromosome and can ari se (1) sporadically or (2) from germline mutations Brain levels of norepinephrine are lower in people with Rett syndrome. The genetic loss of MECP2 changes the properties of cells in the locus coeruleus, the exclusive source of noradrenergic innervation to the cerebral cortex and hippocampus Development is typically normal until 618 months, when language and motor milestones regress, purposeful hand use is lost, and acquired deceleration in the rate of head growth (resulting in microcephaly in some) is seen. Hand stereotypes are typical, and breathing irregulariti es such as hyperventilation, breathholding, or sighing are seen in many. Early on, autistic-like behavior may be seen. The infant with Rett syndrome often avoids detection until 618 months

 The syndrome is associated with the expansion of a single trin ucleotide gene sequence (CGG) on the X-chromosome, and results in a failure to express the protein coded by the FMR1 gene, which is required for normal neural development Fragile X is the most common known single gene cause of autism and the most common inherited cause of intellectual disability Aside from intellectual disability, prominent characteristics of the syndrome include an elongated face, large or protrudin g ears, flat feet, larger testes (macroorchidism), and low muscle tone. Speech may include cluttered speech or nervous speech Fragile X syndrome is an X-linked recessive condition with variable expressivity and possibly reduced penetrance The transmission of fragile X often increases with each passing generation. This seemingly anomalous pattern of inheritance is referred to as the Sherman paradox. Patients with Rett Syndrome initially have seemingly healthy development. An early clinical feature is deceleration of head growth that begins when the individual is aged 2 -4 months. A period of developmental stagnation is followed by a period of regression. RS is a genetic disorder of neurodevelopment arrest rather than a progressive process. The gene for RS is located on the X chromosome (MECP2 gene). Anesthesia 72)Patient with normal Preanaesthetic checkup was connected to monitor in OT. After giving iv antibiotics there was sudden pulseness.Next step is AIIMS MAY 2013 a) Chest compression b) call ambulance c) Two round of breaths Ans () Anatomy 73)Floor of 4th ventricle not formed by AIIMS MAY 2013 a) Mammilary body b) 3rd cranial nerve c) Infundibulum d) PITUTARY STALK Ans (b) REF OHC POZIGOLD 74)A person found unconsious,lying in right lateral position is having bruises over his right scalp, right upper limb,right side of hip,right knee.what would be the reason for above clinical condition? AIIMS MAY 2013 A. Trigeminal n. Injury B. Radial n. Injury C. sciatica n. Injur D.peroneal n. Injury Ans () Pediatrics 75)A child prrsented with pain abdomen on right side.. A slight increase of limbs of right side is seen. on investigation calcified mass in right side id abdomen seen. Diagnosis is AIIMS MAY 2013 a) neuroblastoma b) Wilms tumor c) angiomyolipoma d) ARPKD Ans (b) OHC CONSULTANT 76)Kluver Bucy syndrome in young children.AIIMS MAY 2013 A) hypermetamorphosis B) Hypersexuality C) visual agnosia D) refractory seizures Ans (d) REF MODEL EXAM 3 2012-similair question CONSULTANT-PSYCHIATRY BOOK . Kluver-Bucy syndrome results from lesions of the POZITIVE MODEL EXAM 3 2012 (a) Parietal lobe (b) Temporal lobe on one side (c) Temporal lobe of both hemispheres (b) Prefrontal cortex Ans (c) klver-Bucy syndrome is a behavioral disorder that occurs when both the right and left medial temporal lobes of the brain malfunction. The amygdala has been a particularly implicated brain region in the pathogenesis of this syndrome. The syndrome is named for Heinrich Klver and Paul Bucy, who removed the temporal lobe bilaterally in rhesus monkeys in an attempt to determine its function. This caused the monkeys to develop visual agnosia, emotional changes, altered sexual behavior, hypermetamorphosis and oral tendencies. Though the monkeys could see, they were unable to recognize even previously familiar objects, or their use. They would exam ine their world with their mouths instead of their eyes (oral tendencies) and developed a desire to explore everything (hypermetamorphosis). The monkeys indulged in indiscriminate sexual behavior including masturbation, heterosexual acts and homosexual acts. Contr ary to popular belief, however, the findings did not show an increase in sexual behavior (hypersexualism). Emotionally, the monkeys became dulled, and their facial expressions and vocalizations became far less expressive. They wer e also less fearful of things that would have instinctively panicked them in their natural state, such as humans or snakes. Even after being attacked by a snake, they would willingly ap proach it again. This aspect of change was termed placidity. 77)In INDIA neonatal sepsis not commonly caused by AIIMS MAY 2013

A. Staph aures B. E. coli C. klebseilla D. Group B streptococci Ans () REF OHC POZITIVE 78)Infant can breath simultaneously because ? AIIMS MAY 2013 a) High larynx, b) Short soft palate, c) Small tongue Ans (a) OHC POZIGOLD-NOV-2012 Dermatology 79)pin head size lesions on hand and penisdiagnosis??????.. AIIMS MAY 2013 a) scabies b) lichen planus c) lichen nitidus d) molluscum contagious Ans () Psychiatry 80)According to Hean Piaget cognitive developmental theary Out of sight is out of mind belongs to AIIMS MAY 2013 A) -sensiromotor stage. B) Preoperative C) Concrete Operational D) Formal operational Ans (a) REF CONSULTANT PSYCHIATRY BOOK PAGE 5 Stage Age Development I Sensory Motor 0-2 years Motor and sensory Reflexes coordinating body and five senses imitating novel behavior II Preoperative 2-7 years Learn without reasoning (immanent justice) believes punishment for bad deeds inevitable III Concrete Operational 7-11 years Syllogistic reasoning all horses are mammals conservation and Reversibility IV Formal operational 11yrs- Adoles-cent Inductive an Deductive reasoning 81)Patient presents with left painless scrotal mass,Alfa feto protein and LDH normal.urine examination shows microscopic hematuria likely diagnosis AIIMS MAY 2013 a) Seminoma b) cystitis c) RCC Ans (c) REF-OHC, CONSULTANT 82)After mastoidectmy-pt developed vertigo-pure tone audiogram revealed sensorineural deafness AIIMS MAY 2013 a) petrositis b) suppurative labrynthitis c) d) Ans (b) 83)60 Year old with D type tympanogram-management AIIMS MAY 2013 a) myringoplasty with grommet incision b) nasopharyngeal endoscopy c) d) Ans (b) Reference-Consultant 84)Which of the following is used subcutaneously in the treatment of Asthma attacks AIIMS MAY 2013 a. Salbutamol b. Terbutalin c. Metaprotenolol d. Pinbuterolol Ans (b) Ref-Consultant 85)A patient having PCO2 value of 30mmHg,PO2 105mmHg pH-7.45.He has partially compensated AIIMS MAY 2013 a) Metabolic acidosis b) Resp.alkalosis c) Resp acidosis d) Metabolic acidosis Ans (b) REF OHC POZIGOLD-AIIMS MAY 2012 86)Non-Hodgkin lymphoma of orbit is due to AIIMS MAY 2013 a) B-cell

b) T-cell c) NK cell d) Pre B cell Ans (a) REF-Consultant 87Calculate the sample size of the study for a population whose prevalence is 50% with 95% confidence interval and 45-55%AIIMS MAY 2013 a) 100 b) 200 c) 300 d) 400 Ans (a) REF OHC-STATISTICS SPM CLASS Sample size=4pq/D2 =40.50.5/0.10.1=100 P=prevalence Q=1-prevalence D=range 88)As per NPCB ,no of vision centres to be present in the country isAIIMS MAY 2013 A) 10,000 B) 20,000 C) 30,000 D) 40,000 Ans (b) REF-OHC-SPM 89)Disease not included in the Intergrated disease surveillance project A) Snake bite B) TB C) ARI D) Leptospirosis Ans () 90)Which of the committee recommends 3 yr course in Bachelor of rural health services A) Sundar committee B) Srivatsa committee C) CBHI Ans () 91)Most common MODY is due to A) HNF ALPHA B) IPF-1 C) Glukokinase D) HNF -3 Ans (A) REF-OHC 92)The cause of ketoacidosis in Von Gierkes disease is due to all except A) Patient suffers from hypoglycemia B) In most pts glucose level is low C) Fat mobilisation is low d) Ans (c) 93)Alzhiemers disease-atrophy of AIIMS MAY 2013 A) Parietal and frontal cortex B) Parietal and Temporal cortex C) Parietal and occipital cortex D) Frontal and occipital cortex Ans (b) REF OHC POZIGOLD CONSULTANT alzhiemers Pathologically, atrophy is distributed throughout the medial temporal lobes, as well as lateral and medial parietal lobes a nd lateral frontal cortex. Female sex may also be a risk factor independent P Commonest Dementia P Microscopy Neuritic plaque with A amyloid Silver staining neuro fibrillary Tangle P Anosognosia Unaware of these difficulties P Language naming affected first

 fluency last P Delusions common P Capgras syndrome-OCCURS LATE HERE believing that a careGiven has been replaced by an imposter 10% AIIMS Nov 2011 patients are unaware of these difficulties (Anosognosia), Apraxia Aphasia- an early and prominent feature Simple calculations and clock reading become difficult (ACALCULIA) CSF A beta 42 levels are reduced, whereas levels of hyperphosphorylated tau protein are elevated, occurs late [early in DLB] P MRI atrophy of hippocampus P Hypometabolism of Tempero.parietal cortex P Risk Factors Age, Positive family History POZIGOLD-Alzheimers disease, which is involved? (AIIMS MAY 2008) a) Frontal cortex b) Cortical atrophy of temporoparietal cortex c) Frontal and parietal cortex d) Occipital cortex Ans (b) 94) Oedema in ct absent in which stage of Neurocysticercosis? AIIMS MAY 2013 A. Vesicular stage B. Colloid stage C. Granular nodular stage D. Calcified nodular stage Ans () 95). A 2 days old neonate presented wit seizures; wat is the next investigation? AIIMS MAY 2013 A.skull skiagram B.ultrasound C.ct d.mri Ans (B) REF-CONSULTANT 96 Homogenous opacity in right lung wit obscured right cardiac silhouette. which part of lung is involved? AIIMS MAY 2013 A. Medial seg of RML B. Lateral seg of RML C. Apical seg of RLL D. Medial basal seg of RLL Ans () 97) Area not involved in HIV? AIIMS MAY 2013 a. caudate nucleus b. globus pallidus c. cingulate gyrus d. cerebral white matter Ans () 98)Most common stain for fungal hyphae AIIMS MAY 2013 A) PAS B) Methanamine silver C) Congo red D) Oil red O Ans (B) REF-CONSULTANT 99)vitA prophylaxis given to postpartum women AIIMSAMAY 2013 a) 50,000iu b) 1,00,000iu c) 2,00,000 iu d) Ans () 100)LITHIUM POTENTIATES NON DEPOLARISING MUSCLE RELAXANTS.HOW MANY DAYS PRIOR TO GIVING IT LITHIUM SHOULD BE STOPED- AIIMS MAY 2013 a) 1DAY b) 2 DAYs c) 3 DAY d) 4 DAY Ans (C) 101)A 57 YR OLD MALE PRESENTING WITH ICSOL.INHALATIONAL AGENT OF CHOICE-AIIMS MAY 2013 a) SEVOFLURANE b) ISOFLURANE c) DESFLURANE

d) HALOTHANE Ans (a) REF-CONSULTANT 102)He following enzymes dont participate in Oxygenation Reduction reaction AIIMS MAY 2013 1) Dehydrogenase 2)oxidases 3)reductases 4)peroxidases 103)Boundaries of facial recess. All except? AIIMS MAY 2013 a) b) c) d) 104)Real Time PCR is used for AIIMS MAY 2013 a. Multiplication of RNA b. Multiplication of specific segments of DNA c. Multiplication of Proteins d. To know how much amplification of DNA has occurred Ans () 105)Method to differentiate entry and exit wounds AIIMS MAY 2013 a) kennedy phenomenon b) c) d) ans a Ref-CONSULTANT 106). irreversible steps in glycolysis..AIIMS MAY 2013 a)pyruvate kinase b) hexokinase c)pfk d) ans-b ref-CONSULTANT Reaction 1: Phosphorylation of glucose to glucose-6 phosphate. This reaction requires energy and so it is coupled to the hydrolysis of ATP to ADP and Pi. Enzyme: hexokinase. It has a low Km for glucose; thus, once glucose enters the cell, it gets phosphorylated. This step is irreversible Reaction 3 hydroxyl group on C1 forming fructose-1,6- bisphosphate. Enzyme: phosphofructokinase. This allosteric enzyme regulates the pace of glycolysis. Reaction is coupled to the hydrolysis of an ATP to ADP and Pi. This is the second irreversible reaction of the glycolytic pathway 107)PDA all except AIIMS MAY 2O13 1.co2washout 2.nec 3.boundingpulse 4.pulmonary hemorrhage ans a Ref-OHC POZIGOLD 108)Dermatomal distribution painful vesicular lesions AIIMS MAY 2013 a)HERPES ZOSTER b) c) d) ans a REF-CONSULTANT,OHC,OH BOOK 109)which of the following cancer can be prevented by preserving the food in refrigertor..?? A oesophagus B stomach C colon D Ans () 110)contraindicaited in epileptic seizure AIIMS MAY 2013 a)Ketamine b) c) d) ANS A

ref CONSULTANT 111)Not found in IDA AIIMS MAY 2013 a) Increased RDW b) Decreasd TIBC c) Decreased serum iron Ans (b) REF OHC OH BOOK PAGE 462 CONSULTANT Iron deficiency Anemia 3 Stages 112) Of the Millenium Development Goal How many are directly realated to Health AIIMS MAY 2013 a) 4 b) 3 c) 2 d) 1 Ans (b) REF OHC CONSULTANT POZIGOLD Goal 1: Eradicate Extreme Hunger and Poverty Goal 2: Achieve Universal Primary Education Goal 3: Promote Gender Equality and Empower Women Goal 4: Reduce Child Mortality Goal 5: Improve Maternal Health Goal 6: Combat HIV/AIDS, Malaria and other diseases Goal 7: Ensure Environmental Sustainability Goal 8: Develop a Global Partnership for Development 113)A female presented with recuurent abortions, pain in calves, deficincy of which is seen AIIMS MAY 2013 a) protien s b) Thrombin c) plasmin d) factor XIII Ans () 114)motorcyclist after multiple trauma is having hypoventilation cause is AIIMS MAY 2013 A) damage to respiratory center respiratory apparatus both b) c) d) 115)TEE is better than TTE why -AIIMS MAY 2013 a)Left atrial thrombi b) c) d) ans d REF-POZITIVE OHC 2 RECENT ADVANCES HAND OUT-PAGE 95 TEE The advantage of TEE over TTE is usually clearer images, especially of structures that are difficult to view transthoracicly (through the chest wall). The explanation for this is that the heart rests directly upon the esophagus leaving only millimeters that the ultrasound beam has to travel. In adults, several structures can be evaluated and imaged better with the TEE, including the aorta, pulmonary artery, valves of the heart, both atria, atrial septum, left atrial appendage, and coronary arteries. TEE has a very high sensitivity for locating a blood clot inside the left atrium 116)What is used shelf life of anesthetic agent Succinyl choline AIIMS MAY 2013 a) b) c) d) 117)insulin resistance in hepatic injury due to AIIMS MAY 2013 a)damaged hepatocyte decreased sec of insulin b) c) d) 118)Most important function of MHC is AIIMS MAY 2013 1)Antigen presenting 2) 3) 4) ANS A Ref-consultant,OHC 119)ASHA gets renumeration for all except AIIMS MAY 2013

a) institutional delivery b) zero dose of opv n first dose of BCG c) Recording birth weight d)none Ans (d) REF-OHC RECENT ADVANCES,CONSULTANT AccreditedSocial Health Activist (ASHA)???? AccreditedSocial Health Activist (ASHA) general norm will be One ASHA per 1000 population.In tribal, hilly, desert areas the norm could be relaxed to one ASHA per habitation, must be primarily a woman resident of the village Married/Widow/Divorced and preferably in the age group of 25 to 45 yrs. ASHA should have effective communication skills, leadership qualities and be able to reach out to the community. She should be a literate woman with formal education up to Eighth Class. ASHA would be an honorary volunteer and would not receive any salary or honorarium. 120)which is considered developmental delay AIIMS MAY 2013 a) pincer grasp 9 mnth b) moving up n downstars 2 n half yr c) Not able to sit at 9 month d) Two word syllable by 1 year age Ans (C) REF CONSULTANT,OHC-MKT Cardinal or target developmental milestones Upper age limit (months) Motor Fine motor Language Social 2 - Social smile 4 Head control Holds objects Cooing, turns towards sound Recognition of mother 8 Sits without support Transfers objects from one hand to the other Nonsense vocalization Laughs 12 Stands without support Pincer grasp Babbles syllables Plays interactive games 18 months Walks independently - Key Developmental Milestones : Fine Motor Age Milestone 4 months Grasps a rattle or rings when placed in hand 5 months Reaches out to an object and holds it with both hands (intentional reaching with bidextrous grasp) 7 months Holding objects with crude grasp from palm (palmar grasp) 9 months Holding small object, like a pellet, between index finger and thumb (pincer grasp) Key Developmental Milestones : Language Age Milestone 1 months Turns head to sound 3 months Cooing 6 months Monosyllables (ma, ba) 9 months Bisyllables (mama, baba) 12 months Two words with meaning 18 months Ten words with meaning 24 months Simple sentence 36 months Telling a story Key Developmental Milestones : Personal Social Age Milestone 2 months Social smile 3 months Recognizing mother 6 months Smiles at mirror image 9 months Waves bye-bye 12 months (1 yr) Plays a simple ball game 36 months (3 years) Knows gender 121)what is most important difference between seizure n syncopeAIIMS MAY 2013 a)Urine incontinence b)LOC c)Injury from fall d) Ans (a) REF CONSULTANT 122)What happens immediately after lying down AIIMS MAY 2013 a) increase in cerebral flow b) immediate increase venous return to heart c) decrease of blood flow to lung apex d) Ans () 123)A patient had seizure after injection of sulfonamide. Dx is AIIMS MAY 2013 a) Acute intermittent porphyria b) c) d) ANS A

REF OHC POZIGOLD CONSULTANT 124)Not true in CLL? AIIMS MAY 2013 A. Treatment is curative. B. No treatment required in asymptomatic cases. C. For leucocytosis, urgent treatment is to be done. D. Combination therapy for 35% AIIMS MAY 2013 a)Multiple myeloma b)smouldering myeloma c)non secretory myeloma d)Walderstorms macroglobulinemia ans a REF-OHC ,OH BOOK PAGE,CONSULTANT,POZIGOLD MULTIPLE MYELOMA Diagnosis * Triad - Marrow plasmacytosis > 10% - Lytic bone lesions - Serum / urine M component * Bone marrow plasma cells are CD138+ and monoclonal. * Myeloma-related organ or tissue impairment (end organ damage) (ROTI): Calcium levels increased: renal insufficiency ; anemia: bone lesions: symptomatic hyperviscosity, amyloidosis, recurrent bacterial infections (>2 episodes in 12 months). Asymptomatic myeloma (smouldering myeloma) * M protein in serum >30 g/L and/or * Bone marrow clonal plasma cells >10%. * No myeloma-related organ or tissue impairment. Nonsecretory myeloma * No M protein in serum and/or urine with immunofixation. * Bone marrow clonal plasmacytosis > 10% or plasmacytoma. * Myeloma-related organ or tissue impairment. 137) In pleural tap which structure in not pierced AIIMS MAY 2013 1.Pulmonary pleura 2.thoracodorsal fascia 3skin 4 Ans A 138 which does not contribute to anorectal ring AIIMS MAY 2013 a. puborectalis b. external sphincter c. int sphinter d) Ans REF-CONSULTANT,POZIGOLD 139) lady with osteoporosis is bisphophonate thrapy which is best investigation to see her bone condition AIIMS MAY 2013 1 xray 2 dexa 3 ct scan ANS 140) averge iq is AIIMS MAY 2013 1.70 2. 90 3.111 4.80 ANS 90 REF-CONSULTANT-POZITIVE PSYCHIATRY BOOKLET-PAGE-28 IQ Score Descriptive Level % of Population > 130 Very superior 2.2 120 to 129 Superior 6.7 110 to 119 Bright normal 16.1 90 to 109 Average 50.0 80 to 89 Dull normal 16.1 70 to 79 Border line 6.7 < 70 Mentally challanged 2.2 141) mini mental state examination AIIMS MAY 2013 a) b)

c) d) 142) breathing movements in a fetus lead to all except AIIMS MAY 2013 1.increases towards end of term 2.can lead to RDS 3.develops the respiratory muscles 4.amniotic fluid embolism 143) orphan drug is AIIMS MAY 2013 a)for rare diseases b) c) d) ans a REF-OHC-POZIGOLD 144) anganawadi centres..which standards are followed AIIMS MAY 2013 a)IAP b)ICHS c) d) 145) cyanosis does occur AIIMS MAY 2013 a)critical concentration of reduced hb b) c) d) ans a REF-CONSULTANT 146 social pathology AIIMS MAY 2013 a) b) c) d) 147)Hot spot on scan a)adenolymphoma b)adenocystic carcinoma c) d) ANS-B REF-OHC,POZIGOLD 148)For viewing root angulations following angles can be used a)90 b)90,45 c)90,45,110 d) 149)Radiology technicians should not be exposed to radiation per week more than AIIMS MAY 2013 a)10 ME b) 10 equivalence c) 100 equivalence d) 300 equivalence 150) a4 year old child suffering from vomiting after being treated for a viral illness.Liver biopsy will reveal AIIMS MAY 2013 a)auto immune hepatitis b)NASH c) d) 151 A PREGNANT FEMALE 50 YEARS OLD WITH type 2 dm and hyperlipidemia.Liver biopsy might reveal AIIMS MAY 2013 a)acute liver cirrhosis b)NASH c)peliosis hepatitis d)autoimmune hepatitis ans 152) A 60 yr old elderly smoking 3 packets of cigarette per day developed features of central obesity with weak peripheral extremities.Which of the following causes this? AIIMS MAY 2013 a. Large cell variant b. Squamous cell Ca c. AdenoCa d)Small cell Ca ans- d REF-Consultant,OHC,OH BOOK PAGE 392 System Character * General * Anorexia, cachexia * 30% * Endocrine * 12%

* PTH-rP(squamous) * SIADH(small cell) * ACTH 153) A PATIENT SUFFERING FROM HEAD ache and Temporal arteritis biopsy will reveal AIIMS MAY 2013 a)Giant cells b) c) d) ANS A REF-OHC ,CONSULTANT 154)What is associated with strep. Throat infection a)Rheumatic fever b)AGN c)both ans c Ref-consultant,OHC 155)Crumpled tissue paper appearance is seen in AIIMS MAY 2013 a)Gauchers b)Neimann picks c) d) ans a REF-Consultant,OHC- 2RECENT ADVANCES PAGE 106 POZIGOLD Niemann-Pick disease, type C: subacute/juvenile NiemannPick disease type D: Nova Scotian Type A and B are due to deficiency of lysosomal sphingomyelinase. The involved gene is on chromosome 11p15.1-15.4. Type C (the most common subtype) is due to defective transport of cholesterol between cells and has been linked to a defect in NPC-1 gene on chromosome 18 In the classic infantile type A variant, a missense mutation causes complete deficiency of sphingomyelinase type A being the neuronopathic form and B the non-neuronopathic form. Histology demonstrates lipid laden macrophages in the marrow, as well as sea -blue histiocytes on pathology Giemsa staining can highlight sea blue histiocytes containing ceroid, most common in Type C disease. Future prospects include enzyme replacement and gene therapy. Bone marrow transplant has been attempted for Type B. Niemann-Pick cells are CD-68 positive histiocytes. PAS staining is only faintly positive, but Sudan Black B and Oil Red O are positive, indicating that neutral fat contained in the vacuoles. These lipid deposits are birefringent and have yellow-green fluorescence in UV light. Electron microscopy shows lamellated structures in the lysosomes (similar to myelin figures) and may also demonstrate zebra bodies, parallel lamellat ed structures in the cytoplasm The cells of Gaucher disease are identified by their crinkled tissue paper cytoplasm, seen best o n touch imprints 156) All are true regarding METHANOL poisoning except a)critical level is 1.25 b)fomipazole-inhibits with aldehyde dehydrogenase c) d) 157) seat belt injury is commonly seen in a)Liver b)Mesentry c)spleen d) 158)social pathology is- AIIMS MAY 2013 a)chang in the disease pattern due to change in life style b) c) d) 159)Neck mass-solitary and nontender-4/4cm-biopsy SSC.Suspected primary of unknown origin-stage AIIMS MAY 2013 A)T0 N2a Mx b) c) d) ans 160)damage to facial nerve above chorda tympani will lead to all except AIIMS MAY 2013 a)Hyperacusis b)loss of taste c)loss of sensations ansCONSULTANT 161)minimum amount of TC required for staining of teeth AIIMS MAY 2013 a)5mg/kg/d b) 20mg/kg/d c) 40mg/kg/d d) 80mg/kg/d 162)cell is injured by micro needle.How does it get sealed AIIMS MAY 2013

A)Enzymatic reaction b) c) d) 163)technique which shows change in size, shape of chromosome AIIMS MAY 2013 a)chromosome mapping b)karyotyping c)Genotyping d) 164) Loss of lacrimation is due to injury of- AIIMS MAY 2013 a) b) c) d) 165)urethral crest is formed by AIIMS MAY 2013 a)PROSTATE GLAND B)insertion of detrusor c)insertion of trigone d)pre prostatic sphincter ans a REF-POZITIVE CONSULTANT 166)Vagina is formed by-AIIMS MAY 2013 a)mesoderm of urogenital sinus b)endoderm of urogenital tract c) mesoderm of urogenital ridge d) endoderm of urogenital ridge ans a REF-OHC-MKT-GYNECOLOGY,CONSULTANT Male and Female derivatives of embryonic urogenital structures Embryonic structure Derivatives Male Female Labioscrotal swelling Scrotum Labia majora Urogenital folds Ventral aspect of penis Labia minora Genital tubercle Penis Clitoris Urogenital sinus Urinary bladder Prostate gland Prostatic utricle Bulbo-urethral glands Urinary bladder Urethral and paraurethral glands Vagina Bartholins glands Paramesonephric duct Appendix of testes Hydatid of Morgagni, Uterus, Fallopian tubes Mesonephric duct Ductus epididymis Ductus differentes Duct of epoophoron Gartners duct Mesonephric tubules Ductuli efferentes Paradidymis Epoophoron Paroophoron Undifferentiated gonad Cortex Medulla Testes Seminiferous tubules Rete testis Ovary Ovarian follicles Rete ovary Gubernaculum Gubernaculum Testis Round ligament Ovarian ligament EMBRYOLOGICAL ORIGINS Endoderm Mesoderm Bladder Ureter (mesenephros) (intermed. mesoderm) Urethra Kidney (metanephros) (intermed.) Prostate Seminal vesicles (intermed.) Trigone (bladder) Trigone (ureteric inlets to bladder) Gonads (testes, ovaries; intermed. mesoderm) Genital ducts (vas deferens, fallopian tubes) External genitalia (penis, scrotum, vagina)

 167) Damage control surgery AIIMS MAY 2013 a) Minimum possible intervention b) Maximum possible intervention c) C) d) D) 168) A survey on blind school for the prevalence of blindness when compared to prevalen ce in general population AIIMS MAY 2013 a) Overestimate it b) Underestimate it c) Both are equal 169) . A patient complaints of diarrhoea stool examination shows ova of size 100,which of the following cannot be the cause ? AIIMS MAY 2013 A) cryptosporidium B) opisthorcus viverni C) isospora Ans b Ref-POZIGOLD 170) Tc99 pertechnate hot spot on parotid spot? AIIMS MAY 2013 a) Warthims tumor b) Adenoid cystic lymphoma c) Mucoepidermoid Ca d) Lymphoma Ans-a REF-POZIGOLD,CONSULTANT 171) A patient presented with sudden onset of severe headache with vomitting and nausea.He complaints of neck stiffness .What is the diagnosis? AIIMS MAY 2013 a) SAH b) Basilar migrane c) Cluster headache d) Extradural hemorrhage ANS A REF-POZIGOLD,CONSULTANT,OHC 172) A 19 yr old female with primary amenorrhoea,wide spaced nipples hypoplastic uterus.What is the karyotype? AIIMS MAY 2013 a) 47XXY b) 45XO c) 46XY d)46XX ans-b ref-OHC,POZIGOLD,CONSULTANT 173) The following test is used to differentiate between maternal a nd foetal blood cell AIIMS MAY 2013 a) APT test b) Kleihauer Betke test c) Bubblin test d) Osmotic fragility test ANS-A REF-OHC,POZIGOLD,CONSULTANT 174) A toddler passes a drop of blood per rectum diagnosis is AIIMS MAY 2013 a) Juvenile rectal polyp b) Harmartomatous polyp c) Fistula in ano ANS-A REF-CONSULTANT 175Knowledge of own disease /illness in mental status AIIMS MAY 2013 a) Insight b) Oriention c) Judgement d) Rapport Ans a Ref-consultant 176) The following is the mode of transmission of Legionella pneumonia AIIMS MAY 2013 a) Aerosal transmission b) Infectious droplets C)Blood borne Ans a Ref-OHC,OH BOOK PAGE,POZIGOLD,CONSULTANT * Produces pontaic fever, legionnaires disease. * 1st in philadelphia during American legion convention. * Fastidious Aerobic Gram negative bacilli. * 49 species, 64 serogroups. * L.Pneumophilia 80-90% [Buffered charcoal yeast Extract]- serogroups 1, 4, and 6 are most common.*** * L. micdadei (Pittsburgh pneumonia agent), L. bozemanii, L. dumoffii, and L. longbeachae. * Direct fluorescent antibody (DFA) test-directed primarily at the lipopolysaccharide. * Can live in years in refrigerated water.

* Source water. * Mode of Transmission microaspiration, inhalation. 177) A patient develops itchy urticarial plaques tense blisters which of the following can be used to diagnose AIIMS MAY 2013 a) biopsy b) Direct immunofluorescence c)Indirect immunofluorescence d) ans a ref-OHC,OH BOOK PAGE 239 Dermatitis Herpetiformis * Intensely pruritic, papulo vesicular skin disease. * Symmetrical, extensor surface. * Primary lesion papule, urticarial plaque. * Associated with gluten sensitive enteropathy. * 90% HLA B8/DRW3, HLA DQW2. * 2nd 4th decade. * Biopsy - Sub epidermal bullae with neutrophils in dermal papillae. - Immuno Granular deposits of IgA in papillary dermis and along the epidermal basement membrane zone. * Auto antibodies - IgA anti endomysial antibodies that target tissue Transglutaminase. * incidence of Thyroid abnormalitis, achlorhydria, atrophic gastritis and ant igastric parietal cell antibodies. * Treatment Dapsone Response within 24 48 hrs. * Gluten Restriction. 178) The following are the tests of malabsorption except AIIMS MAY 2013 a) D-Xylose test b) 13C breath test c) 13C breath test d) 14 C breath test 179) HPI does not include AIIMS MAY 2013 a) Child literacy rate b) Life expectancy not beyond 40 yrs c) It differs from developing and developed countries