Melaka Manipal Medical College (Manipal Campus) Progress Examination
International Centre for Health Sciences Block: GIT, Hepatobiliary, CVS and RS September 2008 (Batch 23) and Date: Thursday, J une 3, 2010 Refreshers March 2008 Batch Time: 1.45 pm to 3.45 pm
PATHOLOGY : PAPER I
1. A 64 year old retired teacher with a long history of hypertension experiences pain in his chest while walking around in the market. The pain is central with radiation down his left arm. He sits down, the pain decreases in intensity after 5 minutes but persists.
a. What is the most likely cause of chest pain in this case ? What tests would be relevant to diagnose the patients condition?
After a year, the same patient experiences severe chest pain on waking up in the morning with nausea and profuse sweating. He is rushed to the emergency and a diagnosis of acute myocardial infarction is made. In spite of the best treatment the patient dies after 3 days.
b. On autopsy, what are the possible changes that can be seen in the cardiovascular system of this patient? (2+5=7 marks)
2. Rheumatic fever licks the joints and bites the heart. Explain this statement. (5 marks)
3. Define asthma. Describe the pathological features and pathogenesis of atopic asthma. (1+2+2=5 marks)
4. A 50 year old bus driver, a chronic smoker presented to the OPD with complaints of severe pain in the right hip after a trivial fall.He also had cough, haemoptysis and loss of weight of 6 kgs in 2 months. X-ray of the lung showed a coin sized central radio-opaque shadow in the right lung and x-ray of the right hip revealed an inter-trochanteric fracture of femur. His serum calcium level was 35 mg/dl (normal level is 9- 10.5 mg/dl).
a. What is your final diagnosis? b. Describe the morphology of the lesion in the lung. c. What are the other investigations you will do for this patient? d. Give reasons for the high serum calcium level and the fracture right femur. (1+2+1+1=5 marks)
Please turn over.. INSTRUCTIONS 1. Answer all questions; answer them in the same order as in the question paper. 2. Draw diagrams wherever appropriate. 3. Write the question number clearly in the margin space.
The marks scored will count only if you have the mandatory course requirement of at least 90% attendance in the subject in this block. Page 2 of 2 5. A 45 year old diabetic is admitted to ICU with sudden onset of fever, dyspnoea, tachypnoea and bluish discolouration of lips and tongue. General physical examination showed an ulcer in the right foot with ascending cellulitis. The patient does not respond to treatment and dies in progressive respiratory failure.
a. What is the condition the patient is suffering from? b. List four important causes for the condition. c. Explain the pathogenesis of the condition. (+1+3=5 marks)
6. Briefly discuss the role of H. pylori in the pathogenesis of gastritis and gastric neoplasms. (2+4=6 marks)
7. Compare the morphology of a benign and malignant gastric ulcer. (5 marks)
8. In a tabular format, enumerate the endoscopic, macroscopic and microscopic differences between Crohns disease and Ulcerative colitis. (2+2+2=6 marks)
9. With the help of a diagram, explain the adenoma carcinoma sequence and its molecular biology. (5 marks)
10. Discuss the aetiopathogenesis and the morphology of pancreas in acute pancreatitis. (4+2=6 marks)
11. Describe the aetiopathogenesis and complications of acute appendicitis. (3+2=5 marks)
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Melaka Manipal Medical College (Manipal Campus) International Centre for Health Sciences September 2008 (Batch 23) and Refreshers March 2008 Batch MANIPAL 576 104
Block: GIT, Hepatobiliary, CVS and RS
Roll No.
Date : Thursday, J une 3, 2010
Time : 4.00 pm to 5.00 pm
Duration : 60 minutes
INSTRUCTIONS
Read carefully before you begin.
1. For each statement, select T (True) or F (False) in the answer sheet. 2. Indicate your choice by darkening the appropriate circle in the answer sheet. 3. Use only HB or 2B pencils to darken the circle. 4. Leave blank for Don't Know response. 5. Scoring system: Correct +1 Wrong 0.5 Don't Know 0 6. Indicate your roll number clearly and correctly in the answer sheet. 7. DO NOT write anything in the question paper. 8. The True/False statements are numbered from 101 to 160 and 201 to 260 (Total 120 statements). PROGRESS EXAMINATION Pathology : Paper II The marks scored will count only if you have the mandatory course requirement of at least 90% attendance in the subject in this block. Page 4 of 2 Regarding atherosclerosis
101. Turbulent blood flow plays an important role in the pathogenesis of atherosclerosis 102. There is decreased expression of ICAM-I and E-selectin 103. Plaques vulnerable for rupture have a large fibrocalcific component with little inflammatory component
108. It can occur in previously fit individuals 109. The characteristic histological lesion seen is intimal proliferation and hyalinization of the muscular media 110. It can cause sudden death from cerebral haemorrhage
Capillary microangiopathy in diabetes
111. Is due to abnormal glycosylation of proteins within the vessel wall 112. Shows fibrinoid necrosis of small vessels 113. Leads to basement membrane thickening 114. Causes increased vascular permeability
Thrombo-angiitis obliterans
115. Is also known as Takayasus disease 116. Is associated with smoking 117. Causes gangrene of toes and fingers which require amputation
Left ventricular failure
118. Results in congestion of the lungs 119. Is caused by systemic hypertension 120. Due to chronic obstructive lung disease is called cor pulmonale 121. Leads to congestive organomegaly
Infective endocarditis
122. Results in immune mediated destruction of heart and valves 123. Causes rupture of chordae tendinae 124. Involves the aortic valve in drug addicts 125. Can cause glomerulonephritis
Coarctation of aorta
126. Can cause intracerebral haemorrhage 127. Presents with cyanosis at birth 128. Causes notching of ribs 129. Is more common in females Page 5 of 2 Regarding cardiomyopathy
130. It can cause sudden cardiac death 131. It is due to atherosclerosis of the coronary arteries 132. There is marked hypertrophy of the left ventricle
136. With the progression of the disease, pulmonary function tests will show an obstructive defect 137. Inhalation of organic dusts results in hypersensitivity pneumonitis 138. Bulla formation can occur in progressive massive fibrosis
Alpha-1 antitrypsin
139. Is an acute phase serumprotein 140. Inhibits the action of elastase and collagenase 141. Enzyme deficiency is inherited as autosomal dominant trait
Morphological features of chronic bronchitis include
142. Neutrophilic infiltrate within the bronchial wall 143. Mucous plugging of airways 144. Hypoplasia of submucosal glands 145. Squamous metaplasia
Regarding lobar pneumonia
146. It is a disease where proximal airways are filled with suppurative exudate 147. It is a disease predominantly of distal airways including alveoli 148. Characteristically there is an interstitial inflammatory infiltrate 149. The commonest aetiological organism is streptococcus pneumoniae
Regarding pathological basis for clinical signs and symptoms of lobar pneumonia
150. Bronchial breathing is due to well aerated alveoli conducting bronchial sound 151. Dullness to percussion is because of exudate replacing air in the distal airways 152. Pleuritic pain which occurs during inspiration is due to muscular pain 153. Patient presents with rusty sputum due to altered RBCs in it
Regarding bronchopneumonia and other pneumonias
154. Bronchopneumonic involvement results in exudation seen in large segments of lung parenchyma 155. Bronchopneumonia is usually patchy in its involvement 156. Viral and mycoplasmal pneumonia produce typical alveolar exudate of fibrin rich fluid 157. Cryptococcal pneumonia is common in the immunocompromised hosts
Regarding neonatal respiratory distress syndrome
158. Hyaline membrane disease is commonly seen in full term babies born after caesarean section 159. The basic defect is a deficiency of surfactant resulting in atelectasis 160. The hyaline membrane seen in alveoli is associated with numerous neutrophils Page 6 of 2 Regarding tuberculosis (TB)
201. Hypersensitivity is established as soon as infection occurs 202. Hypersensitivity is associated with some immunity and more necrosis 203. Primary TB is associated with cavitary lesions in the apex of lungs 204. Primary TB heals by fibrosis and calcification 205. Secondary tuberculosis produces fibrocaseous lesions in lung apex
209. Mostly squamous cell carcinomas 210. Associated with H. pylori infection 211. Linked to dietary deficiencies of riboflavin and zinc
Regarding salivary gland tumors
212. Pleomophic adenoma is a mixed tumor that originates from epithelial and mesenchymal cell types 213. Adenolymphoma is a benign tumor 214. Muco-epidermoid carcinoma is associated with Epstein Barr Virus (EBV) infection
Early gastric carcinomas
215. Are limited to mucosa or sub mucosa of the stomach 216. Have less than 10% 5 year survival 217. Can have regional lymph node involvement
The following regarding gastric ulcer and duodenal ulcer are correctly matched
218. Gastric ulcer : Common in blood group O 219. Duodenal ulcer: H. pylori infection is seen in 90% patients 220. Duodenal ulcer: They occur due to increased acid in the stomach
Obstruction is an early feature in carcinomas of descending colon because of
221. Narrowing of the lumen at this site 222. Solid consistency of faeces at this site 223. Polypoid and fungating nature of cancer
The following types of diet are linked to colorectal cancer
224. High fat diet 225. High fibre diet 226. High protein diet
Regarding pathophysiological basis of carcinoid tumours and carcinoid syndrome
227. Diarrhoea and borborygmi are due to the effect of 5-hydroxy tryptamine 228. Endocardial thickening is because of the action of bradykinin
Entero-endocrine cells are capable of secreting
229. Vasoactive intestinal peptide (VIP) 230. Kallikrein 231. 5-hydroxytryptamine 232. Somatostatin Page 7 of 2 The following adenomas are correctly matched with the gross appearance
233. Tubular adenoma : Grossly resembles a raspberry 234. Villous adenoma : Is usually pedunculated 235. Villous adenoma : Grows like a thick carpet
Regarding amoebiasis,it
236. Is caused by Entamoeba coli 237. Leads to flask shaped ulcers in the colon 238. Can result in liver abscess
Typhoid ulcers
239. Are transverse ulcers 240. Are associated with typhoid nodules in the intestine, liver and kidney
Regarding carcinoma pancreas
241. It is usually a squamous cell carcinoma 242. Fibrolamellar variant is a common variant 243. Acute pancreatitis can lead to carcinoma of the pancreas 244. Flitting venous thrombosis is seen
Regarding chronic pancreatitis
245. Steatorrhoea is a complication 246. It can occur because of repeated episodes of acute pancreatitis 247. Autoimmunity can cause chronic pancreatitis 248. Grey-Turners sign is positive in chronic pancreatitis 249. Amylase levels help in the diagnosis
Cholelithiasis
250. Of the cholesterol type is associated with haemolytic anaemia 251. Of the pigment type is yellow in colour 252. Can lead to mucocoele and empyema 253. Can result from deficit of bile salts
Acute cholecystitis
254. Is associated with abdominal pain in the right hypochondrium 255. Has thickened gall bladder due to fibrosis 256. Shows Aschoff-Rokitansky sinuses histologically
In chronic cholecystitis
257. The wall of the gall bladder appears thinned out 258. Palpable gall bladder with obstructive jaundice is seen
Carcinoma of the gall bladder
259. Is usually an adenocarcinoma 260. Has a good prognosis Page 8 of 2 Melaka Manipal Medical College (Manipal Campus) Progress Examination International Centre for Health Sciences Block: GIT, Hepatobiliary, September 2008 (Batch 23) and CVS and RS Refreshers March 2008 Batch Date: Saturday, J une 5, 2010 Time: 1.45 pm to 3.45 pm
PHARMACOLOGY : PAPER I
1. Give pharmacological basis for: a. Combining ezetimibe with statins for the treatment of hyperlipidaemia b. Using dopamine in cardiogenic shock c. Praziquantel is preferred over niclosamide for tape worm infestations. d. Mesalazine is better tolerated than sulfasalazine e. Lignocaine is used in ventricular arrhythmia (2x5=10 marks)
2. Write short notes on: a. Short course chemotherapy for pulmonary tuberculosis. b. Metoclopramide c. Inhaled glucocorticoids (3x3=9 marks)
3. a. Mention the mechanism of action of ranitidine and explain its drug interaction with sucralfate. b. Name three drugs each useful in dry and productive cough. (3+3=6 marks) 4. a. A 45 year old man with chronic duodenal ulcer due to H.pylori was treated with a combination of drugs. Mention a triple drug regimen for this patient and explain the role of each drug in this regimen b. A patient is hospitalized with hydatid disease. He refused to undergo surgery for removal of cysts. Which drug could be helpful in this patient and mention its three other therapeutic uses. (3+2=5 marks)
5. A 60 year old female with history of diabetes was found to be hypertensive. An antihypertensive was prescribed to control her BP.
a. Which class of antihypertensives is preferred in this case? Mention three drugs belonging to the same class. b. Explain the antihypertensive action of the above drugs. (2+2=4 marks)
6. a. Explain the positive ionotropic action of digoxin with the help of a diagram. b. Outline the management of digitalis toxicity and explain its interaction with quinidine. (2+3=5 marks)
Please turn over.. INSTRUCTIONS 1. Answer all questions; answer them in the same order as in the question paper. 2. Draw diagrams wherever appropriate. 3. Write the question number clearly in the margin space.
The marks scored will count only if you have the mandatory course requirement of at least 90% attendance in the subject in this block. Page 9 of 2
7. A 16-year old girl treated for asthma develops skeletal muscle tremors and palpitation after taking an inhaled antiasthmatic drug.
a. What was the drug taken by the patient? Mention another drug belonging to the same class. b. Explain how the above class of drugs help the asthmatic paient ? (1+1=2 marks)
8. a. Mention two prostaglandin analogues with their therapeutic uses. b. Enumerate two second generation antihistaminics and mention their two advantages over the first-generation antihistaminics. c. Explain the mechanism of action of metronidazole and mention its four therapeutic uses. (2+2+4=8 marks)
9. A 60-year-old hypertensive patient with BPH had been treated with hydrochlorothiazide to control his elevated BP, and then he developed weakness.
a. What could be the reason for onset of weakness? Name two drugs which can be added to overcome weakness? b. Explain the basis for using hydrochlorothiazide in this patient. c. Which class of antihypertensive would be preferred in the above patient? Explain. (1+2+2=5 marks)
10. 70 year old Karthik experiences severe chest pain when he walks uphill in cold weather to his home. The pain disappears when he rests. He was advised to take nitroglycerin whenever he gets chest pain.
a. How nitroglycerin relives acute anginal attack? b. Mention two other uses of nitroglycerin with its route of administration. c. Mention two groups of drugs with two examples each that can be given prophylactically in the above patient. (2+1+3=6 marks)
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Melaka Manipal Medical College (Manipal Campus) International Centre for Health Sciences September 2008 (Batch 23) and Refreshers March 2008 Batch MANIPAL 576 104
Block: GIT, Hepatobiliary, CVS and RS
Roll No.
Date : Saturday, J une 5, 2010
Time : 4.00 pm to 5.00 pm
Duration : 60 minutes
INSTRUCTIONS
Read carefully before you begin.
1. For each statement, select T (True) or F (False) in the answer sheet. 2. Indicate your choice by darkening the appropriate circle in the answer sheet. 3. Use only HB or 2B pencils to darken the circle. 4. Leave blank for Don't Know response. 5. Scoring system: Correct +1 Wrong 0.5 Don't Know 0 6. Indicate your roll number clearly and correctly in the answer sheet. 7. DO NOT write anything in the question paper. 8. The True/False statements are numbered from 101 to 160 and 201 to 260 (Total 120 statements). PROGRESS EXAMINATION Pharmacology : Paper II The marks scored will count only if you have the mandatory course requirement of at least 90% attendance in the subject in this block. Page 11 of 2 Compared to metronidazole, tinidazole
101. Has higher cure rate in amoebiasis 102. Has a shorter duration of action 103. Is not well tolerated 104. Has simpler dosage regimen
Diloxanide furoate
105. Kills tropozoites in the liver 106. Is the drug of choice in chronic cyst passers 107. Produces flatulence
Fenofibrate
108. Acts by activating lipoprotein lipase 109. Is useful in patients with marked rise of triglycerides 110. Reduces the incidence of gall stones 111. Is contraindicated in pregnancy
Following are the desirable properties of plasma volume expanders. They should
112. Exert oncotic pressure higher than that of plasma 113. Not remain in circulation for longer duration 114. Not be pyrogenic 115. Be pharmacodynamically inert
In multidrug resistant tuberculosis
116. Resistance is seen to both isoniazid and rifampin 117. Second line antitubercular drugs are useful 118. Choice of drugs is independent of drugs used in the previous regimen 119. The duration of combination therapy is 12-24 months
Isoniazid
120. Acts by inhibiting mycolic acid synthesis 121. Is contraindicated in children less than 6 years of age 122. Causes reddish discolouration of urine 123. Is administered along with pyridoxine
Regarding antitussives
124. They reduce tussal impulses from the respiratory tract 125. They are useful in productive cough 126. Dextromethorphan acts through opioid receptors 127. Promethazine acts by inhibiting cough centre
Ivermectin
128. Inhibits GABA nergic transmission in worms 129. Is the drug of choice in strongyloidosis 130. Produces tonic paralysis in nematodes 131. Is used orally for the treatment of scabies Page 12 of 2
Regarding diethylcarbamazine (DEC)
132. It is used to reduce transmission of filariasis 133. Its overdose can cause Mazzotti reaction. 134. It rapidly kills the adult worms. 135. It can be used for tropical eosinophilia.
Omeprazole
136. Is a prodrug. 137. Inhibits Na + -K + -ATPase in the parietal cells. 138. Can be given by both oral and intravenous route. 139. Is effective for the treatment of Zollinger-Ellison syndrome.
Colloidal bismuth subcitrate
140. Inhibits mucosal PGE 2 production. 141. Detaches H. Pylori fromthe mucosal surface. 142. Should be taken along with antacids. 143. Causes blackening of tongue and stools.
Regarding antacids
144. They can cause metabolic acidosis. 145. Aluminium hydroxide delays gastric emptying. 146. Calcium carbonate can cause acid rebound. 147. They are used to protect the gastric mucosa.
Important effects of digitalis on the heart include
155. Competitively block angiotensin II at its receptor 156. Decrease angiotensin II concentration in the blood 157. Cause potassium retention 158. Are safe in pregnancy
Positive inotropic drugs include
159. Dobutamine 160. Amrinone
Page 13 of 2 Digoxin toxicity is precipitated by
201. Administration of captopril 202. Administration of calcium 203. Hyperkalemia 204. Hypomagnesmia
Sumatriptan
205. Is a 5-HT 2A receptor agonist 206. Has a high oral bioavailability 207. Is effective in the treatment of acute migraine 208. Can be safely used in epileptic patients
Montelukast
209. Is a leukotriene synthesis inhibitor 210. Can be administered orally 211. Is used to terminate an attack of acute asthma
Drugs used to terminate an attack of acute asthma includes
216. Blocks 5-HT 2A receptors 217. Has poor antipruritic action 218. Can suppress appetite in children 219. Is used in the treatment of carcinoid syndrome
Sodium chromoglycate
220. Inhibits degranulation of mast cells 221. Can be used to terminate an attack of allergic rhinitis 222. Is ineffective in preventing exercise-induced bronchospasm
Regarding central sympatholytics
223. Clonidine stimulates 2 receptors 224. Methyldopa acts as a false neurotransmitter at dopamine receptors 225. Administration of clonidine can be stopped abruptly 226. Methyldopa can be administered safely during pregnancy
Following antihypertensive drugs are correctly matched with their adverse effects
232. Decomposes on exposure to light 233. Causes vasodilatation by releasing nitric oxide 234. Is used for the treatment of mild to moderate hypertension 235. Causes metabolic acidosis
245. Is used to empty the bowel before surgery 246. Increases the production of NH 3 in the colon 247. Breaks down into acidic products in the colon 248. Is a stimulant purgative
Regarding antimotility drugs
249. Loperamide is combined with atropine to discourage its abuse 250. They act by blocking receptors in the CNS 251. They can cause toxic megacolon 252. They are contraindicated in ulcerative colitis
Ondansetron
253. Blocks 5HT 3 receptors on vagal afferents in the GIT 254. Can cause constipation 255. Is used in motion sickness 256. Is useful in cancer chemotherapy induced vomiting
Adenosine
257. Acts by activating K + channels 258. Is preferred over verapamil for PSVT 259. Can cause long lasting adverse effects 260. Is given orally
Page 15 of 2 Melaka Manipal Medical College (Manipal Campus) Progress Examination International Centre for Health Sciences Block: GIT, Hepatobiliary, September 2008 (Batch 23) and CVS and RS Refreshers March 2008 Batch Date: Monday, J une 7, 2010 Time: 1.45 pm to 3.45 pm
MICROBIOLOGY : PAPER I
1. A 25 year old American adventurist returned from Uganda with fever, chills and myalgia since 2 days. Blood smear for malaria was negative .Two days later he developed an urticarial rash and bloody diarrhea with pain in right upper quadrant. His liver was enlarged and liver enzymes were elevated. He was found to have eosinophilia. His stool sample sent for investigation revealed a parasitic egg with characteristic lateral spine.
a. Identify the etiology in this case b. Briefly discuss the life cycle of the agent. (1+3=4 marks)
2. Discuss the pathogenesis of enteric fever. (5 marks)
3. Describe the morphology of influenza virus and discuss the role of antigenic variations in influenza infections (2+4=6 marks)
4. Discuss elaborately the pathogenesis of glandular fever with a special emphasis on their mechanisms involved. This disease is an exclusive human disease, substantiate? (4+1=5 marks)
5. Discuss the laboratory diagnosis of diphtheria. (4 marks)
6. Differentiate the pathogenesis of cholera and rotaviral diarrhoea (6 marks)
7. Ralp a 20 year old, living in squalid circumstances was emaciated and undernourished. Radiological examination revealed miliary lung mottling. His sputumspecimen was given for laboratory diagnosis and on specialized staining showed acid fast bacilli. a. Based on the above findings, diagnose the disease. b. Describe the pathogenesis of afore said disease with reference to immune response of the host. c. Write a note on hypersensitivity elicited due to the organism and list the uses of this test (1+3+3=7 marks)
Please turn over.. INSTRUCTIONS 1. Answer all questions; answer them in the same order as in the question paper. 2. Draw diagrams wherever appropriate. 3. Write the question number clearly in the margin space.
The marks scored will count only if you have the mandatory course requirement of at least 90% attendance in the subject in this block. Page 16 of 2
8. Give reasons for the following: a. Colonies of H.influenzae that grow in close proximity to S.aureus are larger b. M.tuberculosis glows brighter in the luciferase assay c. An overnight broth culture of S.pneumoniae clears after addition of 10% deoxycholate d. Extra-intestinal amoebiasis manifests as hepatic amoebiasis with anchovy sauce pus (4x2=8 marks)
9. A 5-year-old girl developed watery diarrhoea since two days after attending her uncle's wedding party. She did not have any fever. She had travelled fromUS to Kundapur along with her parents for her uncle's wedding. Her stool sample in the laboratory grew lactose fermenting, indole producing motile gram negative bacilli. It did not utilise citrate nor produced hydrogen sulphide. a. What is the most probable pathogen in the above case? b. Explain the pathogenesis in the above case. (1+4=5 marks)
10. Discuss the role of seromarkers in the diagnosis of Hepatitis B infection in self limited and carrier patients. (5 marks)
11. Write short notes on: a. Pathogenesis of Clostridium botulinum b. Morphology of Helicobacter pylori (2x2=5 marks)
* * * * * Page 1 of 5
Melaka Manipal Medical College (Manipal Campus) International Centre for Health Sciences September 2008 (Batch 23) and Refreshers March 2008 Batch MANIPAL 576 104
Block: GIT, Hepatobiliary, CVS and RS
Roll No.
Date : Monday, J une 7, 2010
Time : 4.00 pm to 5.00 pm
Duration : 60 minutes
INSTRUCTIONS
Read carefully before you begin.
1. For each statement, select T (True) or F (False) in the answer sheet. 2. Indicate your choice by darkening the appropriate circle in the answer sheet. 3. Use only HB or 2B pencils to darken the circle. 4. Leave blank for Don't Know response. 5. Scoring system: Correct +1 Wrong 0.5 Don't Know 0 6. Indicate your roll number clearly and correctly in the answer sheet. 7. DO NOT write anything in the question paper. 8. The True/False statements are numbered from 101 to 160 and 201 to 260 (Total 120 statements). PROGRESS EXAMINATION Microbiology: Paper II The marks scored will count only if you have the mandatory course requirement of at least 90% attendance in the subject in this block. Page 2 of 5 Vibrio parahemolyticus
101. Produces a heat labile cytotoxin 102. Invades the intestinal epithelial cells 103. Is diagnosed by Kanagawa phenomenon
Enterobius vermicularis
104. Infection in women manifests as vaginitis 105. Produces a bile stained egg 106. Infection is diagnosed by demonstration of eggs using NIH swab
Trichuriasis
107. Results due to the penetration of the rhabditiform larva 108. Manifests as iron deficiency anemia if there is massive prolonged infection 109. Is diagnosed by the demonstration of bile stained egg
Strongyloides stercoralis
110. Have a soil cycle leading to the development of an infective larva 111. Is called old world hook worm 112. Larval forms causes larva currens
Clonorchis sinensis
113. Have cercariae as infective forms for humans 114. Infection leads to the inflammatory reactions in the biliary epithelium 115. Infection is diagnosed by demonstration of an operculated egg from aspirated bile
Fasciola hepatica
116. Has humans as the intermediate host 117. Is a hermaphrodite 118. Infection manifests as abscesses in the liver parenchyma
Taeniasis
119. Manifesting as cysticercosis results due to the consumption of larva 120. Is characterized by the production of a bile stained egg 121. Is diagnosed by the demonstration of scolex in the stool.
Hymenolepis nana
122. Infection results due to the ingestion of bile stained eggs 123. Infection in children manifests as epileptic convulsions 124. Has an indirect cycle having insects as intermediate hosts
Diphyllobothrium latum
125. Has fresh water fish as the definitive host 126. Manifests as pernicious anemia due to deficient vitamin B 12 absorption 127. Infection is diagnosed by the demonstration of operculated egg
Page 3 of 5 Rhinovirus
128. Attaches using the capsid protein with ICAM 2 129. Infection leads to life long immunity 130. Infection is diagnosed by demonstration of antigen from exfoliated cells
Echinococcus granulosus
131. Causes unilocular hydatid disease 132. Adult form resides in the duodenum of sheep 133. In humans is transmitted by ingestion of measly meat 134. Is diagnosed by a delayed hypersensitivity skin test 135. Eggs are non-bile stained
Regarding Enteric fever
136. Blood culture is done in the 1 st week of infection 137. Etiological agent produces non lactose fermenting colonies 138. Typhoid fever is caused by anerogenic bacilli 139. Is prevented using live vaccine containing Vi capsular polysaccharide 140. The live attenuated vaccine is stable mutant of ty-2 strain Cytomegalovirus
141. Is a flavivirus 142. Causes heterophil negative mononucleosis 143. Infection is characterised by presence of atypical lymphocytes 144. Is transmitted by saliva 145. Inhibits T cell response resulting in transient immunosuppresion Regarding oral cavity infections
146. Broad spectrum antibiotics cause impaired immunity predisposing to oral thrush 147. Vitamin D deficiency allows residents to cause guminfections 148. Streptococcus mutans infection results in dental caries 149. The bacteria in plaque use sugar to form lactic acid which decalcifies tooth 150. Bacterioides fragilis are associated with gingivitis
Influenza
151. Infection is diagnosed by haemagglutination inhibition test 152. Virus has fusion protein 153. Infection results in interstitial pneumonia 154. Is prevented by using live attenuated thermal mutants of the virus 155. Causes syncytium formation in cell culture
201. Produces toxin that resembles shiga toxin 202. Infection leads to haemolytic uremic syndrome 203. Produces non sorbital fermenting colonies on modified Mac Conkey's medium 204. Is transmitted by inhalation of the organism
Hepatitis E virus
205. Is a single stranded DNA virus 206. Spreads through parental route 207. Infection runs a severe course in pregnant woman 208. Has a carrier phase
Helicobacterpylori
209. Is a gram positive curved bacilli 210. Has a enterotoxin as its virulence factor 211. Infection is diagnosed by urea breath test 212. Does not produce oxidase 213. Infection is associated with carcinoma of the stomach
Antibiotic associated diarrhoea is
214. Caused by Clostridium difficile 215. Characterized by the formation of cytotoxin 216. Treated with vancomycin
Micro-organisms associated with food poisoning include
221. Has G protein for fusion of the virus to host cell surface 222. Belongs to family orthomyxoviridae 223. Infection has an immunopathologic basis 224. Is a enveloped DNA virus 225. Infection is prevented by vaccination
Mumps
226. Is caused by paramyxovirus 227. Virus has segmented ssRNA as its genome 228. Is characterized by maculopapular rashes on the skin 229. Virus has hemagglutinin and neuraminidase peplomers 230. Infection causes aseptic meningitis
Page 5 of 5 Ascaris lumbricoides
231. Is commonly found in the temperate regions of the world 232. Has digestive and respiratory organs that are rudimentary 233. Produces bile stained operculated eggs 234. Infects man via skin penetration by the filariform larva 235. Releases a toxin called the ascaron that causes urticaria
Pfeiffers bacillus
236. Has outer membrane protein (OMP) as one of its principal antigens 237. Grows well on Levinthals medium 238. Has PRP antigen that induces antibodies that are not protective 239. That are non-capsulated are typable 240. Is highly pleomorphic and appears as long and filamentous in the sputum
Mycoplasma pneumoniae
241. Colonies on agar adsorb erythrocytes 242. Belongs to family Acholeplasmataceae 243. Requires cholesterol and sterol as essential growth factors 244. Causes atypical pneumonia characterised by a paucity of respiratory signs 245. Are resistant to lysis by osmotic shock
Legionnaires disease
246. Is caused by Legionella pneumophila 247. Causative agent is aerobic gram negative bacillus 248. Is characterized by mental confusion and non-bloody diarrhea 249. Causing organism grows on agar supplemented with iron and cysteine 250. Is rapidly diagnosed by screening for antigens in urine
Genus Hantavirus
251. Species are natural pathogens of sea gulls 252. Causes hemorrhagic fever with renal syndrome 253. Infections are mainly transmitted by ingestion 254. Species that cause the pulmonary syndrome are the Sin Nombre 255. Causing epidemic hemorrhagic fever is clinically similar to leptospirosis
Regarding the adult worms of N .americanus:
256. Copulatory bursa has a total of 13 rays with a single dorsal ray 257. Is found in the cooler and drier regions of the world 258. Its habitat is in the jejunum 259. Lay eggs that sink in a saturated solution of sodiumchloride 260. Has the non feeding, infective form as the filariformlarva Page 6 of 5 Melaka Manipal Medical College (Manipal Campus) Progress Examination International Centre for Health Sciences Block: GIT, Hepatobiliary, CVS and RS September 2008 (Batch 23) and Date: Wednesday, J une 9, 2010 Refreshers March 2008 Batch Time: 2.00 to 3.15 pm (Total time for Paper I and Paper II)
FORENSIC MEDICINE
PAPER I
Note: Essay and MTF answer scripts will be collected together at the end of 1 hour 15 minutes.
1. Explain Delusion and Illusion with examples. (2+2=4 marks) 2. Briefly explain the mechanismof action and clinical features of strychnine poisoning. (1+2=3 marks) 3. Briefly explain the clinical features and management of Methanol poisoning. (1+1=3 marks) 4. Describe the clinical features of organophosphorous poisoning. (3 marks) 5. Mention the active principles of Cannabis indica. Briefly describe the various cannabis preparations. (1+5=6 marks) 6. Describe the clinical features and treatment of chronic mercury poisoning. Add a note on saturnism. (3+3=6 marks)
PAPER II
INSTRUCTIONS
Read carefully before you begin.
1. For each statement, select T (True) or F (False) in the answer sheet. 2. Indicate your choice by darkening the appropriate circle in the answer sheet. 3. Use only HB or 2B pencils to darken the circle. 4. Leave blank for Don't Know response. 5. Scoring system: Correct +1 Wrong 0.5 Don't Know 0 6. Indicate your roll number clearly and correctly in the answer sheet. 7. DO NOT write anything in the question paper. 8. The True/False statements are numbered from 101 to 130 (Total 30 statements).
MTFs Please turn over. INSTRUCTIONS 1. Answer all questions; answer them in the same order as in the question paper. 2. Draw diagrams wherever appropriate. 3. Write the question number clearly in the margin space.
The marks scored will count only if you have the mandatory course requirement of at least 90% attendance in the subject in this block. Page 7 of 5 MTFs:
Regarding cardiac poisons
101. Nicotiana tobaccum resembles horse radish 102. Cerberin is an alkaloid 103. Folinerin and rosagenin are active principles of pink oleander
About asphyxiants
104. Carbon monoxide poisoning results in cherry red colored lividity 105. 40-50% concenteration of CoHb in blood resembles drunkenness 106. Cyanide poisoning results in histotoxic anoxia
A mentally ill person
107. If marries, the marriage is valid 108. Can make a valid will 109. Cannot withstand lack of sleep 110. Can be acquitted in the court of law for any crime committed as per Mc Naughtens rule
Chronic ethanol consumption
111. Leads to Wernickes encephalopathy 112. Is treated with methanol 113. causes optic neuritis 114. Can be treated with disulfiram
118. Is also known as aqua fortis 119. Acts by extracting water from the tissues 120. Produces yellowish discoloration of the tissues
The characteristic features of chronic lead poisoning are
121. Bluish discoloration at the junction of the teeth and gums 122. Chronic diarrhea 123. Basophilic stippling of red blood cells 124. Signs and symptoms resembling tetanus
Regarding first aid in a case of snake bite
125. Reassurance plays a major role in preventing death 126. Immobilization of the limb should be done 127. Tourniquet is tied in case of bites on the limbs
Datura seeds
128. Resemble chilly seeds 129. Contain abrin as active principle 130. Cause contraction of pupils
(The Clinics - Surgery) Steve Behrman MD FACS, Ron Martin MD FACS - Modern Concepts in Pancreatic Surgery, An Issue of Surgical Clinics, 1e (2013, Elsevier)