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Page 1 of 2

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)



* * * * *
Page 3 of 2

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

Causes of secondary hypertension include

104. Chronic renal failure
105. Phaeochromocytoma
106. Steroid therapy
107. Conns syndrome

Regarding malignant hypertension

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

Causes of pericarditis include

133. Uraemia
134. Rheumatoid arthritis
135. Myocardial infarction

Regarding pneumoconiosis

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

Auto-immune chronic gastritis is characterized by

206. Hypochlorhydria
207. Pernicious anaemia
208. Hematemesis

Oesophageal carcinomas are

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)




* * * * *
Page 10 of 2

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

148. Increased atrioventricular conduction velocity
149. Increased intracellular calcium
150. Decreased ectopic automaticity

Drugs found to be useful in heart failure include

151. Alpha-adrenoceptor agonists
152. Beta-adrenoceptor agonists
153. Beta-adrenoceptor antagonists
154. ACE inhibitors

ACE inhibitors

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

212. Ipratropium bromide
213. Sodium chromoglycate
214. Budesonide
215. Bambuterol

Cyproheptadine

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

227. Sodium nitroprusside : Reflex tachycardia
228. Minoxidil : Alopecia
229. Furosemide : Hypoglycaemia
230. Methyldopa : Haemolytic anaemia
231. Diazoxide : Hyperglycemia
Page 14 of 2

Sodium nitroprusside

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

Drugs effective in prinzmetals angina include

236. Verapamil
237. Propranolol
238. Pinacidil
239. Isosorbide dinitrate

The following drugs correctly match with their uses

240. Felodipine : Raynauds phenomenon
241. Nimodipine : Cerebral vasospasm
242. Nifedipine : Premature labour
243. Sodium nitrite : Myocardial infarction
244. Verapamil : Migraine

Lactulose

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

The following etiology matches with the infection

156. Actinomyces viscosus : Periodontal disease
157. Haemophilus influenzae : Ottitis media
158. Bacteroides : Acute epiglottitis
159. Streptococcus pneumoniae : Ottitis externa
160. Streptococcus pyogenes : Pharyngitis

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Verotoxigenic E.coli

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

217. Staphylococcus aureus
218. Vibrio parahemolyticus
219. Clostridium botulinum
220. Diarrhoeal strain of Bacillus cercus

Respiratory syncytial virus

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

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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

The following are the examples of inorganic acids

115. Sulphuric acid
116. Nitric acid
117. Carbolic acid

Sulphuric acid

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

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