68 The Investigation of Choice in A

68 The investigation of choice in a 55 year old postmenopausal
woman who has presented with postmenopausal bleeding is:
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1. All of the following are features of prematurity in a neonate,

except:
1. No creases on sole.
2. Abundant lanugo.
3. Thick ear cartilage.
4. Empty scrotum.
2. A normally developing 10 month old child should be able to do all

of the following except :
1. Stand alone.
2. Play peek a boo.
3. Pick up a pellet with thumb and index finger.
4. Build a tower of 3-4 cubes.
3. The following are characteristic of autism except :
1. Onset after 6 years of age.
2. Repetitive behaviour.
3. Delayed language development.
4. Severe deficit in social interaction.
4. The earliest indicator of response after starting iron in a 6- year-

old girl with iron deficiency is:
1. Increased reticulocyte count.
2. Increased hemoglobin.
3. Increased ferritin.
4. Increased serum iron.

5. A 1 month old boy is referred for failure to thrive. On
examination, he shows features of congestive failure. The femoral
pulses are feeble as compared to branchial pulses. The most likely
clinical diagnosis is :
1. Congenital aortic stenosis.
2. Coarctation of aorta.
3. Patent ductus arteriosus.
4. Congenital aortoiliac disease.
6. All of the following statements regarding subendocardinal

infarction are true, except :
1. These are multifocal in nature.
2. These often result from hypotension or shock.
3. Epicarditis is not seen.
4. These may result in aneurysm.
7. All of the following are true for mitral valve prolapse, except :
1. Transmission may be as an Autosomal dominant trait.
2. Majority of the case present with features of mitral

regurgitation.
3. The value leaflets characteristically show myxomatous

degeneration.
4. The disease is one of the common cardiovascular

manifestations of Marfan Syndrome.
8. The following diseases are associated with Epstein â€“ Barr virus
infection, except :
1. Infectious mononucleosis.
2. Epidermodysplasia verruciformis.
3. Nasopharyngeal carcinoma.
4. Oral Hairy leukoplakia
9. Megaloblastic anaemia due to folic acid deficiency is commonly

due to :
1. Inadequate dietary intake.
2. Defective intestinal absorption.
3. Absence of folic acid binding protein in serum.
4. Absence of glutamic acid in the intestine.

10. The most important prognostic factor in breast carcinoma is :
1. Histological grade of the tumour.
2. Stage of the tumour at the time of diagnosis.
3. Status of estrogen and progesterone receptors.
4. Over expression of p-53 tumour suppressor gene.
11. Smoking is generally not associated as a risk factor with :
1. Small cell carcinoma.
2. Respiratory bronchiolitis.
3. Emphysema.
4. Bronchiolitis obliterans organizing pneumonia.
12. The tumour, which may occur in the residual breast or overlying
skin following wide local excision and radiotherapy for mammary
carcinoma, is :
1. Leiomyosarcoma.
2. Squamous cell carcinoma.
3. Basal cell carcinoma.
4. Angiosarcoma.
13. The type of mammary ductal carcinoma in situ (DCIS) most

likely to result in a palpable abnormality in the breast is :
1. Apocrine DCIS.
2. Neuroendocrine DCIS.
3. Well differentiated DCIS.
4. Comedo DCIS.
14. Acinic cell carcinomas of the salivary gland arise most often in
the :
1. Parotid salivary gland.
2. Minor salivary glands.
3. Submandibular salivary gland.
4. Sublingual salivary gland.

15. All of the following statements regarding primary effusion
lymphoma are true except :
1. It generally presents in elderly patients.
2. There is often an association with HHV-8.
3. The proliferating cells are NK cells.
4. Patients are commonly HIV positive.
16. Mantle cell lymphomas are positive for all of the following,
except :
1. CD 23.
2. CD 20.
3. CD 5.
4. CD 43.
17. Fine needle aspiration cytology is not suitable for diagnosing :
1. Tubercular lymphadenitis.
2. Papillary carcinoma thyroid.
3. Plasmacytoma.
4. Aneurymal bone cyst.
18. All of the following immunohistochemical markers are positive in

the neoplastic cells of granulocytic sarcoma, except :
1. CD 45 RO.
2. CD 43.
3. Myeloperoxidase.
4. Lysozyme.
19. B cell prolymphocytic leukemia patients differ from those with B

cell chronic lymphocytic leukemia in :
1. Presenting at a younger age.
2. Having a lower total leucocyte count.
3. Having prominent lymphadenopathy.
4. Having a shorter survival.

20. Which of the following statements is incorrect about pthisis
bulbi?
1. The intraocular pressure is increased.
2. Calcification of the lens is common.
3. Sclera is thickened.
4. Size of the globe is reduced.
21. Which one of the following statements is incorrect about Optic

glioma?
1. Has a peak incidence in first decade.
2. Arises from oligodendrocytes.
3. Causes meningeal hyperplasia.
4. Is associated with type I neurofirbromatosis.
22. Which one of the following stromal dystrophy is a recessive

condition ?
1. Lattice dystrophy.
2. Granular dystrophy.
3. Macular dystrophy.
4. Fleck dystrophy.
23. In which of the following conditions Parakeratosis most

frequently occurs?
1. Actinic Keratoses.
2. Seborrheic keratoses.
3. Molluscum contagiosum.
24. Which one of the following is the most significant risk factor for
development of gastric carcinoma?
1. Paneth cell metaplasia.
2. Pyloric metaplasia.
3. Intestinal metaplasia.
4. Ciliated metaplasia.
25. Which of the following is the most common presenting symptom
of non-cirrhotic portal hypertension?
1. Chronic liver failure.
2. Ascites.
3. Upper gastrointestinal bleeding.
4. Encephalopathy.
26. Ethosuximide is used in the treatment of :
1. Tonic-clonic seizure.
2. Absence seizure.
3. Myoclonic seizure.
4. Simple partial seizure.
27. Which of the following statements is not true about etomidate?
1. It is an intravenous anesthetic.
2. It precipitates coronary insufficiency.
3. It inhibits cortisol synthesis.
4. It causes pain at site of injection.
28. Which one of the following antibacterials should not be used

with d-tubocurarine?
1. Norfloxacin.
2. Streptomycin.
3. Doxycycline.
4. Cefotaxime.
29. Which one of the following drugs is an antipseudomonal

penicillin?
1. Cephalexin.
2. Cloxacillin.
3. Piperacillin.
4. Dicloxacillin.
30. The following statements regarding benzodiazephines are true
except:
1. Binds to both GABAA and GABAB receptors.
2. They have active metabolites.
3. Decreases nocturnal gastric secretion in human being.
4. Extensively metabolized by CYP enzymes.
31. One of the following statements regarding mycophenolate

mofetil is incorrect:
1. It is a prodrug.
2. It is a selective uncompetitive and reversible inhibitor of

inosine monophosphate dehydrogenase.
3. It also inhibits calcineurin.
4. Selectivity inhibits lymphocyte proliferation.
32. All of the following mechanisms of action of oral contraceptive

pill are true, except :
1. Inhibition of ovulation.
2. Prevention of fertilization.
3. Interference with implantation of fertilized ovum.
4. Interference with placental functioning.
33. Which one of the following drugs does not interfere with folic
acid metabolism?
1. Phenytoin.
2. Gabapentin.
3. Phenobarbitone.
4. Primidone.
34. Which one of the following drugs causes constipation?
1. Propranolol.
2. Verapamil.
3. Nitroglycerin.
4. Captopril.
35. Which of the following drugs is not used topically for treatment
of open angle glaucoma:
1. Latanoprost.
2. Brimonidine.
3. Acetazolamide.
4. Dorzolamide.
36. Concomitant administration of clonazepam with which of the

following antiepileptic drug can precipitate absence status?
1. Sodium valproate.
2. Phenobarbitone.
3. Carbamazepine.
4. Phenytoin.
37. Which one of the following agents has been associated with
hemorrhagic stroke?
1. Phenylpropanolamine.
2. Terfenadine.
3. Quinidine.
4. Fenfluramine.
38. All of the following are therapeutic uses of Penicillin G, except :
1. Bacterial meningitis.
2. Rickettsial Infection.
3. Syphilis.
4. Anthrax.
39. All of the following are major complications of massive

transfusion, except:
1. Hypokalemia.
2. Hypothermia.
3. Hypomagnesemia.
4. Hypocalcemia.
40. Which one of the following muscle relaxant has the maximum
duration of action ?
1. Atracurium.
2. Vecuronium.
3. Rocuronium.
4. Doxacurium.
41. Which enzyme is inhibited by Aminophylline?
1. Monoamine Oxidase.
2. Alcohol dehydrogenase.
3. Phjosphodiesterase.
4. Cytochrome P-450.
42. Which one of the following local anaesthetics belongs to the

ester group?
1. Procaine.
2. Bupivacaine.
3. Lignocaine.
4. Mepivacaine.
43. The following are the benozodiazepines of choice in elderly and

those with liver disease, except:
1. Lorazepam.
2. Oxazepam,
3. Temazepam.
4. Diazepam.
44. Which one of the following agents sensitises the myocardium to

catecholamines?
1. Isoflurane
2. Ether.
3. Halothane.
4. Propofol.
45. Which of the following is the muscle relaxant of choice in renal
failure?
1. Rapacurium
2. Pancuronium
3. Atracurium
4. Rocuronium
46. Ovulation is primarily caused by preovulatory surge of :
1. Estradiol.
2. Luteinizing hormone.
3. Progesterone.
4. Follicle stimulating hormone.
47. Most afferent fibers from the lateral geniculate nucleus

terminate in the primary visual cortex in :
1. Layer 1.
2. Layer 2 & 3.
3. Layer 4.
4. Layer 5 & 6.
48. The blobs of the visual cortex are associated with :
1. Ocular dominance.
2. Orientation.
3. Color processing.
4. Saccadic eye movements.
49. The parvocellular pathway, from the lateral geniculate nucleus

to the visual cortex, carries signals for the detection of :
1. Movement, depth and flicker.
2. Color vision, shape and fine details.
3. Temporal frequency.
4. Luminance contrast.
50. A pilot in Sukhoi aircraft is experiencing negative G. Which of
the following physiological events will manifest in such situation?
1. The hydrostatic pressure in veins of lower limb increases.
2. The cardiac output decreases.
3. Black out occurs.
4. The cerebral arterial pressure rises.
51. In human being, the least useful physiological response to low

environmental temperature is :
1. Shivering.
2. Vasoconstriction.
3. Release of thyroxine.
4. Piloerection.
52. The cell bodies of orexinergic neurons are present in:
1. Locus coeruleus.
2. Dorsal raphe.
3. Lateral hypothalamic area.
4. Hippocampus.
53. The tubuloglomerular feedback is mediated by:
1. Sensing of Na+ concentration in the macula densa.
2. Sensing of Cl+ concentration in macula densa.
3. Sensing NaCl concentration in the macula densa.
4. Opening up of voltage gated Na+ channels in afferent

arteriole.
54. The prime driving force for counter current multiplier system is :
1. Medullary hperosmolarity.
2. Reabsorption of Na+ in thick ascending limb.
3. Action of ADH via aquaporin channels.
4. Urea recycling.
55. Which of the following organs is not involved in calcium
homeostasis?
1. Kidneys.
2. Skin.
3. Intestines.
4. Lungs.
56. Testosterone production is mainly contributed by:
1. Leydig cells.
2. Sertolie cells.
3. Seminiferous tubules.
4. Epididymis.
57. Which of the following secretions has a very high pH?
1. Gastric juice.
2. Pancreatic juice.
3. Bile in gall bladder.
4. Saliva.
58. The maintenance of posture in a normal adult human being

depends upon:
1. Integrity of reflex are.
2. Muscle power.
3. Type of muscle fibres.
4. Joint movements in physiological range.
59. The first reflex response to appear as spinal shock wears off in
humans is :
1. Tympanic reflex.
2. Withdrawal reflex.
3. Neck righting reflex.
4. Labyrinthine reflex..
60. The hyperkinetic features of the Huntingtonâ€™s disease are
due to the loss of :
1. Nigrostriatal dopaminergic system.
2. Intrastriatal cholinergic system.
3. GABA-ergic and choloinergic system.
4. Intrastriatal GABA-ergic and cholinergic system.
61. All of the following are part of the treatment of Lithium toxicity,
except:
1. Treating dehydration.
2. Ingestion of polystyrene sulfonate.
3. Hemodialysis.
4. Using an antagonist.
62. All are side effects of Clozapine except:
1. Granulocytopenia.
2. Seizures.
3. Sedation.
4. Extrapyramidal side effects
63. Pavlovâ€™s experiment is an example of:
1. Operant conditioning.
2. Classical conditioning.
3. Learned helplessness.
4. Modelling.
64. Bright light treatment has been found to be most effective in

treatment of :
1. Anorexia Nervosa.
2. Seasonal Affective Disorder.
3. Schizophrenia.
4. Obsessive Compulsive Disorder.
65. The most common side effect reported with treatment with
haloperidol is :
1. Hypotension.
2. Akathisia.
3. Dryness of mouth.
4. Tic disorder.
66. Mutism and akinesis in a person, who appears awake and even
alert, is best described as :
1. Twilight State.
2. Oneroid state.
3. Stupor.
4. Delirium.
67. Loosening of association is an example of :
1. Formal thought disorder.
2. Schneiderian first rank symptoms.

3. Perseveration.
4. Concrete thinking.
68. Intense nihilism, somatization and agitation in old age are the
hallmark symptoms of:
1. Involutional melancholia.
2. Aty[pical depression.
3. Somatized depression
4. Depressive stupor.
69. Rivastigmine and Donepezil are drugs used predominantly in

the management of:
1. Depression.
2. Dissociation.
3. Delusions.
4. Dementia.
70. All of the following are associated with better prognosis in

schizophrenia, except :
1. Late onset.
2. Married.
3. Negative symptoms.
4. Acute onset.
71. The following features are true for Tetralogy of Fallot, except:
1. Ventricular septal defect.
2. Right ventricular hypertrophy.
3. Atrial septal defect.
4. Pulmonary stenosis.
72. Which of the following statements is true regarding testicular

tumours?
1. Are embryonal cell carcinomas in 95% of cases.
2. Bilateral in upto 10% cases.

3. Teratomas are more common than seminomas.
4. Usually present after 50 years of age.
73. The most common retrobulbar orbital mass in adults is:
1. Neurofibroma.
2. Meningioma.
3. Cavernous haemangioma.
4. Schwannoma.
74. In which of the following conditions left atrium is not enlarged:
1. Ventricular septal defect.
2. Atrial septal defect.
3. Aorto-pulmonary window.
4. Patent ductus arteriosus.
75. Expansile lytic osseous metastases are characteristic of primary

malignancy of :
1. Kidney.
2. Bronchus.
3. Breast.
4. Prostate.
76. Which is the objective sign of identifying pulmonary plethora in

a chest radiograph?
1. Diameter of the main pulmonary artery > 16mm.
2. Diameter of the left pulmonary artery > 16mm.
3. Diameter of the descending right pulmonary artery > 16mm.
4. Diameter of the descending left pulmonary artery > 16mm.
77. The most accurate investigation for assessing ventricular

function is :
1. Multislice CT.
2. Echocardiography.
3. Nuclear scan.
4. MRI.
78. The most important sign of significance of renal artery stenosis
on an angiogram is:
1. A percentage diameter stenosis > 70%.
2. Presence of collaterals.
3. A systolic pressure gradient > 20mm Hg across the lesion.
4. Post stenotic dilatation of the renal artery.
79. The MR imaging in multiple sclerosis will show lesions in:
1. White matter.
2. Grey matter.
3. Thalamus.
4. Basal ganglia.
80. The most common location of hypertensive intracranial

haemorrhage is :
1. Subarachnoid space.
2. Basal ganglia.
3. Cerebellum.
4. Brainstem.
81. Which of the following causes rib-notching on the chest

radiograph?
1. Bidirectional Glem shunt.
2. Modified Blalock-Taussing shunt.
3. IVC occusion.
4. Coarctation of aorta.
82. The most sensitive imaging modality to detect early renal

tuberculosis is:
1. Intravenous urography.
2. Computed tomography.
3. Ultrasound.
4. Magnetic Resonance Imaging.

83. All of them use non-ionizing radiation, except:
1. Ultrasonography.
2. Thermography.
3. MRI.
4. Radiography.
84. Mixed tumours of the salivary glands are:
1. Most common in submandibular gland.
2. Usually malignant.
3. Most common in parotid gland.
4. Associated with calculi.
85. In which of the following types of breast carcinoma, would you

consider biopsy of opposite breast?
1. Adenocarcinoma-poorly differentiated.
2. Medullary carcinoma.
3. Lobular carcinoma.
4. Comedo carcinoma.
86. A malignant tumour of childhood, that metastasizes to bones

most often, is:
1. Wilmâ€™s tumour.
2. Neuroblastoma.
3. Adrenal gland tumours.
4. Granulosa cell tumour of ovary.
87. When carcinoma of stomach develops secondarily to pernicious

anemia, it is usually situated in the :
1. Pre Pyloric region.
2. Pylorus.
3. Body.
4. Fundus.
88. With regard to the malignant behaviour of leiomysarcoma, the
most important criterion is :
1. Blood vessel penetration by tumour cells.
2. Tumour cells in lymphatic channels.
3. Lymphocyte infiltration.
4. The number of mitoses per high power field.
89. The most radiosensitive tumour among the following is:
1. Bronchogenic carcinoma.
2. Carcinoma parotid.
3. Dysgerminoma.
4. OSteogenic sarcoma.
90. Ina suspected of ovarian cancer, imaging work-up is required

for all of the following information, except:
1. Detection of adenexal lesion.

2. Characterization of the lesion.
3. Staging.
4. Assess resectability.
91. In which of the following age group Myelodysplastic Syndromes

(MDS) are most common?
1. 2-10.
2. 15-20.
3. 25-40.
4. >50.
92. A patient with leukemia on chemotheraphy develops acute right

lower abdominal pain associated with anemia, thrombocytopenia and
leukopenia. Which of following is the clinical diagnosis?
1. Appendictis.
2. Leukemic colitis.
3. Perforation peritonitis.
4. Neutropenic colitis.
93. All of the following modalities can be used for in-situ ablation of
liver secondaries, except:
1. Ultrasonic waves.
2. Cryotherapy.
3. Alcohol.
4. Radiofrequency.
94. All of the following radioisotopes are used as systemic

radionucleide, except:
1. Phosphorus-32.
2. Strontium-89.
3. Iridium-192.
4. Samarium-153.
95. Phosphorous-32 emits:

1. Beta particles.
2. Alfa particles.
3. Neutrons.
4. X-rays.
96. The ideal timing of radiotherapy for Wilms Tumour after surgery
is:
1. Within 10 days.
2. Within 2 weeks.
3. Within 3 weeks.
4. Any time after surgery.
97. The percentage of pulmonary emboli, that proceed to infraction,

is approximately:
1. 0-5%.
2. 5-15%.
3. 20-30%.
4. 30-40%.
98. Which of the following is used in the treatment of differentiated
thyroid cancer:
1. 131I.
2. 99mTc.
3. 32p.
4. 131I-MIBG.
99. Which one of the following imaging techniques gives maximum

radiation exposure to the patient?
1. Chest X-ray.
2. MRI.
3. CT scan.
4. Bone scan.
100. Which one of the following has the maximum ionization

potential?
1. Electron.
2. Proton.
3. Helim ion.
4. Gamma(ï §) â€“ Photon.
101. Which of the following is not a major criteria for dignosis of

multiple myeloma?
1. Lytic bone lesions.
2. Plasmacytoma on tissue biopsy.
3. Bone marrow plasmacytosis > 30%
4. â€˜Mâ€™Spike > 3g% for 1g G, >2g% for 1g A.
102. The treatment of choice for squamous cell anal cancer is:
1. Abdomino perennial resection.
2. Laser fulgaration.
3. Chemoradiotherapy.
4. Platinum based chemotheraphy.

103. The magnification obtained with a direct ophthalmoscope is:
1. 5 times.
2. 10 times.
3. 15 times.
4. 20 times.
104. The average distance of the fovea from the temporal margin of
the optic disc is:
1. 1 disc diameter.
2. 2 disc diameter.
3. 3 disc diameter.
4. 4 disc diameter.
105. The most common cause of vitreous haemorrhage in adults

is :
1. Retinal hole.
2. Trauma.
3. Hypertension.
4. Diabetes.
106. The retina receives its blood supply from all except:
1. Posterior ciliary artery,
2. Central retinal artery.
3. Retinal arteries.
4. Plexus of zinn & Haller arteries.
107. Which drug can cause macular toxicity when given

intravitreally?
1. Gentamycin.
2. Vancomycin.
3. Dexamethasone.
4. Ceftazidime.
108. Typically bilateral inferior lens subluxation of the lens is seen
in :
1. Marfanâ€™s syndrome.
2. Homocystinuria.
3. Hyperlusinaemia
4. Ocular trauma.
109. Which of the following antiglaucoma medications can cause

drowsiness?
1. Latanoprost.
2. Timolol.
3. Brimonidine,
4. Dorzolamide.
110. Which of the following is the drug of choice for treatment of

corneal ulcers caused by filamentous fungi?
1. Itraconazole.
2. Natamycin.
3. Nystatin.
4. Fluconazole.
111. Which of the following medications is contraindicated in

patients with allergy to sulphonamides?
1. Levobunolol.
2. Bimatoprost.
3. Brinzolamide.
4. Brimonidine.
112. In which of the following uveitic conditions is it contraindicated

to put in an intraocular lens after cataract surgery?
1. Fuchâ€™s heterochromic cyclitis.
2. Juvenile rheumatopid arthritis.
3. Psoriatic arthritis.
4. Reiterâ€™s syndrome.
113. A case of Non-Insulin dependent diabetes mellitus (NIDDM)
with a history of diabetes for one year should have an ophthalmic
examination:
1. As early as feasible.
2. After 5 years.
3. After 10 years.
4. Only after visual symptoms develop.
114. SAFE Strategy is recommended for the control of ?
1. Trachoma.
2. Glaucoma.
3. Diabetic retinopathy.
4. Cataract.
115. As per the 1986-89 NPCB survey, what was the prevalence of
blindness in India (at visual acuity <6/60 in better eye)?
1. 1.38%
2. 1.49%
3. 1.72%
4. 1.8%
116. Under the National Programme for Control of Blindness, who

is supposed to conduct the vision screening of school students?
1. School teachers.
2. Medical officers of health centres.
3. Ophthalmologists.
4. Health assistants.
117. According to the World Health Organization, the definition of

blindness is:
1. Visual acuity <6/60 in the better eye with available correction.
2. Visual acuity <3/60 in the better eye with available correction.
3. Visual acuity <6/60 in the better eye with best correction.

4. Visual acuity <3/60 in the better eye with best correction.
118. The most common cause of ocular morbidity in India is :
1. Cataract.
2. Conjunctivitis.
3. Refractive error.
4. Trachoma.
119. A vitreous aspirate from a case of metastatic endophthalmitis

on culture yields Gram positive round to oval cells, 12-14ï in size.
The aspirate on Gram staining shows the presence of
pseudohyphae. Which of the following is the most likely aetiological
agent?
1. Aspergillus.
2. Rhizopus.
3. Candida.
4. Fusarium.
120. The most common malignancy found in Marjolinâ€™s ulcer is:

2. Squamous cell carcinoma.
3. Malignant fibrous histiocytoma.
4. Neurotrophic malignant melanoma.
121. Mycotic aneurysm is an aneurysm infected because of :
1. Fungal infection.
2. Blood borne infection (intravascular)
3. Infection introduced from outside (extravascular)
4. Both intravascular & extravascular infection.
122. The procedure of choice for the evaluation of an aneurysm is :
1. Ultrasonography.
2. Computed tomography.
3. Magnetic resonance imaging.

4. Arteriography.
123. The most common cause of acquired arteriovenous fistuala is:
1. Bacterial infection.
3. Blunt trauma.
4. Penetrating trauma.
124. Laryngocele arises as a herniation of laryngeal mucosa

through the following membrance:
1. Thyrochyoid.
2. Criciothyroid.
3. Crico-tracheal.
4. Crisosternal.
125. Which one of the following statements is incorrect regarding

stones in the common bile duct?
1. Can present with Charcotâ€™s Triad.
2. Are suggested by a bile duct diameter >6mm of ultrasound.
3. ERCP, sphincterotomy and balloon clearance is now the

standard treatment.
4. When removed by exploration of the common bile duct the T-

tube can be removed after 3 days.
126. Which of the following colonic polyps is not pre-maligant?
1. Juvenile polyps.
2. Hamartomatous polyps associated with Peutz-Jeghers

syndrome.
3. Villous adenomas.
4. Tubular adenomas.
127. A patient of post-cholecystectomy biliary stricture has

undergone an ERCP three days ago. Following this she has
developed acute cholangitis. Th most likely organism is:
1. Escherichia coli.
2. Bacillus fragilis.
3. Streptococcus viridans.
4. Pseudomonas aerogenosa.
128. Biliary stricture developing after Laparascopic

cholecystectomy usually occurs at which part of the common bile
duct?
1. Upper.
2. Middle.
3. Lower.
4. All sites with equal frequency.
129. Apart from Escherichia Coli, the other most common organism
implicated in acute suppurative bacterial peritonitis is:
1. Bacteroides.
2. Klebsiella
3. Peptostreptococcus.
4. Pseudomonas.
130. The treatment of choice for the management of carcinoma of
the anal canal is :
1. Abdomino perineal resection.
2. Primary radiotherapy.
3. Combined radio-and chemotheraphy.
4. Neoadjuvant chemotherapy and local excision.
131. The following statements about thyroglossal cyst are true,

except:
1. Frequent cause of anterior midline neck masses in the first

decade of life.
2. The cyst is located within 2 cm of the midline.
3. Incision and Drainage is the treatment of choice.
4. The swelling moves upwards on protrusion of tongue.
132. Which of the following is not a preferred site for planning

vascular access for maintenance haemodialysis ?
1. Non-dominant extremity.
2. Upper limb.
3. Radio-cephalic AV fistula.
4. Sapheno-femoral fistula.
133. Which of the following drugs is not a part of the â€˜Triple

Therapyâ€™ immunosuppression for post renal transplant patients?
1. Cyclosporine.
2. Azathioprine.
3. FK 506.
4. Prednisolone.
134. Which of the following is not a component of Glasgow Coma

Scale?
1. Eye opening.
2. Motor response.
3. Pupil size.
4. Verbal response.
135. Allenâ€™s test is useful in evaluating:
1. Thoracic outlet compression.
2. Presence of cervical rib.
3. Integrity of palmar arch.
4. Digital blood flow.
136. Neointimal hyperplasia causes vascular graft failure as a result

of hypertrophy of:
1. Endothelial cells.
2. Collagen fibers.
3. Smooth muscle cells.
4. Elastic fibers.
137. Dacron vascular graft is :
1. Nontextile synthetic.
2. Textile synthetic
3. Nontextile biologic.
4. Textile biologic.
138. Total score in Glasgow Coma Scale of a conscious person is :
1. 8
2. 3
3. 15
4. 10
139. Mycotic abscesses are due to:
1. Bacterial infection
3. Viral infection.
4. Mixed infection.
140. The most preferred approach for pituitary surgery at the
present time is:
1. Transcranial.
2. Tranethmoidal
3. Transphenoidal.
4. Transcallosal.
141. The normal range of serum osmolality (in mOsm/L) is:
1. 270 to 285.
2. 300 to 320.
3. 350 to 375.
4. 200 to 250.
142. Which of the following is the most common type of Glial

tumors?
1. Astrocytomas.
2. Medulloblastomas.
3. Neurofibromas.
4. Ependymomas.
143. Which of the following tumors is not commonly known to

increase in pregnancy?
1. Glioma.
2. Pituitary adenoma.
3. Meningioma.
4. Neurofibroma
144. The requirement of potassium in a child is :
1. 1-2 mEq/kg.
2. 4-7 mEq/kg.
3. 10-12 mEq/kg.
4. 13-14 mEq/kg.
145. The common cause of subarachnoid hemorrhage is :

1. Arterio-venous malformation.
2. Cavernous Angioma.
3. Aneurysm.
4. Hypertension.
146. Brain abscess in cyanotic heart disease is commonly located

in :
1. Cerebellar hemisphere
2. Thalamus.
3. Temporal lobe.
4. Parietal lobe.
147. Afferent component of corneal reflex is mediated by :
1. Vagus nerve.
2. Facial nerve.
3. Trigeminal nerve.
4. Glossopharyngeal nerve.
148. In adults, the spinal cord normally ends at:
1. Lower border of L1.
3. Lower border of S1.
149. Middle meningeal artery is direct branch of :
1. External carotid artery.
2. Internal maxillary artery.
3. Superficial temporal artery.
4. Middle cerebral artery.
150. Which of the following is not a common feature of Anorexia

Nervosa?
1. Binge eating.
2. Amennorhea.
3. Self perception of being â€˜fatâ€™.
4. Under weight.
151. An affected male infant born to normal parents could be an

example of all of the following, except:
1. An Autosomal dominant disorder.
2. An Autosomal recessive disorder.
3. A polygenic disorder.
4. A vertically transmitted disorder.
152. The following methods can be used to detect the point

mutation in the beta (ï ¢) â€“ globin gene that causes sickle cell
anemia, except:
1. Polymerase chain reaction with allele-specific oligonucleotide

hybridization.
2. Southem blot analysis.
3. DNA sequencing.
4. Northern blot analysis.
153. A child with a small head, minor anomalies of the face

including a thin upper lip, growth delay, and developmental disability
can have all of the following, except:
1. A chromosomal syndrome.
2. A teratogenic syndrome.
3. A Mendelian syndrome.
4. A polygenic syndrome.
154. In a family, the father has widely spaced eyes, increased facial
hair and deafness. One of the three children has deafness with
similar facial features. The mother is normal. Which one of the
following is most likely pattern of inheritance in this case ?
1. Autosomal dominant.
2. Autosomal recessive.
3. X-linked dominant.
4. X-linked recessive.
155. Mitochondrial DNA is :
1. Closed circular.
2. Nicked circular.
3. Linear.
4. Open circular.
156. Polar bodies are formed during :
1. Spermatogenesis.
2. Organogenesis.
3. Oogenesis.
4. Morphogenesis.
157. Prenatal diagnosis at 16 weeks of pregnancy can be

performed using all of the following, except:
1. Amniotic fluid.
2. Maternal blood.
3. Chorionic villi.
4. Fetal blood.
158. The long and short arms of chromosomes are designated

respectively as :
1. p and q arms.
2. m and q arms.
3. q and p arms.
4. l and s arms.
159. Euchromatin is the region of DNA that is relatively:
1. Uncondensed.
2. Condensed.
3. Overcondensed.
4. Partially condensed.
160. Microsatellite sequence is:

1. Small satellite.
2. Extra chromosomal DNA.
3. Short sequence (2-5) repeat DNA.
4. Looped-DNA.
161. All of the following cell types contain the enzyme telomerase
which protects the length of telomeres at the end of chromosomes,
except :
1. Germinal
2. Somatic.
3. Haemopoetic.
4. Tumour.
162. All of the following are the components of the white pulp of
spleen, except :
1. Periarteriolar lymphoid sheath.
2. B cells.
3. Antigen presenting cells.
4. Vascular sinus.
163. All of the following development events are dependent on the

production of maternal or fetal glucocorticoid, except
1. Induction of thymic involution
2. Production of surfactant by type II alveolar cells
3. Functional thyroid
4. Functional hypothalamopituitary axis
164. Referred pain from all of the following conditions may be felt
along the inner side of right thigh, except:
1. Inflamed pelvic appendix
2. Inflamed ovaries
3. Stone n pelvic Ureter
4. Pelvic abscess
165. A 43 year old woman came with a large abscess in the middle
of the right posterior triangle of the neck. The physician incised and
drained the abscess. Five days later the patient noticed that she
could not extend her right hand above her head to brush her hair.
Which of the following are the signs and symptoms of additional
harm?
1. Damage to scalenus medius
2. Injury to suprascapular nerve
3. Cut to spinal part of accessory nerve
4. Spread of infection to shoulder joint
166. Which of the following inhalational agents is the induction

agent of choice in children?
1. Methyoxyflurae
2. Sevoflurane
3. Desflurane
4. Isoflurane
167. Which of the following anesthetic agents doesnâ€™t trigger

malignant hyperthermia?
1. Halothane
2. Isoflurane
3. Suxamethonium
4. Thiopentone
168. Which of the following is not an indication for endotracheal

intubation?
1. Maintenance of a patent airway
2. To provide positive pressure ventilation
3. Pulmonary toilet
4. Pneumothorax
169. Which of the following agents is not used to provide induced

hypotension during surgery?
1. Sodium nitroprusside
2. Hydralazine
3. Mephenteramine
4. Esmolol
170. Which of the following agents is used for the treatment of

postoperative shivering?
1. Thiopentone
2. Suxamethonium
3. Atropine
4. Pethidine
171. Which of the following is not a sign of stellate ganglion block?
1. Meiosis
2. exopthalmus
3. Nasal congestion
4. Conjuctival redness
172. Which of the following intravenous induction agents is the

most suitable for day care surgery?
1. Morphine
2. Ketamine
3. Propofol
4. Diazepam
173. Blalock and Taussig shunt is done between:
1. Aorta to Pulmonary artery
2. Aorta to Pulmonary vein
3. Subclavian artery to Pulmonary vein
4. Subclavian vein to artery
174. A two month old infant has undergone a major surgical

procedure. Regarding post operative pain relief which one of the
following is recommended:
1. No medication is needed as infant does not feel pain after

surgery due to immaturity of nervous system
2. Only paracetamol suppository is adequate
3. Spinal narcotics via intrathecal route

4. Intravenous narcotic infusion in lower dosage
175. A 5 year old patient is scheduled for tonsiilectomy. On the day

of surgery he had running nose, temperature 37.5ÂºC and dry cough.
Which of the following should be the most appropriate decision for
surgery?
1. Surgery should be cancelled.
2. Can proceed for surgery if chest is clear and there is no history

of asthma
3. Should get x-ray chest before proceeding for surgery
4. Cancel surgery for 3 week and patient to be on antibiotic
176. A common feature of all serine proteases is:
1. Autocatalytic activation of zymogen precursor
2. Tight binding of pancreatic trypsin inhibitor
3. Cleavage of protein on the carboxyl site of serine residues
4. Presence of Ser-His-Asp catalytic triad at the active site

177. During replication of DNA, which one of the following enzymes
polymerizes the Okazaki fragments?
1. DNA Polymerase I
2. DNA Polymerase II
3. DNA Polymerase III
4. RNA Polymerase I
178. During phagocytosis, the metabolic process called respiratory

burst involves the activation of:
1. Oxidase
2. Hydrolase
3. Peroxidase
4. Dehydrogenase
179. Which one of the following is the complementary sequence of

5' TTAAGCTAC 3â€™?
1. 5â€™ GTACGCTTAA 3â€™

2. 5â€™ AATTCGCATG 3â€™
3. 5â€™ CATGCGAATT 3â€™
4. 5â€™ TTAAGCGTAC 3â€™
180. Base substitution mutatins can have be following molecular

consequences except:
1. Changes one codon for an amino acid into another codon for
that same amino acid
2. Codon for one amino acid is changed into a codon of another

amino acid
3. Reading frame changes downstream to the mutant site
4. Codon for one amino acid is changed into a translation

termination codon
181. Vitamin B12 acts as coenzyme to which one of the following

enzymes?
1. Isocitrate dehydrogenase
2. Homocysteine methyl transferase
3. Glycogen synthase
4. G-6-P dehydrogenase
182. The normal cellular counterparts of oncogenes are important

for the following functions except:
1. Promotion of cell cycle progression
2. Inhibition of apoptosis
3. Promotion of DNA repair
4. Promotion of nuclear transcription
183. The ligand-receptor complex dissociates in the endosome

because:
1. Of its large size
2. The vesicle looses its clathrin coat
3. Of the acidic pH of the vesicle
4. Of the basic pH of the vesicle
184. The amino acid which serves as a carrier of ammonia from

skeletal muscle to liver is:
1. Alanine
2. Methionine
3. Arginine
4. Glutamine
185. All of the following amino acids are converted to succinyl â€“
CoA, except:
1. Methionine
2. Isoleucine
3. Valine
4. Histidine
186. The specialized mammalian tissue/organ in which fuel

oxidation serves not to produce ATP but to generate heat is:
1. Adrenal gland
2. Skeletal muscle
3. Brown adipose tissue

4. Heart
187. The human plasma lipoprotein containing the highest

percentage of triacylglycerol by weight is:
1. VLDL
2. Chylomicrons
3. HDL
4. LDL
188. All of the following enzymes are regulated by calcium or

calmodulin, except:
1. Adenylate cyclase
2. Glycogen synthase
3. Guanylyl cyclase
4. Hexokinase
189. The sigma (ï ³) subunit of prokaryotic RNA Polymerase:

1. Binds the antibiotic Rifampicin
2. Is inhibited by ï ¡-amanitin
3. Specifically recognizes the promoter site
4. Is part of the core enzyme
190. Which type of RNA has the highest percentage of modified

base:
1. mRNA
2. tRNA
3. rRNA
4. snRNA
191. There are more than 300 variants of human hemoglobin gene.
Among these only a few are fatal. Hence, the most important factor
to be conserved in a protein for its function is the:
1. Amino acid sequence
2. Ligand binding residues

3. Structure
4. Environment
192. Proteins are linear polymers of amino acids. They fold into
compact structures. Sometimes, these folded structures associate to
form homo â€“ or hetero-dimers. Which one of the following refers to
this associated form?
1. Denatured state
2. Molecular aggregation
3. Precipitation
4. Quaternary structure
193. Which one of the following can be a homologous substitution

for isoleucine in a protein sequence?
1. Methionine
2. Aspartic acid
3. Valine
4. Arginine
194. The comparison of the amino acid sequence of Cytochrome C
from different species shows many variations. Most of these
variations are found:
1. Randomly
2. Only in helical regions
3. Only in strand regions
4. Mainly in loop regions
195. The structural proteins are involved in maintaining the shape

of a cell or in the formation of matrices in the body. The shape of
these proteins is:
1. Globular
2. Fibrous
3. Stretch of beads
4. Planar
196. The major purpose of randomization in a clinical trails is to:

1. Facilitate double blinding
2. Help ensure the study subjects are representative of general

population
3. Ensure the groups are comparable on base line characteristics
4. Reduce selection bias in allocation to treatment
197. The purpose of double blinding in clinical trials is to:
1. Achieve comparability between study and control groups
2. Avoid observer bias
3. Avoid subject bias
4. Avoid observer and subject bias
198. When a drug is evaluated for its usefulness in controlled

conditions, it is termed as a trial signifying:
1. Efficacy
2. Effectiveness
3. Efficiency
4. Effect modification
199. Which of the following is most strongly associated with
coronary heart disease?
1. Apolipoproteins
2. VLDL
3. HDL
4. Total liproproteins
200. The extra energy allowances needed per day during

pregnancy is:
1. 150 KCals
2. 200 KCals
3. 300 KCals
4. 550 KCals
201. In a village having population of 1000, we found patients with

certain disease and the results of a new diagnostic test on that
disease are given below.
Disease
Test result Present Absent
+ 180 400
ï€ 20 400
Which of the following is the positive predictive value of diagnostic

test in that population
1. 45
2. 31
3. 95
4. 50
202. Physical quality of life index is measured by all except:
1. Infant mortality
2. Life expectancy at age one
3. Literacy
4. Per capita income

203. All the statements are true about standardization except:
1. Standardization allows comparison to be made between two

different populations
2. The national population is always taken as the standard

population
3. For Direct Standardization, age specific rates of the study

population are applied to that of the standard population
4. For Indirect Standardization, age specific rates of the standard

population are applied to that of the study population
204. All the following are true in a randomized control trial (RCT)
except:
1. Baseline characteristics of intervention and control groups

should be similar
2. Investigatorâ€™s bias is minimized by double blinding
3. The sample size required depends on the hypothesis
4. The drop-outs from the trial should be excluded from he

analysis.
205. Study the following table carefully and answer the following
question:
Disease
Test result Present Absent
+ 40 225
ï€ 10 225
What is the sensitivity of diagnostic test?
1. 45
2. 20
3. 80
4. 50
206. Pre-treatment evaluation for Lithium therapy should include:
1. Fasting blood sugar
2. Serum creatinine
3. Liver function tests
4. Platelet count
207. According to the World Health Report 2000, Indiaâ€™s health
expenditure is:
1. 4.8% of G.D.P.
2. 5.2% of G.D.P.
3. 6.8% of G.D.P.
4. 7% of G.D.P.
208. The premium of the â€œCommunity based Universal Health

Insurance Schemeâ€ launched during 2003-04 ranges from
1. Rs.1 per day poor and individual to
Rs.2 per day for a family of seven

209. In which of the following year the Transplantation of Human
Organs Act was passed by Government of India?
1. 1994
2. 1996
3. 2000
4. 2002
210. Indian (economic) real GDP growth for the year 2003 is:
1. 6.0
2. 6.5
3. 7.8
4. 10.5
211. A 6-month-old infant had itchy erythematous papules and

exudative lesions on the scalp, face, groins and axillae for one month.
She also had vesicular lesions on the palms. The most likely
diagnosis is:
1. Congenital syphilis
2. Seborrhoeic dermatitis
3. Scabies
4. Psoriasis
212. Pterygium of nail is characteristically seen in:
1. Lichen planus
2. Psoriasis
3. Tinea unguium
4. Alopecia areata
213. A patient had seven irregular hyperpigmented macules on the

trunk and multiple small hyperpigmented macules in the axillae and
groins since early childhood. There were no other skin lesions.
Which is the most likely investigation to support the diagnosis?
1. Slit lamp examination of eye
2. Measurement of intraocular tension

3. Examination of fundus
4. Retinal artery angiography
214. A 24-year-old unmarried woman has multiple nodular, cystic,

pustular and comadonic lesions on face, upper back and shoulders
for 2 years. The drug of choice for her treatment would be:
1. Acitretin
2. Isotretinoin
3. Doxycycline
4. Azithromycin
215. A 45-year-old farmer has itchy erythematous papular lesions

on face, neck, â€˜Vâ€™ area of chest, dorsum of hands and
forearms for 3 years. The lesions are more severe in summers and
improve by 75% in winters. The most appropriate test to diagnose
the condition would be:
1. Skin biopsy
2. Estimation of IgE levels in blood
3. Patch test
4. Intradermal prick test

216. Finger Print Bureau was first established in:
1. England
2. China
3. India
4. Singapore
217. Spaldingâ€™s sign occurs after:
1. Birth of live foetus
2. Death of foetus in uterus
3. Rigor mortis of infant
4. Cadaveric spasm
218. Medical qualifications awarded by institutions out side India

and recognized by MCI are registered in:
1. First schedule of Indian Medical Council Act 1956

2. Second schedule of Indian Medical Council Act 1956
3. Part I of third schedule of Indian Medical Council Act 1956
4. Part II of third schedule of Indian Medical Council Act 1956
219. Scab or Crut of abrasion appears brown:
1. Between 12-24 hours
2. Between 2-3 days
3. Between 4-5 days
4. Between 5-7 days
220. Which of following tests is used to detect semen?
1. Phenolphthalein test
2. Reineâ€™s test
3. Barberioâ€™s test
4. Paraffin test
221. The presence of anti-Saccharomyces cerevisae antibody is a
surrogate marker of one of the following
1. Coeliac disease
2. Crohnâ€™s disease
3. Ulcerative colitis
4. Tropical sprue
222. The most common cause of gastric outlet obstruction in India

is:
1. Tuberculosis
2. Cancer of stomach
3. Duodenal lymphoma
4. Peptic ulcer disease
223. Which of the following parasitic infestation can led to

malabsorption syndrome?
1. Amoebiasis
2. Adcariasis
3. Hookworm infestation
4. Giardiasis
224. Which of the following is not a feature of hypercalcemia:
1. Diarrhoea
2. Polyuria
3. Depression
4. Vomiting
225. Joint erosions are not a feature of:
1. Rheumatoid arthritis
2. Psoriasis
3. Multicentric reticulohistiocytosis
4. Systemic lpus erythematosus
226. Nevirapine is a:
1. Protease inhibitor
2. Nucleoside reverse transcriptase inhibitor
3. Non-nucleoside reverse transcriptase inhibitor
4. Fusion inhibitor
227. Anticentromere antibodies are most commonly associated

with:
1. Diffuse cutaneous systemic sclerosis
2. Mixed connective tissue disease
3. CREST syndrome
4. Polymyositis
228. A 58 years old woman, who had backache and recurrent chest
infections for 6 months, develops sudden weakness of the legs and
urinary retention. Her investigations show a hemoglobin of 7.3gm/dl,
serum calcium 12.6mg/dl, phosphate-2.5mg/dl, alkaline phosphatase-
100u/l, serum albumin-3 gm/dl, globulin-7.1gm/dl and urea-178 mg/d.
What is the most likely diagnosis?
1. Lung cancer
2. Disseminated tuberculosis
3. Multiple myeloma
4. Osteoporosis
229. All of the following drugs are protease inhibitors except:
1. Nelfinavir
2. Saquinavir
3. Abacavir
4. Ritonavir
230. Which one of the following clinical findings excludes the

diagnosis of polymyositis?
1. Neck muscle involvement
2. Extraocular muscle involvement
3. Dysphagia
4. Abdominal muscle involvement

231. All of the following are the known causes of osteroporosis
except:
1. Flurosis
2. Hypogonadism
3. Hyperthyroidism
4. Hyperparathyroidism
232. A 28 years old woman having limited cutaneous scleroderma

for the last 10 years complains of shortness of breath for last one
month. Her pulmonary function tests (PFT) are as follows:
PFT Observed Predicted
FVC 2.63 2.82
FEV1 88% 80%
DLCO 5.26 16.3
What is the most likely diagnosis in this case?
1. Interstitial lung disease

2. Pulmonary artery hypertension
3. Congestive heart failure
4. Bronchiectasis
233. Which of the following is least likely to cause infective

endocarditis:
1. Staphylococcus albust
2. Streptococcus faecalis
3. Salmonella typhi
4. Pseudomonas aeruginosa
234. All of the following may occur due to hyperkalemia, except:
1. Prolonged PR interval
2. Prolonged QRS interval
3. Prolonged QT interval
4. Ventricular asystole
235. Renal artery stenosis may occur in all of the following, except:
1. Atherosclerosis
2. Fibromuscular dysplasia
3. Takayasuâ€™s arteritis
4. Polyarteritis nodosa
236. Sudden cardiac death may occur in all of the following, except:
1. Dilated cardiomyopathy
2. Hypertrophic cardiomyopathy
3. Eisenmengerâ€™s syndrome
4. Ventricular septal defect
237. All of the following are risk factors for atherosclerosis except:
1. Increased waist-hip ratio
2. Hyperhomocysteinemia
3. Decreased fibrinogen levels
4. Decreased HDL levels
238. All of the following may occur in Downâ€™s syndrome except:
1. Hypothyroidism
2. Undescended testis
3. Ventricular septal defect
4. Brushfieldâ€™s spots
239. All of the following may be seen in patients of cardiac

tamponade except:
1. Kussmaulâ€™s sign
2. Pulsus paradoxus
3. Electrical alternans
4. Right ventricular diastolic collapse on echocardiogram
240. A 15 year old female presents with primary amenorrhoea. Her

breasts are Tanner 4 but she has no axillary or pubic hair. The most
likely diagnosis is:
1. Turnerâ€™s syndrome
2. Mullerian agenesis
3. Testicular feminization syndrome
4. Premature ovarian failure
241 The common side effect with Fluoxetine therapy is:
1. Seizure
2. Anxiety
3. Hypotension
4. Loose stools
242 A young girl has consumed barium carbonate with suicidal

intent. She complains of generalized muscle weakness. The most
likely electrolyte is:
1. Hyponatremia
2. Hypocalcemia
3. Hypokalemia
4. Hypomagnesemia
243 All of the following antibacterial agents acts by inhibting cell

wall synthesis, except:
1. Carbapenems.
2. Monobactams
3. Cephamycins
4. Nitrofurantoin
244 A veterinary doctor had pyrexia of unknown origin. his blood

culture in special laboratory media was positive for gram negative
short bacilli which was oxidase positive. Which one of the following is
the likely organism grown in culture?
1. Pasturella spp.
2. Francisella spp.
3. Bartonella spp.
4. Brucella spp.
245 Which one of the following statement is true regarding
pathogenicity of Mycobacteria species?
1. M.tuberculosis is more pathogenic than M.bovis to the

humans.
2. M. Kansasii can cause a disease indistinguishable from

tuberculosis.
3. M.africanum infection is acquired from the environmental

source.
4. M.marinum is responsible for tubercular lymphadenopathy.
246 A young boy had a flea bite while working in a wheat grain
godown. After 5 days he developed fever and had axillary
lymphadenopathy. A smear was sent to the laboratory to perform a
specific staining. Which one of the following staining method would
help in the identification of the suspected pathogen:
1. Albert staining.
2. Zeihl â€“ Neelson staining
3. Mc Fadyeanâ€™s staining
4. Wayson staining
247 A 40 years old women presented to the gynecologist with

complaints of profuse vaginal discharge. There was no discharge
from the cervical os on the speculum examination. The diagnosis of
bacterial vaginosis was made based upon all of the following findings
on microscopy except:
1. Abundance of gram variable coccobacilli.
2. Absence of Lactobacilli.
3. Abundance of polymorphs.
4. Presence of clue cells.
248 A patient complained of chills and fever following a louse bite 2

weeks before. He had rashes all over the body and was delirious at
the time of presentation to the hospital and subsequently went into
coma. A provisional diagnosis of vasculitis due to Rickettsial infection
was made. Which one of the following can be cansative agent:
1. Rickettsia typhi.
2. Rickettsia rickettsiae
3. Rickettsia prowazekii.
4. Rickettsia akarai.
249 A diabetic patient developed cellutitis due to Staphylococcus

aureus, which was found to be Methicillin resistant on the antibiotic
sensitivity testing. All the following antiboditics will be appropriate
except.
1. Vancomycin
2. Imipenem
3. Teichoplanin
4. Linezoiid
250 A VDRL reactive mother gave birth to an infant. All of the

following would help in determining the risk of transmission to the
infant except:
1. TPHA test on the serum sample of the mother.
2. TPHA test on the serum sample of the infant
3. VDRL on the paired serum sample of the infant and mother.
4. Time interval between the treatment of the mother and her

delivery.
251 At what period does tuberculosis flare up most commonly in a

pregnant patient?
1. First trimester
2. Second trimester
3. Third trimester
4. Puerperium.
252 which surgical procedure has the highest incidence of ureteric

injury?
1. Vaginal hysterectomy
2. Abdomainal hysterectomy.
3. Wertheimâ€™s hysterectomy
4. Anterior colporraphy.
253 The following hormone is raised in polycystic ovarian

syndrome:
1. 17-OH Progesterone
2. Follicular stimulating hormone
3. Lutenising hormone
4. Thyroid stimulating hormone
254 which vitamin deficient is most commonly seen in a pregnant

mother who is on phenytion therepy for Epilesy?
1. Vitamin B6
2. Vitamin B12
3. Vitamin A.
4. Folic Acid
255 Which of the following ovarian tumour is most prone to undergo

torsion during pregnancy?
1. Serous Cystadenoma
2. Mucenous Cystadenoma
3. Dermois cyst
4. Theca Lutein Cyst
256 Which one ot the following congenital malformation of the fetus

can be diagnosed in first trimester by ultrasound?
1. Anencephaly
2. Inencephaly
3. Microcephaly
4. Holoprosencephaly.
257 The most common cause of tubal block in India is:
1. Gonorrhoea infection
2. Chlamydia infection
3. Tuberculosis
4. Bacterial Vaginosis
258 The following complications dueing pregnancy increase the risk

of Post Partum Haemorrhage (PPH) except:
1. Hypertension
2. Macrosomia
3. Twin pregnancy
4. Hydramnios.
259 Indicators of impending uterine rupture during labour include all

of the following except:
1. Fetal distress.
2. Hematuria
3. Fresh bleeding per vaginum
4. Passage of meconium
260 which of the following statements is incorrect regarding

polycystic ovarian disease?
1. Elevated LH hormone
2. Can cause infertility
3. May be associated with abnormal glucose tolerance test.
4. Results in postdated pregnancy.
261 Which of the following statements is incorrect regarding

levonorgestral releasing intra-uterine system?
1. There is increased incidence of menorrhagia.
2. This system can be used as hormone replacement therapy.
3. this method is useful for the treatment of Endometerial

hyperplasia
4. Irregular uterine bleeding can be problem initially.
262 All of the following mechanisms might account for a reduced

risk of upper genital tract infection in users of progestin â€“ releasing
IUDs, except:
1. Reduced retrograde menstruation
2. Decreased ovulation
3. Thickened cervical mucus
4. Decidual changes in the endometrium.
263 Emergency contraception prevents pregnancy by all of the

following mechanisms, except.
1. Delaying / inhibiting ovulation
2. Inhibiting fertilization
3. Preventing implantation of the fertilized egg.
4. Interrupting an early pregnancy.
264 Misoprostol is a:
1. Prostaglandin E1 analogue
2. Prostaglandin E2 analogue
3. Prostaglandin antagonist
4. Antiprogestin.
265 Lymphatic drainage of the cervix occurs by all of the following

lymph nodes, except:
1. Parameterial lymph nodes.
2. Deep inguinal lymph nodes.
3. Obtruator lymph nodes
4. Ext. iliac lymph nodes.
266. The treatment for a case of virilising adrenal hyperplasia is:

1. Estrogens
2. Antiandrogens
3. ACTH.
4. Cortisone.
267 A primigravida presents to casually at 32wks.
gestation with acute pain abdomen for 2hours, vaginal bleeding and
decreased fetal movements, She should be managed by:
1. Immediate caesarean section
2. Immediate induction of labour
3. Tocolytic therapy
4. Magnesium sulphate therapy
268 The investigation of choice in a 55 year old postmenopausal

woman who has presented with postmenopausal bleeding is:
1. Pap smear
2. Fractional curettage
3. Transvaginal ultrasound
4. CA-125 estimation
269 In which of the following genital tract malignancy, the risk of

metastasis to ovary is the least?
1. Carcinoma cervix
2. Carcinoma endometrium
3. Carcinoma fallopian tube
4. Uterine sarcoma
270 The best way of diagnosing Trisomy-21 during second

trimester of pregnancy is:
1. Triple marker estimation
2. Nuchal skin fold thickness measurement
3. Chorionic villus sampling
4. Amniocentesis
271 Calcitonin is secreted by:
1. Thyroid gland
2. Parathyroid gland
3. Adrenal glands
4. Ovaries
272 Which of the following is an intraarticular tendon?
1. Sartorius
2. Semitendinosus
3. Anconeus
4. Popliteus
273 which of the following conditions is least likely to present as an

eccentric osteolytic lesion:
1. Aneurysmal bone cyst.
2. Giant cell tumor
3. Fibrous cortical defect

4. Simple bone cyst
274 Bisphosphonates act by:
1. Increasing the osteoid formation.
2. Increasing the mineralisation of osteoid.
3. Decreasing the osteoclast mediated resorption of bone.
4. Decreasing the parathyroid hormone secretion.
275 All the statements are true about exotosis, except:
1. It occurs at the growing end of bone.
2. Growth continues after skeletal maturity.
3. It is covered by cartilaginous cap.
4. Maligant transformation may occur.
276 â€œRugger Jersey Spineâ€ is seen in:

1. Fluorosis
2. Achondroplasia
3. Renal Osteodystrophy.
4. Marfanâ€™s Syndrome.
277 Brown tumours are seen in:
1. Hyperparathyroidism.
2. Pigmented villonodular synovitis
3. Osteomalacia
4. Neurofibromatosis
278 All of the following statements are true about development

dysplasia (DDH) of the hip, except:
1. It is more common in females.
2. Oligohydramnios is associated with a higher risk of DDH.
3. The hourglass appearance of the capsule may prevent a

successful closed reduction.
4. Twin pregnancy is a known risk factor.
279 All are true regarding brachial plexus injury, except:
1. Preganglinoic lesions have a better prognosis than

postganglionic lesions.
2. Erbâ€™s palsy causes paralysis of the abductors and external

rotators of the shoulder.
3. In Klumpkeâ€™s palsy, Hornerâ€™s syndrome may be

present on the ipsilateal side.
4. Histamine test is useful to differentiate between the

preganglinoic and postganglinoic lesions.
280 The ideal treatment of bilateral idiopathic clubfoot in a newborn

is:
1. Manipulation by mother.
2. Manipulation and Dennis Brown splint.
3. Manipulation and Casts.
4. Surgical release.
281 The postero superior retraction pocket, if allowed to progress,

will lead to:
1. Sensori-neural hearing loss.
2. Secondary Cholesteatoma.
3. Tympanoscelerosis.
4. Tertiary cholesteatoma.
282 A 30 year old male is having Attic cholesteatoma of left ear with
lateral sinus thrombophelebitis. Which of the following will be the
operation of choice?
1. Intact canal wall mastiodectomy.
2. Simple mastoidectomy with Tympanoplasty.
3. Canal wall down mastoidectomy.
4. Mastoidectomy with cavity obliteration.
283 Which of the following conditions causes the maximum hearing

loss?
1. Ossicular disruption with intact tympanic membrane

2. Disruption of malleus and incus as well tympanic membrane.
3. Partial fixation of the stapes foorplate.
4. Ottitis media with effusion.
284 During inspiration the main current of airflow in a normal nasal

cavity is through:
1. Middle part of the cavity in middle meatus in a parabolic curve.
2. Lower part of the cavity in the inferior meatus in a parabolic

curve.
3. Superior part of the cavity in the superior meatus.
4. Through olfactory area.
285 Which is the investigation of choice in assessing hearing loss in

neonates ?
1. Impedance audiometry.
2. Brainstem Evoked Response Audiometry (BERA).
3. Free field audiometry.
4. Behavioral audiometry.
286 The most common etiological agent for acute bronchiolitis in
infancy is :
1. Influenza virus.
2. Para influenza virus.
3. Rhinovirus.
4. Respiratory syncytial virus.
287 Which of the following is the principal mode of heat exchange

in an infant incubator?
1. Radiation.
2. Evaporation.
3. Convection.
4. Conduction.
288 Late onset hemorrhagic disease of newborn is characterized by

all of the following features except:
1. Usually occurs in cow-milk fed babies.
2. Onset occurs at 4-12wk of age.
3. Intracranial hemorrhage can occur.
4. Intramuscular vitamin K prophylaxis at birth has a protective

role.
289 Which of the following malformation in a newborn is specific for

maternal insulin dependent diabetes mellitus?
1. Transposition of great arteries
2. Caudal regression
3. Holoprosencephaly.
4. Meningmyelocele.
290 the prognosis of rhabdomysarcoma is likely to be poor if the

site of the tumour is:
1. Orbit
2. Para testicular
3. Extremity
4. Urinary bladder.
291 Which of the following malignant tumors is radioresistant?
1. Ewingâ€™s sarcoma.
2. Retinoblastoma.
3. Osteosarcoma
4. Neuroblastoma.
292 The most common second malignancy in survivors of

retinoblastoma is:
1. Thyroid cancer.
2. Nasopharyngeal carcinoma
3. Optic glioma.
4. Osteosarcoma.
293 The most important determinant of prognosis in Wilms tumor

1. Stage of disease.
2. Loss of heterozygosity of chromosome 1p.
3. Histology.
4. Age less than one year at presentation.
294 The finnish type of cogential nephrotic syndrome occurs due to

gene mutations affecting the following protein.
1. Podocin
2. Alpha-actinin
3. Nephrin
4. CD2 activated protein.
295 Sensorineural deafness may be feature of all, except:
1. Nail patella syndrome
2. Distal renal tubular acidosis.
3. Bartter syndrome.
4. Alport syndrome.
296 With reference to mumps which of the following is true?
1. Meningoencephalitis can precede parotitis.
2. Salivary gland involvement is limited to the parotids.
3. The patient is not infectious prior to clinical parotid

enlargement.
4. Mumps orchitis frequently leads to infertility.
297 A child is below the third percentile for height. His growth
velocity is normal, but chronologic age is more than skeletal age. The
most likely diagnosis is:
1. Constitutional delay in growth.
2. Genetic short stature.
3. Primordial dwarfism.
4. Hypopituitarism.
298 Drug induced lupus can be identified by

1. Anti-histone antibodies.
2. Double stranded DNA antibodies.
3. Antinuclear antibodies.
4. Anti-SM antibodies.
299 The process underlying differences in expression of a gene,

according to which parent has transmitted, is called:
1. Anticipation
2. Mosaicism
3. Non-penetrance
4. Genomic imprinting.
300 the sodium content of ReSoMal (rehydration solution for

malnourished children) is:
1. 90mmol/L.
2. 60mmol/L
3. 45mmol/L
4. 30mmol/L
Posted by புருோனோ Bruno at 6:57 AM 0 comments Links to this post
Labels: AIPG, AIPG_2006, Qe
Friday, May 15, 2009
Brainstem Anatomy Mnemonics
In 2005, Peter Gates published a superb paper titled:
‘The rule of 4 of the brainstem: a simplified method for understanding
brainstem anatomy and brainstem vascular syndromes for the non-
neurologist’.
Gates described a simplified method for answering the question
‘Where is the lesion?’ using only the parts of the brainstem that we
actually examine during a clinical examination to understand
brainstem vascular syndromes.
Firstly, a quick review of the blood supply of the brainstem. Simply
put the blood supply comes from:
paramedian branches
long circumferential branches (SAP)
superior cerebellar artery (SCA)
anterior inferior cerebellar artery (AICA)
posterior inferior cerebellar artery (PICA)
And occlusion of these two groups of vessels results in two distinct
types of brainstem syndrome:
medial (or paramedian) brainstem syndromes
( due to para-median branch occlusion)
lateral brainstem syndromes
( due to occlusion of the circumferential branches, also occasionally
seen in unilateral vertebral occlusion)
And now the rules. If you can remember these rules the diagnosis of
brainstem vascular syndromes becomes a pitifully simple exercise
(?!) - here’s how it works:
In the rule of 4 there are 4 rules
There are 4 structures in the ‘midline‘ beginning with M
There are 4 structures to the ‘side‘ (lateral) beginning with S
There are 4 cranial nerves in the medulla, 4 in the pons and 4 above
the pons (2 in the midbrain)
The 4 motor nuclei that are in the midline are those that divide equally
into 12 except for 1 and 2, that is 3, 4, 6 and 12
(5, 7, 9 and 11 are in the lateral brainstem)
The 4 medial structures and the associated deficits are:
Motor pathway (or corticospinal tract):
contralateral weakness of the arm and leg
Medial Lemniscus:
contralateral loss of vibration and proprioception in the arm and leg
Medial longitudinal fasciculus:
ipsilateral inter-nuclear ophthalmoplegia
(failure of adduction of the ipsilateral eye towards the nose and
nystagmus in the opposite eye as it looks laterally)
Motor nucleus and nerve:
ipsilateral loss of the cranial nerve that is affected (3, 4, 6 or 12)
The 4 ’side’ (lateral) structures and the associated deficits are:
Spinocerebellar pathway:
ipsilateral ataxia of the arm and leg
Spinothalamic pathway:
contralateral alteration of pain and temperature affecting the arm, leg
and rarely the trunk
Sensory nucleus of the 5th cranial nerve:
ipsilateral alteration of pain and temperature on the face in the
distribution
of the 5th cranial nerve
(this nucleus is a long vertical structure that extends in the lateral
aspect of the pons down into the medulla)
Sympathetic pathway:
ipsilateral Homer’s syndrome, that is partial ptosis and a small pupil
(miosis)
According to Gates:
These pathways pass through the entire length of the brainstem and
can be likened to ‘meridians of longitude‘ whereas the various cranial
nerves can be regarded as ‘parallels of latitude‘. If you establish
where the meridians of longitude and parallels of latitude intersect
then you have established the site of the lesion.
The 4 cranial nerves in the medulla are CN9-12:
Glossopharyngeal (CN9):
ipsilateral loss of pharyngeal sensation
Vagus (CN10):
ipsilateral palatal weakness
Spinal accessory (CN11):
ipsilateral weakness of the trapezius and stemocleidomastoid
muscles
Hypoglossal (CN12):
ipsilateral weakness of the tongue The 12th cranial nerve is the motor
nerve in the midline of the medulla. Although the 9th, 10th and 11th
cranial nerves have motor components, they do not divide evenly into
12 (using our rule) and are thus not the medial motor nerves.
The 4 cranial nerves in the pons are CN5-8:
Trigeminal (CN5):
ipsilateral alteration of pain, temperature and light touch on the face
back as far as the anterior two-thirds of the scalp and sparing the
angle of the jaw.
Abducent (CN6):
ipsilateral weakness of abduction (lateral movement) of the eye
(lateral rectus).
Facial (CN7):
ipsilateral facial weakness.
Auditory (CN8):
ipsilateral deafness. The 6th cranial nerve is the motor nerve in the
medial pons.
The 7th is a motor nerve but it also carries pathways of taste, and
using the rule of 4 it does not divide equally in to 12 and thus it is not
a motor nerve that is in the midline.
The vestibular portion of the 8th nerve is not included in order to keep
the concept simple and to avoid confusion. Nausea and vomiting and
vertigo are often more common with involvement of the vestibular
connections in the lateral medulla.
The 4 cranial nerves above the pons are CN1-4:
Olfactory (CN1):
not in midbrain.
Optic (CN2):
not in midbrain.
Oculomotor (CN3):
impaired adduction, supradduction and infradduction of the ipsilateral
eye with or without a dilated pupil.
The eye is turned out and slightly down.
Trochlear (CN4):
eye unable to look down when the eye is looking in towards the nose
(superior oblique). The 3rd and 4th cranial nerves are the motor
nerves in the midbrain.
Thus a medial brainstem syndrome will consist of the 4 M’s and the
relevant motor cranial nerves, and a lateral brainstem syndrome will
consist of the 4 S’s and either
the 9-11th cranial nerve if the lesion is in the medulla, or the 5th, 7th
and 8th cranial nerve if the lesion is in the pons.
Handy tip:
If there are signs of both a lateral and a medial (paramedian)
brainstem syndrome, then one needs to consider a basilar artery
problem, possibly an occlusion.
I’ll let you mull over these rules until the next ‘brainstem’ post, where
you’ll be able to test drive ‘Gates’ Brainstem Rules of 4′ on some
clinical scenarios.
References
Gates, P. The rule of 4 of the brainstem: a simplified method for
understanding brainstem anatomy and brainstem vascular
syndromes for the non-neurologist. Internal Medicine Journal 2005;
35: 263-266 [pubmed]
Goldberg, S. Clinical Neuroanatomy Made Ridiculously Simple.
MedMaster Series, 2000 Edition. [betterworldbooks]
Labels: Anatomy, Brainstem, Mnemonic
Wednesday, January 07, 2009
Difference between acute pyelonephritis and Uncomplicated UTI are
all except
Question 90
Difference between acute pyelonephritis and Uncomplicated UTI are
all except
a. Loss of Concentrating ability
b. Presence of White blood casts
c. Presence of Antibody against Tamm-Horsfall proteins of
tubules
d. Bacterial colony Count more than 108
Answer
Reference:
Harrison 16th Edition Page 1717
Journal reference :
a. P. LARSSON, A. FASTH, U. JODAL, A. SOHL ÅKERLUND, C.
SVANBORG EDÉN (1978) : URINARY TRACT INFECTIONS
CAUSED BY PROTEUS MIRABILIS IN CHILDREN The Antibody
Response to O and H Antigens and Tamm-Horsfall Protein and
Bacterial Adherence to Uro-epithelium . Acta Paediatrica 67 (5), 591–
596. doi:10.1111/j.1651-2227.1978.tb17807.x
b. Kidney International (1976) 9, 23–29; doi:10.1038/ki.1976.3.
Experimental pyelonephritis: The effect of chronic active
pyelonephritis on renal function. Thomas E Miller1, David Layzell1
and Elaine Stewart1
QTDF
Most books
Quality
Spotter
Status
Repeat
Discussion
Normal urine is sterile. UTI can therefore be diagnosed if a single
viable gram negative bacterium inhabits the urinary tract (kidney,
ureters, bladder). In reality, the bacteria causing UTI multiply in log
phase growth in normal urine, and most people with urinary tract
infection have 104-106 bacteria/ml. The acute number will depend
on the urine flow rate, characteristics of the urine, the duration of
infection, etc. The problem in diagnosis is that of contamination
arising from voided specimens passing through the non-sterile distal
urethra. For this reason, clinicians use the criteria of 105 bacteria/ml
of “clean catch” urine to diagnose UTI. At this level, < 1% of the
represent contaminants. At counts of 1000-10,000/ml, there is a
50/50 chance the result represents contamination. Such a count may
represent true infection, but to be sure a second culture showing the
same organism might be more convincing. The second criteria for
diagnosing UTI is the presence of pyuria (> 5 WBC/HPF) on the
urinalysis.
Explanation
a. A severe loss of urine concentrating capacity was
demonstrable when the maximum urinary osmolality of a group of
cases with pyelonephritis was compared with controls. Concentrating
capacity decreased sharply over the first month but further loss over
an eight-month period was minimal.
b. Presence of White blood casts is Pathognomic for
Pyelonephritis
c. Presence of Antibody against Tamm-Horsfall proteins of
tubules . "An increase in antibody levels against O antigen and
Tamm-Horsfall protein was noted only in patients with acute
pyelonephritis indicating that antibody determinations can be useful in
differentiating between upper and lower urinary tract infection caused
by Proteus in similarity to those caused by E. coli"
Comments : This is what the Journal Says : Sera from seven girls
with acute symptomatic pyelonephritis and nine children with acute
symptomatic cystitis caused by Proteus mirabilis were analysed for
antibodies against the bacterial O and H1 antigens and the Tamm-
Horsfall protein. An increase in antibody levels against O antigen and
Tamm-Horsfall protein was noted only in patients with acute
pyelonephritis indicating that antibody determinations can be useful in
differentiating between upper and lower urinary tract infection caused
by Proteus in similarity to those caused by E. coli. In contrast no
difference in adhesive ability was noted comparing Proteus strains
causing acute pyelonephritis or cystitis.
Remarks
If you have a better TEXTBOOK, reference, please send a mail to
bruno@nellaimedicos.com
Labels: 2008, AIPG, AIPG_2008, AIPG_2008_Medicine, Medicine
Thymoma commonly presents with Myasthenia Gravis
Question 89
Thymoma commonly presents with
a. Myasthenia Gravis
b. ??
c. ??
d. ??
Answer
a. Myasthenia Gravis
Reference
Harrison 16th Edition Page
QTDF
Most Books
Quality
Spotter
Status
Repeat
Discussion
Myasthenia gravis (MG) is an acquired autoimmune disorder
characterized clinically by weakness of skeletal muscles and
fatigability on exertion. Thomas Willis reported the first clinical
description in 1672.
The antibodies in MG are directed toward the acetylcholine receptor
(AChR) at the neuromuscular junction (NMJ) of skeletal muscles.
Explanation
The exact mechanism of loss of immunologic tolerance to AChR, a
self antigen, is not understood. MG can be considered a B cell–
mediated disease, as antibodies (a B cell product) against AChR are
responsible for the disease. However, the importance of T cells in
pathogenesis of MG is becoming increasingly apparent. The thymus
is the central organ in T cell–mediated immunity, and thymic
abnormalities such as thymic hyperplasia or thymoma are well
recognized in myasthenic patients.
Comments
Since this question is often repeated, every one attempted it in a jiffy
that they could not even recollect the other choices afterwards
Tips
Ä MG is idiopathic in most patients.
Ä Penicillamine is known to induce various autoimmune disorders,
including MG.
Most common islet cell tumour in MEN 1 is Gastrinoma
Question 88
Most common islet cell tumour in MEN 1 is
a. Gastrinoma
b. Insulinoma
c. Glucagonoma
d. Somatostatinoma
Answer
a. Gastrinoma
Reference
Schwartz 7th Edition Page 1686
Sabiston 15th Edition Page 685
Harrison 16th Edition Page 2231
Robbins 5th Edition Page 1170
Quality
Spotter
Status
Repeat
QTDF
Harrison
Discussion
Neoplasia of the pancreatic islets is the second most common
manifestation of MEN 1 and tends to occur in parallel with
hyperparathyroidism. Increased pancreatic islet cell hormones
include pancreatic polypeptide (75 to 85%), gastrin [60%; Zollinger-
Ellison syndrome (ZES)], insulin (25 to 35%), vasoactive intestinal
peptide (VIP) (3 to 5%; Verner-Morrison or watery diarrhea
syndrome), glucagon (5 to 10%), and somatostatin (1 to 5%). The
tumors rarely produce adrenocorticotropin (ACTH), corticotropin-
releasing hormone (CRH), growth hormone-releasing hormone
(GHRH), calcitonin gene products, neurotensin, gastric inhibitory
peptide, and others. Many of the tumors produce more than one
peptide. The pancreatic neoplasms differ from the other components
of MEN 1 in that approximately one-third of the tumors display
malignant features, including hepatic metastases (Chap. 93).
Explanation
Of the choices given, the most Common Pancreatic Tumour in MEN I
is Gastrinoma.
CommentsMultiple Endocrine Neoplasia (MEN) Syndromes
Type MEN 1 MEN 2 Mixed Syndromes
MEN 2A MEN 2B
Name Wermer’s Syndrome Sipple’s Syndrome
Gene 11q 11-13 RET
ParathyroidParathyroid hyperplasia or adenoma Parathyroid
hyperplasia or adenoma Familial pheochromocytoma and
islet cell tumor
von Hippel-Lindau syndrome, pheochromocytoma, and islet cell
tumor
Neurofibromatosis with features of MEN 1 or 2
Myxomas, spotty pigmentation, and generalized endocrine
overactivity in a single family
Pancreas Islet cell hyperplasia, adenoma, or carcinoma
Pituitary Pituitary hyperplasia or adenoma
Thyroid C Cell Hyperplasia Medullary Thyroid Carcinoma
MTC
Adrenal Rarely Cortical Involvement Pheochromocytoma
Pheochromocytoma
Others Other less common manifestations: foregut carcinoid, ,
subcutaneous or visceral lipomas, dermal angiofibromas or
collagenomas Cutaneous lichen amyloidosis
Hirschsprung disease
Familial Medullary Thyroid Carcinoma Mucosal and gastrointestinal
neuromas
Marfanoid features
Tips
This is one of the most repeated topics for AIPG. There will be 2 to 3
questions every year
MEN
Ä Pancreatic islet cell tumors are diagnosed by identification of a
characteristic clinical syndrome, hormonal assays with or without
provocative stimuli, or radiographic techniques. One approach
involves annual screening of people at risk with measurement of
basal and meal-stimulated levels of pancreatic polypeptide to identify
the tumors as early as possible; the rationale of this screening
strategy is the concept that surgical removal of islet cell tumors at an
early stage will be curative. Other approaches to screening include
measurement of serum gastrin and pancreatic polypeptide levels
every 2 to 3 years, with the rationale that pancreatic neoplasms will
be detected at a later stage but can be managed medically, if
possible, or by surgery. High-resolution, early-phase computed
tomography (CT) scanning provides the best noninvasive technique
for identification of these tumors, but intraoperative ultrasonography
is the most sensitive method for detection of small tumors.
Ä ZES is caused by excessive gastrin production and occurs in
more than half of MEN 1 patients with pancreatic islet cell tumors.
Clinical features include increased gastric acid production, recurrent
peptic ulcers, diarrhea, and esophagitis. The ulcer diathesis is
refractory to conservative therapy such as antacids. The diagnosis is
made by finding increased gastric acid secretion, elevated basal
gastrin levels in serum [generally >115 pmol/L (200 pg/mL)], and an
exaggerated response of serum gastrin to either secretin or calcium.
Other causes of elevated serum gastrin levels, such as achlorhydria,
treatment with H2 receptor antagonists or omeprazole, retained
gastric antrum, small-bowel resection, gastric outlet obstruction, and
hypercalcemia, should be excluded. Gastrin-producing carcinoid-like
tumors are frequently present in the duodenal wall.
Ä Insulinoma causes hypoglycemia in about one-third of MEN 1
patients with pancreatic islet cell tumors. The tumors may be benign
or malignant (25%). The diagnosis can be established by
documenting hypoglycemia during a short fast with simultaneous
inappropriate elevation of serum insulin and C-peptide levels. More
commonly, it is necessary to subject the patient to a supervised 72-h
fast to provoke hypoglycemia. Large insulinomas may be identified by
CT scanning; small tumors not detected by radiographic techniques
may be localized by selective arteriographic injection of calcium into
each of the arteries that supply the pancreas and sampling the
hepatic vein for insulin to determine the anatomic region containing
the tumor. Intraoperative ultrasonography can also be used to
localize these tumors, but preoperative calcium injection data are
helpful in guiding the subtotal pancreatectomy if multiple or no
abnormalities are detected by intraoperative ultrasonography.
Ä Glucagonoma in occasional MEN 1 patients causes a syndrome
of hyperglycemia, skin rash (necrolytic migratory erythema), anorexia,
glossitis, anemia, depression, diarrhea, and venous thrombosis. In
about half of these patients the plasma glucagon level is high, leading
to its designation as the glucagonoma syndrome, although elevation
of plasma glucagon level in MEN 1 patients is not necessarily
associated with these symptoms. The glucagonoma syndrome may
represent a complex interaction between glucagon overproduction
and the nutritional status of the patient.
Ä The Verner-Morrison or watery diarrhea syndrome consists of
watery diarrhea, hypokalemia, hypochlorhydria, and metabolic
acidosis. The diarrhea can be voluminous and is almost always found
in association with an islet cell tumor, prompting use of the term
pancreatic cholera. However, the syndrome is not restricted to
pancreatic islet tumors and has been observed with carcinoids or
other tumors. This syndrome is believed to be due to overproduction
of VIP, although plasma VIP levels may not be elevated.
Hypercalcemia may be induced by the effects of VIP on bone as well
as by hyperparathyroidism.
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68 The Investigation of Choice in A

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68 The Investigation of Choice in A

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68 The investigation of choice in a 55 year old postmenopausal

woman who has presented with postmenopausal bleeding is:

1. Pap smear RxPG TargetPG All India 2008 - Dr.Bruno - Jaypee

from pgmed.org on "MCQsOnline - Online Collection of MCQs of

1. All of the following are features of prematurity in a neonate,

3. Thick ear cartilage.

2. A normally developing 10 month old child should be able to do all

3. Pick up a pellet with thumb and index finger.

4. Build a tower of 3-4 cubes.

3. The following are characteristic of autism except :

1. Onset after 6 years of age.

3. Delayed language development.

4. Severe deficit in social interaction.

4. The earliest indicator of response after starting iron in a 6- year-

1. Increased reticulocyte count.

4. Increased serum iron.

1. Congenital aortic stenosis.

3. Patent ductus arteriosus.

4. Congenital aortoiliac disease.

6. All of the following statements regarding subendocardinal

1. These are multifocal in nature.

2. These often result from hypotension or shock.

3. Epicarditis is not seen.

4. These may result in aneurysm.

1. Transmission may be as an Autosomal dominant trait.

2. Majority of the case present with features of mitral

3. The value leaflets characteristically show myxomatous

4. The disease is one of the common cardiovascular

4. Oral Hairy leukoplakia

9. Megaloblastic anaemia due to folic acid deficiency is commonly

1. Inadequate dietary intake.

2. Defective intestinal absorption.

3. Absence of folic acid binding protein in serum.

4. Absence of glutamic acid in the intestine.

1. Histological grade of the tumour.

2. Stage of the tumour at the time of diagnosis.

3. Status of estrogen and progesterone receptors.

4. Over expression of p-53 tumour suppressor gene.

11. Smoking is generally not associated as a risk factor with :

1. Small cell carcinoma.

4. Bronchiolitis obliterans organizing pneumonia.

3. Basal cell carcinoma.

13. The type of mammary ductal carcinoma in situ (DCIS) most

3. Well differentiated DCIS.

1. Parotid salivary gland.

2. Minor salivary glands.

3. Submandibular salivary gland.

4. Sublingual salivary gland.

1. It generally presents in elderly patients.

2. There is often an association with HHV-8.

3. The proliferating cells are NK cells.

4. Patients are commonly HIV positive.

17. Fine needle aspiration cytology is not suitable for diagnosing :

4. Aneurymal bone cyst.

18. All of the following immunohistochemical markers are positive in

19. B cell prolymphocytic leukemia patients differ from those with B

1. Presenting at a younger age.

2. Having a lower total leucocyte count.

3. Having prominent lymphadenopathy.

4. Having a shorter survival.

1. The intraocular pressure is increased.

2. Calcification of the lens is common.