ANATOMY 1

Chapter 1 Anatomy
1. In L5 root involvement, which among the following is not affected?
A.Thigh adduction
B. Knee flexion
C. Knee extension
D. Toe extension
Ref: B.D Chaurasia 4th. Vol II. 59, 142 Tab 12.1, 148 Tab 12.2

Exp:
Muscles Nerve supply
Knee extension: Quadriceps femoris (main) Femoral N (L2,3,4)
Tensor fascia lata (accessory) Superior gluteal N (L4,5 S1)
Knee flexion: Semitendinosus
Semimembranosus Tibial part of Sciatic N (L5
S1,2)
Biceps femoris
}
Toe extension: Ext. digitorum longus Deep peroneal N (L4,5 S1)
Thigh Adduction: Adductor longus

Adductor brevis
)
Obturator N (L2,3,4Adductor magnus
Pectineus (accessory)
Gracilis ( ,, )
}

Cleft b/w 1st & 2nd toes is supplied by: Deep peroneal nerve (L5) (PGI 1998)

Trendelenberg test is positive in damage of: Superior gluteal nerve (paralysis
of gluteus medius & minimus)

Nerve damaged during venous cut down to access great saphenous vein:
Saphenous nerve (AI
2008)

Largest cutaneous branch of femoral N: Saphenous nerve

Short saphenous vein is accompanied by: Sural nerve (a pure sensory branch
of Tibial nerve)

1) A. Thigh Adduction
2 Rapid Review AIPGMEE 2011
2. Which of the following passes through foramen magnum? (AI 2010)
A. Internal Carotid Artery
B. Sympathetic chain
C. Hypoglossal Nerve
D. Vertebral Artery
Ref: B.D.Chaurasia, 4th, Vol 3. 18
Exp:
STRUCTURES PASSING THROUGH FORAMEN MAGNUM
Apical ligament of dens
Vertical band of cruciate ligament
Membrana tectoria
} Through Anterior part

Vertebral artery
Ant. Spinal artery
Post. Spinal artery
Spinal accessory nerve
Sympathetic plexus around
vertebral arteries
}
Through Subarachnoid space

Lowest part of Medulla oblongata

Meninges } Through posterior part

#Ant. spinal artery is a branch of: Vertebral artery. (PGI1993)

#Vertebral artery is the First & Largest branch of first part of Subclavian
artery.

Fig. Divisions of Vertebral Artery

2) D. Vertebral artery
ANATOMY 3
VERTEBRAL ARTERY
Divisions
V1 : From origin to transverse process of C6 vertebra
Passes through vertebral triangle
V2 : Runs through foramina transversaria of upper six cervical
vertebrae
V3 : Lies in the sub-occipital triangle
V4 : From post. atlanto occipital membrane to the lower border of
pons
Passes through foramen magnum
Pierces duramater, arachnoid & enters subarachnoid space*
(*AIIMS Nov 2005)
Branches
- Cervical branches
· Spinal branches
· Muscular branches
- Cranial branches
· PICA
· Medullary artery
· Ant. spinal artery
· Rarely Post. spinal artery (usually it is a branch of PICA)
20 Rapid Review AIPGMEE 2011

Chapter 2 Physiology
18. Basal metabolic rate is closely associated with:
(AI 2009, 2010)
A. Lean body mass
B. Body surface area
C. Body mass index
D. Body weight
Ref: Ganong. 22nd. 282

Exp:
BMR depends both on lean body mass and body surface area. But it is more
closely related to lean body mass.

Lean body mass gives an estimate of metabolically active components i.e.,
muscles & internal organs
Katch-McArdle formula (BMR based on lean body weight)
BMR (men and women) = 370 + (21.6 X lean mass in kg)
FACTORS AFFECTING BMR

· Genetics. Some people are born with faster metabolisms; some with
slower metabolism.
· Gender. Males > Females. Men have a greater muscle mass and a lower
body fat percentage.
· Age. BMR reduces with age.
· Weight. The heavier you are, the higher your BMR
· Body Surface Area. This is a reflection of your height and weight. The
greater your Body Surface Area factor, the higher your BMR.
Eg. Tall, thin people have higher BMRs.

18) A. Lean body mass

PHYSIOLOGY 31
DC: Diffusion capacity | N:Normal | * FEV1/FVC is the same as FEV1 %

Diffusion capacity is normal in Emphysema

VC ¯ in both restrictive & obstructive lung diseases
Q. A young woman with exertional dyspnoea & PFT showing Normal FVC,
Normal FEV1/FVC & reduced DLCO (Diffusion Lung capacity measured using
carbon monoxide) O2 saturation falls during exercise. Diagnosis is?
(AIIMS Nov 08|AI 10)
Ans: Primary pulmonary HTN

26. The nucleus involved in Papez circuit is:

(AI 2007)
A. Pulvinar
B. Infralaminar
C. VPL nucleus
D. Anterior nucleus of Thalamus
Ref: Guyton 11th . 732

Exp:
Papez circuit is a complex circuit involved in expression of emotions. It connects
the limbic system with Hypothalamus & Thalamus.

Fornix of Hippocampus (Limbic

system)

Mammillary body
(Hypothalamus)

Anterior thalamic nucleus

Cingulate gyrus
(Limbic system)

26) D. Anterior nucleus of Thalamus

32 Rapid Review AIPGMEE 2011

Chapter 3 Biochemistry
27. Vitamin K is involved in the post-translational modification of:
(AIIMS Nov 08, May 01)
A. Glutamate
B. Aspartate
C. Lysine
D. Proline
Ref: Harrison 17th. 743

Exp:
Gamma carboxylation of glutamic acid residues is the post-translational
modification involved in Vit.K dependent clotting factors. Reduced Vit.K is the
co-factor involved in this reaction and is converted to Vit.K epoxide.
VIT. K DEPENDENT FACTORS
· Clotting factors II, VII, IX, X
· Protein C, Protein S
· Osteocalcin, Bone Matrix GIa protein

Vit. C is required for post-translational modification of proline & lysine.
(AIIMS Feb 97)

Vitamin excreted in urine is: Vit. C
VIT. C: FUNCTIONS
· Collagen formation
· Capillary integrity
· Absorptionof iron
· Part of ETC (Electron transport chain)
· Thyroxine metabolism
· Prevents atheromatous plaque formation

27) A. Glutamate
BIOCHEMISTRY 33

Vit.A intoxication casues injury to: Lysososmes (AIIMS May07)

Vit. E toxicity affects: Lymphocytes

Bitoin is required for the activity of: Carboxylases (AIIMS May
03)

Warfarin acts by competitively inhibiting Vit.K epoxide reductase, thus

decreasing the availability of reduced Vit.K.

Ximelagartan: New oral anticoagulant, is a direct thrombin inhibitor.

Parenteral direct thrombin inhibitors: Lepirudin, Argatroban & Bivalirudin.

Fondaparinux, a synthetic pentasaccharide is a congener of LMW Heparin
and acts by binding to antithrombin III and inhibiting Factor Xa.

28. NARP syndrome is seen in: (AIIMS Nov 09)

A. Mitochondrial function disorder
B. Glycogen storage disorder
C. Lysosomal storage disorder
D. Lipid storage disorder
Ref: Harrison’s 17th. 2568

Exp:
Neuropathy, Ataxia and Retinitis Pigmentosa (NARP) syndrome is a
mitochondrial function disorder arising from mutation of ATP-ase 6
(Complex-5)
MITOCHONDRIAL DISORDERS (maternal inheritance/heteroplasmy)
· MELAS (Mitochondrial myopathy, Encephalopathy, Lactic Acidosis & Stroke)
· Kearns-Sayre syndrome
· NARP syndrome
· Myoclonic Epilepsy with Ragged Red Fibres (MERRF)
· C/c Progressive External Ophthalmoplegia (CPEO)

Retinitis pigmentosa (RP ) is associated with:
· Bassen-Kornzweig syndrome (Abetalipoproteinemia)
· Refsum’s disease
· Usher’s syndrome
· Kearns-Sayre syndrome
28) A. Mitochondrial function disorder
42 Rapid Review AIPGMEE 2011

Chapter 4 Pharmacology
37. Drug of choice for central Diabetes insipidus is:
A. Desmopressin
B. Leuprolide
C. Thiazide diuretics
D. Lithium
Ref: Harrison. 17th. 2220
Exp:
The signs and symptoms of uncomplicated pituitary DI can be eliminated
completely by treatment with desmopressin (DDAVP: 1-desamino-8-D-arginine
vasopressin).
Desmopressin
· Longer acting, V2 selective, synthetic analogue of AVP
-Acts selectively at V2 receptors to increase urine concentration and
decrease urine flow.
-More resistant to degradation than AVP and has 3-4 fold longer
duration of action.
· Uses:
1. DOC for nocturnal enuresis.
2. Also used in Von-Willebrand’s disease
· Routes of administration: I.V, SC injection, Nasal inhalation or Oral.

Drugs used in Nephrogenic DI
1. Thiazide diuretics
2. Indomethacin
3. Amiloride in conjunction with low Na diet

DIDMOAD syndrome (Wolfram’s syndrome): Diabetes insipidus, Diabetes
mellitus, Optic atrophy & Deafness (neural)
SIADH: Characterised by excessive release of ADH (vasopressin) which
enhances the reabsorption of water, resulting in concentrated urine &
hyponatremia.

37) A. Desmopressin
PHARMACOLOGY 43

Treatment of SIADH:
1. Conivaptan (DOC, V2 + V1 antagonist)
2. Demeclocycline

Drugs causing SIADH:
1.Vasopressin
2. Chlorpropamide
3. Vincristine
4. Carbamazepine
5. Nicotine
6. Phenothiazines
7. Cyclophosphamide
8. TCA
9. MOA inhibitors
10. SSRI
Vasopressin receptors Action
V1 a Vasoconstriction
V2 Water absorption in collecting duct via Aquaporin
2VasodilatationRelease of Von-Willebrand factor
& Factor VIII from endothelium
V1b (V3) Release of ACTH from pituitary

Lypressin & Terlipressin (V1+V2 analogues): Both are used for the control
of esophageal variceal bleeding.
38. All are true regarding Selective estrogen-receptor downregulator
(SERD), Fulvestrant except:
A. Used for breast cancer
B. Is a selective estrogen antagonist
C. Is slower acting, safer & less effective than SERM
D. Given as once a month i.m. dose
Ref: Goodman & Gilman 34.
Fulvestrant
Fulvestrant is the first FDA approved agent in the new class of estrogen-receptor
downregulators (SERD), which were hypothesized to have an improved safety
profile, faster onset and longer duration of action than the SERMs due to their
pure ER antagonist activity . It was approved in 2002 for

38. C. Is slower acting, safer & less effective than SERM

PATHOLOGY 67

Chapter 5 Pathology

64. Which of the following is not associated with atherosclerotic plaque

formation?
A. Plasma ApoE
B. Alpha-2-macroglobulin
C. Oxidised LDL
D. Increased homocysteine
Ref: 1. Harrison’s 17th. 2419, Tab-350-4
2. Robbin’s 7th. 521
Exp:
Alpha-2-macroglobulin has no relation with atherosclerosis.

Risk Factors for Atherosclerosis include:
· Advanced age
· Male sex
· Genetic factors (polygenic)
· Hyperlipidemia (- LDL, Lp(a)), ApoE mutation
· Hypertension
· Cigarette smoking
· Diabetes mellitus
· S. Homocysteine > 100umol/L
· Prothrombic factors (- Plasminogen Activated Inhibitor-1)
· Inflammatory factors- - CRP (most important factor in risk production)
· ? Chlamydial infection (not fully proven)

64) B. Alpha-2-macroglobulin
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METABOLIC SYNDROME (Syndrome X)
Diagnosis requires 3 or more of the following
· Central obesity: Waist circumference > 102 cm (M), > 88 cm (F)
· Hypertriglyceridemia: Triglycerides >150 mg/dL
· Low HDL: <40 mg/dL (M) & <50 mg/dL (F)
· Hypertension: B.P >130 mm systolic or >85 mm diastolic
· Fasting plasma glucose > 100mg/dL
65. Which is not an autoimmune disease?
A. SLE
B. Grave’s disease
C. Myasthenia gravis
D. Sickle cell disease
Exp:
As we know, Sickle cell disease is a hemoglobinopathy and not an
autoimmune disease.

Gamma Gandy bodies are seen in: Sickle cell anemia (AIIMS, Nov
93)

Commonest renal manifestation in Sickle cell trait: Isosthenuria
Sickling: Mutation in Sickle cell anemia leads to: GAG  GUG (Adenine is
replaced by Uracil).
In effect, polar glutamic acid is replaced by non-polar valine. The amino acid
substitution creates a site on the surface of the Hemoglobin molecule, sometimes
referred to as “sticky patch”. Only deoxyhemoglobin S has a complementary
site to this sticky patch. Therefore deoxyhemoglobin molecules in the RBC
bind to each other and polymerize into long fibers that distort it’s shape.
Note: Sticky patch is present on both oxygenated & deoxygenated HbS. But, in
oxygenated HbS molecule, the complementary site is masked. This is the reason
behind deoxygenation favouring sickling. (AI, 2009)

Role of HbA in polymerisation: HbA does not contain any sticky patch. But it
does have a binding site for sticky patch. Thus it can bind to HbS but cannot
extend the polymer. That is how HbA interferes with polymerisation.
(AIIMS Nov, 2004)

65) D. Sickle cell disease

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Chapter 6 Microbiology

78. Tetracycline is used in the prophylaxis of which of the following

diseases? (AIIMS 2005)
A. Cholera
B. Brucellosis
C. Leptospirosis
D. Meningitis
Ref: Harrison 17th. 971
Exp:
Tetracycline is used in chemoprophylaxis of Cholera.
PROPHYLACTIC USE OF ANTIBIOTICS
· Leptospirosis: Doxycycline (Pencillin G is used for Rx)
· Meningococcal meningitis: Rifampicin
· Infleunza: Oseltamivir
· Rickettsial infections: Tetracyclines
· Rheumatic fever: Pencillin
· Gonorrhea/Syphilis: Pencillin
· Plague: Tetracycline/Doxycycline (Streptomycin is used for Rx)
· Cholera: Doxycycline/Tetracycline
· Diphtheria: Erythromycin (AI 2008)

Drug used for the Rx of cholera in adults: Doxycycline (AI 2005)

DOC for Rx of cholera in pregnancy: Furazolidone (AIIMS 2005)

78) A. Cholera
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81. A farmer developed swellings in the inguinal region which later ulcerated
along with development of constitutional symptoms. What stain can be
used to detect the bipolar stained organisms? (AI 2006)
A. Albert’s stain
B. Wayson stain
C. Ziehl–Neelsen stain
D. Nigrosin stain
Ref: Harrison 17th. 983

Exp:
This is a case of Bubonic plague and the inguinal smear should be examined
immediately with Wayson or Giemsa stain.
 Yersinia pestis
· Gram negative, non-motile, oxidase negative coccobacillus
· Bipolar staining (safety pin appearance)
· Stalactite growth in Ghee broth
· DOC: Streptomycin. The drug used for chemoprophylaxis is
Tetracycline
Another gram-negative bacillus showing bipolar staining, but motile
& oxidase positive is Burkholderia pseudomallei causing Meliodosis.
(AIIMS Nov 2003).
82. Which among the following is the most common fungal infection seen
in immunocompetent patients?
A. Aspergillus
B. Candida
C. Cryptococcus
D. Penicillium marneffei
Ref: 1. Greenwood 16th. 575
2. Textbook of Diagnostic Microbiolgy 3rd. 745
3. Robbins 7th. 397

Exp:
Candida is the most common fungal infection in immunocompetent individuals,
most commonly Candida albicans.
-Prevalence of Aspergillus is second only to Candida albicans.
81) B. Wayson stain 82) B. Candida
FORENSIC MEDICINE 101

Chapter 7 Forensic
Medicine

104. An Infant is brought to the casualty with reports of violent shaking

by parents. Most characteristic injury is:
A. Long bone fracture
B. Ruptured spleen
C. Subdural hematoma
D. Skull bone fracture
Ref: Reddy, 25th. 383

Exp:
This is a case of Battered Baby syndrome (non-accidental injury of
childhood).
Battered Baby syndrome is characterised by bruises, abrasions & lacerations
of different ages due to direct manual violence. Battered babies are frequently
found to have subdural hematoma & intraocular bleeding due to violent
shaking, so also called ‘infantile whiplash syndrome’. In such cases there is no
fracture of skull or no external injuries on the head or body other than bruises
produced in areas where the child is held by the hands.

104) C. Subdural hematoma

102 Rapid Review AIPGMEE 2011
105. Gun powder on clothing can be visualized by:
A. Magnifying lens
B. UV rays
C. Infrared rays
D. Xray
Ref: Parikh 6th. 2.18

Exp:
Soot deposits (blackening) & gun powder on dark coloured fabric & skin can
be better visualised by IR photography.

All tattoos & faint letter marks can be visualised by: IR photography
(AI 1991,2003|AIIMS 1992)
Tests for gun powder detection:
· IR photography
· Dermal nitrate/ Paraffin test (AIIMS Nov 2005)
· Neutron activation analysis
· Atomic absorption spectrophotometry
· Scanning electron microscopy with Xray analyser

Black gun powder (smoke producing) contains: Pot. Nitrate, Sulphur,
Charcoal (PGI Dec 2006|AIIMS 1997)

Smokeless gun powder contains: Nitrocellulose & nitroglycrine

The terms FG, FFG, FFFG are used to describe: Black gun powder (depending
on size of grains) (PGI Jun 2007, Dec 2008)

Dried semen stain on clothes is identified by: UV light (AIIMS Nov 2009)
106. Signature fracture refers to: (AIIMS May 2006)
A. Depressed skull fracture
B. Suture displacement fracture
C. Contrecoup injury
D. Fracture at foramen magnum
Ref: Reddy, 25th. 209
Exp:
Depressed fracture is also known as Signature fracture (fracture-ala signature),
as their pattern often resembles the weapon or agent which caused it.

105) C. Infrared rays 106) A. Depressed fracture

108 Rapid Review AIPGMEE 2011

Chapter 8 Community
Medicine
113. Which is not true regarding diet modification recommended in high
cardiovascular risk groups?
A. Cholesterol less than 100 mg/1000kcal/day
B. Avoid alcohol
C. Fat intake < 10% of total calories
D. Salt limitation to less than 5 gm
Ref: Park 20th. 320
Exp:
The WHO committee considers the following dietary changes necessary for
prevention of CHD
· Reduction of fat intake to 20-30% of total energy intake
· Saturated fat < 10% of total energy intake
· Cholesterol <100mg/1000kcal/day
· Increase in complex carbohydrate consumption
· Avoid alcohol
· Salt intake <5g/day
114. Orthotoluidine test is used for detecting: (AIIMS Nov 04,PGI June 06)
A. Chlorine
B. Nitrites
C. Nitrates
D. Ammonia
Ref: Park 20th. 626
Exp:
-Orthotoluidine test determines both free and combined chlorine in water
together.

113) C Fat intake <10% of total calories 114) A. Chlorine

COMMUNITY MEDICINE 109
(Free chlorine is detected within 10 seconds. Combined chlorine within 15-20
min.)
-Orthotoluidine-Arsenite test determines free and combined chlorine
separately.
CHLORINE DEMAND
The difference between the amount of chlorine added to water and the amount
of residual chlorine remaining at the end of contact time of 1 hour.

Break-point: The point at which chlorine demand of water is met.

Chlorine demand of water can be estimated by: Horrock’s apparatus.
(AIIMS May 2006, 2007)
Estimation of chlorine demand:
1. Calculate volume (Litres) of water in well using formula 3.14x R2 x h x1000
2. Check which cup (1 to 6) of Horrock’s apparatus shows blue colour when
tested with the water sample to be purified (details in Park p.637)
th
3. For example : If it is the 4 cup, 8g (i.e., 4x2) bleaching powder is required
for 455 Litres of water in that well. Then calculate the amount required
for the entire volume in well.

Action of chlorine is due to: Hypochlorous acid (HClO).

Methods of chlorination:
1. Chlorine gas
2. Chloramine
3. Perchloron (High Test Hypochlorite)-contains 60-70% of available chlorine.

Chlorine kills pathogenic bacteria, but has no effect on spores and certain
viruses (Eg. polio, viral hepatits) except at high doses (Superchlorination).

Ozone and UV radiation are more effective than chlorine (have virucidal effect
also). But there will be no residual germicidal effect.

Bleaching powder (CaOCl2) contains 33% available chlorine. Used for
household purification.

Drinking water requires a residual chlorine level of 0.5 ppm for a contact
period of 1 hour. (AIIMS May04)

In post disaster period: 0.7 ppm for contact period of 1 hour.

Swimming pool disinfection : 1 ppm for 1 hour.
ENT 129

Chapter 9 ENT

137. A 5 year old boy while having dinner suddenly becomes aphonic and
is brought to the casualty with complaint of respiratory distress. What
should be the appropriate management? (AIIMS1999|AI2002)
A. Cricothyroidotomy
B. Emergency tracheostomy
C. Humidified oxygen
D. Heimlich manoeuvre
Ref: Dhingra 3rd. 389
Exp:
This is a case of laryngeal foreign body. Emergency management, especially
when the patient is not in a hospital setup is Heimlich’s manoeuvre. Stand
behind the patient and place your arms around his lower chest and give
strong abdominal thrusts. In pediatric patients pounding the back after
turning the patient head down may be tried. If all attempts fail,
cricothyrotomy (laryngotomy) should be performed. It should be converted
to tracheostomy later.
138. Time of occurrence of secondary haemorrhage after tonsillectomy:
(JIPMER 2003)
A. 24 hrs
B. 6 days
C. 12 days
D. 12 hrs
Ref: Dhingra 3rd. 492

137) Ans: D. Heimlich manoeuvre 138) B. 6 Days

130 Rapid Review AIPGMEE 2011
Exp:
Secondary hemorrhage after tonsillectomy is seen between 5th to 10th
post-operative day. Usually occurs after 7 days. Infection in the
tonsillar fossa is the cause for secondary hemorrhage.

Cause of reactionary haemorrhage is slipping of ligatures. It occurs within 24
hours.
139. Gold standard test for diagnosis of laryngopharyngeal reflux is:
A. 24 hr double probe pH monitoring
B. Flexible endoscopy
C. Barium swallow
D. Laryngoscopy
Ref: Ballinger’s textbook of ENT 17th. 886
Exp:
The gold standard for diagnosing and quantifying acid reflux is the 24-hour
double probe pH monitoring.
Procedure: The study is performed by placing a thin catheter containing one or
more solid-state electrodes in the esophagus. The electrodes are spaced 5
to 10 cm apart and are capable of sensing fluctuations in the pH between 2
and 7. The electrodes are connected to a data recorder that the patient
wears for the period of observation. There is a digital clock displayed on
the recorder. When the patient has an event (e.g., heartburn, chest pain,
eructation), he or she is to record the event in a diary, noting the time on
the recorder.

Laryngeal pseudosulcus is seen secondary to: Laryngopharyngeal reflux
(AI 2009)

A singer with singer’s node with history of reflux, the best treatment is: Voice
therapy & PPI (AI 2008)
Complications of Laryngopharyngeal reflux (Reflux laryngitis)
· Subglottic stenosis (PGI 2004)
· Ca larynx
· Cord fixation
· Contact ulcer
· Vocal nodule

139) A. 24hr double probe pH monitoring

OPHTHALMOLOGY 135

Chapter 10 Ophthalmology
145. Which of the following is the most probable diagnosis in a young patient
with loss of central vision and a normal ERG with no family history?
A. Best’s disease
B. Stargardt’s disease
C. Retinitis pigmentosa
D. Central macular hole
Ref: Kanski Ophthalmology 5th. 498, 507
Exp: Patient with loss of central vision & normal ERG, narrows down our
diagnoses to Best’s disease & Stargardt’s disease. However, Best’s disease
can be excluded as it usually appears during childhood & family history
will be invariably present as the condition is autosomal dominant.
Stargradt’s disease usually manifests in young individuals (late second decade
& third decade) & it does not usually have a family history as the condition
is AR.
Stargardt’s Disease
Clinical features
· AR disorder
· Most common form of inherited juvenile macular dystrophy
· Characterised by B/L discrete yellowish flecks of lipofuschin deposition in
the macula
· Macular damages start to occur b/w 6 -20 yrs though visual impairment
becomes apparent in the 3rd decade
· Patients typically present after 20 yrs with gradual blurring of central vision
& black or hazy spots in the centre of their vision
· Vision suddenly deteriorates thereafter
Investigations
Fluorescein angiography: Investigation of choice (shows dark choroid)
Electroretinogram (ERG), (Electrooculogram) (EOG): Usually normal or may
be subnormal

145) B. Stargardt’s disease

136 Rapid Review AIPGMEE 2011

Rx: No effective treatment available

MACULAR DYSTROPHIES (*AIIMS Nov 06, May 07|AI 07)
AR AD

· Stargradt’s disease (juvenile MD) · Juvenile Best’s disease*

· Fundus flavimaculatus (vitelliform MD)
· Bassen kornzweig disease
· Rufsum’s disease · Butterfly MD
· Usher’s syndrome
· Laurence Moon Biedl syndrome (JIPMER 2004)

Best diagnostic test for Best’s disease: EOG

EOG is abnormal in Best’s disease. It is the only disease showing relatively
normal ERG with abnormal EOG (JIPMER 1999)

Most of the Retinal dystrophies are AR inherited except: Best’s disease
& Butterfly MD

Most of the Corneal dystrophies are AD inherited except: Macular
corneal dystrophy (AI
1996)
Electroretinogram (ERG)
Measures changes in the resting potential of eye, induced by stimulation of the
eye with a light stimulus.

In a normal dark adapted eye, ERG shows 3 components:

1. Negative ‘a’ wave- represents activity of rods & cones
2. Positive ‘b’ wave- arises in inner retinal layers
3. ‘c’ wave- related to metabolism of retinal pigment epithelium
MEDICINE 145

Chapter 11 Medicine
155. A girl presented with recurrent occipital headache associated with
ataxia and vertigo. There is history of her mother having similar
complaints. Most probable diagnosis is: (AIIMS Nov 2009)
A. Vestibular neuronitis
B. Basilar migraine
C. TIA
D. –
Ref: Harrison’s 17th. 141
Exp: The above mentioned clinical scenario correlates with Basilar migraine.
Ataxia is due to involvement of cerebellar nuclei and vertigo due to
vestibular nuclei. Both are supplied by branches of basilar artery.
Basilar Migraine: It can be familial and classically the pain is occipital.
Clinical features
· Occipital headache
· Visual symptoms
· Dysarthria
· Ataxia
· Vertigo
· Tinnitus

Retinal migraine: Migraine with involvement of retinal circulation which causes
unilateral photopsia/transient monocular blindness.

Ophthalmoplegic migraine: Migraine with transient, partial 3rd nerve palsy.
(AIIMS May, 2003)

Hemiplegic migraine: AD trait characterized by episodes of hemiparesis along
with migraine.

155) B. Basilar migraine

146 Rapid Review AIPGMEE 2011

MIGRAINE
With aura: Classical migraine (*AIIMS Jun, 2000|AI 2001)
· Recurrent U/L headache with nausea/vomiting & preceded by an aura
which is usually a disturbance of nervous function
Eg. Photopsia, Scintillating scotoma, Paresthesia–lips, face &
hands*, Transient weakness, Aphasia, Dysarthria etc.
Without aura: Common migraine
· 5 times more common than classical migraine
· No aura preceeding headache
· Nausea/ vomiting +
· Hemicranial throbbing headache usually affecting frontotemporal part
· Sensitivity to light & noise is characterisitic

Drugs for Rx of migraine

· 5HT 1B/1D receptor agonist: Sumatriptan, Rizatriptan, Zolmitriptan
· NSAIDs
· Dopamine antagonists: Metoclopramide, Chlorpromazine
Drugs for Prophylaxis
· Propranolol
· TCAs
· Anticonvulsants: Topiramate, Valproate, Gabapentin
· Verapamil
· Methysergide
· Flunarazine

Sumatriptan is not used for prophylaxis of migraine (AI 2010)

CLUSTER HEADACHE (AIIMS Nov 1999)

· Occurs predominantly in young men
· U/L intense, non-throbbing, periorbital pain associated
with reddening of eye, lacrimation, rhinorrhea & nasal stuffiness
· Headache occurs in clusters
· Usually at night
196 Rapid Review AIPGMEE 2011

Chapter 12 Surgery
195. A surgeon removed the part of liver to the left of the falciform ligament.
Which segments have been removed? (AI 2008)
A. 1 & 4a
B. 2 & 3
C. 1 & 4b
D. 5 & 6
Ref: Bailey 24th. 1063: Fig 63.2, 18: Fig 2.24
Exp:
Resection of segments II and III is a commonly performed sublobar
resection and is often referred to as a left lateral segmentectomy and
left lateral sectionectomy or left lobectomy. Left lobe is that part of
liver to the left of the falciform ligament.
Couinad & Bismuth (French) classification
(Functional segmental liver anatomy)
-Liver is divided into 8 functional segments based on distribution of He-
patic vein (mainly) & Portal vein.
(AI 2004)
-Couinaud's segments are numbered in anti-clockwise direction when liver
is visualized from posterior surface.
· Segment I is called Caudate lobe
· Segment IV is called Quadrate lobe

195) B.2 & 3

SURGERY
Anatomical classification
Falciform ligament
divides liver into:
Left (II, III) & Right
(I, IV,V, VI, VII, VIII) lobes
197
Surgical classification
Cantlie's line*/Portal fissure divides
liver into functional Left (II, III, IV)
& Right (V, VI,VII, VIII) lobes
· Left lobe is supplied by Left he-
patic atrtery & Left portal vein;
and drained by Left hepatic vein
· Right lobe is supplied by Right
hepatic atrtery & Right portal
vein; and drained by Right he-
patic vein
· Caudate lobe enjoys dual blood
supply

(*line passing through gall bladder fossa, middle hepatic vein & IVC)

The lobe enlarged in Budd-Chiari syndrome: Caudate lobe

196. Difference between follicular carcinoma and follicular adenoma is:

A. Vascular invasion
B. Mitosis
C. Nuclear pleomorphism
D. Hurthle cells
Ref: Robbins 7th. 1177
Exp:
Capsular & vascular invasion differentiates follicular carcinoma from folli-
cular adenoma.

Follicular carcinoma:

· 2nd most common Thyroid malignancy

· More common in iodine deficient areas

196) A Vascular invasion

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Chapter 13 Obstetrics &

Gynaecology

217. Blood Chimerism is associated with:

A. Monochorionic monoamniotic twins
B. Monochorionic dizygotic twins
C. Singleton pregnancy
D. Vanishing twin
Ref: 1. Journal: Blood Chimerism in a Dizygotic Dichorionic Pregnancy
2. Blood chimerism in monochorionic twins conceived by induced
ovulation: Case report"
Exp:
Chimerism means a person shows 2 cell lines derived from 2 different zygotes.
Blood chimerism is the presence of cells from 2 zygote lineages in lympho-
hematopoietic system alone.
Cells from one fetus will reach the other via vascular connections between the
two. This usually happens in monochorionic twins and it will not result in
chimerism as monochorionic twins are monozygotic as well. (Both fetuses
contain the same cell line. So even if cells are mixed, it will not be apparent).
So blood chimerism will occur only when 2 zygotes share a single placenta and
vascular connections develop.
Traditionally, monochorionicity in multiple pregnancies is associated with
monozygocity. Dizygotic monochorionic twins will not develop in natural
twin pregnancy, but may occur in 'in vitro fertilisation'. Only few cases

217) B. Monochorionic dizygotic twins

O&G 217
have been reported so far. In IVF 3 or 4 zygotes are grown together artificially
and all are introduced into uterus. In this scenario they may develop single
chorion/placenta.
Investigations: To distinguish whole-body chimerism from blood chimerism,
molecular analysis of blood cells and non-hematopoietic tissue (e.g., buccal
cells, hair, and nails) by performing PCR and FISH is necessary.
Eg. We present a case of blood chimerism in a dizygotic monochorionic twin
pregnancy.
The female twin was delivered at 34 weeks of gestation, and the male twin was
stillborn. Pathologic examination confirmed Monochorionic diamniotic
placenta. The karyotype of the female child was obtained using
peripheral blood sample, and it revealed a mixture of 46,XX and
46,XY cells . FISH analysis performed on the buccal cells revealed
100% XX signals. Gross examination of the external genitalia and
abdominal ultrasonography revealed no definitive abnormal findings
in relation to sex differentiation. When XX/XY chimerism is present
in blood lymphocytes, careful examination of external genitalia and
reproductive organs and further studies are required to detect
chimerism in non-hematopoetic tissues. So it is a case of blood
chimerism.
218. In expectant management of placenta praevia, all are done except:
(AIIMS Nov 2010)
A. Cervical encirclage
B. Anti D administration
C. Corticosteroids
D. Blood transfusion
Ref: Dutta 6th. 251
Exp:
Expectant management of placenta praevia (Macafee & Johnson regimen)
is followed when:

218) A. Cervical encirclage

242 Rapid Review AIPGMEE 2011

Chapter 14 Orthopaedics

247. A 65 yrs old lady presented with a swollen and painful knee. On
examination, she was found to have grade III osteoarthritic changes. What
is the best course of action?
A. Conservative management
B. Arthroscopic washing
C. Partial knee replacement
D. Total knee replacement
Ref: 1. Campbell 11th. 916
2. Apley‘s 9th. 573
Exp:
The radiological grading system for OA is Kellgren-Lawrence scale given below.
However, the treatment of OA is not dependent on radiological grading. It is
only based on symptoms & disability of the patient. Moreover, the radiological
grading may not correlate with symptomatology.
Kellgren-Lawrence Grading Scale
Grade 1: doubtful narrowing of joint space and possible osteophytic lipping·
Grade 2: definite osteophytes, definite narrowing of joint space·
Grade 3: moderate multiple osteophytes, definite narrowing of joints space,
some sclerosis and possible deformity of bone contour·
Grade 4: large osteophytes, marked narrowing of joint space, severe sclerosis
and definite deformity of bone contour
The patient in the question is 65 yr old & is having swollen & painful knee.
The best treatment here is Total knee replacement.

Treatment options for OA

247) D. Total knee replacement

ORTHOPAEDICS 243
A. Conservative
· Drugs-NSAIDs, Intraarterial steroids, Hyaluronic acid
· Weight reduction
· Exercise
· Orthoses
B. Surgical
· Arthroscopic wash out
· Osteotomy
· Arthroplasty
· Arthrodesis

248. Blount’s disease is: (PGI Jun 2000)

A. Genu valgum
B. Genu varum
C. Genu recurvatum
D. Menisceal injury
Ref: Bailey & Love 24th. 489
Exp:
BLOUNT’S DISEASE (infantile tibia vara)
-Pediatric (<3yrs) orthopaedic disorder affecting the knee joint.
-Rare growth disorder is characterized by disordered ossification of the medial
aspect of the proximal tibial epiphysis and metaphysis
-Progressive deformity manifests as varus angulation and internal rotation
of the tibia in the proximal metaphyseal region immediately below the
knee.
X-ray: Shows beaking & fragmentation of medial tibial epiphysis.
Rx: Corrective osteotomy (should be done before 4yrs; critical age of
osteotomy) (JIPMER 1998)

248) B. Genu varum

PEDIATRICS 249

Chapter 15 Pediatrics

252. Earliest symptom of GERD which becomes pathological in an

infant is:
A. Respiratory distress
B. Upper GI bleed
C. Regurgitation
D. Intestinal obstruction
Ref: Nelson 18th. 1547
Exp:
-GERD in infants may manifest as obstructive apnoea or as stridor or lower
airway disease. It may also complicate primary airway disease such as
laryngomalacia or bronchopulmonary dysplasia. Otitis media, sinusitis,
lymphoid hyperplasia, hoarseness, vocal cord nodules, and laryngeal edema
have all been associated with GERD.
-Infantile reflux manifests more often with regurgitation (especially
postprandially), signs of esophagitis (irritability, arching, choking, gagging,
feeding aversion), and resulting failure to thrive, symptoms resolve spontaneously
in the majority by 12–24 months. If a question appears based on ‘most common
manifestaion’ the answer will be Postprandial regurgitation.
But most common pathological presentation is with ‘Respiratory distress.’
253. A 7 month old child presents with complaints of recurrent bouts of

252) A. Respiratory distress

250 Rapid Review AIPGMEE 2011
cough terminated by an audible whoop. What is the best way to confirm
the diagnosis?
A. Nasopharyngeal swab
B. Cough plate culture
C. Tracheal aspirate
D. –
Ref: 1. Harrison’s 17th. 935
2. Jawetz Microbiology
Exp:
The best specimen for diagnosis of Pertussis is collected by nasopharyngeal
aspiration, in which a fine flexible plastic catheter attached to a 10-ml syringe is
passed into the nasopharynx and withdrawn while gentle suction is applied.
This should be inoculated without delay on to Bordet-Gengou agar*. Culture
of nasopharyngeal secretions remains the gold standard of diagnosis, although
DNA detection by polymerase chain reaction (PCR) is replacing culture in many
laboratories because of increased sensitivity and quicker results. (*PGI 1994)
Note: As per Jawetz Microbiology,
“A saline nasal wash is the preferred specimen. Nasopharyngeal swabs or
cough droplets expelled onto a “cough plate” held in front of the patient’s mouth
during a paroxysm are sometimes used but are not as good as the saline nasal
wash.”
Thus, if saline nasal wash was among the options it would have been the answer.

Usual incubation period of Pertussis: 7-14 days (AIIMS Nov 2005)

In culture medium Bordetella produces:
a. Bisected pearls/mercury drops colonies.
b. Aluminium paint appearance (Confluent growth )
c. Thumb print appearance

253) A. Nasopharyngeal swab

266 Rapid Review AIPGMEE 2011

Chapter 16 Dermatology

269. Erythema nodosum is seen in all except: (AIIMS 1994)

A. Pregnancy
B. Tuberculosis
C. SLE
D. Chronic pancreatitis
Ref: 1. Harrison17th. 126, 333 Tab 18-1
2. Fitzpatrick Dermatology 6th. 1940
Exp:
Causes of Erythema nodosum:
· Streptococcal Infection (MC cause)
· Sarcoidosis
· Drugs-Sulphonamides, Penicillin, OCP
· Hodgkin’s disease
· TB
· Leprosy
· Brucellosis
· Ulcerative colitis & Crohn’s dsease
· SLE
· Pregnancy
· Behcet’s disease
· Fungal infections
· Histoplasmosis

269) D. Chronic pancreatitis

DERMATOLOGY 267
Tuberculides are hypersensitive reactions to mycobacterium tuberculosis
or its products in a patient with significant immunity
a. True Tuberculides: (AIIMS Nov 2006, May 2007|PGI Jun 2007)
1. Lichen scrofulosorum
2. Papulonecrotic tuberculide

b. Facultative tuberculides:
1.Erythema nodosum
2. Erythema induratum (Nodular tuberculid)

Most common type of cutaneous TB: Lupus vulgaris (Apple jelly
nodules) (PGI Dec 2006)

Lupus vulgaris: Cutaneous TB characterized by erythematous, annular,
irregularly indurated plaque with central scarring.
(AIIMS Nov 2001, Nov 2003)

Erythematous lesion with central crusting: Cutaneous Leishmaniasis

Lesion with central clearing: Tinea corporis

Cutaneous TB secondary to underlying TB lymphadenitis: Scrofuloderma
(AI 1999)

270. Pseudoisomorphic phenomenon is seen in: (AI 1991|PGI 1999)

A. Psoriasis
B. Lichen planus
C. Vitiligo
D. Plane warts
Ref: Fizpatricks’ dermatology 6th.427
Exp:
-Pseudoisomorhic phenomenon: Due to autoinoculation & is seen in infections
like Plane warts, Molluscum contagiosum & Eczematous lesions
-Isomorphic/Koebner’s phenomenon: Appearance of lesion at the site of minor
trauma.
It is seen in:

270) D. Plane warts

270 Rapid Review AIPGMEE 2011

Chapter 17 Anaesthesiology
273. Spinal anesthesia is given at: (AI 1997)
A. L1-L2
B. L2-L4
C. S1
D. Thoracic segment
Ref: Morgan’s Anaesthesiology 3rd. 253
Exp:
-Spinal anesthesia is usually performed at the level of the L3 or L4 vertebrae
in the adult patient, because the spinal needle is introduced below the level at
which the spinal cord ends (lower border of L1).
-In children, as spinal cord extends upto upper border of L3, spinal
anesthesia is given at L4-L5 interspace.
274. Epileptogenic anesthetic agent of the following is:
A. Desflurane
B. Halothane
C. Sevoflurane
D. Ether
Ref: Web. http://www.ncbi.nlm.nih.gov/pubmed/14581667
Sevoflurane consistently produces cortical epileptiform discharges and is dose
dependently epileptogenic at surgical levels of anesthesia.

Inhalational anesthetic agents C/I in patients with h/o epilepsy: Enflurane &
Etomidate (AIIMS 2003)

273) B. L2-L4 274) C. Sevoflurane

ANAESTHESIOLOGY 271

I.V anesthetic agent producing raised ICT: Ketamine
(AI 2000|AIIMS Nov 2007)

Inhalational anesthetic agent of choice for induction of anesthesia in
children: Sevoflurane (AIIMS May 2004)
275. Which of the following anesthetic drugs is contraindicated in a patient
with hypertension?
A. Ketamine
B. Propofol
C. Etomidate
D. Diazepam
Ref: Morgan’s Anaesthesiology 3rd. 170
Exp:
Ketamine increases all pressures (ICT/IOP/BP) & muscle tone due to
sympathetic stimulation.
KETAMINE
· Causes dissociative anesthesia & emergence psychomimetic
hallucinations. (AIIMS Nov 2006)
· Anesthetic of choice in Shock (SGPGI 2002)
· Anesthetic of choice in Status asthmaticus
· Dose: 2mg/kg i.v (AIIMS 1993)

Succinyl choline increases all pressures like Ketamine

Cerebroprotective anesthetic agents:
(PGI Dec 2004|AIIMS Nov, 2007)
· Thiopentone sodium
· Propofol

Dose of Thiopentone sodium: 5mg/kg (3-5mg/kg Think: ‘Trio-Pentone’*)
(JIPMER 1996)
(*Courtesy: www.lifehugger.com)

275) A. Ketamine
RADIODIAGNOSIS 283

Chapter 18 Radiodiagnosis

285. Dose of radiation required for development of hematological

syndrome is:
A. 2.5-5 Gy
B. 10 Gy
C. 100 Gy
D. 200 Gy
Ref: Web. http://orise.orau.gov/reacts/guide/syndrome.htm
Exp:
Dose Syndromes associated Clinical features
< 2 Gy A/c Radiation Syndrome Nausea, vomiting
No need of hospitalisation
2-8 Gy Haematopoietic Syndrome Death in 2-4wks due to
Bone marrow failure
> 10 Gy Gastrointestinal Syndrome Vomiting, Diarrhoea, Sepsis
Death within days
> 30Gy Cardiovascular Syndrome Death within 48hrs
>100Gy Cerebrovascular Syndrome Death within 24-48hrs due to neurological &
cardiovascular failure
(1 Gy = 100 cGy = 100 rad)

285) A. 2.5-5 Gy
284 Rapid Review AIPGMEE 2011
286. Aortic knuckle shadow on chest X-ray, PA view is obliterated by
consolidation of which portion of lung?
A. Upper lingula
B. Lower lingula
C. Apex of lower lobe
D. Posterior part of upper lobe
Ref: Thoracic Imaging by W.Richard Webb & Charles B. Higgins P.39 &
P.43, Fig 2-19
Exp:
On PA/AP chest radiograph, obscuration of specific contours can be
related to abnormalities in specific lobes. (*AIIMS May 2008)
· Right Superior mediastinum (SVC) = Right upper lobe
· Right heart border = Right middle lobe
(*Silhouette sign)
· Right hemidiaphragm = Right lowerlobe
· Left superior mediastinum = Left upper lobe
(aortic knuckle)
· Left heart border = Lingular segments of
left upper lobe
(Silhouette sign)
· Left hemidiaphragm/ Desc. Aorta = Left lower lobe

286) D. Posterior part of upper lobe.

PSYCHIATRY 291

Chapter 19 Psychiatry

293. A 40yr old female patient presented with depressed mood, loss of
appetite and no interest in surroundings for the past 1yr. There is associated
insomnia. These symptoms followed soon after a business loss 1yr
back.Which of the following statements is true regarding the management
of this patient?
A. No treatment is necessary as it is due to business loss
B. SSRI is the most efficacious of the available drugs
C. Antidepressant treatment is based on the side effect profile of the drugs
D. Combination therapy of 2 anti depressant drugs
Ref: Kaplan & Sadock’s 10th 559
Exp:
This lady is having depression, and needs antidepressant medication.
Selection of Initial Medication
The available antidepressants do not differ in overall efficacy, speed of
response, or long-term effectiveness.
Antidepressants, however, do differ in their pharmacology, drug-drug
interactions, short- and long-term side effects, likelihood of discontinuation
symptoms, and ease of dose adjustment.

293) C. Treatment is started based on the side effect profile

292 Rapid Review AIPGMEE 2011
Selection of the initial treatment depends on:
· Chronicity of the condition
· Course of illness
· Family history of illness
· Treatment response
· Symptom severity
· Concurrent general medical or other psychiatric conditions
· Prior treatment responses to other acute phase treatments
· Potential drug interactions
· Patient preference
Side effects of TCA:
· Anticholinergic-C/I ed in glaucoma and BPH
· Alpha blocking-causes postural hypotension
· Sedation
· Seizure
· Wt.gain
Side effects of SSRIs:
· No anticholinergic,hypotensive & sedative side effects
· Causes diarrhea, wt. loss, insomnia, anxiety & sexual dysfunction
(PGI Dec 2007)

MC side effect of SSRIs: Loose stools (AI 2006)
300 Rapid Review AIPGMEE 2011

5. Neuroleptic malignant syndrome (AIIMS May 2004|PGI Dec 2005)

Life threatening complication of antipsychotic treatment characterised by
a/c dystonia, akinesia, altered sensorium, mutism, hyperthermia, sweating,
tachycardia & hypertension.
Investigations: Leukocytosis & elevated CPK (AIIMS May 2006)
Rx: a. Stop the drug
b.Drug of choice: Dandrolene
Other dugs: Bromocriptine, Amantadine (D2 agonists),
Benzodiazepines (for sedation)
c. Cooling
d. Supportive measures

Antipsychotic drugs with least extrapyramidal side effect: Clozapine
(PGI 2002)