Professional Documents
Culture Documents
Aiims May 2010 Ebook
Aiims May 2010 Ebook
Preface
Dear Friends,
Crazy Hope u all enjoyed writing the
AIIMS May 2010 Paper! It was
Complete really an exhilarating experience
for all of us. This paper can
Compendium undoubtedly be termed as the
“craziest” of the AIIMS Paper till
of now…so many repeats were there
that we had to literally hunt for
AIIMS May the new questions! But then
again, those Profs at AIIMS know
2010 very well how to fool the students.
Some questions had their
“EXCEPT” omitted, and whether
they did it intentionally or it was
the printer’s devil…we can at best
speculate. Some questions though
looked easy, had some twists in
them. And last but not the least, to
add to the confusion, some repeat
questions were there whose
answers as given in the Great
Grandfathers’ books (AA & MK)
are still controversial. To sum up,
it was really a crazy paper which
only AIIMS can set!
ANATOMY
2
Online support at: www.saraswatastar.weebly.com
Crazy Complete Compendium of AIIMS May 2010
© Dr Saraswata Das. All Rights Reserved.
PHYSIOLOGY
BIOCHEMISTRY
16. Appetite is stimulated by A/E
a) Agouti related peptide 24. Splicing activity seen in
b) Melanocyte concentrating a) mRNA
hormone b) snRNA
c) Melanocyte stimulating c) tRNA
hormone d) rRNA
d) Neuropeptide Y
25. After digestion by restriction
17. Capacitation occurs in endonucleases DNA strands can be
a) Uterus joined again by
b) Seminal vesicle a) DNA polymerase
c) Epididymis b) DNA ligase
d) Vas deferens c) DNA topoisomerase
d) DNA gyrase
18. The main cause of increased blood flow
to exercising muscles 26. Acetyl coA can be directly converted to
a) Raised blood pressure all except
b) Vasodilatation due to local a) Glucose
metabolites b) Fatty acids
c) Increased sympathetic c) Cholesterol
discharge to peripheral vessels d) Ketone bodies
d) Increased heart rate
27. After overnite fasing,levels of glucose
19. Intrinsic factor of Castle is secreted by tranporters reduced in
a) Chief cells a) Brain
b) Parietal cells b) Muscle
c) Mucus cells c) Adipocytes
d) B cells d) Hepatocyte
3
Online support at: www.saraswatastar.weebly.com
Crazy Complete Compendium of AIIMS May 2010
© Dr Saraswata Das. All Rights Reserved.
4
Online support at: www.saraswatastar.weebly.com
Crazy Complete Compendium of AIIMS May 2010
© Dr Saraswata Das. All Rights Reserved.
51. STEPS done for 59. All of the following statements about
a) Surveillance of risk factors of purification of water are true except
non-communicable disease a) Presence of Clostridial spores
b) Surveillance of incidence of indicates recent contamination
non-communicable disease of water
c) Surveillance of evaluation of b) Coliforms must not be
treatment of non- detectable in any 100 ml
communicable disease sample of drinking water
d) Surveillance of mortality from c) Sodium thiosulphate is used to
non-communicable disease neutralize certain contaminants
5
Online support at: www.saraswatastar.weebly.com
Crazy Complete Compendium of AIIMS May 2010
© Dr Saraswata Das. All Rights Reserved.
64. Which is NOT an alkylating agent? 73. Drug of choice for Zollinger-Ellison
a) 5-FU syndrome
b) Chlorambucil a) Antihistaminics
c) Melphalan b) Proton pump inhibitors
d) Cyclophosphamide c) Dopamine agonists
d) Antacids
65. Which one of the following drugs cause
hypomagnesemia by increased 74. Pharmacovigilance is done for
excretion? monitoring
a) Frusemide therapy a) Drug price
b) Cisplatin b) Unethical practices
c) Digitalis c) Drug safety
d) Aminoglycosides d) Pharmacology students
66. Which is NOT used in treatment of 75. All of the following drug is CYP3A
heroin dependence? inhibitor except
a) Disulfiram a) Erythromycin
b) Buprenorphine b) Itraconazole
c) Clonidine c) Ritonavir
d) Lofexidine d) Saquinavir
6
Online support at: www.saraswatastar.weebly.com
Crazy Complete Compendium of AIIMS May 2010
© Dr Saraswata Das. All Rights Reserved.
7
Online support at: www.saraswatastar.weebly.com
Crazy Complete Compendium of AIIMS May 2010
© Dr Saraswata Das. All Rights Reserved.
99. Psammoma bodies seen in A/E 107. Hyperextensibility with normal elastic
a) Follicular CA of thyroid recoil is a feature of
8
Online support at: www.saraswatastar.weebly.com
Crazy Complete Compendium of AIIMS May 2010
© Dr Saraswata Das. All Rights Reserved.
108. Which of the following about 115. Rapid infusion of insulin causes
atherosclerosis is true? a) Hyperkalemia
a) Intake of PUFA associated with b) Hypokalemia
decreased risk c) Hypernatremia
b) Thoracic aorta involvement is d) Hyponatremia
more severe than abdominal
aorta involvement 116. Digitalis toxicity enhanced by A/E
c) Extent of lesion in veins is a) Renal failure
same as that in arteries b) Hyperkalemia
d) Hypercholesterolemia does not c) Hypercalcemia
always increase the risk of d) Hypomagnesemia
atherosclerosis per se
117. True about hemochromatosis
109. Not a cardiovascular complication of a) Is genetically heterogenous
HIV/AIDS b) Cannot be treated by
a) Cardiac tamponade phlebotomy
b) Recurrent arterial embolism c) Completely penetrant
c) CHF d) More common in female than
d) Aortic aneurysm male
9
Online support at: www.saraswatastar.weebly.com
Crazy Complete Compendium of AIIMS May 2010
© Dr Saraswata Das. All Rights Reserved.
10
Online support at: www.saraswatastar.weebly.com
Crazy Complete Compendium of AIIMS May 2010
© Dr Saraswata Das. All Rights Reserved.
11
Online support at: www.saraswatastar.weebly.com
Crazy Complete Compendium of AIIMS May 2010
© Dr Saraswata Das. All Rights Reserved.
151. A 68 yr old man came with pain and 158. Pain of ovarian carcinoma is referred to
swelling of right knee. Ahlbeck grade 2 a) Back of thigh
osteoarthritic changes were found on b) Gluteal region
investigation. What is the further c) Anterior surface of thigh
management? d) Medial surface of thigh
a) Conservative
b) Arthroscopic washout 159. A woman with primary infertility with CA-
c) High tibial osteotomy 125 level 90 iu. She has bilateral
d) Total knee replacement palpable mass. USG shows mass in
pelvis. Diagnosis may be
152. Which of the following is a pulsatile a) Ovarian CA
tumor? b) TB
a) Osteosarcoma c) Endometrioma
b) Chondrosarcoma d) Borderline ovarian tumor
c) Osteoclastoma
d) Ewing’s sarcoma 160. Causes of primary amenorrhea are A/E
a) Rokitansky syndrome
153. Posterior glenohumeral instability is b) Sheehan syndrome
tested by c) Kallman syndrome
a) Jerk test d) Turner syndrome
b) Crank test
c) Sulcus test 161. Test for ovarian reserve
d) Fulcrum test a) LH
b) LH/FSH ratio
154. Mineral of the bone is c) FSH
a) Calcite d) Estradiol
b) Hydroxyapatite
c) Calcium oxide 162. Clomiphene citrate – True statement is
d) Calcium carbonate a) Euclomiphene is anti-
estrogenic
155. 65 yrs old man with H/o of back pain b) Pregnancy rate is 3 times as
since 3 months. ESR is raised. Marked compared to placebo
stiffness on examination. Mild restriction c) Incidence of twins is 5-6%
of chest movements. On X-ray, d) It has been shown to increase
syndesmophytes are present. Diagnosis fertility in oligospermic males
is
a) Ankylosing spondylitis 163. At what gestational age should a
b) Degenerative osteoarthritis of pregnancy with cholestasis of
spine pregnancy be terminated?
c) Ankylosing hyperostosis a) 34 weeks
d) Lumbar canal stenosis b) 36 weeks
c) 38 weeks
156. A lady presents with right knee swelling. d) 40 weeks
Aspiration was done in which CPPD
crystals were obtained. Next best 164. A lady with placenta previa delivered a
investigation is baby. She had excessive bleeding. After
a) ANA resuscitation most likely complication is
b) RF a) Galactorrhoea
c) CPK b) Diabetes insipidus
d) TSH c) Loss of menstruation
d) Cushing’s syndrome
157. Synovial fluid – True statements are
A/E
a) Secreted by Type A cells
12
Online support at: www.saraswatastar.weebly.com
Crazy Complete Compendium of AIIMS May 2010
© Dr Saraswata Das. All Rights Reserved.
172. The presence of increased levels of 179. Which of the following ocular conditions
which of the following in amniotic fluid is is autosomal dominant in inheritance?
an indicator of open neural tube defect a) Best disease
in the fetus? b) Gyrate atrophy
a) Phosphatidylesterase c) Lawrence-Moon-Biedel
b) Acetylcholinesterase syndrome
c) Pseudocholinesterase d) Bassen Kornzweig disease
13
Online support at: www.saraswatastar.weebly.com
Crazy Complete Compendium of AIIMS May 2010
© Dr Saraswata Das. All Rights Reserved.
14
Online support at: www.saraswatastar.weebly.com
Crazy Complete Compendium of AIIMS May 2010
© Dr Saraswata Das. All Rights Reserved.
d) Microcalcification
PSYCHIATRY
15
Online support at: www.saraswatastar.weebly.com
Crazy Complete Compendium of AIIMS May 2010
© Dr Saraswata Das. All Rights Reserved.
Please Note: For the controversial questions, Maxillary nerve traverses the infraorbital
the BEST POSSIBLE answer has been groove and canal in the floor of the orbit,
provided after going through standard and appears upon the face at the
references. However, these are not absolute & infraorbital foramen. Here is it referred
are open for discussion. Repeat questions to as the infraorbital nerve, a terminal
have NOT been explained for obvious branch. At its termination, the nerve lies
reasons. beneath the quadratus labii superioris,
and divides into a leash of branches
ANATOMY which spread out upon the side of the
nose, the lower eyelid, and the upper lip,
1. C (Anterior nasal division of maxillary joining with filaments of the facial nerve.
nerve)
16
Online support at: www.saraswatastar.weebly.com
Crazy Complete Compendium of AIIMS May 2010
© Dr Saraswata Das. All Rights Reserved.
4. A (Repeat from AIIMS Nov 09, AI 2010) The anterior ethmoidal nerve travels with
the anterior ethmoidal artery and leaves
5. B the orbit through a canal between the
ethmoidal labyrinth and the frontal bone. It
6. C (Repeat from AI 2010) passes through and supplies the adjacent
ethmoidal cells and frontal sinus, and then
7. A (Anterolateral & around the aorta) enters the cranial cavity immediately
lateral and superior to the cribriform plate.
Celiac plexus is the large accumulation
of nerve fibers & ganglia associated with The anterior ethmoidal nerve travels
the roots of the celiac trunk & superior forward in a groove on the cribriform plate
mesenteric artery immediately below the and then enters the nasal cavity by
aortic hiatus of the diaphragm. descending through a slit-like foramen
immediately lateral to the crista galli. It has
branches to the medial and lateral wall of
the nasal cavity and then continues
forward on the undersurface of the nasal
bone. It passes onto the external surface
of the nose by traveling between the nasal
bone and lateral nasal cartilage, and then
terminates as the external nasal nerve,
which supplies skin around the naris, in
the nasal vestibule, and on the tip of the
nose.
17
Online support at: www.saraswatastar.weebly.com
Crazy Complete Compendium of AIIMS May 2010
© Dr Saraswata Das. All Rights Reserved.
18
Online support at: www.saraswatastar.weebly.com
Crazy Complete Compendium of AIIMS May 2010
© Dr Saraswata Das. All Rights Reserved.
intervertebral disc spaces. Please go through it early symptom. Older untreated children become
once, it will help to clear your concepts. hyperactive, with purposeless movements,
rhythmic rocking, and athetosis.
Ref: http://medind.nic.in/iaf/t07/i2/iaft07i2p158.pdf
On physical examination, these infants are
lighter in their complexion than unaffected
siblings. Some may have a seborrheic or
eczematoid rash, which is usually mild and
disappears as the child grows older. These
children have an unpleasant odor of
phenylacetic acid, which has been described as
musty or mousey. There are no consistent
findings on neurologic examination. Most infants
are hypertonic with hyperactive deep tendon
reflexes. About 25% of children have seizures,
and more than 50% have
electroencephalographic abnormalities.
Microcephaly, prominent maxilla with widely
spaced teeth, enamel hypoplasia, and growth
retardation are other common findings in
untreated children. The clinical manifestations of
classic PKU are rarely seen in those countries in
which neonatal screening programs for the
detection of PKU are in effect.
19
Online support at: www.saraswatastar.weebly.com
Crazy Complete Compendium of AIIMS May 2010
© Dr Saraswata Das. All Rights Reserved.
55. C
FORENSIC 56. B
33. A 57. B
20
Online support at: www.saraswatastar.weebly.com
Crazy Complete Compendium of AIIMS May 2010
© Dr Saraswata Das. All Rights Reserved.
21
Online support at: www.saraswatastar.weebly.com
Crazy Complete Compendium of AIIMS May 2010
© Dr Saraswata Das. All Rights Reserved.
http://pt.wkhealth.com/pt/re/eira/abstract.00002018-
Some of the most commonly used drugs 200124030-
prescribed to treat pulmonary hypertension
00005.htm;jsessionid=Lp8fT2gx2MfqnlMyLJkSHKphygq
include:
epoprostenol (Flolan), 3HGGvG4qP1x8zlP3vS7MNDTtL!1947086508!1811956
bosentan (Tracleer), 29!8091!-1?nav=reference
intravenous treprostinil (Remodulin), MICRO
inhaled iloprost (Ventavis),
sildenafil (Viagra, Revatio), 76. C
calcium channel blockers (such as VDRL, RPR & Kahn test are screening
nifedipine), tests. Kahn test is rarely used today.
sitaxsentan (Thelin) - not FDA approved
in the U.S., and Fluorescent Treponemal Antibody
ambrisentan (Letairis). Absorption Test is the most specific test
for syphilis. If this is positive it confirms the
Ref:http://www.medicinenet.com/pulmonar diagnosis
y_hypertension/page5.htm Ref:
http://en.wikipedia.org/wiki/Rapid_plasma_
70. A reagin
71. A 77. B
22
Online support at: www.saraswatastar.weebly.com
Crazy Complete Compendium of AIIMS May 2010
© Dr Saraswata Das. All Rights Reserved.
structures that can be differentiated from The agent recommended for chemical
those of cryptosporidia on the basis of disinfection of fibreoptic bronchoscopes is
size, shape, and number of sporocysts. 2% glutaraldehyde solution; the instrument
The clinical syndromes of Isospora should be immersed in it for 10 to 30
infection are identical to those caused by minutes.
cryptosporidia. The important distinction is Ref: Disinfecting endoscopes: how not to transmit
that infection with Isospora is generally Mycobacterium tuberculosis by bronchoscopy.
relatively easy to treat with TMP/SMX. Can Med Assoc J. 1980 August 23; 123(4): 275–
While relapses are common, a thrice- 280.
weekly regimen of TMP/SMX appears
adequate to prevent recurrence. The sterilization area is equipped with a
glutaraldehyde disinfectant container. –
th
Ref: Harrison 17 / 1175 Flexible Bronchoscopy By Ko Pen Wang,
Atul C. Mehta, J. Francis Turner
81. C
84. D
I am quoting the exact lines from Nelson
for each of the 4 options & the answer will 85. D
be clear to you.
Options A & B are true (see Harrison).
Confusion lies betn options C & D.
Option D - The avidity test can be helpful
to time infection. A high-avidity test result About option C
indicates that infection began >16 wk Although CSF cultures are positive in less
earlier, which is especially useful in than 10% of patients with apparent
determining time of acquisition of infection meningitis, intrathecal antibodies and a
in the 1st or final 16 wk of gestation. A lymphocytic pleocytosis (approximately
low-avidity test result may be present for 100 cells/µL) are present in more than
many months and is not diagnostic of 80%. Patients with meningitis typically
recent acquisition of infection. have elevated protein concentrations (>50
mg/dL) but normal glucose levels (45-80
Option A - The IgM-IFA test is useful for mg/dL). Oligoclonal bands specific for B
the diagnosis of acute infection with T. burgdorferi may be present.
gondii in the older child because IgM
antibodies appear earlier, often by 5 days So option D is our answer.
after infection, and diminish more quickly
than IgG antibodies 86. D
23
Online support at: www.saraswatastar.weebly.com
Crazy Complete Compendium of AIIMS May 2010
© Dr Saraswata Das. All Rights Reserved.
90. C
94. B
The amount of precipitate formed is greatly
Option A - With increasing age, tendons, skin,
influenced by the relative proportions of
and even blood vessels lose elasticity. This is
antigens & antibodies. If increasing quantities
due to the formation of cross-links between or
of antigens are added to the same amount of
within the molecules of collagen (a fibrous
antiserum in different tubes, precipitation will
protein) that give elasticity to these tissues.
be found to occur most rapidly & abundantly in
The “cross-linking” theory of aging assumes
one of the middle tubes in which the antigen &
that with increasing age, the number of cross-
antibody are present in optimal or equivalent
linkages within and between collagen
proprtions. In the preceeding tubes in which
molecules increases, leading to crystallinity
the antibody is in excess, and in the later tubes
and rigidity. – Encyclopedia Britannica
in which the antigen is in excess, the
precipitation will be weak or even absent.
Option B - According to the Free-radical theory,
oxidative damage initiated by reactive oxygen
Ref: Textbook of Microbiology –
th species is a major contributor to the functional
Ananthanarayan, Paniker 6 / 89
decline that is characteristic of aging. While
studies in invertebrate models indicate that
PATHO animals genetically engineered to lack specific
antioxidant enzymes (such as SOD) generally
91. D show a shortened lifespan.
http://en.wikipedia.org/wiki/Reactive_oxygen_s
Gangrenous necrosis is not a specific pattern of pecies#Cause_of_aging
cell death, but the term is commonly used in
clinical practice. It is usually applied to a limb, Option D – From the above para, it isclear that
generally the lower leg, that has lost its blood decreased SOD levels cause aging (not
supply & has undergone necrosis (typically increased SOD levels?. So option D is wrong.
th
coagulative necrosis). – Robbins 8 /15
Option C – Somatic mutation theory of aging -
92. C This theory states that an important part of
aging is determined by what happens to our
93. B genes after we inherit them. From the time of
conception, our body's cells are continually
reproducing. Each time a cell divides, there is a
An unruptured saccular aneurysm is a thin- chance that some of the genes will be copied
walled outpouching at an arterial branch incorrectly, this is called a mutation.
point along the circle of Willis or a major vessel Additionally, exposures to toxins, radiation or
just beyond. Saccular aneurysms measure a few ultraviolet light can causes mutations in your
millimeters to 2 or 3 cm in diameter and have a body's genes. The body can correct or destroy
bright red, shiny surface and a thin, translucent most of the mutations, but not all of them.
wall. Demonstration of the site of rupture requires Eventually the mutated cells accumulate, copy
careful dissection and removal of blood in the themselves and cause problems in the body's
unfixed brain. Atheromatous plaques, functioning related to aging.
calcification, or thromobotic occlusion of the sac
may be found in the wall or lumen of the My opinion is that the Free Radical Theory is
aneurysm. Brownish discoloration of the adjacent more appropriate as damage due to free
brain and meninges is evidence of prior radicals may produce somatic mutations also.
hemorrhage. The neck of the aneurysm may be So I will go with option B.
either wide or narrow. Rupture usually occurs at
the apex of the sac with extravasation of blood
24
Online support at: www.saraswatastar.weebly.com
Crazy Complete Compendium of AIIMS May 2010
© Dr Saraswata Das. All Rights Reserved.
The major theories of aging as a consequence of “Most pts with Wilm’s tumor present clinically
random events are: with a palpable abdominal mass. Often, the pt
has no symptoms & the parents discover the
Cross-linking mass during bathing or the pediatrician finds it
Wear and Tear during a routine physical examination.
Free Radical Hypertension is present in about 25% of
Rate of Living patients and hematuria in 15%.” – Sabiston
th
Somatic Mutations 17 / 2127
25
Online support at: www.saraswatastar.weebly.com
Crazy Complete Compendium of AIIMS May 2010
© Dr Saraswata Das. All Rights Reserved.
26
Online support at: www.saraswatastar.weebly.com
Crazy Complete Compendium of AIIMS May 2010
© Dr Saraswata Das. All Rights Reserved.
The skin of the face, normally around the Auscultatory findings in Eisenmenger
mouth, and the mucosa of the mouth and/or syndrome
throat, as well as the tongue, swell up over the S2
period of minutes to several hours. The ASD – Widely split & fixed
swelling can also occur elsewhere, typically in VSD – Single
the hands. The swelling can be itchy or painful. PDA – Normally split
There may also be slightly decreased P2 Accentuated
sensation in the affected areas due to
compression of the nerves. Urticaria (hives) Pulmonary Regurgitation murmur (Graham
may develop simultaneously. Steell murmur) may be heard.
th
Ref: Ghai 6 / 416 (Box: Fig.15.20); Nelson
In severe cases, stridor of the airway occurs, th
18 /1936
with gasping or wheezy inspiratory breath
sounds and decreasing oxygen levels.
124. B
Intubation is required in these situations to
prevent respiratory arrest and risk of death
125. B
27
Online support at: www.saraswatastar.weebly.com
Crazy Complete Compendium of AIIMS May 2010
© Dr Saraswata Das. All Rights Reserved.
T4 Tumor >3 cm in diameter with and has a tendency to metastasize via CSF
extension up past the aqueduct of pathways.
Sylvius and/or down past the foramen
magnum Medulloblastomas are notorious for spreading
from the cerebellum down to the spine, or
In addition to "T" staging, medulloblastoma "metastasizing". They typically invade the
staging has been modified by including "M" surrounding lining tissues (meninges) before
staging, where the "M" stands for metastasis. gaining access to the cerebrospinal fluid (CSF)
Remember, this is a word that describes how which bathes both the brain and the spine.
far the tumor cells have spread from the Once there, tumor cells can travel through the
original location, if at all. The M stage is CSF and deposit themselves, or "seed", in any
determined not only by the surgeon's part of the spine, resulting in "metastatic
observations, but also in combination with MRI disease". Rarely, these tumor cells can gain
scans and lumbar cytology, and consists of 5 access outside of the CNS and metastasize to
possible groups: distant bone or bone marrow.
Ref:
http://es.oncolink.org/types/article.cfm?c=22&s
M0 No evidence of metastasis =78&ss=783&id=9484&p=2
M1 Tumor cells found in cerebrospinal
fluid (by lumbar puncture and cytology 127. A
study)
M2 Tumor beyond primary site but still 128. A
in brain
M3 Tumor deposits ("seeds") in spine 129. B
area that are easily seen on MRI
M4 Tumor spread to areas outside the 130. C
CNS (outside both brain and spine)
131. B
Each patient is assigned a combination of one
T stage and one M stage. As mentioned in the 132. B
introduction, one of the reasons staging is
important is that it helps predict how a patient 133. A
might do in the long run, or how "curable" their
cancer is, in a way. For medulloblastomas, the Compensated versus decompensated
M stage is considered far more important in shock
determining ultimate patient outcome and
survival than the T stage. In other words,
regardless of what the T stage may be, To begin to categorize and prioritize the
children who are in the M0 group do far better management of a child in shock, first determine
than those in M1, who tend to fare better than the central blood pressure. Blood pressure
M2 kids, who in turn do better than M3 or M4 measurements determine the central driving
children. Ref: pressure responsible for perfusing the most
http://es.oncolink.org/types/article.cfm?c=22&s critical organs, namely the brain and the heart.
=78&ss=783&id=9484&p=2
Minimum blood pressure requirements can be
determined by establishing the fifth percentile
for normal systolic blood pressure in a healthy,
126. B
well-perfused child. The American Heart
“Although Glioblastoma multiforme is the tumor Association, in the course on pediatric
most prone to extraneural metastasis in the advanced life support (PALS), defines infants
adult population, medulloblastoma with fifth–percentile systolic blood pressure as
metastasizes more commonly in children.” – follows:
• Newborn - 60 mm Hg
Tumors of the pediatric central nervous system
By Robert F. Keating, James T. Goodrich, • Infant (1 mo to 1 y) - 70 mm Hg
Roger J. Packer, P.369 • Child (>1 y) - 70 + 2 X age (in y)
Also know:
Thus, children with poor perfusion and blood
Medulloblastoma (WHO grade IV) is a
pressure below the parameters listed above
malignant, invasive embryonal tumor of the
cerebellum that occurs primarily in children, may be said to have decompensated shock.
has a predominantly neuronal differentiation, Such children, if not quickly and
28
Online support at: www.saraswatastar.weebly.com
Crazy Complete Compendium of AIIMS May 2010
© Dr Saraswata Das. All Rights Reserved.
148. D
SURGERY 149. A
150. A
134.C
ORTHO
135. B
151. D
136. A
In 1980, the so-called Ahlbäck classification
137. D was described as follows (Ahlbäck and
Rydberg 1980).
The distribution of polyps in patients is reported
as follows: stomach, 25%; colon, 30%; and Grade 1: narrowing of the articular space;
small bowel, 100%. While these Grade 2: obliteration or almost obliteration of
hamartomatous polyps themselves do not have the articular space;
malignant potential, patients with the syndrome Grade 3: bone attrition less than 5 mm;
have an increased risk of developing Grade 4: bone attrition between 5 and 15 mm,
carcinomas of the pancreas, breast, lung, Grade 5: bone attrition greater than 15 mm.
29
Online support at: www.saraswatastar.weebly.com
Crazy Complete Compendium of AIIMS May 2010
© Dr Saraswata Das. All Rights Reserved.
153. A
154. B
155. C
30
Online support at: www.saraswatastar.weebly.com
Crazy Complete Compendium of AIIMS May 2010
© Dr Saraswata Das. All Rights Reserved.
31
Online support at: www.saraswatastar.weebly.com
Crazy Complete Compendium of AIIMS May 2010
© Dr Saraswata Das. All Rights Reserved.
169. C
Acute shock
Hazards of Gestational Diabetes Mellitus
Lactation failure
Increased perinatal loss is associated with
Asthenia
fasting hyperglycemia. Fetal anomalies are
Hypoglycemic crisis however not increased. This is due to the
absence of metabolic disturbances during
Absence of menstruation organogenesis. (GDM usually presents late in
nd rd
2 or during the 3 trimester).
Menstrual irregularity
Macrosomia
Pallor Polyhydramnios
Birth trauma
Loss of pubic hair Recurrence of GDM in subsequent pregnancy
is about 50%.
32
Online support at: www.saraswatastar.weebly.com
Crazy Complete Compendium of AIIMS May 2010
© Dr Saraswata Das. All Rights Reserved.
181. B
Potential candidates for GDM are those
having a previous birth of an oversized 182. B
baby of 4 kg or more.
The endolymph is produced from perilymph as
th
Ref: Dutta Obstetrics 6 / 284-285 a result of selective ion transport through the
epithelial cells of Reissner’s membrane and not
directly from the blood. The secretory tissue
170. C Mtx can’t be used during pregnancy. called the stria vascularis, in the lateral wall of
the cochlear duct, is thought to play an
171. D important role in maintaining the high ratio of
potassium ions to sodium ions in the
172. B endolymph.
173. A Ref:
http://www.britannica.com/EBchecked/topic/56
9006/stria-vascularis
OPHTHAL
“It has generally been accepted that
174. A endolymph of the cochlea is produced by stria
vascularis.” – Dr. T. Balasubramanian MS,
175. D DLO
http://www.drtbalu.co.in/endolymph.html
176. B
177. B
178. B
179. A
ENT
180. B
Ref:
http://emedicine.medscape.com/article/861126-
overview
183. A (Repeat from All India 2010)
33
Online support at: www.saraswatastar.weebly.com
Crazy Complete Compendium of AIIMS May 2010
© Dr Saraswata Das. All Rights Reserved.
Erythema Nodosum
History
The eruptive phase of erythema nodosum begins
with flulike symptoms of fever and generalized
aching. Arthralgia may occur and precedes the
eruption or appears during the eruptive phase. Classic presentation of erythema
Most lesions in infection-induced erythema nodosum with nodular red swellings
nodosum heal within 7 weeks, but active disease over the shins
may last up to 18 weeks. In contrast, 30% of
idiopathic erythema nodosum cases may last Ref:http://emedicine.medscape.com/article/10816
more than 6 months. Febrile illness with 33-overview
dermatologic findings includes abrupt onset of
illness with initial fever, followed by a painful rash Weber Christian Disease
within 1-2 days.
Weber-Christian disease is a skin condition that
Primary skin lesions - Lesions begin as red features recurring inflammation in the fat layer of
tender nodules (see the image below). Lesion the skin. The involved areas of skin manifest as
borders are poorly defined, and lesions vary from recurrent crops of erythematous, sometimes
2-6 cm. During the first week, lesions become tender, edematous subcutaneous nodules. The
tense, hard, and painful; during the second week, lesions are symmetric in distribution, and the
they may become fluctuant, as in an abscess, but thighs and lower legs are affected most
do not suppurate or ulcerate. Individual lesions frequently. Malaise, fever, and arthralgias
last approximately 2 weeks, but occasionally, frequently occur. Nausea, vomiting, abdominal
34
Online support at: www.saraswatastar.weebly.com
Crazy Complete Compendium of AIIMS May 2010
© Dr Saraswata Das. All Rights Reserved.
th
pain, weight loss, and hepatomegaly may also Robbins 7 /1265 says:
occur. Because its etiology is unknown, Weber- “Panniculitis often involves the lower legs.
Christian disease is often referred to as idiopathic Erythema nodosum presents as poorly defined,
lobular panniculitis. exquisitely tender, erythematous plaques and
nodules that may be better felt than seen. Fever
Age - Weber-Christian disease may occur in and malaise may accompany the cutaneous
young children but has been reported most signs. Over the course of weeks, lesions usually
frequently in people in the fourth to seventh flatten and become bruise-like, leaving no
decades of life. residual clinical scars, while new lesions develop.
Biopsy of a deep wedge of tissue is usually
History required to establish a definitive diagnosis.
Patients with Weber-Christian disease typically
have cutaneous and, less frequently, systemic Erythema nodosum and erythema induratum are
symptoms. but two examples among the many types of
• Patients affected with Weber-Christian panniculitis. Weber-Christian disease (relapsing
disease describe crops of lesions that febrile nodular panniculitis) is a rare form of
appear and resolve during a period of lobular, nonvasculitic panniculitis seen in children
weeks to months. The lesions are often and adults. It is marked by crops of erythematous
symmetric in distribution, and the thighs plaques or nodules, predominantly on the lower
and legs are involved most commonly. extremities, created by deep-seated foci of
Individual nodules regress during the inflammation with aggregates of foamy
course of a few weeks. histiocytes admixed with lymphocytes,
• Systemic symptoms of Weber-Christian neutrophils, and giant cells.”
disease include malaise, fever, nausea,
vomiting, abdominal pain, weight loss, ANESTHESIA
bone pain, myalgia, and arthralgia.
187. B
• The etiology of Weber-Christian disease
is unknown, and patients do not report a
history of thermal, mechanical, or Halothane impairs liver blood flow and
chemical trauma. oxygenation the most, perhaps explaining
increased incidence with its use.
Physical
Physical examination reveals erythematous, Enflurane was shown to reduce hepatic
edematous, and tender subcutaneous nodules. blood flow less than halothane.
• The nodules are usually symmetric and
measure approximately 1-2 cm;
Ref: Hepatotoxicity of inhalational agents –
however, the nodules may be much
Dept of Anesthesia, University of Sydney
larger. The lesions commonly occur on http://www.anaes.med.usyd.edu.au/lecture
the thighs and lower legs but may also s/hepatotox_clt/hepatotoxicity.html
involve the arms, trunk, and face.
• The individual nodules resolve during a
couple of weeks, leaving an atrophic Ajay Yadav has mentioned in his book that
depressed scar. Enflurane depresses hepatic functions due
to decreased hepatic blood flow (Ajay
• Occasionally, the epidermis overlying nd
Yadav 2 /63). However he has never said
the nodules breaks down, and the lesion
that Enflurane causes maximum reduction
discharges a brown liquid oil (ie,
in hepatic blood flow. So answer hee is
liquefying panniculitis).
Halothane.
• In individuals with Weber-Christian
disease with visceral involvement,
hepatomegaly or splenomegaly may be Also see the following reference:
present.
Ref:http://emedicine.medscape.com/article/10084 Enflurane (Ethrane), Isoflurane
11-overview (Forane), and Desflurane (Suprane)
Mild postoperative hepatic dysfunction--
due to altered hepatic blood flow.
These anesthetics can promote formation
of acetylator liver proteins which may
cause hepatotoxicity (type II) similar to that
caused by halothane (Fluothane);
frequency < halothane (Fluothane).
Weber Christian disease
35
Online support at: www.saraswatastar.weebly.com
Crazy Complete Compendium of AIIMS May 2010
© Dr Saraswata Das. All Rights Reserved.
RADIO
190. B
191. B
192. A
193. A
194. A
195. C
36
Online support at: www.saraswatastar.weebly.com
Crazy Complete Compendium of AIIMS May 2010
© Dr Saraswata Das. All Rights Reserved.
Addendum
122. A patient presents with acute rheumatic References which indicate valve replacement is
carditis with fever. True statement is: done (of course after medical therapy has failed
a) Increased Troponin T in acute rheumatic carditis r as follows:
b) Reduced myocardial contractility
c) Signs of inflammation & necrosis
d) Valve replacement will ameliorate Heart Failure May Require Specific Treatment
CCF
Heart failure in rheumatic fever generally
Explanation: responds to bed rest and corticosteroids;
diuretics and then digoxin may be necessary in
This question has been framed on a single para [1]
in Braunwald. Read it below & you can easily rule patients with more severe disease. Digoxin
out options a,b & c. should be used with caution because of its
lowered therapeutic index in active myocarditis
and the possibility of exacerbation of heart block.
"The severity of left ventricular dysfunction, even
Surgical therapy, e.g. valve replacement, is
in the acute setting, appears to correlate with the
extent of valvulitis rather than with any occasionally required.
myocardial injury. Rheumatic myocarditis, in the
setting of preserved LV function, is not http://www.medscape.com/viewarticle/406404_5
associated with the troponin level elevation seen
[11]
in viral myocarditides. Both echocardiographic
data and postmortem pathology findings are Surgical Care
consistent with severe heart failure in acute RF,
being secondary to altered myocardial mechanics When heart failure persists or worsens after
caused by MR rather than secondary to aggressive medical therapy for acute rheumatic
myocarditis. Traditionally, the diagnosis has been heart disease, surgery to decrease valve
made on the basis of auscultation of mitral or,
less commonly, aortic insufficiency in the setting insufficiency may be life-saving.
of heart failure, with cardiomegaly in the most
severe cases. Severe MR is most commonly http://emedicine.medscape.com/article/891897-
associated with the worst prognosis—acute and treatment
sometimes refractory and fatal heart failure. This
subgroup is most likely to develop significant What is the prognosis (predicted outcome
chronic RHD, with an incidence as high as 90 and course) of the disease?
percent. There is a linear relationship between
the severity of MR during the first episode of RF
and subsequent RHD." - Braunwald's Heart
th
Disease 8 /Chapter 83 Flares tend to be unpredictable as far as how
long they will last and their severity. Having
carditis in the first attack is potentially a higher
risk for heart damage, however, complete healing
may follows carditis in some cases. The most
"Unless valvular regurgitation and severe severe heart damage may require heart surgery
congestive heart failure are refractory to drug for valve replacement.
therapy, valve surgery is avoided for acute RF
patients. Surgical morbidity and mortality have http://www.printo.it/pediatric-
been significant and failed repair leading to valve rheumatology/information/Australia/9.htm
replacement frequent, although postoperative
ventricular function generally improves
significantly, consistent with regurgitation rather There are also many case reports available
than myocardial dysfunction being the primary which show promising results with valve
mechanism leading to heart failure.” - replacement.
th
Braunwald's Heart Disease 8 /Chapter 83
37
Online support at: www.saraswatastar.weebly.com