MAY 2016 (MULTIPLE CHOICE QUESTIONS)
Anatomy 8. Organ which have no lymphatic supply:
1. True about inferior oblique muscle:
a. Supplied by inferior division of 3rd CN
b. Primary eye action—Extorsion, abduction & depression
c. The muscle pass below inferior rectus
d. Origin from lacrimal bone
e. Nerve enters the muscle from ocular surface
2. True about Submandibular gland duct obstruction by stone:
a. Presents as a mass below body of mandible
b. Stone in Wharton duct can be palpated below mucous
membrane of floor of mouth
c. Starts pain just after starting a meal
d. Pain carried by glossopharyngeal nerve
3. True about palatine tonsil:
a. Crypts is lined by squamous epithelium
b. Supplied by IX CN
c. Tongue depressor is used for examination
d. Arterial supply is by tonsillar ascending branch of grater
palatine artery
e. Present in oropharynx
4. True about articular cartilage:
a. In zone1 chondrocytes are smaller
ig
b. Zone 2 contains articular cartilage progenitor cells
c. Zone 3 contains calcified cartilage
nd
d. Zone 4 contain calcified cartilage
e. Chondrocytes are active cell
5. True about innervation of parotid gland:
ha
a. Postganglionic parasympathetic fibre—secretomotor
b. Preganglionic parasympathetic fibre relay in Otic ganglion
IC
c. Preganglionic parasympathetic nerve begin in inferior
petrosal nucleus
d. Sympathetic nerve are vasomotor
e. Postganglionic parasympathetic fibres pass through the
PG
glossopharyngeal nerve
6. Which of the following muscle is supplied by median nerve :
a. Oppenens pollocis
b. Adductor pollicis
c. Lateral half of the Flexor digitorum profundus
d. Superficial head of flexor pollicis brevis
e. Deep part of flexor pollicis brevis
7. True about abduction at shoulder joint:
a. Supraspinatus initiates abduction
b. Serratus anterior & trapezius also help in abduction
c. Multipinnate deltoid clavicular fiber is main abductor
d. Axillary nerve injury has no effect on abduction
e. Musculotendinous cuff stabilizes shoulder joint
Answer Key
1. a, c. 2. a, b, c, d. 3. a, b, c, e. 4. a, d, e. 5. a, b, d. 6. a, c, d. 7. a, b, e.
a, b, e.
8. 9. b, c, d, e. 10. c, d, e. 11. a, c, e. 12. a. 13. a. 14. a, b, c.
a. Eyeball b. Brain
c. Liver d. Kidney
e. Spinal cord
9. Which of the following statement(s) is/are true about
sphincters of body:
a. Lower 5 cm of esophageal act as esophageal sphincter &
it is not morphologically different from other portion of
oesophagus
b. Esophageal & pyloric sphinter remains in tonically
contracted state
c. Pre-capillary sphincter is present in b/w meta-arteriole &
capillary
d. Pudendal nerve supplies the sphincter urethrae
e
e. Sphincter of oddi lies at junction of duodenum & CBD
8/
10. Muscle(s), which form the floor of Pelvis:
a. Obturator internus b. Piriformis
c. Puborectalis d. Pubococcygeus
h,
e. Ischiococcygeus
ar 11. True about Atlanto-axial joint:
a. Vertebral artery pass through grove on arch of atlas
vertebrae to foramen magnum
b. Permits flexion & extension
c. Permit side to side movement of head
d. Permits flexion only
e. Permits rotation
12. All are true about CSF except:
a. Total volume is 250 ml
b. Pressure is 60-180 mm of H2O
c. Formed from choroid plexus of 3rd ventricle
d. Formed from choroid plexus of lateral ventricle
Physiology
13. Which of the following play most important role in memory:
a. Synaptic network
b. Electric conduction network
c. Conductivity circuit
d. Conductivity network
14. Cyanide poisoning block K influx & Na efflux. But ATP
reverse this effect. So true statement(s) related to mechanism
of action of cyanide is/are:
a. K influx & Na efflux is regulated by Na-K ATPase enzyme
b. K influx & Na efflux is regulated by Na-K pump
c. ATP provide energy for this channel
d. Na-K ATPase channel is ATP independent
 PGI Chandigarh Self-Assessment & Review: 2017–2013

15. True about Carbon monoxide poisoning: 22. Which of the following feature(s) is/are suggestive of ne-
a. CO has 100 times more affinity than O2 for Hb hogrnic DI in comparison to central DI :
b. Cause right side shifting of O2 dissociation curve a. Desmopressin nasal spray restore urine output to normal
c. Oxygen-haemoglobin saturation curve becomes hyperbol- level
ic shape b. Basal vasopressin level > 1 pg/ml
d. Pulse oximetry can accurately detect level of CO c. Normal posterior pituitary bright spot is not visible on
e. 10-15% level of CO normally may occur in healthy non- MRI scan
smoker d. Change in water loss during fluid deprivation test
16. Dead space is increased in:
a. Positive pressure ventilation
b. Extension of neck Biochemistry
c. Anticholinergic drug
d. Endotracheal tube intubation 23. All are Urea cycle enzymes except:
e. Emphysema a. Ornithine transcarbamoylase
17. Which of the following is true about cardiac innervation: b. Carbamoyl-phosphate synthetase I
a. T1-T5 is sympathetic supply c. Argininosuccinase
b. Inferior & superior cervical ganglia not involve in d. Citrulline synthase

e
innervation e. Arginosuccinnic acid synthetase
24. Non-polar amino acids are:

8/
c. Parasympathetic supply is from vagus nerve
d. Great cardiac nerve arise from superior cervical ganglia a. Proline
e. Inferior cervical ganglia gives off Inferior cardiac nerve b. Lysine
c. Isoleucine

h,
18. True about cortisol level in blood plasma:
a. Morning concentration is 17-18nmol/dl d. Arginine
e. Asparginine
b. Morning concentration is 5-23 μg/dL
ar
25. True about squalene:
c. Evening concentration is almost half of morning concen-
tration a. Present in subhuman primate only
ig
d. Evening concentration is 5-23 μg/dL b. It is one of the major carbohydrate of body
19. Saccadicc eye movement is controlled by: c. It involves in synthesis of cholesterol
nd

a. Parietal lobe d. It involves in synthesis of steroids

b. Prefrontal lobe 26. Molecular weight of protein can be determined/estimated
c. Temporal lobe by:
ha

d. Frontal cortex a. SDS-PAGE

e. Occipital lobe b. Gel filtration chromatography
c. Agarose gel electrophosis
IC

20. True about normal ECG:

a. Normal PR interval is 0.12-0.20 s d. Ultracentrifugation
b. PR internal correspondence initiation of P wave to initia- e. FRET microscopy
tion of R wave 27. Gel used in RNA electrophoresis:
PG

c. QT internal correspondence initiation of Q wave to initia- a. Agarose gel

tion of T wave b. Polyacrylamide plain gel
d. Normal QRS interval < 0.12 s c. Polyacrylamide SDS (Sodium dodecyl sulphate) impreg-
e. Normal QTc interval <0.47 s nated Polyacrylamide gel
21. Which of the following is/are true about SIADH: 28. Which of following releases/provide energy:
a. Desmopressin is used for treatment a. Conversion of ADP to ATP
b. Vasopressin level is inappropriately high b. Breaking of high energy bond to low energy bond
c. Plasma osmolality is higher than urine osmolality c. Conversion of pyruvate to lactate
d. ↑ed Osmolality of urine d. Electrical gradient across inner & outer side of mitochon-
e. ↑ed Osmolality of plasma drial membrane
e. Passage of e- through FAD in electron transport chain

MCQs

Answer Key
15.
c. 16. a, b, c, e. 17. a, e. 18. b, c. 19. d. 20. a, d. 21. b, d.

22.
b. 23. d. 24. a, c. 25. c, d. 26. a, b, d. 27. a. 28. b, d, e.

320
 May  | 2016

29. Which of the following is feature(s) of diabetic ketoacidosis:
a. Decreased triglyceride level
b. Increased fatty acid level
c. ↑Lipoprotein
d. Decreased ketone bodies
e. High Anion gap acidosis
30. Which of the following is/are true about pH of solution:
a. Absolute concentration of acid & salt
b. Relative concentration of acid & salt in solution
c. Increase of temperature increases pH
d. A rise in H+ concentration decreases pH
31. True statement(s) about Magnetic-activated cell sorting:
a. It is a method to separate specific cell from complex
mixture
b. Fluorescent dyes are uses
c. Antibody-coated magnetic nanoparticles are used
d. Antibodies used are specific for certain cell surface markers
38. Second messenger is/are:
a. Ca2+ b. DNA
c. Histone d. cDNA
39. True about genetic code:
a. Follow Mendelian law
b. It is total number of chromosome in the body
c. It is nucleotide sequence which codes for amino acids
d. It codes for DNA
e. None
40. Restriction endonuclease cleaves:
a. dsDNA b. RNA
c. Histone d. Protein
e. ssDNA
41. Phospholipase A2 act on:
a. Phosphoglyceric acid b. Phosphate
c. Ca+ d. Phosphatidyl-inositol
42. Enzyme used in DNA repair is/are:

e
e. Magnetic field is applied a. DNA gyrase

8/
32. Silver staining is done for: b. DNA polymerase
a. DNA b. RNA c. Restriction endonuclease
c. Karyotyping analysis d. Protein d. DNA ligase

h,
e. Collagen 43. Nucleosome contains:

ar a. DNA b. RNA
c. Chromatin d. Histone
Immunogenetics &
ig
Molecular Biology Pathology
33. Non-coding RNA is/are:
nd

44. Serotonin, a mediator of inflammation in our body, is se-

a. miRNA b. Si RNA
creted/released by:
c. tRNA d. mRNA
a. Leukocytes b. Endothelial cell
ha

e. rRNA
c. Mast cell d. Platelet
34. Polymerase III synthesizes:
e. Macrophage
a. Fragment 28S of rRNA b. Fragment 23S of rRNA
45. Autosomal recessive disease(s) is/are :
IC

c. Fragment 5 S of rRNA d. tRNA

a. Sickle cell anaemia
e. mRNA
b. Phenylketonuria
35. Two strands of DNA is/are held by:
c. Tuberous scelerosis
a. Glycosidic bond b. Hydrogen bond
PG

d. Familial polyposis coli

c. Covalent bond d. Ionic bond
e. Marfan syndrome
e. Van der waal force
46. Which of the following is/are features(s) of lewy body de-
36. Which of the following is/are true about Translation:
mentia:
a. N-formyl methionine is first amino acid in prokaryotes
a. Plaque containing beta-amyloid peptide
b. Uses energy in form of GMP
b. Deposition of α-synuclein protein
c. Elongation factor EF-1 & EF-2 used in prokaryotes
c. Often resistant to standard treatment
d. Elongation factor P is used in eukaryotic organism
d. Common in elderly
e. Three initiation factors are required in prokaryotes
e. Risk of falling may present
37. Nucleic acid amplification techniques are:
47. True about Alzheimer’s disease:
a. PCR
a. More common in older age
b. Real time PCR
b. Impairment of the ability to remember new information
c. DNA Cloning
c. Mainly affects long term memory
d. Next generation DNA sequencing
e. ELISA
d. General cognitive behavior impaired in prodromal phase MCQs
e. Atrophy of frontal & parietal lobe

Answer Key
29.
b, c, e. 30. b, d. 31. a, c, d, e. 32. All. 33. a, b, c, e. 34. c, d. 35. b.
36. a, e. 37. a. b. 38. a. 39. c. 40. a. 41. d. 42. b, d.

43. a, d. 44. d. 45. a, b. 46. b, c, d, e. 47. a, b, d, e.

321
 PGI Chandigarh Self-Assessment & Review: 2017–2013

48. All are true about hypersensitivity pneumonitis except: 57. True about surgical jaundice:
a. Type IV Hypersensitivity reaction a. Increase of serum bilirubin
b. More common in smoker b. Increase acid phosphatase
c. Bronchoalveolar lavage shows CD4+ and CD8+ T lympho- c. Increase alkaline phosphatase
cytes d. Urine bilirubin is absent
d. May presents with cough, dyspnea & breathlessness e. Stool sterocobilinogen absent
49. RS cell having same immunophenotyping are present in 58. Which of the following marker favours diagnosis of prein-
which subtypes of Hodgkin’s lymphoma: vasive & invasive cervical cancer:
a. Nodular sclerosis a. Ki67
b. Lymphocyte predominant b. Oncoprotein E6
c. Lymphocyte rich c. p16INK4, cyclin E, and Ki-67
d. Mixed cellularity d. Oncoprotein E8
e. Lymphocyte depletion 59. Which of the following marker/mutation is/are seen in
50. True about Lyonisation of X chromosome: papillary carcinoma of thyroid:
a. Inactivation of X chromosome only in somatic cell a. Synaptophysin b. RET/PTC
b. Inactivation of X chromosome only in germ cell c. P53 d. NTRK1
c. Inactivation of X chromosome in somatic & germ cell both e. RAS

e
d. Maximun number of Barr body is equal to X chromosome

8/
51. Two most common cancer in Indian woman is:
a. Carcinoma breast
b. Carcinoma cervix
Pharmacology

h,
c. Carcinoma colon 60. Which of the following is/are true about pregabalin:
d. Carcinoma stomach ar a. Approved drug for diabetic neuropathy
e. Carcinoma lung b. Approved for treatment of generalized tonic clonic seizure
52. Which of the following is paraganglioma: c. Peripheral edema is side effect
a. Adrenal Pheochromocytoma d. Somnolence is side effect
ig
b. Extra-adrenal Pheochromocytoma e. Approved for use in partial seizure
c. Carotid body tumour 61. Drug(s) used for overactive bladder:
nd

d. Carcinoid tumour a. Oxybutinin

e. Glomus tympanicum b. Tolterodine
53. Feature(s) of XIII factor deficiency is/are:
ha

c. Mirabegron
a. Delayed wound closure d. Onabotulinum toxin A
b. Clot solubility tests are abnormal e. Pirenzepine
IC

c. ↑aPTT 62. All are true about warfarin except:

d. ↑PT a. Act through inhibition of coagulation factor IX
e. ↑ BT b. Protamine sulphate reverses its action
54. Which of the following statement(s) is/are correct except: c. Monitoring is done through INR
PG

a. Increased PT in extrinsic pathways d. Target of INR with warfarin is generally 2-3

b. Increased aPTT in instrinsic pathways e. Skin necrosis is usually occur in 3-10 days of initiation of
c. If platelet count is > 1.5 lac/microL, then normal homeo- warfarin
stasis present 63. True about M/A of doxorubicin:
d. BT is decreased in platelet abnormality a. Intercalate b/w DNA strands
55. True about Dentigerous cyst: b. Inhibition of DNA polymerase
a. Arises in relation to unerupted teeth c. Inhibition of RNA polymerase
b. It most commonly encroaches maxillary antrum d. Inhibition of topoisomerase II
c. Mandibular third molar is common site e. Inhibition of protein synthesis
d. Common in mandible 64. Anticholinergic drug side-effect includes:
56. Prognostic factors for carcinoma esophagus is/are: a. Constipation b. Urinary retention
a. Depth of invasion b. Lymph node status c. Mydriasis d. Hypothermia
c. Tumour grading d. Stage of the disease e. Blurring of vision
MCQs

Answer Key
48.
b. 49. a, c, d, e. 50. a. 51. a, b. 52. b, c, e. 53. a, b. 54. d.
55. a, c, d. 56. All 57. a, c, e. 58. a, b, c. 59. b, d, e. 60. a, c, d, e. 61. a, b, c, d.

62. b. 63. a, d. 64. a, b, c, e.

322
 May  | 2016

220. True about desflurane: 228. Which of the following statement(s) is/are true about
a. Boiling point is <230C physical urticaria
b. Chemically it is Flourinated methyl ethylether a. Cholinergic urticarial is precipitated by cold
c. It increases the effect of muscle relaxant b. Solar urticaria is skin sign of erythropoietic protoporphyria
d. Can be given safely to patient susceptible to malignant c. Dermatographism is an example
hyperthermia d. Cold urticaria is precipitated by emotion
e. More potent than isoflurane
221. Drug(s) not given as transdermal patch:
a. Fentanyl Psychiatry
b. Diclofenac 229. True about schizophrenia:
c. Morphine a. Q-EEG finding is one of diagnostic criteria for schizophre-
d. Clonidine nia
e. Buprenorphine b. Psychosurgery can be done for some resistant cases
222. Endotracheal intubation is/are assessed by: c. Family history of schizophrenia is poor prognosis
a. Mallampati grading d. Depression may be found
b. ASA physical status grading e. Onset only after 40 year of age
c. Thyromental distance 230. Which of the following is/are not side-effect of lithium:

e
d. Teeth arrangement a. Seizure

8/
b. Hyporeflexia
c. Nephrogenic diabetes insipidus
Skin d. Alopecia

h,
e. Tremor
223. Which of the following is/are used in psoriasis: ar
a. High dose oral dexamethasone
b. Methotrexate Radiology
ig
c. TNF-alpha inhibitor 231. True about photodynamic therapy of head & neck cancer:
d. Acitretin a. Tumour sensitizer is used
nd

e. Narrow band UVB b. Singlet oxygen is produced in tumour cell

224. True about skin: c. After therapy, radiosensitizer may remain with tumour cell
a. Epidermis is highly vascular d. Hemoporphyrin given as radiosensitizer
ha

b. Melanocyte is derived from neural crest e. Photosensitivity is a side-effect after therapy

c. Sebaecous gland- holocrine & absent in palm 232. Which of the following cell(s) are less radiosensitive:
d. Apocrine gland presents in axilla & groin a. Osteocyte
IC

e. Hiraadenitis suppurita is infection of apocrine gland b. Erythroblasts

225. Acneiform eruption is/are side effect of : c. Chondrocyte
a. Tetracycline d. Spermatogonia
PG

b. Phenytoin e. Lymphocyte
c. Isoniazid 233. All are true about gamma knife except:
d. Steroid a. Focussed radiation is delivered to tumor
e. Potassium iodide b. Provide equal exposure to surrounding healthy tissue
226. Cicatrical alopecia is/are seen in: c. It is a type of stereotactic surgery
a. Lichen planopilaris d. Primarily used for small brain tumours
b. Discoid lupus erythematous e. Uses Co-60 as source of radiation
c. Andogen efflvum 234. Gamma radiation is/are produced by:
d. Lichen planus a. Co-60 b. Caesium-137
e. Trichotillomania c. P-32 d. Iridium-192
e. Strontium-90
227. Wavelength of UVB is :
235. Precise FNAC can be obtained by using :
a. 250-280 nm b. 280-320 nm
a. USG b. CT
c. 320-400 nm d. 400-700 nm
e. 100-200 nm
c. Endoscopic USG d. MRI MCQs
e. Plain-Xray

Answer Key
220.
a, b, c. 221. b, c. 222. a, c, d, 223. b, c, d. 224. b, c, d, e. 225. b, c, d, e. 226. a, b, d.
227. b. 228. b, c. 229. b, c, d. 230. b. 231. a, b, c, e. 232. a, c. 233. b.

234. a, b, d. 235. a.

333
 PGI Chandigarh Self-Assessment & Review: 2017–2013

236. True about signal characteristic of CSF on MRI & FLAIR: 238. True about USG:
a. Hyperintense on T1WI a. Uses most commonly frequency of 20-50 MHz for diag-
b. Hypointense on T1WI nostic ultrasound
c. Hyperintense on T2WI b. Work on principle of piezoelectric effect
d. FLAIR reduces CSF signal c. Ultrasonic waves only penetrates gas , not liquid
e. FLAIR increases CSF signal d. Gas filled microbubbles are used as contrast media
237. Contrast agent which are not used for CT scan: 239. True about finding of pleural effusion:
a. Water a. CT scan can distinguish between a pleural effusion and a
b. CO2 pleural empyema
c. Barium compounds b. USG can detect very small amount of fluid
d. Iodinated high-osmolality contrast media c. X-ray- homogenous opacity with obliteration of CP angle
e. Polyethylene glycol d. MRI cannot differentiate malignant from benign pleural
disease
e. MRI can differentiate malignant from benign pleural dis-
ease

e
8/
h,
ar
ig
nd
ha
IC
PG

MCQs

Answer Key
236.
b, c, d. 237. b. 238. b, d. 239. a, b, c, e.

334
 MAY 2016  (ANSWERS & EXPLANATIONS)

Anatomy “The submandibular salivary gland is a common site of calculus

1. Ans:  a. Supplied by.... . c. The muscle pass...
[Ref: BDC 6th/ Vol. III 208-11; Snell 9th/556-57; Essential Anatomy by
Moore 2nd/539]
“Occulomotor nerve in orbit: The larger, lower division divides
into 3 branches for the medial rectus, the inferior rectus & the
inferior oblique. The smaller, upper division supplies the
superior rectus & part of the levator palpebrae superioris. All
branches enter the muscle on their ocular surfaces except that
for the IO which enters its posterior border” (BDC 6th/ Vol. III
362)
formation. The presence of a tense swelling below the body of
the mandible, which is greatest before or during ameal and is
reduced in size or absent between meals, is diagnostic of the
condition. Examination of the floor of the mouth will reveal
absence of ejection of saliva from the orifice of the duct of the
affected gland. Frequently, the stone can be palpated in the
duct, which lies below the mucous membrane of the floor of the
mouth” (Snell 9th/ 633-34)
Table (A. K. Jain 6th/204): Salivary Gland –main differentiating features
Gland Secretory duct Parasympathetic supply
(Secretomotor)

e
“Origin: IO arises from the orbital surface of the maxilla, lateral Parotid Stensen’s duct IX (Glossopharyngeal n. )
to the lacrimal groove. The muscle is situated near the anterior

8/
Submandibular Wharton duct VII (Facial n. )
margin of the orbit”(BDC 6th/ Vol. III 208)
“Insertion: The IO is fleshly throughout. It passes laterally, Sublingual Duct of Rivinus VII (Facial n. )
upwards & backwards below the inferior rectus & then deep to

the lateral rectus. The IO inserted close to the superior oblique a
little below & posterior to the latter” (BDC 6th/ Vol. III 208)
“IO: Origin- floor of orbit cavity & insertion- lateral surface of
eyeball deep to lateral rectus” (Snell 9th/551)
ig
Table (BDC 6th/ Vol. III 211 ): Actions of Individual Muscles
nd
h,
“All the 3 pairs of salivary glands are supplied by efferent
ar (Parasympathetic & sympathetic) & afferent nerves (chorda
tympani- br. of VII nerve & IX nerve). Afferent fibers carry
pain impulse from salivary glands” (A. K. Jain 6th/204)
Sialolithiasis

–– Radiopaedia. org/articles
Muscle Vertical Main action Anteroposterior
axis horizontal axis •• It refers to formation of concrements (sialoliths) inside the
axis ducts or parenchyma of salivary glands, and most commonly
ha

occurs in the submandibular glands and their ducts.

Superior rectus Elevates Adducts Rotates medially
•• Sialolithiasis is most common disease of salivary glands,
(Intorsion)
accounting for approximately 50% of all major salivary
IC

Inferior rectus Depresses Adducts Rotates Laterally gland pathology. The submandibular salivary gland is
(Extorsion) most commonly affected (80-90% of cases) with almost
Superior Depresses Abducts Rotates all the remaining cases located in the parotid duct. This is
PG

oblique medially(Intorsion) primarily believed to be due to the increased viscosity of the

Inferior Elevates Abducts Rotates Laterally secretions from the submandibular gland
oblique (Extorsion) •• It is a disease of adults, typically between 30 and 60 years of
age. There is a male predilection
Medial rectus - Adducts -
•• Typically patient presents with a history of recurrent
swelling and pain in the involved gland usually associated
Lateral rectus - Abducts - with eating due to obstructions of the draining duct.
•• Patients most often present with a colicky postprandial
Table: Extraocular Muscles of Orbit swelling of the gland.

Muscle Origin Insertion Innervation Main Action What are the Symptoms of Salivary Gland Stones
Inferior Anterior Sclera deep Oculomotor Abducts, –– http://patient. info/health/salivary-gland-stones
oblique (IO) part of to lateral nerve (CN III) elevates, •• When spit (saliva) cannot exit a blocked tube (duct), it backs
floor of rectus and laterally up into the gland, causing pain and swelling of the gland.
orbit muscle rotates •• The most common symptoms are pain and swelling of
eyeball the affected gland at mealtimes. This occurs if the stone
completely blocks a duct. The saliva cannot pass into your
2. Ans:  a. Presents as a mass... b. Stone in Wharton duct... c. mouth if the duct is blocked by a stone.
Starts pain just after... d. Pain carried by... •• The pain can be sudden and intense just after starting a
meal. Swelling soon follows. The pain and swelling ease
[Ref: BDC 6th/ Vol. III 133-36; Snell 9th/ 633-34; Essential Anatomy by
over about 1-2 hours after a meal.
Moore 2nd/568; Gray’s 40th/520-21]
 PGI Chandigarh Self-Assessment & Review: 2017–2013
3. Ans:  a. Crypts is lined..., b. Supplied by IX CN..., c. Tongue
depressor..., e. Present in oropharynx....
[Ref: BDC 6th/ Vol. III 229-30; Gray’s 40th/566-67;Dhingra 6th/ 257-58;
Snell’s 9th/636]
Examination of oropharynx: First examine the oropharynx by
asking the patient to open the mouth widely. Tongue depressor
is used when this preliminary examination is unsatisfactory, or
when it is required to displace tongue to one side to examine
tonsillolingual sulcus, or to press on the tonsils to look for the
contents of tonsillar crypts” (Dhingra 6th/ 383)
Palatine Tonsil
–– BDC 6th/ Vol. III 229-30; Dhingra 6th/ 257-58
•• It occupies the tonsillar sinus or fossa b/w the palatoglossal
& palatopharyngeal arches
•• It can be seen through the mouth
•• Medial surface of the tonsil is covered by nonkeratinizing
stratified squamous epithelium which dips into the
substance of tonsil in form of crypts
•• Nerve supply: Lesser palatine branches of sphenopalatine
ganglion(CN V) & glossopharyngeal nerve provide
sensory nerve supply
•• Blood supply: 5 arteries 1) Tonsillar branch of facial
artery. This is main artery 2) Ascending pharyngeal artery
from external carotid 3) Ascending palatine, a branch of
ig
facial artery 4) Dorsal linguae branches of lingual artery 5)
Descending palatine branch of maxillary artery
•• Palatine tonsil is situated at the oropharyngeal isthmus
nd
(BDC 6th/ Vol. III 230)
Palatine Tonsil
ha
–– Gray’s 40th/566-67
•• Each palatine tonsil is situated in the lateral wall of the
oropharynx
IC
•• It is covered on its oropharyngeal aspect by nonkeratinized
stratified squamous epithelium. The epithelium lining the
cypts is mostly similar to that of oropharyngeal surface,
PG
i.e., stratified squamous, but there are also patches of
reticulated epithelium, which is much thinner
•• The largest artery supplying tonsil is Tonsillar artery,
which is a branch of facial or sometimes the ascending
palatine artery
4. Ans:  a. In zone 1 chondrocytes... d. Zone 4 contain...
e. Chondrocytes.
[Ref: Guyton 40th/82-83]
Articular Hyaline Cartilage
–– Guyton 40th/82-83
•• Articular hyaline cartilage covers articular surfaces in
synovial joints. It provides an extremely smooth, resistant
surface bathed by synovial fluid, which allows almost
frictionless movement.
•• Adult articular cartilage shows a structural zonation with
increasing depth from the surface.
Answers
& •• Zone 1 is the superficial or tangential layer. The free articular
Explanations
surfaceis a thin, cell-free layer, which contains fine collagen
336
type II fibrils covered superficially by a protein coating. The
cells are small, oval or elongated and parallel to the surface,
relatively inactive, and surrounded by fine tangential fibres.
The collagen fibres deeper within this zone are regularly
tangential, their diameters and density increase with depth.
•• Zone 2 is the transitional or intermediate layer. The cells
are larger, rounder, and are either single or in isogenous
groups. Mostare typical active chondrocytes, surrounded
by oblique collagen fibres.
•• Zone 3 (radiate layer)- cells are large, round and often
disposed in vertical columns, with intervening radial
collagen fibres. As elsewhere, the cells, either singly or in
groups, are encapsulated in pericellular matrix which has
fine fibrils and contains fibronectin and type II, IX and XI
collagen.
•• The deepest layer or calcified layer (zone 4) lies adjacent to
the subchondral bone (hypochondral osseouslamina) of the
e
epiphysis. The adjacent surfaces show reciprocal fine ridges,
8/
grooves and interdigitations, which, with the confluence
of their fibrous arrays, resist shearing stresses produced by
postural changes and muscle action. The junction between
h,
zones 3 and 4 is called the tide mark. With age, articular
ar cartilage thins and degenerates by advancement of the tide
mark zone, and the replacement of calcified cartilage by
bone.
Zones of Articular Cartilage
–– www. orthobullets. com/basic-science
Superficial • Type II collagen orientation is parallel to joint.
zone • Has flattened chondrocytes, condensed collagen
(tangential fibers, and sparse proteoglycans.
zone) • Only zone where articular cartilage progenitor
cells have been found
Intermediate • Type II collagen has an oblique or random
zone organization
• Is the thickest layer with round chondrocytes, and
abundant proteoglycan content
Deep layer • Type II collagen is perpendicular to joint and
(basal layer) crosses tidemark; has the highest concentration
of proteoglycans
• Round chondrocytes arranged in columns
Tidemark • Is deep to the basal layer and separates the true
articular cartilage from the deeper cartilage that
is A remnant of the cartilage anlage
Articular Cartilage
–– http://www. lab. anhb. uwa. edu. au
•• It is a specialised form of hyaline cartilage.
•• It is not surrounded by a perichondrium and is partly
vascularised.
•• It is, depending on the arrangement of chondrocytes and
collagenous fibres, divided into several zones:
Tangential layer (Zone 1)
•• Chondrocytes are rather small and flattened parallel to the
surface. The most superficial part (lamina splendens) is
devoid of cells. Collagen fibres in the matrix of the tangential
 May  | 2016

layer are very fine. They run parallel to the surface of the carotid artery. The vasomotor activity of these fibers may
cartilage. reduce secretion from the gland.
Transitional zone (Zone 2) •• Sensory nerve fibers pass to the gland through the great
•• The chondrocytes are slightly larger, are round and occur auricular and auriculotemporal nerves.
both singly and in isogenous groups.
•• Collagen fibres take an oblique course through the matrix of
the transitional zone.
Radial zone (Zone 3)
•• Fairly large chondrocytes form radial columns, i.e.. the
stacks of cells are oriented perpendicular to the articulating
surface.
•• The course of the collagen fibres follows the orientation of
the chondrocyte columns.
Calcified cartilage layer (Zone 4)
•• It rests on the underlying cortex of the bone.
•• The matrix of the calcified cartilage layer stains slightly

e
darker (H&E) than the matrix of the other layers.

8/
5. Ans:  a. Postganglionic parasympathetic fibre-secretomotor.
b. Preganglionic parasympathetic fibre relay in Otic
ganglion. d. Sympathetic nerve are vasomotor. Fig.: Innervation of parotid gland

h,
[Ref: BDC 6th/ Vol. III 106-12; Snell 9th/630-32; Essential Anatomy by 6.
ar Ans:  a. Oppenens pollocis..., c. Lateral half of ...,
Moore 2nd/513-14; Gray’s 40th/497]
d. Superficial head....
“Preganglionic nerves travel in the lesser petrosal branch of the
[Ref: BDC 6th/ Vol. I 110; Snell 9th/ 431-32; Essential Anatomy by Moore
ig
glossopharyngeal nerve & synapse in otic ganglion. Postgangli-
2nd/454, 458-59; Gray’s 40th/883]
onic secretomotor fibres reach the gland via the auricuotemporal
“Flexor pollicis brevis: The superficial head is usually
nd

nerve” (Gray’s 40th/497)

innervated by the lateral terminal branch of the median nerve.
Nerve Supply of Parotid Gland The deep part is often innervated by the deep branch of the
–– BDC 6th/ Vol. III 110-11 ulnar nerve (C8, T1)” (Gray’s 40th/883)
ha

•• Parasympathetic nerves are secretomotor: They reach the Muscles of thenar eminence (Abductor pollicis brevis, flexor
gland through the auriculotemporal nerve (br. of V CN). pollicis brevis & opponens pollicis) is supplied by median
nerve” (BDC 6th/ Vol. I 120)
IC

The preganglionic fibres begin in the inferior salivatory

nucleus; pass through the glossopharyngeal nerve, its Muscles of hypothenar eminence(abductor digiti minimi, flexor
tympanic branch, the tympanic plexus & the lesser petrosal digiti minimi & oppnens digiti minimi) & adductor of thumb
nerve & relay in the otic ganglion. The postganglionic fibres (adductor pollicis) are supplied by deep branch of ulnar nerve”
PG

pass through the auriculotemporal nerve & reach the gland (BDC 6th/ Vol. I 120)
•• Sympathetic nerves are vasomotor & are derived from the Median Nerve
plexus around the middle meningeal artery –– BDC 6th/ Vol. I 110
•• Sensory nerves to the gland come from the auriculotemporal •• Muscular branch: Flexor carpi radialis, palmaris longus &
nerve but the parotid fascia is innervated by the sensory fibres flexor digitorum superficialis
of the great auricular nerve (C2, C3) •• Anterior interosseus branch: Flexor pollicis longus, the
Parotid Gland lateral half of the flexor digitorum profundus & pronator
quadratus
–– Essential Anatomy by Moore 2nd/513-14
•• It is the largest of three paired salivary glands. Ulnar Nerve
•• The parasympathetic component of the glossopharyngeal –– BDC 6th/ Vol. I 111
nerve (CN IX) supplies presynpatic secretory fibers to the Muscular branch: Flexor carpi ulnaris & the medial half of the
otic ganglion. flexor digitorum profundus
•• The postsynaptic parasympathetic fibers are conveyed
from the ganglion to the gland by the auriculotemporal 7. Ans:  a. Supraspinatus initiates... b. Serratus anterior
nerve. e. Musculotendinous cuff.
•• Stimulation of the parasympathetic fibers produces a thin, [Ref: BDC 6th/ Vol. I 67-70, 146; Snell 9th/364-65; Essential Anatomy by
watery saliva. Moore 2nd/484; Gray’s 40th/812]
Answers
•• Sympathetic fibers are derived from the cervical ganglia
“The conventional view is that supraspinatus initiates abduction &
through the external carotid nerve plexus on the external Explanations
of shoulder & assists deltoid in abduction thereafter. However,

337
 PGI Chandigarh Self-Assessment & Review: 2017–2013
there is evidence that both supraspinatus & deltoid are involved
throughout the range of abduction, including the initiation of the
movement” (Gray’s 40th/812)
“The multipennate acromial fibres are powerful abductors of
arm at the shoulder joint from beginning to 900. A multipennate
arrangement allows a large number of muscle fibres to be packed
into a relatively small volume. As the strength of contraction of
a muscle is proportional to the number of muscle fibres present
in it(And not on their length), a multipennate muscle is much
stronger than other muscles having the same volume” (BDC 6th/
Vol. I 67)
The deltoid originates in three distinct sets of fibers, often
referred to as “heads”
•• The anterior or clavicular fibers assist Pectoralis Major to
flex the shoulder.
•• The lateral fibers or acromial fibers perform basic shoulder
abduction when the shoulder is internally rotated, and
perform shoulder transverse abduction when the shoulder
is externally rotated
•• The posterior fibers or spinal fibers assist Latissimus Dorsi
to extend the shoulder
“Axillary nerve damage: Deltoid is paralyzed, with loss of the
power of abduction up to 900 at the shoulder, rounded contour
of shoulder is lost& there is sensory loss over the lower half of the
deltoid in a badge-like area called regimental badge” (BDC 6th/
Vol. I 68)
ig
“Musculotendinous cuff of the shoulder or rotator cuff
gives strength to the capsule of shoulder joint all around except
nd
inferiorly” (BDC 6th/ Vol. I 69)
“Trapezius upper & lower fibres act with serratus anterior&
rotate the scapula forwards round the chest wall thus playing an
ha
important role in abduction of the arm beyond 900” (BDC 6th/
Vol. I 62)
IC
8. Ans:  a. Eyeball. b. Brain. e. Spinal cord.
[Ref: Handbook of General Anatomy by BDC 5th/ 189; Snell 9th/19]
PG
“Lymph capillaries are absent from the cellular structures like
brain, spinal cord, splenic pulp, bone marrow, articular
cartilage, epidermis, hair, nail & cornea” (Handbook of General
Anatomy by BDC 5th/ 189)
“Lymphatic vessel are found in all tissue & organ of body except
the central nervous system, eyeball, internal ear, epidermis of
the skin, cartilage & bone” (Snell 9th/19)
“Lymphatic vessels (lymphatics), a nearly bodywide network
of thin-walled vessels that have abundant lymphatic valves.
Lymphatic capillaries and vessels occur almost everywhere
blood capillaries are found, except for example, teeth, bone,
bone marrow, and the entire central nervous system. (Excess
Table (Moore): Muscles of Pelvic Walls and Floor
Boundary Muscle Proximal Attachment
Lateral wall Obturator internus Pelvic surfaces of ilium
Answers and ischium; obturator
&
Explanations membrane
tissue fluid here drains into the cerebrospinal fluid.)”
“Lymphatics of the kidney drain into the lateral aortic nodes”
(BDC 6th/Vol. II 316)
9. Ans:  b. Esophageal..., c. Pre-capillary sphin...,
d. Pudendal ner...,. e. Sphincter of oddi ....
[Ref: BDC 6th/ Vol. II 249, 375; Guyton 12th/226; Essential Anatomy by
Moore 2nd/ 168; Gray’s 40th/ 953, 1178]
“The common bile duct enters the duodenum at duodenum
papilla. Its orifice is surrounded by the sphincter of Oddi & it
usually unites with the main pancreatic duct just before entering
the duodenum” (Ganong 25th/508)
“At the lower end of the esophagus, extending upward about 3
cm above its junction with stomach, it is broad lower esophageal
sphincter, also called gasteroesophageal sphincter. This sphincter
comprising of circular muscle normally remains tonically
constricted with an intraluminal pressure of about 30 mm Hg,
e
in contrast to the midportion of the esophagus, which normally
8/
remain relaxed” (Guyton 12th/445)
“Lower oesophageal sphincter, a specialized zone of circular
smooth muscle surrounding the oesophagus at its transit
h,
through the diaphragm and for much of its short abdominal
ar course. This region of the oesophagus is maintained under
tonic contraction”(Gray’s 40th/ 953)
“At the point where each true
capillary originates from a metaarteriole, a smooth muscle fiber
usually encircles the capillary. This is called the precapillary
sphincter. This sphincter can open & close the entrance to the
capillary” (Guyton 12th/226)
“Pyloric sphincter remain slightly tonically contracted almost
all the time. Despite normal tonic contraction of the pyloric
sphincter, the pylorus usually is open enough for water & other
fluids to empty from the stomach into the duodenum with ease”
(Guyton 12th/447)
“The somatic, pudendal nerve supplies the sphincter urethrae
which is voluntary & situated within the wall of urethra” (BDC
6th/ Vol. II 375)
10. Ans:  c. Puborec..., d. Pubococc....,e. Ischiococcy....
[Ref: BDC 6th/ Vol. II 369; Snell 9th/252; Essential Anatomy by Moore
2nd/210, 17]
Pelvic Floor
–– BDC 6th/ Vol. II 369, 425
•• The pelvic floor is formed by the pelvic diaphragm which
consists of the levator ani & the coccygeus
•• Levator ani is divisible into a pubococcygeus part, an
iliococcygeus part & an ischiococcygeus part
•• Pubococcygeus middle fibers constitute Puborectalis
Distal Attachment Innervation Main Action
Greater trochanter Nerve to obturator Rotates thigh laterally;
of femur internus (L5, S1, S2) assists in holding head of
femur in acetabulum
338
 May  | 2016

Boundary Muscle Proximal Attachment Distal Attachment Innervation Main Action

Posterolat- Piriformis Pelvic surface of S2-S4 Greater trochanter Anterior rami of S1 Rotates thigh laterally;
eral wall segments; superior margin of femur and S2 abducts thigh; assists in
of greater sciatic notch and holding head of femur in
sacrotuberous ligament acetabulum
Floor Coccygeus Ischial spine Inferior end of Branches of S4 and Forms small part of pelvic
(ischiococcygeus) sacrum and coccyx S5 spinal nerves diaphragm that supports
pelvic viscera; flexes coccyx
Levator ani Body of pubis; tendinous Perineal Nerve to levator Forms most of pelvic
(puborectalis, arch of obturator fascia; body; coccyx; ani (branches of diaphragm that helps
pubococcygeus, and ischial spine anococcygeal S4), inferior anal support pelvic viscera and
iliococcygeus) ligament; walls of (rectal) nerve, and resists increases in intra-
prostate or vagina, coccygeal plexus abdominal press
rectum, and anal
canal

e
11. Ans:  a. Vertebral artery..., c. Permit side to side..., 12. Ans:  a. Total volume is ....,

8/
e. Permits rota....
[Ref: Ganong 25th/603;BDC 6th/ Vol. III 331-33; Snell 9th/707; Essential
[Ref: BDC 6th/ Vol. III 172-74; Snell 9th/688-89;Essential Anatomy by Anatomy by Essential Anatomy by Moore 2nd/516]
Moore 2nd/288-89; Gray’s 40th/734-35]

h,
Cerebrospinal Fluid (CSF)
The vertebral artery has a characteristic anatomical course
–– Ganong 25th/603
through six (C6-C1) foramina transversaria of the cervical
vertebrae (2nd part), passing through the groove on the surface
ar •• Volume is 150 ml
•• Rate of CSF production is 550 ml/day. Thus the CSF turns
of the arch of the atlas(3rd part) & through foramen magnum
over about 3. 7 times a day
ig
in cranial cavity (4th part)” (Stroke. ahajournals. org & BDC 6th/
•• Lumbar pressure is normally 70-180 mm H2O
Vol. III 174)
nd

“Atlanto-occipital joint permit flexion, extension & lateral Cerebrospinal fluid (CSF)
bending” (BDC 6th/ Vol. III 172) –– BDC 6th/ Vol. III 331-33
“Atlanto-axial joints: Movement is simultaneous at all three •• The total quantity of CSF is about 150 ml.
ha

joint& consists almost exclusively of rotation around the axis. •• It is formed at the rate of about 200 ml per hour or 5000 ml
Rotation is limited mainly by the alar ligaments, with a minor per day(It may be incorrect!!!!)
contribution from the accessory atlanto-axial ligament. The •• CSF is secreted @0. 35-0. 40ml per minute, which mean that
IC

normal range of atlano-axial rotation is about 400” (Gray’s normally about 50% of the total volume of CSF is replaced
40th/735) every 5 to 6 hours- Gray’s 40th/243
Atlanto-axial Joints •• The normal pressure of CSF is 60 to 100 mm of water
PG

•• Formation: The bulk of CSF is formed by the choroid plexuses

–– BDC 6th/ Vol. III 172-74; Essential Anatomy by Moore 2nd/288-89
of lateral ventricles& lesser amount by the choroid plexuses
•• It is b/w C1 & C2 vertebrae
of the third & fourth ventricles. Possibly, it is also formed by
•• There are 3 atlantoaxial articulations- two lateral
the capillaries on the surface of the brain & spinal cord
atlantoaxial joints b/w the lateral masses of C1 & C2
•• Absorption: CSF is absorbed chiefly through the arachnoid
vertebrae & one median atlantoaxial joint b/w the dens of C2
villi & granulations & is thus drained into the cranial venous
& the anterior arch & transverse ligament of the atlas
sinuses. It is also absorbed partly by the perineural lymphatics
•• Movement(mainly rotation) at all three atlantoaxial joints
around the first, second & eight cranial nerves. It is also
permits the head to be turned from side to side, as occurs
absorbed by veins related to spinal nerves
when rotating the head to indicate disapproval(the ‘NO’
movement)
•• The most important factors maintaining stability are the
ligaments, of which the transverse atlantal ligament is the Physiology
stongest. The alar ligaments are weaker
Atlantoaxial joints 13. Ans:  a. Synaptic Net....
–– Snell 9th/688-89 [Ref: Ganong 25th/283-88; Guyton 12th/ 673; A K Jain 6th/1039-40]
There can be extensive rotation of the atlas & thus of the head Synaptic network s single best answer (No idea about other
on the axis options) Answers
&
Explanations

339
 PGI Chandigarh Self-Assessment & Review: 2017–2013
“Long-term memory involves changes in the structure of
neurons including growth of new processes and synapses. So, to
the extent that you remember anything about this material on
memory tomorrow, or next week, or next year, it will be because
structural changes in synapses are beginning in your brains.
An enduring form of synaptic plasticity called long-term
potentiation (LTP) is believed to be involved in many examples
of declarative memory”-neuroscience. uth. tmc
Memory
–– http://www. human-memory. net/processes_consolidation. html
•• Encoding: The persistent spiking in working memory can
enhance the synaptic and cellular changes in the encoding
of episodic memory
•• Consolidation and reconsolidation: Short-term memory
(STM) is temporary and subject to disruption, while long-
term memory (LTM), once consolidated, is persistent and
stable. Consolidation of STM into LTM at the molecular level
presumably involves two processes: synaptic consolidation
and system consolidation. The former involves a protein
synthesis process in the medial temporal lobe (MTL),
whereas the latter transforms the MTL-dependent memory
into an MTL-independent memory over months to years
•• It should be remembered that each neuron makes thousands
of connections with other neurons, and memories and
ig
neural connections are mutually interconnected in
extremely complex ways. Unlike the functioning of a
nd
computer, each memory is embedded in many connections,
and each connection is involved in several memories. Thus,
multiple memories may be encoded within a single neural
ha
network, by different patterns of synaptic connections.
Conversely, a single memory may involve simultaneously
activating several different groups of neurons in completely
IC
different parts of the brain.
“The key to memory is alteration in the strength of selected
synaptic connections. Second messenger systems contribute to
PG
the changes in neural circuitary required for learning & memory.
Alternation in cellular membrane channels are often correlated to
learning & memory. In all but the simplest of cases, the alternation
involves the synthesis of proteins & the activation of genes. This
occurs during the change from short-term working memory to
long-term memory” (Ganong 25th/286)
Discharge of neuron during learning session could lead to changes
which increases mRNA synthesis & hence increase synthesis
of particular proteins. These proteins could modify synaptic
transmission by affecting- transmitter synthesis, membrane
permeability & some other neural process” (A K Jain 6th/1039)
Storage of Information-Memory
–– Guyton 12th/ 673
•• Only a small fraction of even the most important sensory
information usually causes immediate motor response. But
much of the information is stored for future control of motor
activities and for use in the thinking processes. Most storage
Answers occurs in the cerebral cortex, but even the basal regions of
& the brain and the spinal cord can store small amounts of
Explanations
information.
340
•• The storage of information is the process we call memory,
and this, too, is a function of the synapses. Each time certain
types of sensory signals pass through sequences of synapses,
these synapses become more capable of transmitting the
same type of signal the next time, a process called facilitation.
14. Ans:  a. K influx... b. K influx ... c. ATP provide.
[Ref: Reddy 32nd/595; Katzung 13th/1010; Guyton 12th/ 357; A K Jain
6th/459]
“In Complex IV (cytochrome c oxidase), sometimes called
cytochrome A3, four electrons are removed from four
molecules of cytochrome c and transferred to molecular oxygen
(O2), producing two molecules of water. At the same time, eight
protons are removed from the mitochondrial matrix (although
only four are translocated across the membrane), contributing
to the proton gradient which helps in ATP synthesis. The
activity of cytochrome c oxidase is inhibited by cyanide”
e
Na+/K+–ATPase
8/
•• Na+/K+–ATPase (sodium-potassium adenosine
triphosphatase, also known as the Na+ /K+ pump or
sodium-potassium pump) is an enzyme (an electrogenic
h,
transmembrane ATPase) found in the plasma membrane of
all animal cells. The Na+ /K+-ATPase enzyme is a solute
ar pump that pumps sodium out of cells while pumping
potassium into cells, both against their concentration
gradients. This pumping is active (i.e. it uses energy from
ATP) and is important for cell physiology. An example
application is nerve conduction.
•• The process of moving sodium and potassium ions across
the cell membrane is an active transport process involving
the hydrolysis of ATP to provide the necessary energy. It
involves an enzyme referred to as Na+/K+-ATPase. This
process is responsible for maintaining the large excess of
Na+ outside the cell and the large excess of K+ ions on the
inside
•• It accomplishes the transport of three Na+ to the outside of
the cell and the transport of two K+ ions to the inside.
Cyanide
–– Harrison 19th/262e-7
•• Cyanide directly poisons the last step in the mitochondrial
electron transport chain, cytochrome a3, which results
in a shutdown of cellular energy production. Tissues
are poisoned in direct proportion to their metabolic rate,
with the carotid baroreceptors and the brain—the most
metabolically active tissues in the body—affected fastest
and most severely.
•• This poisoning results from cyanide’s high affinity for certain
metals, notably Co and Fe+++. Cytochrome a3 contains
Fe+++, to which CN− binds.
Cyanide Poisoning
–– Reddy 32nd/595
•• It inhibits the action of cytochrome oxidase, carbonic
anhydrase & probably of other enzyme system
•• It blocks the final step of oxidative phosphorylation &
prevents the formation of ATP & its use as energy source

15. Ans:  c. Oxygen-haemoglobin saturation...
[Ref: Ganong 25th/650-51; Guyton 12th/352; A K Jain 6th/ 431; https://
pedclerk. bsd. uchicago. edu/page/carbon-monoxide-poisoning]
“Carbon monoxide shifts the oxygen-haemoglobin satu-
ration curve to the left and changes it to a more hyperbolic
shape. Less oxygen is available for the tissues” (www. ncbi. nlm.
nih. gov)
“The plasma level of carboxyhemoglobin is normally quite low.
At baseline, levels up to 3 percent may be seen in nonsmokers,
while smokers may have levels up to 10-15 percent” (pedclerk.
bsd. uchicago. edu)
“Left shift of O2-Hb dissociation curve occur in – CO poison-
ing, HbF, myoglobin & decrease in body temperature” (A K Jain
6th/ 431)
Detection in Biological Specimens
•• Carboxyhemoglobin blood saturations may range up to
8–10% in heavy smokers or persons extensively exposed to
automotive exhaust gases. In symptomatic poisoned people
they are often in the 10–30% range, while persons who
succumb may have postmortem blood levels of 30–90%.
•• A CO-oximeter is used to determine carboxyhemoglobin
levels. Pulse CO-oximeters estimate carboxyhemoglobin
with a non-invasive finger clip similar to a pulse oximeter.
•• The use of a regular pulse oximeter is not effective in
the diagnosis of carbon monoxide poisoning as people
ig
suffering from carbon monoxide poisoning may have a
normal oxygen saturation level on a pulse oximeter. This
nd
is due to the carboxyhemoglobin being misrepresented as
oxyhemoglobin.
ha
Carbon Monoxide Poisoning
–– Ganong 25th/651
•• The affinity of hemoglobin for CO is 210 times its affinity
IC
for O2, and COHb liberates CO very slowly.
•• An additional difficulty is that when COHb is present the
dissociation curve of the remaining HbO2 shifts to the left,
PG
decreasing the amount of O2 released.
•• Death results when about 70–80% of the circulating
hemoglobin is converted to COHb.
Fig.: (Ganong 25th/650): Effects of anemia and CO on hemoglobin
binding of O2. Normal oxyhemoglobin (14g/dL hemoglobin)
341
May  | 2016
dissociation curve compared with anemia (7 g/dL hemoglobin)
and with oxyhemoglobin dissociation curves in CO poisoning (50%
carboxyhemoglobin).
Note:  That the CO-poisoning curve is shifted to the left of the
anemia curve.
Respiratory Physiology-The Essentials, 8th Edition: Writes
•• Carbon monoxide interferes with the O2 transport function
of blood by combining with Hb to form carboxyhemoglobin
(COHb). CO has about 240 times the affinity of O2 for Hb;
this means that CO will combine with the same amount of
Hb as O2 when the CO partial pressure is 240 times lower.
•• In fact, the CO dissociation curve is almost identical in
shape to the O2 dissociation curve, except that the PCO axis
is greatly compressed.
•• The presence of COHb also shifts the O2 dissociation curve
to the left, thus interfering with the unloading of O2. This is
e
an additional feature of the toxicity of CO.
•• The normal level of COHb is 1%-2% in non-smokers.
8/
Tobacco combustion produces CO so smokers have COHb
levels of 5%-10%.
h,
16. Ans:  a . Positive pres..., b. Extension..., c. Anticholine...,
ar e. Emphy...,.
[Ref: Ajay Yadav 5th/4-5; Ganong 25th/632-33; Guyton 12th/323; A K
Jain 6th/421]
Physiological dead space or total dead space: It includes
anatomical dead space plus volume of air in alveoli which does
not take part in exchange of gases(i.e. wasted alveolar ventilation)
(A K Jain 6th/421)
Emphysema increases dead space (A K Jain 6th/422)
Anatomical Dead Space
–– Increased in Ajay Yadav 5th/5
•• Old age
•• Neck extension
•• Jaw protrusion
•• Bronchodilators
•• Increasing lung volume(like it is more in inspiration)
•• Atropine(cause bronchodilation)
•• Anaesthesia mask, circuits
•• Intermittent positive pressure ventilation(IPPV) & positive
end expiratory pressure(PEEP)
Factors that Increase Dead Space
–– www. openanesthesia. org
•• General anesthesia: Multifactorial, including loss of skeletal
muscle tone and bronchoconstrictor tone
•• Anesthesia apparatus/circuit
•• Artificial airway
•• Neck extension and jaw protrusion (can increase it twofold)
•• Positive pressure ventilation (i.e. increased airway pres-
sure)
•• Upright posture as opposed to supine (because of decreased
perfusion to the uppermost alveoli)
•• Pulmonary embolus, PA thrombosis, hemorrhage, hypo- Answers
&
tension, surgical manipulation of pulmonary artery tree – Explanations
anything that decreases perfusion to well-ventilated alveoli
 PGI Chandigarh Self-Assessment & Review: 2017–2013

•• Emphysema (blebs, loss of alveolar septa and vasculature) •• Parasympathetic stimulation slows the heart rate, reduces
•• Age the force of the contraction, and constricts the coronary
•• Anticholinergic drugs arteries, saving energy between periods of increased
demand.
Alveolar Dead Space
Cardiac Innervation
–– Increased by Ajay Yadav 5th/5
–– A K Jain 6th/ 324
•• Lung pathologies affecting diffusion at capillary membrane
•• Sympathetic supply: T1 to T5 spinal segments.
like interstitial lung disease, pulmonary embolism, pulmonary
•• Sympathetic preganglionic fibres pass into the sympathetic
edema & ARDS
trunk to superior, middle & inferior cardiac ganglion
•• General anaesthesia
•• Sympathetic postganglionic fibres passes via superior, middle
•• IPPV
& inferior cardiac sympathetic nerves
•• PEEP
•• Parasympathetic supply to heart is via two vagus nerves with
•• Hypotension
their cell bodies located in medulla in the nucleus ambigus
Anatomical Dead Space Nerve Supply of Heart
–– Decreased in Ajay Yadav 5th/5 –– BDC 6th/ Vol. I 267
•• Intubation (nasal cavity is bypassed & diameter of tube is less •• Sympathetic nerves are derived from the upper 4 to

e
than airway diameter 5 thoracic segments of spinal cord. These are cardio-

8/
•• Tracheostomy (upper airways & nasal cavity bypassed) acceleratory & on stimulation they increases the heart rate
•• Hyperventilation (decreasing lung volume) & also dilate the coronary arteries
•• Neck flexion •• Parasympathetic nerves reach the heart via the vagus. These

h,
•• Bronchoconstrictors are cardioinhibitory; on stimulation they slow down the
ar heart rate
17. Ans:  a. T1-T5 is sympathetic..., e. Inferior cervical ganglia... •• Both parasympathetic & sympathetic nerves from the
[Ref: BDC 6th/ Vol. I 267;Gray’s 40th/982; Guyton 12th/178; A K Jain
superficial & deep cardiac plexuses, the branches of which
run along the coronary arteries to reach the myocardium
ig
6th/ 324]
•• Superficial cardiac plexus is situated below the arch of the
Cardiac Innervation aorta in front of the right pulmonary artery. It is formed by
nd

•• The cervical ganglia are paravertebral ganglia of the  The superficial cervical cardiac branch of the left
sympathetic nervous system. Preganglionic nerves from the sympathetic chain
thoracic spinal cord enter into the cervical ganglions and
ha

 The inferior cervical cardiac branch of the left vagus

synapses with its postganglionic fibers or nerves. nerve
•• The cervical ganglion has three paravertebral ganglia:
•• Superior cervical ganglion (largest) - adjacent to C2 & C3;
IC

postganglionic axon projects to target: (heart, head, neck)

via “hitchhiking” on the carotid arteries
•• Middle cervical ganglion (the smallest) - adjacent to C6;
PG

target: heart, neck

•• Inferior cervical ganglion. The inferior ganglion may
be fused with the first thoracic ganglion to form a single
structure, the stellate ganglion. –adjacent to C7; target:
heart, lower neck, arm, posterior cranial arteries
•• The inferior cervical ganglion gives off Inferior cardiac
nerve
•• The middle cardiac nerve (great cardiac nerve), the largest
of the three cardiac nerves, arises from the middle cervical
ganglion
•• Nerves emerging from cervical sympathetic ganglia
contribute to the cardiac plexus, among other things.
Unlike all other ganglia, the medial branches of the cervical
ganglia are 95% postganglionic axons.
•• Sympathetic stimulation causes increased heart rate,
impulse conduction, force of contraction, and, at the same
time, increased blood flow through the coronary vessels to
Answers support the increased activity.
&
Explanations
Fig.:  Cervical sympathetic system

342
 May  | 2016

18. Ans:  b. Morning concent..., c. Evening concentrati..., •• This effect results from a 24-hour cyclical alteration in the
signals from the hypothalamus that cause cortisol secretion.
[Ref: Ganong 25th/ 367; Guyton 12th/600; A K Jain 6th/716;CMDT
2016/1716;webmed. com]
When a person changes daily sleeping habits, the cycle
changes correspondingly. Therefore, measurements of
Evening concentration is almost half of morning concentra- blood cortisol levels are meaningful only when expressed
tion (a/c below reference values)
in terms of the time in the cycle at which the measurements
“Cortisol concentration at 8. 00 am in morning 5-20 mcg/dL
are made.
(140-550 nmol/L)” (CMDT 2016/1716)
Table: Reference Ranges for Blood Plasma Content of free Cortisol 19. Ans:  d. Frontal cortex
Time Lower limit Upper limit Unit [Ref: Ganong 25th/189, 195-96; Guyton 12th/786; A K Jain 6th/1115-16]
09:00 am 140 700 nmol/L “Normally saccadic movements are voluntary but can be aroused
5 25 μg/dL
by peripheral visual or auditory stimuli by stimulation of frontal
eye fields(area 8). Thus these movements are programmed in the
Midnight 80 350 nmol/L frontal cortex” (A K Jain 6th/1115-16)
2. 9 13 μg/dL Prefrontal lobe: It lies anterior to the motor areas 4, 6 & 8. The
major areas of the prefrontal lobes are: Broadmann’s areas 9 to 13,

e
Cortisol
24, 32& 44 to 47” (A K Jain 6th/1118)
5-23 micrograms per deciliter (μg/dL) or

8/
Adult/Child Morning “Saccades are programmed in the frontal cortex and the
138-635 nanomoles per liter (nmol/L) superior colliculi and pursuit movements in the cerebellum”
Afternoon 3-16 μg/dL or 83-441 nmol/L (Ganong 25th/196)

h,
Newborn 2-11 μg/dL or 55-304 nmol/L Neural Pathways
ar –– Ganong 25th/189
Reference ranges for serum cortisol: •• Saccades, sudden jerky movements, occur as the gaze shifts
•• Morning - 7-28 μg/dL from one object to another (Ganong 25th/195)
•• Afternoon - 2-18 μg/dL
ig
•• The frontal cortex is also concerned with eye movement,
•• Stimulated - ≥ 18 μg/dL and especially its refinement. The bilateral frontal eye
•• Suppressed - < 2 μg/dL
nd

fields in this part of the cortex are concerned with control

“The concentration of cortisol in the blood averages 12 μg/100 of saccades, and an area just anterior to these fields is
ml, and the secretory rate averages 15 mg/day. However, concerned with vergence and the near response. The frontal
ha

blood concentration and secretion rate of cortisol fluctuate areas concerned with vision probably project to the nucleus
throughout the day, rising in the early morning and declining in reticularis tegmentalis pontinus, and from there to the other
the evening” (Guyton 12th/594) brain stem nuclei mentioned above.
IC

Circadian Rhythm of Glucocorticoid Secretion

•• The secretory rates of CRF, ACTH, and cortisol are high in 20. Ans:  a. Normal PR interval... d. Normal QRS interval...
the early morning but low in the late evening; the plasma
[Ref: Ganong 25th/524; Guyton 12th/179-80; ECG made Easy by
PG

cortisol level ranges between a high of about 20 μg/dl an Hampton 4th/6-7]

hour before arising in the morning and a low of about 5 μg/
dl around midnight.
Fig. (Guyton 12th/600): Typical pattern of cortisol concentration during
the day. Note the oscillations in secretion as well as a daily secretory
surge an hour or so after awaking in the morning
“The PR interval is measured from beginning of P wave to the
beginning of QRS complex” (ECG made Easy by Hampton 4th/6)
A QTc interval longer than 0. 45 s is likely to be abnormal
(ECG Made Easy by Hampton 4th/157)
“Normal QRS interval duration is no greater than 0. 12s” (ECG
made Easy by Hampton 4th/87)
“QT interval is a measure of the time between the start of the
Q wave and the end of the T wave in the heart’s electrical cycle”
ECG Waveforms and Intervals
•• There are four major ECG intervals: RR, PR, QRS, and QT
•• The PR interval measures the time (normally 120–200
ms) between atrial and ventricular depolarization, which
includes the physiologic delay imposed by stimulation of
cells in the AV junction area.
•• The QRS interval (normally 100–110 ms or less) reflects
the duration of ventricular depolarization.
•• The QT interval includes both ventricular depolarization Answers
&
and repolarization times and varies inversely with the heart Explanations
rate.

343
 PGI Chandigarh Self-Assessment & Review: 2017–2013

•• A rate-related (“corrected”) QT interval, QTc, can be

Normal Durations
calculated as QT/√RR and normally is ≤0. 44 s. (Some
references give QTc upper normal limits as 0. 43 s in men and Intervals Average Range Events in the. Heart during
Interval
0. 45 s in women. Also, a number of different formulas have
been proposed, without consensus, for calculating the QTc. ) QRS duration 0.08 to 0.10 Ventrizular depolarization
and atrial reprivatization
Table (Ganong 25th/524): ECG Intervals
QT interval 0.40 to 0.43 Ventricular depolariztion plus
Normal Durations ventricular repolarization

Intervals Average Range Events in the. Heart during ST interval (QT 0.32 ... Ventricular repolarization
Interval minus QRS) (during T wave)

PR interva 0.18 0.12-0.20 Atrial depolarization and

conduction through AV node

e
8/
h,
ar
ig
nd

Fig (Guyton 12th/ 179): Normal electrocardiogram

ha

21. Ans:  b. Vasopressin level... d. ↑ed Osmolality of... 22. Ans:  b. Basal vasopressin level...
IC

[Ref:Harrison 19th/2280; Ganong 25th/698; A K Jain 6th/ 673-74] [Ref: Ganong 25th/698; Guyton 12th/488-89; A K Jain 6th/674]
Desmopressin is very useful in management of diabetes insipi- Failure to Produce ADH: “Central” Diabetes Insipidus
PG

dus” (A K Jain 6th/ 673)

–– Guyton 12th/488
Syndrome of Inappropriate Antidiurectic Hormone
•• An inability to produce or release ADH from the posterior
–– Ganong 25th/698 pituitary can be caused by head injuries or infections, or it
•• The syndrome of “inappropriate” hypersecretion of antidi- can be congenital.
uretic hormone (SIADH) occurs when vasopressin is inap-
•• Because the distal tubular segments cannot reabsorb water
propriately high relative to serum osmolality.
in the absence of ADH, this condition, called “central”
•• Vasopressin is responsible not only for dilutional hypona-
diabetes insipidus, results in the formation of a large volume
tremia (serum sodium < 135 mmol/L) but also for loss of
of dilute urine with urine volumes that can exceed 15 L/day.
salt in the urine when water retention is sufficient to ex-
pand the ECF volume, reducing aldosterone secretion •• The treatment for central diabetes insipidus is
administration of a synthetic analog of ADH, desmo-
Syndrome of Inappropriate Antidiurectic Hormone
pressin, which acts selectively on V2 receptors to increase
Secretion
water permeability in the late distal and collecting tubules.
–– A K Jain 6th/ 673-74 Desmopressin can be given by injection, as a nasal spray, or
•• Hyposmolality orally, and it rapidly restores urine output toward normal.
•• ↑ed urine osmolality
•• The polyuria and polydipsia of nephrogenic DI are not
•• Urine osmolality becomes higher than plasma osmolality
affected by treatment with standard doses of DDAVP
•• Urinary Na+ exceeds 20 mEq/L
Answers
&
Explanations

344
 May  | 2016

Inability of the Kidneys to Respond to ADH:

“Nephrogenic” Diabetes Insipidus
–– Guyton 12th/488-89
•• In some circumstances normal or elevated levels of ADH
are present but the renal tubular segments cannot respond
appropriately. This condition is referred to as “nephrogenic”
diabetes insipidus because the abnormality resides in the
kidneys.
•• This abnormality can be due to either failure of the counter
current mechanism to form a hyperosmotic renal medullary
interstitium or failure of the distal and collecting tubules
and collecting ducts to respond to ADH.
•• The treatment is to correct, if possible, the underlying renal
disorder. The hypernatremia can also be attenuated by a low-
sodium diet and administration of a diuretic that enhances
renal sodium excretion, such as a thiazide diuretic.

e
Distinction b/w central DI & Nephrogenic

8/
–– DI H19 2277-78
•• Nephrogenic diabetes insipidus can be distinguished Fig.: (Harrison 19th/ 2278):  Simplified approach to the differential
from central diabetes insipidus by administration of diagnosis of diabetes insipidus. When symptoms suggest diabetes

desmopressin. Lack of a prompt decrease in urine volume
and an increase in urine osmolarity within 2 hours
after injection of desmopressin is strongly suggestive of
nephrogenic diabetes insipidus.
ig
•• A simpler but equally reliable way to differentiate between
pituitary DI, nephrogenic DI, and primary polydipsia
nd
h,
insipidus (DI), the syndrome should be differentiated from a
ar genitourinary (GU) abnormality by measuring the 24-h urine volume
and osmolarity on unrestricted fluid intake. If DI is confirmed,
basal plasma arginine vasopressin (AVP) should be measured on
unrestricted fluid intake. If AVP is normal or elevated (>1 pg/mL),
the patient probably has nephrogenic DI. However, if plasma AVP is
low or undetectable, the patient has either pituitary DI or primary

is to measure basal plasma AVP. If plasma AVP on ad

libitum fluid intake is normal or elevated (>1 pg/mL) when polydipsia. In that case, magnetic resonance imaging (MRI) of the
brain can be performed to differentiate between these two conditions
measured by a sensitive and specific assay, both primary
by determining whether or not the normal posterior pituitary bright
ha

polydipsia and pituitary DI are excluded and the diagnosis

spot is visible on T1-weighted midsagittal images. In addition, the
of nephrogenic DI can be confirmed, if desired, by a 1- to MRI anatomy of the pituitary hypothalamic area can be examined
2-day outpatient trial of desmopressin therapy. If, however, to look for evidence of pathology that sometimes causes pituitary
IC

basal plasma AVP is low or undetectable (<1 pg/ mL), DI or the dipsogenic form of primary polydipsia. MRI is not reliable
nephrogenic DI is very unlikely and MRI of the brain can be for differential diagnosis unless nephrogenic DI has been excluded
used to differentiate pituitary DI from primary polydipsia. because the bright spot is also absent, small, or faint in this condition
PG

•• A fluid or water deprivation test is used to determine

whether the patient has diabetes insipidus as opposed to
other causes of polydipsia (a condition of excessive thirst
that causes an excessive intake of water). The patient is
required, for a prolonged period, to forgo intake of water
completely, to determine the cause of the thirst. If there
is no change in the water loss despite fluid deprivation,
desmopressin may be administered to distinguish between
the two types of diabetes insipidus which are central &
nephrogenic diabetes insipidus.
•• If MRI and/or AVP assays with the requisite sensitivity
and specificity are unavailable and a fluid deprivation test
is impractical or undesirable, a third way to differentiate
between pituitary DI, nephrogenic DI, and primary
polydipsia is a trial of desmopressin therapy.
Biochemistry
23. Ans:  d. Citrulline synthase
[Ref: Harper 30th/290-96, 29th/274-88; Lippincott 6th/ 253-55; Shinde
7th/450-51; Vasudevan 5th/180-81]
Urea cycle: 5 steps (Shown in Figure)
•• Synthesis of carbamoyl-phosphate
•• Synthesis of citrulline
•• Synthesis of argininosuccinate
•• Cleavage of argininosuccinate
•• Cleavage of arginine to form ornithine & urea

Answers
&
Explanations

345
 PGI Chandigarh Self-Assessment & Review: 2017–2013

e
8/
h,
Fig.: Biosynthesis of Urea or Ornithine – Urea Cycle
ar
Note:  “Rate-limiting enzyme (pacemaker enzyme) of Urea
ig
cycle: Carbamoyl phosphate synthetase I (CPS II is involved
in pyrimidine synthesis)” (Harper 29th/274, 28th/245)
nd

•• Phenylalanine
24. Ans:  a. Proline c. Isoleucine •• Methionine
[Ref: Harper 30th/16-22; Lippincott 6th/1-9; Satyanarayan 4th/ 48] •• Tryptoplan
ha

•• Cystine
Polar Amino Acids with Polar Side Chains
Note:  Methyl side chains and Methylene side chains are non polar
Acidic and Polar side chains
IC

side chains associated with non polar Amino acids.

Aspartic Acid
•• Glutamic Acid
25. Ans:  c. It involves in synthesis of cholesterol, d. It involves in
Basic and Polar side chains
PG

synthesis of steroids.
•• Arginine
•• Lysine [Ref: Harper 30th/267-69; Lippincott 6th/221-22; Satyanarayan 4th/310]
•• Histidine
Squalene
Uncharged & Polar side chains •• It is a natural 30-carbon organic compound originally
•• Asparginine obtained for commercial purposes primarily from shark
•• Glutamine liver oil (hence its name), although plant sources (primarily
•• Serine vegetable oils) are now used as well, including amaranth
•• Threonine seed, rice bran, wheat germ, and olives.
•• Tyrosine •• It is also found in high concentrations in the stomach oil of
Note:  Carboxyl side chains are associated with Acidic amino acids birds in the order Procellariiformes.
while Amino side chains are associated with Basic Amino acids, •• All plants and animals produce squalene as a biochemical
both of which are ‘Polar’ molecules. intermediate, including humans.
Non Polar Amino Acids with Non Polar side chains •• Squalene is a hydrocarbon and a triterpene, and is a natural
•• Glycine and vital part of the synthesis of all plant and animal
•• Alanine sterols, including cholesterol, steroid hormones, and
•• Valine vitamin D in the human body.
•• Leucine •• Squalene is used in cosmetics, and more recently as an
Answers
& •• Isoleucine immunologic adjuvant in vaccines.
Explanations •• Proline •• In animals, squalene is the biochemical precursor to the

346
 May  | 2016

whole family of steroids. Oxidation (via squalene mono
oxygenase) of one of the terminal double bonds of squalene
yields 2, 3-squalene oxide, which undergoes enzyme-
catalyzed cyclization to afford lanosterol, which is then
elaborated into cholesterol and other steroids.
Squalene: Main properties
–– www. scienceforlife
•• Squalene an omega 2 fatty acid has unlike omega 3 fish oils
more complete and effective chemical groups.
•• The biochemical structure of squalene is C30 H50 (C30:
6n-omega 2) all trans isoprenoid, that means a C30 polypre-
nyl compound hold 6 prenyl (better known as isoprenoid
or isoprene).
Application of Squalene
•• Anti-oxidation - powerful Anti-oxidant
•• Oxygen generator - vast recuperation
separation of protein molecules, purification of proteins &
molecular weight determinations” (Vasudevan 5th/485)
“Ultra centrifugation is an indispensable tool for the isolation
of subcellular organelles, proteins, & nucleic acids. In addition,
this technique is also employed in determination of molecular
weight of macromolecules” (Satyanarayan 4th/ 727)
“In order to understand the physical interactions between
protein partners involved in a typical biomolecular process,
the relative proximity of the molecules must be determined
more precisely than diffraction-limited traditional optical
imaging methods permit. The technique of fluorescence
resonance energy transfer (more commonly referred to by the
acronym FRET), when applied to optical microscopy, permits
determination of the approach between two molecules within
several nanometers, a distance sufficiently close for molecular
interactions to occur” (http://www. olympusmicro. com/)

e
•• Immune stimulator - good immune response Table ( Shinde 7th/774): Types of Electrophoresis and their
•• Fat regulator/energy modulator - natural vitality Applications

8/
Type Support Applications
Paper electro- Whatsman No. Detection of gross

h,
phoresis 3 or Cellulose abnormalities in plasma
ar acetate proteins in certain diseases,
membrane e. g. Multiple myeloma,
Cirrhosis, Nephrotic
ig
syndrome, etc
PAGE/SDS Polyacrylamide Separation and purification
nd

PAGE plain or SDS of individual proteins,

(Sodium dodecyl determination of molecular
sulphate) weight of purified
ha

impregnated gels polypeptides

Starch Hydrolyzed Starch Isozyme analysis
Agarose Agarose gel Separation of nucleic acids,
IC

Nucleotide sequencing
Immunoelec- Agarose, Detection and
trophoresis Acrylamide, characterization of antigens
PG

1. Rocket preformed (e.g. Plasma proteins,

2. Crossed microscopic slides enzymes, cell membrane Ag)
3. Immunofixa- or antibodies
tion
Isoelectric Laboratory made Phenotyping of α1-
focusing or preformed antitrypsin, Genetic variants
pH Gradient gels of enzymes, hemoglobins and
Fig.: (Satyanarayan): Outline of cholesterol biosynthesis of other proteins
Polyacrylamide or
26. Ans:  a. SDS-...., b. Gel filtration..., d. Ultracentrifugation... agarose

[Ref: Harper 30th/28; Shinde 7th/772-74; Satyanarayan 4th/ 725, 60;

Vasudevan 5th/482-85]
“SDS-PAGE is commonly used for molecular weight
determination of proteins” (Vasudevan 5th/482)
“SDS-PAGE is a popular technique for determination of
molecular weight of proteins” (Satyanarayan 4th/ 725)
“ Sodium dodecyl sulfate-polyacrylamide gel electrophoresis
(SDS-PAGE) is a reliable method for determining the molecular
weight (MW) of an unknown protein” (net)
“The gel filtration chromatography technique is used for-
27. Ans:  a. Agarose gel
[Ref: www. lonza. com/go/literature/2043; Shinde 7th/774]
Refer explanation (Table) of above Q
“Separation of RNA in agarose gels is used for a number of
different purposes, including Northern blots to monitor RNA
expression levels, checking RNA integrity and size selection
Answers
of RNA for cloning experiments. Separation of RNA based on &
fragment length requires conditions that are different from Explanations

347
 PGI Chandigarh Self-Assessment & Review: 2017–2013

DNA analysis. These include sample preparation, the use
of sample and gel denaturants, electrophoresis buffers, and
visualization. The purpose of the experiment and the size of the
RNA being separated are the primary drivers in determining
which denaturing system to use. The most frequently
used denaturants for RNA agarose gel electrophoresis are
formaldehyde, formaldehyde/formamide, and glyoxal plus
DMSO. In each system, the denatured RNA migrates through
the agarose gel in a linear relation to the log of its molecular
weight (similar to DNA). The most efficient RNA denaturant
is methylmercury hydroxide. Because of the hazards associated
with this denaturant, it is the least used system for RNA analysis”
(www. lonza. com/go/literature/2043)
28. Ans:  b. Breaking of high... d. Electrical gradient across ...
e. Passage of e- through FAD....
[Ref: Harper 30th/115-16; Lippincott 6th/72-77;Shinde 7th/313;
Compounds ∆ (Cal/mol)
Glucose 6-phosphate – 3. 3
Glycerol 3-phosphate – 2. 2
“Proton pump: Electron transport is coupled to the
phosphorylation of ADP by the transport (“pumping”) of
protons (H+) across the inner mitochondrial membrane from
the matrix to the inter membrane space at Complexes I, III,
and IV. This process creates an electrical gradient (with more
positive charges on the outside of the membrane than on the
inside) and a pH gradient (the outside of the membrane is at a
lower pH than the inside). The energy generated by this proton
gradient is sufficient to drive ATP synthesis. Thus, the proton
gradient serves as the common intermediate that couples
oxidation to phosphorylation. (Lippincott 6th/77-78)
The Intermediate Value for the Free Energy of Hydrolysis

e
of ATP Has Important Bioenergetic Significance
Satyanarayan 4th/222-25]

8/
–– Harper 30th/115-16
“In absence of O2 pyruvate is reduced to lactic acid (without •• An estimate of the comparative tendency of each of the
producing ATP). In anaerobic glycolysis, pyruvate acts as a phosphate groups to transfer to a suitable acceptor may be
temporary H-store. It dehydrogenates (oxidizes), the reduced

NADH + H+ back to oxidized NAD+, so that glycolysis can
continue even in absence of O2. In presence of O2, lactic acid can
be oxidized to pyruvic acid again” (Shinde 7th/313, 311)
“FAD accepts 2 electrons & 2 H+ in the dehydrogenases
ig
reaction in ETC forming FADH2” (Harper 30th/121)
“FADH2 produces 2 ATP during the ETC because it gives up
nd
h,
obtained from the ΔG0’ of hydrolysis at 37 °C. The value for
the hydrolysis of the terminal phosphate of ATP divides the
ar list into two groups.
•• Low-energy phosphates, exemplified by the ester
phosphates found in the intermediates of glycolysis, have
ΔG0’ values smaller than that of ATP, while in high-energy
phosphates the value is higher than that of ATP.

its electron to Complex II, bypassing Complex I. By bypassing •• The components of this latter group, including ATP, are
Complex I, we missed a chance to pump protons across the usually anhydrides (e.g., the 1-phosphate of 1, 3-bisphos-
membrane, so less protons have been pumped by the time we phoglycerate), enolphosphates (e.g., phosphoenolpyruvate),
ha

get to Complex IV. Protons still have been pumped, enough to and phosphoguanidines (e.g., creatine phosphate, arginine
fuel 2 ATP created by ATP synthase” (http://www. life. illinois. edu/) phosphate).
Table ( Harper 30th/116): Standard free Energy of Hydrolysis of Some
IC

Table ( Satyanarayan 4th/222-25):  Standard free Energy of Hydrolysis Organophosphates of Biochemical Importance
of Some Important Compounds
∆ G0’
PG

Compounds ∆ (Cal/mol)
High-energy phosphates Compound kJ/mol kcal/mol
Phosphenol pyruvate – 14. 8 Phosphoenolpyruvate -61. 9 -14. 8
Carbamoyl phosphate – 12. 3 Carbamoyl phosphate -51. 4 -12. 3
1, 3-Bisphosphoglycerate – 11. 8 1, 3-Bisphosphoglycerate (to -49. 3 -11. 8
Phosphocreatine – 10. 3 3-phosphoglycerate)

Acetyl phosphate – 10. 3 Creatine phosphate -43. 1 -10. 3

S-Adenosylmethionine – 10. 0 ATP → AMP + PPi -32. 2 -7. 7
Pyrophosphate – 8. 0 ATP → ADP + Pi -30. 5 -7. 3
Acetyl CoA – 7. 7 Glucose 1-phosphate -20. 9 -5. 0
ATP→ADP +Pi – 7. 3 PPi -19. 2 -4. 6
Low-energy phosphates Fructose 6-phosphate -15. 9 -3. 8
ADP→ AMP + PI – 6. 6 Glucose 6-phosphate -13. 8 -3. 3
Glucose 1-phosphate – 5. 0 Glycerol 3-phosphate -9. 2 -2. 2
Answers
& Fructose 6-phosphate – 3. 8
Explanations
29. Ans:  b. Increased fatty... c. ↑Lipopro..., e. High An....

348
 May  | 2016

[Ref: Harper 30th/ 231; Lippincott 6th/339, 345; Satyanarayan 4th/481,
682; Harrison 19th/ 2417-18]
Diabetic Ketoacidosis (DKA)
–– Harrison 19th/ 2417-18
•• DKA is characterized by hyperglycemia, ketosis, and
metabolic acidosis (increased anion gap) along with a
number of secondary metabolic derangements
•• Leukocytosis, hypertriglyceridemia, and hyperlipoprotein-
emia are commonly found as well
•• Ketosis results from a marked increase in free fatty acid
release from adipocytes, with a resulting shift toward
ketone body synthesis in the liver.
•• Reduced insulin levels, in combination with elevations in
catecholamines and growth hormone, increase lipolysis
and the release of free fatty acids. Normally, these free fatty
acids are converted to triglycerides or very-low-density
lipoprotein (VLDL) in the liver.
•• Increased lactic acid production also contributes to the
acidosis. The increased free fatty acids increase triglyceride
and VLDL production. VLDL clearance is also reduced
because the activity of insulin-sensitive lipoprotein lipase in
muscle and fat is decreased. Hypertriglyceridemia may be
severe enough to cause pancreatitis.

e
8/
h,
ar
ig
nd
ha
IC
PG

Fig (Lippincott): Intertissue relationships in type 1 diabetes

Table ( Harrison 19th/2417): Laboratory Values in Diabetic Ketoaci- DKA HHS

dosis (DKA) and Hyperglycemic Hyperosmolar State (HHS)
Chloride Normal Normal
(Representative Ranges at Presentation)
Phosphate Normal Normal
DKA HHS Creatinine Slightly ↑ Moderately ↑
Glucose, mmol/L (mg/dL) 13. 9–33. 3 33. 3–66. 6 Osmolality (mOsm/mL) 300–320 330–380
(250–600) (600–1200) Plasma ketones ++++ +/–
Sodium, meq/L 125–135 135–145 Serum bicarbonate, meq/L <15 meq/L Normal to
Potassium Normal to ↑ Normal slightly ↓ Answers
&
Magnesium Normal Normal Arterial pH 6. 8–7. 3 >7. 3 Explanations

349
 PGI Chandigarh Self-Assessment & Review: 2017–2013

DKA HHS Table: Temperature Effects on the Value of pH Buffers

Arterial PCO2,mmHg 20–30 Normal Temperature °C pH 4.00 pH 7.00 + pH 10.00

Anion gap [Na – (Cl + HCO3)] ↑ Normal to + 0.01 @ 0.01 @ 25 + 0.01 @
slightly ↑ 25°C(10) °C (10) 25°C(10)
10 4.00 7.07 10.18
• Large changes occur during treatment of DKA.
• Although plasma levels may be normal or high at presentation, total-body 15 4.00 7.04 10.14
stores are usually depleted. 20 4.00 7.02 10.06
“Hyper triacylglycerolemia: Not all the fatty acids flooding 25 4.00 7.00 10.00
the liver can be disposed of through oxidation or ketone
30 4.01 6.99 9.95
body synthesis. These excess fatty acids are converted to
triacylglycerol, which is packaged and secreted in very-low- 35 4.02 6.98 9.91
density lipoproteins (VLDL). Chylomicrons are synthesized 40 4.03 6.97 9.85
from dietary lipids by the intestinal mucosal cells following a 50 4.05 6.96 9.78
meal. Because lipoprotein degradation catalyzed by lipoprotein
lipase in the capillary beds of muscle and adipose tissue is low 60 4.08 6.96 9.75

e
in diabetics (synthesis of the enzyme is decreased when insulin
31. Ans:  a. It is a method..., c. Antibody-coated magnetic...,
levels are low), the plasma chylomicron and VLDL levels are

8/
d. Antibodies used are..., e. Magnetic field is appli...
elevated, resulting in hyper triacylglycerolemia” (Lippincott
6th/339-40) [Ref: www. sepmag. eu/blog/bid/. stackexchange. com]

h,
Fluorescent dyes are used in fluorescence-activated cell sorting
30. Ans:  b. Relative concentration..., d. A rise in H+ concentra-
tion.... ar Magnetic-activated Cell Sorting (MACS)
–– biology. stackexchange. com
[Ref: Harper 30th/10-13; Vasudevan 5th/362; Lippincott 6th/6; Sa-
•• MACS, is a procedure developed by Miltenyi Biotec to
tyanarayan 4th/710]
ig
separate cells from complex mixtures using antibody-
“When pH measured at room temperature there is no direct coated magnetic nano particles.
correlation between pH and temperature” (www. researchgate.
nd

•• The antibodies are specific for certain cell surface markers,

net) either expressed on your population of interest (positive
“Factor affecting pH of a buffer: The ratio of salt to acid selection), or expressed on undesired cell types (negative
ha

concentration- Actual concentrations of salt & acid in a buffer selection).

solution may be varying widely, with no change in pH, so long •• After adding the antibody-coated beads to the cell mixture
as the ratio of the concentrations remains the same” (Vasudevan and incubating, the suspension is added to a special single-
IC

5th/362) use separation column affixed to a magnet, to which the

Hydogen Ion Concentration beads stick, while unlabeled cells flow through.
–– (pH) Satyanarayan 4th/710 •• If performing a negative selection, the flow-through is your
PG

•• pH is defined as the negative logarithm of H+ ion
concentration
•• The pH is a narrow scale, ranging from 0 to 14 which
correspondences to 1M solution to 10-14 M solution of
[H+] concentration
•• Pure water has an equal concentration of H+& OH- ion i.e.,
10-7 M each. Thus pure water has a pH 7 which is neutral
•• Solution with pH less than 7 are said to be acidic while those
with pH greater than 7 are alkaline
•• It must be remembered that the term acidic or alkaline are
not absolute but only relative
•• A rise in H+ concentration decreases pH while a fall in H+
concentration increases pH. The reverse is true for OH-
concentration
“Temperature coefficient of variation of pH buffers: Although
the temperature coefficient variation of pH buffers may vary only
minimally over a wide span of temperatures in the acid region, it
may be quite dramatic in the alkaline region. The consequential
Answers
& error can be substantial in the alkaline region” (http://reagecon.
Explanations com/pdf/technical papers)
population of interest and the bound beads and cells are
discarded. If your cells of interest are bound to the beads
(positive selection), the column is washed several times
to make sure unbound or weakly-bound cells are washed
through, then the column is removed from the magnet and
the cell-bead complexes are eluted.
Magnetic-activated Cell Sorting (MACS)
–– http://www. biocompare. com/Bench-Tips/
•• Three major techniques have emerged as most widely
used for separation of specific cells within a complex cell
mixture: centrifugation-based, fluorescence-activated cell
sorting (FACS), and magnetic cell separation.
•• FACS and magnetic cell separation are far more specific
than centrifugation, as the methodologies utilize conjugated
antibodies that specifically recognize the target cells. Using
FACS, cells are separated based on the expression of several
antigens simultaneously.
•• Magnetic separation is limited to one or two antigens, but has
multiple advantages over FACS, including a much shorter
processing time, a simpler platform, and significantly lower

350
 May  | 2016

cost. As magnetic separation is becoming a more widely

adopted technique, here are four important points to
consider when performing this method.
“In fluorescence-activated cell sorting or FACS, the initial
complex cell mixture is first labeled with one or more cell
33. Ans:  a. miRN..., b. Si RNA..., c. tRNA..., e. rRNA...,
surface marker-specific antibodies that have been conjugated
to fluorescent dyes. Cells can also be analyzed that express one
or more recombinant fluorescent proteins in conjunction with
a gene of interest, allowing for selection of cells without using
antibodies. After incubation and wash steps, red blood cells are
lysed, if analyzing whole blood. ”
32. Ans:  All (a. b. c. d. e. )
[Ref: www. gelifesciences. com/gehcls_images; https://en. wikipedia. org]
“Silver staining is a highly sensitive method for detecting
proteins and nucleic acids (dsDNA & RNA) in polyacrylamide
Immunogenetics &
Molecular Biology
[Ref: Harper 30th/394-95, 368; en. wikipedia. org; Lippincott 6th/417]
RNA Exists in two Major Classes
–– Harper 30th/394
•• All eukaryotic cells have two major classes of RNA, the
protein coding RNAs, or messenger RNAs (mRNAs),
and two forms of abundant non-protein coding RNAs
delineated on the basis of size: the large ribosomal RNAs
(rRNA) and long noncoding RNAs (lncRNAs) and small
noncoding RNAs transfer RNAs (tRNA), the small nuclear
RNAs (snRNAs) and the micro and silencing RNAs

e
slab gels” (http://www. bio-rad. com) (miRNAs and siRNAs).
“Silver staining is the use of silver to selectively alter the •• The mRNAs, rRNAs and tRNAs are directly involved in

8/
appearance of a target in microscopy of histological sections; protein synthesis while the other RNAs are participate in
in temperature gradient gel electrophoresis; and in poly either mRNA splicing (SnRNAs) or modulation of gene
acrylamide gels” (wiki) expression by altering mRNA function (mi/SiRNAs) and/or

h,
“Silver staining is the most sensitive method for permanent expression (lncRNAs). These RNA differ in their diversity,
staining of proteins or nucleic acids in poly acrylamide gels”- ar stability, and abundance in cells.
(www. gelifesciences. com)
Silver Staining: Application Table (Harper 30th/395): Classes of Eukaryotic RNA
ig
–– wiki
•• Histological characterization: Silver staining aids the
nd

RNA Types Abundance Stability

visualization of targets of interest, namely intracellular
and extracellular cellular components such as DNA and Protein coding RNA
proteins, such as type III collagen and reticulin fibres by
ha

Messenger ≥ 105 Different 2 – 5% of total Unstable to

the deposition of metallic silver particles on the targets of
(mRNA) species very stable
interest.
IC

•• Diagnostic microbiology: Pseudomonas, Legionella, Nonprotein coding RNAs (ncRNAs)

Leptospira, H. pylori, and fungi such as Pneumocystis and
Candida are organisms that are stained with silver Large ncRNAs
•• Karyotype analysis: Silver staining is used in karyotyping.
PG

Ribosomal 28S, 18S, 5.8S, 80% of total very stable

Silver nitrate stains the nucleolar organization region (rRNA) 5S
(NOR)-associated protein, producing a dark region wherein
the silver is deposited and denoting the activity of rRNA IncRNAs ~1000s ~1 – 2% Unstable to
genes within the NOR. Human chromosomes 13, 14, 15, 21, very stable
and 22 have NORs, which increase the silver stain activity Small ncRNAs
by at least 50 times
•• Genomic and proteomic analysis: Silver staining is used to Transfer RNAs ~60 Different ~15% of total very stable
stain gels species
“Silver staining is used to detect proteins after electrophoretic
Small nuclear ~ 30 Different ≤1% of total very stable
separation on poly acrylamide gels. It combines excellent
(mi/SiRNAs) Species
sensitivity (in the low nanogram range) whilst using very simple
and cheap equipment and chemicals” (http://www. ncbi. nlm. nih. Micro/ 100s - 1000 <1% of total Stable
gov) Silencing (mi/
SiRNAs)

Answers
&
Explanations

351
 PGI Chandigarh Self-Assessment & Review: 2017–2013

34. Ans:  c. Fragment 5 S ..., d. tRNA ....
[Ref: Harper 30th/395-98; Lippincott 428]
“RNA polymerase III: This enzyme synthesizes tRNA, 5S
rRNA, and some snRNA and snoRNA” (Lippincott 428)
increasing their reactivity as acceptors for peptidyl transferase”
(nature. com/nrmicro)
Table ( Shinde 7th/435): Comparison of Translation in Eukaryotes
and Prokaryotes. Mitochondria are Similar to Prokaryotes

Table ( Harper 30th/398): Mammalian Nuclear DNA-Dependent RNA Features Eukaryotes Prokaryotes Mitochondria
Polymerases. (mammalian (bacteria)
cells)
Form of RNA Polymerase Major Products DNA Open Circular Circular
I rRNA Ribosomes 80S 70S 70S
II mRNA, IncRNA, miRNA, SnRNA tRNA (No. ) 31 22 22
III tRNA, 5S rRNA Initiating Methionine Formyl Formyl
amino acid Methionine Methionine
35. Ans:  b. Hydrogen..., Effect of Not affected Inhibited Inhibited
tetracycline
[Ref: Harper 30th/359; Lippincott 6th/396-97; Satyanarayan 4th/75]

e
Initiation 10 3
“The two strands are held together by hydrogen bond formed by factors

8/
complementary base pairs” (Satyanarayan 4th/75)
Elongation EF-1 alpha, EF-1 EF-Tu; EF-Ts
“The base pairs are held together by hydrogen bonds: two
factors beta, EF-1 gamma
between A and T and three between G and C. These hydrogen

h,
EF-2
bonds, plus the hydrophobic interactions between the stacked
bases, stabilize the structure of the double helix”(Lippincott 6th/ ar Steps in Protein Synthesis
397) –– Lippincott 6th/438-42
•• The process of protein synthesis translates the three-
ig
letter alphabet of nucleotide sequences on mRNA into the
20-letter alphabet of amino acids that constitute proteins.
nd

The mRNA is translated from its 5’-end to its 3’-end,

producing a protein synthesized from its amino-terminal
end to its carboxyl-terminal end.
ha

•• Prokaryotic mRNAs often have several coding regions, that

is, they are polycistronic. Each coding region has its own
initiation and termination codon and produces a separate
IC

species of polypeptide.
•• In contrast, each eukaryotic mRNA has only one coding
region, that is, it is monocistronic. The process of translation
PG

is divided into three separate steps: initiation, elongation,

Fig.: (Lippincott 6th/ 397): Two complementary DNA sequences
36. Ans:  a. N-formyl methionin..., e. Three initiation....
[Ref: Harper 30th/419-23; Lippincott 6th/438-42; Satyanarayan 4th/554-
60]
“In eukaryotes, the first amino acid incorporated is methionine
(AUG codon). But in prokaryotes, the same codon attracts
N-formyl methionine, which is the first amino acid” (Vasudevan
5th/432)
“Elongation factor P is a prokaryotic protein translation factor
required for efficient peptide bond synthesis on 70S ribosomes
Answers from fMet-tRNAf Met. It probably functions indirectly by
& (designated eIF to indicate eukaryotic origin). Eukaryotes
Explanations altering the affinity of the ribosome for aminoacyl-tRNA, thus
and termination.
•• Eukaryotic protein synthesis resembles that of prokaryotes
in most aspects. One important difference is that
translation and transcription are coupled in prokaryotes,
with translation starting before transcription is completed.
Coupling is a consequence of the lack of a nuclear membrane
in prokaryotes.
Initiation
•• Initiation of protein synthesis involves the assembly of
the components of the translation system before peptide
bond formation occurs. These components include the
two ribosomal subunits, the mRNA to be translated, the
aminoacyl-tRNA specified by the first codon in the message,
GTP (which provides energy for the process), and initiation
factors that facilitate the assembly of this initiation complex
•• In prokaryotes, three initiation factors are known (IF-1,
IF-2, and IF-3), whereas in eukaryotes, there are over ten
also require ATP for initiation.

352
 May  | 2016

Translocation
•• The now deacylated tRNA is attached by its anticodon to the
P site at one end and by the open CCA tail to an exit (E) site
on the large ribosomal subunit. At this point, elongation
factor 2 (EF2) binds to and displaces the peptidyl tRNA
from the A site to the P site. In turn, the deacylated tRNA is
on the E site, from which it leaves the ribosome.
•• The EF2-GTP complex is hydrolyzed to EF2-GDP,
effectively moving the mRNA forward by one codon and
leaving the A site open for occupancy by another ternary
complex of amino acid tRNA-EF1A-GTP and another cycle
of elongation.
Materials Required for Protein Synthesis
–– (Shinde)
•• Amino acids
•• DNA & 3 RNAs (m-RNA, t-RNA, r-RNA)
•• Elongation
•• Termination
•• Post-translational processing
37. Ans:  a. PCR ..., b. Real time ....
[Ref: Harper 30th/458; Robbins 9th/180; Lippincott 6th/479;Harrison
19th/ 150e-7; http://link. springer. com]
“Introduction of a foreign DNA molecule into a replication cell
permits the cloning or amplification of DNA” (Lippincott 6th/467)
“ELISA: Detects proteins(antigens) or antibodies” (Lippincott
6th/485)
“Real-time PCR automates the laborious process of amplifica-
tion by quantitating reaction products for each sample in every
cycle” (Shinde 7th/269)
Nucleic Acid Amplification Test (NAAT) Strategies
–– Harrison 19th/ 150e-7

e
•• Polyribosomes (polysomes)
•• There are several methods for amplification (copying)
•• Enzymes: Aminoacyl-t-RNA synthetase, peptidyl transferase

8/
of small numbers of molecules of nucleic acid to readily
•• Factors
detectable levels. These NAATs include PCR, LCR, strand
 Initiation facors- I F 1 to 3(For prokaryotes)
displacement amplification, and self-sustaining sequence
10 initiation factors for eukaryotes (elF-1, elF-2, elF-3,

h,

replication.
elF-4A, elF-4B, elF-4G, elF- 4E, elf-5)
•• In each case, exponential amplification of a pathogen-
 Elongation factors-EF1 & EF2 (for eukaryotes)
 Release factors R1 & R2
ar specific DNA or RNA sequence depends on primers that
anneal to the target sequence. The amplified nucleic acid
ƒƒ Coenzymes & cofactors; FH4 Mg2+
can be detected after the reaction is complete or (in real-
ig
•• Energy
time detection) as amplification proceeds. The sensitivity of
 ATP,GTP
NAATs is far greater than that of traditional assay methods
nd

Steps of Translation (Protein synthesis) such as culture.

•• Activation of amino acids
•• Initiation
ha

Table ( Harrison 18th/): Techniques Commonly Used for Mutation Detection

IC

Method Principle Type of Mutation Detected

Polymerase chain Amplification of DNA segment Expansion of triplet repeats, variable number of tandem repeats
PG

reaction (PCR) (VNTR), gene rearrangements, translocations; prepare DNA for

other mutation methods
Reverse Reverse transcription, amplification of DNA segment Analyze expressed mRNA (cDNA) sequence; detect loss of
transcriptase PCR → absence or reduction of mRNA transcription expression
(RT-PCR)
Traditional DNA Direct sequencing of PCR products Point mutations, small deletions and insertions
sequencing Sequencing of DNA segments cloned into plasmid
vectors
Next-generation Sequencing of large contiguous genomic regions, Deep sequencing for detection of mutations and SNPs.
DNA sequencing exome of single or all chromosomes. Sequencing of whole genomes of microorganisms

Table: Nucleic Acid Amplification Methods

Amplification Amplification Manufacturer/license (trade Enzymes used Temperature Nucleic acid target
method category mark) requirement
Polymerase chain Target Roche Molecular System, Inc., Taq DNA polymerase Thermal cycler DNA or RNA
reaction (PCR) Branchburg, NJ, USA (A mplicor)
Answers
&
Explanations

353
 PGI Chandigarh Self-Assessment & Review: 2017–2013

Amplification Amplification Manufacturer/license (trade Enzymes used Temperature Nucleic acid target
method category mark) requirement
Transcription- Target Gen-Probe, Inc., San Diego. CA, Reverse transcriptase, Isothermal RNA or DNA
mediated USA RNA polymerase.
amplification (APTIMA) RNase H
(TMA)
Nucleic acid Target Organon-Teknika. Corp., Durham, Reverse transcriptase, Isothermal RNA or DNA
sequence—based NC, USA (Nuclisens) RNA polymerase,
amplification RNase H
(NASBA)
Strand Target Becton-Dickinson, Sparks, MD, Restrictive Isothermal DNA or RNA
displacement USA (ProbTec) endonucleonase, DNA
amplification (SDA) polymerase
Invader technology Probe Third Wave. Madison. WI, USA Cleavage Isothermal DNA

Cycling probe Probe ID Biomedical Corp., Vancouver, RNase H Isothermal DNA or RNA

e
technology (CPT) Canada

8/
Ligase chain Probe Abbott Laboratories, Abbott Park, DNA ligase Thermal cycler DNA or RNA
reaction (LCR) IL, USA (LCx)

h,
Hybrid capture Signal Digene Diagnostics, Inc., Silver None Isothermal DNA
system Spring, MD. USA ar
Branched DNA Signal Chiron Corp., Emeryville. CA, USA None Isothermal DNA or RNA
(bDNA)
ig
38. Ans:  a. Ca2+ ..., II. Hormones that bind to cell surface receptors
nd

  A. The second messenger is cAMP

[Ref: Harper 30th/501, 91-92, 179, 343; Lippincott 6th/94-95]
   a2 Adrenergic catecholamines
Second Messenger    b-Adrenergic catecholamines
ha

   Adrenocorticotropic hormone (ACTH)

–– Lippincott 6th/91    Antidiuretic hormone (vasopressin)
•• Nucleotides, such as cyclic adenosine mono-phosphate    Calcitonin
IC

(cAMP) and cyclic guanosine monophosphate (cGMP),    Chorionic gonadotropin hormone (CGH)
serve as second messengers in signal transduction pathways.    Corticotropin-releasing hormone
•• “Second messenger” molecules—so named because    Follicle-stimulating hormone (FSH)
   Glucagon
they intervene between the original messenger (the
PG

   Lipotropin (LPH)
neurotransmitter or hormone) and the ultimate effect on the    Luteinizing hormone (LH)
cell—are part of the cascade of events that translates hormone    Melanocyte-stimulating hormone (MSH)
or neurotransmitter binding into a cellular response. Two of    Parathyroid he (PTH)
the most widely recognized second messenger systems are    Somatostatin
the calcium/phosphatidy linositol system, and the adenylyl    Thyroid-stimulating hormone (TSH)
cyclase system, which is particularly important in regulating   B. The second messenger is cGMP
the pathways of intermediary metabolism.    Atrial natriuretic factor
   Nitric oxide
Table ( Harper 30th/501): Classification of Hormones by Mechanism
  C. The second messenger is calcium or phosphatidylinositols (or
of Action both)
   Acetylcholine (muscuranic)
I. Hormones that bind to intracellular receptors    a1 -Adrenergic catecholamines
 Androgens    Angiotensin II
 Calcitriol (1,25[OH],-D3).    Antidiuretic hormone (vasopressin)
 Estrogens    Cholecystokinin
 Glucocorticoids    Gastrin
 Mineralocorticoids    Gonadotropin-releasing hormone
 Progestins    Oxytocin
 Retinoic acid    Platelet-derived growth factor (PDGF)
Answers
&  Thyroid hormones (T3 and T4)    Substance P
Explanations    Thyrotropin-releasing hormone (TRH)

354
 May  | 2016

  D. The second messenger is a kinase or phosphatase cascade Not punctuated

   Adiponectin
Universal
   Chorionic somatomammotropin
   Epidermal growth factor (EGF)
   Erythropoietin (EPO) 40. Ans:  a. dsDNA
   Fibroblast growth factor (FGF) [Ref: Lippincott 6th/465-66; Harper 30th/ 452-54;Satyanarayana 3rd /
   Growth hormone (GH) 580]
   Insulin
   Insulin-like growth factors I and II “Restriction endonucleases (restriction enzymes), which cleave
   Leptin double-stranded (ds) DNA into smaller, more manageable
   Nerve growth factor (NGF) fragments, has opened the way for DNA analysis” (Lippincott
   Platelet-derived growth factor 6th/465)
   Prolactin Restriction enzyme (RE or Restriction Endonuclease)
•• It is an enzyme that cleave double-stranded DNAQ at
39. Ans:  c. It is nucleotide sequence which...,
specific recognition nucleotide known as restriction sitesQ.
[Ref: Harper 30th/413-15; Lippincott 6th/431-34] •• To cut the DNA, a restriction enzyme makes two incisions,
“Mendelian genetics (or Mendelian inheritance or Mendelism) one through each sugar-phosphate backboneQ (i.e.. each

e
is a theory of genetic inheritance which was developed by Gregor strand) of the DNA double helix. This enzyme can restrict
Mendel. Mendelian Genetics is widely regarded as the corner viral replication so called restriction enzymes.

8/
stone of classical genetics. It is a set of primary beliefs relating •• The cut DNA fragments by RE may have sticky ends
to the transmission of hereditary characteristic from parent (cohesive ends)Q or blunts endsQ depending on the
mechanism used by enzyme

h,
organisms to their offspring; it underlies much of genetics”
(www. innovateus. net/science) •• DNA fragments with sticky ends are particularly useful for
recombinant DNA experiments (hybrid or chimeric DNA
Mendelian Genetics
ar molecules)
–– anthro. palomar. edu/mendel
•• Restriction enzyme is named according to the organism
Inheritance patterns which can be explained by simple rules of
ig
from which it was isolated.
dominance and recessiveness of genes.
nd

Genetic Code
–– Lippincott 6th/431-34
•• The genetic code is a dictionary that identifies the
ha

correspondence between a sequence of nucleotide bases

and a sequence of amino acids. Each individual “word”
in the code is composed of three nucleotide bases. These
IC

genetic words are called codons.

•• The process of translation requires a genetic code, through
which the information contained in the nucleic acid
sequence is expressed to produce a specific sequence of
PG

amino acids.
The Nucleotide Sequence of an mRNA Molecule Consists
of a Series of Codons That Specify the Amino Acid
Sequence of the Encoded Protein
–– Harper 30th/414
•• There are 64 (43) specific codons. Fig.: (Lippincott 6th/465)
•• It is now known that each codon consists of a sequence of
three nucleotides; i.e, it is a triplet code. The deciphering of 41. Ans:  d. Phosphati....
the genetic code depended heavily on the chemical synthesis
[Ref: Harper 30th/501, 91-92, 179, 343; Lippincott 6th/207-08]
of nucleotide polymers, particularly triplets in repeated
sequence. These synthetic triplet ribonucleotides were used Phosphatidyl-inositol is a Type of Phospholipid
to program protein synthesis, allowing investigators to –– Shinde 7th/45 Lippincott 6th/207-08:Writes
deduce the genetic code. •• Phospholipases hydrolyze the phosphodiester bonds of
Table (Harper 30th/ 415): Features of the Genetic Code phosphoglycerides, with each enzyme cleaving the phos-
pholipid at a specific site.
Degenerate •• Phospholipases release molecules that can serve as
Unambiguous
messengers (for example, DAG and IP3), or that are
Answers
the substrates for synthesis of messengers (for example, &
Nonoverlapping arachidonic acid). Explanations

355
 PGI Chandigarh Self-Assessment & Review: 2017–2013

[Note:  Phospholipases are responsible not only for degrading phospholipids, but also for “remodeling” them. For example, phospholipases
A1 and A2 remove specific fatty acids from membrane-bound phospholipids; these can be replaced with alternative fatty acids using
fatty acyl CoA transferase

e
Fig.: (Lippincott 6th/207): Degradation of glycerophospholipids by phospholipases

8/
42. Ans:  b. DNA poly..., d. DNA lig..., Mechanism Problem Solution
Double-strand Ionizing radiation, Synapsis, unwinding,

h,
[Ref: Harper 30th/382, 389-92; Lippincott 6th/ 411-13]
break repair chemotherapy, alignment, ligation
“Repair of damaged DNA: When the strand containing ar oxidative free
the mismatch is identified, an endonuclease nicks the strand radicals
and the mismatched nucleotide(s) is/are removed by an
ig
exonuclease. Additional nucleotides at the 5’- and 3’-ends of
the mismatch are also removed. The gap left by removal of the
nd

nucleotides is filled, using the sister strand as a template, by a

DNA polymerase. The 3’-hydroxyl of the newly synthesized
DNA is joined to the 5’-phosphate of the remaining stretch of
ha

the original DNA strand by DNA ligase” (Lippincott 6th/ 411)

Damage to DNA by environmental, physical, and chemical
agents may be classified into four types. Abnormal regions of
IC

DNA, either from copying errors or DNA damage, are replaced

by four mechanisms: (1) mismatch repair, (2) base excision-
repair, (3) nucleotide excision-repair, and (4) double-strand
PG

break repair. These mechanisms exploit the redundancy of

information inherent in the double helical DNA structure. The
defective region in one strand can be returned to its original
form by relying on the complementary information stored in
the unaffected strand.
Table (Harper 30th/382): Mechanism of DNA Repair

Mechanism Problem Solution

Mismatch repair Copying errors Methyl-directed strand
(single base or two- cutting, exonuclease
to five-base unpaired digestion, and
loops) replacement
Base excision– Spontaneous, Base removal by
repair chemical, or N-glycosylase, a
radiation damage to basic sugar removal,
a single base replacement
Nucleotide Spontaneous, Removal of an
Answers
excision–repair chemical, or approximately
& radiation damage to 30-nucleotide oligomer
Explanations a DNA segment and replacement Fig.: (Lippincott 6th/ 412): Nucleotide excision repair of pyrimidine
dimers in E. coli DNA.

356
 May  | 2016

Table (Harper 30th/382): Classes of Proteins Involved in Replication.

Protein Function
DNA polymerases Deoxynucleotide polymerization
Helicases Processive unwinding of DNA
Topoisomerases Relieve torsional strain that results from
helicase-induced unwinding
DNA primase Initiates synthesis of RNA primers
Single-strand binding Prevent premature reannealing of dsDNA
proteins
DNA ligase Seals the single strand nick between the
nascent chain and Okazaki fragments on
lagging strand

43. Ans:  a. DNA d. Histone

e
[Ref: Harper 30th/371-72; Lippincott 6th/ 409]

8/
“Histones are highly alkaline proteins found in eukaryotic cell
nuclei that package and order the DNA into structural units
called nucleosomes. They are the chief protein components

h,
of chromatin, acting as spools around which DNA winds,
and playing a role in gene regulation. Without histones, the
ar unwound DNA in chromosomes would be very long (a length
to width ratio of more than 10 million to 1 in human DNA)”
ig
The Nucleosome Contains Histone & DNA
nd

–– Harper 30th/371-72
•• When the histone octamer is mixed with purified dsDNA
under appropriate ionic conditions, the same x-ray
ha

diffraction pattern is formed as that observed in freshly

isolated chromatin. Biochemical and electron microscopic
studies confirm the existence of reconstituted nucleosomes.
IC

Furthermore, the reconstitution of nucleosomes from DNA

and histones
•• H2A, H2B, H3, and H4 is independent of the cor cellular
PG

origin of the various components. Neither the histone

H1 nor the nonhistone proteins are necessary for the
reconstitution of the nucleosome core.
•• In the nucleosome, the DNA is super coiled in a left handed
helix over the surface of the disk-shaped histone octamer.
The majority of core histone proteins interact with the DNA
on the inside of the super coil without protruding, although
the amino terminal tails of all the histones are thought
to extend outside of this structure and are available for
regulatory PTMs

Fig.: (Lippincott 6th/ 411):   Methyl-directed mismatch repair

Answers
&
Explanations

357
 PGI Chandigarh Self-Assessment & Review: 2017–2013

Fig.: (Harper 30th/371):

Model for the structure of the nucleosome, in which DNA is wrapped around the surface of a protein cylinder consisting of two each of
histones H2A, H2B, H3, and H4 that form the histone octamer. The ~145 bp of DNA, consisting of 1. 75 superhelical turns, are in contact
with the histone octamer. The position of histone H1, when it is present, is indicated by the dashed outline at the bottom of the figure.

e
Histone H1 interacts with DNA as it enters and exits the nucleosome.

8/
Pathology

h,
44. Ans:  d. Plate..., ar
[Ref: Robbins 9th/83; Harshmohan 7th/123; A. K. Jain 6th/762; Ananthanarayan 9th/164]
Mast cell secretes serotonin only in rodents (not in human)
ig
“Serotonin :It is found in the intestinal mucosa, brain tissue & platelets” (Ananthanarayan 9th/ 164)
“About 90% of body’s content of serotonin is localized in the intestine; most of the rest is in platelets & brain. Platelets do not synthesize
nd

serotonin but acquire it by uptake during passage through intestinal blood vessels” (KDT 7th/170)
“Serotonin: It is present in tissue like chromaffin cells of GIT, spleen, nervous tissue, mast cells & plateles” (Harshmohan 7th/123)
“Serotonin: It carries signals along and between nerves - a neurotransmitter. It is mainly found in the brain, bowels and blood platelets”
ha

(http://www. medicalnewstoday. com/articles/232248. php)

IC
PG

Fig.: (Robbins): Chemical mediators of inflammation. EC, endothelial cells.

Answers
&
Explanations

358
 May  | 2016

Serotonin System Disorder

–– Robbins 9th/83
•• Serotonin (5-hydroxytryptamine) is a preformed vasoactive
mediator with actions similar to those of histamine. It is
present in platelets and enterochromaffin cells, and in mast
cells in rodents but not humans.
•• Release of serotonin (and histamine) from platelets is
stimulated when platelets aggregate after contact with
collagen, thrombin, adenosine diphosphate (ADP), and
antigen-antibody complexes. Platelet aggregation and
release are also stimulated by platelet activating factors
(PAF) derived from mast cells during IgE-mediated
reactions.
Ehlers-Danlos syndrome (some variants)
Osteogenesis imperfecta
Achondroplasia
Metabolic Familial hyper cholesterolemia
Acute intermittent porphyria
46. Ans:  b. Deposition of..., c. Often resistant..., d. Common in
elderly..., e. Risk of falling....
[Ref: Davidson 22nd/252, 1195;Robbins 9th/1295-96; Harrison 19th/170-
74, 2605-06; Harshmohan 7th/877; CMDT 2016/1003]

45. Ans:  a. Sickle cell ..., b. Phenylket..., “Around half of people with DLB experience freezing while they
are moving & this put them at risk of falling” (www. lewybody.
[Ref: Robbins 9th/141; Harshmohan 7th/255; Davidson 22nd/53] org/node)

e
Table (Robbins 9th/141): Autosomal Recessive Disorders

8/
Table (CMDT 2016/1003): Common Causes of Age-related Dementia
System Disorder
Disorder Pathology Clinical Features
Metabolic Cystic fibrosis

h,
Alzheimer Plaques containing • Most common age-related
Phenylketonuria
ar disease beta-amyloid peptide, neurode generative
Galactosemia and neurofibrillary disease; incidence
Homocystinuria tangles containing doubles every 5 years
tau protein, occur after age 60
ig
Lysosomal storage diseases throughout the • Short-term memory
α1-Antitrypsin deficiency neocortex impairment is early and
nd

prominent in most cases

Wilson disease • Uriable deficits of
Hemochromatosis executive function,
ha

visuospatial function, and

Glycogen storage diseases
language
Hematopoietic Sickle cell anemia
IC

Thalassemias Vascular Multifocal ischemic • Stepwise or progressive

dementia change accumulation of cognitive
Endocrine Congenital adrenal hyperplasia deficits in association with
Skeletal Ehlers-Danlos syndrome (some variants) repeated strokes
PG

• Symptoms depend on
Alkaptonuria localization of strokes
Nervous Neurogenic muscular atrophies
Friedreich ataxia Dementia Histologically • Cognitive dysfunction,
Spinal muscular atrophy with Lewy indistinguishable from with prominent
bodies Parkinson disease: visuospatial and executive
alpha-synuclein- deficits
Table (Robbins 9th/141): Autosomal Dominant Disorders containing Lewy • Psychiatric disturbance,
bodies occur in the with anxiety, visual
System Disorder brainstem, midbrain, hallucinations, and
Nervous Huntington disease olfactory bulb, and fluctuating delirium
Neurofibromatosis neocortex. Alzheimer • Parkinsonian motor
Myotonic dystrophy pathology may deficits with or after other
Tuberous sclerosis coexist. features
• Cholinesterase inhibitors
Urinary Polycystic kidney disease lessen delirium; poor
Gastrointestinal Familial polyposis coli tolerance of many
psychoactive medications,
Hematopoietic Hereditary spherocytosis
including neuroleptics and
von Willebrand disease Answers
dopaminergics &
Skeletal Marfan syndrome Explanations

359
 PGI Chandigarh Self-Assessment & Review: 2017–2013
Dementia with Lewy Body
–– Robbins 9th/1295-96
•• About 10% to 15% of individuals with PD develop dementia,
particularly with advancing age
•• Characteristic features of this disorder include a fluctuating
course, hallucinations & prominent frontal signs
Lewy Body Dementia
–– Davidson 22nd/252
•• This is a neuro degenerative disorder clinically characterized
by dementia and signs of Parkinson’s disease.
•• The cognitive state often fluctuates and there is a high
incidence of visual hallucinations.
•• Affected individuals are particularly sensitive to the
side-effects of anti-Parkinsonian medication and also to
antipsychotic drugs.
•• The condition is associated with accumulation of abnormal
protein aggregates in neurons that contain the protein
α-synuclein in association with other proteins including
ubiquitin.
•• The condition is often inherited and mutations in the
α-synuclein and β-synuclein genes have been identified in
affected patients.
•• There is no specific treatment but anticholinesterase agents
may well be helpful.
Dementia with Lewy Bodies (DLB)
ig
–– Harrison 19th/2605-06
•• The DLB clinical syndrome is characterized by visual
nd
hallucinations, parkinsonism, fluctuating alertness, falls etc
•• In DLB, dementia and neuropsychiatric syndrome precede
the parkinsonism
ha
•• The key neuropathologic feature in DLB is the presence of
Lewy bodies and Lewy neurites
IC
47. Ans:  
a. More common..., b. Impairment of the ability...,
d. General cognitive..., e. Atrophy of frontal...
[Ref: Robbins 9th/1287-92; Harrison 19th/2598-2602; Harshmohan
PG
7th/876-77; CMDT 2016/1003]
•• “Alzheimer disease: The key clinical feature is impairment
of the ability to remember new information. Hence, patients
present with gradual impairment of memory, usually in
association with disorders of other cortical functions.
Short-term & long-term memory are both affected, but
the defects in former are usually more obvious (Davidson
22nd/252)
•• “Alzheimer disease (AD):Short-term memory impairment
is early and prominent in most cases.” (CMDT 2016/1003)
“Alzheimer disease (AD) is the most common cause of dementia
in the elderly. The disease usually becomes clinically apparent
as insidious impairment of higher intellectual function,
with alterations in mood and behavior. Later, progressive
disorientation, memory loss, and aphasia indicate severe
cortical dysfunction, and eventually, in 5 to 10 years, the patient
becomes profoundly disabled, mute, and immobile” (Robbins
Answers 9th/1287)
& “Macroscopic examination of the brain shows a variable degree
Explanations
of cortical atrophy with widening of the cerebral sulci that is
360
most pronounced in the frontal, temporal, and parietal lobes.
With significant atrophy, there is compensatory ventricular
enlargement (hydrocephalus ex vacuo) secondary to loss of
parenchyma. The major microscopic abnormalities of Alzheimer
disease are neuritic (senile) plaques, neurofibrillary tangles,
and amyloid angiopathy” (Robbins 9th/1288)
Alzheimer’s Disease
–– Harrison 19th/2598-2602
•• Approximately 10% of all persons over the age of 70 years
have significant memory loss, and in more than half, the
cause is Alzheimer’s disease (AD).AD can manifest as
young as the third decade, but it is the most common cause
of dementia in the elderly.
•• In the early stages of typical amnestic AD, the memory
loss may go unrecognized or be ascribed to benign
forgetfulness of aging. Once the memory loss becomes
e
noticeable to the patient and spouse and falls 1. 5 standard
deviations below normal on standardized memory tests,
8/
the term mild cognitive impairment (MCI) is applied. This
construct provides useful prognostic information, because
approximately 50% of patients with MCI (roughly 12% per
h,
year) will progress to AD over 4 years.
ar
48. Ans:  b. More common...,
[Ref: Robbins 9th/694-95;Davidson 22nd/719-20; Harrison 19th/ 1681-
83]
“The pathology of HP is consistent with both type III & type IV
immunological mechanism. For reasons that remain uncertain,
there is a lower incidence of HP in smoker than non-smoker.
Clinical features includes influenza like symptoms accompanied
by cough, breathlessness & wheeze”- Davidson 22nd/719
Hypersensitivity Pneumonitis
–– Robbins 9th/694-95
•• The term hypersensitivity pneumonitis describes a spectrum
of immunologically mediated, predominantly interstitial,
lung disorders caused by intense, often prolonged exposure
to inhaled organic antigens.
•• Most commonly, hypersensitivity results from the inhalation
of organic dust containing antigens made up of the spores
of thermophilic bacteria, fungi, animal proteins, or bacterial
products.
•• Bronchoalveolar lavage specimens from the acute phase
show increased levels of proinflammatory chemokines such
as macrophage inflammatory protein 1α and IL-8.
•• Bronchoalveolar lavage specimens also consistently
demonstrate increased numbers of both CD4+ and CD8+
T lymphocytes.
•• The presence of noncaseating granulomas in two thirds
of the patients suggests that T-cell–mediated (type IV)
hypersensitivity reactions against the implicated antigens
are also common and have a pathogenic role.
•• The clinical manifestations are varied. Acute attacks, which
follow inhalation of antigenic dust in sensitized patients,
consist of recurring episodes of fever, dyspnea, cough, and
leukocytosis.
 May  | 2016

Hypersensitivity Pneumonitis (HP)
–– Harrison 19th/ 1681-83
•• HP has been traditionally categorized as having acute,
subacute, and chronic forms.
•• Acute HP usually manifests itself 4–8 h following exposure
to the inciting antigen, often intense in nature. Systemic
symptoms, including fevers, chills, and malaise, are
prominent and are accompanied by dyspnea. Symptoms
resolve within hours to days if no further exposure to the
offending antigen occurs.
•• In subacute HP resulting from ongoing antigen exposure,
the onset of respiratory and systemic symptoms is typically
more gradual over the course of weeks.
•• Chronic HP can present with an even more gradual onset
of symptoms than subacute HP, with progressive dyspnea,
cough, fatigue, weight loss, and clubbing of the digits.

49. Ans:  a. Nodular sclero..., c. Lymphocyte ..., d. Mixed cellula..., e. Lymphocyte deple....
[Ref: Robbins 9th/ 606-10; Harrison 19th/ 708-09; Harshmohan 7th/349-51]
“In the first four subtypes—nodular sclerosis, mixed cellularity, lymphocyte-rich, and lymphocyte depletion—the Reed-Sternberg
cells have a similar immunophenotype; as a result, these subtypes are often lumped together as classical forms of HL. In lymphocyte
predominance HL, the Reed-Sternberg cells have a characteristic B-cell immunophenotype distinct from that of the classical HL
subtypes” (Robbins 9th/ 607)
Table (Robbins 9th/ 609): Classification of Hodgkin Lymphoma

e
8/
Subtype Morphology and Immunophenotype Typical Clinical Features
Nodular sclerosis Frequent lacunar cells and occasional diagnostic R-S cells; Most common subtype;Usually Stage 1 or 2 disease;
background infiltrate composed of T lymphocytes, eosinophils, Frequent mediastinal involvement.

h,
macrophages and plasma cells; fibrous bands dividing cellular areas F = M, most patients young adults
into nodules. R-S cells CD15+, CD30+; EBV-. ar
Mixed cellularity Frequent mononuclear and diagnostic R-S cells; background More than 50% present as stage 3 or 4 disease. M
infiltrate rich in T lymphocytes, eosinophils, macrophages, plasma > F. Biphasic incidence, peaking in young adults and
cells. R-S cells CD15+, CD30+; 70% EBV+. again in adults older than 55.
ig
Lymphocyte-rich Frequent mononuclear and diagnostic R-S cells; background Uncommon. M > F. Tends to be seen in older adults.
nd

infiltrate rich in T lymphocytes. R-S cells CD15+, CD30+; 40% EBV+.

Lymphocyte Reticular variant: Frequent diagnostic R-S cells and variants with Uncommon. More common in older males, HIV-
depletion a paucity of background reactive cells; diffuse fibrosis variant; infected individuals, and in developing countries.
ha

hypocellular fibrillar background with scattered diagnostic R-S cells More likely to present with advanced disease.
and variants and few reactive cells. R-S cells CD15+, CD30+; most
EBV+.
IC

Lymphocyte Frequent L&H (popcorn cell) variants in a background of follicular Uncommon. Young males with cervical or axillary
predominance dendritic cells and reactive B cells. R-S cells CD20+, CD15-, C30-; lymphadenopathy. Mediastinal.
EBV-.
PG

50. Ans:  a. Inactivation of X chromosome...,

[Ref: Robbins 9th/ 164-65; Genetics in Medicine by Thompson
8th/91;Harrison 19th/735; Harshmohan 7th/252]
Lyonization or inactivation of X-chromosome
Harshmohan
–– 7th/252, 896
•• In female, one of two X-chromosome (either paternal or
maternal) is inactivated during embryogenesis as stated in
Lyon hypothesis
•• This inactivation is passed to all the somatic cells while the
germ cells in the female remain unaffected i.e.. ovary will
always have active X chromosome
•• Such an inactive X-chromosome in the somatic cells in female
lies condensed in the nucleus & is called as sex chromatin seen
specifically in the somatic cells in female
•• Males have a Barr body count of less than 2%
•• A minimum of 30% cells positive for sex chromatin is
indicative of genetically female composition
“The principle of X inactivation is that in somatic cells in
normal females (but not in normal males), one X chromosome is
inactivated early in development, thus equalizing the expression of
X-linked genes in the two sexes” (Genetics in Medicine by Thompson
8th/91)
“In humans with more than one X chromosome, the number
of Barr bodies visible at interphase is always one fewer than
the total number of X chromosomes. For example, men with
Klinefelter syndrome (47, XXY karyotype) have a single Barr
body, whereas women with a 47, XXX karyotype have two Barr
bodies. Barr bodies can be seen on the nucleus of neutrophils”-
http://biology. tutorvista. com/
Answers
&
Explanations

361
 PGI Chandigarh Self-Assessment & Review: 2017–2013

•• Cancer of cervix: In india, it is second most common killer

cancer among women. It is estimated during 2012, 122644 new
cases of cancer cervix occurred in the country (an incidence
rate 22 per lac)” (23rd/ 388)
Table ( Park 23rd/ 384): Women: Estimated Incidence & Prevalence
of cancer (Partial list) in India, 2012-

Cancer Incidence Incidence (age 5yr 5yr Prevalence

(%of total) standardized Prevalence (Proportion per-
rate) (%of total) lac population)

Breast 27.0 25.8 35.3 92.6

Cervix- 22.9 22.0 27.4 72.0

uteri

Table (Park 23rd/ 384): Men: Estimated Incidence & Prevalence of

cancer (Partial list) in India 2012.

e
Cytogenetic Disorders Involving Sex Chromosomes
Cancer Incidence Incidence 5 yr 5 yr

8/
–– Robbins 9th/ 164-65
(% of (age stan- Prevalence Prevalence
•• There are two factors that are peculiar to the sex total) dardized (% of (Proportion
chromosomes: (1) lyonization or inactivation of all but rate) total) per lac

h,
one X chromosome and (2) the modest amount of genetic population)
material carried by the Y chromosome. arLung 11. 3 11. 0 3. 7 5. 4
•• Lyon outlined the X-inactivation, or what is commonly
known as the Lyon hypothesis. It states that (1) only one Lip & oral 11. 3 10. 1 12. 6 18. 5
of the X chromosomes is genetically active, (2) the other X of cavity
ig
either maternal or paternal origin undergoes heteropyknosis
and is rendered inactive, (3) inactivation of either the 52. Ans:  b
 . Extra-adrenal... c. Carotid body tumour... e. Glomus
nd

maternal or paternal X occurs at random among all the cells tympanicum.

of the blastocyst on or about the 16th day of embryonic life,
[Ref: Robbins 9th/ 741-42; Harrison 19th/ 2329-35;Davidson 22nd/ 781;
ha

and (4) inactivation of the same X chromosome persists in all

CMDT 2016/ 1158; Danhert Radiology Review Manual 7th/401]
the cells derived from each precursor cell.
•• The inactive X can be seen in the interphase nucleus as a Pheochromocytoma is a chromaffin-cell neoplasm that can
IC

darkly staining small mass in contact with the nuclear
membrane known as the Barr body, or X chromatin.
51. Ans:  a. Carcinoma..., b. Carcinoma....
PG
arise as an adrenal (adrenal medulla) or extraadrenal tumor.
Extraadrenal pheochromocytoma is also referred to as
paraganglioma” (Anderson Manual of Medical Oncology/Chap 31)

Glenner Classification of Extraadrenal Paragangliomas

[Ref: Park 23rd/ 382-83; Harshmohan 7th/198]
“The five most frequent cancers (2012) in men were cancer
lung, lip & oral cavity, stomach, colorectum & pharynx & in
women, cancer breast, cervix uteri, colorectum, ovary, lip & oral
cavity”- Park 23rd/ 383
Cancer
–– Park 23rd/ 382-84
•• In India, the national cancer registry programme of the ICMR
provides data on incidence, mortality & distribution of cancer
from 25 population-based registries & 5 hospitals based
registries
•• “Breast cancer: It is the most common cancer both in developed
& developing countries. It is estimated that during the year 2012,
about 144937 new cases of breast cancer in women occurred,
which accounts for 27 % of malignant cases in women( an
incidence of 25. 8 per lac)”- 23rd/ 389
Answers •• According to park (ICMR 2012 data) breast cancer is most
&
Explanations
common cancer in women in India.
–– Danhert Radiology Review Manual 7th/401)
A.  Branchiomeric distribution
   1. Associated with great vessels of chest+neck including
carotid body, glomus jugulare, glomus tympanicum
B.  Parasympathetic distribution
   2.  Associated with vagal nerve
   3. Associated with aorticosympathetic chain in
thoracolumbar region from aortic arch to urinary
bladder, including organ of Zuckerkandl
   4.  Associated with visceral organ
Location of Functioning Paragangliomas
–– Danhert Radiology Review Manual 7th/401)
a. Adrenal medulla(>80%)
b. Extra adrenal intra abdominal(8-16%)
c. Extra adrenal in head & neck(2-4%)
Four common sites in head & neck & chest- carotid body, jugular
foramen, path of vagus nerve & middle ear

362
 May  | 2016

Danhert Radiology Review Manual 7th/401-02: Writes
•• Carotid body tumour: Painless pulsatile firm neck mass
below the angle of jaw
•• Glomus tympanicum: Most common tumour in middle ear
•• Glomus jugulare tumour: Most common tumour in jugular
fossa
•• Glomus vagale tumour: Paraganglioma of vagus nerve
•• Inferior nodose paraganglion: Compression of internal
jugular vein
•• Superior jugular paraganglion: Dumbbell shaped mass
Paraganglioma (Carotid Body Tumor)
–– Robbins 9th/ 741-42
•• Paraganglia are clusters of neuroendocrine cells dispersed
throughout the body, some connected with the sympathetic
nervous system and others with the parasympathetic nervous
system. The largest collection of these cells is found in the
concentrate (available through a research study; appropriate
for patients with A-subunit deficiency only) is the treatment of
choice for bleeding or surgical prophylaxis.
•• Severe deficiencies of factor VII, X and XIII occur as
autosomal recessive disorders. They are rare but are
associated with severe bleeding. Typical features include
haemorrhage from the umbilical stump and intracranial
haemorrhage. Factor XIII deficiency is typically associated
with female infertility (Davidson 22nd/1054)
Factor XIII Deficiency
–– Wintrobe’s Clinical Hematology 12th/Chap 57
•• The initial hemostatic plug is not sufficient to prevent blood
loss unless it is stabilized by the action of plasma factor XIII
(fibrin-stabilizing factor). A complex set of reactions among
thrombin, fibrin, and plasma factor XIII is necessary for clot
stabilization

e
adrenal medulla, where they give rise to pheochromocytomas. •• Rebleeding at circumcision is also common. Other
•• Tumors arising in extra-adrenal paraganglia are not bleeding manifestations in these patients include soft

8/
surprisingly referred to as paragangliomas. tissue hemorrhage, hemarthrosis, hematomas, and the
•• Paragangliomas develop in two general locations: development of large pseudocysts. The most life-threatening
complication of factor XIII deficiency is spontaneous

h,
Paravertebral paraganglia (e.g., organs of Zuckerkandl
intracranial hemorrhage. Intracranial hemorrhage is more
and, rarely, bladder). Such tumors have sympathetic ar prevalent in factor XIII deficiency than in other inherited
connections and are chromaffin positive; about half
bleeding disorders.
elaborate catecholamines, as do pheochromocytomas.
•• Surgery in these patients is often complicated by abnormal
 Paraganglia related to the great vessels of the head and
ig
wound healing and excessive postoperative bleeding, which
neck, the so-called aorticopulmonary chain, including
can occur either immediately or later.
the carotid bodies; aortic bodies; jugulotympanic ganglia;
nd

ganglion nodosum of the vagus nerve; and clusters

located about the oral cavity, nose, nasopharynx, larynx, Table ( Harrison 19th/ 733): Laboratory Characteristics of Inherited
and orbit. These are innervated by the parasympathetic
ha

Coagulation Disorders
nervous system, and their tumors are referred to
as nonchromaffin paragangliomas. These tumors Clotting Laboratory Abnormalitya
Factor
IC

infrequently release catecholamines aPTT PT TT

•• Carotid body tumors (and paragangliomas in general) Deficiency
are rare. They usually arise in the sixth decade of life. The Factor XIII – – +/–
carotid body tumor is a prototype of a parasympathetic
PG

paraganglioma. a-Value within normal range(-) or prolonged(+)

53. Ans:  a. Delayed wound... b. Clot solubility... Table ( Wintrobe’s Clinical Hematology 12th/Chap 57 ): Laboratory
Findings in Common Inherited Coagulation Disorders
[Ref: Davidson 22nd/998, 1007, 1054; Harrison 19th/ 733, 736; CMDT
2016/ 556-57] Disorder Partial Prothrom- Thrombin Ancillary
Throm- bin Time Time Tests
Deficiency of Factor XIII
boplastin
–– CMDT 2016/ 556-57 Time
It characteristically leads to delayed bleeding that occurs hours Factor XIII N N N Clot
to days after a hemostatic challenge (such as surgery or trauma). deficiency solubility
The condition is usually life-long, and spontaneous intracranial tests are
hemorrhages as well as recurrent pregnancy loss appear to abnormal.
occur with increased frequency in these patients compared with
A, abnormal; N, normal; v, variable
other congenital deficiencies.
Cryoprecipitate or infusion of a plasma-derived factor XIII

Answers
&
Explanations

363
 PGI Chandigarh Self-Assessment & Review: 2017–2013

e
8/
h,
ar
Fig.: (Harrison 19th/ 733): Coagulation cascade and laboratory assessment of clotting factor deficiency by activated partial prothrombin time
(aPTT), prothrombin time (PT), and thrombin time (TT)
ig
nd

54. Ans:  d. BT is decreased in..., Table ( Harrison 19th/406): Hemostatic Disorders and Coagulation Test
Abnormalities
ha

[Ref: Robbins 9th/118-119; Harrison 19th/406; Harshmohan 7th/307-10]

Prolonged Activated Partial Thromboplastin Time (aPTT)
“Hemostasis is spontaneous arrest of bleeding by physiological
process. Platelet plays very important role in hemostasis. Normal No clinical bleeding—↓ factors XII, high-molecular-weight kininogen,
IC

platelet count is 1.5-4. 0 lacs/microL. Thrombocytopenia is prekallikrein

platelet count less than 1.5 lacs/microL. Spontaneous bleeding Variable, but usually mild, bleeding—↓factor XI, mild↓FVIII and FIX
occurs when platelet count become less than 20, 000/microL” (A.
Frequent, severe bleeding—severe deficiencies of FVIII and FIX
PG

K. Jain 6th/93; Harshmohan 7th/310)

Coagulation Cascade Heparin

–– Robbins 9th/118-119 Prolonged Prothrombin Time (PT)

•• Prothrombin time (PT):This assay tests the extrinsic and Factor VII deficiency
common coagulation pathways. A prolonged PT can result
Vitamin K deficiency—early
from deficiency or dysfunction of factor V, factor VII, factor
X, prothrombin, or fibrinogen. Warfarin anticoagulation
•• Partial thromboplastin time (PTT): This assay tests the Prolonged aPTT and PT
intrinsic and common clotting pathways. Prolongation of
the PTT can be due to deficiency or dysfunction of factor V, Factor II, V, X, or fibrinogen deficiency
VIII, IX, X, XI, or XII, prothrombin, or fibrinogen. Vitamin K deficiency—late
•• Bleeding time: This measures the time taken for a Direct thrombin inhibitors
standardized skin puncture to stop bleeding and provides an
in vivo assessment of platelet response to limited vascular Prolonged Thrombin Time
injury. The reference range depends on the actual method Heparin or heparin-like inhibitors
employed and varies from 2 to 9 minutes. Prolongation
Mild or no bleeding—dysfibrinogenemia
generally indicates a defect in platelet numbers or function.
•• Platelet counts: The reference range is 150 to 300 × 103/µL. Frequent, severe bleeding—afibrinogenemia
Answers
&
Explanations

364
 May  | 2016

•• Expansion of mandible- since the inner table of the mandible

Prolonged PT and/or aPTT Not Correct with Mixing with
is strong, the expansion mainly occurs in the outer aspect of
Normal Plasma mandible. The bone gets thinned out resulting in egg-shell
Bleeding—specific factor inhibitor crackling
No symptoms, or clotting and/or pregnancy loss—lupus Dentigerous Cyst (Follicular cyst)
anticoagulant –– Harshmohan 7th/512
Disseminated intravascular coagulation •• Arise from enamel of an unerupted tooth
•• Mandibular 3rd molar & maxillary canines are most often
Heparin or direct thrombin inhibitor involved
Abnormal Clot Solubility •• Less common than radicular cyst
•• More commonly occur in children & young individuals
Factor XIII deficiency
•• These cysts are more significant because of reported
Inhibitors or defective cross-linking occurrence of ameloblastoma & carcinoma in them
Rapid Clot Lysis Dental Cyst: Radicular Cyst/Periapical Cyst
Deficiency of α2-antiplasmin or plasminogen activator inhibitor 1 –– Manipal Surgery 4th/292
•• This arise from normally erupted, chronically infected, pulp-
Treatment with fibrinolytic therapy

e
less caries tooth
•• Common in women in around 3rd-4th decades

8/
•• Commonly affects the upper jaw(maxilla)
•• It represents as a slow-growing swelling in the maxillary

h,
region resulting in deformity of the face
•• Diagnosis: Presence of caries tooth with expansion of maxilla
ar Radicular Cyst or Apical or Periodontal or Dental Cyst
–– Harshmohan 7th/511-12
ig
Most often it observed at apex of an erupted tooth & sometime
contain thick pultaceous material
nd

Odontogenic Cysts and Tumors

–– Robbins 9th/ 734
•• The overwhelming majority of odontogenic cysts are
ha

derived from remnants of odontogenic epithelium present

within the jaws. In contrast to the rest of the skeleton,
epithelial-lined cysts are quite common in the jaws. In
IC

general, these cysts are subclassified as either inflammatory

or developmental.
•• The dentigerous cyst is defined as a cyst that originates
PG

around the crown of an unerupted tooth and is thought to

be the result of fluid accumulation between the developing
tooth and the dental follicle. Radiographically, these are
unilocular lesions most often associated with impacted
Fig.: ( Wintrobe’s Clinical Hematology 12th/Chap 49): The interpretation
third molar (wisdom) teeth.
of common screening tests of blood coagulation
Table ( Robbins 9th/ 734): Histologic Classification of Odontogenic
55. Ans:  a. Arises in relation..., c. Mandibular..., d. Common.... Cysts

[Ref: Robbins 9th/ 734; Manipal Surgery 4th/292-93;Harshmohan 1. Inflammatory

7th/511-12]  a. Periapical cyst
 b. Residual cyst
Dentigerous Cyst: Follicular Odontome  c. Paradental cyst
–– Manipal Surgery 4th/293 2. Developmental
•• Common in lower jaw (mandible) in women 30-40 years  a. Dentigerous cyst
•• It occurs in relation to unerupted, permanent, molar tooth,  b. Odontogenic keratocyst
most commonly the upper or lower third molar  c. Gingival cyst of newborn
•• Most commonly occur in maxillary premolar or mandibular  d. Gingival cyst of adult
third molar (Logan Turner 10th/49)  e. Eruption cyst
•• This unerupted tooth constantly irritates the cells, produce  f.  Lateral periodontal cyst Answers
degeneration of cells resulting in a dentigerous cyst  g. Glandular odontogenic cyst &
 h. Calcifying epithelial odontogenic cyst (Gorlin cyst) Explanations
•• Absence of molar tooth

365
 PGI Chandigarh Self-Assessment & Review: 2017–2013

56. Ans:  All (a. b. c. d. )
[Ref: Robbins 9th/ 760; Harshmohan 7th/524; Harrison 19th/ 533;
Davidson 22nd/870-71]
“Ca esophagus: Lymph node metastasis, which are common, are
associated with poor prognosis” (Robbins 9th/ 760)
“Lymph node involvement is a bad prognostic factor” (L & B
26th/1004)
The stage of the disease is the most important prognostic factor.
Overall 5-year survival for esophageal cancer remains around
25% (CSDT)
Ca esophagus
–– Sabiston 19th/1054-55
•• The location of the tumor also directs the management of
esophageal cancer. Eight percent of all esophageal tumors
present in the cervical esophagus and are almost always
squamous cell cancers. These tumors may be locally
carcinoma might consider adding tumor length and number
of positive lymph nodes as two important prognostic factors” (
http://onlinelibrary. wiley. com)
Prognostic Factors for Esophageal Cancer
–– http://www. cancer. ca/en/cancer-information
•• Stage: The most reliable prognostic factor for esophageal
cancer is the stage of the tumour at the time of diagnosis.
As with most cancers, the lower the stage, the better
the outcome. Tumours that are only in the lining of the
esophagus have a more favourable prognosis than those that
have grown through the muscle wall or that have spread to
other organs.
•• Tumour size: Small tumours have a more favourable
prognosis than large tumours.
•• Lymph nodes status: The fewer lymph nodes that have
cancer, the better the prognosis.

e
aggressive and are managed with chemoradiotherapy •• Cancer has spread to distant organs: Esophageal cancer
followed by segmental resection of the cervical esophagus. that has spread to distant organs has a less favourable

8/
•• The depth of invasion of a tumor, the T status, is another prognosis.
important variable in determining stage and treatment of •• Cancer that remains after surgery: The amount of cancer
esophageal cancer. that remains after surgery is called residual disease. No

“Tumor size, grade of differentiation, lymphadenopathy,
stage of cancer, and family history of esophageal cancer were
identified as prognostic factors after esophagectomy. Family
history of esophageal cancer is an important prognostic factor
ig
that surgeons should take into consideration when selecting a
treatment method” (ncbi. nlm. nih. gov)
“Tumor length, the number of involved lymph nodes, and
nd
h,
residual disease has a better prognosis than if there is cancer
ar remaining after surgery.
•• Cancer that responds to neoadjuvant therapy: Esophageal
cancer that responds to neoadjuvant therapy is more likely
to be completely removed by surgery. As a result, cancer that
responds to neoadjuvant therapy has a better prognosis than

cancer that doesn’t respond to it.

the ratio of positive lymph nodes are important prognostic •• Tumour grade: A low-grade, or well-differentiated, tumour
factors for survival in patients with esophageal carcinoma. A (G1) often grows slower and is less likely to spread than a
ha

revised TNM classification system for patients with esophageal high-grade tumour (G3 or G4).
IC

57. Ans:  a. Increase..., c. Increase alkaline... e. Stool stero....

[Ref: PJM 20th/20;Harrison 19th/281; CMDT 2016/665]
PG

Table ( CMDT 2016/665): Liver Biochemical Tests: Normal values and changes in hepatocellular and obstructive jaundice.

Tests Normal Values Hepatocellular Jaundice Obstructive Jaundice

Biluribin
Direct 0.1-0.3 mg/dL (1.71-5.13 mcmol/L) Increased Increased
Indirect 0.2-0.7 mg/dL (3.42-11.97 mcmol/L) Increased Increased
Urine bilirubin None Increased Increased
Serum albumin 3.5-5.5 g/dL(35-55 g/L) Decreased Generally unchanged
Alkaline phosphatase 30-115 units/L(0.6-2.3 inkat/L) Mildly increased (+) Markedly increased (++++)
Prothrombin time INRof 1.0-1.4. After vitamin K, 10% Prolonged if damage is severe; Prolonged & obstruction is marked;
decrease in 24 hours does not respond to parenteral generally responds to parenteral
vitamin K vitamin K
ALT, AST ALT < 30 units/L(0.6 mkat/L) (men), < 19 Increased, as in viral hepatitis Minimally increased
units/L(0.38 mkat/L) (women); AST 5-40
units/L(0.1-0.8 mkat/L)
Answers
&
Explanations

366