ASN -11- Patho

Q. Aplastic anaemia can progress to all except:

a. AML
b. Myelodysplastic anemia
c. Pure red cell aplasia
d. Paroxysmal Nocturnal Hemoglobinuria

Q. The anticoagulant of choice for performing coagulation studies is:

a. EDTA
b. Heparin
c. Trisodium citrate
d. Double oxalate

Transdermal Rotigotine: A Clinically Innovative Dopamine-Receptor Agonist for the Management of Parkinson's Disease

Rotigotine is a highly lipophilic dopamine-receptor agonist and the first transdermally delivered agent to demonstrate efficacy and safety as monotherapy in early Parkinson's disease and to reduce “off” hours in levodopa-treated patients with advanced Parkinson's disease. The rotigotine pharmacophore is nonergolinic and demonstrates high affinity for dopamine D₂ and D₃ receptors. With once-daily application, the patch matrix provides continuous, nonfluctuating plasma drug levels at steady state, resulting in continuous and steady plasma and brain levels and striatal dopamine-receptor stimulation.

Read More: http://pharmacotherapyjournal.org/doi/abs/10.1592/phco.29.12.1452?cookieSet=1

Brinzolamide

Brinzolamide is a white powder commercially formulated as a 1% ophthalmic suspension to reduce intraocular pressure (IOP). Pharmacologically, brinzolamide is a highly specific,   
non-competitive, reversible, and effective inhibitor of carbonic anhydrase II (CA-II), able to suppress formation of aqueous humor in the eye and thus to decrease IOP. 


Ref: http://www.ncbi.nlm.nih.gov/pubmed/19668749

NESTROFT

Naked Eye Single Tube Red Cell Osmotic Fragility Test (NESTROFT)

NESTROFT is a screening test for the detection of thalassaemia & common haemoglobinopathies

The principle of NESTROFT is based on the limit of hypotonicity which the red cell can withstand. In this procedure 2 ml of 0.36% buffered saline is taken in a test tube, 20ml of whole blood is added to it, and is allowed to stand at room temperature. After 20 minutes reading is taken on a NESTROFT stand on which a thin black line is marked. If the line is visible through the solution, the test is considered as negative and if line is not visible it is considered as positive. Positive test is due to the reduced osmotic fragility of red cells (Fig. 1).

Fig. 1. NESTROFT stand showing positive and negative samples in different tubes. Tubes from L to R: Tubes 1-3 and 6-8 are positive samples where black line is not visible through the solution, Tubes 4-5 and 9-10 negative samples where black line is visible through the solution.

VISION 2020

VISION 2020 is the global initiative for the elimination of avoidable blindness, a joint programme of the World Health Organization (WHO) and the International Agency for the Prevention of Blindness (IAPB) with an international membership of NGOs ( ORBIS), professional associations, eye care institutions and corporations.

Group A - ORBIS International

ORBIS is dedicated to the prevention of blindness ... the saving of sight ... the delivery of training ... the transfer of skills... and the creation of a world where quality eye care, education and treatment are available to every human being.

ORBIS Mission Statement

ORBIS is a non-aligned, non-profit global development organization. Our mission is to preserve and restore sight by strengthening the capacity of local partners to prevent and treat blindness.

Type D personality: the heart, stress, and cortisol

Many studies have demonstrated the role of psychosocial and behavioural risk factors in the aetiology and pathogenesis of cardiovascular disorders. Recently, a new personality construct, the type D or ‘distressed’ personality, has been proposed.


 Type D behaviour is characterized by the joint tendency to experience negative emotions and to inhibit these emotions while avoiding social contacts with others. The observation that cardiac patients with type D personality are at increased risk for cardiovascular morbidity and mortality underlines the importance of examining both acute (e.g. major depression) and chronic (e.g. certain personality features) factors in patients at risk for coronary events. Both type D dimensions (negative affectivity and social inhibition) are associated with greater cortisol reactivity to stress. Elevated cortisol may be a mediating factor in the association between type D personality and the increased risk for coronary heart disease and, possibly, other medical disorders.

LUMINATE trial

A new agent for the treatment of noninfectious uveitis: rationale and design of three LUMINATE (Lux Uveitis Multicenter Investigation of a New Approach to Treatment) trials of steroid-sparing voclosporin .


Uveitis is an inflammatory, putative Th1-mediated autoimmune disease that affects various parts of the eye and is a leading cause of visual loss. Currently available therapies are burdened with toxicities and/or lack definitive evidence of efficacy. Voclosporin, a rationally designed novel calcineurin inhibitor, exhibits a favorable safety profile, a strong correlation between pharmacokinetic and pharmacodynamic response, and a wide therapeutic window. The LUMINATE (Lux Uveitis Multicenter Investigation of a New Approach to TrEatment) clinical development program was initiated in 2007 to assess the safety and efficacy of voclosporin for the treatment, maintenance, and control of all forms of noninfectious uveitis. If LUMINATE is successful, voclosporin will become the first Food and Drug Administration-approved corticosteroid-sparing agent for this condition. 


  ref:        http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2699819/

HEPATIC HILAR AREA: THE PLATE SYSTEM

 The plate system consists of bile ducts and blood vessels
surrounded by a sheath that is continuous with Glisson’s
capsule, intrahepatically, and the hepatoduodenal
ligament, extrahepatically. This system also contains a
large number of lymphatics, nerves, and a small vascular
network. 
Couinaud  states that the bile ducts and
hepatic artery are located within the plate system, but
that the portal vein is covered with a separate sheath
of loose connective tissue, and that is why the plate
containing the extrahepatic bile duct and hepatic artery
can be easily separated from the portal vein. Three
plates are found in the hilar area: the hilar plate, the
cystic plate, and the umbilical plate

To know in detail, please check this pdf file:
http://www.springerlink.com/content/euykkaghl6c09t3k/fulltext.pdf

EVIDENCE-BASED MEDICINE (AIIMS NOV 2011 Discussion)

The "art of medicine" is defined traditionally as a practice combining medical knowledge (including scientific evidence), intuition, and judgment in the care of patients . EBM updates this construct by placing much greater emphasis on the processes by which clinicians gain knowledge of the most up-to-date and relevant clinical research to determine for themselves whether medical interventions alter the disease course and improve the length or quality of life. The meaning of practicing EBM becomes clearer through an examination of its four key steps: Formulating the management question to be answered Searching the literature and online databases for applicable research data Appraising the evidence gathered with regard to its validity and relevance Integrating this appraisal with knowledge about the unique aspects of the patient (including the patient's preferences about the possible outcomes) Step 1 involves generating well-formulated questions that involve four or five components—PICOD: patient or population, intervention, comparator, outcome, and, sometimes, D for study design, (e.g., does routine percutaneous coronary intervention improve survival compared with initial medical management in 60-year-old men with stable angina and known CAD?) Steps 2 and 3 are the heart of EBM as it is currently used in practice and relate to the underlying fundamental principle that the strength of medical evidence supporting a therapy or strategy is hierarchical. The process of searching the world's research literature and appraising the quality and relevance of studies thus identified can be quite time-consuming and requires skills and training that most clinicians do not possess. Thus, the best starting point for most EBM searches is the identification of recent systematic overviews of the problem in question (Table 3-3). Table 3-3 Selected Tools for Finding the Evidence in Evidence-Based Medicine Name Description Web Address Availability Evidence-Based Medicine Reviews Comprehensive electronic database that combines and integrates: 1. The Cochrane Database of Systematic Reviews 2. ACP Journal Club 3. The Database of Abstracts of Reviews of Effectiveness www.ovid.com Subscription required. Available through medical center libraries and other institutions. Cochrane Library Collection of EBM databases, including The Cochrane Database of Systematic Reviews—full text articles reviewing specific health care topics. www.cochrane.org Subscription required. Abstracts of systematic reviews available free online. Some countries have funding to provide free access to all residents. ACP Journal Club Collection of summaries of original studies and systematic reviews. Published bimonthly. All data since 1991 available on Web site, updated yearly. www.acpjc.org Subscription required. Clinical Evidence Monthly updated directory of concise overviews of common clinical interventions. www.clinicalevidence.com Subscription required. Free access for United Kingdom and developing countries. MEDLINE National Library of Medicine database with citations back to 1966. www.nlm.nih.gov Free via Internet. Generally, the EBM tools listed in Table 3-3 provide access to research information in one of two forms. The first, primary research reports, is the original peer-reviewed research work that is published in medical journals. Initial access to this information in an EBM search may be gained through MEDLINE, which provides access to a huge amount of data in abstract form. However, in using MEDLINE it is often difficult to locate reports that are on point in a sea of irrelevant or unhelpful information and be reasonably certain that important reports have not been overlooked. The second form, systematic reviews, comprehensively summarizes the available evidence on a particular topic up to a certain date and provides the interpretation of the reviewer and thus is the highest level of evidence in the hierarchy. Explicit criteria are used to find all the relevant scientific research and grade its quality. The prototype for this kind of resource is the Cochrane Database of Systematic Reviews. One of the key components of a systematic review is a meta-analysis. The next two sections will review some of the major types of clinical research reports available in the literature and the process of aggregating those data into meta-analyses. SOURCES OF EVIDENCE: CLINICAL TRIALS AND REGISTRIES The notion of learning from observation of patients is as old as medicine itself. Over the last 50 years, physicians' understanding of how best to turn raw observation into useful evidence has evolved considerably. Case reports, personal anecdotal experience, and small single-center case series are now recognized as having severe limitations in validity and generalizability, and although they may generate hypotheses or be the first reports of adverse events, they have no role in formulating modern standards of practice. The major tools used to develop reliable evidence consist of the randomized clinical trial and the large observational registry. A registry or database typically is focused on a disease or syndrome (e.g., cancer, CAD, heart failure), a clinical procedure (e.g., bone marrow transplantation, coronary revascularization), or an administrative process (e.g., claims data used for billing and reimbursement). By definition, in observational data, the care of the patient is not controlled by the investigator. Carefully collectedprospective observational data can achieve a level of quality approaching that of major clinical trial data. At the other end of the spectrum, data collected retrospectively (e.g., chart review) are limited in form and content to what previous observers thought was important to record, which may not serve the research question under study particularly well. Data not specifically collected for research (e.g., claims data) often have important limitations that cannot be overcome in the analysis phase of the research. Advantages of observational data include the ability to capture a broader population than is typically represented in clinical trials because of inclusion and exclusion criteria. In addition, observational data are the primary source of evidence for questions for which a randomized trial cannot or will not be performed. For example, it may be difficult or unethical to randomize patients to test diagnostic or therapeutic strategies that are unproven but widely accepted in practice. In addition, patients cannot be randomized to a sex, racial/ethnic group, socioeconomic status, or country of residence. Physicians are also not willing to randomize patients to a potentially harmful intervention, such as smoking or overeating to develop obesity. The major difference between a well-done randomized clinical trial and a well-done prospective observational study of a particular management strategy is the lack of protection from treatment selection bias in the latter. The use of observational data to compare diagnostic or therapeutic strategies assumes that there is sufficient uncertainty in practice to ensure that similar patients will be managed differently by different physicians. In short, the analysis assumes that there is an element of randomness (in the sense of disorder rather than in the formal statistical sense) to clinical management. In such cases, statistical models attempt to adjust for important imbalances and "level the playing field" so that a fair comparison among treatment options can be made. When management is clearly not random (e.g., all eligible left main coronary artery disease patients are referred for coronary bypass surgery), the problem may be too confounded (biased) for statistical correction, and observational data may not provide reliable evidence. In general, the use of concurrent controls is vastly preferable to that of historical controls. For example, comparison of current surgical management of left main CAD with left main CAD patients treated medically during the 1970s (the last time these patients were routinely treated with medicine alone) would be extremely misleading since the quality of "medical therapy" has made substantial improvements in the interval. Randomized controlled clinical trials include the careful prospective design features of the best observational data studies but also include the use of random allocation of treatment. This design provides the best protection against confounding due to treatment selection bias (a major aspect of internal validity). However, the randomized trial may not have good external validity (generalizability) if the process of recruitment into the trial resulted in the exclusion of many potentially eligible subjects. Consumers of medical evidence need to be aware that randomized trials vary widely in their quality and applicability to practice. The process of designing such a trial often involves a great many compromises. For example, trials designed to gain U.S. Food and Drug Administration (FDA) approval for an investigational drug or device have to address certain regulatory requirements that may result in a trial design different from what practicing clinicians would find useful. META-ANALYSIS The Greek prefix meta signifies something at a later or higher stage of development. Meta-analysis is research done on research data for the purpose of combining and summarizing the available evidence quantitatively. Although it can be used to combine nonrandomized studies, meta-analysis is used most typically to summarize all the randomized trials on a particular therapeutic problem. Ideally, unpublished trials should be identified and included to avoid publication bias (i.e., "negative" trials may not be published). Furthermore, some of the best meta-analyses obtain and analyze the raw individual patient-level data from all trials rather than working only with what is available in the published reports of each trial. Not all published meta-analyses are reliable sources of evidence on a particular problem. Their methodology must be scrutinized carefully to ensure proper study design and analysis. The results of a well-done meta-analysis are likely to be most persuasive if they include at least several large-scale, properly performed randomized trials. Although meta-analysis can help detect benefits when individual trials are inadequately powered (e.g., the benefits of streptokinase thrombolytic therapy in acute MI demonstrated by ISIS-2 in 1988 were evident by the early 1970s through meta-analysis), in cases in which the available trials are small or poorly done, meta-analysis should not be viewed as a remedy for the deficiency in primary trial data. Meta-analyses typically focus on summary measures of relative treatment benefit, such as odds ratios or relative risks. Clinicians also should examine what absolute risk reduction (ARR) can be expected from the therapy. A useful summary metric of absolute treatment benefit is the number needed to treat (NNT) to prevent one adverse outcome event (e.g., death, stroke). NNT is simply 1/ARR.  For example, if a hypothetical therapy reduced mortality rates over a 5-year follow-up by 33% (the relative treatment benefit) from 12% (control arm) to 8% (treatment arm), the absolute risk reduction would be 12% – 8% = 4% and the NNT would be 1/.04, or 25. Thus, it would be necessary to treat 25 patients for 5 years to prevent 1 death. If the hypothetical treatment was applied to a lower-risk population, say, with a 6% 5-year mortality, the 33% relative treatment benefit would reduce absolute mortality by 2% (from 6 to 4%), and the NNT for the same therapy in this lower-risk group of patients would be 50. Although not always made explicit, comparisons of NNT estimates from different studies should account for the duration of follow-up used to create each estimate

Oguchi's disease & Mizuo phenomenon

Oguchi's disease, first described by Chuta Oguchi in 1907. is a rare autosomal recessive trait characterized by congenital stationary night blindness and an unique morphological and functional abnormality of the retina. Patients have nonprogressive night blindness since young childhood with normal day vision, but they often claim improvement of light sensitivities when they remain long in the dark environment; dark-adaptation study demonstrates that highly elevated rod thresholds decrease several hours later and eventually result in a recovery to the normal or nearly normal level. The eyegrounds have an appearance of diffuse or patchy, silver-gray or golden-yellow metallic sheen and the retinal vessels stand out in relief against the radiant background. A prolonged dark adaptation of three hours ormore, leads to disappearance of the unusual discoloration the normal reddish appearance, called Mizuo-Nakamura phenomenon. 



Oguchi's disease is also unique in the electroretinographic responses in the light- and dark-adapted condition. Recent identification of the arrestin gene mutation in patients with Oguchi's disease may account for the characteristic fundus and 
functional abnormality.

The fundus oculi presents a most peculiar appearance. The posterior pole and in many cases the whole of fundus, instead of having a normal orange-red colour, presents a curious shining greyish-pink background, on which the retinal vessels stand out sharply. The vessels appear dark with little distinction between the arteries and the veins. The finer divisions of the blood vessels can be easily followed to their finest ramifications. At places a dark shadow or a bright white line may be seen alongside the blood vessel.

The most interesting feature of this disease in well marked cases is the reversal of all the features described above, if the patient sits in the dark for about one hour. This is called Mizuo's phenomenon. The retina looks nor­mal and the night-blindness disappears. After the fundus has resumed the normal colour, exposure to room light of 40-50 foot candles soon leads to the appearance of fundus dis­colouration. It begins with a spotty distribu­tion after about 15 minutes' exposure and within one hour the colour transformation is complete.

In some cases the discolouration of the fundus is mild and Mizuo's phenomenon is slight or absent, but night-blindness is definitely complained of.

Mizuo–Nakamura phenomenon. (A) A golden sheen is seen in the mid-peripheral fundus of both eyes before dark adaptation. (B) The golden sheen is extinguished after 30–45 min of dark adaptation.

Microscopical examination :Two peculiar fea­tures have been noticed

1. The cones are unusually numerous and are present to the practical exclusion of the rods in a large area. Many of the cones are abnormally long and their nuclei are ectopic,i.e. they are outside the outer limiting mem­brane. The bipolar layer is thicker than nor­mal and the ganglion cell layer is eight to ten cell deep.

2. There is an anamolous layer of tissue between the cones and the pigment epithelium. It is not a true cellular layer, but rather appears as a degenerated syncytial structure containing many pigment granules.

Classification

Oguchi's disease has been further classified into various types

Type I : Typical cases with marked fund us discolouration, Mizuo's phenomenon and re­covery of dark adaptation.

Type II: 

(a) slight fundus discolouration, partial Mizuo's phenomenon and without recovery of dark adaptation.

(b) slight fundus discolouration without Mizuo's phenomenon and without recovery of dark adaptation.

Heredity

It is universally agreed that the condition is transmitted as an autosomal recessive without sex discrimination. Consanguinity also plays an important part.

ASN 11 repeats from Nov 2010

MICROBIOLOGY:


67. In plasma sterilization, control used is:

a. B. subtilis
b. B. steatothermophilus
c. C. perfringens
d. C. tetani.

ORTHOPEDICS:


152. Gallow's traction is used for fracture:

a. Shaft femur.
b. Neck femur
c. Shaft tibia
d. Tibial tuberosity.

ASN 11 repeats from May 2009

MEDICINE:


119. Kawasaki disease- treatment of choice:

a. ivIg
b. Steroid
c. Azathioprine
d. Antibiotics.


SKIN:


177. Which of the following shows deposition of IgA in dermal papilla?

a. Dermatitis herpetiformis
b. IgA papillomatosis of childhood
c. Bullous pemphigoid
d. Gestational herpes.


178. Intraepidermal Ig G deposition is seen in:

a. Pemphigus
b. Bullous pemphigoid
c. Herpes genitalis
d. Dermatitis herpetiformis.

AIIMS NOV 11 repeats from May 2008

BIOCHEMISTRY:


23. Poly (A) tail translates into:

a. Poly proline
b. Poly lysine
c. Poly alanine
d. Poly glycine.


OBG:


162. Marker for granulosa cell tumor:

a. CA 19-9
b. CA 50
c. Inhibin
d. Teratoma.

AIIMS Nov 2011- Repeat from May 2007

SPM:


49. Best method to compare new test and gold standard test:

a. Correlation study
b. Regressive study
c. Bland and Altman analysis
d. Kolmogorov- Smirnov test

SURGERY:


154. Severity of acute pancreatitis correlate with levels of all of the following except:

a. Glucose
b. Amylase
c. Transaminase
d. Calcium.

AIIMS November 2011- Repeats from AIPGE 2007

Ref: Mudit Khanna AIPGME - 2007

BIOCHEMISTRY:


30. All of the following are true regarding oxygenases except:

a. Incorporate 2 atoms of oxygen.
b. Incorporate 1 atom of oxygen.
c. Required for hydroxylation of steroids.
d. Required for carboxylation of drugs.




40. CAP in LAC operon is an example of:

a. Positive regulator
b. Negative regulator
c. Constitutive expression
d. Attenuation.


PHARMACOLOGY:


86. True about Octreotide are all except:

a. Is active orally.
b. Supresses growth hormone secretion
c. Useful for variceal bleeding
d. Useful in secretory diarrhea.


MEDICINE:


175. The following are components of Brown Sequard syndrome except:

a. Ipsilateral extensor plantar response.
b. Ipsilateral pyramidal tract involvement.
c. Contralateral spinothalamic tract involvement.
d. Contralateral posterior column involvement.


176. Which of the following is the classical CSF finding seen in TBM?

a. Increased protein, decreased sugar, increased lymphoctes.
b. Increased protein, sugar and lymphocytes.
c. Decreased protein, increased sugar and lymphocytes.
d. Increased sugar, protein and neutrophils.


ORTHOPEDICS:


249. Which is not a deep heat therapy?

a. Short wave diathermy
b. Infrared therapy
c. Ultrasound therapy
d. Interferential therapy.


260. Which is not a marker of new bone formation?

a. Alkaline phosphatase.
b. Osteocalcin
c. Urine Hydroxy proline
d. Pro collagen


262. Which of these muscles undergo wasting first in osteoarthritis knee?

a. Quadriceps only
b. Hamstrings only
c. Both quadriceps and hamstrings
d. Gastronemius.

AIIMS NOV 2011- Direct repeats from ASN 2006

Ref: Review of AIIMS by Ashish - Amit.

PHYSIOLOGY


12. Adrenaline, noradernaline and dopamine act through:

a. Single pass receptor
b. Four pass receptor
c. Seven pass receptor
d. Ligand gated receptor


14. Mean arterial pressure is calculated as:

a. (SBP + 2DBP)/3
b. (DBP + 2SBP)/3
c. (SBP + 3DBP)/2
d. (DPB + 3SBP)/2


BIOCHEMISTRY

20. Same amino acid is coded by multiple codons due to following:

a. Degeneracy
b. Frame-shift mutation
c. Transcription
d. Mutation


23.  Anticoagulant used to estimate glucose from a sample sent from PHC is

a. EDTA
b. Calcium oxalate
c. Potassium oxalate + NaF
d. Sodium citrate


25. The 40 nm gap between the tropocollagen molecule in collagen, which serve as the site of bone formation is occupied by which of the following:

a. Carbohydrate
b. Ligand moeity
c. Ca++
d. Fe ++

COMMUNITY MEDICINE

39. You have diagnosed a patient clinically as having SLE and ordered 6 tests. Out of which 4 tests have come positive and 2 are negative. To determine the probability of SLE at this point, you need to know:

a. Prior probability of SLE; sensitivity and specificity of each test.
b. Incidence of SLE and predictive value of each test.
c. Incidence and prevalence of SLE.
d. Relative risk of SLE in this patient.


41. Direct standardization is used to compare the mortality rates between two countries. This is done because of the difference in:

a. Causes of death.
b. Denominators
c. Age distributions
d. Numerators.


45. Using a new technique, Hb was estimated in a blood sample.  The test was repeated 10 times.  The reports were :  9.5, 9.2, 9.4, 9.6, 9.7, 9.9, 10.2, 10.3, 10.5, 12.1. Accurate value of Hb was estimated by standard tests to be 10.2. The new technique has:

a. High validity and high reliability
b. Low validity and low reliability
c. High validity and low relibility
d. Low validity and high reliability.


46. In a study in UK, an association was found between sale of antiarrhytmic drug and an increase in deaths due to asthma. This is an example of

a. Ecological study
b. Cohort study
c. Case reference study
d. Experimental study.


49. Socialization of medicine leads to all except:

a. Ensures complete utilization of services by all people.
b. Free medical care supported by state.
c. Eliminates the competition among physicians in search of clients.
d. Ensures social equity, universal coverage of health services.


56. Which epidemiologicla study gives the most accurate result:

a. Meta analysis.
b. Cross-sectional study.
c. Randomized control trial with double blind.
d. Cohort study.


PHARMACOLOGY

72. The following drug is not useful for MRSA.

a. Cefaclor
b. Cotrimoxazole
c. Ciprofloxacin
d. Vancomycin


MICROBIOLOGY


74. An elderly male presented with fever, chest pain and dry coug.  Sputum cultured on charcoal yeast medium.  The organism is :

a. H.influenza
b. Moraxella catarrhalis
c. Legionella
d. Burkholderia cepacia


76. A young male presented with urethral discharge.  On urine examination, pus cells were found but no organisms. Which method would be the best for culture?

a. Mc coy cell line
b. Thayer Martin medium
c. LJ medium
d. Levinthal medium


80. With reference to Bacteroides fragilis, the following statements are true except:

a. B. fragilis is the same frequent anaerobe isolated from clinical samples.
b. B. fragilis is not uniformly sensitive to metronidazole.
c. The lipopolysachharide formed by B. fragilis is structurally and functionally different from the conventional endotoxin.
d. Shock and DIC are common in Bacteroides bacteremia.


81. A child had pustular lesion on leg. On gram staining, gram positive coccin are seen . To establish the diagnosis of Group A streptococcal erythroderma, the test used is :

a. Bile solubility test
b. Catalase test
c. Optochin sensitivity
d. Bacitracin sensitivity


82. A patient admitted to an ICU is on central venous line for last one week.  He is on ceftazidime and amikacin.  After 7 days of antibiotics, he develops a spike of fever and his blood culture is positive fro gram positive cocci in chains, which are catalase negative.  Following this, vancomycin was started but the culture remained positive for the same organism, even after 2 weeks of therapy.  The most likely organism causing infection is:

a. Staphylococcus aureus
b. Viridans streptococci
c. Enterococcus faecalis
d. Coagulase negative staphylococci.


PATHOLOGY:


93. In acute inflammation due to the contraction of endothelial cell cytoskeleton, whicn of the following results:

a. Delayed transient increase in permeability
b. Early transient increase
c. Delayed permanent increase
d. Early permanent increase


95. The most common gene defect in idiopathic steroid resistant nephrotic syndrome:

a. ACE
b. NPHS 2
c. HOX 11
d. PAX


MEDICINE


98. Reflux disease, which cause of proteinuria is nephrotic range?

a. Membranous glomerulonephritis
b. Focal segmental glomerulosclerosis
c. Nodular glomerulosclerosis
d. Crescenteric glomerulonephritis.


99. Which deleterious effect is least likely to occur in hypothermia?

a. Cardiac arrhythmia
b. Decreased peripheral resistance
c. Reversible coagulation
d. Renal failure.

104. Treatment for multiple sclerosis:

a. Interferon alpha
b. Interferon beta
c. Infliximab
d. Interferon gamma.


108. Which of the following is not a limb girdle dystrophy?

a. Sarcoglycan dystrophy
b. Dystrophin dystrophy
c. Dysferin dystrophy
d. Calpain dystrophy.


109. Which of the following is the most specific test for Rheumatoid arthritis?

a. Anti-ccp antibody
b. Anti Igm antibody
c. Anti IgA antibody
d. Anti IgG antibody


112. Which of the following exclusively involve neurons?

a. Spinocerebellar ataxia
b. Supranuclear palsy
c. Corticobasilar degeneration
d. Multiple system atrophy.


114. A young male patient presents with LDL 600 mg/dl, triglycerides 160 mg/dl.  What would be the most likely finding on physical examination?

a. Tendon xanthoma.
b. Lipemia retinalis
c. Eruptive tuberous xanthoma
d. Xanthelasma.


119. HAM test is done for:

a. GPI anchor protein
b. Complement defect
c. Spectrin defect
d. Mannose binding protein.


120. 16 year old with primary amenorrhea attends OPD. She has normal sexual development and normal breast but with absent pubic and axillary hair.  Examination shows b/l inguinal hernias.  USG shows absent uterus and blind vagina.  Diagnosis will be:

a. Turner syndrome
b. Mullerian agenesis
c. STAR syndrome
d. Androgen insensitivity syndrome.


PEDIATRICS


121. A newborn presents with congestive heart failure, on examination has bulging anterior fontanellae with a bruit on auscultation.  Trans fontanella USG shows a hypoechoic midline mass with dilated lateral ventricles.  Most likely diagnosis is:

a. Medulloblastoma.
b. Encephalocele
c. Vein of Galen malformation
d. Arachnoid cyst.


123. All the following can occur in a neonate for heat production except:

a. Shivering
b. Breakdown of brown fat with adrenaline secretion
c. Universal flexion like a fetus
d. Cutaneous vasoconstriction.


127. The most important fatty acid present in breast milk for growth is:

a. Docosahexaenoic acid
b. Palmitic acid
c. Linoleic acid.
d. Linolenic acid.


SURGERY:


144. Which fruit juice helps in preventing UTI:

a. Grape
b. Raspberry
c. Cranberry
d. Orange


149. Which is not elevated in a child presenting with icterus, pruritus and clay coloured stools.

a. Gamma glutamyl transpeptidase
b. Alkaline phosphatase
c. 5- nucleotidase
d. Glutamate dehydrogenase.


151. A 45-yr old female complaints of progressive lower limb weakness, spasticity, urinary hesitancy.  MRI shows intradural enhancing mass lesion.  Most likely diagnosis is:

a. Dermoid cyst
b. Intradural lipoma
c. Neuroepithelial cyst
d. Meningioma.


OBSTETRICS AND GYNECOLOGY


162. Which drug is given to prevent HIV transmission from mother to child?

a. Nevirapine
b. Lamivudine
c. Stavudine
d. Abacavir


163. After coming head of breech will have difficulty in delivery in all the following conditions except:

a. Hydrocephalus
b. Placenta previa
c. Incomplete dilation of cervix
d. Extension of head.


166. Lady with infertility with b/l tubal block at cornua.  Best method of managment:

a. Laparoscopy and Hysteroscopy
b. Hydrotubation
c. IVF
d. Tuboplasty


172. Which of the following is the least likely physiological change in pregnancy?

a. Increase in intravascular volume
b. Increase in cardiac output
c. Increase in stroke volume
d. Increase in peripheral vascular resistance.


174. Premature baby of 34 weeks was delivered. Baby had bullous lesion on the body.  X-ray shows periostitis.  What is the next investigation?

a. VDRL for mother and baby
b. ELISA for HIV
c. PCR for TB
d. Hepatitis surface antigen for mother.


OPHTHALMOLOGY


180.  Oculomotor nerve palsy causes all except:

a. Miosis
b. Ptosis
c. Outward eye deviation
d. Diplopia.


SKIN


187. A 3 year old child has eczematous dermatitis on extensor surfaces. His mother has a history of bronchial asthma.  Diagnosis should be:

a. Atopic dermatitis
b. Contact dermatitis
c. Seborrheic dermatitis
d. Infantile eczematous dermatitis


ANAESTHESIA


188. Which of the following is not true of Xenon anaesthesia?

a. Non explosive
b. Mnimal CVS side effect
c. Slow induction and recovery
d. Low blood gas solubility


189. Which of the following anaesthesia will produce decreased EEG activities?

a. Hypothermia
b. Early hypoxia
c. Ketamine
d. N2O