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Answers for Questions in AIIMS Nov 2011 from Operation Harri – A Book for AIIMS and AIPG from Positive Coaching

60 out of 200 Questions in AIIMS Nov 2001 were from Operation Harri – A Book for AIIMS and AIPG from Positive Coaching

60 out of 200 Questions in AIIMS Nov 2001 from Operation Harri - A Book for AIIMS and AIPG from Positive Coaching

60 out of 200 Questions in AIIMS Nov 2001 from Operation Harri – A Book for AIIMS and AIPG from Positive Coaching

The highlight of this book is that, in between chapters Questions have been sandwiched [AIIMS, ALL Indian Questions and mock Questions], So that both theory and MCQs are judiciously covered. It will be useful for medical students to get oriented with P.G. Medical entrance exam preperations.

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Few eBooks by Pozitive

Operation Harri : eBook (Pozitive Operative Harri)
Pozitive : AIIMS : May 2013 : Discussion
AIIMS November 2013 Q & A by Pozitive

-oOo-

-oOo-

About Operation Harri . . .

Dr. Krithiga Rajan, M.D (Peds) Rank 4-TN 2008 says

I am proud to say that i am one of those who reaped the benefits of the programme “OPERATION HARRI” when it was introduced in the year 207. The important facts from each page of Harrison were discussed, reinforced and carved in our brain. It helped a lot to get through the entrance exam successfully. Being condensed as a book now, it would be still more useful to come out with flying colours in your entrance exams

Dr. Ilavarsi M.D (Int.Med) Rank 3-AIIMS Nov 2010 says

OPERATION HARRI is one of the brain children and a powerful weapon of POSITIVE… I did not understand its importance fully well when I was preparing for pg entrance… only after entering AIIMS, I came to know that most of the PG students text book for the purpose of their university examinations… but OPEARATION HARRI is a boon in disguise for those who have not read Harrison during their UG days… it gives you extra force in the exams…

Dr. R. Priyadharsini. M.D (OG), Rank-55, TN-2008 says

Operation Harri is an unique programme for PG aspirants. It is brought out in a concised, readable and all the more remembrable manner. Apart from Medicine, it coverss Pharm, Path, Micro, Physio. It will be useful to laborious task of reading the massive volumes of Harrison books is much simplified and is neatly encapsulated as a tablet format. More than 50% of the questions in the All India exams can be answered by just reading this book. The reciepse is ready for you. Choice is yours.

Dr. V. Palani Kumaran M.D, Rank-9-TN-2011 says

I am the one of the greatest fan of OPEARTION HARRI. The collection of OPERATION HARRI will be very much useful not only for MCQ preparation but also useful in having academic knowledge in Medicine for further carrier. Really it is a boon to have OPERATION HARRI in text which, I am sure is going to make a lot of true POSITIVIANS Succeed in Entrance Exams and also to acquire good basic knowledge thoroughly in Medicine. I wish the Almighty for all success

-oOo-

GOD IS GREAT  

 POSITIVE

“OPERATION HARRI”

 EVIDENCE BASED

AIIMS NOVEMBER 2011 [Questions from “OPERATION HARRI” text book]

Neither this question:

      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 : ?(AIIMS-NOV-2011)

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

ans-a

     (120% of canditates would have answered this!!!)

Nor this question: Will decide your rank in AIIMS NOV 2011 Exam

137. Which of the following were proved to be false by use of evidence based medicine? (AIIMS-NOV-2011)

A. Monitoring blood glucose and preventing hyperglycemia has been shown to be effective in recovery in ICU patients
B. APACHE score >25, dinopaeraux should be stopped
C. ?
D. ?

     (99.99% of canditates would not have answered this correctly(luck excluded)!!!)

– But these questions below will

144. Chromosomal mutations can be identified from all except. ?(AIIMS-NOV-2011)-A SAMPLE TO PROVE THE EFFICACY OF OPERATION HARRI

1. single stranded polymorphism
2.dideoxy nucleotide trail sequencing
3.agarosge gel electrophoresis
4.Denaturing Gradient Gel Electrophoresis (DGGE)

ANS-C

193. Correct match of drug and its metabolic enzyme are all except? ?(AIIMS-NOV-2011)-THE ULTIMATE QUESTION TO PROVE THE EFFICACY OF OPERATION HARRI*****

a.digoxin – p glycoprotein
b.carvedilol- CYP2D6
c.ca2+ channel blocker- CYP3A4
d.simvastatin – glucoronide conjugation

ANS-D

(Only 0.1% could have answered this correctly and that 0.1% is you (POSITIVIANS) guys!!!)

 

 


“OPERATION HARRI”

EVIDENCE BASED


1. Correct match of drug and its metabolic enzyme are all except? ?(AIIMS-NOV-2011)-THE ULTIMATE QUESTION TO PROVE THE EFFICACY OF OPERATION HARRI*****

a.digoxin – p glycoprotein
b.carvedilol- CYP2D6
c.ca2+ channel blocker- CYP3A4
d.simvastatin – glucoronide conjugation

ANS-D

REF-OPERATION HARRI-PAGE 6

Molecular Pathways  Mediating Drug Disposition

Molecule

Substrates

Inhibitors

 

CYP3A

 Calcium channel blockers Amiodarone
 Anti Arrythmics Ketoconazole, Itraconazole
Statins Erythro, Clarithro
 Indinavir, Saquinavir, Ritonavir(AIIMS-MAY-2010***)
 

 

CYP2D6

 Timolol, metoprolol,carvedilol Quinidine
Phenformin TCA
Codeine Fluoxetine, Paroxetine
Propafenone, flecainide
TCA
Fluoxetine, paroxetine
CYP2C9 Warfarin Amiodarone
Phenytoin Fluconazole
Glibizide Phenytoin
Losartan
CYP2C19 Omeprazole
Mephenytoin

 

Thiopurines – methyl transferase 6-Mercaptopurine Azathioprine
N-acetyl Transferase  INHProcainamideHydralazineSulfa
UGT1A1 Irinotecan
Pseudo cholinesterase  Succinyl choline
P glycoproteinP-Glycoprotein  Digoxin  Quinidine
 HIV Protease inhibitors  Amiodarone
 Many CYP3A substrates  Verapamil
 Cyclosporine
 Itraconazole
Erythromycin

Not (m)any of the books you use for entrance examinations can answer this question!!!

2. Chromosomal mutations can be identified from all except. ?(AIIMS-NOV-2011)-A SAMPLE TO PROVE THE EFFICACY OF OPERATION HARRI

1. single stranded polymorphism
2.dideoxy nucleotide trail sequencing
3.agarosge gel electrophoresis
4.Denaturing Gradient Gel Electrophoresis (DGGE)

ANS-C

POSITIVE-OPERATION HARRI PAGE-287

Methods Used for the Detection of Mutations
Method Principle Type of Mutation Detected
Commonly Used Techniques
Fluorescent in situ hybridization (FISH)(AIIMS-NOV-2010***) Hybridization to chromosomes with fluorescently labeled probes Numerical or structural abnormalities in chromosomes
Southern blot cDNA probe Large deletion, insertion, rearrangement, expansions of triplet repeat, amplification.
Polymerase chain reaction (PCR) Amplification of DNA segment Expansion of triplet repeats, variable number of tandem repeats (VNTR), gene rearrangements, translocations.
Reverse transcriptase PCR (RT-PCR) Reverse transcription, amplification of DNA segment absence or reduction of mRNA transcription Analyze expressed mRNA (cDNA) sequence; detect loss of expression
DNA sequencing * Direct sequencing of PCR products Point mutations, small deletions and insertions
Sequencing of DNA segments cloned into plasmid vectors
Restriction fragment polymorphism (RFLP) Detection of altered restriction pattern of genomic DNA (Southern blot) or PCR products Point mutations, small deletions and insertions
Other Techniques
Single-strand conformational polymorphism (SSCP) * PCR of DNA segment: Mutations result in conformational change and altered mobility Point mutations, small deletions and insertions
Denaturing gradient gel electrophoresis (DGGE)* PCR of DNA segment: Mutations result in conformational change and altered mobility Point mutations, small deletions and insertions
RNAse cleavage Cleavage of mismatch between mutated and wild-type sequence Point mutations, small deletions and insertions
Oligonucleotide specific hybridization (OSH) Hybridization of PCR products to wild-type or mutated oligonucleotides immobilized on chips or slides Point mutations, small deletions and insertions
Microarrays
(AI-2010***)
Hybridization of PCR products to wild-type or mutated oligonucleotides Point mutations, small deletions and insertions
Genotyping of SNPs
Protein truncation test (PTT) Transcription/translation of cDNA isolated from tissue sample Mutations leading to premature truncations
Pyrosequencing Clonal amplification of single DNA fragments on microparticles followed by massive parallel sequencing Sequencing of whole genomes of microorganisms, resequencing of amplicons
Multiplex ligation-dependent probe amplification (MLPA) Quantification of PCR-generated amplicons reflecting the number of copies of a specific DNA sequence Copy number

DNA Sequencing

* Capillary electrophoresis-based Sanger method in which dideoxynucleotides are used to randomly terminate DNA polymerization at each of the four bases

3. Which drug is given to prevent HIV transmission from mother to child.(AIIMS-NOV-2011)

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

ANS-A

REF-OPERATION HARRI PAGE-808, CONSULTANT, POSI GOLD AIIMS NOV 2006, Ques: 79, Page 197

OPERATION HARRI

Maternal-Fetal/Infant Transmission

*    HIV can be transmitted to the fetus as early as the first and second trimester of pregnancy. (AI-2011***)

*    However, maternal transmission to the fetus occurs most commonly in the perinatal period.

*    The relative proportions of mother-to-child transmissions were 23–30% before birth, 50–65% during birth, and 12–20% via breast-feeding.

*  Zidovidine from 2nd Trimester through delivery and of the infant for 6 wks

            ¯  

      infection rate < 1 %

*    Choice of antiretroviral therapy for pregnant women -based on the same considerations used for women who are not pregnant.

*    A single dose of nevirapine given to the mother at the onset of labor and a single dose to the infant within 72 h of birth.

4. HAM test is done for?(AIIMS-NOV-2011)

a.G.P.I anchor protein
b.Complement defect
c.Spectrin defect
d.Mannose binding protein

ANS-A

REF-POSIGOLD-AIIMS-NOV-2006, Quest: 11, Page 192

OPERATION HARRI-PAGE-480

Pathogenesis-PNH

*   Acquired clonal disease.

*    Inactivating somatic mutation in a single hematopoeitic stem cell of a gene on X-chromosome – (Pig-A)* PIG-A – necessary for biosynthesis of the glycosyl phosphatidylinositol anchor (GPI) –(AI-2010***)

*    GPI attaches many proteins to RBC surface.

Lysis of RBC after complement activation either by acid (Ham test) or by reduction in ionic strength (sucrose lysis test).

* Analysis of GPI linked proteins (eg CD 55) on RBC or granulocytes by flow cytometry – superior

5. A 3 year old has eczematous dermatitis on extensor surfaces. His mother has a history of Bronchial asthma. Diagnosis should be.(AIIMS-NOV-2011)

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

Ans a

POSITIVE-OPERATION HARRI-PAGE-230, POSIGOLD AIIMS NOV 2006, Ques: 100, Page 198

Atopic dermatitis (AD) is the cutaneous expression of the atopic state, characterized by a family history of asthma, allergic rhinitis, or eczema.

*   When both parents are affected by AD, >80% of their children manifest the disease. When only one parent is affected,  50%.

*   Increased IgE synthesis, increased serum IgE, and impaired delayed-type hypersensitivity reactions.

*   The clinical presentation often varies with age. Half of patients with AD present within the first year of life, and 80% present by 5 years of age.

*   80% ultimately coexpress allergic rhinitis or asthma.

* The infantile patternextensor surfaces

6. Normal ovarian function is seen in? ?(AIIMS-NOV-2011)

A. Müllerian agenesis       B. Sweyer syndrome
C. Turner syndrome         D. ?

ANS-A

REF-MODIFIED POSIGOLD-AI-2010-OPERATION HARRI –PAGE-213, CONSULTANT

OPERATION HARRI-DICSUSSION

*    Abnormalities of the uterus and outflow tract typically present as primary amenorrhea.

*    Patients with normal pubertal development and a blind vagina- the differential diagnosis includes obstruction by a transverse vaginal septum or imperforate hymen; müllerian agenesis (Mayer-Rokitansky-Kuster-Hauser syndrome), which has been associated with mutations in the WNT4 gene(AI-2010***); and androgen insensitivity syndrome (AIS), which is an X-linked recessive disorder that accounts for ~10% of all cases of primary amenorrhea.

*    Patients with AIS have a 46, XY karyotype, but because of the lack of androgen receptor responsiveness, they have severe underandrogenization and female external genitalia. The absence of pubic and axillary hair (AIIMS-NOV-2010***)distinguishes them clinically from patients with müllerian agenesis.

*    Asherman syndrome presents as secondary amenorrhea or hypomenorrhea and results from partial or complete obliteration of the uterine cavity by adhesions that prevent normal growth and shedding of the endometrium. Curettage performed for pregnancy complications accounts for >90% of cases(AI-2006***)

* Müllerian agenesis may also require surgical intervention, although vaginal dilatation is adequate in some patients. Because ovarian function is normal, assisted reproductive techniques can be used with a surrogate carrier.

7. What will be the associated finding in a patient with hematuria with hypercalciuria? (AIIMS-NOV-2011)

A. Isomorphic RBC    B. RBC cast
C. Nephrotic range proteinuria
D.

ANS-A

REF-OPERATION HARRI-PAGE -185

i) Hematuria, Pyuria, and Casts

*    Normal red blood cell excretion is up to 2 million RBCs per day.

*    Hematuria is defined as two to five RBCs per high-power field (HPF) and can be detected by dipstick.

*   Persistent or significant hematuria (>three RBCs/HPF on three urinalyses, or a single urinalysis with >100 RBCs, or gross hematuria).

*    Hypercalciuria and hyperuricosuria are  risk factors for unexplained isolated hematuria in both children and adults.

*    The RBCs of glomerular origin are often dysmorphic when examined by phase-contrast microscopy.

*    The most common etiologies of isolated glomerular hematuria are IgA nephropathy, hereditary nephritis, and thin basement membrane disease.

*    Hematuria with dysmorphic RBCs, RBC casts, and protein excretion >500 mg/d is  diagnostic of glomerulonephritis.

8. A mentally retarded child can have Down’s syndrome due to all except? ?(AIIMS-NOV-2011)

A. Deletion of 21st chromosome
B. Trisomy of 21st chromosome
C. Robertsonian translocation
D. Mosaic

ANS-A

REF-OPERATION HARRI-PAGE 291 ,CONSULTANT

Numerical Abnormalities

*    Clinically, the most important of these is trisomy 21, the most frequent cause of Down syndrome- the most common chromosome abnormality in live-born individuals.

*    Incidence rates for trisomies 13 and 18 in livebirths are 1/20,000 and 1/10,000, respectively.

5% of all cases of Down syndrome involve individuals with mosaic trisomy 21,

Robertsonian and reciprocal. Robertsonian rearrangements -, in which the long arms of two acrocentric chromosomes (chromosomes 13, 14, 15, 21, and 22) join together, generating a fusion chromosome that contains virtually all of the genetic material of the original two chromosomes.

* ~3% of Down syndrome cases are due to unbalanced Robertsonian translocations, most often involving chromosomes 14 and 21.

9. If 4 nucleotide repeats code for an amino acid. What is the number of amino acids coded possible:  ?(AIIMS-NOV-2011)

a.16                             b.64
c.4                               d.256

ANS-D

REF-OPERATION HARRI,BIOCHEM CONSULTANT

Ans-d

REF-OPERATION HARRI-PAGE 270

Codons, a triplet of bases that specifies a particular amino acid. It is possible to arrange the four bases into 64 different triplet codons (43). Each codon specifies 1 of the 20 different amino acids. More codons than amino acids, the genetic code is degenerate

10.  lady with hb-9, mcv- 50 , ferritin-200 , tibc-294 fe- 30mg/dl?(AIIMS-NOV-2011)

a.fe def                       b.anaemia of chronic d’s
c.thalasemia minor      d.thalasssemia major

ANS-B

REF-OPERATION HARRI-PAGE-463, CONSULTANT

 

 

Diagnosis of Hypoproliferative Anemias
Tests Iron Deficiency Inflammation Renal Disease Hypometabolic States
Anemia Mild to severe Mild Mild to severe Mild
MCV (fL) 60–90 80–90 90 90
Morphology Normo-microcytic Normocytic Normocytic Normocytic
SI <30 <50 Normal Normal
TIBC >360 <300 Normal Normal
Saturation (%) <10 10–20 Normal Normal
Serum ferritin (g/L) <15 30–200 115–150 Normal
Iron stores 0 2–4+ 1–4+ Normal


11. Karyotyping of fetus can be done frm a/e?(AIIMS-NOV-2011)

a.Chorionic villlus sampling

b.cordocentesis
c.amniocentesis           d.fetal skin

Ans: ?D

REF – OPERATION HARRI -PAGE289

Prenatal diagnosis

     Amniocentesis involves the removal of a small amount of amniotic fluid, usually at 16 weeks of gestation. The main indications for amniocentesis include advanced maternal age above age 35, abnormal serum triple marker test (alfa-fetoprotein, beta human chorionic gonadotropin, pregnancy-associated plasma protein A, or unconjugated estriol), a family history of chromosomal abnormalities, or a Mendelian disorder amenable to genetic testing.

–     Chorionic villus sampling (CVS), in which a small amount of the chorion is removed by a transcervical or transabdominal biopsy. Chromosomes and DNA obtained from these cells can be submitted for cytogenetic and mutational analyses. CVS can be performed earlier in gestation (weeks 9–12) than amniocentesis.

–     Later in pregnancy, beginning at about 18 weeks of gestation,(AI-2006***) percutaneous umbilical blood sampling (PUBS) permits collection of fetal blood for lymphocyte culture and analysis.

12. TB meningitis features, blood picture will show which of the following-?(AIIMS-NOV-2011)

a.lymphocytosis ,low glucose ,high protein
b. lymphocytosis ,normal glucose ,high protein
c.                                       d.

ANS-A

POSIGOLD ALL INDIA 2007, QUES: 36, PAGE 36

REF-CONSULTANT, OPERATION HARRI-PAGE-711

Tuberculous Meningitis and Tuberculoma

  –   Seen most often in young children.

  –   In more than half of cases, evidence of old pulmonary lesions or a miliary pattern is found on chest radiography.

 –    Cerebrospinal fluid (CSF)- high leukocyte count (up to 1000/microL), usually with a predominance of lymphocytes, a protein content of 1–8 g/L, low glucose concentration.

–     AFB are seen on direct smear of CSF sediment in up to one-third of cases.

–     Culture of CSF is diagnostic in up to 80% of cases and remains the gold standard.

–     Polymerase chain reaction (PCR) has a sensitivity of up to 80%, but rates of false-positivity reach 10%.

–     The ADA concentration may be a sensitive test but has low specificity.

–     Tuberculoma-CT or MRI reveals contrast-enhanced ring lesions.

13. Preleukemic conditions all except?(AIIMS-NOV-2011)

a.pnh
b.paraoxysmal cold hemoglobinuria
c.myelodysplasia        d.aplastic leukemia

ANS-B

REF-OPERATION HARRI-PAGE-480

Paroxysmal Cold Hemoglobinuria (PCH)

*    Mostly in children, usually triggered by a viral infection, usually self-limited.

*    Donath-Landsteiner antibody.

*    Antibody-anti-P specificity and binds to red cells only at a low temperature (optimally at 4°C), but when the temperature is shifted to 37°C, lysis of red cells takes place in the presence of complement.

Paroxysmal Nocturnal Hemoglobinuria (PNH)

*    Intracorpuscular defect acquired at the stem cell level.

*    Clinical – Triad

   – Hemolytic anemia.

   – Venous thrombosis.

   – Deficient hematopoeisis(Pancytopenia).

*    RBC – ­ sensitivity to hemolytic action of complement .

*    ­ platelet aggregation (due to complement)   ® thrombosis.

* Platelet – normal life span.

* Venous thrombosis

   – 40%.

   – Budd. Chiari.

   – CVT – common cause of death.

* Bone marrow – normocellular.*

*    15 – 30% ® Aplastic anemia.

*    Commonest cause of death has been venous thrombosis followed by infection.

*    1–2% of all cases PNH may terminate in acute myeloid leukemia.

*    Spontaneous recovery from PNH has been well documented.

Pathogenesis

14. A patiemt has normal PT,Plat count and inc aPTT,factor 8 levels given as 60 iu/ml, no bleeding history, diagnosis? ?(AIIMS-NOV-2011)

a.Factor IX def.                 b.Thalassemia
c.Factor VIII inhibitors     d.Lupus anticoagulant

ANS-?A

REF-OPERATION HARRI-PAGE 538

Acquired Inhibitors of Coagulation Factors

* FVIII is the most common target of antibody formation.

*    Occurs predominantly in older adults.

*    Autoimmune diseases, malignancies (lymphomas, prostate cancer), dermatologic diseases, and pregnancy.

*    In contrast to hemophilia, hemarthrosis is rare.

*    The diagnosis is based on the prolonged aPTT with normal PT and TT.*

The aPTT remains prolonged after mixture of the test plasma with equal amounts of pooled normal plasma for 2 h at 37°C.

*    Major bleeding is treated with high doses of human or porcine FVIII, PCC/PCCa, or recombinant FVIIa.

*    Anti-CD20 monoclonal antibody (rituximab) – effective in patients with autoantibodies to FVIII.

*    Lupus anticoagulant can be associated with venous or arterial thrombotic disease- a prolonged PTT that does not correct on mixing.

* To distinguish acquired inhibitors from lupus anticoagulants- the dilute Russell’s viper venom test and the hexagonal-phase phospholipids test will be negative in patients with an acquired inhibitor and positive in patients with lupus anticoagulants

15. Which of the following does not present with eosiniphilia and ARF.. ?(AIIMS-NOV-2011)

a.drug induced interstitial nephritis
b.atheroembolic phenomena
c.contrast nephropathy    d.PAN

ANS-D.?C

REF-OPERATION HARRI-PAGE 182,274

Intrinsic Renal Disease

*    Ischemic and toxic ATN account for ~90% of acute intrinsic renal failure.

*    ATN can often be distinguished from prerenal azotemia by urinalysis and urine electrolyte composition.

*    The kidney is vulnerable to toxic injury by virtue of its rich blood supply (25% of cardiac output) .

*    Eosinophiluria – suggestive of allergic interstitial nephritis or atheroembolic renal disease and is observed by using a Hansel stain.

*    Stigmata of atheroemboli (livedo reticularis, distal peripheral infarcts, eosinophilia).

Eosinophilia -1) drugs (iodides, aspirin, sulfonamides, nitrofurantoin, penicillins, and cephalosporins). 2)Allergies such as hay fever, asthma, eczema, serum sickness, allergic vasculitis, and 3)collagen vascular diseases (e.g., rheumatoid arthritis, eosinophilic fasciitis, allergic angiitis, and periarteritis nodosa) and 4)malignancies (e.g., Hodgkin’s disease; mycosis fungoides; chronic myeloid leukemia; and cancer of the lung, stomach, pancreas, ovary, or uterus), as well as in Job’s syndrome and CGD.

16. prothrombin time measurement –?(AIIMS-NOV-2011)

a.within 2 hr should be measured
b.immediately refrigerate to preserve coagulant factor function
c. platelet rich plasma is required
d. activate with kaolin

REF-PARTIAL HELP-OPERAATION HARRI-PAGE: 544

Monitored by prothrombin time- performed by adding thromboplastin, a reagent that contains tissue factor, phospholipid, and calcium, to citrated plasma and determining the time to clot formation.

17. 1 6 year old girl wth primary amenorrhea attends OPD. She has normal sexual development and normal breast but with absent public and axillary hair. Examination shows B/L inguinal hernias.USG shows absent uterus and blind vagina. Diagnosis will be?(AIIMS-NOV-2011)

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

REF-POSITIVE GENETICS, POSIGOLD, AIIMS NOV 2006, Quest: 88, Page 197

OPERATION HARRI–PAGE-213, CONSULTANT

OPERATION HARRI-DICSUSSION

*    Abnormalities of the uterus and outflow tract typically present as primary amenorrhea.

*    Patients with normal pubertal development and a blind vagina- the differential diagnosis includes obstruction by a transverse vaginal septum or imperforate hymen; müllerian agenesis (Mayer-Rokitansky-Kuster-Hauser syndrome), which has been associated with mutations in the WNT4 gene(AI-2010***); and androgen insensitivity syndrome (AIS), which is an X-linked recessive disorder that accounts for ~10% of all cases of primary amenorrhea.

*    Patients with AIS have a 46, XY karyotype, but because of the lack of androgen receptor responsiveness, they have severe underandrogenization and female external genitalia. The absence of pubic and axillary hair (AIIMS-NOV-2010***)distinguishes them clinically from patients with müllerian agenesis.

*    Asherman syndrome presents as secondary amenorrhea or hypomenorrhea and results from partial or complete obliteration of the uterine cavity by adhesions that prevent normal growth and shedding of the endometrium. Curettage performed for pregnancy complications accounts for >90% of cases(AI-2006***)

* Müllerian agenesis may also require surgical intervention, although vaginal dilatation is adequate in some patients. Because ovarian function is normal, assisted reproductive techniques can be used with a surrogate carrier.

18. An elderly male presented with fever, chest pain and dry cough, sputum cultured on charcoal yeast medium, the organism is (AIIMS-NOV-2011)

a.H.influenza               b.Moraxella catarrhalis

c.Legionella                 d.Burkholderia cepacia

ANS-C

REF-POSIGOLD, OPERATION HARRI – PAGE660

Culture

*    Multiple selective BCYE media- grow slowly, requiring 3–5 days.

*    L. pneumophila is often isolated from sputum that is not grossly or microscopically purulent.

*    Sputum containing more than 25 epithelial cells per high-power field (a finding that classically suggests contamination).

Antibody detection

*    A fourfold rise in titer is diagnostic.

 * 12 weeks are often required for the detection of an antibody response.

 *   Used primarily in epidemiologic studies.

 *   Cross-reactivity with Legionella spp. and some gram-negative bacilli.

19. Oculomotor nerve palsy causes all except?(AIIMS-NOV-2011)

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

REF-POSIGOLD

OPERATION HARRI-PAGE-107

Total palsy of the oculomotor nerve causes ptosis, a dilated pupil, and leaves the eye “down and out” because of the unopposed action of the lateral rectus and superior oblique.

20.In herpes zoster all are seen commonly except? (AIIMS-NOV-2011)

a. Pseudo dendritic

b. Anterior stromal keratitis
c. Endothelitis              d. Sclerokeratitis

ans-a

REF-POSITIVE PEARL-OPHTHAL,OPERATION HARRI-PAGE-97

H. Zoster

–  Usually in nasocilliary nerve involvement (Hutchinson’s sign).

–     Stromal keratitis, anterior uveitis, raised intraocular pressure, ocular motor nerve palsies, acute retinal necrosis, and postherpetic scarring and neuralgia are common sequelae.

–     antiviral agents and cycloplegics. In severe cases, glucocorticoids.

POSITIVE PEARL-OPHTHAL HANDOUT

Herpes Zoster Ophthalmicus

  • It usually involves ophthalmic division of 5th cranial nerve
  • Hutchinson sign: ocular symptoms + vesicles in nose
  • Vesicles turn to pustules and then crusting rapidly
  • Ocular signs are keratitis, conjunctivitis, episcleritis, and anterior uveitis
  • Long-term effects are posterior subcapsular cataract, neurotrophic uveitis
  • Complications: acute retinal necrosis, cerebral angitis, ischemic optic neuropathy.
  • T/T: Acyclovir (800 mg x 5times a day) and valacyclovir (500 mg/day). To be given within 72 hours of start, may reduce ocular complications but not of postherpetic neuralgia.
  • If anterior uveitis presents: Cycloplegia + topical steroids

21. Increased level of alanine in serum after fasting suggests? ?(AIIMS-NOV-2011)

A. Increased muscle breakdown
B. Reduced amino acid utilisation from gluconeogenesis
C. Break in continuity of plasma membrane resulting in leakage of amino acids
D.

ANS-A

REF-CONSULTANT,OPERATION HARRI-PAGE-PAGE-322

Gluconeogenesis

*    The major aim of protein catabolism during a state of starvation is to provide the glucogenic amino acids (especially alanine and glutamine)

*    In the hypometabolic/starved state, protein breakdown for gluconeogenesis is minimized, especially as ketones derived from fatty acids become the substrate preferred by certain tissues.

*      In the hypermetabolic/stress state, gluconeogenesis increases dramatically

22. Same aminoacid is coded by multiple codons due to following : ?(AIIMS-NOV-2011)

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

ANS-A

REF-OPERATION HARRI PAGE-PAGE-277,

POSIGOLD-AI-2007, AI-2006, AIIMS NOV 2006, Ques: 189, Page 204,CONSULTANT-

What is degeneracy of codon?

There are three nucleotides which make combinations of three to form a codon. So 4C3 i.e., 4^3 = 64 combinations or codons are possible, we know three of them are stop codons, so 61 code for 20 aminoacids i.e., more than one codon code for a single aminoacid, this is Known as degeneracy of codon.

OPERATION HARRI-DISCUSSION

Structure of DNA

*    DNA is a double-stranded helix composed of four different bases: adenine (A), thymidine (T), guanine (G), and cytosine (C). Adenine is paired to thymidine, and guanine is paired to cytosine, by hydrogen bond interactions.

*    Messenger RNA (mRNA) is encoded by  sense or coding strand of the DNA double helix and is translated into proteins by ribosomes.

*    Codons, a triplet of bases that specifies a particular amino acid. It is possible to arrange the four bases into 64 different triplet codons (43). Each codon specifies 1 of the 20 different amino acids.

*    More codons than amino acids, the genetic code is degenerate.

23. Systemic steroids are indicated in? ?(AIIMS-NOV-2011)

A. Pustular psoriasis  B. Impetigo herpetiformis
C. Psoriatic arthropathy
D. Psoaritic erythroderma

ANS-C

PARTIAL HELP FROM OPERATION HARRI-page-231

psoriasis

*    Most patients with localized, plaque-type psoriasis can be managed with midpotency topical glucocorticoids.

*    A topical vitamin D analogue (calcipotriene) and a retinoid (tazarotene) are efficacious in the treatment of limited psoriasis and have  replaced other topical agents such as coal tar, salicylic acid, and anthralin.

*    Ultraviolet B (UV-B) light, narrowband UV-B, and ultraviolet A (UV-A) spectrum with either oral or topical psoralens (PUVA) are  effective.

*    The long-term use of UV light is associated with an increased incidence of non-melanoma and melanoma skin cancer.

*    UV light therapy is contraindicated in patients receiving cyclosporine.

*    Oral glucocorticoids should not be used for the treatment of psoriasis due to the potential for developing life-threatening pustular psoriasis when therapy is discontinued.

*    Methotrexate is an effective agent, especially in patients with psoriatic arthritis.

24. Intra-epidermal IgG is associated with? (AIIMS-NOV-2011)

A. Pemphigus             B. Bullous pemphigoid
C. ?                              D. ?

ANS-A

REF-OPERATION HARRI-PAGE238, CONSULTANT

Pemphigus Vulgaris

*    Intraepidermal blistering diseases characterized by loss of cohesion between epidermal cells (a process termed acantholysis).

*    Manual pressure to the skin of these patients may elicit the separation of the epidermis (Nikolsky’s sign)-also seen in toxic epidermal necrolysis, Stevens-Johnson syndrome.

*    Predominates in patients >40 years.

*    PV typically begins on mucosal surfaces.

*    PV may be associated with severe skin pain.

*   Lesions  heal without scarring.

*    Postinflammatory hyperpigmentation is usually present at sites of healed lesions.

*    Biopsies – intraepidermal vesicle formation secondary to loss of cohesion between epidermal cells (i.e., acantholytic blisters).

*    Blister formation is within the suprabasal portion of the epidermis.

*    Direct immunofluorescence microscopy of lesional or intact patient skin shows deposits of IgG on the surface of keratinocytes.

25. A man presents with a 6 month history of recurrent oral ulceration. He has yellowish ulcerations on his lip which are erythematous, with a central halo and nodular lesions on his shin. Diagnosis is : (AIIMS-NOV-2011)

A. Behcet’s syndrome                  B. Herpes labialis
C. Fixed drug eruption  D. Pemphigus vulgaris

ANS-A

REF-OPERATION HARRI-PAGE-128,MKT

26. IgA deposits in dermal papilla. Diagnosis? (AIIMS-NOV-2011)

a.Dermatitits herpetiformis
b.pemphigus
c.Bullous pemphigoid
d.IgA dermatosis of childhood

ans-a

REF-OPERATION HARRI PAGE 238

27. HRT is useful in all except?(AIIMS-NOV-2011)

a.Flushing                    b.Osteoporosis
c.Vaginal atrophy

d.Coronary heart disease

ANS-D

REF-POSIGOLD

OPERATION HARRI-PAGE-15

Hormone therapy – no cardioprotective effect

28. Which of the following is the least likely physiological change in pregnancy?(AIIMS-NOV-2011)

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

ANS-D
REF – OPERATION HARRI – PAGE 18,

OPERATION HARRI -DISCUSSION

MEDICAL DISORDERS DURING PREGNANCY

a) Introduction

*    Cardiac output increase by 40%.

*    Heart rate – increases by 10/mt in 3rd Trimester.

*    2nd Trimester –decrease systemic vascular resistance.

*    B.P – measured in the sitting position(lateral recumbent position is associated with a lower blood pressure).

*    HT – more than 2 readings elevated at 6 hrs apart.

CONSULTANT DISCUSSION

Cardiovascular changes in pregnancy

Cardiac output              increased 40%

        Increase in pulse rate

        Increase in stroke volume

        Increase in contractility

        Peripheral resistance diminished

29. Granulosa cell tumor marker?(AIIMS-NOV-2011)

a.inhibin                      b.CA-19-9
c.CA 5                         d.CA-125

ANS-A

REF-CONSULTANT,OPERATION HARRI-PAGE429

OPERATION HARRI –DISCUSSION

Granulosa cell tumors -secrete estrogen and cause menstrual abnormalities, bleeding, and precocious puberty-Endometrial carcinoma can be seen in 5%.

*    Sertoli and Leydig cell tumors-produce androgens with resultant virilization or hirsutism.

*    Can be cured with total abdominal hysterectomy and bilateral salpingo-oophorectomy. – grow slowly.

*    Serum markers – estradiol, inhibin, and müllerian inhibitory substance.

*    Neither radiation therapy nor chemotherapy.

30. With reference to Bacteroides fragilis, the following statements are true except?(AIIMS-NOV-2011)

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

REF-POSIGOLD,OPERATION HARRI-PAGE 699

Pathogenesis

*    Occur when an anatomic barrier becomes disrupted and constituents of the local flora enter a site that was previously sterile.

*    Prevotella melaninogenica attaches to other microorganisms- fimbriae that facilitate attachment.

*    Some Bacteroides strains have pili.

*    Virulence factor-polysaccharide complex of B. fragilis.

*    Interleukin (IL) 8, IL-17, and tumor necrosis factor (TNF)alfa-stimulate abscess formation.

*    IL-10- the cytokine inhibits of abscess formation.**

*    The collagenase produced by P. gingivalis may enhance tissue destruction.

*    An enterotoxin has been identified in B. fragilis strains associated with diarrheal disease.

*    B. fragilis possess lipopolysaccharides (LPSs, endotoxins) that are 100–1000 times less biologically potent than endotoxins associated with aerobic gram-negative bacteria-lower frequency of DIC and purpura in Bacteroides bacteremia (AIIMS-NOV-06***,AIIMS-N0V-2011).

31. A patient admitted to an ICU is on central venous line for the 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 for 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 2weeks of therapy. The most likely organism causing infection is?(AIIMS-NOV-2011)

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

ANS-C

REF-OPERATION HARRI-623,POSIGOLD

OPERATION HARRI DISCUSSION

Enterococci and Nonenterococcal Group D Streptococci

*    Gram positive -Cocci  -Nonmotile -Predominately inhabit human intestines.

*   Facultative anaerobes (prefer anaerobic) -Used as indicators of fecal pollution.

*    Belong to Lancefield’s serologic group D -Catalase negative.

*    Can grow in 6.5% NaCl.

*    Can grow at a pH range of 9.6 to 4.6 .

*    Can grow at temperatures ranging from 10 to 45°C .

*    Sensitive to chlorination.

*    A common cause of nosocomial bacteremia in patients with intravascular catheters and account for 10–20% of cases of bacterial endocarditis.

*    Enterococci are frequently cultured from bile and are involved in infectious complications of biliary surgery.

*    Treatment-resistant to all cephalosporins*- enterococcal endocarditis and meningitis-penicillin or ampicillin plus gentamicin.

*    Penicillin Resistance – 2 methods.

1) b lactamase- E. faecalis-Trt- vancomycin, ampicillin/sulbactam, amoxicillin/clavulanate, imipenem, or meropenem may be used in combination with gentamicin.

2)   Altered penicillin binding protein- common among E. faecium isolates.

32. The following drug is not useful for MRSA?(AIIMS-NOV-2011)

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

ANS-A

Ref-OPERATION HARRI-PAGE-60, CONSLUTANT

OPERATION HARRI DISCUSSION

MRSA

*    Vancomycin – Vancoresistance – Van A gene

Drugs used

*    Chloramphenicol

*    Linezolid

*    Minocycline

*    Quinupristin/Dalfopristin

*    Septran

*    Quinolones

*    Tigecycline

*    Dalbavancin, oritavancin, and ceftobiprole

*    Oral agents -clindamycin, TMP-SMX, doxycycline, telavancin and linezolid.

*    New – Daptomycin – (Parentral, cidal) – is approved for the treatment of bacteremias and complicated skin infections. It is not effective in respiratory infections- has a novel mechanism of action: it disrupts the cytoplasmic membrane Ortivancin – a new Glycopeptide

SIMILAIR QUESTION IN SURGERY DICSUSSION

Not useful against MRSA

a) Cefaclor                

b) Cotrimoxazole

c) Ciprofloxacin

d) Vancomycin         

e) Linezolid

ANS-A

33. Efavirenz acts through the following mechanism(AIIMS-NOV-2011)

a.Protease inhibitor
b.Preventing HIV entry into cell
c.Reverse transcriptase inhibitor
d.Integrase inhibitor

ANS-C

REF-CONSULTANT,OPERATION HARRI-PAGE-830

Reverse Transcriptase Inhibitors

Nucleoside

Nucleotide

  • Zidovidine
  • Didanosine
  • Zalcitabine
  • Stavudine
  • Lamivudine
  • Abacavir
  • Emtricitabine
Tenofovir

NNRTI

*    Nelvirapine

*    Delaviridine

*    Efavirnez

Protease Inhibitor

*    Saquinavir

*    Ritonavir

*    Indinavir

*    Nelfinavir

*    Amprenavir

*    Fosamprenavir

*    Lopinavir

*    Atazanavir

Fusion Inhibitor
–  Enfuvirtide

ANS-

Disease Protein featured Official abbreviation
Alzheimer’s disease Beta amyloid[6][7][8]
Diabetes mellitus type 2 IAPP (Amylin)[9][10] AIAPP
Parkinson’s disease Alpha-synuclein[7] none
Transmissible spongiform encephalopathy e.g. Bovine spongiform encephalopathy PrPSc[11] APrP
Huntington’s Disease Huntingtin[12][13] none
Medullary carcinoma of the thyroid Calcitonin[14] ACal
Cardiac arrhythmias, Isolated atrial amyloidosis Atrial natriuretic factor AANF
Atherosclerosis Apolipoprotein AI AApoA1
Rheumatoid arthritis Serum amyloid A AA
Aortic medial amyloid Medin AMed
Prolactinomas Prolactin APro
Familial amyloid polyneuropathy Transthyretin ATTR
Hereditary non-neuropathic systemic amyloidosis Lysozyme ALys
Dialysis related amyloidosis Beta 2 microglobulin Aβ2M
Finnish amyloidosis Gelsolin AGel
Lattice corneal dystrophy Keratoepithelin AKer
Cerebral amyloid angiopathy Beta amyloid[15]
Cerebral amyloid angiopathy (Icelandic type) Cystatin ACys
systemic AL amyloidosis Immunoglobulin light chain AL[14] AL
Sporadic Inclusion Body Myositis S-IBM none

 

Official
abb.
Amyloid type/Gene Description
AL amyloid light chain AL amyloidosis / multiple myeloma. Contains immunoglobulin light-chains (λ,κ) derived from plasma cells.
AA SAA AA amyloidosis
β amyloid/APP Found in Alzheimer disease brain lesions.
ATTR transthyretin A mutant form of a normal serum protein that is deposited in the genetically determined familial amyloid polyneuropathies. TTR is also deposited in the heart in senile systemic amyloidosis.[6] Also found in Leptomeningeal amyloidosis.
Aβ2M β2 microglobulin Not to be confused with Aβ, β2m is a normal serum protein, part of major histocompatibility complex (MHC) Class 1 molecules. Haemodialysis-associated amyloidosis
AIAPP amylin Found in the pancreas of patients with type 2 diabetes.
APrP prion protein In prion diseases, misfolded prion proteins deposit in tissues and resemble amyloid proteins. Some examples are Creutzfeldt–Jakob disease (humans), BSE or “mad cow disease” (cattle), and scrapie (sheep and goats).
AGel GSN Finnish type amyloidosis
ACys CST3 Cerebral amyloid angiopathy, Icelandic-type
AApoA1 APOA1 Familial visceral amyloidosis
AFib FGA Familial visceral amyloidosis
ALys LYZ Familial visceral amyloidosis
 ? OSMR Primary cutaneous amyloidosis
ABriADan ITM2B Cerebral amyloid angiopathy, British-type
Danish-type
Pro prolactin Prolactinoma
AKer keratoepithelin Familial corneal amyloidosis
AANF atrial natriuretic factor Senile amyloid of atria of heart
ACal calcitonin Medullary carcinoma of the thyroid

Other Information About Positive

Comments

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  4. venkatesh says:

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