Answers for 100 Questions in AIPG 2012 ( All India PG / AIPPG / AIPGME / AIPGMEE 2012 ) from Operation Harri – A Book for AIIMS and AIPG from Positive Coaching

1. A patient with HIV and diarrhoea.He was treated with a drug which acts by pyruvate-ferredoxin oxidoreductase (PFOR) enzyme . The possible organism AI-2012 [THE ULTIMATE QUESTION TO PROVE THE COMPLETENESS OF OPERATION HARRI*** – covers Quality Medicine, Pharmacology, Microbiology]

a)cryptosporodium

b)trypanosomiasis

c)candidiasis

d)

ans-a

OPERATION HARRI – PAGE 905

z) Nitazoxanide

* Cryptosporidiosis and giardiasis.

* Interference with the pyruvate-ferredoxin oxidoreductase (PFOR) enzyme–dependentelectron transfer reaction.

* Rapidly hydrolyzed to an active metabolite.

* Taken with food.

* Highly bound to plasma protein. (>99.9%).

2. RTA Type 1 true A/E [THE QUESTION TO PROVE THE EFFICACY OF POSITIVE]

a)urine cannot be acidified below 5.5

b)nephrocalcinosis

c)FeHco3 is more than 15%

d)hypokalemia

ans-c

OPERATION HARRI-202

Renal tubular acidosis

Proximal RTA (type 2 RTA)

* Due to generalized proximal tubular dysfunction manifested by glycosuria, generalized aminoaciduria, and phosphaturia (Fanconi syndrome).

* HCO₃^– is not reabsorbed normally in the proximal tubule.

* The fractional excretion of [HCO₃^–] may exceed 10–15%.

* The urine pH is acid (pH < 5.5).

DISTAL	PROXIMAL
* Normal anion gap * Inappropriately high urine pH (pH > 5.5). *Fe HCO3 -5% * Hypokalemia *Nephrocalcinosis , Stones. *Positive UAG, low urine [NH4+]	* Normal anion Gap * Urine pH < 5.5 * Fe HCO3 > 15 – 20 % * Hypokalemia * No nephrocalcinosis , Stones. * Positive UAG, low urine [NH4+]

Classic distal RTA (type 1 RTA)

* Hypokalemia, hyperchloremic acidosis, low urinary NH₄⁺ excretion (positive UAG, low urine [NH₄⁺]), and inappropriately high urine pH (pH > 5.5).

* Such patients are unable to acidify the urine below a pH of 5.5.

* Most patients have hypocitraturia and hypercalciuria, so nephrolithiasis, nephrocalcinosis, and bone disease are common.

3. Massive splenomegaly not asso with AI-2012

a. CML
b. PV
c. essential thrombocythemia
d. primary myelofibrosis

ans-c

OPERATION HARRI – PAGE 486

Essential Thrombocytosis

* Hemorrhagic thrombocythemia.

* Distinct female predominance, in contrast to the other chronic myeloproliferative disorders.

* Megakaryocytopoiesis and platelet production depend upon thrombopoietin and its receptor, Mpl.

* Chromosomes 3 and 1, where the genes for thrombopoietin and its receptor Mpl, respectively, are located.

* Early megakaryocytic progenitors require the presence of interleukin 3 (IL-3)

* Megakaryocytes are unique among hematopoietic progenitor cells because reduplication of their genome is endomitotic rather than mitotic.***

* Like erythropoietin, thrombopoietin is produced in both the liver and the kidneys.

* ANA, RA factor, DCT – positive.

* Increase CD 34 (unknown reasons).

Clinical

– No symptoms or signs are specific for ET, but these patients can have hemorrhagic and thrombotic tendencies.

– Mild splenomegaly(Massive splenomegaly -PV, IMF, or CML) (AIIMS-NOV-2010***).

4. Not a endogenous pyrogen[AI 2012] [ALL POSITIVIANS SHOULD HAVE ANSWERED THIS!!!]

A.IL 18

B.IF apha

C.TNF alfa

D.IL 6

Ans-a

OPERATION HARRI – PAGE 55

SIMILAR QUESTIONS IN OPERATION HARRI BOOK – PAGE NO: 108, Ques: 48 [POSITIVE POTENTIALS]

Pick out the one which is not a pyrogenic cytokine

a) IL – 1 b) IL – 6

c) TNF d) IFN – α e) IL – 18

Ans E

5. Pregnant lady with low platelet – 50000) which is not the possibility?

a. DIC
b. TTP
c. HELLP
d. Evan’s syndrome

ans-d

OPERATION HARRI – PAGE 531

Immune Thrombocytopenic Purpura (ITP)

* An acquired disorder leading to immune-mediated destruction of platelets and possibly inhibition of platelet release from the megakaryocyte.

* In children it is usually an acute disease, self-limited course- adults , more chronic course.

* Secondary – systemic lupus erythematosis (SLE), HIV and hepatitis C.

* The association of ITP with Helicobacter pylori infection is unclear.

* The peripheral blood smear may show large platelets, with otherwise normal morphology.

* Combined autoimmune hemolytic anemia with ITP (Evans’s syndrome).

May be inherited in an autosomal dominant, autosomal recessive, or X-linked pattern.

6. All are seen in DIC except AI-2012

a)inc PT

b)inc fibrinogen

c)dec platelets

d)

ans-B

OPERATION HARRI – PAGE 537

DIC

Lab

* Schistocytes.

* Low Platelet.

* Increased PT, PTT, Thrombin Time.

* Decreased Fibrinogen. (AI-07***)

* Increased FDP(most sensitive).

* D dimer immunoassay increase-(more specific ).

7. a/e have episodic weakness except AI-2012 [Not (m)any books used for entrance exams can answer this!!!]

A) channelopathy
B) lambert eaton
C) hypercalcemia
D) hyperphosphtemia

Ans-d

OPERATION HARRI – PAGE 74

Episodic weakness (AI – 2006)

A. Electrolyte disturbance

* Hypokalemia

* Hyperkalemia

* Hyponatremia

* Hypernatremia

* Hypercalcemia

* Hyper magnesemia

* Hypophosphatemia

B. Channelopathies

C. Myasthenia

D. Multiple sclerosis

E. Transient ischemic attacks of the brainstem

F. Transient global cerebral ischemia

Episodic generalized weakness can occur due to all of the following acute electrolyte disturbances, except: [AIIMS MAY 2006] OPERATION HARRI PAGE 105, FIRING ROUND- 2, Ques No 14:

a) Hypokalemia b) Hypocalcemia

c) Hyponatremia d) Hypophosphatemia

Åns B

8. Salmonella typhi infective dose load-AI-2012

1. 1-10

2. more than 10

3. 10^3-10^5

4. 10^8-10^11

Ans-c

OPERATION HARRI – PAGE 679

SALMONELLA TYPHI

c) Pathogenesis

* The infectious dose is 10³–10⁶ colony-forming units(AIIMS-2006***).

* Conditions that decrease either stomach acidity (an age of <1 year, antacid ingestion, or achlorhydric disease) or intestinal integrity increase susceptibility.

* Traverse the intestinal layer through phagocytic microfold (M) cells that reside within Peyer’s patches.

* Bacteria-mediated endocytosis (BME)- dependent on the direct delivery of Salmonella proteins into the cytoplasm of epithelial cells by a specialized bacterial secretion system (type III secretion).

* Survive the antimicrobial environment of the macrophage by sensing environmental signals*

POSIGOLD

Salmonella typhi is the causative agent of typhoid fever. The infective dose of S.typhi is –AIIMS 2006

a) One bacillus

b) 10 to power 8 – 10 to power 10 bacilli
10⁸-10¹⁰

c) 10 to power 2 – 10 to power 5 bacilli 10²-10⁵

d) 1 – 10 bacilli

9. Diabetic patient – infection with aseptate and broad hyphae [AI 2012]

A.candida

B.aspergillus

C.pencillium

D. Apophysomyces

Ans-d

OPERATION HARRI – PAGE 874, 875

Aspergillus hyphae are hyaline, narrow, and septate, with branching at 45°; no yeast forms are present.

* Molecular diagnostic techniques promise to be both faster and more sensitive than culture.

MUCOR

a) Introduction

* Order Mucorales-Mucor, Rhizopus , Rhizomucor, Absidia, Cunninghamella, Apophysomyces, and Saksenaea.

* Infectious form-spores

Broad, (diameter, 6–50microm), nonseptate hyphaewith branches at right angles(Aspergillus, Fusarium-narrow, septate hyphae with narrow-angle branching.)

10. Old Lady presenting with abdominal pain, dyspnoea ,Ca 125 marker [AI 2012]

A. Ca ovary

B. Ca colon

C. Ca lung

D.

Ans-a

OPERATION HARRI – PAGE 433, 345

OVARIAN TUMOR

Prognosis of epithelial tumors is also highly influenced by histologic grade but less so by histologic type-well-differentiated, 88%; moderately differentiated, 58%; poorly differentiated, 27%.

* CA-125 levels generally reflect volume of disease, and high levels usually indicate unresectability and a poorer survival.

Tumor Markers	Cancer	Non-Neoplastic Conditions
Hormones
Human chorionic gonadotropin	Gestational trophoblastic disease, gonadal germ cell tumor	Pregnancy
Calcitonin	Medullary cancer of the thyroid
Catecholamines	Pheochromocytoma
Oncofetal Antigens
Alphafetoprotein	Hepatocellular carcinoma, gonadal germ cell tumor	Cirrhosis, hepatitis Carcinoembryonic antigen [AIIMS MAY 2007***]
	Adenocarcinomas of the colon, pancreas, lung, breast, ovary	Pancreatitis, hepatitis, inflammatory bowel disease, smoking
Enzymes
Prostatic acid phosphatase	Prostate cancer	Prostatitis, prostatic hypertrophy
Neuron-specific enolase	Small cell cancer of the lung,neuroblastoma
Lactate dehydrogenase	Lymphoma, Ewing’s sarcoma	Hepatitis, hemolytic anemia, many others
Tumor-Associated Proteins
Prostate-specific antigen	Prostate cancer	Prostatitis, prostatic hypertrophy
Monoclonal immunoglobulin	Myeloma	Infection, MGUS
CA-125: [AIIMS MAY 2006***]	Ovarian cancer, some lymphomas	Menstruation, peritonitis, pregnancy
CA 19-9	Colon, pancreatic, breast cancer	Pancreatitis, ulcerative colitis
CD30	Hodgkin’s disease, anaplastic large cell lymphoma
CD25	Hairy cell leukemia, adult T cell leukemia/lymphoma

11. All occur in pregnancy except[AI 2012]

a)increase in heart rate

b)increase in blood volume

c)decrease in systolic blood pressure

d)

OPERATION HARRI – PAGE 14

* Cardiac output increase by 40%.

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

* 2^nd 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.

12. Ptosis, diplopia, external strabismus [AI 2012]

A. Abducens

B. Oculomotor

C. Trochlear

D. Cervical sympathetic chain

Ans-b

OPERATION HARRI – PAGE 102

Oculomotor Nerve

* The third cranial nerve innervates the medial, inferior, and superior recti; inferior oblique; levator palpebrae superioris; and the iris sphincter.

* 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.

* A lesion of the oculomotor nucleus in the rostral midbrain produces signs that differ from those caused by a lesion of the nerve itself. There is bilateral ptosis because the levator muscle is innervated by a single central subnucleus. There is also weakness of the contralateral superior rectus, because it is supplied by the oculomotor nucleus on the other side.

* In Nothnagel’s syndrome, injury to the superior cerebellar peduncle causes ipsilateral oculomotor palsy and contralateral cerebellar ataxia.

* In Benedikt’s syndrome, injury to the red nucleus results in ipsilateral oculomotor palsy and contralateral tremor, chorea, and athetosis.

* Claude’s syndrome incorporates features of both the aforementioned syndromes, by injury to both the red nucleus and the superior cerebellar peduncle.

* Weber’s syndrome– injury to the cerebral peduncle causes ipsilateral oculomotor palsy with contralateral hemiparesis.

POSIGOLD

Oculomotor nerve palsy causes all except, [AIIMS Nov 2006]

a) Miosis b) Ptosis

c) Outward eye deviation d) Causes diplopia

13. Hypertriglyceridemia and Hypercholesterolemia seen in Human Immunodeficiency Virus-1-Infected Treated with AI-2012

a) Ritonavir b) Reltegravir
c) Didanosine d) Efavirenz

ANS-A

OPERATION HARRI – PAGE 832,

Protease Inhibitors
Saquinavir mesylate	Diarrhea, nausea, headaches, hyperglycemia, fat redistribution, lipid abnormalities
Ritonavir
Indinavir sulfate	Nephrolithiasis, indirect hyperbilirubinemia, hyperglycemia, fat redistribution, lipid abnormalities
Nelfinavir mesylate	May contain traces of the potential carcinogen/teratogen ethyl methane sulfonate
Amprenavir Fosamprenavir	Nausea, vomiting, diarrhea, rash, oral paresthesias, elevated liver function tests, hyperglycemia, fat redistribution, lipid abnormalities
Lopinavir/ritonavir	Diarrhea, hyperglycemia, fat redistribution, lipid abnormalities
Atazanavir	Hyperbilirubinemia, PR prolongation, nausea, vomiting, hyperglycemia, fat maldistribution
Tipranavir	Diarrhea, nausea, fatigue, headache, skin rash, hepatotoxicity, intracranial hemorrhage
Darunavir	Diarrhea, nausea, headache
Entry Inhibitors
Enfuvirtide	Local injection reactions, hypersensitivity reactions, increased rate of bacterial pneumonia
Maraviroc- only CCR5 blocker-tropic HIV-1	Hepatotoxicity, nasopharyngitis, fever, cough, rash, abdominal pain, dizziness, fever, musculoskeletal symptoms

14. Least common presentation in multiple myeloma AI-2012

a)hyperviscosity,

b)anemia,

c)bone pains,

d)infections

ANS-A

OPERATION HARRI – PAGE 514

Bone pain is the most common symptom in myeloma- 70% of patients- precipitated by movement

Recurrent infections

* Normocytic and normochromic

* Interaction of the M component with clotting factors I, II, V, VII, or VIII.

* Hyperviscosity syndromes – most common with IgM, IgG3, and IgA paraproteins. Normal relative serum viscosity is 1.8 poise. i.e., serum is normally almost twice as viscous as water)-

15. Not a cause of secondary hemochromatosis ? [AI 2012]

a)B thalasemia,

b)Sideroblasticanemia

c)sherocytosis

d)PNH

ANS-D

OPERATION HARRI – Page 481, 469

Treatment of PNH

* Androgens.

* Steroids-not useful.

* BMT-The only form of treatment that can provide a cure for PNH is allogeneic bone marrow transplantation.

* A humanized monoclonal antibody, eculizumab, (AI-2011***) directed against the complement protein C5.

* Antilymphocyte globulin (ALG or ATG) and cyclosporine.

Transfusional Hemosiderosis: Treatment

* Most toxic fraction of iron—low-molecular-weight iron.

* Chelation must begin before 5–8 years of age in beta-thalassemia major.

* Irreversible end-organ deterioration develops at relatively modest levels of iron overload.

* A unit of packed RBCs contains 250–300 mg iron (1 mg/mL).

* Vitamin C should not be supplemented because it generates free radicals in iron excess states.

* Patients who receive >100 units of packed RBCs develop hemosiderosis.

* The ferritin level rises, followed by early endocrine dysfunction (glucose intolerance and delayed puberty), cirrhosis, and cardiomyopathy.

* Liver biopsy – both parenchymal and reticuloendothelial iron. The superconducting quantum-interference device (SQUID) is accurate at measuring hepatic iron.

* Cardiac toxicity – insidious. Early development of pericarditis is followed by dysrhythmia.

16. New drug for IBS-constipation predominant[AI 2012]

A.infliximab

B.lubiprostone

C.

D.

Ans-b

OPERATION HARRI – PAGE 164

x) Constipation

* Fewer than three bowel movements per week.

* In idiopathic constipation– delayed emptying of the ascending and transverse colon with prolongation of transit (often in the proximal colon) and a reduced frequency of propulsive HAPCs.

Causes of Constipation in Adults
Chronic
Irritable bowel syndrome	Constipation-predominant, alternating
Medications	Ca2+ blockers, antidepressants
Colonic pseudo-obstruction	Slow-transit constipation, megacolon (rare Hirschsprung’s, Chagas)
Disorders of rectal evacuation	Pelvic floor dysfunction; anismus; descending perineum syndrome; rectal mucosal prolapse; rectocele
Endocrinopathies	Hypothyroidism, hypercalcemia, pregnancy
Psychiatric disorders	Depression, eating disorders, drugs
Neurologic disease	Parkinsonism, multiple sclerosis, spinal cord injury
Generalized muscle disease	Progressive systemic sclerosis

* Barium enema has advantages over colonoscopy in the patient with isolated constipation.

* Melanosis coli, or pigmentation of the colon mucosa, indicates the use of anthraquinone laxatives such as cascara or senna.

* Novel agents that induce secretion (e.g., lubiprostone, a chloride channel activator).

17. Basal exudates, infiltration [AI 2012]

A. TB meningitis

B. HSV meningitis

C.

D.

ANS-A

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%.

18. Not a germ cell tumor [AI 2012]

A. Granulosa cell tumour

B. Choricarcinoma

C.Dysgerminoma

D.

Ans-a

OPERATION HARRI – PAGE 433, 435

a) Introduction

* Ovarian cancer can develop from three distinctive cell types (germ cells, stromal cells, and epithelial cells).

Five major subtypes of common epithelial tumors: serous (50%); mucinous (25%), endometrioid (15%); clear cell (5%); and Brenner tumors (1%), the latter derived from the urothelium

g) Ovarian Germ Cell Tumors

* Teratoma, dysgerminoma, endodermal sinus tumor, and embryonal carcinoma.

(3) primitive malignant germ cell tumors, including dysgerminoma, yolk sac tumors, immature teratomas, embryonal carcinomas, and choriocarcinoma

Ovarian Stromal Tumors

* Named for the stromal tissue involved: granulosa, theca, Sertoli, Leydig, and collagen-producing stromal cells.

* The granulosa and theca cell stromal cell tumors – first three decades of life.

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

19. Lymphoma least commonly in- AI-2012

A.ataxia telengiectasia,

B. Common variable immunodeficiency disease
C SLE

d)Lynch syndrome

ANS-d

OPERATION HARRI – PAGE 436, 505

The Lynch syndrome – autosomal dominant mutation of mismatch repair – predispose to nonpolyposis colon cancer as well as endometrial and ovarian cancer.

c) Predisposing factors

Inherited immunodeficiency disease

Klinefelter’s syndrome.

Chédiak-Higashi syndrome.

Ataxia telangiectasia syndrome.

Wiscott-Aldrich syndrome.

Common variable immunodeficiency disease.

Acquired immunodeficiency diseases

Iatrogenic immunosuppression.

HIV-1 infection.

Acquired hypogammaglobulinemia.

Autoimmune disease

Sjögren’s syndrome.

Celiac sprue.

Rheumatoid arthritis and systemic lupus erythematosus.

Chemical or drug exposures

Phenytoin

Digoxin

Radiation

Prior chemotherapy and radiation therapy

20. A young boy came with dyspnea and was found to have a mediastinal mass. which of the following is known to produce mediastinal lymphadenopathy? AI-2012

A.diffuse large B cell Lymphoma
B. B cell rich T cell lymphoma
C. T cell ALL
D.

Ans- ?A / C

OPERATION HARRI – PAGE 509, 510

Diffuse Large B Cell Lymphoma

* Most common type of non-Hodgkin’s lymphoma.*

* Cytogenetic and molecular genetic studies are not necessary for diagnosis.

* Primary mediastinal diffuse large B cell lymphoma- younger median age (i.e., 37 years) and a female predominance .

* Neoplastic cells are heterogeneous but predominantly large cells with vesicular chromatin and prominent nucleoli.

* More than 50% of patients will have extranodal involvement at diagnosis, with the most common sites being the gastrointestinal tract and bone marrow

1) Precursor T Cell Lymphoblastic Leukemia/Lymphoma

* More common in children and young adults, males.

* Most often found in young men presenting with a large mediastinal mass and pleural effusions(AI-2006***).

* The majority of patients treated can be cured.

* Advanced age is an adverse prognostic factor. Adults with precursor T cell lymphoblastic lymphoma who present with high LDH levels or bone marrow or CNS involvement –treated with bone marrow transplantation.

21. Gene in A blood group [AI 2012]

A. AO

B. OO

C. AB

D. BO

Ans-a

OPERATION HARRI – PAGE 517

b) ABO Antigens and Antibodies

* O type RBCs lack A or B antigens.

* These antigens are carbohydrates attached to a precursor backbone-H substance is the immediate precursor on which the A and B antigens are added-addition of N-acetylgalactosamine creates the A antigen, while the addition of galactose produces the B antigen.

* Rare individuals lack the H gene, which codes for fucose transferase, and cannot form H substance- have Bombay phenotype (O_h).

* Chromosome 9p and are expressed in a Mendelian codominant manner.

* All individuals produce antibodies to the ABH carbohydrate antigen that they lack-isoagglutinins.

* Bombay phenotype produce antibodies to H substance (which is present on all red cells except those of hh phenotype) as well as to both A and B antigens – compatible only with other hh donors.

22. Short bowel syndrome absorption defect [AI 2012]

A. Vit B12

B. Vit K

C. Vit C

D.

Ans-a

OPERATION HARRI – PAGE 474

x) Intestinal Causes of Cobalamin Malabsorption

* Intestinal Stagnant Loop Syndrome

* Ileal Resection-Removal of 1.2 m of terminal ileum causes malabsorption of cobalamin.

* Tropical Sprue.

* Fish Tapeworm Infestation.

* Gluten-Induced Enteropathy- Malabsorp-tion of cobalamin occurs in ~30% of untreated patients.

y) Selective Malabsorption of Cobalamin with Proteinuria (Imerslund Syndrome: )

* Autosomally recessive disease.

* Most common cause of megaloblastic anemia due to cobalamin deficiency in infancy in Western countries.

23. Hereditary aplastic anemia [AI 2012]

A. fanconi’s anemia

B.PNH

C.

D.

Ans-a

OPERATION HARRI – PAGE 482

Inherited conditions

* Fanconi’s anemia.

* Dyskeratosis congenital.

* Shwachman-Diamond syndrome.

* Reticular dysgenesis.

* Amegakaryocytic thrombocytopenia.

* Familial aplastic anemias.

* Preleukemia (monosomy 7).

* Nonhematologic syndrome (Down’s, Dubowitz, Seckel).

24. Protein precipitates at 60deg redisolves at further heating AI-2012

a) Bence Jones Protein

b)

c)

d)

Ans-a

OPERATION HARRI – PAGE 183

A sulfosalicylic acid precipitate that is out of proportion to the dipstick estimate is suggestive of light chains (Bence Jones protein), and light chains typically redissolve upon warming of the precipitate.

25. Butterfly lesion on face + blood finding AI-2012

a)Anti DsDNA Ab

b)anticentromere

c)

d)

ans-a

OPERATION HARRI,

26. Elderly man Vaccine Not to be given AI-2012

a) Measles

b) H Influenza

c) TT..

d) Pneumococcal

Ans-a

OPERATION HARRI – PAGE 22

Disease Prevention

Vaccination

* Efficacy declines with age

* Influenza – annually

* Pneumococcal – at least once

* Boosters – 5 years

* TT – every 10 years

27. Seen in Von Hippel Lindau ? AI-2012

a) craniospinal hemangioblastoma
b) multiple tumors rarely seen

c)

d)

ans-a

OPERATION HARRI – PAGE 278, 426

Von Hippel–Lindau syndrome(renal cell carcinoma, pheochromocytoma, pancreatic tumors, hemangioblastomas) – (AIIMS***)

Hereditary chronic pancreatitis, Peutz-Jeghers syndrome, Von Hippel-Lindau syndrome, familial atypical multiple-mole melanoma syndrome, ataxia-telangiectasia, Gardner’s syndrome [a variant of familial adenomatous polyposis (FAP)] and Lynch syndrome II, a subtype of hereditary nonpolyposis colorectal cancer (HNPCC).

28. Endotoxin does not play a role in pathogenesis of which organism ? AI-2012

a) E coli, …….

b)V.cholera

c)

d)

ans-b

OPERATION HARRI – PAGE 556, 557, 685

m) Tissue damage and disease

Enterotoxins

* E. coli

* Salmonella

* Shigella

* Staph.

* V. Cholera

Toxins

* Staphylococci

* Streptococci

* Pseudomonas

* Bordetella

ADP – ribotransferase activity

* Cholera

* Diphtheria

* Pertussis

* E.coli – heat labile toxin

* P. Aeuroginosa exotoxin(A, S, and T**)

Toxin producing

* Salmonella

* Yersinia

* Pseudomonas

à inject toxins directly into host Target cells by means of a complex set of proteins à Type III system.

Super antigens(stimulating certain T cells to proliferate without processing of the protein toxin by antigen-presenting cells)

– staphylococcal enterotoxins, TSST-1-Streptococcal

29. The characteristic lesion in Nocardia: AI-2012

a. brain abscess

b)

c)

d)

OPERATION HARRI – PAGE 697

NOCARDIA

* Extrapulmonary Disease

* Most common site of dissemination is the brain– a subacute abscess- supratentorial- multiloculated* *Endocarditis occurs rarely and can affect either native or prosthetic valves *Meningitis is uncommon

30. Cholera toxin mode of action– AI-2012

a)cAMP

b) cGMP

c)

d)

ans-a

OPERATION HARRI – PAGE 685

Toxin

* A subunit – Monomeric

* B Subunit – Pentameric binding unit – Binds to GM1 ganglioside on surface of epithelial cells.

* A subunit – Irreversibly transfers ADR ribosome from Nicotinamide adenine Di nucleotide to its specific Target protein – GTP binding regulatory component of adenylate cyclase in intestinal epithelial cells – The result is ­ cyclic AMP.

* Cyclic AMP – inhibits absorptive sodium in crypt cells and activates the secretory chloride transport system .

* Genes encoding cholera Toxin – part of genome of a bacteriophage – CTX.

* Cholera toxin also enhances intestinal secretion via prostaglandins and/or neural histamine receptors.

31. All are bactericidal except [AI 2012]

A. INH

B. Tigecycline

C. Daptomycin

D. Moxifloxacin

Ans-b

OPERATION HARRI – PAGE 612,

Daptomycin

* Forms a channel that causes depolarization of the membrane by efflux of intracellular ions, resulting in cell death.

INH

Inhibition of mycolic acid cell wall synthesis via oxygen-dependent pathways such as the catalase-peroxidase reaction.

* Bacteriostatic against resting bacilli and bactericidal against rapidly multiplying organisms.

* MIC for MTB – < 0.1 mg.Ml.

* MIC for M. kansaii – 0.5-2 mg/mL.

* Metabolised in liver via acetylation and

32. Pregnant lady with syphilis doc AI-2012

a) pencillin

b) erythromycin

c) ciprofloxacin

d)

ans-a

OPERATION HARRI PAGE 738

Treatment of Acquired Syphilis

* Penicillin G is the drug of choice for all stages of syphilis.

* Other antibiotics effective in syphilis – tetracyclines, erythromycin, and the cephalosporins.

* Sulfonamides and the quinolones are inactive.

* Early Syphilis, Late Latent and Late Syphilis – Penicillin G benzathine.

* Neurosyphilis- IV aqueous crystalline penicillin G.

* Penicillin-allergic patients- doxycycline or tetracycline;neurosyphilis,pregnancy- desensitization and treatment with penicillin.

* Congenital Syphilis- An infant should be treated at birth if a) the treatment status of the seropositive mother is unknown;b) if the mother has received inadequate or nonpenicillin therapy or c) has received penicillin therapy in the third trimester.

33. Not useful in MRSA ? AI-2012

a) Cefaclor,

b) ciprofloxacin,

c) vancomycin

d)

ans-a

OPERATION HARRI 620

t) 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

34. Slow aceylator on INH – AI-2012

a)peripheral neuropathy ,

b) hepatotoxicity,

c)cardiotoxicity

ANS-B

OPERATION HARRI – PAGE 9

* Slow Acetylators

– rare in Asia

– high incidence of Drug induced lupus, INH Toxicity (Hepatitis).

* INH hepatitis – by a reactive metabolite of acetyl hydralazine.

35. The commonest source of liver abscess AI-2012

a)hematogenous

b)biliary tract disease

c)traumatic

ans-b

OPERATION HARRI – PAGE 586

LIVER ABSCESS

most subject to the development of abscesses**.

* Associated disease of the biliary tract is most common cause*

* Pylephlebitis (suppurative thrombosis of the portal vein)-another common cause.

* Fever – most common presenting sign .

* Amebic serologic testing gives positive results in >95% of cases.

* Treatment-drainage—either percutaneous (with a pigtail catheter kept in place) or surgical—is the mainstay.

* Primary surgical intervention. – the presence of multiple, sizable abscesses; viscous abscess contents that tend to plug the catheter; associated disease (e.g., disease of the biliary tract) requiring surgery; or the lack of a clinical response to percutaneous drainage in 4–7 days.

Liver Abscess

Single most reliable investigation	* Increased Alkaline Phosphatase(70%)
Bacteremia	*33%
Organism – From biliary tract	* Enteric gram negative
– From intra peritoneal source	* B. fragilis
-Hematogenous	* S. aureus

Splenic Abscesses

* Much less common than liver abscesses.

* Hematogenous spread of infection is more common.

* Bacterial endocarditis is the most common associated infection.***

* Splenomegaly is found in ~50% of cases.

* Chest radiographic findings – an infiltrate or a left-sided pleural effusion.

* CT scan of the abdomen – the most sensitive diagnostic tool.

* Streptococcal species – the most common cause.***

* Anaerobic – only 5.%

* Treatment-single, small (<3-cm)- percutaneous drainage; complex, multilocular abscesses or multiple abscesses-splenectomy with adjunctive antibiotics.

* Post splenectomy – vaccinated against encapsulated organisms (Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitidis).

36. Undiff Carcinoma Marker AI-2012

a)Cytokeratin

b)

c)

d)

ANS-A

OPERATION HARRI

37. Hormone increased in prader willi [AI 2012]

A. GH

B.FSH

C.LH

D.Ghrelin

Ans: D

OPERATION HARRI – PAGE 328, 327, 330

In the Prader-Willi syndrome– obesity coexists with short stature, mental retardation, hypogonadotropic hypogonadism, hypotonia, small hands and feet, fish-shaped mouth, and hyperphagia- chromosome 15 deletion, and reduced expression of the signaling protein necdin.

Growth hormone (GH), which exerts lipolytic activity, is diminished in obesity and is increased with weight loss. Despite low GH levels, insulin-like growth factor (IGF) I (somatomedin) production is normal.

Among the latter are ghrelin, which is made in the stomach and stimulates feeding, and peptide YY (PYY) and cholecystokinin, which are made in the small intestine and signal to the brain through direct action on hypothalamic control centers and/or via the vagus nerve.

38. A patient on Tacrolimus presented with seizures investigations – Sr. Na+ – 136, Sr. Cat 7.5, Sr. Albumin 1.5 gm/dl. urea, 96. Sr. creatia 0.9 Cause for seizure [AI 2012] [THE MOST PRACTICAL QUESTION IN ALL INDIA 2012]

A. Hyponatremia

B. Hypocalcemia

C. Drug toxicity

D. uremia

Ans-c

OPERATION HARRI – PAGE 196

d) Diagnostic Approach

* About 50% of total calcium is ionized, and the rest is bound principally to albumin.

* Corrected Calcium-When serum albumin concentrations are reduced, a corrected calcium concentration is calculated by adding 0.8 mg/dL to the total calcium level for every decrement in serum albumin of 1.0 g/dL below the reference value of 4.1 g/dL for albumin.

* Chronic hypercalcemia is most commonly caused by primary hyperparathyroidism.

* If the PTH level is increased (or “inappropriately normal”) in the setting of an elevated calcium and low phosphorus, the diagnosis is almost always primary hyperparathyroidism.

* A calcium/creatinine clearance ratio (calculated as urine calcium/serum calcium divided by urine creatinine/serum creatinine) of <0.01 is suggestive of FHH (AIIMS-2005***)

39. Infections spread from the middle ear through all except [AI 2012]

A. lymphatics

B. Bone erosion

C. Round and oval windows

D. Osseous thrombophlebitis

Ans-a

OPERATION HARRI PAGE 122

j) Chronic Otitis Media

* When the perforation is more peripheral, squamous epithelium from the auditory canal may invade the middle ear through the perforation, forming a mass of keratinaceous debris (cholesteatoma) at the site of invasion.

* Has the potential to erode bone and promote further infection, which can lead to meningitis, brain abscess, or paralysis of cranial nerve VII.

40. Conductive hearing loss in occurs in all except[AI 2012]

A. Middle ear effusion

B. otosclerosis

C. Endolymphatic hydrops

D.

Ans-c

OPERATION HARRI PAGE 117

Menieres Disease

* Episodic vertigo.

* Fluctuating sensori neural hearing loss.

* Tinnitus.

* Aural Fullness.

* Onset – 5^th decade.

* Distention of endolymphatic system (endolymphatic hydrops).

* Low frequency, unilateral Sensori neural hearing loss – Typical

* Trt – for vertigo

Low salt diet

Vestibular nerve section

Otosclerosis

* Autosomal Dominant.

* Fixation of stapes.

* Low-frequency conductive hearing loss.

* Teen age.

* Accelerated by pregnancy.

* Extension à cochlear otosclerosis (mixed hearing loss).

* Stapedectomy.

* Fluoride.

41. Diabetic male with ear infection,facial palsy, granulations: [AI 2012]

A. Malignant otitis externa

B.Middle ear infection

C.Middle ear malignancy

D.

Ans-a

OPERATION HARRI

Malignant otitis Externa (AIIMS – 06)

* Elderly diabetics, immuno compromised.

* Purulent Ear discharge with deep seated pain.

* Granulation tissue in the postero inferior wall of Ext. canal.

* Cranial N – commonest VIIth. **

* Commonest – pseudomonas.

* S. aureus, Staphylococcus epidermidis, Aspergillus, Actinomyces.

* Sigmoid sinus thrombosis.

42. Old male with dysphagia grade 2, anemia, foul breath with lung crepitations: [AI 2012]

A. Zenkers diverticulum

B. Plummer winson syndrome

C. Cork screw esophagus

D. Schaztskis ring

Ans-a

OPERATION HARRI PAGE 152

* Tracheobronchial aspiration unrelated to swallowing may be due to achalasia, Zenker’s diverticulum, or gastroesophageal reflux.

Plummer vinson syndrome

* Iron deficiency anemia

* Angular stomatitis

* Glossitis

* Dysphagia

* Oral squamous cell Ca

* Oesophageal Ca at post cricoidal tissue web.

43. Ear infection is caused by [AI 2012]

A.Vibrio cholera

B.Vibrio mimicus

C.Vibrio parahaemolyticus

D.Vibrio alginolyticus

Ans-d

OPERATION HARRI PAGE-687

* V. alginolyticus

* The most salt-tolerant of the vibrios and can grow in salt concentrations of >10%.** * Otitis externa, otitis media, and conjunctivitis.

44. Dermatome for little finger [AI 2012]

A.C7

B.C8

C.T1

D.C5

Ans-b

OPERATION HARRI – PAGE 52

Cervical Radiculopathy—Neurologic Features

	Examination Findings
Cervical Nerve Roots	Reflex	Sensory	Motor	Pain Distribution
C5	Biceps	Over lateral deltoid	Supraspinatus (initial arm abduction) Infraspinatus (arm external rotation) Deltoid (arm abduction) Biceps (arm flexion)	Lateral arm, medial scapula
C6	Biceps	Thumb, index fingers Radial hand/forearm	Biceps (arm flexion) Pronator teres (internal forearm rotation)	Lateral forearm, humb, index finger
C7	Triceps	Middle fingers Dorsum forearm	Triceps (arm extension) Wrist extensors Extensor digitorum (finger extension)	Posterior arm, dorsal forearm, lateral hand
C8	Finger flexors	Little finger Medial hand and forearm	Abductor pollicis brevis (abduction D1) First dorsal interosseous (abduction D2) Abductor digiti minimi (abduction D5)	4th and 5th fingers, medial forearm
T1	Finger flexors	Axilla and medial arm	Abductor pollicis brevis (abduction D1) First dorsal interosseous (abduction D2) Abductor digiti minimi (abduction D5)	Medial arm, axilla

45. Sub clavian line catheterization, sudden hyper resonant lung field[AI 2012]

A. Tension pneumothorax

B. Air embolism

C. Pulm Edema

D.

Ans-a

OPERATION HARRI PAGE 326

TPN

The subclavian approach is best tolerated .

The jugular approach is less likely to lead to a pneumothorax.

* Catheters are made of silastic, polyurethane, or polyvinyl chloride. Silastic catheters are less thrombogenic and are best for tunneled catheters. Polyurethane is best for temporary catheters.

j) Complications(AIIMS-NOV-2008***)

1) Mechanical

* Pneumothorax, catheter infection.

46. Name the Phase II reaction of detoxification [AI 2012]

A. Conjugation

B. Hydroxylation

C. Oxidation

D.

ANS-A

OPERATION HARRI – PAGE 6

Drug Metabolism

– Mainly in liver, but also in kidney, intestinal epithelium, lung and plasma

47. Test to identify gene expression[AI 2012]

A. Southern blot

B. Northern Blot

C. Knock out Mice

D. Transgenic animals

Ans-d

OPERATION HARRI – PAGE 279

Transgenic Mice as Models of Genetic Disease

* Genetic models- Mus musculus (mouse-better choice), Drosophila melanogaster (fruit fly), Caenorhabditis elegans (nematode), Saccharomyces cerevisiae (baker’s yeast), and Escherichia coli.

* Transgenic mice are generated by pronuclear injection of foreign DNA into fertilized mouse oocytes and subsequent transfer into the oviduct of pseudopregnant foster mothers.

* Targeted Knock-out-Substitution of functional gene with inactive gene by homologous recombination in embryonic stem cells.

* Targeted Knock-in-Introduction of mutation into gene by substitution of endogenous gene with gene carrying a specific mutation-Can accurately model human disease.

48. All can occur within 12 to 24 hrs fasting except [AI 2012]

A. Muscle glycogen depletion

B. Increase ketone bodies

C. Increase FFA

D. Decrease serum protein

Ans D

OPERATION HARRI – PAGE 322

Protein Catabolism

* After about 10 days of total starvation, the unstressed individual loses about 12–18 g/d protein .

49. Linear Ig A deposits [AI 2012]

A.Dermatitis herpetiformis

B.Pemphigus vulgaris

C.bullous disorder of childhood

D.

ANS C

OPERATION HARRI – PAGE 238

Linear IgA disease	Pruritic small papules on extensor surfaces; occasionally larger,	Subepidermal blister with neutrophil-rich infiltrate	Linear band of IgA in epidermal BMZ	BPAG2
Cicatricial pemphigoid		Subepidermal blister that may or may not include a leukocytic infiltrate	Linear band of IgG, IgA, and/or C3 in epidermal BMZ	BPAG2, laminin 5, or others
Epidermolysis bullosa acquisita	Blisters, erosions, scars, inflammatory, tense blisters may be seen initially	Subepidermal blister that may or may not include a leukocytic infiltrate	Linear band of IgG and/or C3 in epidermal BMZ	Type VII collagen(AIIMS-2007***)
Dermatitis herpetiformis	Extremely pruritic elbows, knees, buttocks, and posterior neck	Subepidermal blister with neutrophils in dermal papillae	Granular deposits of IgA in dermal papillae	Epidermal transglutaminase

Disease	Immunopathology
P. foliaceous	IgG on keratinocytes
P. Vulgaris	IgG on keratinocytes
Bullous pemphigoid	Linear IgG/3 in epidermal BMZ
Cicatrical pemphigoid	Linear IgG, A/C3, in epidermal BMZ
Epidermolysis bullosa acquisita	Linear IgG/C3, in epidermal BMZ
Pemphigoid gestationis	Linear C3 (only) in epidermal BMZ
Dermatitis Herpetiformis	Granular IgA in Dermal papilla
Linear IgA disease	Linear IgA in epidermal BMZ

50. Lesion in trunk with collarette scales [AI 2012]

A.P.Alba

B.P.Rosea

C.PRP

D.

Ans-b

OPERATION HARRI – PAGE 232

f) Pityriasis Rosea

* More commonly in the spring .

* First manifestation -the herald patch.

* Palm and sole lesions are extremely rare.

* Moderately pruritic and lasts 3–8 weeks.

* Treatment – oral antihistamines, midpotency topical glucocorticoids, and UV-B phototherapy.

51. Trunk asymptomatic erythematous papules with perianal lesions,oral white plaque [AI 2012]

A.Psoarsis

B.Secondary syphilis

C.P.Rosea

D.

Ans-b

OPERATION HARRI –PAGE-736

52. Electron beam irradiation useful in which skin tumour ? [AI 2012]

a) Sezary syndrome,

b) mycosis fungoides

c)

d)

Ans (b)

OPERATION HARRI-PAGE -510-511

2) Mature (Peripheral) T Cell Disorders

Mycosis Fungoides

* Also known as cutaneous T cell lymphoma-an indolent lymphoma.

* Mid-fifties, males.

* May develop generalized erythroderma and circulating tumor cells, called Sézary’s syndrome.

* More advanced disease has been treated with topical glucocorticoids, topical nitrogen mustard, phototherapy, psoralen with ultraviolet A (PUVA), electron beam radiation, interferon, antibodies, fusion toxins, and systemic cytotoxic therapy.

53. Past H/O child death . Mother C/O blistering lesions in the child [AI 2012]

A. Epidermolysis bullosa

B.

C.

D.

Ans: A

OPERATION HARRI-PAGE 240

54. All are autosomal dominant except [AI 2012]

A. Peutz jeg. syndrome

B. Gardners syndrome

C.Ataxia telengiectasia

D.

Ans-c

OPERATION HARRI-PAGE 408

Hereditable (Autosomal Dominant) Gastrointestinal Polyposis Syndromes
Syndrome	Distribution of Polyps	Histologic Type	Associated Lesions
Familial adenomatous polyposis	Large intestine	Adenoma	None
Gardner’s syndrome	Large and small intestines	Adenoma	Osteomas, fibromas, lipomas, epidermoid cysts, ampullary cancers, congenital hypertrophy of retinal pigment epithelium
Turcot’s syndrome	Large intestine	Adenoma	Brain tumors
Nonpolyposis syndrome (Lynch syndrome)	Large intestine (often proximal)	Adenoma	Endometrial and ovarian tumors
Peutz-Jeghers syndrome	Small and large intestines, stomach	Hamartoma	Mucocutaneous pigmentation; tumors of the ovary, breast, pancreas, endometrium
Juvenile polyposis	Large and small intestines, stomach	Hamartoma, rarely progressing to adenoma	Various congenital abnormalities

55. Bone marrow Stem Cells A/E AI-2012

a) Mesenchymal cells

b) Myoblast

c)

d)

OPERATION HARRI – PAGE 298-302

56. Female + finger pain + cant touch Cold

a) Sausage Digits

b) Purpuric lesion in the hand

c)

d)

OPERATION HARRI-PAGE 242

m) Scleroderma and Morphea

* Usually begin on the hands, feet, and face, with episodes of recurrent nonpitting edema.

* Sclerodactyly.

* The fingers shrink in size and become sausage-shaped.

* Periungual telangiectases(AI-2011***) are usually present– Matlike telangiectases are often present, particularly on the face and hands.

* Hyperpigmentation and hypopigmentation are also often present.

* Raynaud’s phenomenon, i.e., cold-induced blanching, cyanosis, and reactive hyperemia, is present in almost all patients and can precede development of scleroderma by many years.

* The combination of calcinosis cutis, Raynaud’s phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia has been termed the CREST syndrome.

* Anticentromere antibodies -with the CREST syndrome.

57. Which of these is not a cause of increased MCV and normal MCH ? AI-2012

A. Aplastic bone marrow
B. Thalasemia
C. Vit B12 deficiency
D.

ANS-B

OPERATION HARRI – PAGE 467, 483

k) Thalassemia Syndromes: Introduction

* Unaffected globins proceeds at a normal rate. Unbalanced chain accumulation dominates the clinical phenotype.

* Most common form of mutations – derangement of splicing of the mRNA precursor or prematurely terminate translation of the mRNA.

* Hypochromia and microcytosis characterize all forms because of the reduced amounts of hemoglobin tetramers.

* Heterozygotes (beta-thalassemia trait)-Anemia is minimal.

Lab

* PS – MCV ­

– ¯ Retic count.

* Marrow is usually readily aspiratable (Dry tap- myelofibrosis, myelopthisis).*

* Fat cells > 75%.

* Correlation between marrow cellularity and disease severity is imperfect.

* Chromosome studies of bone marrow cells are often revealing in MDS and should be negative in typical aplastic anemia.

58. A 16 yr old boy presented with growth failure. O/E FSH, LH, Testosterone decreased. All can be the cause except [AI 2012]

A. Constitutional growth delay

B. Kallman syndrome

C. Kleinefelter syndrome

D.

Ans-c

OPERATION HARRI

59. Myasthenia gravis –what type of auto immunity [AI 2012]

A. Type I

B. Type II

C. Type III

D. . Type IV

Ans-b

OPERATION HARRI-PAGE 433, 435,

60. Acute pulmonary edema — except [AI 2012]

A. Digoxin

B.Morphine

C.Digoxin

D.Lasix

ANS-C

OPERATION HARRI,

61. Decreased IgM, bleeding tendency with eczema [AI 2012]

A.Wiskott aldrich sysndrome

B.

C.

D.

Ans-a

OPERATION HARRI

62. Pt with 500ml hemetemesis. clinically 5cm spleen palpable. likely cause is AI-2012

1. DU

2.GU

3.Portal hypertension

4.??

Ans-c

OPERATION HARRI – PAGE 172

63. Child with recurrent resp infection, h/O bulky stool stools AI-2012

a)cystic fibrosis

b)

c)

d)…

ans-A

OPERATION HARRI

64. Thiazide used in t/t of a/e AI-2012

a-idiopathic hypercalceuria wit nephro calcinosis
b-hyperlipedemia
c-ccf

d-

ans-b

OPERATION HARRI

65. Carcinoid,true is AI-2012

a) Commonest tumor of small intestine
b) Multiple tumors lead to increased lung cancer

OPERATION HARRI

Carcinoid and Other Neuroendocrine Lung Tumors

* Neuroendocrine lung tumors- includes typical carcinoid, atypical carcinoid, and large cell neuroendocrine cancer, as well as SCLC.

* High-grade -SCLC and large cell neuroendocrine cancer.

* Low- and intermediate-grade tumors – typical carcinoid and atypical carcinoids.

* Carcinoids, like SCLCs, may secrete other hormones, such as ACTH or AVP, and can cause paraneoplastic syndromes that resolve on resection.

* Carcinoid syndrome– cutaneous flush, bronchoconstriction, diarrhea, and cardiac valvular lesions.

* Carcinoid tumors that have an unusually aggressive histologic appearance (referred to as atypical carcinoids) metastasize in 70% of cases to regional nodes, liver, or bone, compared with only a 5% rate of metastasis for carcinoids with typical histology.

* Five-year survival is 21% for patients with large cell neuroendocrine cancer, 65% for atypical carcinoid, and 90% for typical carcinoid.

66. Proteinuria + haematuria + Anti HCV +ve AI-2012

A)MPGN

b)cryoglobulinemia

c)

d)

ans-a

OPERATION HARRI

67. HBV+ve Pregnant..AI-2012

a) Ig to child > within 12 hours

b)

c)

d)

OPERATION HARRI – PAGE 563

Exposure prophylaxis

* Hep B	* IVIg within 12 hrs
* Measles	* IVIg within – 6 days, actively immunized 3–6 months after immunoglobulin
* Tetanus	* Postexposure prophylaxis is 250–500 units of TIG *For treatment of tetanus -3000–6000 units of TIG IM.
* Rabies	* 20 IU/kg, Rabies vaccine is given as well at 0, 3, 7, 14, and 28 days.
* Varicella	* Maximal benefit requires administration within 96 h of exposure.
* Rubella	* Women in the first trimester who have a documented rubella exposure
* Hepatitis A	* Immunoglobulin within 2 wks

68. 7yr old child comes wid Ambiguous genitalia..he does nt have hyperpigmentation or hypertension..mullerian structures r present..shows phallus 2.5cm n labial folds r separated with two perineal openings..no gonads palpable in folds or intraabdominaly.. Which one explains the condition?AI-2012

a. Simple virilisation of primary CAH

b. complete androgen insensitivity synd

c.5 alpha reductase def

d. Maternal virilising synd

Ans-a

OPERATION HARRI

69. Blood in vessels dosent clot AI-2012

a) Antithrombin III

b)

c)

d)

OPERATION HARRI

70. Non-Small Cell Ca Lung True A/E AI-2012

a) Single Chemo after 70

b)

c)

d)

OPERATION HARRI – PAGE 396

Small Cell Lung Cancer

* Radiotherapy.

* Treatment with curative intent usually involves midplane doses of 60–64 Gy, while palliative thoracic radiation involves delivery of 30–45 Gy.

* The most common side effect of curative thoracic radiation is esophagitis.

* Acute radiation esophagitis occurs during treatment but is usually self-limited..

* Radiation therapy provides relief of intrathoracic symptoms: hemoptysis, 84%; superior vena cava syndrome, 80%; dyspnea, 60%; cough, 60%; atelectasis, 23%; and vocal cord paralysis, 6%.

* Docetaxel and pemetrexed are second-line agents for patients who have progressive disease on first-line chemotherapy and still have a good performance status.

* Bevacizumab, a monoclonal antibody to VEGF-contraindications- squamous cancer- brain metastases, hemoptysis, and bleeding disorders.

* Erlotinib is an oral inhibitor of the EGFR kinase -side effects include acneiform skin rash and diarrhea.

s) Small Cell Lung Cancer

* SCLC is a chemotherapy-sensitive disease.

* Etoposide plus cisplatin or carboplatin – Topotecan has modest activity as second-line therapy.

* Chemosensitive disease- Patients who relapse >3 months since the completion of their initial chemotherapy.

71. Women with contact lens –common infection [AI 2012]

A. Acanthamoeba

B.

C.

D.

Ans-a

OPERATION HARRI

Acanthamoeba castellani.

* Occurs in chronically ill or debilitated patients.

* Risk factors – lymphoproliferative disorders, chemotherapy, glucocorticoid therapy, lupus erythematosus, and AIDS.

* Reaches the central nervous system (CNS) hematogenously.

* Cutaneous ulcers or hard nodules.

* Mimics a space-occupying lesion.

* Demonstration of the trophozoites and cysts of Acanthamoeba on wet mounts or in biopsy.

* Treatment- pentamidine, trimethoprim-sulfamethoxazole, and fluconazole.

* Uniformly fatal.

Keratitis

* Linked to extended-wear contact lenses, and rare cases are associated with laser-assisted in situ keratomileusis (LASIK).

72. CRAO [AI 2012]

a) diabetic retinopathy

b) CMV retinitis,

c) mucormycosis

d)

ans-

OPERATION HARRI

73. PPI decreases efficacy of clopidogrel… AI-2012

a. cyt 2b b. cyt 2c

c. cyt 2d d.

ans-b

OPERATION HARRI-PAGE 6

Molecular Pathways Mediating Drug Disposition