Most sensitive test for evaluation of anteriorcruciate ligament | Crack PGIMER NOV 2016

The most sensitive test for evaluation of anteriorcruciate ligament is

A. Lachmann test
B. Mcmurrays test
C. Anterior draw test
D. Posterior draw test

E. Apleys grinding test

The Answer is. A. Lachmann test

The most sensitive test for evaluation of the ACL is theLachmann test. Flex the knee to 15–30 degandpull the proximal tibia forwards. Excessive laxity may indicaterupture of the ACL. Anterior translation of the tibia associatedwith a soft or no endpoint is a positive test. The testmay be negative in chronic ruptures as the ACL stump canscar to the PCL.

Most commonly injured carpal bone | Crack PGIMER NOV 2016

The most commonly injured carpal bone is

A. Lunate 
B. Scaphoid
C. Capitates 
D. Hamate 
E. Pisiform

The Answer is. B. Scaphoid

Scaphoid is made up of the proximal and distal poles, a tubercle& waist. The proximal pole is completely intra-articular&receives all of its blood supply from the distal branches oftheradial artery. This enters the scaphoid in a retrogradefashion (distal to proximal). Therefore, fractures in theproximal pole are most at risk of non-union or avascularnecrosis. In contrast, distal pole fractures tend to heal withoutproblems.

Investigations useful for Lower GI bleeding | Crack PGIMER NOV 2016

Investigations useful for Lower GI bleeding includes

A. RBC Scan
B. Upper GI endoscopy
C. Colonscopy
D. Mesenteric angiography
E. Prosctoscopy

The answer is. B. Upper GI endoscopy, C. Colonscopy, D. Mesenteric angiography, E. Prosctoscopy

After resuscitation has been initiated, the first step in theworkup is to rule out anorectal bleeding with a digital rectalexam and anoscopy or sigmoidoscopy. With significantbleeding, it is also important to eliminate an upper GI source.

An NG aspirate that contains bile and no blood effectively rulesout upper tract bleeding in most patients. However, whenemergent surgery for life-threatening hemorrhage is beingcontemplated, preoperative or intraoperative EGD is usuallyappropriate. This is particularly relevant if blind subtotalcolectomy for massive hemorrhage is being considered.

Subsequent evaluation depends on the magnitude of thehemorrhage. With major or persistent bleeding, the workupprogresses depending on the patient's hemodynamicstability.Colonoscopy is the mainstay of diagnosis because itallows both visualization of the pathology and therapeuticintervention in colonic, rectal, and distal ileal sources ofbleeding. The usual adjuncts to colonoscopy include taggedRBC scan and angiography. If these modalities are notdiagnostic, the source of the hemorrhage is considered obscure(these lesions and their evaluation are considered in the finalsection).

Selective angiography, using either the superior or inferiormesenteric arteries, can detect hemorrhage in the range of 0.5to 1.0 mL/min and is generally only employed in the diagnosisof ongoing hemorrhage. It can be particularly useful inidentifying the vascular patterns of angiodysplasias.

Primary site of hematopoiesis in the fetus | Crack AIIMS, AIPG NOV 2016 MCQs

Which organ is the primary site of hematopoiesis in the fetus before mid pregnancy? 

A. Bone 
B. Liver 
C. Spleen 
D. Lung

Answer.B. (Liver) Fetal Hematopoiesis

·         Begins in the yolk sac (2 -8 weeks) - progenitor cells migrate from the yolk sac to the liver at 5-8 weeks gestation Only terminal differentiation of red cells occurs in the yolk sac

·         Liver active from 5-8 weeks gestation - mainly red cells. Spleen also involved before 20 weeks

·         Begins in the medullary cavity of the clavicle at about 10-12 weeks and in the medullary cavity of long of bones at - 20 weeks gestation

·         Some lymphocytes are produced in lymph nodes 

Radical mastoidectomy | Crack AIIMS, AIPG NOV 2016 MCQs

Which of the following is not included in the radical mastoidectomy? 

A. Closure of the auditory tube 
B. Ossicles removed 
C. Cochlea removed 
D. Exteriorization of mastoid

Answer. B. Ossicles removed.

A simple mastoidectomy consists of opening the mastoid cortex and identifying the aditus and antrum.

A complete or canal wall up mastoidectomy necessitates removal of all of the mastoid air cells along the tegmen, sigmoid sinus, presigmoid dural plate, and posterior wall of the external auditory canal. The posterior wall of the external auditory canal is preserved.

A canal wall down mastoidectomy includes a complete mastoidectomy in addition to removal of the posterior and superior osseous external auditory canal. The tympanic membrane is reconstructed to separate the mucosal lined middle ear space from the mastoid cavity and ear canal.

A modified radical mastoidectomy is identical to a canal wall down mastoidectomy except the middle ear space and native tympanic membrane are not manipulated. This procedure is useful when there is no extension of cholesteatoma in the middle ear space or medial to the malleus head or incus body. This procedure is often indicated in patients with a cholesteatoma in their only or better hearing ear.

A radical mastoidectomy is a complete mastoidectomy in which the tympanic membrane and ossicles are not reconstructed, thus exteriorizing the middle ear and the mastoid. The eustachian tube is often obliterated with soft tissue to reduce the risk of a chronic otorrhea. A skin graft can be placed in the middle ear to reduce the risk of mucosalization and otorrhea.

Dense bodies contain MCQ | Crack PGIMER NOV 2016

Dense bodies contain

A. Fibrinogen 
B. PF 4
C. PDGF 
D. TGF beta
E. Ionized calcium

The answer is. E. Ionized calcium

Platelets are disc-shaped; anucleate cell fragments that areshed from megakaryocytes in the bone marrow into the bloodstream. They play a critical role in normal hemostasis, byforming the hemostatic plug that initially seals vasculardefects, and by providing a surface that recruits andconcentrates activated coagulation factors. Their functiondepends on several glycoprotein receptors, a contractilecytoskeleton, and two types of cytoplasmic granules.α-Granules have the adhesion molecule P-selectin on theirmembranes and contain fibrinogen, fibronectin, factors V andVIII, platelet factor 4 (a heparin-binding chemokine), plateletderivedgrowth factor (PDGF), and transforming growth factor-β (TGF-β). Dense (or δ) granules contain ADP and ATP, ionizedcalcium, histamine, serotonin, and epinephrine.

Neurovascular anatomic structures MCQ | Crack PGIMER NOV 2016

The following statement(s) is/are true concerning neurovascular anatomic structures in the inguinal region.

A. The inferior epigastric artery and vein run upward in the preperitoneal fat posterior to the transversalis fascia close to the lateral margin of the internal inguinal ring 

B. The iliohypogastric and ilioinguinal are motor and sensory nerves in the inguinal region which lie beneath the external oblique aponeurosis 

C. The ilioinguinal nerve runs anterior to the spermatic cord in the inguinal canal and at the superficial inguinal ring, branches into the sensory supply to the pubic region and the upper scrotum or labium majoris

D. The genital branch of the genitofemoral nerve is a sensory nerve only to the upper thigh and genital area

E. direct inguinal hernia arises superior and medial to the inferior epigastric vesssels

The answer is. B. The iliohypogastric and ilioinguinal are motor and sensory nerves in the inguinal region which lie beneath the external oblique aponeurosis

C. The ilioinguinal nerve runs anterior to the spermatic cord in the inguinal canal and at the superficial inguinal ring, branches into the sensory supply to the pubic region and the upper scrotum or labium majoris

Arising anteriorly from the external iliac artery, the inferior epigastric artery with its accompanying vein runs obliquely medially and upward in the preperitoneal fat, posterior to the transversalis fascia and close to the inferior margin of the internal inguinal ring. Inguinal hernias arising superior to the inferior epigastric vessels are indirect inguinal hernias, whereas those arising inferior to the vessels are direct inguinal hernias. The iliohypogastric and ilioinguinal nerves are motor and sensory nerves to the muscles and skin of the inguinal region.

The nerves penetrate the transversus abdominis muscle at the point above the middle of the iliac crest, lie below the internal oblique muscle up to the point just medial and superior to the anterior superior iliac spine, and then penetrate the internal oblique muscle and lie below the external oblique aponeurosis.

The ilioinguinal nerve runs anterior to the spermatic cord in the inguinal canal and at the superficial inguinal ligament, branches into sensory supply to the pubic region and the upper scrotum or labium majoris. The genital branch of the genitofemoral nerve perforates the transversalis fascia usually just inferior to the internal ring. It courses along the posterior surface of the spermatic cord and supplies motor fibers to the cremaster muscle. At the superficial inguinal ring, it divides to provide sensory innervation to the scrotum and medial aspect of the upper thigh.

Breathing exercises for Asthma:

Abstract

Background

There is much anecdotal evidence in Eastern and Western literature describing considerable benefits for patients with asthma when treated with breathing interventions. The term 'breathing exercise, training and retraining' has numerous interpretations depending on the nature of the therapy, therapist and cultural background.

Objectives

To assess the evidence for the efficacy of breathing retraining in the treatment of patients with asthma.

Search methods

Trials were searched for in the Cochrane Airways Group trials register, Cochrane Complementary Medicine Field trials register, EMBASE: Physical Medicine & Rehabilitation Field, and Databases of the physiotherapy library of current research, World Congress of Physical Therapy Proceedings (1995) and AMED (Allied & Complementary Medicine Database 1985-2003/4). Hand searching of the Association of Chartered Physiotherapists in Respiratory Care Journals was undertaken.

Chartered physiotherapists in the field of respiratory medicine were contacted and appeals made in the 'Physiotherapy' Journal and the Physiotherapy Respiratory Care magazine. Searches were undertaken of bibliographies from the included studies and other appropriate papers. Authors of included studies were contacted for information concerning other relevant trials.

Selection criteria

Randomised or quasi-randomised controlled trials of breathing retraining in patients of all ages with a diagnosis of asthma. Breathing retraining should be a major component of the treatment intervention.

Data collection and analysis

Two reviewers (EH & FR) independently assessed trial quality and extracted data. Authors of included trials were contacted for additional data. Where possible adverse effects were noted.

Main results

Abstracts were identified and 42 full text papers were obtained for assessment and possible inclusion. Thirty five studies were excluded. A total of five studies were included in the original review. Two further studies have been added to this update. Most studies were of small size. Two studies demonstrated significant reductions in rescue bronchodilator use and three studies showed reductions in acute exacerbations, although these were measured in different ways. Two single studies showed significant improvements in quality of life measures. Overall, benefits of breathing exercises were found in isolated outcome measures in single studies. Five studies compared breathing retraining with no active control and two with asthma education control groups.

Authors' conclusions

Comparisons and conclusions were difficult to evaluate as treatment interventions and outcome measurements from the seven trials varied considerably. At present therefore no reliable conclusions can be drawn concerning the use of breathing exercises for asthma in clinical practice. However trends for improvement, notably in quality of life measurements, are encouraging and further studies including full descriptions of treatment methods and outcome measurements are required.

Plain language summary

Breathing exercises for asthma

The term 'breathing exercise or re-training' has numerous interpretations depending on the nature of the therapy, therapist and cultural background. The objective of this review was to assess the evidence for the effectiveness of breathing retraining for patients with asthma. Due to the small number of studies meeting the criteria for inclusion into this review, the small number of patients in the studies and the use of diverse interventions in the included studies, no reliable conclusions can be drawn as to the beneficial effects of breathing retraining in asthma. However with the introduction of two further studies trends for improvement in an increased number of outcomes were found. There is therefore a need for large scale trials involving breathing retraining in order to observe its effectiveness in the treatment and management of asthma.

Source: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD001277.pub2/abstract

Cushing’s disease PGI Based MCQ | Crack PGIMER NOV 2016

A 45-year-old male is diagnosed with Cushing’s disease. He undergoes a bilateral adrenalectomy and recovers well from the operation. On his return to the work one year later, he complains of a constant dull headache, peripheral visual disturbances and increasing pigmentation of the skin creases of both hands. The most likely diagnosis is: 

A. Ectopic ACTH secreting tumour 
B. Prolactinoma 
C. Nelson syndrome 
D. Addison’s disease 
E. Side effects from iatrogenic steroid intake

The answer is. C. Nelson syndrome

Nelson syndrome occurs in patients who undergo bilateral adrenalectomies; the loss of negative feedback over time causes a macroadenoma to form in the pituitary which secretes adrenocorticotropin (ACTH). A spectrum of symptoms may arise due to the effects of serum ACTH, as well as the deficiency in other pituitary hormones. An ectopic tumour secreting ACTH can produce similar symptoms; however they usually originate from oat cell of small cell lung carcinomas which are associated with weight loss rather than headaches and visual disturbances. Iatrogenic steroid side effects would cause symptoms imitating cortisol excess such as striae, bruising, thin skin and weight gain. A prolactinoma  can cause some of the symptoms the patient complains of, such as headache and visual disturbances, due to impingement upon surrounding structures. However, symptoms in males does not involve hyperpigmentation and usually include loss of libido, impotence and gynaecomastia. Addison’s disease (D) causes similar symptoms described in the question stem, however the cause of adrenal function loss is due to autoimmune action or infection. 

LEAST diagnostic value When evaluating for possible otitis media | Crack AIIMS NOV 2016 MCQs

When evaluating for possible otitis media, which of the following is of the LEAST diagnostic value?

A. History of a new onset of ear pulling starting several days after URI
B. Presence of the light reflex
C. Translucency of the tympanic membrane (TM)
D. Mobility in response to pneumatoscopy

Answer. B. Presence of the light reflex

The light reflex can often be visualized in an abnormal ear. Gauging decreased translucency of the TM and evaluating for the presence of a fluid level behind the TM requires experience, but these are good indicators of infection when detected. Mobility in response to pneumatoscopy is also quite sensitive in practiced hands. New-onset ear pulling after URI is frequently associated with otitis media.

LEAST consistent with a clinical diagnosis of acute appendicitis | Crack AIIMS NOV 2016 MCQs

Which of the following is the LEAST consistent with a clinical diagnosis of acute appendicitis?

A. Normal temperature
B. Normal white blood cell (WBC) count
C. Recent gastroenteritis
D. Vomiting preceding the onset of abdominal pain

Answer. D. Vomiting preceding the onset of abdominal pain

The classic progression of symptoms of appendicitis occurs more commonly in older children and adults. Children younger than 2 years often present when the appendix is already perforated because the preceding symptoms are too nonspecific to call attention to the pathology. Lack of anorexia or fever and normal WBC counts are common findings in pediatric patients. Gastroenteritis is often associated with appendicitis, possibly on the basis of an acutely, but secondarily, inflamed appendix. Vomiting more commonly presents after the onset of abdominal pain

LEAST consistent with a diagnosis of intussusception | Crack AIIMS NOV 2016 MCQs

Which one of the following is the LEAST consistent with a diagnosis of intussusception?

A. Intermittent colicky abdominal pain, interspersed with symptom-free periods
B. Grossly normal appearing stool
C. Normal plain films of the abdomen
D. Previously healthy 9-year-old child

Answer .D. Previously healthy 9-year-old child

Intermittent colicky pain, occurring about every 20 min, is the typical history for intussusception. Because the child looks and acts completely normal between pain episodes, the diagnosis is often overlooked. The stool commonly appears grossly normal until ischemia progresses and “currant jelly” stools develop. Although a mass effect in the right upper quadrant on x-ray or palpation is suggestive of the diagnosis, up to one-third of plain films are normal. The usual age range for presentation is between 3 months and 6 years. 

Vitamins become a major electron acceptor, aiding in the oxidation of numerous substrates | AIIMS Based MCQ

Which of the following vitamins become a major electron acceptor, aiding in the oxidation of numerous substrates? 

A. Vitamin B6 
B. Niacin 
C. Riboflavin 
D. Thiamine

Answer. B. Niacin

NAD is the functional coenzyme derivative of niacin. It is the major electron acceptor in the oxidation of molecules, generating NADH, which is the major electron donor for reduction reactions. Thiamine (also known as vitamin B1) occurs functionally as thiamine pyrophosphale and is a coenzyme for enzymes such as pyruvate dehydrogenase. Riboflavin (vitamin B2) functions in the coenzyrne forms of FMN or FAD. When concentrated, both have a yellow color due to the riboflavin they contain. Both function as prosthetic groups of oxidation- reduction enzymes or flavoproteins. Flavoproteins are active in selected oxidation reactions and in electron transport, but they do not have the ubiquitous role of NAD+. 

Patient with muscle weakness and raised CPK levels | Crack AIIMS NOV 2016 MCQs

10-year-old boy has increasing muscle weakness and raised CPK levels. The most likely defect is in plasma membrane of 

A. Nerves 
B. Muscle fibers 
C. Basement membrane 
D. All body cells

Answer .B. Muscle fibers

 Several lysosomal enzymes are released by damaged or degenerating muscle fibers and may be measured in serum.

• The most useful these enzymes is the creatine kinase (CK), which is found in only three organs and may be separated into corresponding isozymes: MM for skeletal muscle, MB for cardiac muscle, and BB for brain.

• Serum CK determination is by no means a universal screening test for neuromuscular disease because many disease of the motor unit may not be associated with elevated enzymes.

• However, the CK level is characteristically elevated in certain diseases, such as Duchenne muscular dystrophy, and the magnitude of increase is characteristic for particular disease. 

A 6-month-old infant presents to the “diarrhea clinic” unit with some dehydration. | AIIMS MCQ

A 6-month-old infant presents to the “diarrhea clinic” unit with some dehydration. What is the most probable cause of this? 

A. Entarnoeba histolytica 
B. Rotavirus 
C. Giardia lamblia 
D. Shigella

Answer B. Rotavirus.

• In India, rotavirus and enterotoxigenic E. coil account for nearly half of the total diarrheal episodes among children.

• Rotavirus is more frequently isolated in children with severe disease than in mild cases.

• Cholera accounts for 5—I 0% of cases.

• Shigella accounts for majority of cases of dysentery. 

Components responsible for synthesis of the short RNA molecules essential for DNA replication | Crack AIIMS NOV 2016 MCQs

The replication fork consists of four components. Which of the following components is responsible for synthesis of the short RNA molecules essential for DNA replication? 

A. Helicase 
B. Primase 
C. Polymerase 
D. SSB

Answer. B. Primase

Primase synthesizes the short RNA molecules required for initiation of a new DNA strand. DNA synthesis requires an RNA primer because polymerase, the major enzyme for DNA replication, can only add bases to an existing strand and cannot begin a new strand de novo. DNA polymerase moves along the DNA in one direction and synthesizes both new DNA strands at once. Since DNA is always synthesized 5' to 3', one of the strands (the leading strand) is synthesized continuously, whereas the other (the lagging strand) is synthesized in short stretches called Okazaki fragments. Helicase is the enzyme responsible for unwinding DNA at the replication fork. SSBs (single-strand binding proteins) bind to the unwound DNA to prevent pre mature re-annealing. 

Persistent diarrhea MCQ | Crack AIIMS NOV 2016 MCQs

Persistent diarrhea is defined as diarrhea that begins as an acute episode and lasts for at least: 

A. 7 days 
B. 10 days 
C. 14 days 
D. 2l days

Answer. D. 21 days

Persistent Diarrhea lasts for at least 21 days. 

Patient with pitting oedema of his ankles MCQ | Crack PGIMER NOV 2016

A 58-year-old male presents with pitting oedema of his ankles. He suffers from recently diagnosedhypertension, but is otherwise healthy. Blood results show low albumin and a urine dipstick is positive for protein. The most appropriate initial treatment is: 

A. High protein diet 
B. Diuretics 
C. Prophylactic anti coagulation 
D. ACE inhibitor 
E. Bed rest

The answer is. B. Diuretics

This patient has the classic triad of proteinuria, low serum albumin and oedema that occurs in the nephrotic syndrome. This can occur due to a number of disease processes such as diabetes and SLE, as well as those specific to the kidney, including minimal-change nephropathy and focal- segmental glomeruloscierosis. First-line management should include dietary measures to restrict sodium intake and a diuretic . Potental diuretics include furosemide which is often required to control any associated severe oedema. High protein diets do not have any benefit to the management of nephritic syndrome, a normal low salt diet should be encouraged. Albumin infusion can be used as adjuncts in patients who are resistant to diuretic therapy but never in isolation as they have transient beneficial effects. Bed rest should also be discouraged in patients since coagulation factors, for example antithrornbin, are also lost as part of the proteinuria creating a hypercoagulable state, patients are therefore at risk of thrornboembolism, including renal vein thrombosis. Therefore, prophylactic anticoagulation is desirable to protect against hypercoagulation and should always be considered, Angiotensin-converling enzyme (ACE) inhibitors protect against proteinuria by reducing the filtration pressure upon the glomerular capillaries. 

Histopathological features of extra hepatic Biliary Atresia | Crack PGIMER NOV 2016

Which of the following are histopathological features of extra hepatic Biliary Atresia?

A. Bile lakes 
B. Hepatocyte ballooning degeneration 
C. Marked bile duct proliferation 
D. Fibrosis of hepatic duct 
E. Parenchymal cholestasis

Answer (A) Bile lakes ; (C) Marked Bile duct proliferation ; (D) Fibrosis of hepatic duct (E) Parenchymal cholestasis

Histologically florid feature of extrahepatic biliary obstruction are

— Marked bile ductular proliferation, containing inspissated bile and lakes of extravasated bile.

— Portal tract oedema and fibrosis Parenchymal cholestasis Both& aftec birth 

Physical Quality of Life Index (PQLI) | Crack AIIMS NOV 2016 MCQs

All of the following indicators are included: in Physical Quality of Life Index (PQLI) except: 

A. Infant mortality rate 
B. Life expectancy at age one 
C. Literacy rate 
D. Per capita income

Answer. D. Per capita income

PHYSICAL QUAILTY OF LIFE INDEX

 It has 3 indicators- Infant mortality, life expectancy at age one, literacy rate.  

• These components measure results rather than inputs.

• For each indicator, performance is placed on scale of 0 to 100 where 0 is worst performance and 100 as best performance.
• Ultimate objective is to attain a PQLI of 100. 

Causes of frame-shift mutation | Crack AIIMS 8 May 2016 MCQs

Which one of the following causes a frame-shift mutation?

A. Transition 
B. Transversion 
C. Deletion 
D. Substitution of purine for pyrimidine

Answer. C. Deletion                          

Point mutations that are frame-shift mutations put the normal reading frame out of register by one base pair. The insertion of an extra base pair or the deletion of one or more base pairs falls into this category. Transitions and transversions are not frame-shift mutations; they are substitutions of one base pair for another. Substitutions are the most common type of mutation. In transitions, a purine is replaced by a purine or a pyrimidine by a pyrimidine. In transversions, a purine is replaced by a pyrimidine or vice versa. It has been suggested that transitions occur spontaneously owing to the tautomeric changes in basehydrogen- bond locations. Transversions can be caused by defective DNA polymerases.

Prader-Willi syndrome based MCQ | Crack AIIMS NOV 2016 MCQs

Disorders like Prader-Willi syndrome can involve changes in gene structure or modification. Which of the following processes occurs at the 5 position of cytidine and often correlates with gene inactivation?

A. Gene conversion 
B. Sister chromatid exchange
C. Pseudogene 
D. DNA methylation

Answer. D. DNA methylation

Angelman syndrome                          DCP        15

Cri du chat                                           D             5

Cystic fibrosis                                      P              7q

Down syndrome                                  C             21

Haemochromatosis                              P              6

Hemophilia                                          P              X

Klinefelter syndrome                           C             X

Neurofibromatosis                                              17q/22q

Polycystic kidney disease  P              16 (PKD1) or 4 (PKD2)

Prader–Willi syndrome                       DC          15 (CpG DNA Methylation)

Sickle-cell disease             P              11p

Tay–Sachs disease             P              15

Turner syndrome               C             X

D = deletion

C = chromosomal abbreation

P = point mutation

Diagnosis of chr 22 deletions in CML | Crack AIIMS NOV 2016 MCQs

True statement regarding diagnosis of chr 22 deletions in CML is

A. Increased incorporation of labelled acetate into histones of chromatin regions on 22
B. Altered DNA restriction patterns of chromosome 22 regions with methylationsensitive endonucleases
C. Altered pattern of small RNAs along leukemic chromatin
D. Altered DNA sequence for at least one chromosome 22 locus

Answer. D. Altered DNA sequence for at least one chromosome 22 locus

Chromosome deletion involves a breakage of DNA, with loss of the distal chromosome. The primary change in chronic myelogenous leukemia with chromosome 22 deletion would be a break in the chromosomal DNA that deletes certain sequences, joining DNA before the deletion point with telomeric sequences that do the chromosome replication (option d).

Other chromosomal alterations not there in Chr 22 deletions, but in other cancers include:

- altered primary transcription, altered “second” code of epigenesis through histone modification, altered Methylation

The Philadelphia chromosome (22 deletion) actually have a chromosome 9:22 translocation that joins the Abelson ABL oncogene on chromosome 9 to a BCR (breakpoint cluster region) on chromosome 22

Conversion of acetyl CoA to malonyl CoA | Crack AIIMS NOV 2016 MCQs

Which one of the following cofactors must be utilized during the conversion of acetyl CoA to malonyl CoA?

A. Thiamine pyrophosphate
B. Acyl carrier protein (ACP)
C. NADP 
D. Biotin

Answer D. Biotin

The key enzymatic step of fatty acid synthesis is the carboxylation of acetyl CoA to form malonyl CoA. The carboxyl of biotin is covalently attached to an amino acid group of a lysine residue of acetyl CoA carboxylase. The reaction occurs in two stages. In the first step, a carboxybiotin is formed: HCO3⁻+biotin-enzyme +ATP →+CO2^- biotin-enzyme +ADP +Pi. In the second step, the CO2 is transferred to acetyl CoA to produce malonyl CoA:CO2-biotin-enzyme +acetyl CoA →+malonyl CoA + biotin-enzyme. None of the other cofactors listed are involved in this reaction.

Histopathological features of extra hepatic Biliary Atresia | Crack PGIMER NOV 2016

Which of the following are histopathological features of extra hepatic Biliary Atresia?

A. Bile lakes 
B. Hepatocyte ballooning degeneration 
C. Marked bile duct proliferation 
D. Fibrosis of hepatic duct 
E. Parenchymal cholestasis


Answer (A) Bile lakes ; (C) Marked Bile duct proliferation ; (D) Fibrosis of hepatic duct

(E) Parenchymal cholestasis

Histologically florid feature of extrahepatic biliary obstruction are

— Marked bile ductular proliferation, containing inspissated bile and lakes of extravasated bile.

— Portal tract oedema and fibrosis Parenchymal cholestasis Both& aftec birth 

True about left sided colon carcinoma | Crack PGIMER NOV 2016

True about left sided colon carcinoma 

A. Anemia 
B. Obstruction 
C. Melena 
D. Feculent
E. Sigmoid is usually spared

Answer (B) Obstruction

• Carcinoma left colon are usually of stenosing variety, so main symptoms are those of increasing intestinal obstruction.
Other features are:

- Pain

- Alteration bowel habit

- Abdominal Distension

• Right sided growths are proliferative and grow towards periphery.