Most common histologic type of carcinoma of the oral cavity | Crack AIIMS, AIPG NOV 2016 MCQs

The most common histologic type of carcinoma of the oral cavity is

A. Adenocarcinoma
B. Clear cell carcinoma
C. Large cell undifferentiated carcinoma
D. Squamous cell carcinoma

The answer is d.

Carcinoma of the oral cavity accounts for approximately 5% of all human malignancies. More than 90% of oral carcinomas are of the squamous cell type; precursor lesions include leukoplakia (dysplastic leukoplakia) and erythroplasia, with transformation rates of approximately 15 and 50%, respectively. Oral carcinoma is more common in males. Smoking, tobacco chewing, chronic irritation, heat exposure, and irradiation are all thought to contribute to carcinogenesis. The lower lip is the most common site, followed by the floor of the mouth, the anterior tongue, the palate, and the posterior tongue. Prognosis varies according to site but is best for lesions of the lip and worst for lesions in the floor of the mouth.

Peyronie’s disease of penis | Crack PGIMER NOV 2016

Regarding Peyronie’s disease of penis, which of the following is correct?

A. Hard plaques of fibrosis usually be palpated in the tunica of one or both corpora cavernosa.
B. Plaque can lead to normal penis to bend
C. All cases progress
D. Drug treatment cures the condition
E. Nesbitts operation can be done

The answer is.  A. Hard plaques of fibrosis usually be palpated inthe tunica of one or both corpora cavernosa.E. Nesbitts operation can be done

Peyronie’s disease is a relatively common cause ofdeformity of the erect penis. On examination, hardplaques of fibrosis can usually be palpated in the tunica ofone ore both corpora cavernosa. The plaques may calcify.Unyielding plaque within the elastic wall causes the erectpenis to bend towards the side of plaque. Etiology isunknown. There is an association with Dupuytren’scontracture.Treatment is difficult. Some cases continue to progress.

Others seem to remit after 3-5 years. Drug treatment isnot beneficial.Nesbitts operation can be done to correctdeformity that interferes with sexual function.

Breech Presentation | Crack PGIMER NOV 2016

Breech Presentation

A. Occurs in 25% of pregnancies at 28 weeks.
B. Occurs in less than 5% of pregnancies at term.
C. Is associated with fetal abnormality.
D. Is associated with uterine malformation.
E. Is associated with hydramnios.

The answer is.  B. Occurs in less than 5% of pregnancies at term. , C. Is associated with fetal abnormality. , D. Is associated with uterine malformation E. Is associated with hydramnios

Breech presentation

A fetus is said to be in a breech presentation when thebuttocks of the baby are presenting first at the bottom of theuterus, and the head is in the upper part, or fundus of theuterus.

There are three types of breech presentations, frank,complete, and incomplete.

The frank breech presentation is the most common of thethree and the safest position for a baby to be in if a vaginaldelivery is to be attempted.

This occurs in 3-4% of all deliveries.

The percentage of breech deliveries decreases with advancinggestational age from 22% of births prior to 28 weeks' to 1-3%of births at term.

Predisposing factors for breech presentation

·   Preterm labor and birth - if labor starts when the baby isstill small enough to move rather freely in the uterus.

·   A placenta in the fundus - the placenta takes up some ofthe space in the top of the uterus.

·   Uterine malformations

·   Fibroids in the lower part of the uterus

·   More than one fetus

·   Polyhydramnios or Oligohydroamniosis

·   Fetal abnormalities (eg, CNS malformations, neckmasses, aneuploidy)

·   A very relaxed uterus from many previous children

Vaginal breech delivery: Three types of vaginal breechdeliveries

1.       Spontaneous breech delivery: No traction or manipulation ofthe infant is used

2.       Assisted breech delivery: This is the most common type ofvaginal breech deliver

3.       Total breech extraction: The fetal feet are grasped, and theentire fetus is extracted - Total breech extraction should beused only for a noncephalic second twin; it should not beused for a singleton fetus as it is associated with a birth injuryrate of 25% and a mortality rate of approximately 10%

A vaginal delivery may be attempted for a baby in thebreech position if:

ü A The baby is in a frank breech position

ü The baby is small enough to pass easily through thevagina

ü No obstetrical problems, such as placenta previa

ü Pregnant woman's pelvis is a normal or above averagesize

ü The baby has already descended well into the pelvis aslabor begins

ü The baby's head is tucked down toward its chest – notExtended

Combination of episodic elevations | Crack AIIMS, AIPG NOV 2016 MCQs

The combination of episodic elevations in serum transaminase levels along with fatty change in hepatocytes is most suggestive of infection with

A. Hepatitis A virus 
B. Hepatitis B virus
C. Hepatitis C virus 
D. Hepatitis D virus

The answer is c. The hepatitis viruses are responsible for most cases of chronic hepatitis, but the chance of developing chronic hepatitis varies considerably depending on which type of hepatitis virus is the infecting agent. Neither hepatitis A nor hepatitis E virus infection is associated with the development of chronic hepatitis.

About 5% of adults infected with hepatitis B develop chronic hepatitis, and about one-half of these patients progress to cirrhosis. In contrast to hepatitis B, chronic hepatitis develops in about 50% of patients with hepatitis C.

Clinically, chronic hepatitis C is characterized by episodic elevations in serum transaminases, and also by fatty change in liver biopsy specimens.  Hepatitis D infection occurs in two clinical settings. There might be acute coinfection by hepatitis D and hepatitis B, which results in chronic hepatitis in less than 5% of cases. If, instead, hepatitis D is superinfected upon a chronic carrier of hepatitis B virus, then about 80% of cases progress to chronic hepatitis.

World Hepatitis Day 28th July

Features of tentorial herniation | Crack PGIMER NOV 2016

Features of tentorial herniation include:

A. Vomiting
B. Deterioration of consciousness
C. Dilated pupil
D. Impaired respiration
E. Hemiparesis

The Answer is. A,B,C,D,E.

Tentorial herniation:

• Occurs when a mass lesion makes one cerebralhemisphere too large for its compartment and cause theinfero-medial part of the cerebral hemisphere to bepushed through the tentorial hiatus (which separates thecerebrum from the cerebellum)

• The increased pressure causes vomiting

• Deterioration of consciousness occurs due todisturbance of the reticular formation

• Compression on the third nerve results in dilated pupil,ocular alsy and ptosis

• Results in coning with the whole brainstem beingpushed downward. This interfere with the vital functionsof respiration (controlled by medulla oblongata)compression of the pyramidal fibres result in hemiparesis

Deficiency of enteropeptidase (enterokinase).| Crack AIIMS, AIPG NOV 2016 MCQs

A young boy presents with failure to thrive. Biochemical analysis of a aspirate after a meal reveals a deficiency of enteropeptidase (enterokinase). The levels of which digestive enzymes would be affected?

A. Amylase 
B. Colipase
C. Lactase 
D. Trypsin

The answer is D. Enteropeptidase formerly called enterokinase activates trypsinogen by limited proteolytic digestion to give trypsin is itself capable of activating trypsinogen, which produces a positive feedback effect. Trypsin also activates chymotrypsinogen (and several other proteolytic enzymes), so deficiency of enteropeptidase results in a severe deficiency of enzymes that digest protein. Amylase aids in the breakdown of starches to oligosaccharides, maltose, and maltotriose. Colipase along with other lipases functions to digest fats.

Lactase is a brush-border disaccharidase that hydrolyzes the bond between galactose and glucose in lactose.

Pepsin is a proteolytic enzyme secreted in an inactive form (pepsinogen) by the chief cells .of the stomach. Pepsinogen is activated by stomach acid, and so is not dependent on enteropeptidase. Pepsin alone will not replace the activities of other proteolytic enzymes, partly because food does not remain in the stomach for an extended period of time.

Premature labour PGI MCQ

Premature labour

A. Is associated with an increased risk of breech presentation
B. Is associated with uterine anomaly
C. Asymptomatic bacteruria is a proven risk factor
D. Is associated with genital tract infection
E. Is associated with cigarette smoking

The answer is. A,B,C,D,E

Preterm labor is defined as occurring before 37 weeks ofgestation.It is the major cause of neonatal mortality indeveloped countries.

Causes

·   Maternal Age less than 18 or more than 35 years

·   Previous induced abortions

·   Women with a low BMI

·   Women with a previous preterm birth

·   Multiple pregnancies

·   Maternal medical conditions such as high blood pressurepre-eclampsia,maternal diabetes, asthma, thyroiddisease, and heart disease

·   Cervical incompetence or short cervix

·   Uterine malformations

·   Placenta previa or placental abruption

·   Premature rupture of membranes

·   Abnormal amounts of amniotic fluid – Polyhydramniosor Oligohydramnios

·   Mental status of the women - Anxiety,Depression

·   Use of tobacco, cocaine, and excessive alcohol duringpregnancy

·   Infection - Bacterial vaginosis,pyelonephritis,asymptomatic bacteriuria, pneumonia, and appendicitis

Dorsal column lesion | Crack PGIMER NOV 2016

A dorsal column lesion is associated with loss ofwhich of the following modalities?

A. Pain
B. Light touch
C. Vibration sense
D. Proprioception
E. Temperature sense

The answer is.  B. Light touch, C. Vibration sense, D. Proprioception

The dorsal column spinal pathway carries sensation of:

• vibration

• proprioception

• half the touch fibres

These fibres have their cell bodies in the dorsal root ganglia.

The fibres then travel via the posterior nerve roots up thedorsal column without relaying in the cord. The fibres relay inthe medulla - in the nucleus gracilis (fibres from below themid-thoracic region) and cuneatus (fibres from above thispoint) - and cross the midline to continue as the mediallemniscus to the thalamus.

Epstein-Barr virus | Crack PGIMER NOV 2016

Epstein-Barr virus is associated with:

A. Burkitt's lymphoma
B. Cervical neoplasia
C. nasopharyngeal carcinoma
D. pharyngitis
E. auto-immunehemolytic anaemia

The answer is.  A. Burkitt's lymphoma, C. nasopharyngeal carcinoma, D. pharyngitis, E. autoimminue haemolytic anaemia

b-Seems a little vague. Is associated withlymphocytic lymphomas which could present in the neck andcervical lymphadenpopathy in infectious mononucleosis.

c-Anaplastic nasopharyngeal carcinoma, common in SE China,virtually all cases have evidence of EB in the tumour tissue.

d-Infectious mononucleosis. Usually severe pharyngitis.

e-Usually resolves after 1-2 months.

Prussak space | Crack PGIMER NOV 2016

Prussak space is present in:

A. Mastoid antrum
B. Epitympanum
C. Mesotympanum
D. Hypotympanum
E. Ext. auditory canal

The Answer is. B. Epitympanum

Prussak’s space is present posterior to posterior to pars flaccid in epitympanum. It is a common site for retraction pockets and cholesteotoma. It is bounded by :

Laterally	Pars flacida
Medially	Neck of malleus
Superiorly	Lateral malleolar fold
Inferiorly	Lateral process of malleus

Why cereals and pulses are combined | Crack PGIMER NOV 2016

Why cereals and pulses are combined 

A. 10% cereals contain protein and pulses contain 40% 
B. Cereals are deficient in methionine and lysine is deficient in pulses 
C. Cereals are deficient in lysine and methionine is deficient in pulses 
D. Cereals are rich in essential AA 
E. cereals have more fat and pulses have more protein

The Answer is. (C) Cereals are deficient in lysine and methionine is deficit in Pulses ;

* Cereals are main source of energy (carbohydrate).

* Cereal proteins are poor in nutritive quality being deficient in essential amino acid lysine.

* Protein content is 6-12%.

* Pulses contain 20-25% of proteins.

* Pulse protein is deficient in methionine and lesser extent in cystein.

* The traditional Indian diets, cereal and pulse proteins complement each other and provide a more balanced and complete protein intake, 

Slowly rising blood pressure along with the appearance of ankle edema and proteinuria

A 31-year-woman has attended prenatal clinic during her first pregnancy. She has been noted during the third trimester to have a slowly rising blood pressure along with the appearance of ankle edema and proteinuria. Coexistent features often seen with her disease include which of the following? 

A. twin pregnancies and hydatidiform mole 
B. young multigravida status 
C. hypothyroidism 
D. orthostatic hypotension

Answer. A. Twin pregnancies and hydatidiform mole

Twin pregnancy carries nearly a 4-fold increased risk of preeclampsia, independent of race and parity, and the risk of a nulliparous twin pregnancy is 14 times that of a parous singleton pregnancy. Any pathophysiologic model for preeclampsia needs to account for the risk twin pregnancy poses as well as other risk factors, such as nulliparity and molar pregnancy. 

Sign of separation of Placenta | Crack AIIMS, AIPG NOV 2016 MCQs

Which one of the following is not a sign of separation of placenta? 

A. Fundus of the uterus rises to the umbilicus 
B. The uterus is well contracted and retracted 
C. The cord “lengthens” when you press the uterus down, but recedes on release 
D. Excessive vaginal bleeding

Answer. C (The cord “lengthens”when you press the uterus down, but recedes on release)

The 3rd stage of labor comprises the phase of placental separation and its expulsion.

Signs of placental separation

1. The uterus becomes globular and firmer and ballotable.

2. There is often a sudden gush of blood.

3. The uterus rises in the abdomen because the placenta, having separated, passes down into the lower uterine segment and vagina, where its bulk pushes the uterus upward.

4. The umbilical cord protrudes further out of the vagina, indicating that the placenta has descended.
5. Permanent lengthening of the cord stabilized. This can be elicited by pushing down the fundus when a length of cord comes outside valve which remains permanent even after release of pressure. 

Second-degree uterine prolapse Clinical MCQ | Crack AIIMS, AIPG NOV 2016 MCQs

A young nulliparous woman presents with a second-degree uterine prolapse. The most appropriate management of this patient would be 

A. Purandare’s cervicopexy 
B. Gilliam’s ventrosuspension 
C. Hodge pessary 
D. Fothergill’s operation

Answer.A (Purandare’s cervicopexy)

Purandare's cervicopexy is an operation performed for nulliparous type of uterine prolapse, in the presence of good abdominal wall muscle tone. In this operation, the uterus is suspended extraperitoneally from the angles of the rectus sheath using a mersilene tape, sutured to the front of the supravaginal cervix after opening the uterovesical fold and displacing the urinary bladder down. The operation remains effective as long as the abdominal wall muscle tone remains good. Once the muscle tone is lost due to any reason, the prolapse recurs.

MOST common cause of preload disorders in children | Crack AIIMS, AIPG NOV 2016 MCQs

What is the MOST common cause of preload disorders in children?

A. Distributive shock
B. Hypovolemic shock from vomiting and diarrhea
C. Congestive heart failure
D. Severe anemia

Answer. B. Hypovolemic shock from vomiting and diarrhea

Preload is the amount of blood that the heart receives to distribute to the body. In addition to heart rate, afterload, and cardiac contractility, preload determines cardiac output. In children, the most common cause of decreased preload is hypovolemia, usually from vomiting and diarrhea. Distributive shock secondary to sepsis, neurogenic spinal shock, or anaphylaxis is a less common cause of preload reduction. Acute anemia may also be associated with decreased preload. Congestive heart failure is a frequent complication in children with congenital heart disease. Increased preload results in elevation of left atrial pressure leading to pulmonary edema and decreased oxygenation.

The primitive reflex that persists throughout life | Crack AIIMS, AIPG NOV 2016 MCQs

The primitive reflex that persists throughout life is 

A. Moro reflex 
B. Tonic neck reflex 
C. Palmar grasp reflex 
D. Parachute reflex

Answer.D (Parachute reflex)

Timing of selected primitive reflexes

Reflex	Onset	Fully developed	Durations
Palmer grasp	28 weeks	32 weeks	2-3 months
Moro	28-32 weeks	37 weeks	5-6 months
Rooting	32 weeks	36 weeks	Less prominent after 1 month
Tonic neck	35 weeks	1 month	6-7 months
Parachute	7-8 months	10-11 months	Remain throughout life

An 8-month-old boy is referred for evaluation following a urinary tract infection | Crack AIIMS, AIPG NOV 2016 MCQs

An 8-month-old boy is referred for evaluation following a urinary tract infection. Ultrasound examination of the abdomen is normal. The most appropriate investigation to evaluate his lower urinary tract is 

A. Radionuclide cystogram 
B. Micturating cystourethrogram 
C. Intravenous pyelogram 
D. Cystoscopy

Answer.B (Micturating cystourethrogram)

Diagnostic imaging studies following UTI 

• Recommended radiological evaluation includes a combination of ultrasound abdomen, micturating urethrogram (MCU) and radionuclide renal scan.

•  Detailed radiological investigations are performed on all children:

1. Below 3-year-old with first UTI                                   

2. Those with symptoms of pyelonephritis

3. Recurrent UTI                                                                 

4. Abnormal voiding

5. Family history of UTI or hypertension. 

Statement(s) concerning tracheoesophageal fistulas | Crack PGIMER NOV 2016

Which of the following statement(s) is/are true concerning tracheoesophageal fistulas? 

A, The majority of acquired tracheoesophageal fistulas are due to malignant disease 
B. A water-soluble contrast esophogram should be obtained for diagnosis 
C. Malignant tracheoesophageal fistulas represent one of the few indications for endoesophageal prosthesis 
D. A benign tracheoesophageal fistula from an endotracheal intubation injury often requires a thoracotomy for repair 
E. none is true

The answer is. A, The majority of acquired tracheoesophageal fistulas are due to malignant disease, C. Malignant tracheoesophageal fistulas represent one of the few indications for endoesophageal prosthesis

Ninety percent of acquired fistulas between the esophagus and tracheobronchial tree in adults are the result of malignant disease. Tracheoesophageal fistulas complicate the course of disease in about 5% of patients who have esophageal carcinoma. Nearly 80% of patients with malignant tracheoesophageal fistulas die within three months of the onset of symptoms and in 85% of these patients, the cause of death is aspiration pneumonia, not distant metastatic disease. For the most part, malignant tracheoesophageal fistula represents incurable disease for which resection carries significant mortality and is seldom indicated. Palliative relief of recurrent aspiration is the aim of therapy. Effective occlusion of the fistula may be achieved by insertion of one of a variety of available endoesophageal endoprostheses. These tubes are placed into the esophagus with the aid of an esophagoscope and may occlude the esophageal side of the fistula sufficiently to allow swallowing of liquids without aspiration into the tracheobronchial tree. More recently, expandable metal stents have been used successfully in the treatment of malignant tracheoesophageal fistulas.

Nonmalignant fistulas result from the erosion by contiguous infected subcarinal mediastinal lymph nodes; trauma; late sequelae of chronic mid-esophageal traction diverticulum; or erosion by an endotracheal or tracheostomy tube cuff in a patient requiring prolonged ventilatory support. Small fistulas, such as resulting from an endotracheal intubation injury, are approached through a cervical collar or oblique incision anterior to the sternocleidomastoid muscle. Although such cuff injuries usually produce circumferential tracheal damage which necessitates a tracheal resection, this can also be performed through a cervical collar incision. 

Statement(s) regarding ulcerative colitis | Crack PGIMER NOV 2016

Which of the following statement(s) regarding ulcerative colitis is/are correct? 

A. The most common age of onset for ulcerative colitis is in early adulthood 
B. Approximately 25% of cases of ulcerative colitis occur after the age of 60 
C. Males are affected approximately twice as frequently as females 
D. Approximately 10% to 25% of patients with ulcerative colitis have first degree relatives with the disease
E. all are true

The answer is. A. The most common age of onset for ulcerative colitis is in early adulthood

D. Approximately 10% to 25% of patients with ulcerative colitis have first degree relatives with the disease

Most cases of ulcerative colitis have onset between the ages of 15 and 40 years. While the age of onset may extend to old age, only 3% to 5% of the cases have onset after age 60. Males and females are affected equally frequently. Clear-cut familial patterns have been observed in ulcerative colitis. Ten to 25% of patients with this disease have first degree relatives with ulcerative colitis. Monozygotic twins have higher concordance for inflammatory bowel disease than dizygotic twins.

H. Pylori infection in humans | Crack PGIMER NOV 2016

Which of the following statement(s) regarding H. Pylori infection in humans is/are correct? 

A. H pylorimay be isolated from antral gastric mucosa in nearly 100% of patients with active duodenal ulceration
B. H pyloripossess cell surface receptors that bind small intestinal mucous cells 
C. Therapeutic regimens for duodenal ulcer that eliminate the organism are associated with lower ulcer recurrence rates than those in which the organism persists.
D. The incidence of the organism in the normal population increases with age.
E. Antralgastritis is associated with development duodenal ulcer

The answer is. C. Therapeutic regimens for duodenal ulcer that eliminate the organism are associated with lower ulcer recurrence rates than those in which the organism persists .

D. The incidence of the organism in the normal population increases with age.

E. Antral gastnitis is associated with development duodenal ulcer

Helicobacter pylon has received enormous tive attention in recent years as a possible in- cause of peptic ulceration. The evidence that causes ulcers is substantial but largely infertral gastritis is nearly always present in paduodenal ulceration. H pyloriinfestation of the mucosa is causative for gastritis

Resolution of gastritis follows eradication of the organism and drug regimens that are bactericidal have lower rates of ulcer recurrence than regimes which have no anti-bactericidal actions.

* Not all pateints who have H.pylori develop ulcerations. Only abour half of pateints with ulcerations have evidence of h.pylori