Most common cause of mass mediastinum in children | Crack PGIMER NOV 2016

Most common cause of mass mediastinum in children

A. Rhabdosarcoma
B. Duplication cyst of oesophagus
C. Lymphoma 
D. Neuroblastoma
E. Thymoma

The Answer is . (D) Neuroblastoma

Differential Diagnosis of posterior inediastinal mass

• Neurogenic tumour

• Hiatus hernia

• Meningocele

• Esophageal tumour

• Foramen of bochdalek hernia

• Thoracic spine disease

• Extramedullary erythropoiesis

• Mesenchymal tumours

• Neurogenic tumours are more common in posterior mediastinum. Eg.Neuroblastoma, Ganglioneuroma, ganglioneuroblastoma.

MCQ’s:

m/c medistnal tumor in adult: Thymoma

m/c site for lymphoma is: ant medistnum

Agammaglobulinemia | Crack PGIMER NOV 2016

All are true regarding agammaglobulinemia except: 

A. Loss of germinal center in lymph node 
B. Normal cortical lymphocytes 
C. Decreased lymphocytes in paracortex and medulla 
D. Decreased red pulp in spleen
E. Immunodeficiency (cell mediated)

The Answer is . (B) Normal cortical lymphocytes; (C) Decreased lymphocytes in paracortex and medulla
(D) Decreased red pulp in spleen ; (E) Immunodeficiency (cell mediated)

• Agammaglobulinemia is a primary humoral immunodeficiency affecting male child older than six months of age. It is X-linked disorder.

• There is failure of B cell precursors (pro-B, pre-B) to differentiate into B-cells, The block in the

differentiation of B-cells is due to mutations in cytoplasmic bruton tyrosine kinase

• Bursa-dependent area shows depletion of cells

• In Lymph node B-cell areas : Cortical follicles, medullary cords

T-cell areas : para cortical areas

• In spleen :B-cell areas: Perifollicular region, germinal centre, mantle layer

T-cell areas red-pulp

• Cell-mediated immunity is nt affected

• As Bursa dependant area cells are affected — so B Cell areas of L.N. and spleen shows depletion of cells. 

Infant with blood in stools mass in abdomen | Crack PGIMER NOV 2016

Infant with blood in stools mass in abdomen, most probable diagnosis is 

A. Intussusception
B. Volvulus
C. Idiopathic abdominal epilepsy
D. Hirschsprung’s disease
E. Wilms tumor

The Answer is . (A) Intussusception

• Intussusception in infants present with acute intestinal obstruction — abdominal pain, stools are stained with blood

likecurrant jelly, abdominal mass.

So, the probable diagnosis according to the question is intussusception.

• Volvulus —pain abdomen, distension, no blood in stool

• Hirschsprung’ s disease - No bloody stool.

• Idiopathic abdominal epilepsy- recurrent abdominal pain.

DiGeorge Syndrome | Crack PGIMER NOV 2016

Which is found in DiGeorge Syndrome?

A. Tetany 
B. Eczema 
C. Mucocutaneous candidiasis 
D. Absebnt B and Tcells
E. Total absence of T cells

The Answer is . (A) Tetany; (C) Mucocntaneous candidiasis

• Di George’s syndrome is a developmental defect involving the endodermal derivative of 3rd and 4th pharyngeal pouches, whih leads to aplasia or hypoplasia of the thymus and parathyroid glands

• Circulating T-cells are reduced

• Tetany (hypocalcemic) can occur.

• Humoral immunity is largelyunaffected.

• Low immunity against viral and fungal infection ; mucocutaneous candidiasis occurs.

• Congential cardiac anomalies (Fallot’s tetralogv) including great vessels of heart, facial deformities are prominent.

• Eczema is seen in wiskot-Aidrich syndrome.

• The individuals have a small but histologically normal thymus allowing most patients to develop functional T-cells

in number that may or may not be adequate for host defense. 

Vaccine (s) not to be frozen | Crack PGIMER NOV 2016

Vaccine (s) not to be frozen is/are:

A.BCG 
B.OPV 
C.DPT
D. Measles
E. TT

The Answer is . (A) BCG; (C) DPT ; (E) TT

• Vaccines which must be stored in COLD PART but NEVER allowed to FREEZE are

— Typhoid

—DPT                                   

—BCG
Vaccines which must be stored in top shelf (for minimum temperature)

• Polio - 20°c

• Measles

(ii) Freeze dried Vaccines — BCG, yellow fever, measles

The Jackson's Cross cylinder | Crack AIIMS, NEET NOV 2016 MCQs

The Jackson's Cross cylinder is a :

A. Sphero-cylindricalness 
B. Spherical lens
C. Cylindricalness 
D. Prismatic lens

Answer.A. Sphero-cylinderical lens

Jackson cylinder is a particular type of spherocylindrical lens used to determine both power and axis of astigmatic correction of an eye.

Jackson's cross cylinder test: It is used to verify the strength and axis of the cylinder prescribed. 

Zell Ballen | Crack AIIMS, NEET NOV 2016 MCQs

Zell ballen pattern is typical of: 

A. Astrocytoma 
B. Meningioma 
C.Pheochromocytoma
D.Chondrosarcoma

Ans. (c).Phaeochromocytoma

• The characteristic microscopic pattern of phaeochromocytoma is one of solid, round “cell aggregates”
(Zeliballen), cords, ribbons or trabeculae separated by a rich fibrovascular stroma.
• Phaeochromocytomas are stained by antibodies to Neuron specific enolase, chromagranin
A, Synaptophysin
• They are calcitonin, VIP, Bombesin, somatostatin and serotonin positive invariably.
• Bilateral in 10% cases                      • Extraadrenal in 10% cases
• Familial in 10% cases                      • Malignant in 10% cases
• Multiple in 10% cases                      • turinary VMA levels seen.
• turinarymetanephrine                      • MIBG Scan is most specific and sensitive for diagnosis.
Associated with:
• MEN 2 syndromes                           

• Von hippel landau syndrome
• Neurofibromatosis                           

• Struge weber syndrome

8 yr. old boy with undescended testis | Crack PGIMER NOV 2016

8 yr. old boy with undescended testis, your concern to ask for operation is due to 

A. Cosmetic reasons 
B. Infertility 
C. Risk of malignancy 
D. Impotence
E. failure to develop secondary sexual charecteristics

The Answer is . (B) Infertility (C) Risk of malignancy

• Early orchidopexy reduces the risk of primary germ cell tumours of testis

There is no reliable statistics as to whether orchidopexy diminishes the liability of malignancy. However.it does improve the prospect of early diagnosis.

• orchidopexy decreases the risk of neoplasia when performed before 10 yr.

— The definite histological changes occur in an undescended testis by age of 6 yrs, hence orchidopexy should be

done before child goes to school 5 yrs. of age). After 16 years, irrevesible, destructive changes occur, halt, the spermtogenesis, limit the androgen production to half the normal output. However, the secondary sexual charecteristics are sually not affected.

Paliperidone | Crack AIIMS, NEET NOV 2016 MCQs

True about Paliperidone ? 

A. It is D2 and 5-HT2A receptor antagonist 
B. Used for treatment of schizophrenia 
C. Can cause Neuroleptic Malignant Syndrome 
D. All are true

Answer.D. All are true

Paliperidone is an atypical antipsychotic developed D2 and 5-HT2A receptor antagonism. Treatment of schizophrenia

Side Effects & Adverse Reactions

The most common side effects of Invega are reported to be restlessness and extrapyramidal disorder, including involuntary movements, tremors and muscle stiffness. Neuroleptic Malignant Syndrome as a rare, but potentially lethal reaction to the medication.

Other risks include:

Tardive Dyskinesia

• Diabetes

• Hyperprolactinemia

'First order 'symptoms of schneiders' schizopremia | Crack AIIMS, NEET NOV 2016 MCQs

'First order 'symptoms of schneiders' schizopremia include all except: 

A. Depersonilization 
B. Running commentary of one’s thoughts
C. Primary delusion 
D. Somatic passivity

Answer. A. Depersonilization         

There are 11 first rank symptoms first three are related to thoughts – thought insertion , withdrawal & broadcasting next three are related to hallucinations –1St person ,2ND person & 3RD person  next three are    made phenomena  remember VIA MADE VOLITION, MADE IMPULSE, MADE AFFECT (mood) Last two  are   Somatic passivity &  Delusional perception

Drugs may induce a psychosis & confused with, or misdiagnosed as, paranoid schizophrenia

Which of the following drugs may induce a psychosis that is easily confused with, or misdiagnosed as, paranoid schizophrenia? 

A. Barbiturates 
B. Heroin 
C. Benzodiazepines 
D. Amphetamines

Answer. D. Amphetamines

• Amphetamine intoxication can result in a psychosis very closely resembling acute paranoid schizophrenia, with symptoms including paranoid delusions and visual hallucinations.

• Some investigators feel that prominent visual hallucinations and a relative absence of thought disorder are more characteristic of amphetamine psychosis, but other investigators feel the symptoms are indistinguishable.

• Other drugs that produce psychoses similar to schizophrenia include phencyclidine PCP) and lysergic acid diethylamide (LSD).

Low renin essential hypertension | Crack AIIMS, NEET NOV 2016 MCQs

A 36-year-old male presents with low renin essential hypertension. Renin release from the juxtaglomerular apparatus is normally inhibited by which of the following? 

A. Prostaglandins 
B. Aldosterone 
C. Stimulation of the macula densa 
D. Increased pressure within the afferent arterioles

Answer. D. Increased pressure within the afferent arterioles

• Juxtaglomerular (JG) cells are sensitive to changes in afferent arterial intraluminal pressure.

• Increased pressure within the afferent arteriole leads to a decrease in renin release, whereas decreased pressure tends to increase renin release.

• Angiotensin appears to inhibit renin release by initiating the flow of calcium into the JG cells.

• Renin release is increased in response to increased activity in the sympathetic neurons innervating the kidney.

Prostaglandins, particularly PGI₂ and PGE₂, stimulate renin release.

• Stimulation of the macula densa leads to an increase in renin release, and although the mechanism is not fully understood, it appears that increased delivery of NaCl to the distal nephron is responsible for stimulating the macula densa. Aldosterone does not appear to have any direct effect on renin release.

Ossifying Fibroma | Crack PGIMER NOV 2016

The following statement is/are true about non ossifying fibroma 

A. Eccentric in position (metaphysis) 
B. Can present at 30 to 40 yr. age group 
C. Multinucleated giant cells are seen on histopathology
D. True bone tumor 
E. Commonly presents as pathological #

The Answer is. (A) Eccentric in position (metaphysis) (C) Multinucleated giant cells are seen on histopathology
• Both Fibrous Cortical defects and Non-ossifying Fibroma occur, in first and 2nd decades (taken as developmental defects)

•Metaphysial location

•>50% are bilateral or multiple locations

• Fibroblasts are arranged in pin wheel pattern

• Non-ossifying fibroma may present with patholological fracture also 

ASD is seen in a/e | PGI Frequently Asked MCQ Topics

ASD is seen in a/e

A. Turners syndrome
B. Ellisvancrevald synd. 
C. Down’s synd. 
D. Haltoram syndrome
E. TAR synd

The Answer is .(A) Turner’s syndrome

In the following syndrome ASD seen

Syndrome Cardiovascular manifestation

ELLIS-Van Creveld Syndrome                                                        -Single osteum or atrial septal defect

TAR Syndrome (thrombocytopenia +absent radius)                   - ASD, TOF

Holt-oram                                                                                             - ASD

Downs syndrome                                                                                 - ASD, VSD

Turners syndrome                                                                               - Coarctation of aorta

Osteo-fluorosis | Crack PGIMER NOV 2016

Osteo-fluorosis is characterized by 

A. Vertebral sclerotic lesions 
B. Calcification in ligaments and tendons 
C. Intervertebral disc calcification
D. mottling
E. caries

The Answer is. (A) Vertebral sclerotic lesions;(B) Calcification in ligaments and tendons

• Fluorosis is an osteoscierotic disease. Deposition of calcium occur in bone and soft tissues — ligaments, tendons, interosseous membrane.

• Spine shows increased density.

MCQ: Intervertebral disc space calcification is seen in alkaptonuria

Iliac horn | Crack PGIMER NOV 2016

Iliac horn’ is seen in 

A. Achondroplasia 
B. Muco-polysaccharodosis
C. Nail patella syndrome 
D. Tuberous sclerosis
E. Lowe syndrome

The Answer is. (C) Nail patella syndrome

• ‘Iliac horn’ is seen in Nail patella syndrome

• Nail patella syndromc is.an autosomal dominant trait characterised by multiple osseous abnormalities primarily affecting elbows and knees, nail dysplasia, absence of patella and nephropathy. *Bony spine arises from posterior aspect of iliac horn.

Surest sign of salpingitis | Crack AIIMS, NEET NOV 2016 MCQs

Surest sign of salpingitis is 

A. Edema of tubes 
B. Enlargement of tubes 
C. Seropurulent discharge from the part of the tube 
D. Hyperaemic tubes

The Answer is C.  V/Q mis­matches will cause arterial oxygen levels (Pao2) to decrease. Decreased Pao2 will stimulate the peripheral chemoreceptors, which, in turn, will increase alveolar ventilation and decrease PaCo2. The decreased PaCo2 will cause a respiratory alkalosis (increasing pH). Hypoxemia will also cause lactate lev­els to rise, increasing the anion gap (and blunting the rise in pH). The fall in Pao2 causes the A - a gradient to rise.

Ovarian tumours | NEET Based MCQs

Ovarian tumours are commonly arise from 

A. Stroma
B. Surface epithelium
C. Germinal epithelium
D. Endodermal

The Answer is D. The A — a gradient is the partial pressure difference between the alveolar i and arterial oxygen tensions. The arterial blood gas tension has been measured. The alveolar oxygen tension must be calculated using the modified alveolar gas equation.

                                                            30 mmHg

P_AO₂ = 0.21 x (760—47) mmHg  -------------------

                                                                  0.8

P_AO₂ = 150 mmHg— 37.5 mmHg= 112.5 mmHg

(A — a) _oxygen gradient = 113 mmHg — 60 mmHg = 53 mmHg

The patient’s low arterial oxygen tension results from a decrease in diffusion capacity and V/Q abnormalities. The resulting hypoxemia will lead to an increase in red blood cell production and therefore an increase in hematocrit. The low oxygen will also cause an increase in pulmonary vascular resistance and therefore an increase in right atrial pressure. Hypoxemia will also lead to an increase in alveolar ventilation and a respiratory alkalosis, which will be compensated for by an increase in bicarbonate concentration.

Concerning Mammography | PGI Frequently Asked Medical PG topics

Concerning mammography true statement is:

A. The maximum (peak) energy in the X-Rayspectrum is determined by the characteristicradiation from molybdenum
B. A K-edge filter is used
C. The ideal radiation is 30 keV
D. Typical mean glandular breast dose from a singlefilm is 10mGy
E. a focus to film distance of 100 cm is used

The answer is. B. A K-edge filter is used

The maximum energy in the X-ray spectrum is determined bythe peak tube potential (kVp) across the X-ray tube. Lowenergies (18–20 keV) are required in order to distinguish thesoft tissues by photoelectric interaction. The target materialused is molybdenum. It produces characteristic radiation of17.9 keV and 19.5 keV. A K-edge beam filter ofmolybdenum is used to reduce all other energy X-rays in thespectrum as the filter is relatively transparent to its own characteristic (K-edge) radiation.Typical glandular breast dose from a single film is less than2mGy.A focus to film distance of approximately 60 cm is used.

Pseudo-hyperkalemia | PGI MCQs for MD MS Preparations

Pseudo-hyperkalemia causes include

A. Hemolysis
B. Thrombocytosis
C. Leukocytosis
D. Venipuncture technique
E. Hematocrit < 20%

The answer is. A. Hemolysis, B. Thrombocytosis ;C. Leukocytosis, D. Venipuncture technique

Pseudohyperkalemia is a rise in the amount of potassium thatoccurs due to excessive leakage of potassium from cells,during or after blood is drawn. It is a laboratory artifact ratherthan a biological abnormality and can be misleading tocaregivers Pseudohyperkalemia is typically caused byhemolysis during venipuncture (by either excessive vacuumof the blood draw or by a collection needle that is of too finea gauge); excessive tourniquet time or fist clenching duringphlebotomy or by a delay in the processing of the bloodspecimen. It can also occur in specimens from patients withabnormally high numbers of platelets(>500,000/mm³), leukocytes (>70000/mm³), or erythrocytes (hematocrit >55%). People with "leakier" cell membranes have beenfound, whose blood must be separated immediately to avoidpseudohyperkalemia

Type 1 diabetes mellitus & Type 2 diabetes mellitus | Crack AIIMS, AIPG NOV 2016 MCQs

Which one of the listed findings is more characteristic of juvenile diabetes mellitus (type 1 diabetes mellitus) than of adult onset diabetes mellitus (type 2 diabetes mellitus)?

A. Amyloid deposition occurs in islets of Langerhans
B. It is associated with HLA-DR3 and HLA-DR4
C. Numbers of insulin receptors on adipocytes are decreased
D. There is insulin resistance that results from marked obesity

The answer is D.

Diabetes may produce abnormalities that affect any part of the kidney, such as the glomerulus,the blood vessels (benign nephrosclerosis), the tubules (Armanni-Ebstein lesions, which refers to vacuolization of the cells of the proximal convoluted tubules), the interstitium, and the pelvis (infection leads to pyelonephritis and acute papillary necrosis). Diabetic lesions of the glomerulus include capillary basement thickening, diffuse glomerulosclerosis (increase in mesangium and mesangial cells), and nodular glomerulosclerosis. The latter refers to oval hyaline masses at the periphery of the glomerulus and is also called Kimmelstiel-Wilson disease. Nodular glomeruloscleroses may resemble amyloid, and, if they are present, amyloid staining should be done. Other characteristic lesions found in the glomerulus include “capsular drops”(round nodules found between Bowman’s capsule and the parietal epithelium) and “fibrin caps” (subendothelial accumulations along capillary loops). 

Renal abnormality described as Kimmelstiel-Wilson disease | Crack AIIMS, AIPG NOV 2016 MCQs

Which one of the listed statements best characterizes the renal abnormality described as Kimmelstiel-Wilson disease?

A. Amyloid nephrosis
B. Capsular drops
C. Glycogen nephrosis
D. Nodular glomerulosclerosis


The answer is D. 
Diabetes may produce abnormalities that affect any part of the kidney, such as the glomerulus,the blood vessels (benign nephrosclerosis), the tubules (Armanni-Ebstein lesions, which refers to vacuolization of the cells of the proximal convoluted tubules), the interstitium, and the pelvis (infection leads to pyelonephritis and acute papillary necrosis). Diabetic lesions of the glomerulus include capillary basement thickening, diffuse glomerulosclerosis (increase in mesangium and mesangial cells), and nodular glomerulosclerosis. The latter refers to oval hyaline masses at the periphery of the glomerulus and is also called Kimmelstiel-Wilson disease. Nodular glomeruloscleroses may resemble amyloid, and, if they are present, amyloid staining should be done. Other characteristic lesions found in the glomerulus include “capsular drops”(round nodules found between Bowman’s capsule and the parietal epithelium) and “fibrin caps” (subendothelial accumulations along capillary loops). 

Ocular Histoplasmosis syndrome | Crack PGIMER NOV 2016

The following are true about ocular Histoplasmosis syndrome:

A. it is caused by Histoplasma capsulatum
B. a visit to a cave inhabited by bats is a significant history
C. the patient is usually immunocompromised
D. pneumonia is usually present
E. the 'histo' test postivity is needed for detection of new cases.

The answer is. A. it is caused by Histoplasma capsulatum, 

B. a visit to a cave inhabited by bats is a significant history

Patient is not necessarily immunocompromised. pneumonia isnot usually present. Histo test positive in 90% cases but itdoesnt distinguish between new cases and already exposedcases

Foreign bodies Ingestion | Crack PGIMER NOV 2016

Which of the following is true regarding foreign bodies ingestion in children?

A. Needles are the most common.
B. They always cause complication if they passbeyond cardia
C. Patients with button batteries can be kept onobservation
D. Most swallowed objects pass spontaneously
E. Child in a supine position, material is morelikely to enter the right main bronchus

The answer is. D. Most swallowed objects pass spontaneously

E. Child in a supine position, material is morelikely to enter the right main bronchus

Coins are the most frequently swallowed foreign bodiesin children. Once beyond the cardia, they almost nevercause complication in normal gastrointestinal tract.Button batteries must be removed urgently if they remainin the esophagus or stomach because they can causeperforation or poisoning. The need to remove sharpobjects depends on their size, age of the child and theirposition in the gut. In a child in an upright position, theright-sided airways are direct entries from the trachea.The left main bronchus is smaller than the right mainbronchus and is slightly angled. In a child in a supineposition, material is more likely to enter the right mainbronchus.

Suspected immunodeficiency | Crack PGIMER NOV 2016

The following should be avoided in suspected immunodeficiency:

A. MMR
B. DPT
C. Oral polio vaccine
D. Pneumovax II vaccination
E. Transfusion of packed cells

The answer is.  A. MMR, C. Oral polio vaccine, E. Transfusion of packed cells

•Live vaccines: MMR, oral polio, BCG, measles.

•Killed: pertussis.

•Inactivated: IM polio.

•Toxoids: DT.

•Submit: Hib.

Packed cells contain a few lymphocytes which can givetransfusional graft versus hostdisease (GVHD) in SCID, which is invariably fatal. Viruses canalso be transmitted viablood products.