Hypogonadism in cirrhosis | PGI May 2017 Preparations MCQ

NIME Next Batch PGI Quest in Delhi from 10 August to 20 August

Hypogonadism in cirrhosis is due to 

A. Direct effect of alcohol on testes 
B. Increased estrogen due to decreased catabolism 
C. Increased peripheral conversion of androgens into estrogen 
D. Increased testosterone 
E. None of the above

Ans. A. Direct effect of alcohol on testes ; (B) Increased estrogen due to decreased catabolism; (C) Increased peripheral conversion of androgens into estrogen 

• The testicular atrophy is due to disorder of hormonal metabolism or direct toxic effect on testis. 

• In cirrhosis of liver a combined testicular and pituitary abnormality leads to decreased testosterone production. The decreased testosterone (i.e. androgen insufficiency) production most likely results from inhibition of LH secretion by estrogens in patients with chronic liver disease. 

Isoenzymes MCQ | PGI May 2017 Preparations MCQ

NIME Next Batch PGI Quest in Delhi from 10 August to 20 August

True about isoenzymes is/are 

A. Different km value 
B. Act on different substrate 
C. Consist of multimeric complex 
D. Same electrophoretic mobility 
E. Have different physical properties

Ans. A. different km value; (C) Consist of multimeric complexes; (E)Have different physical properties

Isoenzymes are distinct enzyme forms that catalyze same reaction It exists in the same organism in several olecular forms 

— Most of the isoenzymes are enzymes that catalyse the same reaction but differ in their physical properties because of genetically determined differences in amino acid sequence. 

— They have different Km value. 

— Isoenzyme of an oligomeric enzyme process different combination of its peptide protomer.

Products accumulated in Hunter’s syndrome | PGI May 2017 Preparations MCQ

Products accumulated in Hunter’s syndrome are: 

A. Keratan sulfate 
B. Dermatan sulfate 
C. Chondroitin sulfate 
D. Heparan sulfate 
E. Hyaluronic acid

Ans. B. Dermatan sulfate ; (D) Heparan sulfate

• In Hunter syndrome the accumulated metabolites are
—Dermatan sulfate
— Heparan sulfate
• Hunter’s syndrome is X-linked recessive disorder.
• Other mucopolysaccharidoses:-

Type	Syndrome	Enzyme to defect	Accumulated Metabolite
I	Hurler or scheie	Iduronidase	Dermation sulfate Heparan sulfate
II	Hunter	Iduronate sulfatase	—
IIIA	Sandfilippo A	Heparan-N-sulfatase	Heparan sulfatase
IIIB	SandfilippoB	N-Acetylglucosaminidase	Heparan sulfatase
IV	Morquio	N-Acetyl galactosamine 6-sulfatase	Keratan sulfatase
VI	Maroteaux-Lamy	N-Acetyl galacto samine 4-sulfatase	Dermatan sulfatase
VII	Sly	3-Glucuronidase	Dermatan sulfatase; Heparan sulfatase

Nitric oxide | PGI May 2017 Preparations MCQ

True about nitric oxide 

A. Free radical 
B. Vasodilator 
C. Oxidizing agent 
D. Catalyst 
E. Platelet aggregator

Ans. A. Free radical ; (B) Vasodilator ; (C) Oxidizing agent ; (D) Catalyst
• Nitric oxide is a gas synthesized by endothelial cells previously known as endothelium derived

relaxing Factor (EDRF), causes vasodilatation. It stimulates guanyl cyclase.

- NO has very short half life (3-4 sec.) as in tissues it reacts with oxygen and superoxide

producing peroxynitrite which decomposes to form highly reactive OH radical

Important component of cell wall | PGI May 2017 Preparations MCQ

PGI Quest Delhi Batch From 10 Aug to 20 Aug

Which important component of cell wall has carbohydrate moiety 

A. Phosphoglyceride 
B. Triacylglycerol 
C. Sphingomyelin 
D. Cholesterol 
E. GM2 Gangliosides


Ans. E. GM2 Gangliosides :
• The major lipids in mammalian membranes are
— Phospholipids
— Glycosphingolipids
— Cholesterol
• Among these, lipid with carbohydrate component is glycosphingolipids. They are
—Cerebrosides
—Gangliosides
• Phosphoglycerides = Glycerol + Fatty acids + Phosphate + Nitrogenous or Non- Nitrogenous group (choline, ethanolamine, serine and inositol)
• Sphingomyelin fatty acid sphingosine + phosphate - Nitrogenous group

Adamantinomatous craniopharyngioma | PGI May 2017 Preparations MCQ

The following are true of Adamantinomatous craniopharyngioma except

A. Adamantinomatous variant is common in adults
B. metastatic calcification seen
C. wet keratin is diagnostic
D. palisading of squamous epithelium seen
E. arises from the vestigial remnants of rathke’sPouch

Ans. A,B

The craniopharyngioma is thought to be derived from vestigial remnants of Rathke pouch. These slow-growing tumors account for 1% to 5% of intracranial tumors; a small minority of these lesions arise within the sella, but most are suprasellar, with or without intrasellar extension. A bimodal age distribution is observed, with one peak in childhood (5 to 15 years) and a second peak in adults 65 years or older. Two distinct histologic variants are recognized: adamantinomatous craniopharyngioma (most often observed in children) and papillary craniopharyngioma (most often observed in adults). The adamantinomatous type frequently contains radiologically demonstrable calcifications; the papillary variant calcifies only rarely.

Adamantinomatous craniopharyngioma consists of nests or cords of stratified squamous epithelium embedded in a spongy “reticulum” that becomes more prominent in the internal layers. “Palisading” of the squamous epithelium is frequently observed at the periphery. Compact, lamellar keratin formation (“wet keratin”) is a diagnostic feature of this tumor. As was mentioned above, dystrophic calcification  is a frequent finding. Additional features include cyst formation, fibrosis, and chronic inflammatory reaction. The cysts of adamantinomatous craniopharyngiomas often contain a cholesterol-rich, thick brownish-yellow fluid. These tumors extend fingerlets of epithelium into adjacent brain, where they elicit a brisk glial reaction. 

Normal Distribution Curve | PGI May 2017 Preparations MCQ

Normal distribution curve:

A. Mean, median, mode are same
B. B/L symmetrical
C. Bell shape
D. SD is zero
E. Mean is one

Ans. A, B, C

The standard distribution curve (Normal distribution) is a perfectly symmetrical, bell shaped curve such that the mean, median and mode, all have the same value and coincide at the centre

Standard Distribution Curve (Normal): Mean = Median = Mode

CHARACTERISTICS OF A NORMAL DISTRIBUTION CURVE:

Standard normal curve – smooth

Bell – shaped ^[MCQ]

Perfectly symmetrical

Based on infinitely larger number of observation

Total area of the curve is 1 ^[MCQ]

The mean is zero ^[MCQ]

Standard deviation is one ^[MCQ]

Mean, Median and Mode all coincide ^[MCQ]

Area in 1SD is 68.3% ^[MCQ]

Area in 2SD is 95.4% ^[MCQ]

Area in 3SD is 99.7% ^[MCQ]

Paralysis of polio virus infection | PGI May 2017 Preparations MCQ

The paralysis of polio virus infection

A. Is upper motor neurone type
B. is asymmetrical
C. Usually affects the lower limbs more severely than the upper limbs
D. Is more severe if strenuous physical exercise occurred in the incubation period
E. May be caused by polio vaccination

Ans.  B, C, D, E

Poliomyelitis is caused by three types of polio virus.

Type 1 polio virus is the most virulent and prior to immunization was responsible for major epidemics.

Polio virus is an enterovirus and is spread by the feacal oral route. Other factors associated with paralysis are: pregnancy, tonsillectomy and prophylactic injections.

The incubation period is 3-21 days (usually 7-14 days). 

Diseases will produce referred pain in left shoulder | PGI May 2017 Preparations MCQ

All of the following sites with diseases will produce referred pain in left shoulder except?

A. Heart 
B. Spleen
C. Tail of pancreas 
D. Kidney superior aspect
E. Left hemi diaphragm

Ans. D.

Locations of Referred Pain and Its Causes Right Shoulder

Liver Gallbladder Right hemi diaphragm

Left Shoulder

Heart Tail of pancreas Spleen Left hemi diaphragm

Scrotum and Testicles Ureter

G6PD deficiency | PGI May 2017 Preparations MCQ

The following are features of G6PD deficiency

A. episodic hemolysis
B. presence of bite cells
C. presence of Heinz bodies
D. both intravascular and extra vascular hemolysis isseen
E. presence of spherocytes

Ans. A, B, C, D, E

The episodic hemolysis that is characteristic of G6PD deficiency is caused by exposures that generate oxidant stress. The most common triggers are infections, in which oxygen-derived free radicals are produced by activated leukocytes. Oxidants cause both intravascular and extravascular hemolysis in G6PD-deficient individuals. Exposure of G6PD-deficient red cells to high levels of oxidants causes the cross-linking of reactive sulfhydryl groups on globin chains, which become denatured and form membrane-bound precipitates known as Heinz bodies.^[MCQ] These are seen as dark inclusions within red cells stained with crystal violet. Heinz bodies can damage the membrane sufficiently to cause intravascular hemolysis. Less severe membrane damage results in decreased red cell deformability. As inclusion-bearing red cells pass through the splenic cords, macrophages pluck out the Heinz bodies. As a result of membrane damage, some of these partially devoured cells retain an abnormal shape, appearing to have a bite taken out of them. Other less severely damaged cells revert to a spherocytic shape due to loss of membrane surface area. Both bite cells and spherocytes are trapped in splenic cords and removed rapidly by phagocytes.

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Diarrhoea, Dementia, and Dermatitis MCQ

Diarrhoea, Dementia, and Dermatitis are due to deficiency of 

A. Thiamine 
B. Riboflavine 
C. Nicotinic acid 
D. None

Ans. C.Nicotinic acid                                                                                        

> Early symptoms of pellagra include loss of appetite, generalized weakness and irritability, abdominal pain, and vomiting. Bright-red gloasitia then ensues, followed by a characteristic skin rash that is pigmented and scaling, particularly in skin areas exposed to sunlight.
>This rash is known as “Casal’s necklace” because it forms a ring around the neck; it is seen in advanced cases.
>Vaginitis and esophagitis may also occur.

INTESTINAL TUMOR MCQ

INTESTINAL TUMOR is: 

A. Barium meal and follow through 
B. USG
C. Enteroclysis 
D. Ct scan with contrast



Ans. D. (CT scan with contrast) 
Small intestinal tumors
These include: 
o Lymphoma 
o Adenocarcinoma 
o Gist (gastrointestinal stromal tumor) 
o Secondaries 
Enteroclysis is not more widely used because of perceived patient discomfort potentially high radiation dose and 
extraluminal pathology is not assessable. 
Usg has a limited role in the diagnosis and management of disorders of the small intestine. 

Unilateral inter-nuclear ophthalmoplegia | PGI May 2017 Preparations MCQ

Unilateral inter-nuclear ophthalmoplegia is associated with:

A. Reduced adduction on the affected side
B. Reduced convergence
C. Nystagmus on abduction in the affected side
D. Diplopia can occur
E. There is abnormal optico-kinetic nystagmus

Ans. A,D,E

Unilateral internuclear ophthalmoplegia:

• Results from a lesion in the medial longitudinalfasciculus between the sixth nerve and third nerve nuclei

• Causes failure of the ipsilateral medial rectus to adducton horizontal gaze

• There is nystagmus of the contralateral abducting eye(caused by excessive innervation to the normal lateralrectus in accordance with hering's law)^[

Premature Labour | PGI May 2017 Preparations MCQ

Premature Labour.

A. Is associated with an increased risk of breechpresentation.
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.

Ans. A,B,C,D,E

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

developed 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, thyroid

disease, 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 bacteruria, pneumonia, and appendicitis

Tentorial herniation | PGI May 2017 Preparations MCQ

Features of tentorial herniation include:

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

Ans. A,B,C,D,E

Tentorial herniation:

• Occurs when a mass lesion makes one cerebralhemisphere too large for its compartment and cause the

Infero-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 palsy 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

Adult scabies is characterized by | AIIMS Based MCQ

Adult scabies is characterized by all of the following except: 

A. Involve palm and sole 
B. Involve face 
C: Involve genitalia
D. Involve web spaces

Ans. B. Involve face
• The most obvious manifestation of scabies is itching which is generally worst at night & when the patient is warm.
• The pathognomonic lesions of scabies are burrows which appears as slightly raised, brownish & tortuous. The distribution of this burrow’s are
• Wrists, boarders of hands, sides of fingers & the finger web spaces, feet & in male the genitalia.
+ Palms & soles of young children & elderly.
+ In adults other than the elderly, burrows may occur on the palms in women, but they are less frequently found on the palms in men.
+ Burrows on the trunk are uncommon in adults, but may be found in the elderly infants.
+ Seen on the head & neck in babies but rarely in adults.
+ Scalp in adults who uses topical steroids for seborrhoeic dermatitis.

Painful lymphadenopathy | AIIMS Based MCQ

Painful lymphadenopathy is seen in: 

A. Donovanosis 
B. Syphilis 
C. Chancroid 
D. Gonorrhaea

Ans. C. Chancroid 

• The lymph nodes are painful in both acute and chronic lymphadenitis acute leukemia, but are painless in syphillis, lymphosarcoma, secondary carcinoma, lymphoma etc. 

• Chancróid (Soft chancre) is caused by Haemophilus Ducrey, has an ip of 3-5 days is characterised by painful, non indurated ulcer and painful lymphadenopathy. Ito test is done here. 

• Donovanosis or granuloma inguinale is caused by calymmatäbacterium granulomatis, has an IP of 1-4 wks in characterised by one or more subcutaneous nodules that erode through skin to produce ulcer, granulomatous sharply defined painless leson. The genitalia are involved in 90% of cases and genital swelling, particularly of the labia, is a common feature and occasionally progresses to psuedoelephastiasis. Lymphadeopathy is not seen and pseudobubos are seen.

• In syphilis, painless, indurated papule formed that may oater or turn to ulcer and painless, firm, shotty, discrete iympba’denophthy seen. - 

• In herpes infection painful papule is formed that ulcerate in 3-6 days. Tender inguinal lymphadenopathy dysuria, urethral and vaginal discharge are local Sx. 

In Gonorrhea, lymphadenopathy is not found.

In lymphogranuloma venerum after the genital lesion has healed, painful matted suppurative lymphadenopathy occurs. Multiple sinus tracts, Groove’s sign.Elephantiasis of valve positive.

Frei’s intradermal test is positive. 

Kobnèr’s phenomenon | AIIMS Based MCQ

Kobnèr’s phenomenon seen in all except:

A. Lichen plannus 
B. Vitiligo
C. Behcet syndrome 
D. Psoriasis


Ans. C. Behcet syndrome
• Kobner response is the development of lesions in previously normal skin that has been subjected to trauma.Diseases showing this response are 
- Erythema multiforme 
- Hailey-Hailey disease 
- Kaposi’s sarcoma 
- Leukemia 
- Lichen planus & sclerosus 
- Necrobiosis liopoidica 
- Peroforating collagenosis & folliculitis 
- Psoriasis 
- Vasculitis 
- Vitiligo 
- Xanthomas
• Kobner response is best not used to dermatosis that occurs due to spread of an infective agent like molluscum contagiousum or warts; for this phenomenon, the term pseudo-kobner is used. 

• It is controversial whether it is appropriate to use the term Kobner phenomenon for the pustular response to injury in Behcet’s syndrome & pyoderma gangrenosum. 

Drugs used for controlling heart rate intraoperatively | AIIMS Based MCQ

MI of following drugs are used for controlling heart rate intraoperatively EXCEPT 

A. Propranolol/metoprolol 
B. Verapamil 
C. Esmolol 
D. Procainamide

Ans. D. (Procainamide) 

Procainamide is a class of antiarrhythmic agent (la) which blocks fast sodium channels but prolongs action potential duration. It is rarely used during anesthesia because of their propensity to produce hypotension. It is effective in the treatment of ventricular tachydysrhythmia. Verapamil effectively controls heart rate. Dose is 5—10mg IV over 1—3 mm. Propranolol/metoprolol and esmolol are B-adrenergic-blocking drugs that are effective for controlling the heart rate intraoperatively. 

Doses: 
Metoprolol : 5—15 mg IV over 20 min.
Esmolol : 0.5—1 mg/kg every 60 min. 

Lyme disease | PGI May 2017 Preparations MCQ

The following are recognized features of Lyme disease:

A. Recurrent headache
B. Seventh nerve facial palsy
C. Behavioural change
D. CSF neutrophil leukocytosis
E. Neutrophil pleocytois on CSF examination.

Ans. A,B,C,D,E

Borrelia Burgdoferi (spirochete).

It is a Zoonosis, with incubation period: 3-32 days.

Clinical features:

Early - Localised: annular rash (erythema migrans), fever,malaise, headache.

Late– Arthritis, waxing and waningover weeks (knee in 90%) worsens over time.

Complications -Dehydration,encephalitis, polyneuritis, impaired memory.

Disseminated: Haemotogenous spread, multiple small skinlesions, conjunctivitis,nodes, aseptic meningitis, seventh nerve palsy. 

Function of Health worker female | PGI May 2017 Preparations MCQ

Function of Health worker female, correct options are:

A. Perform 50% of deliveries
B. Trains dais
C. Enlist dais of the subcentre
D. Chlorination of water
E. Collectors of urine samples.

Ans. A,C

* Under the multipurpose worker system, one health workerfemale and one health worker male are posted at each

subcentre.

* Health worker female conduct about 50% of total deliveries.

* They help the health assistants in training programme of dais.

* List dais in their area and involve them in promoting family welfare work.

* They test the urine for albumin and sugar and do thehaemoglobin typing during their home visit. At the clinic they

conduct urine examination and estimate Hb%.

* Water chlorination is done by health worker male.

CNS involvement in AIDS | PGI May 2017 Preparations MCQ

Concerning CNS involvement in AIDS:

A. Toxoplasma may give rise to a foal lesion with neurological weakness.
B. The HIV virus can be isolated from the brain of anencephalopathic patient.
C. A diagnostic elevation in the CSF IgM occurs in toxoplasmic infection.
D. Cerebral toxoplasmosis can be treated by Pyrimethaminealone.
E. Occular involvement may cause blindness.

Ans.  A,B,E

Cerebral toxoplasmosis presents very variably, from an acuteencephalopathy to subtle neurological syndromes. It should beconsidered in all undiagnosed neurologicaldisease in the under ones, especially if there are retinal lesions.

Characteristic are hydrocephalus, seizures with focal defects,spinal or bulbar palsies, microcephaly, and decreased IQ.

Investigations such as skull x-ray or CT scan show calcificationof the periventricular area, tachyzoites in the CSF and positiveblood titres. Pyrimethamine and Sulphadiazine have asynergistic effect in treating it, and folinic acid may be

necessary to prevent seizures.

Inclubation period | PGI May 2017 Preparations MCQ

Which of the following diseases have inclubation period < 10 days:

A. Cholera 
B. Influenza
C. Plague 
D: Measles
E. Rubella

Ans. A,B,C

Incubation periods :

Cholera : Few hours to 5 days, but commonly 1-2 days

Influenza : 18 to 72 hours

Plague : Bubonic 2-7 days

Septicaemic : 2-7 days

Pneumonic: 1-3 days

Rubella : 2-3 weeks

Measles : 10-14 days

Skeletal metastases | AIIMS Based MCQ

A 40yr old female suffering from breast cancer received Taxane based chemotherapy one week back. She comes to casualty with high fever and on examination she is in shock. Her blood counts show neutrophil count of 100/cu.mm. The treatment of choice 

A. Send immediate blood culture and wait for blood culture report before starting antibiotics. 
B. Filgrastim monotherapy 
C. Emperic Ceftazidime 
D. Emperic polychemotherapy with Carbopenems, Amikacin and Vancomycin

Ans. C. Emperic monotherapy should be initiated and the drug of choice is Ceftazidime. Pseudomonas, Klebsiella and E.coli are the commmest organisms causing febrile neutropenia. If blood culture shows ESBL positive organisms then piperacillin/tazobactam, carbopenems or cefipime monotherapy should be started. Amikacin has a synergistic action against these organisms and can be added to these drugs. Fulgrastim is used as prophylaxis for febrile neutropenia or can be combined with these antibiotics to shorten the course of febrile neutropenia. Filgratim is not used alone in established febrile neutropenia. 

Rapid Acting Insulin | PGI May 2017 Preparations MCQ

Rapid Acting Insulin is/are

A. Insulin Lispro 
B. Insulin Aspart
C. LenteHumulin 
D. Velosulin BR
E. Ultralentehumulin

Ans. A. B

Preparation Preparation	PREPARATION
Rapid acting Insulin	Insulin Lispro, Insulin Aspart
Short acting insulin	Regular, regular Humulin, Velosulin BR
Intermediate acting	LenteHumulin, Lente NPH humulin, NPH
Long acting	Ultralentehumulin, Insulin glargine - Lantus