Rapid Review AIPGMEE, 2011

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ANATOMY

Chapter

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Anatomy

1. In L5 root involvement, which among the following is not affected? A.Thigh adduction B. Knee flexion C. Knee extension D. Toe extension Ref: B.D Chaurasia 4th. Vol II. 59, 142 Tab 12.1, 148 Tab 12.2 Exp:

Muscles Nerve supply Knee extension: Quadriceps femoris (main) Femoral N (L2,3,4) Tensor fascia lata (accessory) Superior gluteal N (L4,5 S1) Knee flexion: Semitendinosus Semimembranosus Tibial part of Sciatic N (L5 S1,2) Biceps femoris Toe extension: Ext. digitorum longus Deep peroneal N (L4,5 S1) Thigh Adduction: Adductor longus

}

Adductor brevis ) Obturator N (L2,3,4Adductor magnus Pectineus (accessory) Gracilis ( ,, )

}


Cleft b/w 1st & 2nd toes is supplied by: Deep peroneal nerve (L5) (PGI 1998)
Trendelenberg test is positive in damage of: Superior gluteal nerve (paralysis

of gluteus medius & minimus) Nerve damaged during venous cut down to access great saphenous vein: Saphenous nerve (AI 2008)
Largest cutaneous branch of femoral N: Saphenous nerve
Short saphenous vein is accompanied by: Sural nerve (a pure sensory branch of Tibial nerve)


1) A. Thigh Adduction

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2. Which of the following passes through foramen magnum? (AI 2010) A. Internal Carotid Artery B. Sympathetic chain C. Hypoglossal Nerve D. Vertebral Artery Ref: B.D.Chaurasia, 4th, Vol 3. 18

Exp: STRUCTURES PASSING THROUGH FORAMEN MAGNUM Apical ligament of dens Vertical band of cruciate ligament Membrana tectoria

}

Vertebral artery Ant. Spinal artery Post. Spinal artery Spinal accessory nerve Sympathetic plexus around vertebral arteries

}

Through Anterior part

Through Subarachnoid space

Lowest part of Medulla oblongata Meninges

}

Through posterior part

#Ant. spinal artery is a branch of: Vertebral artery. (PGI1993) #Vertebral artery is the First & Largest branch of first part of Subclavian artery.

Fig. Divisions of Vertebral Artery

2) D. Vertebral artery

ANATOMY

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VERTEBRAL ARTERY Divisions V1 : From origin to transverse process of C6 vertebra Passes through vertebral triangle V2 : Runs through foramina transversaria of upper six cervical vertebrae V3 : Lies in the sub-occipital triangle V4 : From post. atlanto occipital membrane to the lower border of pons Passes through foramen magnum Pierces duramater, arachnoid & enters subarachnoid space* (*AIIMS Nov 2005) Branches - Cervical branches · Spinal branches · Muscular branches - Cranial branches · PICA · Medullary artery · Ant. spinal artery · Rarely Post. spinal artery (usually it is a branch of PICA)

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Rapid Review AIPGMEE 2011

Chapter

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Physiology

18. Basal metabolic rate is closely associated with: (AI 2009, 2010) A. Lean body mass B. Body surface area C. Body mass index D. Body weight Ref: Ganong. 22nd. 282

Exp: BMR depends both on lean body mass and body surface area. But it is more closely related to lean body mass.
Lean body mass gives an estimate of metabolically active components i.e., muscles & internal organs Katch-McArdle formula (BMR based on lean body weight)

BMR (men and women) = 370 + (21.6 X lean mass in kg) FACTORS AFFECTING BMR · · · · ·

Genetics. Some people are born with faster metabolisms; some with slower metabolism. Gender. Males > Females. Men have a greater muscle mass and a lower body fat percentage. Age. BMR reduces with age. Weight. The heavier you are, the higher your BMR Body Surface Area. This is a reflection of your height and weight. The greater your Body Surface Area factor, the higher your BMR. Eg. Tall, thin people have higher BMRs.

18) A. Lean body mass

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PHYSIOLOGY

DC: Diffusion capacity | N:Normal | * FEV1/FVC is the same as FEV1 %
Diffusion capacity is normal in Emphysema
VC ¯

in both restrictive & obstructive lung diseases Q. A young woman with exertional dyspnoea & PFT showing Normal FVC, Normal FEV1/FVC & reduced DLCO (Diffusion Lung capacity measured using carbon monoxide) O2 saturation falls during exercise. Diagnosis is? (AIIMS Nov 08|AI 10) Ans: Primary pulmonary HTN 26. The nucleus involved in Papez circuit is: (AI 2007) A. Pulvinar B. Infralaminar C. VPL nucleus D. Anterior nucleus of Thalamus Ref: Guyton 11th . 732

Exp: Papez circuit is a complex circuit involved in expression of emotions. It connects the limbic system with Hypothalamus & Thalamus.

Fornix of Hippocampus (Limbic system) Mammillary body (Hypothalamus)

Anterior thalamic nucleus Cingulate gyrus (Limbic system)

26) D. Anterior nucleus of Thalamus

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Biochemistry

27. Vitamin K is involved in the post-translational modification of: (AIIMS Nov 08, May 01) A. Glutamate B. Aspartate C. Lysine D. Proline Ref: Harrison 17th. 743

Exp: Gamma carboxylation of glutamic acid residues is the post-translational modification involved in Vit.K dependent clotting factors. Reduced Vit.K is the co-factor involved in this reaction and is converted to Vit.K epoxide. VIT. K DEPENDENT FACTORS · Clotting factors II, VII, IX, X · Protein C, Protein S · Osteocalcin, Bone Matrix GIa protein
Vit. C is required for post-translational modification of proline & lysine. (AIIMS Feb 97)
Vitamin excreted in urine is: Vit. C VIT. C: FUNCTIONS · Collagen formation · Capillary integrity · Absorptionof iron · Part of ETC (Electron transport chain) · Thyroxine metabolism · Prevents atheromatous plaque formation 27) A. Glutamate

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BIOCHEMISTRY
Vit.A intoxication

casues injury to: Lysososmes

(AIIMS May07)


Vit. E toxicity affects: Lymphocytes
Bitoin is required for the activity of: Carboxylases

(AIIMS May

03)
Warfarin

acts by competitively inhibiting Vit.K epoxide reductase, thus decreasing the availability of reduced Vit.K.
Ximelagartan: New oral anticoagulant, is a direct thrombin inhibitor.
Parenteral direct thrombin inhibitors: Lepirudin, Argatroban & Bivalirudin.
Fondaparinux, a synthetic pentasaccharide is a congener of LMW Heparin and acts by binding to antithrombin III and inhibiting Factor Xa. 28. NARP syndrome is seen in: A. Mitochondrial function disorder B. Glycogen storage disorder C. Lysosomal storage disorder D. Lipid storage disorder

(AIIMS Nov 09)

Ref: Harrison’s 17th. 2568

Exp: Neuropathy, Ataxia and Retinitis Pigmentosa (NARP) syndrome is a mitochondrial function disorder arising from mutation of ATP-ase 6 (Complex-5) MITOCHONDRIAL DISORDERS (maternal inheritance/heteroplasmy) · · · · ·

MELAS (Mitochondrial myopathy, Encephalopathy, Lactic Acidosis & Stroke) Kearns-Sayre syndrome NARP syndrome Myoclonic Epilepsy with Ragged Red Fibres (MERRF) C/c Progressive External Ophthalmoplegia (CPEO)


Retinitis pigmentosa (RP ) is associated with:

· Bassen-Kornzweig syndrome (Abetalipoproteinemia) · Refsum’s disease · Usher’s syndrome · Kearns-Sayre syndrome 28) A. Mitochondrial function disorder

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Pharmacology

37. Drug of choice for central Diabetes insipidus is: A. Desmopressin B. Leuprolide C. Thiazide diuretics D. Lithium Ref: Harrison. 17th. 2220 Exp: The signs and symptoms of uncomplicated pituitary DI can be eliminated completely by treatment with desmopressin (DDAVP: 1-desamino-8-D-arginine vasopressin). Desmopressin · Longer acting, V2 selective, synthetic analogue of AVP -Acts selectively at V2 receptors to increase urine concentration and decrease urine flow. -More resistant to degradation than AVP and has 3-4 fold longer duration of action. · Uses: 1. DOC for nocturnal enuresis. 2. Also used in Von-Willebrand’s disease · Routes of administration: I.V, SC injection, Nasal inhalation or Oral.
Drugs used in Nephrogenic DI 1. Thiazide diuretics 2. Indomethacin 3. Amiloride in conjunction with low Na diet
DIDMOAD syndrome (Wolfram’s syndrome): Diabetes insipidus, Diabetes mellitus, Optic atrophy & Deafness (neural) SIADH: Characterised by excessive release of ADH (vasopressin) which enhances the reabsorption of water, resulting in concentrated urine & hyponatremia. 37) A. Desmopressin

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PHARMACOLOGY


Treatment of SIADH: 1. Conivaptan (DOC, V2 + V1 antagonist) 2. Demeclocycline
Drugs causing SIADH: 1.Vasopressin 2. Chlorpropamide 3. Vincristine 4. Carbamazepine 5. Nicotine 6. Phenothiazines 7. Cyclophosphamide 8. TCA 9. MOA inhibitors 10. SSRI Vasopressin receptors Action V1 a Vasoconstriction V2

Water absorption in collecting duct via Aquaporin 2VasodilatationRelease of Von-Willebrand factor & Factor VIII from endothelium

V1b (V3)

Release of ACTH from pituitary


Lypressin & Terlipressin (V1+V2 analogues): Both are used for the control of esophageal variceal bleeding. 38. All are true regarding Selective estrogen-receptor downregulator (SERD), Fulvestrant except: A. Used for breast cancer B. Is a selective estrogen antagonist C. Is slower acting, safer & less effective than SERM D. Given as once a month i.m. dose Ref: Goodman & Gilman 34. Fulvestrant Fulvestrant is the first FDA approved agent in the new class of estrogen-receptor downregulators (SERD), which were hypothesized to have an improved safety profile, faster onset and longer duration of action than the SERMs due to their pure ER antagonist activity . It was approved in 2002 for 38. C. Is slower acting, safer & less effective than SERM

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PATHOLOGY

Chapter

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Pathology

64. Which of the following is not associated with atherosclerotic plaque formation? A. Plasma ApoE B. Alpha-2-macroglobulin C. Oxidised LDL D. Increased homocysteine Ref: 1. Harrison’s 17th. 2419, Tab-350-4 2. Robbin’s 7th. 521 Exp: Alpha-2-macroglobulin has no relation with atherosclerosis.
Risk Factors for Atherosclerosis include: · Advanced age · Male sex · Genetic factors (polygenic) · Hyperlipidemia (- LDL, Lp(a)), ApoE mutation · Hypertension · Cigarette smoking · Diabetes mellitus · S. Homocysteine > 100umol/L · Prothrombic factors (- Plasminogen Activated Inhibitor-1) · Inflammatory factors- - CRP (most important factor in risk production) · ? Chlamydial infection (not fully proven)

64) B. Alpha-2-macroglobulin

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METABOLIC SYNDROME (Syndrome X) Diagnosis requires 3 or more of the following · Central obesity: Waist circumference > 102 cm (M), > 88 cm (F)

· Hypertriglyceridemia: Triglycerides >150 mg/dL · Low HDL: 85 mm diastolic · Fasting plasma glucose > 100mg/dL 65. Which is not an autoimmune disease? A. SLE B. Grave’s disease C. Myasthenia gravis D. Sickle cell disease Exp: As we know, Sickle cell disease is a hemoglobinopathy and not an autoimmune disease.
Gamma Gandy bodies are seen in: Sickle cell anemia (AIIMS, Nov 93)
Commonest renal manifestation in Sickle cell trait: Isosthenuria Sickling: Mutation in Sickle cell anemia leads to: GAG  GUG (Adenine is replaced by Uracil). In effect, polar glutamic acid is replaced by non-polar valine. The amino acid substitution creates a site on the surface of the Hemoglobin molecule, sometimes referred to as “sticky patch”. Only deoxyhemoglobin S has a complementary site to this sticky patch. Therefore deoxyhemoglobin molecules in the RBC bind to each other and polymerize into long fibers that distort it’s shape. Note: Sticky patch is present on both oxygenated & deoxygenated HbS. But, in oxygenated HbS molecule, the complementary site is masked. This is the reason behind deoxygenation favouring sickling. (AI, 2009)
Role of HbA in polymerisation: HbA does not contain any sticky patch. But it

does have a binding site for sticky patch. Thus it can bind to HbS but cannot extend the polymer. That is how HbA interferes with polymerisation. (AIIMS Nov, 2004) 65) D. Sickle cell disease

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Microbiology

78. Tetracycline is used in the prophylaxis of which of the following diseases? (AIIMS 2005) A. Cholera B. Brucellosis C. Leptospirosis D. Meningitis Ref: Harrison 17th. 971

Exp: Tetracycline is used in chemoprophylaxis of Cholera. PROPHYLACTIC USE OF ANTIBIOTICS · Leptospirosis: Doxycycline (Pencillin G is used for Rx) · Meningococcal meningitis: Rifampicin · Infleunza: Oseltamivir · Rickettsial infections: Tetracyclines · Rheumatic fever: Pencillin · Gonorrhea/Syphilis: Pencillin · Plague: Tetracycline/Doxycycline (Streptomycin is used for Rx) · Cholera: Doxycycline/Tetracycline · Diphtheria: Erythromycin (AI 2008)
Drug used for the Rx of cholera in adults: Doxycycline (AI 2005)
DOC for Rx of cholera in pregnancy: Furazolidone (AIIMS 2005)

78) A. Cholera

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81. A farmer developed swellings in the inguinal region which later ulcerated along with development of constitutional symptoms. What stain can be used to detect the bipolar stained organisms? (AI 2006) A. Albert’s stain B. Wayson stain C. Ziehl–Neelsen stain D. Nigrosin stain Ref: Harrison 17th. 983

Exp: This is a case of Bubonic plague and the inguinal smear should be examined immediately with Wayson or Giemsa stain.  Yersinia pestis · Gram negative, non-motile, oxidase negative coccobacillus · Bipolar staining (safety pin appearance) · Stalactite growth in Ghee broth · DOC: Streptomycin. The drug used for chemoprophylaxis is Tetracycline
Another gram-negative bacillus showing bipolar staining, but motile & oxidase positive is Burkholderia pseudomallei causing Meliodosis. (AIIMS Nov 2003). 82. Which among the following is the most common fungal infection seen in immunocompetent patients? A. Aspergillus B. Candida C. Cryptococcus D. Penicillium marneffei Ref:

1. Greenwood 16th. 575 2. Textbook of Diagnostic Microbiolgy 3rd. 745 3. Robbins 7th. 397

Exp: Candida is the most common fungal infection in immunocompetent individuals, most commonly Candida albicans. -Prevalence of Aspergillus is second only to Candida albicans.

81) B. Wayson stain

82) B. Candida

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FORENSIC MEDICINE

Chapter

7

Forensic Medicine

104. An Infant is brought to the casualty with reports of violent shaking by parents. Most characteristic injury is: A. Long bone fracture B. Ruptured spleen C. Subdural hematoma D. Skull bone fracture Ref: Reddy, 25th. 383

Exp: This is a case of Battered Baby syndrome (non-accidental injury of childhood). Battered Baby syndrome is characterised by bruises, abrasions & lacerations of different ages due to direct manual violence. Battered babies are frequently found to have subdural hematoma & intraocular bleeding due to violent shaking, so also called ‘infantile whiplash syndrome’. In such cases there is no fracture of skull or no external injuries on the head or body other than bruises produced in areas where the child is held by the hands.

104) C. Subdural hematoma

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105. Gun powder on clothing can be visualized by: A. Magnifying lens B. UV rays C. Infrared rays D. Xray Ref: Parikh 6th. 2.18

Exp: Soot deposits (blackening) & gun powder on dark coloured fabric & skin can be better visualised by IR photography.
All tattoos & faint letter marks can be visualised by: IR photography (AI 1991,2003|AIIMS 1992) Tests for gun powder detection: · IR photography · Dermal nitrate/ Paraffin test (AIIMS Nov 2005) · Neutron activation analysis · Atomic absorption spectrophotometry · Scanning electron microscopy with Xray analyser
Black gun powder (smoke producing) contains: Pot. Nitrate, Sulphur, Charcoal (PGI Dec 2006|AIIMS 1997)
Smokeless gun powder contains: Nitrocellulose & nitroglycrine
The terms FG, FFG, FFFG are used to describe: Black gun powder (depending on size of grains) (PGI Jun 2007, Dec 2008)
Dried semen stain on clothes is identified by: UV light (AIIMS Nov 2009) 106. Signature fracture refers to: (AIIMS May 2006) A. Depressed skull fracture B. Suture displacement fracture C. Contrecoup injury D. Fracture at foramen magnum Ref: Reddy, 25th. 209

Exp: Depressed fracture is also known as Signature fracture (fracture-ala signature), as their pattern often resembles the weapon or agent which caused it. 105) C. Infrared rays

106) A. Depressed fracture

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Community Medicine

113. Which is not true regarding diet modification recommended in high cardiovascular risk groups? A. Cholesterol less than 100 mg/1000kcal/day B. Avoid alcohol C. Fat intake < 10% of total calories D. Salt limitation to less than 5 gm Ref: Park 20th. 320

Exp: The WHO committee considers the following dietary changes necessary for prevention of CHD · Reduction of fat intake to 20-30% of total energy intake · Saturated fat < 10% of total energy intake · Cholesterol