Medicine

Most Recent Questions

R1. A 45 years old woman with history of back pain came to OPD. On examination she was positive for Schober test,
and had hyperpigmentation of ears/ nose. Radiology given in Photograph. Likely diagnosis is
[AIIMS May 2017]

/e
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Ans.
R1. b a. Ankylosing spondylitis b. Ochronosis c. Hypoparathyroidism d. Fluorosis
R2. b

R2. Most appropriate treatment for the patient suffering from condition shown in Photograph
[AIIMS May 2017]

a. Lignocaine b. DC cardioversion c. Diazoxine d. Prilocaine

Explanations of the questions are given at the end of the subject

 Most Recent Questions 423

R3.  R5. 

MEDICINE
Identify the cause of condition as shown in In the test shown (Photograph), normal two
Photograph [AIIMS November 2016] point discrimination on finger tips is
[Recent Question 2017]

a. Muscular dystrophy
b. Congenital myopathy

/e
c. Myasthenia gravis a. 1 mm b. 2–4 mm
d. Inclusion body myositis c. 8–12 mm d. 40 mm
,3
20
R4. 
A 40-year-old male presented with features R6. A 76-year-old male came to emergency
of fever and productive cough with postural department with complaints of retrosternal pain
increase. He has a history of binge drinking. for 6 hours. The following is the ECG of the same
X-ray of the patient is shown below. Which of the patient. The appropriate next line of management
on

following is the appropriate management? of this patient is  [AIIMS May 2016]

[AIIMS November 2016]
ot
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Ans.
R3. a
R4. a
R5. b
R6. c

a. IV abciximab
b. IV thrombolysis
c. Primary percutaneous intervention
d. Low molecular weight heparin

a. IV Clindamycin
b. Lobectomy
c. Gemcitabin and paclitaxel
d. ATT

Explanations of the questions are given at the end of the subject

 424 Most Recent Questions
PHOTON 20

R7. 
A 52-year-old diabetic patient complaints of R8.  Identify the ECG given  [AIIMS November 2015]
palpitations. His ECG is as below. The first line of
management is 
[AIIMS May 2016; AIIMS November 2015]

a. Sinus rhythm
b. PSVT
c. Atrial fibrillation
d. Ventricular fibrillation

R9.  Identify the ECG given [AIIMS November 2015]

a. Primary PCI

/e
b. Cardioversion
c. IV amiodarone
d. Adenosine
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a. Sinus rhythm
b. PSVT
on

c. Torsades de pointes
d. Ventricular fibrillation
ot
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Ans.
R7. d
R8. c
R9. c

Explanations of the questions are given at the end of the subject

 Medicine

Most Recent Questions

R1. A 45 years old woman with history of back pain came to OPD. On examination she was positive for Schober test,
and had hyperpigmentation of ears/ nose. Radiology given in Photograph. Likely diagnosis is
[AIIMS May 2017]

/e
,3
20
on
ot
Ph

Ans.
R1. b a. Ankylosing spondylitis b. Ochronosis c. Hypoparathyroidism d. Fluorosis
R2. b

R2. Most appropriate treatment for the patient suffering from condition shown in Photograph
[AIIMS May 2017]

a. Lignocaine b. DC cardioversion c. Diazoxine d. Prilocaine

Explanations of the questions are given at the end of the subject

 Most Recent Questions 423

R3.  R5. 

MEDICINE
Identify the cause of condition as shown in In the test shown (Photograph), normal two
Photograph [AIIMS November 2016] point discrimination on finger tips is
[Recent Question 2017]

a. Muscular dystrophy
b. Congenital myopathy

/e
c. Myasthenia gravis a. 1 mm b. 2–4 mm
d. Inclusion body myositis c. 8–12 mm d. 40 mm
,3
20
R4. 
A 40-year-old male presented with features R6. A 76-year-old male came to emergency
of fever and productive cough with postural department with complaints of retrosternal pain
increase. He has a history of binge drinking. for 6 hours. The following is the ECG of the same
X-ray of the patient is shown below. Which of the patient. The appropriate next line of management
on

following is the appropriate management? of this patient is  [AIIMS May 2016]

[AIIMS November 2016]
ot
Ph

Ans.
R3. a
R4. a
R5. b
R6. c

a. IV abciximab
b. IV thrombolysis
c. Primary percutaneous intervention
d. Low molecular weight heparin

a. IV Clindamycin
b. Lobectomy
c. Gemcitabin and paclitaxel
d. ATT

Explanations of the questions are given at the end of the subject

 424 Most Recent Questions
PHOTON 20

R7. 
A 52-year-old diabetic patient complaints of R8.  Identify the ECG given  [AIIMS November 2015]
palpitations. His ECG is as below. The first line of
management is 
[AIIMS May 2016; AIIMS November 2015]

a. Sinus rhythm
b. PSVT
c. Atrial fibrillation
d. Ventricular fibrillation

R9.  Identify the ECG given [AIIMS November 2015]

a. Primary PCI

/e
b. Cardioversion
c. IV amiodarone
d. Adenosine
,3
20
a. Sinus rhythm
b. PSVT
on

c. Torsades de pointes
d. Ventricular fibrillation
ot
Ph

Ans.
R7. d
R8. c
R9. c

Explanations of the questions are given at the end of the subject

Answers & Explanations
R1. Ans. (b)  Ochronosis •• Diagnosis is also supported by the history: History
of alcoholism (Patients lie down for longer durations
[Ref. CMDT 2017 p1677]
diminishes pharyngeal / laryngeal reflexes making them
OCHRONOSIS (ALKAPTANURIA) prone for aspiration of oral contents into the lung) and
•• Triad of Alkaptonuria: the history of fever with productive cough, changing with
ƒƒ Homogentisic aciduria (urine blackens on standing when posture
oxidized or alkalinized) •• Management:
ƒƒ Eumelanin–like pigmentation of skin, sclera, cartilages, etc ƒƒ Primary treatment: IV clindamycin 600 mg TDS
ƒƒ Degenerative ochronicarthropathies usually in the fourth ƒƒ Other options: Beta lactam + Beta lactamase inhibitor or
decade of life especially in spine, hip and knees Moxifloxacin
•• AR disorder ƒƒ Surgical/percutaneous interventions are indicated for
•• Deficiency of homogentisic acid oxidase: Lead to increased
failed antibiotics
homogentisic acid levels in fluids
R5. Ans. (b)  2–4 mm
R2. Ans. (b)  DC cardioversion
[Ref. DeJong’s The Neurologic Examination, 7/e p542]
[Ref. Oxford Handbook of Tropical Medicine by Brent, 4/e p384]]
•• Minimum distance felt as two separate points on Two-point
BROAD COMPLEX REGULAR TACHYCARDIA discrimination test:
•• Any broad complex regular tachycardia should be taken as
ƒƒ 1 mm: Tip of tongue
VT unless proved otherwise
ƒƒ 2–3 mm: Lips

/e
•• Two features absolutely suggestive of VT in this patient:
ƒƒ 2–4 mm: Finger tips
ƒƒ Tall left Rabbit ear in V1: Brugada’s sign
ƒƒ 4–6 mm: Dorsum of fingers
ƒƒ Vereckei’s sign positive: Absolutely positive QRS
complexes in aVR
•• Treatment:
,3 ƒƒ 8–12 mm: Palm
ƒƒ 20–30 mm: Back of hand
20
ƒƒ Amiodarone for stable patients ƒƒ 30–40 mm: Dorsum of foot
ƒƒ DCC for unstable patients (Higher success rate compare
to drugs) R6. Ans. (c)  Primary percutaneous intervention
ƒƒ Lignocaine is not used unless it’s a post MI/ Ischemic VT
on

[Ref. Clinical Cardiology: Current Practice Guidelines, Updated 1/e

p270]
R3. Ans. (a)  Muscular dystrophy
SYNOPSIS FOR MANAGEMENT OF ACUTE MI
ot

[Ref. Hutchison’s Clinical Methods, 23/e p302]

(ECG in Photograph)
PSEUDOHYPERTROPHY OF CALVES •• Patients facing a transport time <30 minutes should be
Ph

•• One of the hallmarks of Muscular dystrophy.

transferred for primary PCI
•• Here the muscle is replaced by fatty tissue which gives the
•• Thrombolytic-eligible patients who present <2 to 3 hours
characteristic psudohypertrophied appearance
from onset of symptoms and have >30 minutes transport
•• Causes of Pseudohypertrophy:
ƒƒ Muscular dystrophy
time should receive thrombolytic therapy
ƒƒ Hypothyroidism
•• Patients presenting >2 to 3 hours after the onset of chest
ƒƒ Glycogen storage diseases pain and have a transport time of 60 minutes or less should
ƒƒ Trichinosis (rare) be promptly transported for primary PCI
•• Causes of True hypertrophy: •• If the anticipated transport time is >60 minutes, patients can
ƒƒ Athletes be treated with either thrombolytic therapy or primary PCI
ƒƒ Manual laborers •• In the given question, we have only the details of the
ƒƒ Acromegaly duration of the symptoms, which is 6 hours. (>2–3 hour
ƒƒ Anabolic steroid abuse scale)
•• Transportation time < 60 min—Primary PCI
R4. Ans. (a)  IV Clindamycin •• Transportation time > 60 minutes—thrombolysis or
[Ref. Harrison, 19/e p815] primary PCI
•• Clinical picture (Photograph) is clearly suggestive of a Lung
abscess R7. Ans. (d)  Adenosine
ƒƒ CXR show a thick walled cavity clear cut air fluid level •• ECG shows narrow complex tachycardia most probably
with characteristic location in the SVT (ECG in Photograph)
ƒƒ Right side which is suggestive of aspiration •• Next line of management is IV adenosine
 Other Systems of Body 443

MEDICINE
100.  Role of Substance of abuse (Photograph) in HIV 103. Clinical Sign/ Lesion used as shown in the Photograph
 [Recent Question 2013] occur due to …….  [Recent Question 2014]

a. Pontine lesion
b. Cerebral hypoxia
c. Metabolic encephalitis
d. Diffuse cerebral anoxia

a. Decrease infectivity b. Improve CD4 count 104. A 35-years-old Smoker presents with Condition
c. Increase appetite d. Improves immunity shown in Photograph. Most likely diagnosis is
[Recent Question 2013]

/e
101.  Positive Sign as shown in Photograph is found in
 [Recent Question 2012]
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a. Marfan’s syndrome a. Diabetic gangrene b. Buerger’s disease

b. Duchenne’s muscular dystrophy c. Atherosclerotic plaque d. Septic foot Ans.
c. Congenital myopathy
100. c
d. Guillain Barre syndrome
101. b
102. c
105. Method shown (Needle) in Photograph is NOT done
103. d
for all of the following except [Recent Question 2014] 104. b
102. Most specific test of Connective tissue disorder
shown in Photograph [Recent Question 2012] 105. d

a. ssDNA b. dsDNA a. Down’s syndrome b. Trisomy 21

c. Anti-Smith antibody d. Histones c. Phenylketonuria d. Gastrochisis

Explanations of the questions are given at the end of the subject

 444 Other Systems of Body
PHOTON 20

106. Sign elicited (Arrow) as shown in Photograph 109. Diagnose the Underlying Condition shown in
indicate the Fundus Photograph [Recent Question 2013]

a. CRAO
b. CRVO
a. Hypercalcemia b. Hypocalcemia c. Diabetic retinopathy
c. Hypernatremia d. Hyponatremia d. Hypertensive retinopathy

/e
107. 
Condition shown in the Photograph can be 110. Sign elicited (Arrow) as shown in Photograph
caused by indicate
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a. ICSOL
Ans. b. Malignant hypertension
106. b c. Chronic meningitis a. Hypercalcemia b. Hypocalcemia
107. d d. All of the above c. Hypernatremia d. Hyponatremia
108. d
109. b
110. b 108. A case of Portal hypertension (Photograph) is 111. Condition shown in the Photograph is a late
111. c characterized by complication of

a. Umbilical hernia b. Distension of veins a. Lung cancer b. Pancreatic cancer

c. Bilateral gynaecomastia d. All of the above c. Grave’s disease d. Addison’s disease

Explanations of the questions are given at the end of the subject

 Other Systems of Body/ Instruments-I, Procedures and Laboratory Medicine 445

112. Diagnose the Underlying Condition shown in 115. Diagnose the Underlying sign (Arrow) shown in

MEDICINE
the Fundus Photograph the Fundus Photograph

a. Retinal artery occlusion

b. Diabetic retinopathy
a. Retinal artery occlusion b. Normal fundus c. Hypertensive retinopathy
c. Hypertensive retinopathy d. Optic atrophy d. Optic atrophy

/e
113. Identify the Substance deposited in Ring shown 116. 
All of the following statements are correct
in Photograph [Recent Question 2013] regarding the procedure that is carried out with
,3 the instrument shown in Photograph except
 [AIIMS May 2016]
20
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a. Lead b. Mercury
c. Iron d. Copper a. The procedure may be carried out in lateral or Ans.
prone position 112. d
b. Useful for the diagnosis of infiltrative and 113. d
114. 
Cause of Condition of a Male shown in granulomatous disorders 114. d
Photograph is [Recent Question 2012] c. Platelet count of 40,000/cu mm is a 115. a
contraindication 116. c
d. Breath holding is not necessary during this procedure 117. c

117.  Identify the Instrument shown in Photograph

 [AIIMS November 2015]

a. Pleural tap needle

b. Liver biopsy needle
a. Klinefelter’s syndrome b. Spironolactone c. Lumbar puncture needle
c. Idiopathic d. All of the above d. Bone marrow aspiration needle

Explanations of the questions are given at the end of the subject

 446 Instruments-I, Procedures and Laboratory Medicine
PHOTON 20

118. Best Investigation for Function of part (Box in 121.  Site (Arrow) shown in the Photograph is used for
Photograph) [Recent Question 2013]

a. ECHO b. MRI a. Pleural fluid aspiration b. Bone marrow biopsy

c. Nuclear scan d. Multi-slice CT scan c. Ascitic tap d. Liver biopsy

/e
119.  Identify the Instrument shown in the Photograph 122.  Identify the Instrument shown in the Photograph
 [Recent Question 2013, 2016]
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a. Foley’s catheter
b. Nasogastric tube
Ph

a. Foley’s catheter b. Nasogastric tube c. Malecot’s catheter

Ans. c. Malecot’s catheter d. Stomach tube d. Sangstaken-Blakemore tube
118. a
119. d
120. c 120.  Site (Arrow) shown in the Photograph is used for 123. 
Monitoring (Arrow) shown in Photograph is
121. a NOT done for [Recent Question 2013]
122. a
123. c

a. Regulating speed and amount of Fluid infusion

b. Deciding requirement for Blood infusion
a. Pleural fluid aspiration b. Bone marrow biopsy c. Administering thrombolytics
c. Ascitic tap d. McBurney’s incision d. Deciding need for Plasma infusion

Explanations of the questions are given at the end of the subject