All India Institute of Medical Sciences 2003 - Question Paper

4. Difference in the size of images formed by the 2 eyes.
Ans 4

177. Ophthalmoplegic migraine means:
1. When headache is followed by complete paralysis of the IIIrd and VI nerve on the identical side as the hemicrania.
2. When the headache is followed by partial paralysis of the IIIrd nerve on the identical side as the hemicrania with out any scotoma.
3. Headache associated with IIIrd, IVth and VIth nerve paralysis.
4. Headache associated with optic neuritis

Ans 3. In Ophthalmoplegic Migraine headache occurs in conjunction with diplopia. As the intensity of an ipsilateral severe headache subsides after a day or more, paresis of one or more of cranial nerves III, IV, and VI occurs. The 3rd cranial nerve is affected in about 80% of cases, initially with ptosis and then oculomotor paresis, which is usually complete but may be partialq. This is usually transient; but may outlast pain for a few weeks. Other symptoms are vomiting, nausea. CMDT also says that ophthalmic division of V CN may be affected. MYDRIASIS may occur in 50% cases.

Important about Ophthalmoplegic Migraine: In ADULTS if it occurs always consider the possibility of aneurysms.(these are very rare in childhood). Exclude Other D/D by imaging including--
Tolosa-Hunt syndrome q (granulomatous inflammation in the cavernous sinus), orbital pseudotumor (an idiopathic infiltration of orbital structures with chronic inflammatory cells), Diabetic cranial neuropathy.


References
Evans RW. Headaches during childhood and adolescence. In: Evans RW, Mathew NT, eds. Handbook of Headache. Philadelphia: Lippincott, Williams, and Wilkins; 2000:chap 7.
Lee AG, Brazis P. Ophthalmoplegic migraine. In: Gilman S, ed. Medlink. Neurobase. San Diego: Arbor Publishing; 2000.
Troost BT, Zagami AS. Ophthalmoplegic migraine and retinal migraine. In: Olesen J, Tfelt-Hansen P, Welch KMA, eds. The Headaches. second ed. Philadelphia: Lippincott, Williams, and Wilkins; 2000:chap 64.
Medscape: Randolph Warren Evans, MD, 11/30/2000
Ref CMDT 2003 Pg 947, HPIM 15th Page 76

ans is three as option 1 specifically mentions complete paralysis that is usually but not always not the case & option three is absolutely accurate.

Other Migraine questions:
In CLASSIC migraine Throbbing headache is CONTRALATERAL to visual display. (Contrast to Ophthalmoplegic migraine)
SCOTOMA called as "fortification spectra"Q starts as a small Para central scotoma - expands in a C shape manner. It has scintillating lights around it in a serrated (fortification) form. It expands and disappears out of visual field in 20-25 minutes.
Carotidynia Q is lower jaw/ Facial migraine like headache. (Older age group, with carotid pulsations)
Bikersaff"s Migraine: Basilar migraine in young adolescent females with blindness.
Rizatriptanq is the fastest acting Triptan.
Aspirin, NSAIDS, isomethepteneq used to abort mild migraine.
BIOFEEDBACK q therapy is useful in helping patients deal with stress.
Triggering factors include Chocolate, alcohol, Food additives, Bright light, menstrual cycle (around menstruation), anxiety, stress, exercise, OCPs.

178 Surface ectoderm provide rise to all of the subsequent structures other than.
1. Lens
2. Corneal epithelium
3. Conjunctival epithelium
4. Anterior layers of iris.
Ans four Lens is formed by surface ectoderm. Cornea epithelium is formed by surface ectoderm rest of layers are formed by mesothelium (these are endothelium, descemet's membrane, stroma, bowman's layer. Iris is formed by neuroectoderm - epithelial layers. Blood vessels of iris derived from mesoderm.
Other questions: Retina, Pineal Gland, Neurohypophysis, CNS neurons, preganglionic neurons derived from Neuroectoderm.
Dilator and sphincter pupillae muscles, ciliary muscle, carotid body, most bones of face, skull other than occipital bone, bones of middle ear, pia and arachnoid layer, schwann cells, parafollicular cells , postganglionic neurons and odontoblasts derived from NEURAL CREST.
Extraocular muscles, skeletal muscles of head-neck-trunk, muscles of tongue, vertebrae ribs occipital bone and dura matter are derived from PARAXIAL MESODERM


179 Enucleation of the eyeball is contraindicated in
1 Endophthalmitis
2. Panophthalmitis
3. Intraocular tumour
4. Painful blind eye
Ans 2

Indications for enucleation are -ABSOLUTE -Retinoblastoma and malignant melanoma. Relative are Painful blind eye subsequent glaucoma, Endophthalmitis, mutilating ocular injuries, anterior staphyloma and pthysis bulbi q
Indications for evisceration are Panophthalmitis, expulsive choroidal hemorrhage and bleeding anterior staphyloma. In Panophthalmitis we prefer evisceration to prevent infection reaching meninges.

180. The treatment of congenital glaucoma is
1. Essentially topical medications
2. Trabeculoplasty
3. Trabeculotomy with trabeculectomy
4. Cyclocryotherapy.
Ans three

181. Hypochloremia hypokalemia and alkalosis are seen in:
1. Congenital hypertrophic pyloric stenosis
2. Hirschsprung's disease.
3. Esophageal atresia
4. Jejunal atresia
Ans one

182 There is a high risk of renal dysplasia in
1. Posterior urethral valves.
2. Bladder extrophy
3. Anorectal maloformation
4. Neonatal sepsis
Ans one (ref Schwartz surgery.)

183. Cells from the neural crest are involved in all other than.
1. Hirschsprung's disease
2. Neuroblastoma
3. Primitive neuroectodermal tumour
4. Wilm's tumour
Ans four

184 A 'Malignant pustule' is a term used for
1. An infected malignant melanoma
2. A carbuncle
3. A rapidly spreading rodent ulcer.
4. Anthrax of skin
Ans four [neeharika, Aurangabad]
185 A warthin's tumour is:
1. An adenolymphoma of parotid gland
2. A pleomorphic adenoma of the parotid
3. A carcinoma of the parotid.
4. A carcinoma of submandibular salivary gland
Ans one Warthin's tumour is also known as papillary cystadenoma lymphomatosum. Occurs more in males, age ~ 60 yrs, Diagnosis possible without biopsy by 99Tc pertechnate scan. T/t is superficial parotidectomy.

186 A newborn baby had normal APGAR score at birth and developed excessive frothing and choking on attempted feeds. The investigation of option is:
1. Esophagoscopy
2. Bronchoscopy
3. MRI chest
4. X-ray chest and abdomen with the red rubber catheter passed per orally into esophagus
Ans 4
A I P P G AIIMS Answers

187. A new born baby has been referred to the casualty as a case of congenital diaphragmatic hernia. The 1st clinical intervention is to:
1. Insert a central venous pressure line.
2. Bag and mask ventilation
3. Insert a nasogastric tube.
4. Ventilate with high frequency ventilator
Ans 3

188 1 year old male child is presented with poor urinary stream since birth. The investigation of option for valuation is:
1. Voiding cystourethrography (VCUG)
2. USG bladder
3. Intravenous urography
4. Uroflowmetry
Ans 1

189. Which of the subsequent statements about peptic ulcer disease is actual.

1.Helicobacter pylori eradication increases the likelihood of occurrence of complications.
2. The incidence of complications has remained unchanged.
3. The incidence of Helicobacter pylori re-infection in India is very low.
4. Helicobacter pylori eradication does not alter the recurrence ratio.
Ans ?
. Which of the subsequent is not a contraindication for extra corporeal Shockwave Lithotripsy (ESWL) for renal calculi?
1. Uncorrected bleeding diathesis
2. Pregnancy
3. Ureteric stricture
4. Stone in a calyceal diverticulum.
Ans 4

191. Which of the subsequent is not an improper investigation for anterior urethral stricture?
1. Magnetic Resonance Imaging
2. Retrograde urethrogram
3. Micturating cystourethrogram
4. High frequency ultrasound
Ans 1
192. The recommended treatment for preputial adhesions producing ballooning of prepuce during micturition in a 2-year-old boy is: -
1. Wait and watch policy
2. Circumcision
3. Dorsal slit
4. Preputial adhesions release and dilatation
Ans 3
193 All are accurate about potassium balance other than.
1. Most of potassium is intracellular
2. 3 quarter of the total body potassium is obtained in skeletal muscle.
3. Intracellular potassium is released into extra- cellular space in response to severe injury or surgical stress.
4. Acidosis leads to movement of potassium from extracellular to intracellular fluid compartment.
Ans 4

194. Hypocalcaemia characterized by all other than.
1. Numbness and tingling of circumoral region.
2. Hyperactive tendon reflexes and positive Chvostek's sign.
3. Shortening of Q-T interval in ECG.
4. Carpopedal spasm
Ans 3

195 Which of the subsequent not actual of gas gangrene.
1. It is caused by clostridium perfringens
2. Clostridium Perfringens is a gram-negative spore-bearing bacillus.
3. Gas gangrene is characterized by severe local pain crepitus and signs of toxemia.
4. High dose penicillin and aggressive debridement of affected tissue is the treatment of established infection.
Ans two they are gram +ve

196. "Sleep apnea", is described as a temporary pause in breathing during sleep lasting at lowest.
1. 40 seconds
2. 30 seconds
3. 20 seconds
4. 10 seconds
Ans four HPIM 15th page 1520. Sleep apnea is of 2 kinds Obstructive & central. Nocturnal Polysomnography used to diagnose & distinguish ranging from Obstructive & central apnea. (Monitoring of multiple physiological factors during sleep.)
Current pediatric diagnosis and treatment page 30, 15th Ed mentions apnea as "any cessation of respiration longer than 20 sec, or any cessation of respiration with the appearance of cyanosis." Also apnea in neonate most common reason in prematurity. If ques. comes of apnea of prematurity it is better mark 20 sec otherwise "HARRISON IS ALWAYS RIGHT"
Hypopnoea is described as reduce in respiration with drop in oxygenated hemoglobin levels by at lowest four %.

197. In a blast injury, which of the subsequent organ is lowest vulnerable to the blast wave.
1. G.I. tract
2. Lungs
3. Liver
4. Ear drum
Ans (3) Ref Bailey & Love . Exp: In Blast injury - Eardrum, Hollow Organs, Lungs are most affected. Liver is spared due to its homogenosity.[Saurabh Tripathi, TN Medical College ,Mumbai; Dipak Gupta, BPKIHS, Nepal]

198 Regarding testicular tumour, the subsequent are false other than.

1. They are commonest malignancy in older man
2. Seminomas are radiosensitive
3. Only 25% of Stage one teratomas are cured by surgery alone.
4. Chemotherapy rarely produces a cure in those with Metastatic disease.
Ans three Seminomas are radioSensitive, Slowly growing. [SSS]

199 A young patient presents with history of dysphagia more to liquid than solids. The 1st investigation you will do is:

1. Barium Swallow
2. Esophagoscopy
3. Ultrasound of the chest
4. C.T. Scan of the chest
Ans 1

200. A 45 years old hypertensive male presented with sudden onset severe headache, vomiting and neck stiffness. On exam he didn't have any focal neurological deficit. His CT scan showed blood in the Sylvain fissure. The probable diagnosis is:

1. Meningitis
2. Ruptured aneurysm
3. Hypertensive bleed.
4. Stroke
Ans 2?3?


Answers to few ques. are doubtful / missing

Earning:   Approval pending.