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Author: RxPG, Posted on Monday, June 09 @ 11:11:46 IST by RxPG  

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AIIMS

RxPG AIIMS  BOOK may 2002 and nov 2001 papers [ fully solved, completely referenced, mnemonics and tips]
422 pages
Paperback
Price 100/-
Publisher JAYPEE


First five pages for preview

PAGE ONE

1.    ST segment elevation is seen in all except:

       A.       Ventricular aneurysm



B. Coronary spasm

C. AMI

D. Pericarditis

Ref: 104, ECG Made Easy, 5th edn

1364, HPIM, 14th edn

11,21,62,179,81, Martin Dunitz

Status: Repeat, but with difference choices

Quality: Spotter

Discussion

Elevation of the ST segment is an indication of acute myocardial injury usually due either to a recent infarction or to pericarditis. The leads in which elevation occurs indicate the part of the heart that is damaged,

V leads—anterior damage

Most leads—pericarditis

Explanation

A. Ventricular aneurysm is a sequelae of MI. So it may cause ST segment elevation but not necessarily.

B. Coronary spasm causes printzmetals (variant) angina. Angina is an ischaemic disease. Usually ischaemia presents as horizontal depression of the ST segment associated with upright T wave as opposed to infarction. But printzmetals is an exception and causes ST elevation.

C. AMI has been explained above as a cause of ST segment elevation.

D. Acute pericarditis is characterised by ST elevation (concave upward) in leads facing the effusion.

Ans: None of the above as all the choices are correct. How­ever ventricular aneurysm shows incosnsitent association as compared to rest of the three which have characteristic associations.

PAGE TWO

2. Which of the following is not a tributary of cavernous sinus?

A. Sphenoparietal sinus

B. Petrosal sinus (superior)

C. Ophthalmic vein

D. Middle cerebral vein

Ref: 73, BDC III, 2nd edn

Status: New question

Quality: Reader

QTDF: BDC

Discussion

The veins connecting to cavernous sinus are of two types, tributaries (incoming channels) and draining channels (communications).

Explanation

A. Sphenoparietal sinus is a tributary coming from the meninges.

B. Superior petrosal sinus is a draining channel and not a tributary. It drains cavernous sinus into transverse sinus.

C. Ophthalmic veins (superior and inferior) are tributaries coming from orbit.

D. Middle cerebral vein (superficial) is a tributary coming from brain.

Comments

So folks, you must have never expected a “catch” in such an innocuous looking question. But in a AIIMS paper, you should be prepared for everything and never attempt a question only on face value.

Ans: (B) Petrosal sinus (superior).

PAGE THREE

3. Most common virus infection after 2 months of renal transplantation is:

A. Herpes zoster

B. Toxoplamosis

C. HSV

D. CMV

Ref: 843, HPIM, 14th edn (Table 136-3)

Status: Repeat

Quality: Spotter

QTDF: HPIM

Explanation

A. Infection with herpes group viruses (except CMV) may become evident within 6 months of renal transplantation or later. VZV may cause fatal disseminated infection in nonimmune kidney transplant recipients, but in immune patients reactivated zoster usually does not disseminate outside the dermatome.

B. Toxoplasmosis is excluded in the first instance it self as it is not a virus (toxoplasma gondii—protozoan). Moreover it is not a very much common infection after renal transplant and is implicated only in some ensuing CNS infections.

C. HSV can infect post-transplantation though not as frequently. The most common strain implicated in infection after renal transplant is HSV6.

D. CMV infection is responsible for about 50% of all renal transplant recipients presenting with fever 1 to 4 months after transplantation. Thus it is the most common viral infection, post-renal transplantation.

Ans: (D) CMV

PAGE FOUR

4. What is required to detect infection of fetus in utero in toxoplasmosis?

A. IgG in mother

B. IgG in fetus

C. IgM in fetus

D. IgM in Mother

Ref: 1498, CMDT 2002

Status: Repeat

Quality: Reader

QTDF: CMDT

Explanation

A. IgG specific antibody is invariably present in mother if she is positive for toxoplasmosis. But that does not prove infection of fetus.

B. IgG specific antibody is nearly always present in the fetus if the mother is positive, but this passively transferred antibody disappears in 6-12 months and it does not definitely prove fetal infection.

C. IgM specific antibody in fetus is detected by cordocentesis and is diagnostic of fetal infection. But a negative result does not exclude the diagnosis.

D. Using the same logic as applied in option a, IgM specific antibody in mother does not prove fetal infection. However, it increases the risk of infection in fetus.

Comments

The most useful tests for confirmation of fetal infection are:

1. Ultrasound examination.

2. Aminocentesis for detection of toxoplasma DNA in amniotic fluid.

3. Cordocentesis for detection of IgM specific antibody.

Ans: (C) IgM in fetus.

PAGE FIVE

5. In an old patient, the best indicator of probability of developing cardiovascular disease can be calculated by:

A. LDL/HDL ratio

B. TG

C. Total cholesterol

D. None of the above

Ref: 1255-57, CMDT 2002

Status: New question

Quality: Reader/Spotter

QTDF: CMDT

Eplanation

A. Initial cholesterol measurements for the purpose of screening for cardiovascular disease can be via various strategies like (1) measuring total cholesterol alone, (2) measuring total cholesterol and HDL cholesterol, (3) measuring LDL and HDL cholesterol ratio. Each is acceptable, but treatment decisions are always based on the LDL and HDL cholesterol levels. But this is for general population and not specifically for elderly patients.

B. TG (triglycerides) levels are not an acceptable criterion of the cardiovascular disease risk screening.

C. As discussed in option one total cholesterol can be one of the criteria of cardiovascular disease risk screening but is not specifically mentioned for elderly population.

D. This is a bit confusing. In this question the age of the elderly patient is not provided and CMDT says that meta-analysis of evidence relating cholesterol to coronary heart disease in the elderly suggests that cholesterol is not a risk factor for coronary heart disease for persons over age 75.

Comments

So it is a confusing question with two probable options. Although the question is unclear about the age of the patient, we feel that option D is the correct answer or you people can find some direct proof from some where to convince yourself. Anyway check out for errata at http://books.meramamc.com.

Ans: (D) None of the above




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