MMS AIIMS NOV 2018-Compressed PDF

Q1.
MMS – AIIMS NOV 2018
Patient with syphilis having a stamping gait quality on closing eyes. Tract
involved?
A) Spinocerebellar
B) Dorsal column
C) Lateral STT
D) Vestibulospinal
ANSWER - B
Clearly the disease is Tabes dorsalis – which affects posterior column with high
incidence.
Also stamping quality of gait is typical of a posterior column lesion. Question
does NOT have any features of Rhomberg’s (Swaying towards the side of
lesion)
Q2. MMS – AIIMS NOV 2018
Not involved in gustation/olfaction

A) CN V
B) CN X
C) CN XII
D) CN IX
ANSWER - C
Simple. 3,4,6,12 are pure motor and not involved in any sensory relays of any
kind.
Involvement of paracentral lobule causes all except:

A) (Gait) Apraxia
B) Urinary incontinence
C) Anal incontinence
D) Perianal anesthesia
ANSWER - D
Paracentral lobule is involved in Bladder and bowel functions + Sensory /

motor innervation of contralateral leg.
Lesion can result in Incontinence (Bladder/bowel) + Gait apraxia + leg
weakness/sensory loss of leg
NOTE: Perianal anesthesia is a feature of conus medullaris lesions of soinal

cord.
Which of the following has to monitored in the fetus of a mother taking lithium:
A) Cardiac
B) Urogenital
C) NTD
D) Facial
ANSWER - A
Easy pick – Lithium causes Ebstein’s. Monitor for cardiac anomalies.

Which is NOT included in UIP?

A) MR
B) Adult JE
C) Influenza
D) Rotavirus
ANSWER - B
Childhood JE is included. Adult JE is not.

Influenza is there in the schedule (WHO/CDC) & can be given in children after
6 months. But note that routine influenza vaccine is not included in Indian
schedule.
BCG is protective against?

A) CNS and disseminated TB
B) Pulmonary TB
C) Skeletal TB
D) Pulmonary & CNS
ANSWER - A
Age old data. Efficacy of BCG varies but in communities where it is effective it
reduces incidence of Disseminated TB & CNS TB. Even if they do get it would
be with less severity.
Maximum steroid production by fetal adrenals:

A) Cortisol
B) Progesterone
C) Corticosterone
D) DHEAS
ANSWER - D
DHEAS is the principal steroid of the fetal adrenal gland.

Relative bradycardia is uncommon in:

A) Brucellosis
B) Typhoid
C) Malaria
D) Factitious fever
ANSWER – None > C
Highly ambiguous question.

If you go purely by Harrison – Answer would be Malaria (Just because
Harrison does not mention it)
NOTE: Clearly current practice includes malaria & excludes brucellosis.
Answer of Malaria given for this question is purely Harrison bases and NOT
knowledge based
LNG dose in Emergency contraception:

A) 1-3 mg within 72 hours
B) 1.5 mg within 72 hours
C) 1.5 µg within 72 hours
D) 3 µg within 72 hours
ANSWER – B
Two regimens are available.

Plan B (Progesterone only pills) are considered to be the current regimen of
choice. Has to be taken within 72 hours. LNG 1.5 mg taken as a single dose is
preferred compared to 0.75mg taken 12 hours apart.
Copper containing IUD’s are the gold standard (100% effective) and can be
taken up to 120 hours.
Mifepristone single dose is also an alternative for up to 120 hours.
How to differentiate from Tamponade vs Tension Pneumothorax: (or other way)

A) Raised JVP
B) Raised heart rate
C) Breath sounds
D) Not improving after initial fluid resuscitation
ANSWER – D
Tension Pneumothorax – Hypotension / mediastinal shift + U/L absent air

entry + Hyper-resonant note on involved side.
Tamponade – Hypotension + Muffled Heart sounds + Clear chest with normal
air entry.
Elevated JVP & Hypotension are seen in both (But accentuated ’X’ descent in
JVP is a feature of tamponade only). Both may not improve after fluid
resuscitation as both of them are classified under obstructive shock
Chest trauma + Tachypnea (RR ≥ 40) + Hypotension (BP-90/60) + Hyper-

resonant note on involved side. Next step:
A) Intubate
B) CXR
C) IVF
D) Wide bore needle insertion on 2nd ICS
ANSWER – D
Typical tension pneumothorax. Insert wide bore needle (preferably 14G/12G)

ASAP in the 2nd ICS on the involved side.
Technique for Ryle’s tube insertion:

A) Supine with Neck flexed
B) Sitting with neck flexed
C) Supine with neck extended
D) Sitting with neck extended
ANSWER – B
Repeat. For NG tube:

Ideal position is sitting with neck flexed (If conscious)
In Comatose patients – Supine with neck flexed.
(Note: Supine with Neck extended is ideal for ET intubation)

GCS score:
Intubated patient with opening eyes on command + Moves all 4 limbs on
command
A) 10
B) 12
C) 9
D) 11
ANSWER – C
GCS of this patient is E3 VT M6 = 9T/10 or 9/10 + V=nt.

GCS is 9 here. Cannot give any score for the verbal entity.
NOTE: Score can never be “0”. Similarly for an intubated patient you can never
give a score of ”1” as well.
It is better to calculated only for a total score of 10.
16F Foley’s colour:

A) Blue
B) Yellow
C) Black
D) Orange
ANSWER – D
Lucky that they asked 16F which is commonly used. Answer is orange.
6F- Light green
8F – light blue
10F – Black
12F – White
14F – Green
16F – Orange
18F – red
20F- Yellow
22F – violet
24F – Blue
26F – Cream
28F - Olive green
30F – Grey
32F – Brown
It is absolutely insane to remember all this unless you have handled all of them
personally.
Reason for thyroid storm after thyroid surgery:

A) Infection
B) Rough handling of thyroid at surgery
C) Inadequate preop preparation
D) Thyroiditis
ANSWER – C
1. Spontaneous thyroid storm in patient with Grave’s – Usually infection

2. Thyroid storm after thyroidectomy – almost always due to inadequate
preparation
Nobel prize for medicine/physiology in 2018 for the discovery of:

A) Negative immune regulation
B) Apoptotic pathway
C) Crispr-Cas9
D) Molecular mechanisms controlling circadian rhythm
ANSWER – A
James Allison/Taksu Honjo worked on Negative immune regulation in 1992

for which they received Nobel prize in 2018 in Medicine/Physiology. Their
paper formed the basis of current cancer immunotherapy.
But the original concept of cancer immunotherapy was discovered by William
Cole (1872)
Most important marker for Alcoholic hepaitis:

A) GGT
B) ALP
C) ALT
D) LDH
ANSWER – C
Tricky. Be sure about your recall.

Alcoholic hepatitis – AST elevation > ALT elevation. GGT and ALP are totally
non-specific and nit important in HEPATITIS scenario. TO CALL IT
HEPATITIS YOU NEED ALT elevation. Or AST >ALT to tell it is ALCOHOLIC
HEPATITIS (specifically in the ratio of ≥2:1).
Take home: ALT is relatively specific for hepatitis scenario but AST is not. The
ratio of AST/ALT is specific for Alcoholic hepatitis & NOT AST alone
NOTE: If the question was on alcoholic liver disease (not hepatitis) – then
ALT will be normal. AST will be elevated along with GGT/5’ Nucleotidase &
they have a normal ALP usually. In this case answer becomes GGT.
IFN beta stimulated by:

A) Bacterial infection
B) Viral infection
C) Fungal infection
D) Mycoplasma infection
ANSWER – B
IFN alpha IFN beta IFN gamma

Type Type I Type I Type II
Name Leucocyte Fibroblast Immune
interferon interferon interferon
Source Leucocytes( Fibroblasts/ Activated T
monocyte epithelial cells & NK
macrophage cells cells
system)
Function Major function is against Immune
virus infection regulation.
Has a role in
Th1 pathway
Cannot be diagnosed without positive ANA:

A) SLE
B) Sjogren
C) Drug induced lupus
D) Scleroderma
ANSWER – A
Simple, uncomplicated.& extremely practical.

Rule of thumb- ANA positivity is a must in SLE diagnosis. ANA
negativity twice rules out SLE. Even though ANA positivity cannot
confirm SLE – negativity can rule out.
Note: There is NO ANA negative SLE. But there is ANA negative

scleroderma (ACR/EULAR 2013)
Also Drug induced lupus – secondary to Quinidine/Minocycline
tends to be ANA negative.
Infertility in karatgener:
A) Asthenozoospermia
B) Oligospermia
C) Blockage of epididymis
D) Undescended testes
ANSWER – A
One of the easy picks. Kartagener is a primary ciliary disorder and as

such the sperms have abnormal/reduced motility
(Asthenozoospermia)
Blockage of epididymis is a feature of Young syndrome (But there is
no Situs inversus like Kartagener’s syndrome & patients tends to have
normal sperm motility)
16 year old girl was brought for seizures in the night. She is seizure free for 6
months. Current EEG/MRI is normal. What is the further strategy?
A) Lifelong treatment with AED’s
B) Stop treatment & follow up with 6 monthly EEG
C) Continue same treatment for 2 years
D) Stop treatment
ANSWER – C
Most guidelines recommend treatment with AED’s for at least 2-5

years of seizure free interval before discontinuing (minimum of 2
years of seizure free period must be documented).
Taper the dose of AED’s rather than abrupt cessation.
Pulmonary Tb with documented resistance to INH & Rifampicin. Appropriate

management?
A) 6 drugs for 4 months & 4 drugs for 12 months
B) 5 drugs for 2 months & 4 drug for 1 month & 3 drug for 5 months
C) 6 drug for 6 months & 4 drugs for 18 months
D) 4 drug for 4 months & 6 drugs for 12 months
ANSWER – C
Here we are dealing with an MDR TB.

Recommended regime (TB-India):
IP: Z+E+ Levoflox+ Kanamycin+Ethionamide+Cycloserine X 6-9 months
CP; E + Levoflox + Ethionamide + Cycloserine X 18 months
Treatment/Prevention of AMS (Acute Mountain Sickness):

A) Dexamethasone
B) Diltiazem
C) Digoxin
D) Acetazolamide
ANSWER – D
Acetazolamide can improve acclimatization & hence can be used as a first line
drug to prevent/treat AMS.
Dexamethasone can only treat AMS (especially HAPE – High Altitude
Pulmonary edema) but cannot improve acclimatization.
Combining Verapamil & Metoprolol will result in:

A) AF
B) Tachycardia
C) Torsades de pointes
D) Brady/AV blocks
ANSWER – D
As simple as it gets. Both are AV nodal blockers and hence – Brady/AV

blocks.
Child taking ATT comes with ophthalmic issues. Drug associated:

A) INH
B) Streptomycin
C) Ethambutol
D) Rifampicin
ANSWER – C
No explanation needed. Child is probably having optic neuritis due to

ethambutol.
SPIKES protocol is used for:

A) Triage
B) Communication with patients/attendants regarding bad news
C) Writing death certificate
D) RCT
ANSWER – B
It is for breaking bad news to patients/attendants. Six steps involved are:

STEP 1: S—SETTING UP the Interview
STEP 2: P—ASSESSING THE PATIENT'S PERCEPTION
STEP 3: I—OBTAINING THE PATIENT'S INVITATION
STEP 4: K—GIVING KNOWLEDGE AND INFORMATION TO THE PATIENT
STEP 5: E—ADDRESSING
THE PATIENT'S EMOTIONS WITH EMPATHIC RESPONSES
STEP 6: S—STRATEGY AND SUMMARY
Side effect of salbutamol are all except:

A) Hypokalemia
B) Tachycardia
C) Tremor
D) Hypoglycemia
ANSWER - D
Repeat. Salbutomol does not cause hypoglycemia.

Hypokalemia, Tremors, Tachycardia are all well known side effects of
salbutamol due to Beta 2 agonistic action.
Salbutamol is said to produce hyperglycemia – Theoretically yes. But practically
not a significant effect of salbutamol.
A patient presents with tamponade. As an intern you are asked to measure the
BP. What will you ask the patient to do in relation with breathing:
A) Breathe normally
B) Rapid shallow breaths
C) Slow and deep breaths
D) Hold breath
ANSWER - A
The question ideally asks the ability to document pulsus paradoxus. BP

documentation of pulsus. Paradoxus requires the patient to breathe normally
and does not require any special manoeuvre.
60 year old female with left brachiocephalic weakness for 1 hour comes with a
BP of 160/100 mm Hg. CT brain – normal. Next step:
A) Aspirin + Clopidogrel
B) IV thrombolysis
C) Manage BP alone
D) No interventions needed
ANSWER - B
Patient is in window period (<4.5 hours) and no contra-indications has been

listed for thrombolysis. CT brain is normal suggesting there is no hemorrhage.
As such the next step is thrombolysis with Alteplase/Tenecteplase. There is no
standard role for Double Antiplatelet therapy(Aspirin + Clopidogrel) in Ischemic
stroke (except in certain extremely special scenarios). Even if aspirin is given it
has to be given ≥ 24 hours post thrombolysis. Only if thrombolysis or any
intervention cannot be done/need not be done – Aspirin can be given as soon as
possible after CT.
Cardiac axis at 90 degrees. ’R’ wave will be maximum in which lead:

A) II
B) avF
C) avL
D) III
ANSWER - B
90 degrees cardiac axis corresponds straight to lead avF and hence as such
maximum ‘R’ wave amplitude would be seen in that lead only.
Patient came to Emergency room with severe bleeding and his Blood group was
unknown. Which of the following blood group of FFP you will prefer for
transfusion ?
a) A+
b) AB
c) O-ve
d) O +ve
ANSWER - B
Universal blood donor – O negative

Universal acceptor – Ab positive
Universal FFP donor – AB positive
Universal FFP acceptor – O negative
Which of the following is not done before ABG:

A) Allens test
B) Heparin to rinse the syringe
B) Flexion of wrist
D) Poking at 45 degree angle
ANSWER - C
While taking ABG – wrist is generally kept in hyper-extension. This is to make

the vessel straight and to fix the position (because of tension in hyperextension).
Flexion will make the vessel loose & the vessel will slip easily while poking.
Postrenal transplant patient presents with diarrhoea after 3 months , and it was
showing organism measuring 2-6 micron meter and kinoyn stain positive. Most
likely it is caused by ?
A) Balantidium coli
B) Clostridium difficile
C) Cycloisospora belli
D) Cryptosporidium hominis
ANSWER - D
Opportunistic infections are extremely common post transplant in the period

starting from 1 month post transplant to 6 months post transplant.
Clostridium difficle is usually seen within 1 month post transplant because of
profound antibiotic use.
Kinyoun stain (Modified acid fast) positivity rules out Balantidium.
Now it is between cryptosporidium vs cycloisospora. Size (smaller i.e., 2-6
microns) tells us that the organism is undoubtedly cryptosporidium hominis
(previously parvum)
Patient had Recurrent optic neuritis of both eyes with Extensive Transverse
Myelitis. Visual acuity in Right eye is 6/60 & visual acuity in Left eye 6/18.
Patient showed 50% response to steroids. Diagnosis is:
A) NMO
B) SACD (Subacute combined degeneration of spinal cord)
C) Posterior cerebral artery stroke
D) Neurosyphilis
ANSWER - A
NMO.
Clinical scenario matches classic Wingerchuk criteria. (Optic neuritis +
simultaneous transverse myelitis)
Next investigation will be – anti NMO igG (in blood>CSF)
Best treatment would be Steroids + IVIg
40 yr old woman with proteinuria with the IF pattern as follows:

A) FSGS
B) PSGN
C) Lupus
D) Goodpasture
ANSWER - C
The IF image shows classic “FULL HOUSE” pattern in lupus.

Patient comes with Chronic diarrhoea with normal D-xylose test & abnormal
schilling test. Duodenal biopsy is normal. What is the probable diagnosis?
A) Ileal disease
B) Ulcerative colitis
C) Celiac disease
D) Intestinal lymphangiectasia
ANSWER - A
D-xylose test is a test of mucosal permeability of upper intestine.

Along with normal D-xylose + Duodenal biopsy being normal – Two options can
be ruled out pretty easily. Celiac & Intestinal lymphangiectasia.
Ulcerative colitis does not cause malabsorption.
Answer by exclusion is ileal disease ( may have normal D-xylose & abnormal
schilling test as vit B12 absorption happens in terminal ileum)
A patient who is a known case of CKD has complaints of vomiting. His ABG
reports are as follows: pH - 7.40, pCo2 - 40, HCO3 – 25. Na -145, chloride-100.
A) Normal anion gap met acidosis
B) High anion gap met acidosis
C) no acid base abnormality
D) High anion gap metabolic acidosis with metabolic alkalosis
ANSWER - D
Even though ABG looks completely normal – clinical history is the key here.
CKD patients generally have high AG metabolic acidosis. On the background of
that he has developed vomiting (which is an alkalotic state). Both opposing
disorders have normalized the ABG. But the patient is actually having a double
disorder.
What is the difference between RIFLE & KDIGO criteria in differentiating a

tubular injury?
A) Uosm
B) Urinary Na
C) Urinary NGAL
D) FeNa (Una x Scr / Sna x Ucr)
ANSWER - C
RIFLE originally used Urinary sodium, urine osm, FeNa to define tubular
dysfunction/injury. Currently urinary NGAL/Kim-1/Cystatin C/L-FABP all are
being evaluated as more sensitive and specific markers of tubular injury (KDIGO
2017/18)
What does the blue & non-dotted/solid line in the image indicate?
A) Pulmonary fibrosis
B) Atelectasis
C) Emphysema
D) ARDS
ANSWER - C
This is a compliance curve.

Left & up in the graph – Indicates increased compliance
Right & down in the graph – Indicates reduced compliance
Hence the answer is emphysema (Increased compliance)

All the other disorders mentioned have reduced compliance.
Patient presents to you with Osteomalacia and severe phosphoturia. Which of

the following cancers are known to case this?
A) Osteosarcoma
B) Fibrosarcoma
C) ALL
D) Breast cancer
ANSWER - B
Diagnosis is TIO (Tumour induced osteomalacia due to excessive FGF-23

secretion)
FGF 23 secreted in excess classically by “phosphaturic mesenchymal tumor,
mixed connective tissue variant” – also called as PTMTMCT
Tumours that may cause this are:
1. Fibromas
2. Sarcomas
3. Osteoblastomas
4. Hemangiopericytomas
5. Giant cell tumours
6. Rarely lung/prostate
Patient presents to you with Osteomalacia and severe phosphoturia. Which of

the following cancers are known to case this?
A) Osteosarcoma
B) Fibrosarcoma
C) Undifferentiated sarcoma
D) Malignant peripheral nerve sheath tumours
ANSWER - B
Diagnosis is TIO (Tumour induced osteomalacia due to excessive FGF-23

secretion)
FGF 23 secreted in excess classically by “phosphaturic mesenchymal tumor,
mixed connective tissue variant” – also called as PTMTMCT
Tumours that may cause this are:
1. Fibromas
2. Sarcomas
3. Osteoblastomas
4. Hemangiopericytomas
5. Giant cell tumours
6. Rarely lung/prostate
All of the following drugs increase bleeding when given to a patient on warfarin
EXCEPT:
a. Isoniazid
b. Amiodarone
c. Carbamazepine
d. Cimetidine
ANSWER - C
Easy one -
Carbamazepine reduces INR by enhancing metabolism of warfarin. Hence predisposes to
clotting & not bleeding. See table below- those given in bold are important.
Drugs that increase INR with Drugs that decrease INR with warfarin
Warfarin
• Acarbose • Azathioprine & 6 MP / Sulfasalazine
• Acetaminophen • AED’s (especially phenytoin, carbamazepine,
• Allopurinol Phenobarbitone)
• Amiodarone • Bosentan
• Bismuth • Cholestyramine
• Celecoxib (especially COX2 inhibitors) • Isotretinoin
• H2RA (cimetidine/Ranitidine) • Nevirpapine
• Quinolones • Rifampicin
• Macrolides • PTU
• Azole antifungals • Raloxifene
• Colchicine • Ribavirin
• Danazol
• Disopyramide
• Statin & Fibrates NOTE: Effect of PI’s are variable –
• PPI’s Amprenavir/Atazanavir/Saquinavir increase INR.
• Ropinirole Darunavir/Lopinavir reduce INR.
Indinavir/Ritonavir/Tipranavir may increase or decrease.
Which of the following hormones is kept in inhibition by the hypothalamus?

A. Growth hormone
B. GH and prolactin
C. Prolactin
D. Prolactin only
ANSWER - B
GH & Prolactin - both are uner inhibitory control from hypothalamus. Prolactin
under dopaminergic control and GH under somatostatin control (also known as
GHIH – Growth Hormone inhibitory Hormone). GH is probably the only
hormone with both inhibitory(GHIH-somatostatin) as well as stimulatory
control (GHRH). Prolactin is probably the only hormone under pure inhibition
from hypothalamus.
All others are regulated by stimulatory control by various regulatory hormones.
Erythropoietin acts on ?
A) CFU (CFU-E)
B) Late erythtoblast
C) Reticulocyte
B) Blast forming unit (BFU-E)
ANSWER - A
One easy one.

Maximum action of EPO is to improve survival of CFU-E.
Proved by multiple experiments – In vitro CFU-E does not survive without EPO.
Death due to smoke inhalation is due to ?

A) Hypoxemia
B) Anemic hypoxia
C) Ischemic hypoxia
B) All of the above
ANSWER - B
In smoke/fire patient generally dies of excess CO poisoning (most frequent

cause of death). If there is low PaO2 – it is called as hypoxic hypoxia. In smoke
(CO poisoning) PaO2 will be normal and the problem is COHb. Abnormal Hb or
Reduced Hb concentrations comes under anemic hypoxia.
NOTE: Clinically speaking - Hypoxemia (low PaO2) can happen if the rapid fire
consumes a lot of oxygen and the FIO2 in the atmospheric air reduces to ≤ 15%
(normal 21%). Hypoxemia can also result from Non cardiogenic pulmonary
edema/ARDS after toxic smoke. Hence ideal answer would be A+B (or) B>A.
Since needed a single option – answer chosen B.
Small amounts of repeated thin stools with mucus, subjective feeling of fever
and lower abdominal pain, with leukocytes in stool. Which of the following is
likely?
A) Giardia
B) Entamoeba
C) Staph
D) Clostridium perfringens
ANSWER - B
Except Amebiasis all others cause watery & non-bloody diarrhea. Also none of
the other mentioned disorders apart from Amebiasis has WBC’s in stool.
Amebiasis can cause intermittent abdominal pain & mucoid / bloody diarrhea
as a part of chronic disease.
Fever can be seen approximately in 10-30% of patients with Amebiasis.
Which of the following tubes contain Sodium flouride as anticoagulant?

A)
B)
C)
D)
ANSWER - B
Gray vacutainer contains Sodium fluoride (For glucose estimation. NaF inhibits
glycolysis)
Vacutainer chart – Note: Red may be plain or may contain clot activator
Northern blot technique is used for

a) DNA
b) Proteins
c) RNA
d) Fat
ANSWER - C
Easy one
Northern blot – RNA
Southern blot – DNA
Western blot - Proteins
Which of the following can help in differentiating thymoma from ALL?

A) Tdt
B) Cytokeratin
C) CD3
D) CD1a
ANSWER - B
Simple one. Cytokeratin is an epithelial cell marker. (will be absent in

lymphoma)
Intern drops blood on the floor, what should be done next?

A) 1% sodium hypochlorite
B) Mop the floor
C) Cover it with absorbing material
D) Inform the infection control board of hospital
ANSWER - C
Question asked what should be done next.

These are guidelines from WHO – BEST PRACTICE (for blood spillage)
Blood spillage may occur because a laboratory sample breaks in
the phlebotomy area or during transportation, or because there is excessive
bleeding during the procedure. In this situation, clean up the spillage and record
the incident, using the following procedure.
• Wear a pair of non-sterile gloves.
• Use tongs or a pan and brush to sweep up as much of the broken glass (or container) as possible. Do not pick up
pieces with your hands.
• Discard the broken glass in a sharps container. If this is not possible due to the size of the broken glass, wrap the
glass or container in several layers of paper and discard it carefully in a separate container. Do not place it in the
regular waste container.
• Use disposable paper towels to absorb as much of the body fluids as possible. (Step 1)
• Wipe the area with water and detergent until it is visibly clean. (Step 2)
• Saturate the area again with sodium hypochlorite 0.5% (10 000 ppm available chlorine). This is a 1:10 dilution of
5.25% sodium hypochlorite bleach, which should be prepared daily (Step 3)
• Rinse off the tongs, brush and pan, under running water and place to dry.
• Remove gloves and discard them.
• Wash hands carefully with soap and water, and dry thoroughly with single-use towels.
• Record the incident in the incident book if a specimen was lost, or persons were exposed to blood and body fluids.
NOTE: LOCAL GUIDELINES IN DIFFERENT HOSPITALS MAY VARY. BUT GOLD STANDARD WILL BE -
WHO’s BEST PRACTICE GUIDELINES.
Morphine given for all except

A) Ischemic pain
B) Biliary colic
C) Cancer pain
D) Post op pain
ANSWER - B
Morphine has theoretical risk of biliary spasm. Hence avoided in biliary colic.
Patient presents with recent onset breathlessness and ECG is taken. ECG is
shown below. What is the diagnosis?
A) AF
B) PSVT
C) AMI
D) MAT
ANSWER - D
ECG shows narrow complex tachycardia with irregular rhythm.

Since P waves are seen it rules out AF.
Different morphologies of P waves (≥3) in lead II rules out Sinus arrhythmia.
All the above said features confirm MAT.
Also absence of chest pain & significant ST elevations rules out AMI.
Note- This is a fictional ECG. May not be the same asked in AIIMS.
Patient who is a known case of thalassemia major already on repeated blood

transfusions with history of iron overload previously treated with chelating
agents. She also has a history of cardiac arrhythmia. She came for BT now.
During BT patient complained of backache and looks extremely anxious. what is
next management?
A) Observe for a change in colour of the urine
B) Continue BT, Do ECG
C) Stop BT and wait for patient to get normal and start
D) Stop BT & Do clerical check
ANSWER - D
The patient has ominous signs of a major Acute Hemolytic transfusion reaction (
Backache/anxiety). STOP THE TRANSFUSION WITHOUT ANY DELAY.
Also further work up is mandatory(especially the basic clerical work like
checking the blood product details and cross matching reports) and do not
restart transfusion until it is complete. MMS algorithm is given below:
Which of the following is NOT useful in measuring cardiac output?

A) Transthoracic Echocardiogram
B) Central Venous Catheter
C) Thermodilution Pulmonary catheter
D) Continuous Cardiac output pulmonary catheter
ANSWER - B
Central Venous catheter alone is NOT useful for measuring Cardiac output.
Various ways of measuring CO are:
1. PAFC (Pulmonary artery floatation catheters) – Uses dye dilution &
Thermodilution techniques (Bolus & continuous thermodilution cardiac
output monitoring) are available.
2. Arterial waveform analysis
3. Fick partial rebreathing method (uses CO2)
4. Lithium dilution (uses peripheral vein)
5. Combined lithium dilution and pulse con- tour analysis
6. Thoracic electrical bioimpedance
7. Aortic doppler (Transesophageal & Trans-cutaneous)
8. Point of care Echo (Transthoracic as well as Transesophageal) – LVOT is
analyzed for Cross sectional area(CSA) & Velocity Time Integral (VTI). CO is
measured by the formula CO = CSA x VTI x HR
IMAGES asked in Medicine
X ray is suggestive of Pneumoperitoneum

Rain drop pigmentation – Arsenic poisoning

Image of a chemoport
Image of a Rectal thermoprobe

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Q1.

MMS – AIIMS NOV 2018

Not involved in gustation/olfaction

Involvement of paracentral lobule causes all except:

Paracentral lobule is involved in Bladder and bowel functions + Sensory /

NOTE: Perianal anesthesia is a feature of conus medullaris lesions of soinal

Easy pick – Lithium causes Ebstein’s. Monitor for cardiac anomalies.

Which is NOT included in UIP?

Childhood JE is included. Adult JE is not.

BCG is protective against?

Maximum steroid production by fetal adrenals:

DHEAS is the principal steroid of the fetal adrenal gland.

Relative bradycardia is uncommon in:

Highly ambiguous question.

LNG dose in Emergency contraception:

Two regimens are available.

How to differentiate from Tamponade vs Tension Pneumothorax: (or other way)

Tension Pneumothorax – Hypotension / mediastinal shift + U/L absent air

Chest trauma + Tachypnea (RR ≥ 40) + Hypotension (BP-90/60) + Hyper-

Typical tension pneumothorax. Insert wide bore needle (preferably 14G/12G)

Technique for Ryle’s tube insertion:

Repeat. For NG tube:

(Note: Supine with Neck extended is ideal for ET intubation)

GCS of this patient is E3 VT M6 = 9T/10 or 9/10 + V=nt.

16F Foley’s colour:

Reason for thyroid storm after thyroid surgery:

1. Spontaneous thyroid storm in patient with Grave’s – Usually infection

Nobel prize for medicine/physiology in 2018 for the discovery of:

James Allison/Taksu Honjo worked on Negative immune regulation in 1992

Most important marker for Alcoholic hepaitis:

Tricky. Be sure about your recall.

IFN beta stimulated by:

IFN alpha IFN beta IFN gamma

Cannot be diagnosed without positive ANA:

Simple, uncomplicated.& extremely practical.

Note: There is NO ANA negative SLE. But there is ANA negative

One of the easy picks. Kartagener is a primary ciliary disorder and as

Most guidelines recommend treatment with AED’s for at least 2-5

Pulmonary Tb with documented resistance to INH & Rifampicin. Appropriate

Here we are dealing with an MDR TB.

Treatment/Prevention of AMS (Acute Mountain Sickness):

Combining Verapamil & Metoprolol will result in:

As simple as it gets. Both are AV nodal blockers and hence – Brady/AV

Child taking ATT comes with ophthalmic issues. Drug associated:

No explanation needed. Child is probably having optic neuritis due to

SPIKES protocol is used for:

It is for breaking bad news to patients/attendants. Six steps involved are:

Side effect of salbutamol are all except:

Repeat. Salbutomol does not cause hypoglycemia.

The question ideally asks the ability to document pulsus paradoxus. BP

Patient is in window period (<4.5 hours) and no contra-indications has been

Cardiac axis at 90 degrees. ’R’ wave will be maximum in which lead:

Universal blood donor – O negative

Which of the following is not done before ABG:

While taking ABG – wrist is generally kept in hyper-extension. This is to make

Opportunistic infections are extremely common post transplant in the period

40 yr old woman with proteinuria with the IF pattern as follows:

The IF image shows classic “FULL HOUSE” pattern in lupus.

D-xylose test is a test of mucosal permeability of upper intestine.

What is the difference between RIFLE & KDIGO criteria in differentiating a

This is a compliance curve.

Hence the answer is emphysema (Increased compliance)

Patient presents to you with Osteomalacia and severe phosphoturia. Which of