few things about various histological types of CARCINOMA THYROID

1)most common type = papillary carcinoma
2)most commonly associated with h/o radiation exposure to neck = papillary
latent period for such radiation induced carcinoma = 30 years
3)type not associated with radiation exposure = lymphoma
4)most common type associated with dystrophic calcification= papillary
5)psammoma bodies are seen in = papillary
6)orphan annie eyed nucleus seen in = papillary
7)best prognosis = papillary
8)worst prognosis=anaplastic
9)type associated with lateral aberrant thyroid(cervical metastasis)= papillary

10)type associated with MEN-2 syndrome = medullary
11)type associated with amyloidosis = medullary
12)type derived from parafollicular C cells = medullary
13)type associated with hypocalcaemia = medullary

14)type originating in a case of longstanding multinodular goitre= follicular
15)bony metastasis common in = hurthle cell carcinoma(variant of follicular carcinoma)
16)FNAC not useful in = follicular

FEW DANGEROUS AREAS !!!

all these have been asked as MCQs before

1)dangerous area of eye = CILIARY REGION (penetrating trauma here makes eye prone to sympathetic ophthalmitis)

2)dangerous area of face = area between upper lip and lower part of nose (infection here can spread to cavernous sinus through facial vein)

3)dangerous area of hand = also k/a area of pulleys or NO MAN'S LAND or zone 2. This lies between the distal palmar crease and the proximal interpalangeal joint.

QUES AIIMS NOV 2009)MOST COMMON CAUSE OF NEONATAL SEPSIS IN INDIA

aiims nov 2009) which of the following is the most common cause of neonatal sepsis in india?
a)group B streptococcus
b)eschirichia coli
c)pseudomonas
d)listeria

answer=before answering remember the top three most common causes of neonatal sepsis in india
1)klebsiella
2)staphylococcus aureus
3)pseudomonas
according to this order you have to answer the ques because options may be changed in upcoming exams,,,but here in our ques answer = pseudomonas
reference= here is a link to AIIMS protocol on neonatal sepsis
http://www.newbornwhocc.org/clinical_protocols.htm
also read this journal by indian academy of pediatrics
http://medind.nic.in/icb/t08/i3/icbt08i3p261.pdf

both these clearly write the most common organisms to be klebsiella>staph.aureus>pseudomonas

most common cause of meningitis among different age groups

most common cause of meningitis in india

a) till 2 months---------------------------gram negative bacteria esp.klebsiella,e.coli

b)2 months -3 years----------------------H.influenzae type B

c)3 years-20 years-------------------------streptococcus pneumoniae

d)>20 years----------------------------------streptococcus pneumoniae



most common cause of meningitis in WESTERN WORLD(DEVELOPED COUNTRIES)


a)till 2 months----------------------------group B streptococci

b))2 months -3 years------------------streptococcus pneumoniae

c)3 years-20 years---------------------neisseria meningitidis

d)>20 years-------------------------------streptococcus pneumoniae



i have written both india and western trends here to make u realise why mudit khanna and many other guides differ in their own answers on this ques from one paper to another.
this is because they use references from books like nelson,which are based on data collected in western world.

e.g in wetern world vaccination against H.influenzae is routinely done that is why H.influenzae meningitis is not common there
but in developing world (in our country also) even routine vaccination like OPV and BCG donot have 100 %coverage..forget about H.INFLUENZAE
so thats why among 2 months -3 years h.influenzae is most common cause in india
while in west,,,it is rare.

i have given both trends, but to solve mcqs u have to learn ONLY THE TREND IN INDIA

all ACE inhibitors are prodrugs except CAPTOPRIL and LISINOPRIL

.............

features of hallucinations

following are the features of hallucinations from FISH'S PSYCHIATRY and CAMPBELL'S PSYCHIATRY DICTIONARY
1)it is a perception in the absence of stimulus.
2)it is clearly delineated and as vivid as a true sense perception.
3)it is independent of the will of the observer.
4)it occurs in outer objective space (e.g. outside ears in case of auditory hallucination).
5) sensory organs may be involved in subtypes like reflex hallucination and functional hallucinations.

note: if it occurs in inner subjective space (e.g. inside the person's own head in case of auditory hallucinations)=>it is known as PSEUDOHALLUCINATION and in this sensory organs are not involved.

now lets see few questions

ques 1)All of the following are true about hallucinations except?
a)it is as vivid as sense perception.
b)it is independent of the will of the observer.
c)occurs in inner subjective space.
d)it occurs in the absence of perceptual stimulus
this question came in may aiims 09 and the answer is C

ques 2)all are features of hallucinations except?
a)it is independent of will of observer
b)sensory organs are not involved.
c)it is as vivid as that in a true sense perception.
d)it occurs in absence of a perceptual stimulus.
this is ques from allindia 2003 ques no.298
and mudit khanna gives answer as C which is wrong ...correct answer is B since sensory organs may be involved.
for furthur reasoning ,,,,check comments....

few things on PNH....important topic aiims/allindia

PNH(paroxysmal nocturnal haemoglobinuria)...some important facts

pathogenesis-----this is due to mutation in PIGA gene(phosphatidylinositol glycosylated A gene) =>causing deficiency of GPI(glycosylated phosphatidyl inositol) which binds certain protective proteins to
cell membranes of RBCs,platelets and WBCs,these protective proteins PROTECT THE CELLS (RBC/WBC/PLATELETS) FROM COMPLEMENT MEDIATED LYSIS
these protective proteins are 1)CD 59(also k/a MIRL=membrane inhibitor of reactive lysis) ; 2) CD55(also k/a decay accelerating factor) ; 3)C8 binding protein,etc............out of these,CD59 is the most important

so PIGA mutation => GPI deficiency => deficiency of CD59,CD55,etc =>leading to complement mediated lysis of RBCs,platelets and WBCs

MCQs on PNH features
1)LAP score is decreased
2)pancytopenia with hyper/hypo/normocellular bone marrow is seen
3)gold standard for diagnosis-flow cytometry
4)other tests used for diagnosis--HAM oxidase test,,,,,,sucrose hemolysis test....but these are not reliable
5)ECULIZUMAB----monoclonal antibody against complement protein C5.....used in treatment of PNH

myasthenia gravis most sensitive test????

hey guys,,,if you see ques 185 allindia 2005 mudit khanna writes edrophonium test
which is wrong.
edrophonium test has low sensitivity and harrison writes that it is used infrequently to diagnose MG and is limited to situations when other investigations do not yield a conclusive diagnosis.
harrison writes that single fibre EMG is the confirmatory test but specificity is low.If you search for the most sensitive investigation for MG on google books and sites like wikipedia,,you will find its SINGLE FIBRE EMG which is most sensitive.
so please change the answer in allindia 2005 mudit khanna paper
i thank dr.varun agarwal who gathered the following material in support of all this:

reference no 1) http://neuromuscular.wustl.edu/mtime/mgdx.html
it writes few things against edrophonium test(also k/a tensilon test),,,just check out
Utility of Tensilon test
Only useful in patients with objective, preferably measurable, findings on physical examination
Rarely helpful in the diagnostic evaluation of equivocal cases of MG
Sensitivity for MG is relatively low (60%) compared to other diagnostic tests
and few things in favour of SFEMG from the same site
SFEMG is the most sensitive test for MG
Sensitivity: > 95% positive in generalized & ocular MG

reference no.2) - http://en.wikipedia.org/wiki/Myasthenia_gravis
read the lines from wikipedia:

''The "edrophonium test" is infrequently performed to identify MG; its application is limited to the situation when other investigations do not yield a conclusive diagnosis ...
Its single fiber electromyography, which is considered to be the most sensitive (although not the most specific) test for MG.''


i have got more material to prove the above written facts,,,you can safely mark as according to the following statements in the exam:
1) most sensitive investigation for MG = single fibre EMG
2)most specific investigation for MG = anti Ach receptor antibodies


please comment if you have doubts on this

few controversies....

ques 1) which is the drug of choice for seizures in pregnancy??? (allindia 2002)
a)sodium valproate
b)carbamazepine
c)phenobarbitone
d)phenytoin
this ques is one of the most controversial questions in aipge history with different sources giving different answers....here are few
1)mudit khanna = phenobarbitone
2)IAMS coaching =phenobarbitone
3)rxpg site = phenytoin
4)bhatia coaching = carbamazepine
5)pgi sources = carbamazepine
answer is CARBAMAZEPINE
here is the reference----- read the following lines from LAURENCE 9th EDITION PAGE 416
''with current information,carbamazepine seems to be the safest drug for use in pregnancy. Data on lamotrigine(more recently used) are increasing,but it has not been shown,to be strongly associated with malformations.''


QUES 2)which is the drug of choice for absence seizures?
a)sodium valproate
b)ethosuximide
we all know its ethosuximide....but these days some guides are saying otherwise,,even some coaching institutes say valproate,mainly because in harrison table for treatment of epilepsy,,valproate has been written over ethosuximide in the table....but nowhere in harrison it is mentioned that valproate is the drug of choice...if anybody finds this statement in any other book,,please update here...till then go with ethosuximide because i have got a standard text book ref for that...read on
page 387 katzung pharma 10th edition
''valproate is very effective against absence seizures.Although ethosuximide is the drug of choice when absence seizures occur alone,valproate is preferred when the patient has concomitant generalised tonic clonic attacks.The reason for preferring ethosuximide for uncomplicated absence seizures is valproate's idiosyncratic hepatotoxicity.''
so when asked DOC for absence seizures= ethosuximide
DOC for complicated/mixed/resistant absence seizures = valproate

most common

1)most common endocrinal manifestation of MEN-1 =hyperparathyroidism
2)most common neuroendocrine tumour in MEN-1=GASTRINOMA >INSULINOMA
3)most common enteropancreatic tumour in MEN-1= GASTRINOMA >INSULINOMA
4)most common pancreatic tumour in MEN-1=insulinoma(since gastrinomas are more commonly in duodenum)
5)most common location of insulinoma=equally in pancreatic head,body and tail
6)most common benign pancreatic ENDOCRINE tumour overall=insulinoma
7)most common MALIGNANT pancreatic ENDOCRINE tumour overall=gastrinoma(because insulinomas are mostly benign)
8)most common provocative test for diagnosis of gastrinoma=secretin stimulation test
9)most sensitive diagnostic test for gastrinoma= fasting gastrin levels

drugs used in alcohalic rehabilitation (MAY AIIMS 2009)

Following drugs are used in rehabilitation of alcohal dependence patients :
mnemonic= ''Say No To DARO''
Say - SSRIs
No - naltrexone,nalmefene
To - topiramate
D - disulfiram
A - acamprosate
R - ramonibant (its a cannabinol receptor antagonist)
O - ondansetron

this was asked in may aiims 2009

most common congenital anomaly in baby of diabetic mother

1)most common CONGENITAL MALFORMATION in the baby of diabetic mother = CVS malformations > CNS malformations.
but this was organ system wise,,,if you ask lesion wise then
2)most common lesion is = neural tube defects > transposition of great vessels.
3)most specific lesion is = caudal regression syndrome (sacral agenesis)

solve the following questions based on this info and the concept will be clear.

ques1)which is the most common congenital malformation in a baby of diabetic mother?
a)neural tube defects
b)sacral agenesis
c)CVS malformations
d)GI malformations

ques 2)which is the most common congenital malformation in a baby of diabetic mother?
a)neural tube defects
b)sacral agenesis
c)transposition of great vessels
d)GI malformations

ques 3)which is the most specific congenital malformation in a baby of diabetic mother?
a)neural tube defects
b)sacral agenesis
c)transposition of great vessels
d)GI malformations

To check the answers ...see comments below this post

2 controversial questions of AIPGE 2010 on readers' request

2 controversial questions of OBG that came in aipge 2010

ques 1) drug of choice for intrahepatic cholestasis in pregnancy
a)cholestyramine
b)ursodiol
c)steroids
d)antihistaminics

ques 2)most useful investigation for VVF
a)3 swab test
b)cystoscopy
c)urine culture
d)IVP

answer of ques 1) ursodiol
ques 2) cystoscopy

answers have been verified by HOD OBG pgi chandigarh....

MITRAL STENOSIS X-RAY FINDINGS (HOT TOPIC PGI)

1) Backward displacement of oesophagus by enlarged left atrium==== earliest finding (aipge08).
2)straightening of left heart border.
3)dalatation of UPPER lobe pulmonary veins (k/a inverted moustache sign).
4)prominence of main pulmonary arteries.
5)kerley B lines ( these lines denote interstitial oedema)
6)lifting of left bronchus=> splaying of carina
7)double atrial shadows.

high yielding facts from nov AIIMS 09

all these were asked as MCQs in nov 2009 aiims
so have a very high chance of repeat this year
remember all these points

1) most common cause of neonatal sepsis in india = klebsiella > staphylococcus aureus > pseudomonas > e.coli.
2)cranial nerve ,which on stimulation ,elevates mood = vagus nerve.
3)most useful investigation for diagnosis for ectopic pregnancy = transvaginal USG.
4)tocolytic of choice in heart disease = atosiban.
5)best time for surgery of orchidopexy = 6-12 months.
6)best treatment for desmoid tumour = wide excision followed by radiotherapy.
7)full thickness graft is not taken from axilla.
8)in hyperkalemia without ECG changes,no need of giving calcium gluconate in treatment.
9)type of anaemia in intestinal tuberculosis = megaloblastic anaemia.
10)cryoprecipitate transfusion does not require ABO cross matching.
11)most sensitive investigation for myasthenia gravis = single fibre EMG.
12)most common cause of Subarachnoid haemorrhage = HEAD TRAUMA >aneurysmal rupture.
13)most common progestin used for emergency contraception = levonorgesterol.
14)OPV is a live attenuated vaccine.
15)thinnest part of sclera is behind the insertion of rectus muscle.

multiple sclerosis....all MCQs

MCQs on multiple sclerosis

-disease of WHITE MATTER

-most common presentation is OPTIC NEURITIS

-investigation of choice is MRI

-CSF exam-OLIGOCLONAL BANDS SEEN

-extrapyramidal symptoms NOT seen

-DOES NOT cause diabetes inspidus

-CAUSES impotence

-IT IS THE MOST COMMON CAUSE OF bilateral internuclear ophthalmoplegia

-new drugs used:GLATIRAMER,NATALIZUMAB,MITOXANTRONE

-interferon used in treatment is BETA INTERFERON

ONLY...................

1) only hepatitis virus which is a DNA virus = hepatitis B virus (aiims )

2)only tetracycline that is not nephrotoxic = doxicycline (allindia 2008)

3)only immunoglobulin that is heat labile = IgE (allindia mcq)

4)only circulation that does not have thrombomodulin expressed over its surface= cerebral circulation (aiims mcq)

5)only muscle of larynx not supplied by recurrent laryngeal nerve = cricothyroid ( which is supplied by external branch of superior laryngeal nerve) (allindia mcq)

6)only part of penis that does not drain into superficial inguinal lympnodes = glans penis , which drains into deep inguinal lymhnodes (allindia 2007)

7)only serotype of neisseria against which vaccine has not been developed = type B (aiims 04)

8)only muscles in the body which are not derived from mesoderm = muscles of iris (dilator and sphincter pupillae),which are derived from ectoderm. (aiims)

9)only abductor muscle of larynx = posterior cricoarytenoid (pgi)

10)only hepatitis virus that can be cultured = hepatitis A (aiims mcq)

BIOCHEMICAL MARKERS OF BONE METABOLISM

This is an extremely important topic.
remember this chart. reference=table 333-5 page 2273 16th edi harrison

A)BONE FORMATION MARKERS
1)serum bone specific alkaline phosphatase.
2)serum osteocalcin.
3)serum propeptide of type 1 procollagen.

B)BONE RESORPTION MARKERS
1)urine and serum crosslinked N-telopeptide.
2)urine and serum crosslinked C-telopeptide.
3)urine total free deoxypyridinoline.
4)urine hydroxyproline.
5)serum TRAP(tartrate resistant acid phosphatase).
6)serum bone sialoprotein.
7)urine hydroxylysine glycosides.

DRUG OF CHOICE-PART 1

1)DOC for severe falciparum malaria = artesunate (allindia 2009).
2)DOC for obsessive compulsive disorder = SSRIs(fluoxetine) > TCAs(clomipramine). (aiims mcq)
3)DOC for drug induced parkinsonism = centrally acting anticholinergics.
4)DOC for drug induced akathisia = beta blockers > centrally acting anticholinergics ( aiims may2004).
5)DOC for PSVT = adenosine.
6)DOC for seizures in pregnancy = phenobarbitone (allindia mcq)
7)DOC for type 1 lepra rxn = corticosteroids.
8)DOC for type 2 lepra rxn = thalidomide .(allindia 2008)
9)DOC for MRSA = vancomycin > linezolid > ciprofloxacin. (aiims)
10)DOC for enuresis = desmopressin > imipramine.
remember treatment of choice for enuresis = bell and pad method (allindia 2008) .

some BIOCHEMICAL abnormalities to remember

remember these biochemical abnormalities.....all mcqs


1) congenital hypertrophic pyloric stenosis------hypokalemic hypochloremic metabolic alkalosis.(aiims mcq)

2)BARTTER'S SYNDROME-----HYPOKALEMIC HYPOCHLOREMIC METABOLIC ALKALOSIS with HYPERCALCIURIA.(allindia ,hppg)


3)colorectal villous adenoma----hypokalemic hypochloremic hyponatraemic METABOLIC ACIDOSIS.(aiims mcq)


4)LIDDLE SYNDROME-----HYPOKALEMIC ALKALOSIS WITH HYPERTENSION WITH HYPERNATRAEMIA(aiims mcq)

5)GORDON SYNDROME----HYPERKALEMIC ACIDOSIS WITH HYPERTENSION. (pgi mcq)

6)ureterosigmoidostomy----hyperchloremic acidosis with hypokalemia .(aiims mcq)