(Study Material) ALL INDIA 2005 (AIPGE 2005 January, Answers, Explanation and Notes) (Pg-2)
PAPER : ALL INDIA 2005 (AIPGE 2005 January, Answers, Explanation and Notes)
Page -2
Q.26 Which one of the following is the investigation of choice for evaluation of
suspected Perthe’s disease ?
1) Plain X-ray
2) Ultrasonography (US)
3) Computed Tomography (CT)
4) Magnetic Resonance Imaging.
Answer is 4
Dahnert Radiological review manual, 5th Ed, Pg-49
Haaga; CT/MRI of whole body
MRI is 90-100 sensitive and 85-90% specific for diagnosis of Perthe’s disease
and avascular necrosis (Haaga). MRI can detect the earliest changes in signal
intensity of tissues. Edema seen as a high- signal- intensity (bright) on MRI T2
weighted image as earliest sign of inflammation.
So it is the investigation of choice in evaluation of suspected Perthe”s
disease
If Question were – Next step in evaluation of patient, or what will be the
first investigation of choice? Then answer will be – Plain X-ray
PEARL POINTS about Legg-Calve-Perthe’s disease- Coxa plana
-It is idiopathic avascular necrosis of femur head
-Only 10% cases are bilateral,
-M: F ratio - 5:1, but in bilateral cases M: F is 2:1
-When occur In adults it is called Chandler’s disease
-Loss of “asterisk “ sign – seen on CT/MRI
-Double line sign (in 80% of cases) seen on MRI
Q.27. Eisenmenger syndrome is characterized by all except:
1. Return of left ventricle and right ventricle to normal size.
2. Pulmonary veins not distended.
3. Pruning of peripheral pulmonary arteries.
4. Dilatation of central pulmonary arteries.
Answer is 1 Dahnert Radiological review manual, 5th Ed, Pg -627-628
CXR findings of Eisenmenger syndrome
- Pronounced dilatation of central pulmonary arteries
- Pruning of peripheral pulmonary arteries
- Enlarged RV+ RA
- Return of LA +LV to normal size
- Normal pulmonary vein
- No redistribution of pulmonary vein (normal venous pressure).
Q.28 In which one of the following conditions the Sialography is
contraindicated?
1. Ductal calculus.
2. Chronic parotitis
3. Acute parotitis
4. Recurrent sialadenitis.
Answer is 3
LB 24TH/728
Mumps is the most common cause of acute painfull parotid swelling,that
predominantly affect the children.acute bacterial parotitis is most commonly
caused by staph. Aureus. Sialography is absolutely contraindicated in acute
infection.
Q.29 The most common site of leak in CSF rhinorrhea is:
1. Sphenoid sinus.
2. Frontal sinus.
3. Cribriform plate.
4. Tegmen tympani.
Answer is 3 Snell’s clinical anatomy 7th Ed, Pg-802
Harrison principle of internal medicine 15th Ed
Cribriform plate of the ethmoid bone may be damaged in the fractures of ant.
cranial fossa. The patient will be having epistaxis and CSF rhinorrhea. CSF may
also leak through the adjacent sinus. Persistent rhinorrhea and recurrent
meningitis are indications for surgical repair of torn dura and underlying
fracture.
Pearl points about head injury. (Bailey and love’s 24th ed/596)
Glial and macrophage reactions begin within 2 days after brain contusion and
result in scarred, hemosiderin-stained depressions on the surface (plaques
jaunes) after years. Those are one
source of posttraumatic epilepsy that occurs after years of the head injury.
Administration of prophylactic antibiotic in fracture base of skull gives no
benefit.
Even it can increase morbidity and mortality.
Dexamethasone having controversial role in treating raised I.C.T. in-patient of
head
injury. But it has a definite role in raised ICT due to other reason.
Fluid leaking from nose and ear should be screened for ?-transferrin (tau
protein) to
confirm the CSF.
Fresh blood clot and coagulopathic proteins gives mixed density on CT called
SWIRL sign
Blow out fracture is fracture of orbital floor gives TEAR DROP sign on CT.
Q.30 Which of the following is the most common renal cystic disease in infants
is?
1. Polycystic kidney.
2. Simple renal cyst.
3. Unilateral renal dysplasia.
4. Calyceal cyst.
Answer is 3
Current pediatric diagnosis and treatment, 11th Ed, Pg-15;
Dahnert Radiological review, 5th Ed, Pg-928-929
-Most abdominal masses in the newborn are associated with the kidneys
(multicystic dysplastic kidney, hydronephrosis, etc)
-MCDK –is Potter type II cyst
-It is second most common cause of an abdominal mass in neonate (after
hydronephrosis)
-It is most common form of cystic disease in infants
- U/L MCDK is the most common form of multicystic dysplastic kidney (80-90%).
Lt: Rt ratio 2:1
-Nuclear studies (99m-Tc MAG3) preferred over IVP for evaluation of the function
of kidneys, because in first month of life the concentrating ability of even
normal neonatal kidneys is suboptimal.
Q.31 The most common type of total anomalous pulmonary venous connection is:
1. Supracardiac.
2. Infracardiac
3. Mixed.
4. Cardiac.
Answer is 1
Ref- C.P.D.T; 11Ed / 557
Dahnert Radiological review, 5th Ed, Pg-603
TAPVC –It is classified according to the site of entry of pulmonary vein into
the right of the heart
Type 1 – (55%) entry into left SVC or Rt SVC (Supracardiac)
Type 2 - entry into Rt atrium or coronary (cardiac)
Type 3 - entry in portal vein (Infracardiac)
Type 4 – mixed
Q.32 Which one of the following is the most common location of hypertensive
bleed in the brain?
1. Putamen/external capsule.
2. Pons.
3. Ventricles.
4. Lobar white matter.
Answer is 1 Harrison principle of internal medicine 15th ed/2386
Intraparenchymal hemorrhage is most
common type of intracranial hemorrhage. Hypertension, trauma, and cerebral
amyloid angiopathy are among the imp. causes. Advanced age and heavy alcohol
consumption also increase the risk. Cocaine use is one of the most important
causes of it in the young adults.
The most common sites of
Intraparenchymal bleed are the basal ganglia (Putamen, thalamus, and adjacent
deep white matter), deep cerebellum, and Pons. The Putamen is the most common
site for hypertensive hemorrhage
Q.33 Which one of the following is the most preferred route to perform cerebral
angiography?
1) Transfemoral route
2) Transmaxillary route
3) Direct Carotid Puncture
4) Transbranchial route.
Grainger and Allison’s Diagnostic Radiology 4th ed./150
Harrison internal medicine 15th ed/.
It is possible to opacity arteries in many areas of the body using a direct
percutaneous needle puncture.
The common carotid and vertebral arteries can be punctured in the neck using an
anterior approach to obtain arteriograms of the carotid and vertebrobasilar
systems; the subclavian, axillary or brachial arteries can be punctured for
upper limb arteriography, the abdominal aorta (high or low) for lumbar, pelvic
and leg arteriography; and the femoral artery for single leg studies.
But now Percutaneous studies in the head and neck and upper limb have been
largely supplanted by the transfemoral catheter method.
Grainger and Allinson Diagnostic Radiology 4th ed.
Harrison internal medicine 15th ed/.
Q.34 Which one of the following soft tissue sarcomas frequently
metastasizes to lymph nodes?
1. Fibrosarcoma.
2. Osteosarcoma.
3. Embryonal Rhabdomyosarcoma.
4. Alveolar soft part sarcoma.
Answer is 3
Harrison
principle of internal medicine 15th ed/626
Sarcomas tend to metastasize through the blood rather than the lymphatic system;
lymph node metastases occur in 5% of cases.
Exceptions are
Synovial and epithelioid sarcomas,
Clear-cell sarcoma (melanoma of the
soft parts),
Angiosarcoma, and
Rhabdomyosarcoma
Where nodal spread may be seen in 17%
The pulmonary parenchyma is the most common site of metastases in
sarcomas. Exceptions are
|
Leiomyosarcomas of GIT |
Liver |
|
Myxoid liposarcomas |
Seek fatty tissue |
|
Clear-cell sarcomas |
Bones |
|
Alveolar soft part sarcoma |
CNS |
In the treatment of sarcomas Doxorubicin (Adriamycin is trade name) -based chemotherapy is favored (as in Leiomyosarcomas).
Q.35 Which one of the following radioisotope is not used as permanent implant?
1. Iodine-125
2. Palladium-103.
3. Gold-198.
4. Caesium-137.
Regional therapy of advanced carrier, Michael T. Lutze. Jushua T. Rubin. Ist ed/184.
R.C.S. Pointon, The Radiotherapy of malignant Disease 2nd ed/7.
Radioisotopes used, as permanent implant is known as brachytherapy.
Brachytherapy sources. Some of these radionuclides, e.g. radium-226, are accompanied by an equilibrium amount of one or more radioactive daughter products, which have different half-lives and emit different radiations.
| Radionuclide | Radiation emitted | Half-life |
| Radium-226 | Gamma rays | Gamma rays |
| Caesium-137 | Gamma rays | 30 years |
| Cobalt-60 | Gamma rays | 5.26 years |
| Indium-192 | Gamma rays | 74 days |
| Gold-198 | Gamma rays | 2.7 days |
| Strontium-90 | Beta rays | 28.1 years |
| Yttrium-90 | Beta rays | 64 hours |
- Caesium 137 source are now more commonly used.
- Gold 198 is used for Permanent gold seed implant.
- Stronum 90 - Bone
Yitrium 90 - Pituitary gland
Iodine 125 - CNS metastasis (RUBIN)
Q.36 Which one of the following tumors shows calcification on CT scan?
1. Ependymoma
2. Meduloblastoma.
3. Meningioma.
4. CNS lymphoma.
Answer is 3
Dahnert; Radiological review manual 5th Ed /299
CT findings of Meningioma—
1.Sharply demarcated well circumcised slowly growing mass
2.Wide attachment to adjacent dura mater
3.Cortical buckling of underlying brain
4. Hyperdense (70-75% due to psammomatous calcification) lesion on NECT
5.Calcification as circular/radial pattern seen on CT in20-25% cases
6. Hyperostosis of adjacent bone (in 18%)
| MRI findings— |
Angiography –mother in law phenomenon |
| 1
Dural tail sign in 60 % of cases 2 Hypervascularity |
1 Sunburst or
spoke-wheel pattern of vascularity, 2 Early draining vein |
D / D of suprasellar mass with calcification
- Craniopharyngioma (90% have calcification)
-Meningioma (25 % calcified as seen on CT)
-Granuloma
-Dermoid / Teratoma
-Rarely hypothalamic Glioma or Optic Glioma
Q.37 The technique employed in radiotherapy to counteract the effect of tumor motion due to breathing is known as:
1. Arc technique.
2. Modulation.
3. Gating.
4. Shunting.
Answer is 3
Grainger and Allison’s, diagnostic radiology 4th ed/143 Gated imaging
When any motion of body produces disturbance and motion related artifact in
images in Radiology or during radiotherapy, then gating is done to reduce the
motion related artifacts.
If cardiac motion - ECG gating done
If respiratory motion - Diaphragmatic gating done.
Q.38 In which of the following diseases, the overall survival is increased by
screening procedure?
1 Prostate cancer.
2 Lung cancer.
3 Colon cancer.
4 Ovarian cancer.
Answer is 3
Harrison principle of internal medicine 15th ed/501
Widespread screening for breast, cervical, and colon cancer is beneficial for
certain age groups
|
Breast Cancer Annual or biennial screening with mammography or mammography plus clinical breast examination in women over the age of 50 saves lives.
|
Lung Cancer Screening® chest radiographs and sputum cytology has been evaluated as methods for lung cancer screening. No reduction in lung cancer mortality has been found |
|
Colorectal Cancer ® Annual fecal occult blood testing using hydrated specimens could reduce colorectal cancer mortality by a third. Two case-control studies suggest that regular screening of people over 50 with sigmoidoscopy decreases mortality.
|
Cervical Cancer Screening with Papanicolaou smears decreases cervical cancer mortality. Guidelines recommend regular Pap testing for all women who are sexually active or have reached the age of 18. The recommended interval for Pap screening varies from 1 to 3 years |
Q.39 Gamma camera in Nuclear Medicine is used for:
1 Organ imaging.
2 Measuring the radioactivity.
3 Monitoring the surface contamination.
4 RIA.
Answer is 2
Walter – Miller, Textbook of Radiotherapy; Pg -112
Grainger and Allison diagnostic radiology 4th Ed/141
Gamma camera is the devices used to observe the distribution of an isotope in an
organ, or in a part of the body. It receives the gamma ray photons from patient
through a grid of thousands of holes drilled parallel to each other. Gamma
camera measures the radioactivity in body then forms a image
GAMMA CAMERA IS Used for detection of radioactivity IN BODY. The M/C used
detector is scintillation detector.
Scintillators - when these are struck by a photon of X-ray or gamma ray they
scintillate
(released as a flash of light). In gamma camera - Scintillator used is made upto
NaI crystal.
Q.40 At t=0 there are 6x1023 radioactive atoms of a substance, which decay with
a disintegration constant () equal to 0.01/sec. What would be the
initial decay rate?
1 6x1023
2 6x1022
3 6x1021
4 6x1020
Answer is 3
Grainger and Allison’s. Diagnostic radiology 4th ed/140.
Radioactive decay -
- dN 1
l
= -
dt N
l
= is decay constant
dN
= is decay
rate. It dt = is from starting (dt = T2 - T1)
dt
it T1 is 0 than dt = t
t
So initial decay role dN = - lXN
= .001 x 6 x 1023
= 10-2 x 6 x 1023
= 6 x 1021 is
the answer
- Initial decay rate =
radioactive atoms initially x disintegration constant
=6 x10 (23) x .01
=6 x 10 (21)
Q.41 An 18-year-old boy comes to the eye casualty with history of injury with a tennis ball. On examination there is no perforation but there is hyphaema. The most likely source of the blood is
1 Iris vessels.
2 Circulus iridis major.
3 Circulus iridis minor.
4 Short posterior ciliary vessels.
Answer is 2
Parson disease of eye 19th ed/16,407
Circulus Arteriosus major situated along the base of iris in the ciliary body.
Circulus arteriosus minor along papillary margin
A concussion injury to iris, especially angle resection leads to hemorrhage in
the ant.
Chamber called hyphaema.
Q.42 A 25-year-old male gives history of sudden painless
loss of vision in one eye for the past 2 weeks. There is no history of trauma.
On examination the anterior segment is normal but there is no fundal glow. Which
one of the following is the most likely cause?
1 Vitreous haemorrhage.
2 Optic atrophy.
3 Developmental cataract.
4 Acute attack of angle closure glaucoma.
Answer is 1
Parson disease of eye 19th ed/360
A. K. Khurana ophthalmology 2nd ed/11
|
Optic atrophy |
Painless but gradual loss of vision |
|
Developmental cataract |
Painless but gradual loss of vision |
|
Acute attack of angle closure glaucoma |
Painful, sudden loss of vision |
|
Vitreous hemorrhage |
Painless, sudden onset fall in vision |
Q.43 The mother of a one and a
half year old child gives history of a white reflex from one eye for the past 1
month. On computed tomography scan of the orbit there is calcification seen
within the globe. The most likely diagnosis is:
1 Congenital cataract.
2 Retinoblastoma.
3 Endophthalmitis.
4 Coats of disease.
Answer is 2
Wolfgang Dahnert Radiology Review Manual 5th ed/345
Kanski’s Clinical Ophthalmology Pg-338.
- Leukocoria (white papillary reflex) is most common sign (in about 60% of
cases).
- Strabismus - 2nd most common sign (20% of cases).
- Anterior segment invasion by Retinoblastoma is a rare presentation, if it
occurs,is seen in older children with an average age > 6 yrs.
- Metastasis seen to the regional lymph nodes and brain.
- USG detect the presence of calcification at calculates tumor dimension
- CT can also detect calcification; also detect gross involvement of optic
nerve,orbital and CNS extension.
- MRI is more useful for optic nerve evaluation.
Q.44 Enlarged corneal nerves may be seen in all of the following except:
1 Keratoconus.
2 Herpes simplex keratitis.
3 Leprosy.
4 Neurofibromatosis.
Answer is 2
Ref. Grayson’s Diseases of the Cornea, 4th Ed pg-50
Corneal nerves may be seen in normal eyes as fine branching white lines.
That originates at the limbus in the mid stroma and become more anterior
centrally. Corneal nerves are visualized more clearly when they are thickened.
-Causes of thickened corneal nerves are –
Fuch’s dystrophy
Keratoconus
Neurofibromatosis
Refsum’s disease
Ichthyosis Leprosy
Congenital glaucoma
Multiple Endocrine neoplasia
Use of Cannabis Sativa
Aging
Q.45 Under the WHO ‘Vision 2020’ programme, the ‘SAFE’ strategy is
adopted for which of the following diseases?
1 Trachoma.
2 Glaucoma.
3 Diabetic retinopathy.
4 Onchocerciasis.
Answer is 1
(trachoma)
WHO MANNUAL OF OPHTH.
It is a repeat question
GET 2020 (global elimination of glaucoma) was launched under leadership of
W.H.O. in 1997. Through this the primary health care approaches are based on
evidence based SAFE strategy.
S surgery
A antibiotic
F facial cleanness
E environmental changes
Q.46 Type I hypersensitivity is mediated by which of the following
immunoglobulins?
1 Ig A.
2 Ig G.
3 Ig M.
4 Ig E.
Answer is 4
H15TH /1827
Type I Immediate Reaction Hypersensitivity
1 First exposure sensitizes host
2 Macrophages and B cells present epitopes to Th2 cells, which produce
interleukin (IL)-4
3 IL-4 causes class switch to Ig E
4 Mast cells and basophils bind Ig E to high-affinity receptors
5 Ig E cross-linking initiates granule release
These granules contain histamine, heparin, and proteases that induce edema,
increased mucus secretion, and smooth muscle contraction; this is the immediate
reaction that occurs
Q.47 Horner’s syndrome is characterized by all of the following except:
1 Miosis.
2 Enophthalmos
3 Ptosis.
4 Cycloplegia
Answer is 4
H15TH/564
Harrison principle of internal medicine 15th ed/564
Sympathetic nerve paralysis leads to Horner's syndrome (enophthalmos, ptosis,
miosis, and ipsilateral loss of sweating and loss of ciliospinal reflex). Triad
of Horner's syndrome? miosis with ipsilateral ptosis and anhidrosis constitutes
Horner's syndrome, although anhidrosis is an inconstant feature. Two other
features are loss of ciliospinal reflex and enophthalmos. But these don, t
constitute the part of triad. Cycloplegia is not a feature of it.
Q.48 The superior oblique muscle is supplied by:
1 3rd cranial nerve.
2 4th cranial nerve.
3 5th cranial nerve.
4 6th cranial nerve.
Answer is 2
Harrison principle of internal medicine 15th ed/176
Trochlear Nerve
The fourth cranial nerve originates in the midbrain, just caudal to the
oculomotor Nerve complex.
Only nerve that exit the brainstem dorsally and cross to innervate the
Contralateral superior oblique.
The principal actions of this muscle are to depress and to intort the globe.
Palsy
Therefore results in hypertropia and excyclotorsion. "Head tilt test"
is a
cardinal diagnostic feature.
Note?Trochlear nerve is longest intracranial nerve. While 10th nerve is longest
cranial nerve.
Abducent is not the longest intracranial nerve but it is most common nerve
involved in raised
I.C.T. and gives pseudolocalising sign (Dutta’s anatomy).
Q.49 Which of the following statement is true regarding Acanthamoeba keratitis?
1 For the isolation of the causative agent, corneal scraping should be
cultured on a nutrient agar plate.
2 The causative agent, Acanthamoeba is a helminth whose normal
habitat is soil.
3 Keratitis due to Acanthamoeba is not seen in the
immunocompromised host.
4 Acanthamoeba does not depend upon a human host for the
completion of its life cycle.
Answer is 4
Harrison principle of internal medicine 15th ed/1202
Free-living amebas are Acanthamoeba, Naegleria, and Balamuthia are distributed
throughout the world and have been isolated from a wide variety of fresh and
brackish water. They don’t need of a human host for the completion of its life
cycle.
Risk factors for their infection
|
Lymphoproliferative |
Chemotherapy |
PEARL POINTS
Culture is done on nonnutrient agar plates seeded with Escherichia coli.
Fluorescein-labeled antiserum is available for the detection of protozoa in
biopsy specimens.
Examination of the cerebrospinal fluid for trophozoites may be diagnostically
helpful, but lumbar puncture may be contraindicated because of increased
intracerebral pressure.
The persistence of Legionella pneumophila in water supplies may be attributable
to chronic infection of these amebas, particularly Naegleria.
The characteristic clinical sign is an annular, Para central corneal ring
representing a corneal abscess.
Q.50 A 30-year-old man has 6/5 vision each eye, unaided. His cycloplegic
retinoscopy is +1.0 D sph. at 1 meter distance. His complaints are blurring of
newsprint at 30 cm. that clears up in about two minutes. The most probable
diagnosis is:
1 Hypermetropia.
2 Presbyopia.
3 Accommodative inertia.
4 Cycloplegia.
Answer is 3
Gunter K. Von Noorden, Binocular vision and ocular mortality 6th ed/86.
• A blurred retinal image is the stimulus to accommodation. Then accommodation
starts and completed with in few seconds. In accommodation inertia -
accommodation is slow to come in action but Person ultimately accommodates, it
takes few minutes to fully accommodate.
• Accommodation is of the reciprocal of the Fixation distance. Thus if
fixation distance is 1 met
- accommodation is 1 D.
If 1/2 meter - 2D.
If 1/3 meter - 3D.
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