PAPER : ALL INDIA 2005 (AIPGE 2005 January, Answers, Explanation and Notes)

Page -9

Q.201 Adenosine deaminase (enzyme) deficiency is associated with:
1 Severe combined immunodeficiency (SCID).
2 X-linked agammaglobulinemia.
3 Transient hypogammaglobulinemia of infance.
4 Chronic granulomatous disease.
Answer is 1             R7th /201
Severe combined immunodeficiency (SCID) is inherited as both autosomal recessive and X-linked recessive form. Autosomal recessive form of SCID characterized by severe lymphopenia, the failure in T and B cell development. It is due to mutations in the RAG-1 or RAG-2 genes. About half of patients with autosomal recessive SCID are deficient in an enzyme involved in purine metabolism, adenosine deaminase (ADA), due to mutations in the ADA gene.

Q.202 Which of the following viral infections is transmitted by tick.
1 Japanese encephalitis.
2 Dengue fever.
3 Kyasanur forest disease (KFD).
4 Yellow fever.

Answer is 3             K Park P.S.M. 17th ed/543.

Q.203 Atypical pneumonia can be caused by the following microbial agents except?
1 Mycoplasma pneumoniae.
2 Legionella pemmophila.
3 Human Corona virus.
4 Klebsiella pneumoniae.
Answer is 4                     Robbins Pathology 7 ed/747

Common Causes of Community acquired atypical pneumonia are.

 Q.204 The serum concentration of which of the following human Ig G subclass is maximum?
1 IgG1.
2 IgG2.
3 IgG3.
4 IgG4.
Answer is 4         H16TH ED /1922.AN6TH ED/81
Ig G comprises approximately 75 to 85% of total serum immunoglobulin. The four Ig G subclasses are numbered in order of their level in serum, IgG1 being found in greatest amounts and IgG4 the least.
 

Q.205 Chlamydia trachomatis is associated with the following except:
1 Endemic trachoma.
2 Inclusion conjunctivitis.
3 Lymphogranuloma venereum.
4 Community acquired pneumonia.
Answer is 4         H16TH ED /1531
Disease caused by Chlamydia trachomatis
 

Q.206 The following statements are true regarding Clostridium perfringens except:
1 It is the commonest cause of gas gangrene.
2 It is normally present in human faeces.
3 The principal toxin of C.perfringens is the alpha toxin.
4 Gas gangrene producing strains of C. perfringens produce heat resistant spores.
Answer is 4                 PANICKAR 6TH/230

Clostridia are present in the normal colonic flora at concentrations of 109 to 1010 per gram. C. ramosum is the most common and is followed in frequency by C. perfringens in colonizing clostridium. While most common colonizing organisms in colon are bacteriods.
C. perfringens is the most common of the clostridial species isolated from tissue infections (gasgangrene) and bacteremias.
C. perfringens is associated with food poisoning (type A) and enteritis necroticans (type C).
C. perfringens possesses at least 17 possible virulence factors. This species has been divided into five types (A through E) on the basis of four major lethal toxins: ?, ?, ?, and ?. The ? toxin is a phospholipase C (lecithinase) that splits lecithin into phosphorylcholine and diglyceride. This is a major toxin and associated with gas gangrene. Gas gangrene producing strains of C. perfringens produce heat labile spores and get destroyed with boiling

207 The most common organism amongst the following that causes acute meningitis in an AIDS patients is:
1 Streptococcus pneumoniae.
2 Streptococcus agalactiae.
3 Cryptococcus neoformans.
4 Listeria monocytogenes..
Answer is 3         Harrison 16th /1116

The AIDS dementia complex, or HIV encephalopathy, is considered an AIDS-defining illness. AIDS
dementia complex is commonest CNS disorder in AIDS patient.
Among the more frequent opportunistic diseases that involve the CNS are toxoplasmosis,
cryptococcosis, progressive multifocal leukoencephalopathy, and primary CNS lymphoma.
Toxoplasmosis is the most common opportunistic infection of CNS in AIDS patients. It is the most
common cause of chrioretinitis in these patient, while CMV is the most common cause of retinitis
in AIDS.
C. neoformans is the leading infectious cause of meningitis in patients with AIDS. It is the
initial AIDS-defining illness in approximately 2% of patients and generally occurs in patients
with CD4+ T cell counts <100/uL. Cryptococcal meningitis is particularly common in patients with
AIDS in Africa.

Q.208 A bacterial disease that has been associated with the 3 “Rs” i.e., rats, ricefields, and rainfall is:
1 Leptospirosis.
2 Plague.
3 Melioidosis.
4 Rodent-bite fever.
Answer is 1             K Park P.S.M. 17th P (222)

• Leptospirosis is a zoonosis with a worldwide distribution. Water is an important vehicle in their transmission. Epidemics of leptospirosis may result from exposure to flood waters contaminated by urine from infected animals
• Leptrospira are excreted in urine of infected animals for a long time. Rats, mice and voles particularly R. novergicus and Mus musculus are Reservoirs.
• Human infection is usually caused by occupational exposure to the urine of infected animals, eg agricultural and live stock farmers, worker in rice fields.
• Leisure time activities such as swimming and fishing also carry risks.
• Leptospira shed in urine and can survive for weeks in soil and water heavy rainfall can leads to high level of contamination of soil of that area. Potential contamination of water occurs.

Q.209 A child was diagnosed to be suffering from diarrhoea due to Compylobacter jejuni. Which of the following will be the correct environmental conditions of incubation of the culture plates of the stool sample:
1 Temperature of 42oC and micro-aerophilic.
2 Temperature of 42oC and 10% carbon dioxide.
3 Temperature of 37oC and micro-aerophilic.
4 Temperature of 37oC and 10% carbon dioxide.
Answer is 1             David Greenwood, Medical,Microbiology 16th edition/288

Campylobacter are Small spiral Gram negative with single flagellum at one or both pole. They are
usually sensitive to O2 and super oxide, yet O2 is essential for growth, so micro-aerophilic
condition must be provided for their cultivation. Compylobacter jejuni grow best at 42-43oC.
Note, other campylobactor like enteritis grows best at 37oC temp.

Q.210 Which one of the following statements is true regarding Chlamydia pneumoniae:
1 Fifteen serovars have been identified as human pathogens.
2 Mode of transmission is by the airborne bird excreta.
3 The cytoplasmic inclusions present in the sputum specimen are rich
in glycogen.
4 The group specific antigen is responsible for ithe production of complement fixing antibodies.
Answer is 4         Brooks medical microbiology ,23ed/chapter 28.
Chlamydia pneumoniae prduces the glycogen negetive inclusion bodies that are much like of
Chlamydia psittaci and are sulfonamide-resistant. Only one serovrar has discovered. Serology
using the Microimmunofluroscent test is the bmost sensitve method for the detection of Chlamydia
pneumoniae infection. This test is the species specific not the complement fixing antibody
detection by complement fixation test. Because the complement fixing antibodies are against the
group specific antigen so detection of these antibodies are not species specific.
Mode of transmission is by the airborne bird excreta is seen in Ch. Psittaci.

Q.211 Which of the following ultrasound marker is associated with greatest increased risk for Trisomy 21 in fetus:
1 Echogenic foci in heart.
2 Hyperechogenic bowel.
3 Choroid plexus cysts.
4 Nuchal edema.
Answer is         Williams /p 988
Risk associated with Down syndrome.

1) Nuchal fold ? 6 mm - 38%
2) Femur length - 34%
3) BPD/FL - 22%
4) Hyperechogenic bowel - 11%
5) Choroid plexus cyst - 0%

Q.212 The highest incidence of Gestational Trophoblastic Disease is in:
1 Australia.
2 Asia.
3 North America.
4 Western Europe.
Answer is 2                 H 16th /588, Dutta 5TH /206

Gestational choriocarcinoma accounts for <1% of female gynecologic malignancies. In the United States, the incidence is about 1 per 1000 pregnancies; in Asia, 2 per 1000 pregnancies. The spectrum of disease ranges from benign hydatidiform mole to trophoblastic malignancy
(placental-site trophoblastic tumor and choriocarcinoma).
A prior history of molar pregnancy is also a risk factor. Prior history of hydatidiform mole is a risk factor for choriocarcinoma.

Q.213 The smallest diameter of the true pelvis is:
1 Interspinous diameter.
2 Diagonal conjugate.
3 True conjugate.
4 Intertuberous diameter.

Answer is 2                         Dutta 5TH / p 90

Inter spinous diameter is the smallest diameter of the true pelvis. It is approximately

Q.214 The most common pure germ cell tumor of the ovary is:
1 Choriocarcinoma.
2 Dysgerminoma.
3 Embryonal cell tumor.
4 Malignant Teratoma.
Answer is 2             Dahnert Radiological review manual 5th edi/1046.
COGDT 9TH /chapter 49
Malignant germ cell tumor of ovary comprises 7% of tumor.

(a) Mature teratomy (10%) = the only benign variety and it is mixed tumor
(b) dysgerminoma (1.9%)
(c) immature Teratoma (Malignant Teratoma) (1.3%)
(d) Endodermal sinus tumor (1%)
(e) Malignant mixed germ cell tumor (.7%)
(f) Choriocarcinoma (.1%)
(g) Embryonal carcinoma (.1%)

Q.215 Infants of diabetic mother are likely to have the following cardiac anomaly:
1 Coarctation of aorta.
2 Fallot’s tetrology
3 Ebstein’s anomaly.
4 Transposition of great arteries.
Answer is 2         Famarof & Martin ‘s Neonatal-
Perinatal Medicine 7th Ed vol -1,Pg-282.

The congenital anomaly most specific for pregnant woman with DM is caudal dysplasia (sacral
agenesis), which occurs 200-400 times more often in diabetic women.) This lesion (sacral
agenesis) is most specific but not more common than Neural tube defect and Congenital
heart defects.
Malformations of CNS that are more common in decreasing frequency are
- Neural tube defect (open myelomeningocoele)
- Anencephaly
- Holoprocencephaly

Risk of Cardiac malformation such as TGA and VSD are increased 5 fold. TGA is the most common congenital cardiac anomaly in diabetic infants.

Q.216 Which one of the following is the ideal contraceptive for a patient with heart disease?
1 IUCD.
2 Depoprovera.
3 Diaphragm.
4 Oral contraceptive pills.
Answer is 2             Dutta /p 296

Barrier method of contraceptive (condom) is the ideal contraceptive - only barrier method given in choice is diaphragm.

Q.217 The karyotype of a patient with Androgen Insensitivity Syndrome is:
1 46xx.
2 46xy.
3 47xxy.
4 45x0.
Answer is 2         Robbins 7th/181, SHAWS 13TH /105
HARRISON 15th/chapter-338

Complete testicular feminization (also called complete androgen insensitivity) is a common
form of male pseudohermaphroditism; It is the third most common cause of primary amenorrhea after
gonadal dysgenesis(Turner syndrome) and congenital absence of the vagina
(Mayer-Rokitansky-Kuster-Hauser syndrome). The karyotype is 46,XY, and the mutation is X-linked.
Reifenstein syndrome (also called partial androgen insensitivity) is the term applied to forms of incomplete male pseudohermaphroditism

Q.218 The following drug is not helpful in the treatment of ectopic pregnancy:
1 Methotrexate.
2 Misoprostol.
3 Actinomycin-D.
4 RU 486.
Answer is 2         Williams’ 21st/898
                                        Novak’s Gynecology 13th ed/530
Methotrexate is a antineoplastic drug that acts as afolic acid antagonist and highly effective against rapidly proliferating trophoblast.single dose treatment is easier to administer and monitor than variable dose methotrexate therapy, but it i8s associated with high failure rate. A ai p p g .c o m paperIn case of failure second dose of methotrexate is given.
A five-day course of intravenous actinomycin results in coplete resolution of an ectopic pregnancy even in case of methotrexate failure.
RU 486(Mifepristone) combined with methotrexate is safe and effective treatment without obvious side effects.Drugs used direct injections are

Misoprostol is Prostagladins E1 analouge. It is not used in ectopic pregnancy.

219 The best period of gestation to carry out chorion villous biopsy for prenatal diagnosis is?
1 8-10 weeks
2 10-12 weeks
3 12-14 weeks
4 14-16 weeks
Answer is 2         Dutta 5th /p 113
Williams 21st/ch.37
Chorionic villus sampling is the second most common procedure for genetic prenatal diagnosis. It is routinely performed at about 10 to 12 weeks of gestation, it allows for an earlier detection of abnormalities and a safer pregnancy termination, because there is an increased association of limb defects (Oromandibulo digital dysplasia) when the procedure is performed before the 9th week. So it is not done before the 9th week.

Q.220 Which one of the following biochemical parameters is the most sensitive to detect open spina bifida?
1 Maternal serum alpha fetoprotein.
2 Amniotic fluid alpha fetoprotein.
3 Amniotic fluid acetyl cholinesterase.
4 Amniotic fluid glucohexaminase.

Answer is 3                 Rodecks& Whittle”s
                                Fetal Medicine,.Pg-377
When amniotic fluid acetyl cholinesterase (AchE) measurement is available for diagnostic purposes, nearly all of the false positive amniotic fluid AFP measurements could be identified.So it is the most sensitive test for detection of open spina bifida. Elevation of Amniotic fluid
alpha fetoprotein level without increased acetyl cholinesterase can be due to other etiology or from blood contamination.

Q.221. Risk of preterm delivery is increased if cervical length is:
1. 2.5 cm.
2. 3.0 cm.
3. 3.5 cm.
4. 4.0 cm.
Answer is 1                             Williams 21st/701
                                            Preterm birth, FUCHS 2nd edition/30-31
Mean cervical length at 24 weeks was 35 mm, and those women with progressively shorter cervices experienced increased rates of preterm birth.
When the cervical length measured by vaginal ultrasound was less than 50th percentile (< 37 mm), risk of preterm delivery was increased 3.7 fold.
If manual measured cervix was shorter than the 50th percentile (18 mm), premature birth was increased 2.9 fold.

Q.222. Diagnosis of beta Thalassemia is established by:
1. NESTROFT Test.
2. Hb A1C estimation.
3. Hb electrophoresis.
4. Target cells in peripheral smear.

Q.223. All are the risk factors associated with macrosomia except:
1. Maternal obesity.
2. Prolonged Pregnancy.
3. Previous large infant.
4. Short Stature.
Answer is 4                 Williams 21st/ 759

Factors that favor the likelihood of large fetus
1) Obesity 5) Male fetus
2) Multiparity 6) Previous infant > 4 kg
3) Prolonged gestation 7) Race and ethnicity
4) Maternal age.

Q.224. Which of the following statements is incorrect in relation to pregnant women with epilepsy?
1. The rate of congenital malformation is increased in the offspring of women with epilepsy.
2. Seizure frequency increases in approximately 70% of women.
3. Breast feeding is safe with most anticonvulsants.
4. Folic acid supplementation may reduce the risk of neural tube defect.
Answer is 2                     Williams 21st/1408-1409

During pregnancy increased seizure frequency seen in 35%, while decreased frequency in 15% and no change in 50%. Women taking antiepileptic drugs should receive the Folic acid supplementation as most of these agents deplete this nutrient. Folic acid supplementation reduces the risk of neural tube defect. The rate of congenital malformation is increased in the offspring of women with epilepsy even when patient is not taking the antiepileptics.

Q.225. All are the causes of intrauterine growth retardation except:
1. Anemia.
2. Pregnancy induced hypertension.
3. Maternal heart disease.
4. Gestational diabetes.
Answer is 4         Williams 21st / 751-752,Dutta 5th / 499
Maternal conditions commonly associated with I.U.G.R.
1) Renal disease
2) Vascular disease like eclampsia, pre-eclampsia etc.
3) Chronic hypoxia
4) Maternal anaemia
5) Placental insufficiency
6) Multiple pregnancy
7) Antiphospholipid antibody syndrome.

Pre-eclampsia, heart disease, malnutrition may be life threatening and important cause of fetal growth retardation.
Note - Diabetic mother ihave risk of macrosomia in place of I.U.G.R

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