AIIMS MAY 2013 Questions with Answers

1)SUBSCAPULARIS - FORGOTTEN MUSCLE 

2)16 yr female with normal pubic hair and breast c/o primary amennorrhea-mullarian dysgenesis 

3)Retts syn nt seen is macrocepaly 

4)A chalazion also known as a meibomian gland lipogranuloma, 

5)The floor (inferior wall) is formed by except - ethmoid 

6)pco2-30,po2-115,pH-7.45.pt has compensated-a.resp alkalosis 

7)Rho kinase inhibitor-fausidil 

8)test to differentiate maternal and fetal rbc-ans. apt test 

9)Oedema in ct absent in which stage of Neurocysticercosis? Calcified nodular stage 

10)gallow traction.....for frac shaft femur 

11)orphan drug is?? drug for rare diseases 

12)Maximum tolerated dose of a new drug is evaluated in: PHASE 1 

13)75yr diabetic with granulation tissue at external auditory canal- malignant otitis externa 

14)rapid growing atypical org not involved in lung infection ans:m.kansasii 

15)iodine is nt gvn in...ans ws hyperthyroidsm 

16)unconscious man lying in rt. lat. position with injury to face,hand,lat.aspect of rt. knee. 
most common cause for this clinical presentation? - common peroneal n 

17)if confidence limit is increased-previously insignificant data becomes significant 

18)no.of vision centres under npcb ans.20000 

19)pleural tap pierces all except pulmonary pleura 

20)legionella pneumophila-air conditioners 

21)difference between seizure n syncope-urine incontinence 

22)girl with primary amenorrhea,wide spaced pages - turner's 45XO 

23)prolonged post antibiotic effect and time dependent killing seen in penicillin. 

24)Meningocele ans is n.saline 

25)gertsmann syndrome 

26)signature fracture?ans depressed fracture 

27)pyogenic meningitis 

28)GU tb 

29)protein c - recurrent abortions plus leg pain deficient is 

30)not a major criteria in acute rheumatic fever-a.polyarthralgia 

31)child wid abdominal mass..wid right hand n leg longer - Wilm's tumour 

32)complete cartilage-cricoid 

33)vaginal epithelium- endoderm of urogenital sinus 

34)apoptosis not-inflammation 

35)hypertensive pt headache vomiting neck rigidity- SAH 

36)stain for fungal hyphae?KOH 

37)Mucormycosis Rx Amphotericin B 

38)fics law options-passive osmosis along conc gradient only 

39)mother 6 wk pregnancy....surest test-fhs by doppler 

40)A patient had seizure after injection of sulfonamide. Dx is-AIP Acute intermittent 
porphyria 

41)Adenolymphoma for tc scan hotspot 

42)ENT old guy with 3m h/o hearing loss with intact tympanum with fluid behind TM 
further mang 
ans----> investigate for nasopharyngeal CA 

43)true about celiac block ?ans----> M/C s/e is diarrhoea and hypotension 


44) loss of lacrimation occurs due to injury to: greater petrosal nerve 

45)elevation at site of prostatic utricle is formed due to:glands 

46)IV anaesthetic C/I in epileptics ---> ketamine 

47)in RTA pCo2 drops bcoz1 respiratory centre affected2resp apparatus affected3 both(A) 

48)Damage control surgery Ans minimum intervention to stabilize and can be operated latee 


49)not true of conjunctivitis...2)corneal infiltrn present 

50)pda not true?co2 wash out 

51)The advent of refrigeration has dramatically reduced STOMACH cancer incidents as it 
has revolutionized food preservation 

52)hrt not considered a therapeutic option for?prevention of cardiovascular diseases 

55)mortality in emergency abdominal aneurysm repair >50% 

56)irreversible enzymes in glycolysis.....1hexokinase,pyruvate kinase,phosphofructokinase 

57)in drug design concern is for3 increasing frequency of drug and target interaction 
58)Ridley Jopling Leprosy classification based on CLINICAL BACTERIOLOGICAL 
HISTOPATH AND IMMUNOLOGY 

59)Which is true- BRIMONIDINE DECREASE AQUEOUS PRODUCTION 

60)Complete cartilage ring seen in Cricoid cartilage 
61)earliest cx of ileostomy---- necrosis 

62)eggs size 100micron wid malabsorption.. al except-- --- opisthorcis viverini 

63)Chronic alcohol pt with 2 days h/o free alcohol Presented with seizure Diazepam 

64)stain used for fungus?silver methanamine 

65)in a surgery being done for intracranial space occupying lesion, which one is 
used:isoflurane 

66)A 7 yrs old child wd a few spots of blood in stools. Diagnosis?Juvenile polyp 

67)opioid kappa dysphoria 

68)acute infectious hepatitis 

69)phemphigus- direct immunofluroscence 

70)in von gierke ketone will be synthesised bcs of al except fat mobilisation low 

71)embryonal hb- zeta epsilon 

72)Infant can breath simultaneously because ?High larynx 

73)normally after lying down wt occurs like increase in cerebral flow/immediate in venous 
return 


74)girl with OPC poisoning .. false is atropine reverses muscle weakness 

75)legionela transmitd by aerosol air cnditn 

76)oral ulcer genital ulcer- behcet disease 

77)painless ulcer in labia majora with everted margins- ? syphillis 

78)RT PCR used for DNA Amplification 

79)Child with croup, well hydrated, feeding well, consolable. T/t is Single dose 
Dexamethasone 

80)cigratte smoker having left scrotal swelling afp and ldh negative dx RCC 

81)osteoblastic metastasis prostate 

82)rhabdomyosarcoma marker? desmin 

83)not a risk factor for rhegmat rd?hyperopia 

84)Coronary care unit and cancer care facility to be established at the district level hospital 

85)silvery papules on penis wrist n forearm n children... scabies 

86)most vascular tumor of brain spinal cord Hemangioblastoma 

87)SLE Like except - Penicillin 

88)Insight 

89)most common complication in baby <1kg? ROP 

90)orbit involvemnt in ?b cell lymphoma 

91)FISH used for known genetic loci 

92)thumb sign epiglottitis 

93)Old woman on alendronate for 7 years develops pain in hip nd thigh IOC - Xray 

94)Iron deficiency anemia A/E REDUCED TIBC 

95)All are done to prevent maternal to fetal transmission of HIV except-Vaginal delivery 

96)Lesion on T3 dermatome-Diagnosis is VZV 

97)The following enzymes dont participate in Oxygenation Reduction reaction-
Dehydrogenase 

98)Social pathology denotes-Change in ds pattern due to change in lifestyle 

99)ocular Mx - Breast 

100)answer for one Q was Petrositis - retro orbital pain,Facial palsy 

101)there was a Q about Bell palsy Except - Urgent Sx decompression 

102)asymptomatic child with delta wave short PR interval which drug not to be given-beta 
blocker 

103)child with mental retardation , seizures and angiomylipoma in kidney diagnosis is a) 
tuberous sclerosis 

104)Regarding Myopic degeneration which of the following is True 

-Myopic degeneration can lead to retinal detachment 

105)Floor of 3 ventricle not formed - 3rd cranial nerve 

106)Which is not included in 3rd stage labour to prevent PPH-Immediate cutting n cord 
clamping 

107)Most important functuon of MHC is1)Antigen presenting 

108)A 60 year old male with history of Diabetes complained of gradual diminution of vision 
over 2-3 days followed by sudden loss of vision. which of the following will be the most 
important investigation in this scenario ? Serum Creatinine levels 

109)Anti Craving Acamprostate 

110)cyanosis does occur - critical con of reduced hb 

111)Alternate to Valproate in Juv Myoclonic Ep.Levatiracetam 

112)most serious complication of pelvic fracture-hypovolemic shock 

113)which is the anaesthetic of choice for hypotension during surgery for aortic stenosis? 

phenylephrine 

114)fick s law ? Passive Only 

115)fmale wid fever,smthng,red spot on applying bp cuff-n.meningitis 

116)Ovulation....aftrr folical stimulayion 

117)8 yr boy,buly n rigid muscle,creat. kinase decreases wid age-dystrophin gene 

118)gynaecomastia z a/w?cushng z a/w smal cel! 

119)Discharge from synaptic vesicle is prevented by....preventing flow of ca+2 to the nerve 
terminal 

120)IDSP - TB NOT INCLUDED 

121)Ocriplasmin is a recombinant protease - VITREOMACULAR ADHESION 

122)Retinoblastoma - Strabismus 

123)alzheimer's disease - Temporal & Parietal 

124)which is not seen in actue pyelonephritis-hypoechoic 


125)B/L Babinsky - Thalamic Hmg 

126)no of health goals in MDG ? 3 

127)N.gonorrhoea---- gram negative coccoid 

128)anorectal ring is formed by all except internal anal sphincter 

129)BOTH cgn and rf for sore throat pt 

130)The most common MODY type is HNF1 alpha. 

131)pulseless after Antibiotic - chest compression 

132)which organ cant use ketone bodies 

133)neonatal sepsis not caused by agalactae 

134)wechsler intelligence scale scoring Avg IQ - 90 

135)not calcify PHPV 

136)asha dont receive renumeration for birth weight measurement 

137)Psychosocial,Criminal Psychology,Psychodevelopmental some Q 

138)Burns in children assessed by lund and browser 

139)Pigmentatory changes between posterior pole and equator (misspelled as equation in 
paper), [salt and paper retinopathy] are seen in all of following except ? D. Fundus 
flavimaculatus 


140)An ophthalmologist working in district hospital is likely to perform following surgical 
procedure most commonly ? Bilateral Lamellar Tarsus Rotation or phaco?? 


141)Seat Belt - abdominal aorta or Mesentry 

142)tracheobronchial tree... ?? 

143)which is given sc terbutline 

144)Hypothermia Can Be beneficial to patient 

145)for appointing at subcentre level, 3 yr trainining has been proposed by wic commite? 

146)Rx of choice for intractable seizure?? 

147)following microinjection healing occirs by? 

148)a pt.has renal failure and bone pain.serum M spike.35% plasma cell.diagnosis-multiple 
myeloma/Plasma cell Leukemia 

149)In sentinel lymph node biopsy for carcinoma breast, nerve commonly injured 

150)LBBB by all except ashman syndrome

151)not true about methyl alcohol poisoning- a)effects are due to formic acid except fomepizole 
competitively inhibits aldehyde dehydrogenase 


152)The prevalence of a disease in a group of 100 people is 80 percent. What is the 95 percent 
confidence interval 


153)meningococcal meningitis endemic >10 


154)Deworming ?? 


155)vaccine for meningococcal meningitis should be given to lab worker 


156)intrauterine respiration in fetus except RDS 


157)dose of vitamin A in post partum woman-3,00,000 i u within 1 mnth f giving birth 


158)Human Poverty Index 


159)CLL - Rx not needed in Asymp pt 


160)Supra condyar fracture true is 


a. distal segment is mostly displaced anteriorly 


b. cubitus valgus is more common than cubital varus 


c. injury causes weakness of elbow flexion 


d. nerve injury related manifestations are transitory 


161)which is not developmental delay-moving up n downstars 2 n half yr 


162)Neck node has SCC on biopsy. No primary found. AJCC staging is T0N2aM0 


163)Homogenous opacity in right lung wit obscured right cardiac silhouette. which part of lung is 
involved?A. Medial seg of RML 


164)tee for detecting mural thrombi in left ventricle apex 


165)INFECTIVITY OF DS,ALL TRUE EXCEPT-measles 3 days after rash 


166)which is the major metabolite of progesterone-Pregnendiol 


167)mech of insulin resistance in liver disease ?? Steatosis 


168)Ritonavir inhibits except ?? 


169)vasopressin antagonist act on medullary ct 


170)Mild ptosis. Emg myopathic pattern..ach antibody neg - Ocular MG 


171)ACL-a pt after sorts injury ...laxity on full extension and not in 90 degree ?? 


172)micropuncture of cell memb with a needle..repair occurs by-linear movement of proteins 


173)childhood blindness estimation from blind schools - over estimation 


174)CMV RETINITIS,...... MOST ? USEFUL / ? DIAGNOSTIC METHOD 


viral nucleic acid detection in intraocular fluid 


175)Which of the following type of hip dislocation is characterised by,internal rotation of limb, 
limb shortening and restriction of abduction ?Posterior 


176)Nephrotic syndrome steroid toxicity DOC Levamisole?? 


177)Neonate in icu seizure first line of investigation Sonology/MRI 


178)ESR in TB 


179)lesions in liver and kidney with contract enhancement, patient with seizures - Tuberous Scl 


180)Benign breast sign....Stroma?? 


181)Patient complains of ear discharge from post canal wall , TM normal, no hearing loss 


chronic otitis externa 


182)Rickets - When bone specific alkaline phosphatase is normal 


183)FACIAL RECESS 


184)Surgical alteration or suturing of gunshot wounds creates problems - Kennedy phenomenon. 


185)Duncan's placental separation-a)peripheral separation,b)maternal surface presents at 
vulva,c)blood b/w placenta and uterus, 


186)Lithium to be stopped?days before surgery 


187)suicide enzyme== 5Lox, COX, thomboxane synthase, ??? 


188)in hiv infn all affected except ant cingulate cortex/caudate nucleus/globus pallidus/lower 
white matter 


189)The mollusc shell is a biogenic composite biomineralisation 


190)not a test for mal absorption d - xylose 13--- tech??? 


191)bone anchored hearing aids 


192)out of sight out of mind is sensorimotor stage 


193)Father of Oto neurology 


194)2yr child with burns all over face and scalp and thigh-45% 


195)Priapism is caused by poison of-Spanish fly 


196)klyver Lucy syn nt seen is seizures 


197)shelf life of suxamethonium:2 yr 


198)if a chromosome divides in an axis perpendicular to its usual axis of division it is going to form isochromosome 

199)crumpled tissue paper appearance of cells is seen in Glucocerebrocide 


200)policy related to mental health

APPG 2013 Question Paper with Answers 176-200

176. Gas Bloat syndrome is a complication of 

A. Partial Gastrectomy 
B. Nissen's funduplication 
C. Dor funduplication 
D.Toupet funduplication 
Ans B 
Nissen fundoplication is a surgical procedure to treat gastroesophageal reflux disease (GERD) and hiatus hernia. In GERD it is usually performed when medical therapy has failed, but with paraesophageal hiatus hernia, it is the first-line procedure. 
Nissen fundoplication is generally considered to be safe and effective, with a mortality rate of less than 1%. Studies have shown that after 10 years, 89.5% of patients are still symptom-free. 
Complications include "gas bloat syndrome", dysphagia (trouble swallowing), dumping syndrome, excessive scarring, vagus nerve injury, and rarely, achalasia.[5] The fundoplication can also come undone over time in about 5-10% of cases, leading to recurrence of symptoms. If the symptoms warrant a repeat surgery, the surgeon may use Marlex or another form of artificial mesh to strengthen the connection.[6] Postoperative irritable bowel syndrome, which lasts for roughly 2 weeks, is possible. 
In "gas bloat syndrome", fundoplication can alter the mechanical ability of the stomach to eliminate swallowed air by belching, leading to an accumulation of gas in the stomach or small intestine. Data varies, but some degree of gas-bloat may occur in as many as 41% of Nissen patients; whereas the occurrence is less with patients undergoing partial anterior fundoplication.[7] Gas bloat syndrome is usually self-limiting within 2 to 4 weeks, but in some it may persist. The offending gas may also come from dietary sources (especially carbonated beverages), or involuntary swallowing of air (aerophagia). If postoperative gas-bloat syndrome does not resolve with time, dietary restrictions, and counselling regarding aerophagia, correction may be necessary, either by endoscopic balloon dilatation[citation needed] or repeat surgery to revise the Nissen fundoplication to a partial fundoplication. 
Vomiting is often difficult or even impossible with a fundoplication. In some cases, the purpose of this operation is to correct excessive vomiting. However, when its purpose is to reduce gastric reflux, difficulty in vomiting may be an undesired outcome. Initially, vomiting is impossible; however, small amounts of vomit may be produced after the wrap settles over time, and in extreme cases such as alcohol poisoning or food poisoning, the patient may be able to vomit freely. 

177. The commonest graft used for CABG is 

A. internal mammary artery, 
B. radial artery 
C. long saphenous vein 
D. short saphenous vein 
Ans C 
The saphenous vein in the leg is the most common vein used as a bypass graft 
Long saphenous vein is the most common conduit utilized for surgical coronary revascularizatio 

178. Giant cell reparative granuloma of Jaw is treated by 

A. Antibiotics 
B. wedge resection 
C. resection and bone grafting 
D. curettage 
Ans D 
the traditional treatment of GCRG is represented by surgical removal via an intra-oral approach and the extent of tissue removal ranges from a simple curettage to an en bloc resection. Curettage alone, or in combination with a periostal bone resection is the treatment modality most often used. Curettage has also been supplemented with cryosurgery and peripheral ostectomy. The surgical defect usually heals by secondary intention.

179. The commonest cause for esophageal perforation is 

A. barotrauma 
B. foreign bodies 
C. latrogenic 
D. penetrating injury to the chest 
Ans c 
Most esophageal perforations are iatrogenic 

180. Which of the following is a delayed absorbable synthetic suture material ? 

A. Chromic catgut 
B. Vicryl 
C. Silk . 
D. Nylon 
Ans B 

The delayed absorbable monofilament sutures such as polydioxanone (PDS®) and polyglyconate (Maxon®), used for abdominal wound closure have good tensile strength and low tissue reaction, but the knots are not as strong.

Polydioxanone (PDS) is also good for contaminated fields because it has a low affinity for bacteria. It is good for general use, tissue approximation, biliary work, anastomoses, fascial closures, heart surgery, and orthopaedic 
Vicryl 
• Tensile strength 
65% @ 14 days 
40% @ 21 days 
10% @ 35 days 
• Absorption complete by 70 days 
Polydioxone 
8. Tensile strength 
70% @ 14 days 
50% @ 28 days 
14% @ 56 days 
9. Absorption complete by 180 days 

181. The ischiorectal fossa is at an increased risk for infection due to 
A. absence of deep fascia 
B. proximity to anus 
C. poor blood supply 
D. presence of fibro fatty tissue 
Ans C 
Both the Perianal and Ischiorectal spaces are common site of abscesses. Poor blood supply and coarse lobulated fat predispose it for infection. The Ischiorectal abscess may be the result of spread of infection from the nearby area - skin, lumen of bowel or perirectal tissue above the levator ani or through the blood or lymphatic. They can be excised fearlessly because of the poor vascularity of the fossa. 
Abscesses in this region are - (a) Perianal abscess (b) Ischiorectal abscess (c) Supra levator abscess 

182. "Thumb printing" on plain skiagram of abdomen is characteristic sign of 
A. Crohn's colitis 
B. Ischemic colitis 
C. Amoebic colitis 
D. Ulcerative colitis 
Ans B

183. Which one of the following is TRUE regarding Warthin tumour ? 
A. It is the second most common benign tumor of parotid gland 
B. About 50% are bilateral 
C. It is a malignant tumor 
D. Occurs in young individuals 

Ans A 
Warthin's tumor primarily affects older individuals (age 60–70 years). There is a slight female predilection according to recent studies, but historically it has been associated with a strong male predilection 
Warthin's tumor is the second most common benign parotid tumor. 

184. All of the following patients presenting with abdominal pain and shock need immediate laparotomy, EXCEPT 
A. Ruptured ectopic pregnancy 
B. Haemorrhagic pancreatitis 
C. Rupture abdominal aortic aneurysm 
D. Ruptured liver hemangioma 
Ans D 
he classical indications for either surgery or minimally invasive therapy are the relief of symptoms due to the hemangioma or the treatment of the spontaneously ruptured hemangioma. The latter event is potentially life-threatening. However, emergent surgical resection of the ruptured hemangioma is associated with a high morality rate. 
Top priority in the patient with a ruptured hepatic hemangioma is hemodynamic stabilization. Some authors have recommended surgical ligation of the hepatic artery as a next step. Others have recommended arterial embolization instead. Once the patient is stabilized, formal surgical resection of the hepatic hemangioma can be performed.

185. Which one of the following statements about acute diverticulitis is INCORRECT? 
A. Sigmoid is the commonest site 
B. Peri-colic abscess can occur 
C. Fistulization is an immediate cause for emergency surgery 
D. Conservative treatment may be successful in severe attack 
Ans D 
With the aid of CT scanning, patients can be grouped into categories at presentation based upon their imaging findings. Hinchey et al4 devised a classification system encompassing four clinical stages of perforated diverticulitis, which was later modified. Kaiser et al retrospectively evaluated the management of the patient based on the modified Hinchey classification (stage 0 mild clinical diverticulitis, Ia confined pericolic inflammation, Ib confined pericolic abscess, II pelvic or distant intraabdominal abscess, III generalized purulent peritonitis, IV fecal peritonitis) at presentation based on clinical, CT, or operative findings. Patients who were in the stage 0 and Ia groups did very well with just antibiotics. Only ~6% of these patients required a semiurgent resection because of an inadequate response to conservative therapy. All patients in stages III and IV underwent an urgent surgical resection. The patients in stages Ib and II were managed with a combination of antibiotics, percutaneous image guided drainage, and surgery. The higher the patient's stage, the less likely they were to avoid resective surgery, both in the short and long term.5 Patients with stage III and IV disease should be managed with surgery; patients with stage I or II disease are generally candidates for nonoperative management 

Fistulas are another recognized complication from diverticulitis. Both colo-vaginal and colo-vesicle fistulas can occur. The primary treatment for both of these situations is surgical. In a poor-risk patient, nonoperative therapy may be appropriate. Some patients may develop a small bowel obstruction from sigmoid diverticulitis due to a loop of small bowel being involved in the inflammatory process. This may improve with time as the colonic inflammation improves.

186. Lower esophageal sphincter is relaxed by all EXCEPT 
A. Theophylline 
B. Caffeine 
C. Prostaglandin F2 
D. Dopamine 
Ans C

187. Which one of the following type of cutaneous melanoma carries the best prognosis ? 
A. Superficial Spreading Melanoma . (SSM) 
B. Nodular Melanoma (NM) 
C. Lentigo Maligna Melanoma (LMM) 
D. Acral Lentigenous Melanoma (ALM) 
Ans C 


188.Fournier's gangrene is characterized by all EXCEPT 
A. Sudden appearance of scrotal inflammation 
B. Known to follow minor injuries or procedures in the perineal areas 
C. Obvious cause is evident 
D. Haemolytic streptococcus associated with other organisms causes a fulminating 
inflammation of subcutaneous tissues 

Ans D 
Wound cultures from patients with Fournier gangrene reveal that it is a polymicrobial infection with an average of 4 isolates per case. Escherichia coli is the predominant aerobe, and Bacteroides is the predominant anaerobe. 
Other common microflora include the following: 
• Proteus 
• Staphylococcus 
• Enterococcus 
• Streptococcus (aerobic and anaerobic) 
• Pseudomonas 
• Klebsiella 
Clostridium 



In the majority of cases Fournier gangrene is a mixed infection caused by both aerobic and anaerobic bacteria.[1] Death can result from Fournier gangrene 
Impaired immunity (eg, from diabetes) is important for increasing susceptibility to Fournier gangrene. Trauma to the genitalia is a frequently recognized vector for the introduction of bacteria that initiate the infectious process. 
Although originally described as idiopathic gangrene of the genitalia, Fournier gangrene has an identifiable cause in 75-95% of cases.[11] The necrotizing process commonly originates from an infection in the anorectum, the urogenital tract, or the skin of the genitalia.[12] 
Anorectal causes of Fournier gangrene include perianal, perirectal, and ischiorectal abscesses; anal fissures; and colonic perforations. These may be a consequence of colorectal injury or a complication of colorectal malignancy,[13, 14] inflammatory bowel disease,[15] colonic diverticulitis, or appendicitis. 
Urogenital tract causes include infection in the bulbourethral glands, urethral injury, iatrogenic injury secondary to urethral stricture manipulation, epididymitis, orchitis, or lower urinary tract infection (eg, in patients with long-term indwelling urethral catheters). 
Dermatologic causes include hidradenitis suppurativa, ulceration due to scrotal pressure, and trauma. Inability to practice adequate perineal hygiene, such as in paraplegic patients, results in increased risk. 
Accidental, intentional, or surgical trauma[16] and the presence of foreign bodies may also lead to the disease 

189. Facial disproportionate growth is characteristic of which of the following syndromes ? 
A. Treacher Collins 
B. Crouzon 
C. Pierre Robin 
D. All of the above 

190. Dieulafoy's lesion is 
A. an arteriovenous malformation of stomach 
B. an angiodysplasia of colon 
C. a type of esophageal varices 
D. an aorto enteric fistula 
Ans A 
Dieulafoy's lesion (exulceratio simplex Dieulafoy) is a medical condition characterized by a large tortuous arteriole in the stomach wall that erodes and bleeds. It can cause gastric hemorrhage 


191. The commonest deformity seen in CTEV is 
A. forefoot equinus 
B. equine varus of forefoot and hindfoot 
C. calcaneo valgus of hindfoot 
D. subluxation of calcaneo cuboid joint 

Calcaneo-Navicular most common (2/3) 
- talocalcaneal middle facet is next most common (1/3) 
- rest uncommon

192. Histologically tumour osteoid is found in 
A. Ewing's Sarcoma 
B. Chondrosarcoma 
C. Osteosarcoma 
D. Chordoma 
Ans C 
Osteosarcoma is diagnosed most easily when it appears in its classic, or conventional, form. The tumor cells vary from spindled to polyhedral; their nuclei are pleomorphic and hyperchromatic. Mitotic figures are easily demonstrable, and atypical mitotic figures also may be identified. The tumor cells are engaged in the production of extracellular matrix that may be osseous, cartilaginous, or fibrous in various proportions. The production of bone or osteoid directly by tumor cells at least somewhere in the tumor is the absolute requirement for diagnos 


193. Swan Neck deformity of hand is a feature of 
A. Psoriatic arthritis 
B. Rheumatoid arthritis 
C. Osteoarthritis 
D. Gouty arthritis 
Ans b 

Swan neck deformity is a deformed position of the finger, in which the joint closest to the fingertip is permanently bent toward the palm while the nearest joint to the palm is bent away from it (DIP hyperflexion with PIP hyperextension). It is commonly caused by injury or inflammatory conditions like rheumatoid arthritis or sometimes familial (congenital, like Ehlers-Danlos syndrome 

194. Parathyroid Hormone (P.T.H.) does NOT lead to 
A. increased tubular reabsorption of calcium 
B. increased tubular reabsorption of phosphates 
C. bone resorption in skeleton 
D. augmentation of calcium absorption in the intestine 
Ans B

195. Radiograph shows Looser's zones (pseudo-fractures) in which one of the following conditions ? 
A. Rickets 
B. Osteomalacia 
C. Scurvy 
D. Unicameral Bone cyst 
Ans A 
Looser's zones (also known as cortical infarctions) are wide transverse lucencies traversing bone usually at right angles to the involved cortex and are associated most frequently with osteomalacia and rickets . They are pseudofractures and considered a type of insufficiency fracture. Typically, the fractures have sclerotic irregular margins, and are often symmetrical

196. Caries Sicca is 
A. tuberculosis of the shoulder 
B. flake formation (Rice water bodies) in synovial tuberculosis 
C. tuberculosis of the sacrum 
D. tuberculosis of the Sacroiliac 
Ans A 
Caries sicca (shoulder tuberculosis)

197. Which type of the following is NOT an External Fixator ? 
A. Schanz pins 
B. Llizarov 
C. Knowle's pins 
D. Joshi's 
Ans C 
Schanz pins – TEMPORARY EXT FIXATOR 
oshi's external stabilisation system fixator in the management of idiopathic clubfoot 
if surgery is indicated, open reduction and internal fixation using a Knowles pin is an effective method for managing mid-third clavicular fracture 

198. Spondylolysis is the term used for 
A. forward slip of the vertebra over the lower vertebra 
B. degenerative changes in the spine 
C. defect in the pars-interarticularis 
D. straightening of the lumbar spine 
Spondylolysis is a defect of a vertebra. More specifically it is defined as a defect in the pars interarticularis of the vertebral arch. 


199. 'Thomas Splint' was initially designed by HO. Thomas 
A. as a first aid for First World War Soldiers 
B. for the treatment of fracture shaft femur 
C. for initial ambulation and First Aid of supracondylar fracture femur 
D. for immobilisation in the treatment for tuberculosis of the knee joint 
Ans D 
The Thomas half-ring splints consist of a padded half-circle of steel which is strapped to the hip, hinged to a U-shaped rod that extends along both sides of the leg. An ankle strap may be fashioned from cloth, and tied or twisted to apply traction force. It was deviced by H.O. Thomas, initially for immobilization for tuberculosis of the knee. It is now commonly used for the immobilisation of hip and thigh injuries 

200. All the following statements are TRUE regarding Intertrochanteric fracture femur, EXCEPT 
A. Is a very common fracture in old age 
B. Can be managed conservatively 
C. Open reduction and internal fixation with early ambulation is the ideal treatment 
D. Non-union is a common complication 
Ans D 
intertrochanteric fractures should be considered for conservative treatment 
Nonunion is much less common in Intertrochanteric fractures 
Open reduction and internal fixation with early ambulation is the ideal treatment 
Nonoperative management is often appropriate in the following circumstances: 
• Nonambulatory or demented patients with mild pain 
• Patients with old nondisplaced or impacted fractures and mild pain 
• Unstable patients with major, uncorrectable comorbid disease 
Patients at the end stage of a terminal illness 
Nonunion 
A fracture of the femoral neck is particularly likely to go on to nonunion - the situation in which the healing process has halted and the fracture will not heal without intervention. In young people with femoral neck fractures this condition would likely be treated by some form of bone grafting procedure and re-fixation in an attempt to obtain healing without sacrificing the hip joint. In the elderly, nonunion would more likely be treated by artificial hip replacement with the aim of getting the patient comfortable and back on their feet quickly. 
Nonunion is much less common in Intertrochanteric fractures but the same principles appl 
Intertrochanteric fracture 


Intertrochanteric hip fracture in a 17-year-old male 


Fracture supported by dynamic hip screw 
An intertrochanteric fracture, below the neck of the femur, has a good chance of healing. Treatment involves stabilizing the fracture with a lag screw and plate device to hold the two fragments in position. A large screw is inserted into the femoral head, crossing through the fracture; the plate runs down the shaft of the femur, with smaller screws securing it in place. 
The fracture typically takes 3–6 months to heal. As it is only common in elderly, removal of the dynamic hip screw is usually not recommended to avoid unnecessary risk of second operation and the increased risk of re-fracture after implant removal. The most common cause for hip fractures in the elderly is osteoporosis; if this is the case, treatment of the osteoporosis can well reduce the risk of further fracture. Only young patients tend to consider having it removed; the implant may function as a stress riser, increasing the risk of a break if another accident occurs.