CONTENTS

18
20
Section A  Recent Pattern Questions (June 2018)..................................................................................................................................... 1–128

s
Q
Section B  Recent Pattern Questions (Jan 2018)................................................................................................................................... 129–306

rn
Section C  Last Minute Revision Tables..................................................................................................................................................... 307–620

tte
ECG Made Easy................................................................................................................................................................................................. 621–648

Pa
QUESTIONS AND TABLES AT A GLANCE WITH PAGE NUMBERS

B
Subjects Recent Pattern Recent Pattern Last Minute Revision

DN
Questions (June 2018) Questions (Jan 2018) Tables
No. of Questions Page Nos No. of Questions Page Nos No. of Tables Page Nos

&
Anatomy 25 3 15 131 57 309

Physiology 24 14 14 139 60 333

T
EE
Biochemistry 24 21 14 149 51 353

Pharmacology 24 29 28 156 11 371

N

Pathology 21 36 32 164 50 381

of

Microbiology 16 47 20 182 67 399

Forensic Medicine 13 53 10 192 35 425

w

PSM 27 57 20 197 40 441

vie

Medicine 21 64 18 206 65 458

Re

Surgery 23 75 30 215 50 476

Pediatrics 13 84 09 230 73 492

of

Obstetrics and Gynecology 17 90 28 238 71 523

ENT 11 99 09 259 27 542

s
ge

Orthopedics 05 103 10 266 26 552

Ophthalmology 13 107 13 276 40 567

Pa

Dermatology 06 113 06 284 30 577

Anaesthesia 04 117 06 289 20 588

e
pl

Radiology 09 119 12 292 22 595

m

Psychiatry 06 125 09 300 35 603

Sa

Total 302 300 830

ECG Made Easy 621

Time Gross Light microscope Complications

Recent Pattern Questions (June 2018)

1–3 days yy Extensive coagulative necrosis. Tissue surrounding Post infarction fibrinous
infarct shows acute inflammation with neutrophils. pericarditis

18
20
s
Q
3–14 days yy Macrophages, then granulation tissue at margins. yy Free wall rupture →

rn
tamponade; papillary
muscle rupture →

tte
mitral regurgitation;
interventricular

Pa
septal rupture due
to macrophage-
mediated structural

B
degradation

DN
2 weeks Contracted scar complete. Dressler syndrome,
to several HF, arrhythmias,
months true ventricular
aneurysm (risk of mural

&
T thrombus).
N EE
of
w

12. Classical pathway macrophage activating molecule:

vie

a. IFN-γ
b. IL-4
c. IL-13
Re

d. IL-1
Ans.  a. IFN-γ
of

Table 6:  Pathways for macrophage activation

Classical M1 Alternative M2
s
ge

Induced by innate immunity (TLRs, IFN-γ) Induced by IL-4, IL-13

Phagocytosis, initiate inflammatory response Tissue repair and control of inflammation
Pa

13. E-cadherin mutation is seen in which type of carcinoma:

a. IDC
b. Lobular carcinoma
e

c. Metaplastic carcinoma
pl

d. Metastasis
m

Ans.  b. Lobular carcinoma

Sa

yy Atypical ductal and atypical lobular hyperplasias may have acquired chromosomal aberrations such as loss of 16q or gain of 17p, changes
also found in carcinoma in situ.
41
yy Atypical lobular hyperplasia also shows loss of E-cadherin expression, a feature it shares with lobular carcinoma in situ. This form of
intraepithelial spread is called “pagetoid” because of its resemblance to Paget disease.
18
20
s
Q
Fig. 4: Large mass Fig. 5: “Leaf-like” lobulations

rn
yy Microscopically, the mass shows increased stromal cellularity, clefts lined by epithelium, stromal overgrowth, and irregular margins.

tte
yy Some may become malignant.
Pathology

18. Which disease is caused by anti-phospholipase 2 antibody:

Pa
a. MPGN b. MGN
c. FSGN d. MCD

B
Ans.  b. MGN

DN
MEMBRANOPROLIFERATIVE GLOMERULONEPHRITIS (MPGN)

yy Type I—subendothelial immune complex (IC) deposits with granular IF; “tram-track” appearance on PAS stain (See figure A) and
HandE stain (See figure B) due to GBM splitting caused by mesangial in growth.

&
T
N EE
of
w

A B
vie

yy Type II—also called dense deposit disease.

yy MPGN is a nephritic syndrome that often copresents with nephrotic syndrome.
yy Type I may be 2° to hepatitis B or C infection.
Re

yy May also be idiopathic.

yy Type II is associated with C3 nephritic factor (IgG antibody that stabilizes C3 convertase → persistent complement activation → decreases
C3 levels).
of

MINIMAL CHANGE DISEASE (MCD) [LIPOID NEPHROSIS]

s

yy LM: normal glomeruli (lipid may be seen in PCT cells).

ge

yy IF: ⊝.
Pa
e
pl
m
Sa

44
C
Table 2:  Sleep architecture diagram

Type Features

Recent Pattern Questions (Jan 2018)

Awake Low voltage-random fast-beta waves

18
20
Drowsy 8 to 12 cps-alpha waves

s
Q
rn
Stage 1 3 to 7 cps theta waves

tte
Pa
Stage 2 12 to 14 cps-sleep spindles and K complexes

B
DN
&
Delta sleep 1/2 to 2 cps-delta waves>75
T
N EE
of

REM sleep Low voltage-random, fast with sawtooth waves

w
vie
Re

3. All of the following characteristic pattern seen in Brown-Séquard syndrome; except:

a. Ipsilateral weakness
b. Ipsilateral loss of position and vibration
of

c. Ipsilateral loss of pain and temperature

d. Contralateral loss of pain and temperature
s

Ans.  c. Ipsilateral loss of pain and temperature

ge

Ref: Ganong’s Review of Medical Physiology 25th Ed; Page No-172

Pa

BROWN-SÉQUARD SYNDROME

Brown-Séquard syndrome is caused by damage to one half of the spinal cord, resulting in paralysis and loss of proprioception on the same (or
e

ipsilateral) side as the injury or lesion, and loss of pain and temperature sensation on the opposite (or contralateral) side as the lesion.
pl
m
Sa

141
Ans.  a. Varicella-zoster
Ref: BRS Microbiology and Immunology 6th Ed; Page No. 153 & Jawetz’s; Medical Microbiology 27th Ed; Page No-427-28

Recent Pattern Questions (Jan 2018)

yy Varicella-zoster virus causes chickenpox on primary infection in children and zoster (shingles) after reactivation in adults.
yy Varicella-zoster virus (VZV) reactivates from the neurons of sensory ganglia (usually in areas supplied by the trigeminal nerve and

18
thoracic ganglion) to cause herpes zoster or shingles.
yy Latent in dorsal root or trigeminal ganglia; CN V1 branch involvement can cause herpes zoster ophthalmicus.

20
yy Most common complication of shingles is postherpetic neuralgia.
yy Postherpetic neuralgia (PHN) may occur after skin lesions of shingles have crusted.

Treatment and Prevention

s
yy Shingles may be treated with oral acyclovir and famciclovir; PHN may be treated with famciclovir.

Q
yy The incidence of both diseases is decreased by immunization of the elderly (age 60 or older) with Zostavax vaccine (contains a higher
dose of live attenuated virus than childhood VZV vaccines).

rn
yy Shingles may also be treated or infection prevented by varicella zoster immune globulin (VZIG) preparations.
yy An attenuated virus, the Oka strain, is used in vaccines to prevent chickenpox and diminish shingles recurrences.

tte
Difference between Chicken Pox and Shingles

Pa
B
DN
&
T
N EE
of
w

Fig. 1: Latent infections by herpes viruses. Examples are shown for both herpes simplex and varicella-zoster viruses. Primary infections
vie

occur in childhood or adolescence, followed by establishment of latent virus in the cerebral or spinal ganglia. Later activation causes
recurrent herpes simplex or zoster. Recurrences are rare for zoster. CMI,
Abbreviation: Cell-Mediated Immunity.
Re
of
s
ge
Pa
e
pl

   Chicken pox      Shingles

m

4. Sabin Feldman dye test is used for diagnosis of which of the following condition:
a. Botulism
Sa

b. Toxoplasmosis
c. Sarcoidosis 183
d. Yellow fever
yy Miscellaneous
ƒƒ Cryptogenic organizing pneumonia (COP)

Recent Pattern Questions (June 2018)

ƒƒ Idiopathic pulmonary fibrosis
ƒƒ ILD associated with connective tissue disorders: mixed connective tissue disease, rheumatoid arthritis, SLE, scleroderma
ƒƒ Radiation pneumonitis

18
CLINICAL FEATURES

20
yy Symptoms
ƒƒ Cough (nonproductive)

s
ƒƒ Dyspnea (at first with exertion; later at rest)

Q
ƒƒ Fatigue
ƒƒ Other symptoms may be present secondary to another condition (such as a connective tissue disorder)

rn
yy Signs
ƒƒ Digital clubbing is common (especially with idiopathic pulmonary fibrosis) (see Figure)

tte
Pa
B
DN
&
Fig. 3: Clubbing of the finger
T
ƒƒ Rales at the bases are common
EE
ƒƒ Signs of pulmonary HTN and cyanosis in advanced disease

DIAGNOSIS
N

yy CXR (see Figure)

of

ƒƒ Findings are usually nonspecific.

ƒƒ Typical diffuse changes are noted (ground glass, honeycombing, reticular, reticulonodular).
yy High-resolution CT scan shows the extent of fibrosis better than other imaging modalities.
w
vie
Re
of
s
ge

A B
Pa

Figs 4A and B: A. Initial chest X-ray showed ground glass opacity and consolidation on both lung fields (especially the right lower lung
field); B. Initial contrast-enhanced chest computed tomography showed multiple irregular nodular infiltrations in both lungs and patchy
e

consolidation with ground glass opacity in the right middle and lower lungs
pl
m

10. A person had an episode of dengue serotype 1, after 2 years with serotype 2. What will be effect of this episode?
a. Mild ds d/t neutralizing abs present
Sa

b. Increased chances of DHF

c. No chances of DHF 69
d. No effect on present illness
6. Myocardial stunning pattern not matching the ECG. What is the diagnosis?
a. Takotsubo cardiomyopathy b. Restrictive cardiomyopathy
c. Brigade’s cardiomyopathy d. Pericardial something

Recent Pattern Questions (Jan 2018)

Ans.  a. Takotsubo cardiomyopathy

18
Ref: Harrison’s Principle of Internal Medicine 19th Ed; Page No-97, 298-e3
yy Takotsubo cardiomyopathy it is also known as “broken heart syndrome”—ventricular apical ballooning likely due to increased sympathetic

20
stimulation (stressful situations).
yy The Clinical sign of Takotsubo cardiomyopathy is chest pain associated with ECG findings mimicking a myocardial infarction of the
anterior wall.

s
yy A bulging out of the left ventricular apex with a hypercontractile base of the left ventricle is often noted; during the course of evaluation

Q
of the patient.
yy The hallmark of Takotsubo cardiomyopathy is bulging-out of the apex of the heart with preserved function of the base.

rn
7. What is the alternative drug for epinephrine in ACLS?

tte
a. Amiodarone infusion b. Atropine
c. High dose vasopressin d. Adenosine

Pa
Ans.  c. High dose vasopressin

ADVANCED CARDIAC LIFE SUPPORT ALGORITHMS

B
DN
&
T
N EE
of
w
vie
Re
of
s
ge
Pa
e
pl
m
Sa

209
Type Frequency Etiology and characteristics Treatment
Indinavir Rare Patients will be on protease inhibitors or HIV. Hydration, surgical removal.

Recent Pattern Questions (Jan 2018)

Stones consist of precipitated indinavir.
Radiolucent on KUB and CT

18
Ammonium Rare Typically occurs in the setting of chronic Antibiotics, in case of urinary tract infection,
urate diarrheal state (Inflammatory bowel disease, discontinuation of offending agent like laxative

20
laxative abuse). The gastrointestinal losses abuse, volume repletion and potassium
of fluids, sodium and potassium content, supplementation as needed
leaving ammonium (excreted in response to

s
gastrointestinal alkali loss) as the major cation

Q
in urine to bind urate and precipitated as
ammonium urate

rn
tte
CRYSTALS FOUND IN NEPHROLITHIASIS

Type Shape Figure

Pa
Calcium oxalate Envelope-shaped

B
DN
&
T
EE
Struvite Coffin lid-shaped
(Mg-NH4-PO4)
N
of
w
vie
Re

Uric acid Rhomboid shaped

of
s
ge
Pa

Cystine Hexagonal shaped

e
pl
m
Sa

219
ETIOLOGY

yy Pyloric stenosis is usually not present at birth. It is unusual in stillbirths and probably develops after birth and is more concordant in

Recent Pattern Questions (Jan 2018)

monozygotic than dizygotic twins.
yy Pyloric stenosis commonly associated with eosinophilic gastroenteritis, Zellweger syndrome, Apert syndrome, Smith-Lemli-Opitz

18
syndrome, trisomy 18, and Cornelia de Lange syndrome.

20
CLINICAL MANIFESTATIONS

yy Initial symptom of pyloric stenosis is nonbilious vomiting. The vomiting may or may not be projectile initially but is usually progressive,

s
occurring immediately after a feeding.

Q
yy The most common clinical symptoms of pyloric stenosis is hyperbilirubinemia, it is also known as icteropyloric syndrome.
yy Unconjugated hyperbilirubinemia is more common seen compare to conjugated.

rn
DIAGNOSIS

tte
yy Palpating the pyloric mass is the most diagnostic factor.
yy The mass is movable, firm, olive shaped, approximately 2 cm in length, hard, and it is best palpated from the left side, and located above

Pa
and to the right of the umbilicus in the midepigastrium beneath the liver’s edge.
yy After an episode of vomiting the easiest palpated is olive shaped mass.
yy Gastric peristaltic wave may be visible after feeding, that progress across the abdomen.

B
DN
&
T
N EE
of

Fig. 2: Gastric peristaltic wave in an infant with pyloric stenosis

w

yy Two imaging studies are most commonly used to establish the diagnosis. For majority of cases ultrasound examination confirms the
diagnosis. Criteria for diagnosis are an overall pyloric length 15-19 mm, pyloric diameter of 10-14 mm and pyloric thickness 3-4 mm.
vie

yy Ultrasonography is the most sensitivity (approximately 95%) test.

yy An elongated pyloric channel (string sign), parallel streaks of barium seen in the narrowed channel, producing a “double tract sign” and
Re

a bulge of the pyloric muscle into the antrum (shoulder sign) are seen in contrast studies.
of
s
ge
Pa
e
pl
m
Sa

Fig. 3: Double tract sign 233

9. Identify the condition shown in the CT scan image below:

Recent Pattern Questions (Jan 2018)

18
20
s
Q
rn
a. Dandy-Walker malformation

tte
b. Cerebellar vermis hypoplasia
c. Mega cisterna magna

Pa
d. None
Ans.  a. Dandy-Walker malformation

B
Ref: Nelson Text book of Pediatrics 20th Ed; Page No-2811-16
yy The CT scans shows cystic expansion of fourth ventricle due to absence of roof. So it is a feature of dandy walker malformation.

DN
Feature of Dandy-Walker Malformation
yy Cystic expansion of fourth ventricle due to absence of roof.

&
yy Associated agenesis of posterior cerebellar vermis and corpus callosum
yy Presents with increasing head size and prominent occiput, long-tract signs, cerebellar ataxia, and delayed motor development, positive
transillumination.
T
N EE
of
w
vie
Re

DIFFERENCE BETWEEN
of

Dandy-Walker malformation, cerebellar vermis hypoplasia and mega cisterna magna

s
ge
Pa
e
pl
m
Sa

237
Recent Pattern Questions (June 2018)
18
20
s
Q
rn
tte
Pa
REVERSED UMBILICAL ARTERY DIASTOLIC FLOW

B
DN
&
T
N EE
of
w
vie
Re
of

6. Which of the following agent’s infection causes heavy placenta?

a. HSV
s

b. CMV
ge

c. Syphilis
d. HIV
Pa

Ans.  b. CMV
yy Serological testing for primary maternal cytomegalovirus (CMV) infection during pregnancy is not routine, but ultrasound studies are
routine. Therefore, we evaluate placental thickening in women with primary CMV infection during pregnancy.
e

yy Most are asymptomatic; however, some women have mononucleosis like syndrome.
pl

7. All of the followings are used in inherited thrombophilia testing in pregnancy; except:
m

a. Antithrombin deficiency
b. Protein C deficiency
Sa

c. Lupus anticoagulant
d. Factor V Leiden mutation 93
yy It is 1-1.25 cm behind the inferior turbinate.

18
20
s
Q
rn
tte
Pa
ENT

B
DN
&
T
EE

Fig. 6: Transnasal endoscopic appearance of the nasopharynx

N
of
w
vie
Re
of
s
ge

Fig. 7: Rathke’s pouch is represented by a dimple, high in nasopharynx

Pa

yy Posterior to this is a slit-like space, which is the fossa of Rosenmüller.

yy Fossa of Rosenmüller is the most common site for origin of nasopharyngeal carcinoma.
yy Inflammation of nasopharyngeal bursa is called nasopharyngeal bursitis.
e
pl

8. Site for placing an electrode in auditory brain stem implant is:

a. Sinus tympani
m

b. Round window
Sa

c. Lateral ventricle
d. Recess of fourth ventricle
264
Type of fracture Radiological view
Galeazzi’s fracture

Recent Pattern Questions (Jan 2018)

18
20
s
Q
rn
tte
Pa
Colles’ fracture

B
DN
&
T
EE
Smith’s fracture
N
of
w
vie
Re
of
s
ge
Pa
e
pl
m
Sa

269
Contd…
Tumor type Characteristics Radiological findings
Giant cell tumor “Soap bubble” appearance on X-ray

18
20
s
Q
rn
Orthopedics

tte
Osteosarcoma (osteogenic Codman triangle (from elevation of periosteum)
sarcoma) Or sunburst pattern on X-ray

Pa
B
DN
&
T
EE

Ewing Sarcoma “Onion skin” periosteal reaction in bone

N
of
w
vie
Re
of
s
ge

Table 3:  Most common site involved in bone tumor

Tumor type Site involved
Pa

Osteochondroma Metaphysis
Giant cell tumor Epiphysis
e

Osteosarcoma (osteogenic sarcoma) Metaphysis

pl

Ewing sarcoma Diaphysis

m

Osteoid osteoma Diaphysis

Sa

104
Ans.  c. Anterior chamber depth increased

Recent Pattern Questions (June 2018)

REFRACTORY POWER DEPENDS ON

yy Radii of curvature

18
yy Difference in refractive index between two media at interface of refraction. (Anterior surface of cornea has maximum refractive power
due to maximum change (0.376) in refractive index from air to cornea.

20
yy Axial length of eyeball

12. In pterygium, elastotic degeneration occurs in which layer:

s
a. Epithelium

Q
b. Endothelium
c. Bowman’s layer

rn
d. Descemet’s membrane
Ans.  c. Bowman’s layer

tte
PTERYGIUM

Pa
yy A triangular, fibrovascular growth of degenerative subconjunctival tissue over the cornea, destroying its bowman’s membrane and
superficial stroma.

B
yy Histologically, similar to pinguecula showing elastotic degeneration of the subconjunctival tissue with added vascularization.

DN
&
T
EE

Fig. 1: Pterygium showing cap, head and body and Histology shows collagenous degenerative changes in vascularized sub-epithelial
N

stroma
yy Most commonly seen nasally and situated always within the palpebral aperture, though it can be present temporally-also known as
of

double pterygium.
yy Stocker Line also seen pterygium and Fuchs islets also seen in high magnification.
w
vie
Re
of
s

Fig. 2: Stocker Line

ge

PTERYGIUM VS PINGECULA
Pa
e
pl
m
Sa

111
       Pterygium           Pinguecula
Dermatology

18
20
s
Q
1. Cutis marmorata occurs due to exposure to:
a. Cold temperature

rn
b. Dust
c. Hot temperature

tte
d. Humidity
Ans.  a. Cold temperature

Pa
Ref: Neonatal and Infant Dermatology by Lawrence F. Eichenfield; Page No-74
yy The ability of neonates to adjust to extrauterine surroundings is at first immature, and they can exhibit distinct cutaneous blood flow

B
abnormality.
yy When neonates are cold, their constricted capillaries and venules may produce a reticulated, mottled, blanchable, violaceous pattern

DN
termed cutis marmorata. See the figure:

&
T
N EE
of
w

Fig. 1: The legs of an infant with physiologic cutis marmorata

vie

yy Exposure to cold temperature may also induce more vasoconstriction in acral than central areas of the body, resulting in deep violaceous
to blue coloration of the hands, feet and lips, termed acrocyanosis.
Re

yy Both of these conditions occur more often in premature infants. These transient conditions rapidly improve upon rewarming of the
infants, and the tendency to occur diminishes with age.
yy Cutis marmorata should not be confused with cutis marmorata telangiectatica congenita, a vascular malformation that persists for
several years and occurs in large, well-defined patches.
of
s
ge
Pa
e
pl
m
Sa

Fig. 2: Acrocyanosis; purplish discoloration of the feet on exposure to cold

MALLAMPATI CLASSIFICATION

Class I Soft palate, fauces, entire uvula, pillars

18
20
s
Q
rn
Anesthesia

tte
Pa
Class II Soft palate, fauces, portion of uvula

B
DN
&
T
EE

Class III Soft palate, base of uvula

N
of
w
vie
Re
of

Contd…
s

Class IV Hard palate only

ge
Pa
e
pl
m
Sa

290
Ans.  b. Premature ejaculation
Ref: Kaplan Step 2 CK Lecture Notes 2018 of Psychiatry; Page No- 80-82

Recent Pattern Questions (Jan 2018)

yy The treatment of premature ejaculation typically consists of behavioral techniques aimed at prolonging the time before ejaculation occurs.
These include the squeeze-and-go technique.

18
yy Choices plethysmography and postage stamp are for the diagnosis of erectile dysfunction.
yy Dilators are for the treatment of pain/penetration disorder.

20
SEXUAL DYSFUNCTIONS

s
Phase Characteristics Disorder Treatment

Q
Desire Focuses on the patient’s drives, yy Hypoactive sexual desire: Patients Address issues with patient, such as
motivation, and desires have a decrease or absence of sexual feelings of guilt, poor self-esteem,

rn
fantasies, desires, etc. homosexual impulses, etc. Couples
yy Sexual aversion: A complete therapy may be indicated if due to

tte
aversion to all sexual contact marital conflict
Arousal Consists of a sense of sexual pleasure yy Female sexual arousal: Persistent Address issues of guilt, anxiety, and

Pa
with accompanying physiologic failure to achieve or maintain ad- fear. Evaluate for use of medications
changes equate lubrication during the sexual that cause vaginal dryness, such as
act antihistamines or anticholinergics.

B
yy Impotence: Persistent or recur- Instruct in relaxation techniques
rent inability to attain or maintain Must rule out if organic versus psycho-

DN
adequate erection until completion logical. Consider plethysmography or
of the sexual act postage stamp test
Orgasm Physiologic state in which sexual yy Female orgasmic disorder and Address issues of guilt, fear of

&
tension is released and contractions delayed ejaculation: Recurrent or impregnation, etc. Treatment includes
are produced in various organs persistent inability to achieve an use of vibrators, education, and
T
orgasm either through masturbation fantasy
EE
or sexual intercourse Consider behavioral techniques such
yy Premature ejaculation: Ejacula- as squeeze and stop-and-go. Address
tion before the man wishes to do issues of anxiety about the sexual act.
N

so, before penetration, or just after Consider the use of SSRIs to delay
penetration ejaculation
of

Pain Subjective sense of pain associated yy Genito-pelvic pain disorder: Pain Help the woman deal with issues of
with the sexual act. Most likely due to associated with sexual intercourse anxiety and tension about the sexual
w

dynamic factors in either male or female. Not act.

vie

diagnosed when organic cause Behavioral techniques, such as the

has been found or if due to lack of use of dilators and relaxation. Address
vaginal lubrication issues of fear of impregnation, strict
Re

yy Penetration disorder: Involuntary upbringing, religion, etc.

constriction of the outer one-third
of the vagina that interferes with the
of

sexual act
s

3. Expression and consequent release of previously repressed emotion is called as:

a. Regression
ge

b. Dissociation
c. Abreaction
Pa

d. All of the above

Ans.  c. Abreaction
e

Ref: First Aid for the Psychiatry Clerkship 4th Ed; Page No- 134
pl

yy Abreaction is the strong emotional reaction patients may experience when retrieving traumatic memories.
m

4. New name of mental retardation according to American Association of Mental Retardation:

a. Feeble Mindedness
Sa

b. Madness
c. Intellectual disability 301
d. Mentally unstable