AIPGMEE 2016 MCQ Anatomy Abdomen

Fusion of the caudal portions of the kidneys during
embryonic development is most likely to result in which of
the following congenital conditions?
A. Bicornuate uterus
B. Cryptorchidism
C. Horseshoe kidney
D. Hypospadias
E. Renal agenesis
Answer - C. During development, the kidneys typically “ascend”
from a position in the pelvis to a position high on the
posterior abdominal wall. Although the kidneys are bilateral
structures, occasionally the inferior poles of the two kidneys
fuse. When this happens, the “ascent” of the fused kidneys
is arrested by the first midline structure they encounter, the
inferior mesenteric artery. The incidence of horseshoe
kidney is about 0.25% of the population.

AIPGMEE 2016 Pathology MCQ

A 77-year-old woman has chronic renal failure. Her serum
urea nitrogen is 40 mg/dL. She is given a diuretic medication
and loses 2 kg (4.4 lb). She reduces the protein in her diet and
her serum urea nitrogen decreases to 30 mg/dL. Which of the
following terms best describes cellular responses to disease and
treatment in this woman?
A Adaptation
B Apoptosis
C Necroptosis
D Irreversible injury
E Metabolic derangement
Answer- A
Normal cells handle physiologic demands and maintain
metabolic functions within narrow ranges, termed homeostasis.
Under disease conditions with stress on cells, there is
adaptation to a new steady state. In this case, the loss of renal
function leads to a higher urea nitrogen level as well as retention
of fluid. The diuretic induces loss of the excess fluid to
yield a new steady state. The protein restriction reduces urea
nitrogen excretion, which also leads to a new steady state.
Both are adaptations. Apoptosis refers to single cell necrosis
in response to injury. An irreversible injury leads to cell
death, but the changes described here are not evidence for
cellular necrosis. The metabolism of cells is maintained for
adaptation, with response to the diuretic and to protein restriction.

AIPGMEE 2016 MCQ CVS Medicine

A 15-year-old man presents to the clinic accompanied by his mother for evaluation of “red hands.”
He earned money last winter clearing sidewalks of snow and plans to do so again in the upcoming
weeks. He reports developing red discoloration of his hands after returning home from the cold. The
discoloration persisted for a few minutes until his hands were rewarmed. He denies weakness,
paresthesia, pain, or skin lesions. He is otherwise healthy. At the time of consultation, inspection of
his hands is unrevealing. Radial and ulnar pulses are 2+/2 bilaterally. The Allen test and reverse
Allen test reveal return of color to the hands in 7 seconds bilaterally. His mother reports that she and
her mother both have Raynaud phenomenon. The patient’s mother expresses concern that her son may
have systemic lupus and she requests further testing.
What is the most likely diagnosis?
a. Raynaud disease
b. Raynaud phenomenon
c. Normal physiologic cold response
d. Acrocyanosis
e. Thermal injury

Answer - c. Normal physiologic cold response.
This patient is exhibiting a normal response to prolonged
exposure to cold. The diagnosis of Raynaud phenomenon is clinical and includes the presence of
pallor or acrocyanosis and pain with cold exposure. Redness of the hands with warming after
prolonged cold exposure, without concomitant pain, may be a normal response in a healthy young
individual. He should be counseled to wear gloves and report any change in his symptoms, as his
family history does predispose him to development of Raynaud phenomenon.

AIPGMEE 2016 SPM mcq

All of the following statements are true about the childhood mortality rates in India except:

(a) Almost 2/3rd of infant mortality rate (IMR) occurs in neonatal period

(b) Almost 2/3rd of the under -five mortality occurs in the first year of life

(c) About one in ten children die before they reach the age of five years

(d) Neonatal mortality is higher among female children as compared to males

Ans. (d) 

[Ref. http://www.ncbi.nlm.nih.gov/pubmed/23151996 , Park 21/e p51S-30, Park 22/e p520-32]

Infant mortality is higher in boys than girls in most parts of the world. This has been explained by sex differences in genetic and biological makeup, with boys being biologically weaker and more susceptible to diseases and premature death. At the same time, recent studies have found that numerous preconception or prenatal environmental factors affect the probability of a baby being conceived male or female. I propose that these environmental factors also explain sex differences in mortality. I contribute a new methodology of distinguishing between child biology and preconception environment by comparing male-female differences in mortality across opposite-sex twins, same-sex twins, and all twins. Using a large sample of twins from sub-Saharan Africa, I find that both preconception environment and child biology increase the mortality of male infants, but the effect of biology is substantially smaller than the literature suggests. I also estimate the interacting effects of biology with some intrauterine and external environmental factors, including birth order within a twin pair, social status, and climate. I find that a twin is more likely to be male if he is the firstborn, born to an educated mother, or born in certain climatic conditions. Male firstborns are more likely to survive than female firstborns, but only during the neonatal period. Finally, mortality is not affected by the interactions between biology and climate or between biology and social status.

Almost 2/3rd of IMR occurs in neonatal period (IMR = 47 per 1000 LBand NNMR = 32 per 1000 LB)

Almost 2/3rd of the U5MRoccurs in the first year of life (IMR= 47 per 1000LBand U5MR= 63 per 1000 LB)

About one in ten children die before they reach the age of five years (U5MR= 63 per 1000 LB).

• Post-neonatal mortality rate (PNNMR): Is the number of neonataldeaths (deaths within completed28days after birth) per 1000 live births in that year

• IMR = NNMR + PNNMR = ENNMR + LNNMR + PNNMR

AIPGMEE 2016 MCQ Surgery

All of the following have been associated with an increased risk for hungry bone syndrome after parathyroidectomy except:
A. Graves disease
B. Tertiary hyperparathyroidism
C. Preoperative PTH level
D. Age
E. Large single adenomas

COMMENTS: “Hungry bone syndrome” is characterized by
postparathyroidectomy hypocalcemia and hypophosphatemia.
Patients most at risk are those with four-gland hyperplasia from
secondary or tertiary hyperparathyroidism. The postoperative
calcium level in these patients can drop critically low and necessitate
intravenous calcium supplementation. During this period
both serum calcium and phosphate levels must be monitored
closely. In some patients it can take more than 4 to 5 days for serum
calcium and phosphate levels to stabilize. Other patients shown to
have increased risk for this condition are those who are older or
have concomitant thyrotoxicosis or a large single adenoma. The
preoperative PTH level has not been found to be an independent
predictor of whether “hungry bone syndrome” will develop
postoperatively.
A N S W E R : C

AIPGMEE 2016 MCQ Surgery

All of the following are indications for surgical treatment of
secondary hyperparathyroidism except:
A. Calcium-phosphate product of less than 70
B. Uremic pruritus
C. Osteitis fibrosa cystica
D. Calciphylaxis
E. Tumoral calcinosis


COMMENTS: Secondary hyperparathyroidism is most commonly
managed medically with the use of calcimimetic agents,
phosphate binders, adequate calcium intake, and vitamin D replacement.
Surgical treatment is indicated in patients with (1) renal
osteodystrophy, (2) calciphylaxis, (3) calcium-phosphate product
of greater than 70, (4) soft tissue calcium deposition and tumoral
calcinosis, and (5) calcium level greater than 11 mg/dL with an
inappropriately high level of PTH. Renal osteodystrophy is a
major issue in hemodialysis patients. The aluminum present in the
dialysate bath accumulates in bone and contributes to the development
of osteomalacia. Osteitis fibrosa cystica, a type of renal
osteodystrophy, is characterized by marrow fibrosis and increased
bone turnover. Bone cysts, osteopenia, and decreased bone strength
develop. To halt progression of this disease process, these patients
with secondary hyperparathyroidism are treated surgically. Calciphylaxis
is a rare vascular disorder in which calcium is deposited
in the media of small to medium-sized arteries. As a result, ischemic
damage to the dermal and epidermal structures develops. The
ulcerated lesions are extremely painful and can become infected
with subsequent sepsis and eventually death. Patients with early
signs of calciphylaxis should undergo urgent parathyroidectomy,
although there is some evidence that aggressive management of
serum calcium and parathyroid levels with cinacalcet may be beneficial.
Care should be taken in wound care management because
aggressive débridement can lead to chronic nonhealing wounds
since wound healing is very poor in these patients. Uremic pruritus
is characterized by severe itching that is thought to result from
increased deposition of calcium salt in the dermis without the
visible lesions of calciphylaxis. Parathyroidectomy seems to alleviate
these symptoms and halts progression to the more serious skin
and vascular complications seen with calciphylaxis.
A N S W E R : A

AIPGMEE 2016 Surgery MCQ

You examine a 35-year-old female patient who presents with a right parotid
swelling. Which of the following structures does not lie within the parotid gland?
A. Mandibular nerve
B. External carotid artery
C. Facial nerve
D. Marginal mandibular nerve
E. Retromandibular vein
answer - A Mandibular nerve
From superficial to deep, the following structures all lie within the
parotid gland:
• Facial nerve
• Retromandibular vein
• External carotid artery
The marginal mandibular nerve is a branch of the facial nerve. The
facial nerve enters the parotid gland as it emerges from the stylomastoid
foramen, giving rise to five branches (temporal branch, zygomatic
branch, buccal branch, marginal mandibular nerve and cervical branch)
within the parotid gland.
Answer A is correct as the mandibular nerve (V3) is the third main
branch of the trigeminal nerve (cranial nerve 5) and does not lie within
the parotid gland. The other two main branches of the trigeminal nerve
are the ophthalmic (V1) and the maxillary (V2) nerves