Prelim round of quiz held at AIIMS, Delhi on 20/10/19

1. AIIMS MEDICINE QUIZ
20th October 2019
PRELIMS

2. Prelims
Block A (Question 1-10): 45 sec
Block B (Question 11-19): 1.30 minute
Block C (Question 20-30): 1 minute
Revisit each question: 15 seconds each
● All questions carry equal marks (1).
● Tiebreaker questions have been
marked with *.
● In case of a tie, team with more
correct answers to tiebreaker
questions will be chosen.
● No more than 3 teams from any
college will be selected for finals.

3. Q1
Identify this famous doctor who is a pioneer in the field of medical
research?

4. A1
Scurvy.
James Lind.
By conducting one of the first ever clinical trials,he developed the theory
that citrus fruits cured scurvy.

5. Q2
‘B’ has been used by Oriental herbalists for more than two thousand years in the
treatment of many illnesses, especially ‘A’. For many years after the discovery,
access to the purified drug ‘B’ and the plant from which it was extracted were
restricted by their government. It was not until the economic reform in the late
1970s and early 80s that news of the discovery reached scientists outside this
country when results were published in the Medical Journal in 1979. In the late
90s, Novartis bought a new patent for ‘B’, providing it at reduced prices to the
WHO. Since 2006, ‘B’ has now become the mainstay of treatment of ‘A’.
Identify ‘A’ and ‘B’ (0.5+0.5).

6. A2
• A – Malaria
• B – Artemisinin
derivatives from the
plant Artemisia annua.

7. Q3
Where do you find Stag
Antlers’ sign on a chest X-Ray?

8. A3
Upper lobe pulmonary venous diversion (cephalisation) in pulmonary
venous hypertension or pulmonary edema as seen on frontal chest
radiograph.
aka hands-up sign or inverted moustache sign.

9. Q4
Which antihypertensive was introduced with a lot of promise was
taken off the market due to its direct implication in causing suicides?

10. A4
• Reserpine blocks
release of NA, 5HT and
DA.
• The other major side
effect is dose
dependent
Parkinsonism.

11. Q5
‘A’ was a Dutch physician and physiologist who developed the ‘B’ in 1903
for which he subsequently received the Nobel in Physiology and
Medicine in 1924. The ‘B’ has undergone many modifications today but
still remains the most useful tool in assessing a patient with ‘C’ the most
common cause of death worldwide.
Identify ‘A’, ‘B’ and ‘C’

12. A5
• A – Willhelm Einthoven
• B – EKG or ECG
• C – Myocardial Infarction

13. Q6
The use of products such as
these is contraindicated in
patients with which disease?

14. A6

15. Q7.
• Identify the phenomenon.
• Any 1 disease which is characteristically associated with it?

16. A7
• Emperipoleisis (intact cell within
the cytoplasm of another cell (Greek :
en is inside, peripoleomai is go round).
• Unlike phagocytosis, in which the engulfed cell is killed
• Autoimmune hepatitis, Rosai Dorfmann

17. Q8
These classical radiological signs signify?

18. A8
Ruptured hydatid cyst.
Half points for hydatid disease

19. Q9
Peter Safar was an anesthesiologist who established the first ever ICU
with ‘advanced life support’ at the University of Pittsburgh and the
first ever intensive care medicine program. Along with James Elam he
is credited to have pioneered the modern technique for what?

20. A9
• Chest compressions/ CPR
• Not accepted BLS/ACLS

21. Q10
What is the calcium content in a 10 mL 10% calcium gluconate
injection (in mg of elemental calcium)?

22. A10
930 mg-950 mg of calcium

23. Q11*
19 yr old girl presented with acute onset ascending paralysis of B/L lower
limbs for last 3 days with weakness in upper limbs and head lagging for 1 day
without paraesthesia or loss of sensation. No H/O fever, URTI, UTI or
diarrhea before this illness.
Examination shows hypotonic limbs with areflexia. NCV showed normal
SNAPs, reduced CMAPs and normal latency/conduction velocity in both
upper and lower limbs. CSF was performed to confirm the diagnosis.
● What is the antibody involved in this disease?
● If the CSF failed to show the classical dissociation with proteins 102 mg
and 55 cells(100% Lympho). What additional investigation is mandatory
in such patients with high clinical suspicion of this diagnosis?

24. A11
GBS, AMAN subtype
● Anti-GD1a
● HIV serology
CSF pleocytosis is well recognized in HIV-associated GBS and GBS associated
with leptomeningeal carcinomatosis.

25. Q12
Something does not seem right

26. A12
Limb lead reversal (LA <-> RA)
When the limb electrodes (LA, RA, LL) are exchanged without disturbing the neutral electrode
(RL/N), Einthoven’s triangle is “flipped” 180 degrees or rotated, resulting in leads that switch
positions, become inverted or remain unchanged (depending on their initial position and vector).
This has the following effects on the ECG:
• Lead I becomes inverted.
• Leads II and III switch places.
• Leads aVL and aVR switch places. => Lead aVR becomes positive
• Lead aVF remains unchanged.
In contrast to dextrocardia there is normal R wave progression in
the precordial leads.

27. Q13 Find your ex.
X

28. A13
Transcortical sensory /posterior transcortical aphasia

29. Q14
An 18-year-old student presents with severe abdominal pain, nausea, and vomiting of 1-
day duration. On examination he is mildly tachycardic and diaphoretic. Abdominal exam is
significant for epigastric tenderness and mild hepatomegaly. He reports similar episodes
of epigastric pain in the past, which resolve spontaneously. He denies any other
significant medical history. He admits to occasional alcohol and marijuana use. Laboratory
values are as follows:
WBC 9000/μL
ALT 50 U/L
AST 60 U/L
ALP 180 U/L
T. Bilirubin 1.8 mg/dL
Lipase 2000 IU/L
The laboratory calls you to report that the patient’s serum appears to be milky. What’s
the diagnosis?

30. A14
Hypertriglyceridemia induced acute pancreatitis

31. Q15
● Identify the
disease (0.25)
● Name three
drugs approved
for use in this
disease. (0.25x3)

32. A15
1. Famial hypercholesterolemia
2. Drugs approved
a. Statins
b. PCSK9 inhibitors
c. Ezetimibe
d. Mipomersan
e. Lomitapide

33. Q16*
12 year old with cyanosis on and off since birth.Right and left heart
catheterisation with pressures and oxygen saturation shown. Diagnosis?
Chamber O2 Saturation Pressure
SVC 88 -
IVC 66 -
RA 87 a6 v8 (6)
RV 89 50/6
PA 88 35/14 (23)
LA 86 a7 v7 (6)
LV 89 120/6
FA 88 130/80 (105)

34. A16
TAPVC

35. Q17
A passage in the New Testament describes a paralyzed man miraculously regaining the
ability to stand and walk. In a small town in southeast Minnesota on the morning of
September 21, 1948, a similar miracle began to unfold. A 29-year-old woman was
hospitalized at the Mayo Clinic (Rochester, MN) for severe rheumatoid arthritis that
caused debilitating joint immobility. She was injected with a small amount of an
experimental new drug, at the time named A, which was discovered and investigated in
tandem by B and C. Two days and 2 more injections later the patient could walk and left
the hospital to enjoy a 3-hour shopping spree. Just 2 short years later B and C shared the
Nobel Prize in Physiology or Medicine with Tadeus Reichstein.
Identify A.

36. A17
● Cortisone

37. Q18*
● An 18-year-old man was involved in a car accident and presented in altered
sensorium (E2 V1 M4). He was diagnosed to have sub-arachnoid hemorrhage. He
was treated with mechanical ventilation and osmotic therapy. However, next
morning his sensorium gradually worsened to E1 VT1 M1. He did not receive
sedative or analgesic medicines in the night. The patient’s BP was 180/100 mmHg,
HR was 60/min, RR was 14/min and he wasn’t triggering the ventilator. His core
body temperature was 34 F. His pupils were 5 mm, non-reactive to light.
Oculocephalic and oculovestibular reflexes were absent. The patient did not cough
during suctioning. The patient’s electrolytes, renal and hepatic functions were
normal, blood glucose was 135 mg/dL and there were no appreciable blood-gas
disturbances.
● Based on available data, is this patient eligible for brain death testing? If yes, why?
If no, why?

38. A18
The patient is hypothermic.
“Nobody is dead, until they’re warm and dead”

39. Q19
“ I know that I know nothing”
- Socrates
What is Dunning-Kruger Effect?
Y
a
x
i
s
X axis

40. A19
In the field of psychology,
the Dunning–Kruger effect is
a cognitive bias in which people
mistakenly assess their cognitive
ability as greater than it is.
It is related to the cognitive bias
of illusory superiority and comes
from the inability of people to
recognize their lack of ability.

41. Q20* Identify the device.

42. A20
CRT-D.
Not CRT-P. Half points for
CRT.

43. Q21
If the Virchow’s node lies in
the “Seat of the Devil”, then
which infectious disease is
also known as the “King’s
Evil” because in the
medieval times it was
believed that the touch of a
king could heal it?

44. A21
• Scrofula/cervical LN TB/cold abscess.
• Half points for LN TB.
• No points for TB.

45. Q22
A 70 year old male patient with a history of adenocarcinoma of the
prostate diagnosed 6 months back presents to the emergency
department with sudden onset paraplegia with back pain and bladder
bowel incontinence. Before further evaluation what is the drug of
choice to salvage the patient’s condition based solely on clinical
suspicion?

46. A22
• IV Methylprednisolone.
• Diagnosis: Neoplastic Spinal Cord Compression.
• IV steroids given within 12 hours can prevent permanent motor
deficits.

47. Q23
Which of these is not characteristically associated disease with Type 2
Autoimmune hepatitis
A. Vitiligo
B. Autoimmune thyroiditis
C. Autoimmune adrenal insufficiency
D. Type 1 diabetes mellitus

48. A23
Autoimmune adrenalitis

49. Q24
Match the following clinical trials:
Name of trial Study protocol
1. CULPRIT-SHOCK A. Ticagrelor vs clopidogrel for ACS
2. SPRINT B. ARNI
3. PARADIGM C. Reperfusion strategies in patients with acute
myocardial infarction and hypotension
4. PLATO D. Intensive versus Standard Blood-Pressure Control

50. A24
● CULPRIT SHOCK : PCI Strategies in patients with acute myocardial
infarction and cardiogenic shock:
● SPRINT trial: Intensive versus Standard Blood-Pressure Control
● PARADIGM HF: ARNI
● PLATO : ticagrelor vs clopidogrel for ACS

51. Q25
• This is Steve McQueen a popular American actor
of the 50’s-70’s who had the title of the ‘King of
Cool’. A few months before his death, McQueen
had given a medical interview in which he blamed
his condition on _______exposure. While
McQueen felt _________ used in movie
soundstage insulation and race-drivers' protective
suits and helmets could have been involved, he
believed his illness was a direct result of massive
exposure while removing ________ lagging from
pipes aboard a troop ship while in the Marines.
He quit smoking almost 2 years before his death.
• Fill in the blank and his cause of death
A scene from ‘The Great St.
Louis Robbery’ 1959.

52. A25
• Asbestos.
• Malignant Mesothelioma.

53. Q26*
Rarely there are some
discoveries which
shape the future of
mankind
This paper talks about
one such discovery
Identify the discovery?

54. A26
• Discovery of Philadelphia chromosome by Nowell and Hungerford

55. Q27
In patients harbouring this mutation, the following screening guidelines are
usually recommended: routine Upper GI endoscopy, Capsule endoscopy,
Colonoscopy, Breast MRI or digital mammography, Transvaginal ultrasound
and endoscopic ultrasound every 1-3 years. What gene mutation are we
talking about?

56. A27
STK11.
Peutz Jeghers

57. Q28
An 18 year old male dies suddenly during a track and field event.
During a recent sports physical he was noted to have a III/VI systolic
crescendo-decresendo murmur at the left lower sternal border
radiating to axilla, that became louder with Valsalva. A paradoxical
split S2 heart sound was heard. Which of the following is his likely
diagnosis?
A. Congenital coronary anomaly
B. Commotio cordis
C. Idiopathic hypertrophic subaortic stenosis
D. Dilated cardiomyopathy

58. A28
C. Aka HCM

59. Q29
Match (multiple answers possible)
1. Burkitts Lymphoma
2. Mantle cell lymphoma
3. Follicular Lymphoma
4. Maltoma
A. t(14,18)
B. t(2, 8)
C. t(8 , 14)
D. t(11, 14)
E. t(11, 18)
F. t(8, 22)

60. A29
• 1- BCF
• 2-D
• 3-A
• 4-E

61. Q30
● What investigation is depicted?
● Deficiency of what component
would you suspect if the ”MA” was
reduced?

62. A30
● Thromboelastography
● Platelet >> Coagluation factors