kussmual sign

Kussmual sign is a paradoxical rise of JVP on inspiration and is seen in
1. Constricitve Pericarditis
2. Restrictive Cardiomyopathy
3. Inferior wall MI( RV MI)

Alteranatively remember kussmual sign is absent in CARDIAC TAMPONADE and SUPERIOR VENA CAVA SYNDROME. Logic being that in these conditions the amount of congestion in jugular veins is so large that the pulsations are not seen. Normally we can appreciate the pulsations in jugular vein at a rate twice that of the beating of the carotid artery.

PNEUMONICS FOR MURMURS

MID-DIASTOLIC MURMURS--C.A.M.

1. Carey coombs murmur: Characterstic murmur of rheumatic carditis
2. Austin Flint murmur: characterstic murmur of Severe Aortic Regurgitation
3. Mitral Stenosis
4. PEDIATRIC DATA: Flow murmurs seen in ASD/Tricuspid atresia.

EARLY DIASTOLIC MURMURS--G.A.P.
1. Graham steele murmur: pulomnic regurgitation
2. Aortic regurgitation( mild)
3. Pulmonic Regurgitation ( mild)

SOLVED MCI SEPT 2012 RELEASED 1st jan 2013

 This book has been compiled after hours of brain storming with your seniors who excelled in the examination and created a niche for themselves. I have an experience of 8 years for helping FMG crack this examination in the word go and can vouch for the fact that nothing succeeds like success.

This small book should be read at time which is usually wasted like in between classes or updating status on fb. The percentage of repeats is upto 10% and new questions are introduced from the database. Still on basis of my experience i was able to predict subjects less likely to be quizzed like in September exam surgery was not asked much. Hence in my classes and interactions updates would be given on regular basis.

The classes given is proportional to the pattern that flucutuates between the march and the September exam and hence the subtle variations introduced in the academy.

AIIMS medicine recall NOVEMBER 2012

142. Patient with ICD collapses, ICD imaging modality
a. Chest x ray
b. MRI
c. CT
d. USG
Answer (a) Chest X ray
Reference: Harrison: 18 th edition/ just above table 233-9/ chapter 233./Emedicine:http://emedicine.medscape.com/article/162245-overview#aw2aab6c12

143. A patient on amphotericin B develops hypokalemia of 2.3meq/l. K+ supplementation requires is?
a. 40meq over 24 hrs
b. 60meq over 24 he's
c. 80 meq over 24 hrs
d. 120-160meq over 24 hrs
Answer (A) 40meq over 24 hrs
Reference: Harrison 18th edition, chapter 46
143. A patient with 12cm abscess in liver which was drained under sonographic monitoring 3 times and On follow up a residual cavity of 4cm was found to be present .An oral lumicidal drug was given for 14 days. Next plan of action shall be:
a. Stool examination serially
b. USG weekly for 1 month followed by monthly USG till 1 year.
c. USG weekly for 1 month followed by CT scan at 3 months.
d. Monthly CT scan
Answer (b) USG weekly for 1 month followed by monthly USG till 1 year.
Reference: Harrison 18 th edition chapter 202
144. Which of the following is Not true aboutpolymyositis ?
a. Limb girdle weakness
b. Ophthalmoplegia
c. Para-neoplastic syndrome
d. Spontaneous discharge in EMG.
Answer (B) Ophthalmoplegia
Reference: Harrison 18th chapter 383
145. 35 year old female with recurrent renal stone. not advised is:
a. Increase water
b. Restrict protein
c. Restrict salt
d. Ophthalmoplegia
Answer (D) Ophthalmoplegia
Reference: Harrison 18th edition/ chapter 281/page 1817/ Reference: www. Uptodate.com/contents/prevention of recurrent calcium stones in adults, Campbell’s urology chapter 43
146. A 28 yr old man has lenticonus and ESRD now. His maternal uncle also died of similar illness. Diagnosis is
a. ARPKD
b. ADPKD
c. Oxalosis
d. Alport's syndrome
Answer: (D) Alport’s syndrome
Reference: Harrison 18th Chapter 357
147. Pinna calcification Except
a. Gout
b. Onchrnosis
c. Frost bite
d. Addisons disease
Answer (a) Gout
Reference :Chapter 54. Skin Manifestations of Internal Disease, Harrison 18th (www.nejm.org/doi/full/10.1056/NEJMicm1000193)
148. Which of the following doesnot need treatment?
a. Neuroblastoma
b. Burkitts
c. t cell lymphoblastic leukemia
d. Not Recalled
Answer is A
Reference: Nelson 18th text book of pediatrics/chapter 498
149. With ageing, a slight decrease in cognitive impairment is seen due to increase in level of
a. Homocysteine
b. Taurine
c. Methionine
d. Cysteine
Answer (a) Homocysteine
Reference: CMDT 2012 / page 1620
150. A Patient presents with pain in Meta-Tarso-Phalangeal joints and is a known case of Chronic Renal Failure. This is due to accumulation of-
a. Rh factor
b. Uric acid
c. Serum urea
d. HLA B27 typing
Answer (b) Uric Acid
Reference: Harrison 18th edition/table 280.4/ chapter280 and http://www.ncbi.nlm.nih.gov/pubmed/21321568
151. SARS causative agent
a. Corona-virus
b. Picorna-virus
c. Myxovirus
d. Recalled
Answer: (a) Corona-virus
Reference  :Harrison 18th edition-chapter 179
152. Blink reflex is used for?
a. Mid pontine lesions
b. Neuromuscular transmission
c. Axonal neuropathy
d. Motor neuron disease
Answer (a) Mid pontine lesions
Reference: http://www.ncbi.nlm.nih.gov/pubmed/17727783/ Clinical value of blink reflex
153. Grisel syndrome all are true except:
a. Post-adeniodectomy
b. Conservation treatment
c. Inflammation of cervical spine ligaments
d. No need for neurosurgeon
Answer (d) No need for neurosurgeon
Reference: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2639892/
154. Cervical syringomyelia all are seen except
a. Burning sensation in hands
b. Hypertrophy of abductor pollicisbrevis
c. Plantar extensor
d. Absent biceps reflex.
Answer: (b) Hypertrophy of abductor pollicisbrevis
Reference: Harrison textbook of medicine 18 th edition chapter 377/ above figure 377-7http://emedicine.medscape.com/article/1151685-clinical
155. 70year female is on treatment with Alendronate for severe osteoporosis.Now she complains of pain in right thigh. What is the next investigation to be performed?
a. DEXA scan
b. x ray
c. Serum vitamin D levels
d. Serum alkaline phosphate levels
Answer (b) X-ray
Reference: CMDT 2012/page 1118
156. A 70 year old retired Military person with good previous medical record complains of bi-temporal headache which is decreased in lying down position. He states that he gets relief by giving pressure over bilateral temples. The patient also complains of loss of appetite with feeling feverish.
a. Chronic tension headache
b. Temporal arteritis
c. Migraine
d. Fibromyalgia
Answer (b) Temporal arteritis
Reference: CMDT 2011 page 819 and http://emedicine.medscape.com/article/809492-clinical#a0216
157. A patient of rheumatoid arthritis develops sudden onset Quadriparesis, , increased muscle tone of limbs with exaggerated tendon jerks and worseningof  gait. The investigation to be done:
a. Flexion and extension Cervical area X ray of neck
b. MRI brain
c. EMG and NCV
d. Carotid angiography
Answer( a) Flexion and extension Cervical area X ray of neck
Reference:Harrison chapter 15/18 th edition

159. Type 1 renal tubular acidosis all are trueExcept?
a. Renal stones
b. Hypokalemia
c. > 4mg/ day Sodium bicarbonate
d. Urine pH > 5.
Answer (c) > 4mg/ day Sodium bicarbonate
Reference: Harrison 18th edition 284/ CMDT 2011 page 862
160. A diabetes mellitus patient with fungal infection of sinuses and peri-orbital region with significant visual impairment:
a. Amphotericin B
b. Itraconazole
c. Ketoconazole
d. Broad spectrum antibiotics
Answer: Amphotericin B
Reference: Harrison 18th  Edition/ Chapter 205
161. Gait apraxia?
a. ACA
b. MCA
c. PCA
d. Posterior choroidal artery
Answer: (a) Amphotericin B
Reference: chapter 24 Harrison18th : Gait and balance disorders
162. Prions, which of following is correct
a. Long incubation period
b. Destroyed by autoclaving at 121C
c. Nucleic acid present
d. Immunogenic
Answer (a) Long incubation period
Reference: The following lines are excerpt from Harrison 18th chapter 383:
163. A patient with Tubercular meningitis was taking ATT regularly. At end of 1 month of regular intake of drugs deterioration in sensorium is noted in condition of the patient. Which of the following investigations is not required on emergency evaluation?
a. MRI
b. NCCT
c. CSF examination
d. Liver function tests
Answer (c) CSF examination
References: included in the text
Therefore the following logical conclusion can be:
ALTERED SENSORIUM due to Hepatic encephalopathy secondary to hepatotoxicity of ATT.  Hence LFT should be performed.
ALTEREDED SENSORIUM due to Obstructive hydrocephalus could lead to raised ICT leading to pressure on midbrain and resultant status.  Therefore a MRI scan can identify the process and necessitate a neurosurgical consult.
(Page 540 of OP GHAI 7th edition) ALTERED SENSORIUM due to end-arteritis resulting in brain infarction and hypo-dense lesions.  Tubercular encephalopathy results in diffuse edema of brain simulating post-infective allergic encephalopathy,   Necrotizing or hemorrhagic leuko-encephalopathy may occur in TB meningitis.. In choice NCCT is given and it can identify infarction as well cerebral Edema.
The que3stion mentions altered sensorium in the patient and if we see the table in (Fig 376-1 harry boy 17th edition Harrison) on altered sensorium, imaging should be performed.  Lumbar puncture now can precipitate the ominous herniation of the brain.
164. What is feature of temporal arteritis
a. Giant cell arteritis
b. Granulomatous vasculitis
c. Necrotizing vasculitis
d. Leucocytoclasticvasculitis
Answer (a) Giant cell arteritis
Reference: Harrison: 18th edition/ chapter 326
165. A patient withHepatits C, exhibits hypo-complimentemia, 2g/day proteinuria andhematuria is present. The most probable diagnosis is: REPEAT
a. M.P.G.N.
b. Cryo-globulinemia
c. Membranous Glomerulopathy
d. Post-infectious Glomerulonephritis
Answer (a) M.P.G.N.
Reference: Chapter 326/ Harrison 18th edition/http://emedicine.medscape.com/article/329255-clinical/CMDT 2012 pg 899.
166. All are indicated in a patient increased s. cysteine and multiple renal stones except:
a. Cysteamine or
b. Increase fluid intake
c. Alkalinisation of urine
d. Pencillamine
Answer: (a) Cysteamine or
Reference: CMDT 2012/ page 923/chapter 287 harrison 18th edition
 

pediatrics MCI 2102- result expected before weekend

MCI September 2012 Paediatrics


1. At what  age does child know his gender ?

a. 1 yr

b. 1- 2 yr

c. 21/2- 3 yrs!

d. 4 yrs

A child can tell his age gender by 3 years of age. He can recall a story as well for example if some child ate his lunch then he would come home and can complain to the mother for the same. A child at 3 yrs has 20 teeth was asked in previous examination. A child at three can draw a circle at 3 yrs.

So when you sit in next exam, do invest 15 minutes into what a child can do ? at 2 yrs ,3 yrs and 4 yrs. this is asked as the preschool age group shapes the personality of child and therefore one of the most important periods of growth.

Reference: DIAMS pediatric notes .



2. Not a sign of good attachment of baby to breast :

a. Baby suckles with lower lip inverted!

b. Upper part of areola visible.

c. Baby suckles in slow pauses

d. Chin of baby touches the breast.

Well think logically if the baby is to suckle properly, the lower lip must be EVERTED. This is a repeat question .

3. 1st sign of sexual maturity in boys

a. Phallic enlargement

b. Testicular volume!

c. Change of voice

d. Change in body structure and skin changes

1st sexual change in boys is increase in testicular enlargement while in girls would be thelarche. REPEAT

4. A baby can lift his head and chest of the bed in prone position by the age of

a. 3 months

b. 4 months

c. 6 months!

d. 9 month

a child in prone position /or held in ventral suspension at birth would be like a rag doll with inability to hold neck.

Head control comes at 4 months and child placed in prone position can raise his head of couch but not the chest.

A child at 6 months can raise his head neck and chest off the couch using strength of his shoulder muscles.

Those who attended my class would recall 3 6 8 12 rule

3- neck becomes strong

6- shoulders become strong

8- back muscles become strong

12 – leg muscles become strong.



5. The length of baby becomes 100 cm at

a. 1 yrs

b. 2 yrs

c. 3 yrs

d. 4yrs !



6. Musty odour of urine is seen in

a. Phenylketonuria!

b. Maple syrup urine disease

c. Isovaleric academia

d. Organic aciduria



7. Sub-periosteal bleeding is seen in:

a. Scurvy!

b. Rickets

c. Diamond balckfann syndrome

d. Acute ITP

LAST minute tips -MCI sept 2012

1. sleep pattern to be reversed to normal. instead of studying all night study at day time .
2. carry choclates with you to avoid hypoglycemia.
3. its humid so wear accordingly
4. attempt all questions .
5. carefully fill the answer sheet or your answer sheet is bound be rejected. causes - ink smuding /sweat smudging / incorrect code filled/ incorrect ROLL NUMBER filled
6. no point in reading derma /radio/ psychaiarty. if you did not study them earlier.... congrats on wasting next few months of your life
7. revise @ 1 subject perr day PSM/ PHARMA/ BIOCHEM/ SURGERY/ GYNAE/OBS/MEDICINE
8. revise all SPM data one day before .

MCI march 2012 screening exam

MCI MARCH 2012 medicine questions
1. Shrinking lung disorder is seen is


a. Sjogren’s syndrome

b. Systemic lupus eruthematosus (cant get simpler )

c. Polyarthritis nodosa

d. Behcet’s syndrome

2. The drug of choice in scleroderma induced hypertensive crisis is

a. ACE inhibitors ( malignant hypertension and renal crisis needs a permanent solution! so dont answer as nitroprusside as it will work for few minutes and then back to square one.

b. Angiotensin receptor blockers (ARBs)

c. Β – blockers

d. Sodium nitroprusside

3. Schistocytes are seen in

a. Iron deficiency anemia

b. Megaloblastic anemia

c. Microangiopathic hemolytic anemia !! also known as burr  cells and helmet cells

d. Aplastic anemia

4. Puddle’s sign is used to detect

a. Chylothorax

b. Ascites!!

c. Abdominal aortic aneurysm

d. Renal artery stenosis

5. Oral vancomycin can be used for treatment of

a. Hepatic encephalopathy

b. Pseudomembranous colitis!!

c. Staphylococcal food poisoning

d. None of the above

6. Which of the following could suggest presence of an ectopic Cushing’s syndrome in a patient with hypercortisolism

a. Hypertension

b. Glucose intolerance

c. Metabolic alkalosis!!

d. Truncal obesity

7. After taking alcohol, a hitherto healthy individual has persisting vomiting and vomits blood. The most likely diagnosis is

a. Boerhaave’s syndrome

b. Mallory Weiss syndrome!!

c. Barrett’s oesophagus

d. Carcinoma oesophagus

8. The most radio sensitive tumor amongst the following is

a. Squamous cell carcinoma

b. Seminoma!!

c. Soft tissue sarcoma

d. Lympho epithelioma

9. Most useful investigation of choice for liver abscess is

a. Exploratory laparotomy

b. Ultrasound !!

c. Liver enzymes

d. Parasite in the stool

10. The commonest fluid used for fluid resuscitation in burns is

a. Normal saline

b. Ringer lactate!!

c. Human albumin

d. Fresh frozen plasma

11. All of the following are clinical signs of hypothyroidism except

a. Cardiomegaly

b. Pericardial effusion

c. Tachycardia!!

d. Delayed relaxation of ankle jerk

12. Radio isotope scan used in the diagnosis of Meckel’s diverticulum is

a. Tc99!!

b. I131

c. HIDA

d. RBC labeled

13. ‘Bloody Triad’ of massive blood loss and transfusion is characterized by

a. Acidosis, hypotension and oliguria

b. Acidosis, hypotension and coagulopathy

c. Acidosis, hypothermia and coagulopathy!!

d. Acidosis, hyperthermia and coagulopathy

14. Examination of the synovial fluid in tuberculosis usually reveals the following

a. Low count of leucocytes, increased glucose content and decreased proteins

b. Leucocytosis, decrease of both glucose and protein content

c. Leucocytosis, decreased glucose content and a raised protein content!!

d. Leucocytosis, increased glucose and protein content

15. Investigation of choice for detection & characterization of interstitial lung disease is

a. MRI

b. Ventilation – Perfusion Scan

c. High resolution C.T. scan!!

d. Chest X - ray

16. Pulsus bisferiens is seen in all of the following except

a. Aortic stenosis & aortic regurgitation

b. Mitral valve prolapse !!

c. Severe aortic regurgitation

d. Hypertrophic obstructive cardiomyopathy

17. All of the following are true of osteomalacia except

a. Proximal myopathy

b. Raised serum calcium !!

c. Bone biopsy shows increased demineralized bone matrix

d. Vitamin D deficiency

18. Major cause of death in ESRD (End Stage Renal Disease) patients on dialysis is

a. Cardiovascular disease

b. Infection!!

c. Uremia

d. Respiratory failure

19. Acromegaly is characterized by all except

a. Diabetes

b. Enlarged nasal sinuses

c. Increased heel pad thickness

d. Muscular hypertrophy!!

20. Which of the following conditions is not associated with ST segment elevations on ECG

a. Early repolarization

b. Hyperkalemia

c. Acute pericarditis

d. Hypocalcemia !!

21. Which one of the following diseases can produce atrioventricular block

a. Lyme’s disease!!

b. Malaria

c. Typhoid

d. Leptospirosis

22. Which of the following is not a complication of Crohn’s disease

a. Fistula formation

b. Stricture

c. Perineal sepsis

d. Toxic megacolon!!

23. A 29 yrs old unmarried female presents with dyspnea. Her chest X – Ray is normal, FVC- 92 % & FEV1/FVC-89%. On exercise, her oxygen saturation drops from 92 % to 90 %. What is the most likely diagnosis ( DIRECT AIIMS RIP OFF)

a. Alveolar hypoventilation

b. Primary pulmonary hypertension!!

c. Interstitial lung disease

d. Anxiety

24. Which one of the following condition is not associated with clubbing

a. Primary biliary cirrhosis

b. Chronic bronchitis!!

c. Cryptogenic fibrosing alveolitis

d. Bronchiectasis

25. All of the following illness can occur at high attitude except

a. Cerebral oedema

b. Pulmonary oedema

c. Pulmonary barotraumas!! ( spontaneous pneumothorax occurs in smokers ....so NASA and IAF does not employ SMOKERS. )

d. Retinal hemorrhage (( i crossed checked on emedicine that is occurs.)

26. All of the following are features of cluster heacache except

a. It may be associated with unilateral photophobia/phonophobia

b. Onset of headache is nocturnal in about half of the patients

c. Patients tend to move about during attacks

d. Women are affected three times more often than men !!

27. Raynaud’s phenomenon has typical progression of colour change as follows

a. Red → Blue → White

b. Red → White → blue

c. blue → Red → White

d. White → Blue → Red!!

28. Human herpes virus 8 infection is associated with

a. Hairy cell leukemia

b. Kaposi sarcoma!!

c. Oral hairy leucoplakia

d. Molluscum contagiosum

29. All of the following are signs of hemorrhagic shock except

a. Tachycardia

b. Hypotension

c. Increased pulse pressure!!

d. Tachypnea

30. A man has had a lymph node biopsy. Histopathology of the node shows Reed – Sternberg cells. The most likely diagnosis is

a. Immune deficiency syndrome

b. Lymphoma!!

c. Tuberculosis

d. Non specific infection

31. A baby of 6 months weighing 8 kg is brought with acute diarrhea. He is drowsy and unable to drink. The ideal first line of management should be

a. Ringer lactate 250 ml in 1 hr

b. Ringer lactate 250 ml in 30 minutes!!

c. Ringer lactate 800 in 3 hrs

d. ORS 600-800 ml in 4 hrs

32. The ratio of chest compression to breathing in Pediatric life support is

a. 3:1!!

b. 4:1

c. 5:1

d. 6:1

33. Which type of cerebral palsy is most commonly seen as a sequel of billirubin encephalopathy

a. Spastic quadriparesis

b. Spastic diplegia

c. Atonic cerebral palsy

d. Extra pyramidal cerebral palsy!!

34. A 30 yrs old man presents with generalized edema, hematuria, hypertension and subnephrotic proteinuria (<2 gm). Urine examination shows microscopic hematuria, serum complement is decreased & positive for hepatitis C antibodies. The most likely diagnosis is

a. Focal segmental glomerulosclerosis

b. Mied cryoglobulinemia

c. Lupus nephritis

d. Membranoproliferative glomerulonephritis !!

35. Which of the following is not true for achalasia cardia

a. Absence of gastric air bubble in bubble in chest X – ray

b. Symptoms of dysphagia and chest pain

c. Decreased pressure of lower esophageal sphincter on manometry!!

d. Nifedipne is effective in treatment

36. Which of the following is the most reliable clinical endpoint to indicate adequate atropinisation in organophsphate poisoning

a. Pupillary dilatation

b. Control of diarrhea

c. Heart rate more than or equal to 100 beats/min!!

d. Absence of oropharyngeal secretions

37. Whipple’s triad does not include documentation for

a. High insulin level!!

b. Symptoms consistent with hypoglycemia

c. Low plasma glucose

d. Relief of symptoms after raising plasma glucose

38. “Bone within bone” appearance is classically seen in

a. Osteogenesis imperfect

b. Osteopetreosis!!

c. Renal osteodystrophy

d. Achondroplasia

39. Which of the following is not a feature of Turner’s Syndrome

a. Adult stature less than 145 cms

b. Long 4th metacarpals and metarsals !!

c. Medial Tibial Exostosis

d. Lymphedema of dorsa of hands

40. Pulmonary fibrosis is a side effect associated with the use of

a. Actinomycin

b. Bleomycin!!

c. Doxorubicin

d. Mithramycin

41. All of the following are true about neuroendocrine response in shock except

a. Incrased cortisol

b. Increased insulin!!

c. Increased glucagon

d. Increased epinephrine

42. Oligemic lung fields are seen in all of the following conditions EXCEPT

a. Transposition of great vessels

b. Atrial septal defect (ASD)!!

c. Tetralogy of Fallot

d. Pulmonary stenosis

43. Commonest causative organism for gas gangrene is

a. Clostridium septicum

b. Clostridium welchiii!!

c. Clostridium oedematiens

d. Clostridium histolyticus

44. (Patho) Renal vein thrombosis is most commonly associated with

a. Diabetic nephropathy

b. Membranous glomerulopathy!!

c. Minimal change disease

d. Membrano-proliferative glomerulonephritis

45. (Patho) the most common complication of blood transfusion is

a. Haemolytic reaction

b. Embolism

c. Febrile and allergic reaction!!

d. Bacterial sepsis

46. Body mass index is calculated by

a. (weight in Kg/Height in meters2) 100!!

b. (weight in Kg/Height in meters3) 100

c. (weight in Kg2)/Height in meters2) 100

d. (weight in Kg/2 x Height in meters2) 100

47. A 14 years old boy presents with history of frequent fighting at school disciplinary problems, stealing money, truancy and vandalism. What is the most appropriate diagnosis:

a. Attention deficit hyperactivity disorder

b. Autistic disorder

c. Narcissistic personality disorder

d. Conduct disorder!!