Tamil Nadu PG Entrance Review - Bruno - PARAS - TargetPG

TargetPG Tamil Nadu PG Entrance - Self Assessment & Review – Question Papers of TNPG 2002 to 2006 with Answers References, Explanations, Discussion, Mnemonics, Tables and Diagrams
Author : Bruno
Publisher : PARAS
Cover Price : Rs 425

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Sample Questions

Question Stem

148) The rate of increase in head circumference in 0 - 3 months is

Choices given

A) 2 cm per month

B) 1 cm per month

C) ½ cm per month

D) 0.25 cm per 3 months

Answer

A) 2 cm per month

Reference

Nelson 15^th Edition Table 11.5

Question Analysis

Based on	Question Category	Question Grade	Question Type	Books	Target PG Opinion
Fact	Subtle Point	PG Entrance	Straight forward	Given in All books	Needs Memory

Facts about Growth and Caloric Requirements

Age	Approximate Daily Weight Gain (g)	Approximate Monthly Weight Gain	Growth in Length (cm/mo)	Growth in Head Circumference (cm/mo)	Recommended Daily Allowance (kcal/kg/day)
0–3 mo	30	2 lb	3.5	2.00	115
3–6 mo	20	1 1/4 lb	2.0	1.00	110
6–9 mo	15	1 lb	1.5	0.50	100
9–12 mo	12	13 oz	1.2	0.50	100
1–3 yr	8	8 oz	1.0	0.25	100
4–6 yr	6	6 oz	3 cm/yr	1 cm/yr	90–100

Interpretation

Self Explanatory

Remarks

Another way of remembering

Time	Head Circumference
Birth	35 cm
3 months	40 cm
6 months	44 cm
12 months	47 cm
2 years	49 cm
12 years	52 cm

Tit Bits

Period	Rate of Growth
0 to 3 months	2 cm per month
3 to 6 months	1 cm per month
6 to 12 months	½ cm per month
1 to 2 years	½ cm per 3 months
2 to 7 years	½ cm per year
7 to 12 years	1/3 cm per year

Question Stem

201) Acute Cholecystitis is associated with

Choices given

A) Hyperaesthesia in Sherren’s Triangle

B) Boas’ Sign

C) Bed shaking Test of Bapat

D) Sign-de-dance

Answer

B) Murphy’s Sign

Reference

A manual on Clinical Surgery, 5^th Edition Das Page 362, 340

Question Analysis

Based on	Question Category	Question Grade	Question Type	Books	Target PG Opinion
Concept	Clinically Applied point	MBBS	Straight forward	Given in All books	Needs Memory

Facts

Ä An area of hyperaesthesia between the 9^th and 11^th rib on the posteriorly on the right side is known as the Boas’ sign and is suggestive of Acute Cholecystitis

Ä To elicit tenderness in cholecystitis one may place the right hand just below the right costal margin on the lateral border of the right rectus (the gall bladder point). Moderate pressure is exerted with the fingers to palpate the fundus of the gall bladder. The patient is now asked to take a deep breath in, the gall bladder descends and is hurt by the examining finger. The patient will immediately wince with a ‘catch’ in the breath if the organ is inflamed. This is called Murphy’s sign (Moynihan’s method)

Interpretation

A) Presence of hyperaesthesia in the Sherren’s Triangle (this is formed by lines joining the umbilicus, right anterior superior iliac spine and symphysis pubis) is regarded as a good guide in the diagnosis of gangrenous appendicitis

B) Murphy’s Sign and Boas’ sign are seen in Cholecystitis

C) Bed shaking Test of Bapat can be applied when early peritonitis is still on doubt. The foot end of the bed is moved slightly and this will evoke pain at the position of the inflamed organ

D) In Intussusception, a sausage shaped lump may be felt in the epigastrium or left lumbar region. It is usually associated with empty right iliac fossa(Sign-de-dance) .

Remarks

Ä Other signs in Acute Appendicitis include

o Rovsing’s Sign

o Blumberg’s sign

o Cope Psoas Test

o Obturator Test

o Baldwing’s Test

Tit Bits

Ä Murphy's sign (inspiratory arrest during subcostal palpation) is widely regarded as pathognomonic of cholecystitis. It is certainly present in patients with established acute cholecystitis, but it only reflects peritoneal inflammation in the right upper quadrant, other causes of which include chronic cholecystitis, acute hepatitis, and a localized abscess around a perforated duodenal ulcer.

Question Stem

113) ICDS components all except

Choices given

A) Immunization

B) Iron and Folic Acid Preparation

C) Vitamin A Prophylaxis

D) Iodine deficiency precautions

Answer

D) Iodine deficiency precautions

Reference

Park 17^th Edition Pages 407, 455

Question Analysis

Based on	Question Category	Question Grade	Question Type	Books	Target PG Opinion
Fact	Basic point	PG Entrance	Straight forward	Given in Park	Needs Memory

Facts

The components of the ICDS scheme are

1. Supplementary Nutrition
2. Nutrition and Health Education
3. Immunization
4. Health Check Up
1. Record of Height and Weight at periodical intervals
2. Watch over milestones
3. Immunization
4. General Check up every 3 to 6 months to detect disease, malnutrition
5. Treatment for diseases like Diarrhoea, Dysentrery, Respiratory tract infection etc
6. Deworming
7. Prophylaxis against vitamin A deficiency and Anaemia
8. Referral of serious cases
5. Non – formal School Education

Interpretation

Where as ICDS scheme has Iron and Folic Acid Supplementation and Vitamin A administration, iodine Deficiency precaution is not one of the components

Remarks

Ä Supplementary Nutrition is given for 300 days a year

Ä Non formal School education is imparted to children of the ages 3 - 6

Ä Administrative Unit is

o Community development Block every 1,00,000 population in Rural / Urban Areas and

o Tribal Development Block every 35,000 population

Tit Bits

The Supplementary Nutrition in ICDS Scheme is

Ä Children below 1 year

o 200 Cal and 8 to 10 grams of protein

Ä Children 1 - 6 years

o 300 Cal and 15 grams of protein

Ä Pregnant and Nursing mother

o 500 Cal and 25 grams of protein

Question Stem

237) Eustachian Tube

Choices given

A) Connects Inner Ear with Nasopharynx

B) Consists of a Bony Part of 25mm and Cartilaginous Part of 15 mm

C) Posterolateral Part is Cartilagenous

D) It maintains the Pressure between Middle Ear and nasopharynx

Answer

D) It maintains the Pressure between Middle Ear and nasopharynx

Reference

Diseases of Ear, Nose and Throat. - P.L.Dhingra - 3^rd Edition Page 75

Question Analysis

Based on	Question Category	Question Grade	Question Type	Books	Target PG Opinion
Fact	Basic point	MBBS	Straight forward	Given in Robbins	Needs Memory

Facts

Eustachian Tube is also called as Pharyngotympanic Tube or Auditory Tube. The functions of the tube are

1. Ventilation
2. Regulation of Middle Ear Pressure
3. Middle Ear Clearance of secretions

Interpretation

A) Eustachian Tube Connects Middle Ear with Nasopharynx

B) Eustachian Tube Consists of a Bony Part of 15mm and Cartilaginous Part of 25 mm

C) Anteromedial Part of the Eustachian Tube is Cartilagenous

D) It maintains the Pressure between Middle Ear and nasopharynx

Remarks

Ä The lining of the tube is respiratory pseudostratified ciliated columnar epithelium

Ä Behind the tubal elevation the lateral wall of nasopharynx has a variable depression, the pharyngeal recess or fossa of Rosenmüller

Tit Bits

Ä In the Right Atrium, valve of the inferior vena cava is called as Eustachian valve.

Question Stem

200) Sebaceous cyst is

Choices given

A) A horny induration of the cuticle with a hard centre caused by undue pressure, chiefly affecting the toes and feet

B) A localized thickened or hardened part of skin

C) A dry, rough excrescence on the skin

D) A Retention Cyst

Answer

A)

Reference

A manual on Clinical Surgery, 5^th Edition Das page 42

A textbook of Surgical Short Cases, 2^nd Edition Das, page 4

Question Analysis

Based on	Question Category	Question Grade	Question Type	Books	Target PG Opinion
Concept	Basic point	MBBS	Straight forward	Given in Short Cases Das	Needs Memory

Facts

Ä Epidermal inclusion cysts, are often incorrectly referred to as sebaceous cysts and are the most commonly encountered cysts of the skin.

Ä They may occur in childhood, but are more common in early adulthood; the most common sites are the scalp, face, and back. Lesions may be solitary or multiple, and present as 0.5 to 5.0 cm spherical, slightly compressible, intradermal or subcutaneous masses.

Ä A dilated follicular orifice may connect the cyst to the cutaneous surface, usually near the dome of the cyst. The wall of the cyst is composed of fully differentiated epithelium which reproduces the epidermis.

Ä Desquamated keratinocytes are shed into the centre of the cyst, forming a white cheesy material. Infection of epidermal inclusion cysts leads to fibrosis of the surrounding dermis. This event is of importance to the surgeon; previously infected cysts may be difficult to dissect and en-bloc excision is the treatment of choice. Cysts that have not previously been infected or manipulated surgically may be bluntly dissected free of the surrounding tissue following a simple equatorial incision of the overlying skin. Cysts on the face, however, should have their lining teased from within via a small incision to minimize cosmetic deformity.

Interpretation

A) A corn is a horny induration of the cuticle with a hard centre caused by undue pressure, chiefly affecting the toes and feet

B) A callosity is a localized thickened or hardened part of skin

C) A wart is a dry, rough excrescence on the skin

D) A sebaceous cyst is a retention cyst of sebaceous glands .

Remarks

Ä Muir-Torre Syndrome. was described by Muir and co-workers in 1967 and Torre in 1968 to include sebaceous adenomas, epidermoid cysts, fibromas, desmoids, lipomas, fibrosarcomas, and leiomyomas with visceral cancers. 9

Tit Bits

Ä Gardner's syndrome is a familial disease consisting of gastrointestinal adenomatous polyposis; osteomas of the mandible, skull, and long bones; and a variety of soft tissue lesions, including sebaceous cysts, fibromas, lipomas, and desmoid tumors

Question Stem

236) Central or Centro Caecal loss of vision occurs in

Choices given

A) Optic Neuritis

B) Lesion of Optic Tract

C) Lesions of Optic Chiasma

D) Lesions of Occipital Lobe

Answer

A) Optic Neuritis

Reference

Nema 4^th Edition page 273

Question Analysis

Based on	Question Category	Question Grade	Question Type	Books	Target PG Opinion
Fact	Clinically Applied point	PG Entrance	Straight forward	Given in most books	Needs Memory

Facts

Let us see the differences between Papillitis and Papilledema

Papillitis	Papilloedema
Unilateral	Bilateral
Sudden Diminision of Vision	Central Vision is unimpaired for a long time
Ill Sustained Pupillary Reaction (Marcus Gunn Pupil)	Pupil Round and reacts to light briskly
Media might be hazy due to exudation into vitreous	Media Clear
Disc Swelling Rarely more than 2 to 3 D	May be as high as 6 D
Central or Centro Caecal Scotoma (between fixation and Blind Spot) especially for Red and Green	Enlarged Blind Spot(due to separation of retina around the disc by the edema) and concentric constriction of field due to optic nerve atrophy
Normal X Ray Skull	Sliver beaten appearance and erosion of posterior clinoid
Condition temporary	Condition progresses until treated

Interpretation

Self Explanatory

Remarks

Ä Pseudoneuritis or Pseudopapillitis is a condition occurring in Hypermetropic Eyes and there is no venous engorgement, edema or exudates and blind spot is not enlarged. A flourescein angiogram reveals no leakage

Tit Bits

Ä Refer to Question 231, TNPG 2004

Question Stem

231) Wernicke's Hemianopia occurs in lesions of

Choices given

A) Optic nerve

B) Optic Chiasma

C) Optic Tract

D) Occipital Lobe

Answer

C) Optic Tract

Reference

Parson 19^th Edition Page 528, 120

Question Analysis

Based on	Question Category	Question Grade	Question Type	Books	Target PG Opinion
Fact	Clinically Applied point	PG Entrance	Straight forward	Given in most books	Needs Memory

Facts

Site of Lesion	Clinical Presentation
Optic Nerve	Ipsilateral Blindness Marcus Gunn Pupil
Optic Chiasma	Bitemoporal Hemianopia
Distension of 3rd Ventricle Atheroma Carotid Aneurysm Post Communicating Arteries	Binasal hemianopia
Optic Tract	Homonymous Hemianopia Wernicke’s Hemianopic Pupil
Temporal Lobe	Inferior Quadrantic homonymous defect
Parietal Lobe	Superior Quadrantic homonymous defect
Optic Radiations	Homonymous Hemianopia with Macular Sparing
Occipital Lobe	Homonymous Hemianopia with Macular Sparing

Interpretation

Self Explanatory

Remarks

Ä Earliest lesion in Pituitary

Ä Unilateral Central Scotoma + Contralateral Sup Quadrantanopia due to invlovement of von Willebrands knee

Ä Early loss in Intra Sellar and Extra Sellar Tumours

Ä Upper half of the field is defective

Ä Early Loss in Supra Sellar Tumours

Ä Lower Half of the field is defective

Tit Bits

Ä Riddoch's Phenonemon is Appreciation of a dim kinetic image is retained with loss of appreciation of static bright image and is seen in Occipital Lobe lesions

Ä Refer to Question Number 236, TNPG 2003 Section

Question Stem

101) Dichotomy refers to

Choices given

A) Marrying two wives

B) Marrying two husbands

C) Fee Splitting

D) A type of plant

Answer

C) Fee Splitting

Reference

The Essentials of Forensic Medicine and Toxicology 17^th Edition Narayana Reddy Page 22

Question Analysis

Based on	Question Category	Question Grade	Question Type	Books	Target PG Opinion
Concept	Basic point	MBBS	Straight forward	Given in Reddy	Needs memory

Facts

Dichotomy of fee splitting is receiving or giving commission or other benefits to a professional colleague or manufacturer or trader in drugs, appliances or a chemist, dentist etc.

Interpretation

A) A male marrying two females is bigamy

B) A female marrying two males is biandry!! - a common practice in gypsies

C) Dichotomy is “fee Splitting”

D) There are a group of plants called as Dichotomous plants so named because of the branching pattern. In Human Body, Branching of Trachea, Retinal and to a certain extent pulmonary vasculature is dichotomous

Remarks

Ä Look at the references given for a complete list

Ä Question 101 TNPG 2003 Paper has a similar questions

Tit Bits

Ä The Geneva Convention Act prohibits the use of Red Cross and other allied emblems for any purpose without the approval of Government of India, and imposes the penalty on any one who uses such emblems. It is the right only of the members of Medical Services of Any Army