Contents

Subjects No. of Questions Page Nos.

1. Anatomy 10 1-7

2. Physiology 7 9-15

3. Biochemistry 10 17-24

4. Immunogenetics and Molecular Biology 8 25-31

5. Pathology 18 33-47

6. Pharmacology 13 49-56

7. Microbiology 7 57-62

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8. Forensic Medicine 6 63-66

9. Preventive and Social Medicine 13 67-75

10. Ophthalmology 8 77-82

11. ENT 10 83-89

12. Medicine 20 91-105

13. Surgery 25 107-123

14. Obstetrics and Gynecology 18 125-136

15. Pediatrics 6 137-142

16. Orthopedics 9 143-149

17. Anesthesia 6 151-155

18. Dermatology 5 157-160

19. Psychiatry 6 161-164

20. Radiology 7 165-169

Total Questions 212

 PGI Supplement November 2017

1. Muscle (s) of anterior compartment of leg is/are:

a. Peroneus tertius
b. Peroneus brevis
c. Peroneus longus
d. Flexor digitorum longus
e. Extensor hallucis longus
“The four muscles in the anterior compartment of the leg are- tibialis anterior, extensor digitorum longus, extensor hallucis longus, and
fibularis (Peroneus) tertius”- Moore 2nd/360
Muscle of posterior compartment of leg: Superficial- Gastrocnemius, soleus and plantaris; Deep-Flexor digitorum longus, popliteus,
flexor halluces longus and tibialis posterior- BDC 7th/ Vol. II 118
Table 1 (Essential Anatomy by Moore 2nd/360-63): Muscles of anterior and lateral compartment of leg

Muscle Proximal Attachment Distal Attachment Innervation Main Action (s)

Anterior compartment
Tibialis anterior
Extensor hallucis
longus
Lateral condyle and superior
half of lateral surface of tibia
and interosseous membrane
Middle part of anterior surface
of fibula and interosseous
membrane
Medial and inferior surfaces
of medial cuneiform and
base of 1st metatarsal
Dorsal aspect of base of
distal phalanx of great toe
(hallux)
Deep fibular (peroneal) Dorsiflex ankle and inverts
nerve (L4 and L5) foot
Deep fibular (peroneal) Extends great toe and
nerve (L5 and S1) dorsiflexes ankle

ANATOMY Extensor digitorum

longus
Lateral condyle of tibia and
superior three fourths of
Middle and distal phalanges
of lateral four digits
Deep fibular (peroneal)
nerve (L5 and S1)
Extends lateral four digits
and dorsiflexes ankle

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anterior surface of interosseous
membrane
Fibularis Inferior third of anterior surface Dorsum of base of 5th Deep fibular (peroneal) Dorsiflexes ankle and aids

Questions (Peroneus) Tertius

Lateral compartment
of fibula and interosseous
membrane
metatarsal nerve (L5 and 51) in eversion of foot

Answers Fibularis (peroneus)

longus
Head and superior two thirds
of lateral surface of fibula
Base of 1st metatarsal and
medial cuneiform
Superficial fibular
(peroneal) nerve
(L5, S1, and S2)
Evert foot and weakly
plantar flex ankle

Fibularis (peroneus) Inferior two thirds of lateral Dorsal surface of tuberosity Superficial fibular Evert foot and weakly

Explanations brevis surface of fibula on lateral side of base of 5th

metatarsal
(peroneal) nerve
(L5, S1, and S2)
plantar flex ankle

2. True about epiglottis:
a. Contains serous gland
b. Contains mucous secreting glands
c. It is oval shaped
d. Made up of elastic cartilage
e. Has bilateral lymphatic supply
Epiglottis/Epiglottic Cartilage BDC 7th/ Vol. III 264
l The epiglottis is a leaf-shaped structure.
l It is a flap that is made of elastic cartilage tissue covered with a
mucous membrane, attached to the entrance of the larynx
l The epiglottis is one of nine cartilaginous structures that
make up the larynx (voice box). While one is breathing, it lies
completely within the pharynx. When one is swallowing it
serves as part of the anterior of the larynx.
l The epiglottis has two surfaces, a lingual and a laryngeal surface,
related to the oral cavity and the larynx respectively
Answer
1. a. Peroneus tertius, e. Extensor hallucis longus
2. b. Contains mucous secreting glands, d. Made up of elastic cartilage, e. Has bilateral lymphatic supply
Moore 2nd/628; Gray’s 40th/ 577-78, 588; Dhingra 6th/283-85; H and N Cancer by L B Harrison 3rd/368; H and N Surgery by Satalof 1st/693]
l The entire lingual surface and the apical portion of the laryngeal
surface (since it is vulnerable to abrasion due to its relation to
the digestive tract) are covered by a stratified squamous non-
keratinized epithelium.
l The rest of the laryngeal surface on the other hand, which is in
relation to the respiratory system, has respiratory epithelium:
pseudostratified, ciliated columnar cells and mucus secreting
Goblet cells.
Lymphatic Drainage Gray’s 40th/ 588; Moore 2nd/628
l The vocal cords, with their firmly bound mucosa and paucity of
lymphatics, provide a clear demarcation between the upper and
lower areas of the larynx.
l Above the vocal cords, the lymph vessels draining the
supraglottic part of the larynx accompany the superior laryngeal
artery, pierce the thyrohyoid membrane, and end in the upper
deep cervical lymph nodes, often bilaterally. The supraglottic
lymphatics also communicate with those at the base of the
[Ref: BDC 7th/ Vol. II 101-02; Essential Anatomy by Moore 2nd/360-63]
[Ref: BDC 7th/ Vol. III 264; Snell’s 8th/ 802;

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PGI Supplement November 2017
l There is a good longitudinal anastomosis between these branches
on the wall of the ureter, which means that the ureter can be
safely transected at any level intraoperatively, and a uretero-
ureterostomy performed, without compromising its viability.
The branches from the inferior vesical artery are constant in
their occurrence and supply the lower part of the ureter as well
as a large part of the trigone of the bladder. The branch from the
renal artery is also constant and is preserved whenever possible
in renal transplantation to ensure good vascularity of the ureter.
Arteries Supplying Ureter BDC 7th/ Vol.II352
Part of ureter Arteries supplying
(A) Upper part Renal artery. Also by- gonadal or colic vessel
Middle part Branches from aorta. Also by-gonadal or iliac vessel
Pelvic part Vesical, middle rectal or uterine vessels
“The internal pudendal artery is a branch of the anterior division of
the internal iliac artery and is the primary supply of the perineum.
It is a larger vessel in males than in females. It branches include:
inferior rectal artery, deep artery of the penis/clitoris, dorsal artery of
the penis/clitoris, perineal artery, posterior scrotal artery, transverse
perineal artery, urethral artery and artery to thebulb . It supplies:
perineum, genitalia, anal region, erectile tissues”- BDC 7th/ Vol.II456;
radiopaedia.org
(B)
Fig. 2 (BDC 7th/Vol. II 388; aibolita.com/sundries):Structures piercing the
perineal membrane: (A) Male; (B) Female
4. Blood supply of ureter is/are from all, except:
a. Middle rectal artery
b. Internal pudendal artery
c. Gonadal vessel
d. Common Iliac artery
e. Vesical artery
Arteries Supplying Ureter Gray’s 40th/1241
l The ureter is supplied by branches from the renal, gonadal,
common iliac, internal iliac, vesical and uterine arteries, and
the abdominal aorta
l The pattern of distribution is subject to much variation.
l The abdominal ureter is supplied from vessels originating
medial to the ureter, while the pelvic ureter is supplied by vessels
lateral to the ureter.
Fig. (Gray’s 40th/1241):Arterial supply of the left ureter. The proximal
part takes its blood supply medially, and the distal part is supplied
laterally
Answer
4. b. Internal pudendal artery [Ref: BDC 7th/ Vol.II352; Gray’s 40th/1241]
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PGI Supplement November 2017
1. True regarding Rennin-angiotensin system:
a. Renin is secreted by modified smooth muscle cells of
efferent arteriole
b. Macula densa is a part of renin-angiotensin system
c. Renin converts angiotensinogen to angiotensin-I
d. Angiotensin-converting enzyme is present in endothelium
of the lung vessels
e. Angiotensin-II stimulates release of aldosterone from zona
glomerulosa
Angiotensin-converting enzyme is present in the endothelium of
the lung vessels- Guyton 13th (SAE)/273
“Angiotensin II: It stimulates zona glomerulosa of adrenal cortex
to increase aldosterone secretion- A K Jain 6th/506
“Renin is synthesized and stored in an inactive form called
prorenin in the juxtaglomerular cells (JG cells) of the kidneys. The
JG cells are modified smooth muscle cells located in the walls of the
afferent arterioles immediately proximal to the glomeruli. When the
arterial pressure falls, intrinsic reactions in the kidneys themselves
cause many of the prorenin molecules in the JG cells to split and
release renin. Most of the renin enters the renal blood and then
passes out of the kidneys to circulate throughout the entire body.
However, small amounts of the renin do remain in the local fluids
of the kidney and initiate several intrarenal functions”- Guyton 13th
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(SAE)/273
The juxtaglomerular apparatus (JGA) consists of three types
of cells: A K Jain 6th/504-05
l Macula densa, a part of the distal convoluted tubule of the
same nephron: They function as chemoreceptors. They are
stimulated by a decreased sodium ion load thereby causing
increased renin release
l Juxtaglomerular cells, (also known as granular cells) which
secrete renin
l Mesangial cells or lacis cell: supporting cell. Play a role
in the regulation of glomerulation filtration. They show Fig. 2 (Ganong 25th/699):Summary of the renin-angiotensin system and
granulation to secrete renin in conditions of extreme the stimulation of aldosterone secretion by angiotensin II. The plasma
hyperactivity concentration of renin is the rate-limiting step in the renin-angiotensin
system; therefore, it is the major determinant of plasma angiotensin II
concentration
2. True about function Loop of Henle:
a. Fluid reaching descending limb from proximal convoluted
tubule is hypotonic
b. Descending limb reabsorbs water
c. Thin ascending limb actively absorbs sodium chloride
d. Thick ascending limb permeable to water
e. Descending limb imperable to water
Tubular fluid remains isotonic in the proximal tubule (so fluid reaching
descending limb is also isotonic)- Guyton 13th (SAE)/509
Loop of Henle A K Jain 6th/521
Fig. 1 (Ganong 25th/703):Diagram of glomerulus, showing the l Thin descending segment : highly permeable to water but
juxtaglomerular apparatus relatively impermeable to solids (Specially NaCl)
Answer
1. b. Macula densa is a part of renin-angiotensin system; c. Renin converts angiotensinogen to angiotensin-I; d. Angiotensin-converting enzyme is
present in endothelium of the lung vessels; e. Angiotensin-II stimulates release of aldosterone from zona glomerulosa
[Ref: Ganong 25th/699-706; Guyton 13th (SAE)/272-74; A K Jain 6th/506]
2. b. Descending limb reabsorbs water
[Ref: Ganong 25th/683-84; Guyton 13th (SAE)/510-12; A K Jain 6th/521]
PGI Supplement November 2017 Pathology

l Azathioprine can also be used as the sole maintenance immunosuppressive agent in patients with low-activity disease.
l Newer agents such as mycophenolate mofetil (MMF) are increasingly being used but formal evidence to inform practice in this area is
1. Which of the following urea cycle enzymes is/are found in cytosol: lacking. Patients should be monitored for acute exacerbations (LFT and IgG screening with patients alerted to the possible symptoms)
a. Carbamoyl phosphate synthetase I and such exacerbations should be treated with corticosteroids.
b. Ornithine transcarbomylase Type II autoimmune hepatitis , is associated not with ANA but with anti-LKM 1. This is the same anti-LKM seen in some patients
c. Arginosuccinate synthetase with chronic hepatitis C. Anti-LKM2 is seen in drug-induced hepatitis, and anti-LKM3 (directed against uridine diphosphate glucuronyl
d. Arginosuccinate lyase transferases) is seen in patients with chronic hepatitis D. More controversial is whether or not a third category of autoimmune hepatitis exists,
e. Arginase type III autoimmune hepatitis. These patients lack ANA and anti-LKM1 but have circulating antibodies to soluble liver antigen. Type III
autoimmune hepatitis does not appear to represent a distinct category but, instead, is part of the spectrum of type I autoimmune hepatitis; this
subcategory has not been adopted by a consensus of international experts”-Harrison 19th/2050
“Urea synthesis is a five step cyclic process, with five distinct enzyme. The first two reactions (Catalyzed by Carbamoyl phosphate synthetase I
and ornithine transcarbomylase) leading to the synthesis of urea occur in the mitochondria, whereas the remaining cycle enzymes (reaction Microsomal antibody Antigen Disease
3-5; Arginosuccinate synthetase, Arginosuccinate lyase and arginase) are located in the cytosol”- Lippincott 6th/252-54; Harper 30th/293 anti-LKM 1 cytochrome P450 2D6 autoimmune hepatitis type II and chronic hepatitis C (10%)
anti-LKM 2 cytochrome P450 2C9 drug-induced hepatitis (tienilic acid–induced)
anti-LKM 3 cytochrome P450 1A2 chronic active hepatitis in association with autoimmune polyendocrine syndrome type 1;
hepatitis D

16. Which of the following is/are not feature of Turner syndrome:

a. Tall stature b. Associated with celiac disease
c. 45XO karyotype d. 45XO/46XY karyotype
e. Hypertension

“Celiac disease is also associated with diabetes mellitus type 1, IgA deficiency, Down syndrome, and Turner’s syndrome”-Harrison 19th/1942
“Turner’s syndrome affects around 1 in 2500 females. It is classically associated with a 45XO karyotype but other cytogenetic

PREVIEW
abnormalities may be responsible, including mosaic forms (e.g. 45XO/46XX or 45XO/46XY) and partial deletions of an X chromosome”-
Davidson 22nd/ 765

Fig 1. Biosynthesis of urea or ornithine – urea cycle

High yielding facts

l Carbomyl phosphate synthetase I reaction is rate limiting step in urea formation- Vasudevan 5th/180
l Urea cycle is also k/a Krebs-Henseleit cycle or ornithine cycle- Satyanarayan 4 th/337; Vasudevan 5th/180
l Urea has two amino groups, one derived from NH3 and the other from aspartate. Carbon atom is supplied by CO2- Satyanarayan 4th/337
l Urea is synthesized in liver

Fig. 3 (Davidson 22nd/ 765): Clinical features of Turner’s syndrome (45XO) (IGT = impaired glucose tolerance)
Answer
16. a. Tall stature [Ref: Robbins 9th/839-40 ; Harrison 19th/2049-51 ; Davidson 22nd/962-63]
Answer
1. c. Arginosuccinate synthetase, d. Arginosuccinate lyase, e. Arginase
[Ref: Harper 30th/293; Lippincott 6th/252-54; Vasudevan 5th/180-81; Satyanarayan 4th/337]

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PGI Supplement November 2017 PGI Supplement November 2017

l Conversely, sufficiently high concentrations of agonist can surmount the effect of a given concentration of the antagonist; that is, the
Emax (It is the maximal response that can be produced by the drug) for the agonist remains the same for any fixed concentration of 17. True about morphological feature (s) of alcoholic steatosis:
antagonist a. Fat droplet in hepatocyte b. Mallory body may be seen
l Because the antagonism is competitive, the presence of antagonist increases the agonist concentration required for a given degree of c. May cause hepatic necrosis d. Perivenular fibrosis may be seen
response, and so The concentration (C’) of an agonist required to produce a given effect in the presence of a fixed concentration ([I]) of e. Macro-nodule formation
competitive antagonist is greater than the agonist concentration (C) required to produce the same effect in the absence of the antagonist.
Perivenular fibrosis may be seen in both alcoholic steatosis and alcoholic hepatitis
ALCOHOLIC STEATOSIS (Fatty liver): Grossly,the liver is enlarged, yellow, greasy and firm with a smooth and glistening capsule.
Microscopically, the features consist of initial microvesicular large droplets of fat displacing the nucleus to the periphery. Fat cysts may
develop due to coalescence and rupture of fat-containing hepatocytes. Less often, lipogranulomas consisting of collection of lymphocytes,
macrophages and some multinucleate giant cells may be found”- Harshmohan 7th/606

Fig. 1 (KDT 7th/59):Dose response curve showing competitive (a) and non-competitive (b) antagonism; A-agonist, B-competitive antagonist,
C-Non-competitive antagonists

“Potency is the relationship between the dose of a drug and the Cholinergic Agonists KDT 7th/102

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therapeutic effect. It refers to the drug’s strength. A drug is considered
potent when a small amount of the drug achieves the intended effect. Choline esters Alkaloids
Efficacy is the ability of a drug to produce the desired therapeutic Acetylcholine Muscarine
effect. Efficacy means that the drug is effective. When comparing two
Methacholine Pilocarpine
drugs that work equally, the one with the lower dose has a higher
potency. They have equal efficacy”- healthyliving.azcentral.com Carbachol Arecoline
Bethanechol

Anticholinesterase-Reversible KDT 7th/105

Carbamates Acridine
Fig. 4 (Robbins 9th/842): Alcoholic liver disease. The interrelationships among hepatic steatosis, alcoholic hepatitis, and alcoholic cirrhosis are
Physostigmine (Eserine) Tacrine
shown, along with depictions of key morphologic features. It should be noted that steatosis, alcoholic hepatitis, and steatofibrosis may also
Neostigmine develop independently. In particular some patients present initially with cirrhosis without any of the other forms of alcoholic liver disease
Pyridostigmine
Alcoholic Liver Disease Robbins 9 th/842 with amount and chronicity of alcohol intake. The lipid begins
Edrophonium l There are three distinctive, albeit overlapping forms of alcoholic as small droplets that coalesce into large droplets which distend
Rivastigmine, Donepezil liver injury: (1) hepatocellular steatosis or fatty change, (2) the hepatocyte and push the nucleus aside
Galantamine alcoholic (or steato-) hepatitis, and (3) steatofibrosis (patterns Alcoholic (Steato-) Hepatitis Robbins 9 th/843
of scarring typical for all fatty liver diseases including alcohol) Alcoholic hepatitis is characterized by:
10. Which are direct-acting cholinomimetic drugs: Anticholinesterase-Irreversible KDT 7th/105 up to and including cirrhosis in the late stages of disease. l Hepatocyte swelling and necrosis: Single or scattered foci of
a. Neostigmine Hepatocellular Steatosis Robbins 9 th/842 cells undergo swelling (ballooning) and necrosis. The swelling
b. Donepezil Organophosphates Carbamates l It may cause hepatomegaly, with mild elevation of serum results from the accumulation of fat and water, as well as
c. Bethanechol Dyflos (DFP) Carbaryl* (SEVIN) bilirubin and alkaline phosphatase levels. Severe hepatic proteins that are normally exported.
d. Methacholine dysfunction is unusual. Alcohol withdrawal and the provision l Mallory-Denk bodies: These are usually present as clumped,
Echothiophate Propoxur* (BAYGON)
e. Pilocarpine of an adequate diet are sufficient treatment. amorphous, eosinophilic material in ballooned hepatocytes.
Malathion* *Insecticides They are made up of tangled skeins of intermediate filaments
The direct-acting cholinomimetic drugs can be divided on the basis £ l All changes in alcoholic liver disease begin in acinus zone 3 and
Nerve gases for chemical such as keratins 8 and 18 in complex with other proteins such as
Diazinon* (TIK-20) extend outward toward the portal tracts with increasing severity
of chemical structure into esters of choline (including acetylcholine) warfare ubiquitin.
and alkaloids (such as muscarine and nicotine). Tabun£, Sarin£, Soman£ of injury.
l Hepatic Steatosis (Fatty Liver). After even moderate intake of l Neutrophilic reaction: Neutrophils permeate the hepatic lobule
Anticholinesterase drugs are indirect acting drugs and accumulate around degenerating hepatocytes, particularly
alcohol, lipid droplets accumulate in hepatocytes increasing
Answer
Answer
10. c. Bethanechol; d. Methacholine; e. Pilocarpine [Ref: KDT 7th/102,105; Katzung 13th/120; Satoskar 25th/290-95]
17. a. Fat droplet in hepatocyte; d. Perivenular fibrosis may be seen [Ref: Robbins 9th/842-44; Harrison 19th/2053; Davidson 22nd/958; Harshmohan
7th/19-20,606-07]

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PGI Chandigarh: Supplement Nov 2017 | YOP: 2018 | Pages: 169

By Manoj Chaudhary | Color: 2 color | ISBN: 9789386827319

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