This is the Prelims round Quiz, for Premier Medillectuals. That was held in Maulana Azad Medical College on 15th September, 2018.

3. RULES:
• There are 20 questions in total.
• Star marked questions will be used as tie
breakers. In case of further tie, sudden death
from first question onwards will be used as the
method of elimination.
• Cheating will not be tolerated in any form, so
phones on the table, chits/books in the bag, just
use your brains.
• 6 teams from the prelims will move to the mains.
• The decision of the quizmasters will be final and
binding.

5. Q. 1
• In the year 1924, X and Seigo Minami published the first
observations on changes in the metabolism of tumors. They had
observed that tumors acidified the Ringer solution (an isotonic salt
solution, with 2.4 mM NaHCO3) when 13 mM glucose was added,
as indicated by a change in the color of organic pH-indicators. In this
acidified solution, lactic acid was chemically identified.
• X corroborated his in vitro results in rats having either a hepatoma
or sarcoma, where he found a higher lactic acid content (chemically
determined) in blood vessels leaving the tumor than in vessels
entering the tumors.
• 1)Who is X? (0.5)
• 2) Briefly explain the basis and significance of the discovery. (1)

6. Q. 2*
• "One way to alleviate the pain of banging your
shin while on a hike is to encounter a grizzly
bear.“
1. Which phenomenon does this refer to?(1)
2. Name two mediators largely responsible for
this.(1)

7. Q. 3
1.Identify the above shown
figure. (0.5)
2.What do each of the waves
represent? (1.5)

8. Q. 4
• A twenty-eight year old female was scheduled to undergo excisional
reconstruction and plating of the mandible following a diagnosis of
ameloblastoma on incisional biopsy under local anaesthesia. On
preanaesthetic evaluation, there was no significant finding except
restricted mouth opening and a swelling over the mandible. On
attempting laryngoscopy the patient was found to have masseteric spasm
following administration of succinylcholine. After one hour it was noted
that the EtCO2 was being maintained at 47 -48 mmHg inspite of slight
hyperventilation. Within half an hour EtCO2 rose gradually to 60 mm Hg
and then suddenly to 80 mm Hg .The patient's pulse rate rose gradually to
130 beats per minutes and then suddenly to 160 beats per minutes .At
this time the patient was found to have nasopharyngeal temperature of
106.5.
• 1) Identify the condition.(0.5)
• 2) Give the underlying biochemical basis of the above condition. (0.5)
• 3 )* Name another condition that has the same underlying basis. (1)

9. Q. 5
• The Nobel prize in Physiology or Medicine for
2017 was awarded to Jeffrey C. Hall, Michael
Rosbash, and Michael Young for their
discoveries of molecular mechanisms
controlling the circadian rhythm.
• Enlist any three genes that were found to be
responsible for maintaining our day-night
cycle.(1.5)

10. Q.6
• A well aimed hit here and you you have the
‘wind knocked out of you’, there’s excruciating
pain and you can’t breathe.
• What is it that gets hit?

11. Q. 7
• Enumerate any two bones in the human body
without a periosteum. (1)
• Which bone is an exception to the law of
ossification? (0.5)
• Which is the largest joint of the human body?
(0.5)

12. Q. 8
• Explain the mechanism of dwarfism in these
cases:
1. Laron dwarfism (1)
2. Kasper Hauser dwarfism (1)
3. Achondroplasia (1)

13. Q.9 – CONNECT(1.5)

14. Q. 10*
• CRISPR (Clustered Regularly-Interspaced Short Palindromic
Repeats)-Cas9 (CRISPR associated protein 9) has rapidly become the
most promising genome editing tool with great potential to
revolutionize medicine. Through guidance of a 20 nucleotide RNA
(gRNA), CRISPR-Cas9 finds and cuts target protospacer DNA
precisely 3 base pairs upstream of a PAM (Protospacer Adjacent
Motif). The broken DNA ends are repaired by either NHEJ (Non-
Homologous End Joining). Theoretically, CRISPR-Cas9 could be used
to modify any genomic sequences, thereby providing a simple, easy,
and cost effective means of genome wide gene editing.
Q. Where has this technology been derived from?(1)
Q. What is it's original use?(1)

15. Q. 11
• A patient complains about having difficulty
swallowing. Name two congenital vascular
abnormalities that may produce this
complaint. Explain the embryological basis of
each.(0.5+0.5+0.5+0.5)

16. Q. 12
X is a ventricular arrhythmia resulting due to
prolongation of the QT interval on the ECG. It is a form of
polymorphic ventricular tachycardia, translating from
french to “twisting of the points”, named such because of
the unique appearance of the ECG, which appears as if it
is twisting around a point.
1. Identify X. (0.5)
2. Which ion channel is likely to be affected in order to
produce such an effect? (0.5)

17. Q. 13
• Hirschprung disease is due to a congenital
absence of ganglion cells in both myenteric
and submucosal plexuses of a segment of
distal colon, as a result of failure of normal
cranial to caudal migration of neural crest cells
during development. The action of ___X____
on the ___Y____ receptor is necessary for
normal migration of certain neural crest cells.
• X & Y? (0.5 + 0.5)

18. Q. 14*
In an extremely rare case, a baby girl with a severe congenital disorder and
near-total missing external body skin, was born at a city hospital in Nagpur
on 13 June, 2016.
A 23-year-old woman from Amravati gave birth to the girl at Lata
Mangeshkar Medical College and Hospital. While speaking to Hindustan
Times, Dr Yash Banait, a child specialist at the hospital said the baby was
born with a congenital disorder and that this kind of disorder occurs
because of mutation in the genes.
X is a very rare severe genetic skin disease that cause thickening of the
stratum corneum of the epidermis. In such cases, the child’s whole body is
encased in an ‘armour’ of thick white plates of skin separated with deep
cracks. In addition, the eyes, ears, private parts and the appendages may
be abnormally contracted,” said obstetrician and gynaecologist Dr Avinash
Banait.
The overall incidence of X is 1 in 300,000 births, he said.
The female baby died after 2 days and was the first reported case of X in
India.

19. 1. Identify X. (1)
2. Mutation of
which gene
leads to X? (0.5)

20. Q. 15
(1.5)

21. Q. 16(1)
• An anti-aging protein called _ X__ , named
after a daughter of Zeus in Greek mythology,
has recently been discovered to play
important roles in calcium and phosphate
homeostasis, in part by reciprocal effects on
1,25-dihydroxycholecalciferol. It plays an
important role in stabilising membrane
localisation of proteins important in calcium
and phosphate reabsorption like TRPV5 and
Na-K-ATPase.

22. Q. 17
A child had nausea, vomiting, and symptoms of hypoglycemia:
sweating, dizziness, and trembling. It was reported that these
attacks occurred shortly after eating fruit or cane sugar. This was
resulting in a strong aversion to fruits. The child was below
normal weight and was an only child who had been breast fed,
during which time none of these symptoms was evident. The
clinical findings included some cirrhosis of the liver, a normal
glucose tolerance test, and reducing substances in the urine that
did not react positively with glucose test papers, in which glucose
oxidase was used as the basis for test.
1. What is the likely diagnosis? (0.5)
2. Explain the hypoglycemia. (0.5)
3. How does this condition potentiate hyperuricemia? (0.5)

24. Q. 19 (0.5)
Which of the following conditions does not
predispose to atherosclerosis?
a) Lipoprotein Lipase deficiency
b) Apo E mutation
c) Defective LDL receptors
d) Hepatic lipase deficiency

25. Q. 20
• A 30 y/o male was brought to the Emergency
with a history of syncope 30 minutes back. The
blood pressure in his right arm was measured to
be 100/70 mm Hg. During the course of
examination, the patient gained consciousness,
but could not seem to remember what had
happened to him. He also complained of
weakness in his left arm. Having a high index of
suspicion for _____, you ordered a radiological
investigation, which showed the following:

26. Q. What condition is seen here? (0.5)
Q. What are the two most common
causes leading to this? (1)

29. SAFETY SLIDE

30. ANSWERS

31. Q. 1
• In the year 1924, X and Seigo Minami published the first
observations on changes in the metabolism of tumors. They had
observed that tumors acidified the Ringer solution (an isotonic salt
solution, with 2.4 mM NaHCO3) when 13 mM glucose was added,
as indicated by a change in the color of organic pH-indicators. In this
acidified solution, lactic acid was chemically identified.
• X corroborated his in vitro results in rats having either a hepatoma
or sarcoma, where he found a higher lactic acid content (chemically
determined) in blood vessels leaving the tumor than in vessels
entering the tumors.
• 1)Who is X? (0.5)
• 2) Briefly explain the basis and significance of the discovery. (1)

32. 1.X is Otto Warburg
2. 2. Cancer cells have increased level of anaerobic
respiration even in p/o oxygen. This gives selective
advantage to the cancer cells as there is less
shuttling of glucose-derived chemical energy into
ATP production and increase buildup of
biomolecules*

33. Q. 2*
• "One way to alleviate the pain of banging your
shin while on a hike is to encounter a grizzly
bear.“
1. Which phenomenon does this refer to?(1)
2. Name two mediators largely responsible for
this.(1)

34. 1. STRESS- INDUCED ANALGESIA
• NOREPINEPHRINE
• ENDOGENOUS CANNABINOIDS LIKE 2AG
(ARACHIDONOYLGLYCEROL) AND
ANANDAMIDE

35. Q. 3
1.Identify the above shown
figure. (0.5)
2.What do each of the waves
represent? (1.5)

36. His bundle electrogram.
A deflection - AV node activation
H spike - transmission through His
bundle
V deflection - ventricular
depolarization

37. Q. 4
• A twenty-eight year old female was scheduled to undergo excisional
reconstruction and plating of the mandible following a diagnosis of
ameloblastoma on incisional biopsy under local anaesthesia. On
preanaesthetic evaluation, there was no significant finding except
restricted mouth opening and a swelling over the mandible. On
attempting laryngoscopy the patient was found to have masseteric spasm
following administration of succinylcholine. After one hour it was noted
that the EtCO2 was being maintained at 47 -48 mmHg inspite of slight
hyperventilation. Within half an hour EtCO2 rose gradually to 60 mm Hg
and then suddenly to 80 mm Hg .The patient's pulse rate rose gradually to
130 beats per minutes and then suddenly to 160 beats per minutes .At
this time the patient was found to have nasopharyngeal temperature of
106.5.
• 1) Identify the condition.(0.5)
• 2) Give the underlying biochemical basis of the above condition. (0.5)
• 3 )* Name another condition that has the same underlying basis. (1)

38. 1.Malignant hyperthermia
2. RYR 1 mutation
3. Central Core Disease

39. Q. 5
• The Nobel prize in Physiology or Medicine for
2017 was awarded to Jeffrey C. Hall, Michael
Rosbash, and Michael Young for their
discoveries of molecular mechanisms
controlling the circadian rhythm.
• Enlist any three genes that were found to be
responsible for maintaining our day-night
cycle.(1.5)

40. PERIOD
TIMELESS
DOUBLETIME
CLOCK
CYCLE
NIGHT OWL ( CRYPTOCHROME1)

41. Q.6
• A well aimed hit here and you you have the
‘wind knocked out of you’, there’s excruciating
pain and you can’t breathe.
• What is it that gets hit?

42. Solar/Celiac plexus- excessive
discharge causes temporary
paralysis of diaphragm.

44. Q. 7
• Enumerate any two bones in the human body
without a periosteum. (1)
• Which bone is an exception to the law of
ossification? (0.5)
• Which is the largest joint of the human body?
(0.5)

45. 1. Patella
Fabella
Pisiform…
Malleus, incus, stapes
2. Fibula
3. Knee Joint!

46. Q. 8
• Explain the mechanism of dwarfism in these
cases:
1. Laron dwarfism (1)
2. Kasper Hauser dwarfism (1)
3. Achondroplasia (1)

47. 1. GH insensitivity decreased
plasma IGF-1
2.Psychosocial  Chronic abuse and
neglect
3.FGFR3 mutation

48. Q.9 – CONNECT(1.5)

49. Sites of Extra-medullary
hematopoiesis

50. Q. 10*
• CRISPR (Clustered Regularly-Interspaced Short Palindromic
Repeats)-Cas9 (CRISPR associated protein 9) has rapidly become the
most promising genome editing tool with great potential to
revolutionize medicine. Through guidance of a 20 nucleotide RNA
(gRNA), CRISPR-Cas9 finds and cuts target protospacer DNA
precisely 3 base pairs upstream of a PAM (Protospacer Adjacent
Motif). The broken DNA ends are repaired by either NHEJ (Non-
Homologous End Joining). Theoretically, CRISPR-Cas9 could be used
to modify any genomic sequences, thereby providing a simple, easy,
and cost effective means of genome wide gene editing.
Q. Where has this technology been derived from?(1)
Q. What is it's original use?(1)

51. 1.Bacteria and Archaea
2.Part of their immunity  protects
bacteria against invasive viral
genomes

52. Q. 11
• A patient complains about having difficulty
swallowing. Name two congenital vascular
abnormalities that may produce this
complaint. Explain the embryological basis of
each.(0.5+0.5+0.5+0.5)

53. Double aortic arch
Right subclavian
Right Aortic Arch

54. Q. 12
X is a ventricular arrhythmia resulting due to
prolongation of the QT interval on the ECG. It is a form of
polymorphic ventricular tachycardia, translating from
french to “twisting of the points”, named such because of
the unique appearance of the ECG, which appears as if it
is twisting around a point.
1. Identify X. (0.5)
2. Which ion channel is likely to be affected in order to
produce such an effect? (0.5)

55. Torsades de Pointes
K+ channel blocker

56. Q. 13
• Hirschprung disease is due to a congenital
absence of ganglion cells in both myenteric
and submucosal plexuses of a segment of
distal colon, as a result of failure of normal
cranial to caudal migration of neural crest cells
during development. The action of ___X____
on the ___Y____ receptor is necessary for
normal migration of certain neural crest cells.
• X & Y? (0.5 + 0.5)

57. X Endothelin
Y  Endothelin B

58. Q. 14*
In an extremely rare case, a baby girl with a severe congenital disorder and
near-total missing external body skin, was born at a city hospital in Nagpur
on 13 June, 2016.
A 23-year-old woman from Amravati gave birth to the girl at Lata
Mangeshkar Medical College and Hospital. While speaking to Hindustan
Times, Dr Yash Banait, a child specialist at the hospital said the baby was
born with a congenital disorder and that this kind of disorder occurs
because of mutation in the genes.
X is a very rare severe genetic skin disease that cause thickening of the
stratum corneum of the epidermis. In such cases, the child’s whole body is
encased in an ‘armour’ of thick white plates of skin separated with deep
cracks. In addition, the eyes, ears, private parts and the appendages may
be abnormally contracted,” said obstetrician and gynaecologist Dr Avinash
Banait.
The overall incidence of X is 1 in 300,000 births, he said.
The female baby died after 2 days and was the first reported case of X in
India.

59. 1. Identify X. (1)

60. X Harlequin Ichthyosis

61. Q. 15
(1.5)

62. MORGAGNI (eponymous structures)
Columns,Foramen,Sinus,Hydatid

63. Q. 16(1)
• An anti-aging protein called _ X__ , named
after a daughter of Zeus in Greek mythology,
has recently been discovered to play
important roles in calcium and phosphate
homeostasis, in part by reciprocal effects on
1,25-dihydroxycholecalciferol. It plays an
important role in stabilising membrane
localisation of proteins important in calcium
and phosphate reabsorption like TRPV5 and
Na-K-ATPase.

64. ALPHA-KLOTHO

65. Q. 17
A child had nausea, vomiting, and symptoms of hypoglycemia:
sweating, dizziness, and trembling. It was reported that these
attacks occurred shortly after eating fruit or cane sugar. This was
resulting in a strong aversion to fruits. The child was below
normal weight and was an only child who had been breast fed,
during which time none of these symptoms was evident. The
clinical findings included some cirrhosis of the liver, a normal
glucose tolerance test, and reducing substances in the urine that
did not react positively with glucose test papers, in which glucose
oxidase was used as the basis for test.
1. What is the likely diagnosis? (0.5)
2. Explain the hypoglycemia. (0.5)
3. How does this condition potentiate hyperuricemia? (0.5)

66. 1) Hereditary Fructose Intolerace
(Aldolase B deficiency)
2. Fructose-1-phosphate
accumulates inhibits Glycogen
phosphorylase
3. sequestration lead to
hypophosphatemiaATP depletion
increased purine synthesis

68. Tortuous arteries

69. Q. 19 (0.5)
Which of the following conditions does not
predispose to atherosclerosis?
a) Lipoprotein Lipase deficiency
b) Apo E mutation
c) Defective LDL receptors
d) Hepatic lipase deficiency

70. A

71. Q. 20
• A 30 y/o male was brought to the Emergency
with a history of syncope 30 minutes back. The
blood pressure in his right arm was measured to
be 100/70 mm Hg. During the course of
examination, the patient gained consciousness,
but could not seem to remember what had
happened to him. He also complained of
weakness in his left arm. Having a high index of
suspicion for _____, you ordered a radiological
investigation, which showed the following:

72. Q. What condition is seen here? (1)
Q. What are the two most common
causes leading to this? (1)

73. 1) Subclavian Steal Syndrome
2)  Atherosclerosis
Cervical Rib