QM: Chetna Dengri

2. 2

3. • Cheating will not be tolerated in any form. Indulging in cheating will result
in immediate disqualification of the team.
• Each question will be shown for 30-45 sec
• Some questions are star marked (*) as tie breaker
• If any tie persists then Sudden Death Method from first question will be
used
• Top 6 teams will be selected for the main round
• The decision of the quiz master is final and binding.
3

4. Q1.(0.5)
What does this Doodle celebrates?
4

5. Q2.(1)
• An 8 year old boy was referred to Pediatrics Clinic, due to developmental
delay and seizure attacks from 6 year ago. There was no evidence of seizure
or mental retardation in his family.
• He had a happy face and the parents noticed developmental delay at 2 year
old. He was admitted in a hospital because of tonic-colonic seizures and
valproate sodium was administered to him.
• On physical examination, he had mandibular prognathism, strabismus and
unusual laughing facial expression. His head circumference was 51 cm.
• His walking was unsteady, but muscles tone, force and deep tendon reflexes
were normal. Joints range of motion was normal. Besides, he had speech
disability and could walk independently, but could not run. He had
restricted communicative abilities and suffered from severe mental
retardation.
Laboratory findings were normal. Brain MRI and CBC test were normal.
5

6. What is the genetic basis for this syndrome?
6

7. Q3.
A 35 year old lady is evaluated by
his physician, who determines that
his blood pressure is significantly
elevated at 185/130 mmHg.
Lab test reveal –
Plasma renin activity …(1)…
Plasma aldosterone..(2)..
Left renal vein renin level…(3)…
Right renal vein renin is …(4)…
Identify 1,2,3,4 (4)
7

8. Q4. Out of these 3, which is the most
specific lesion for diagnosis of the case
constituted by this triad. (0.5)
8

9. Q5.(1)** A 37-year-old man without any significant
past medical history presented to emergency
room after he had an episode of dysphagia
while he was drinking water; at the same
time, he felt that the fluid was stuck and he
strained to push the fluid down. After a
while, he felt a sudden sharp, retrosternal,
stabbing chest pain.
The patient stated that he had intermittent
dysphagia but no hematemesis, hematochezia
or melena. Esophagogastroduodenoscopy
(see image)
Diagnosis?
9

10. Q6. Connect(1).
10

11. These two techniques
come under regional
anesthesia of the
airway and allow
awake intubation in
cases of suspected
difficult intubation ,
upper airway trauma
or cervical spine
fractures
Identify the two
procedures or
techniques.
A B
Q7.(1+1)
11

12. Q8.(1)
The patient is placed in a standing or sitting position, and the arms are
raised parallel to the ground in the scapular plane. The arm is rotated to
full internal rotation (thumb down) Once rotated, the clinician pushes
down on either the wrists or the elbow, and the patient is instructed to
resist the downward pressure.
Positive if weakness, pain or both are present during resistance.
What does the positive test signify?
12

13. Q9 Connect(1)**
• Terfenadine
• Ondansetron
• Arsenic
• Ziprasidone
13

14. Q10. This disease was first reported in Saudi Arabia in
2012 and spread across the globe thereafter .
Identify the disease.(1)
14

15. Q11.(1+1) Someone recently died from this disease.
a. What enzyme is deficient in the familial form of disease?
b. What is the location of this enzyme inside the cell?
15

16. Q12. Which of the following structure is most
prone to get damaged in Knee dislocation and
Why?(0.5*2)
16

17. Q13.(1)
You are working in a rural health clinic in northern India. You evaluate
an 8 year old boy who has never seen a physician. His mother tells you
that he is unable to keep up with peers in terms of physical activity. On
initial examination of his skin , you notice clubbing and cyanosis in his
feet, but his hands appear normal. Without any further examination, you
suspect that he has a congenital abnormality.
Diagnosis?
17

18. Q14.(1)**
A 65-year-old male with history of diabetes mellitus, hypertension,
atherosclerotic carotid disease, and three-vessel coronary artery disease
with CABG performed last month, who presented with moderate
intensity 5 out of 10 prolonged left-sided chest pain, worse with
physical activity involving the left upper extremity. The pain persisted
overnight and the patient presented the following day to the emergency
department. Since bypass surgery, the patient had been doing well with
no anginal symptoms and was maintained on aspirin 81 mg daily,
clopidogrel 75 mg daily, metoprolol 25 mg twice daily, enalapril 10 mg
daily, and metformin 500 mg twice daily.
Explain the cause for current complaint?
18

19. Q15. Name the technique developed lately with
the aim of treating asthma.(1)**
19

20. Q16.(1)
20

21. This maneuver’s main use is something else.
But it is also used to diagnose Arnold Chiari
malformation, palpation of supraclavicular
lymph nodes and arrest of SVT.
NAME THE MANEUVER
Q17(1)
21

22. A 30-year-old male, previously
diagnosed with Addison's
disease, on steroid
supplementation for 18 years,
presented to you with difficulty
walking, paraparesis, difficulty
speaking. No psychotic
symptoms or history of
substance abuse.
MRI is given in the image.
What is the inheritance
pattern of this disorder?
Q18.(1)
22

23. Q19. (1)
• A 50 year old male presented with increasing abdominal girth,
generalized weakness, easy fatigability, proximal muscle weakness,
decreased libido, erectile dysfunction, loss of pubic and axillary hairs and
diabetes and hypertension. Evaluation at this stage revealed
hypercortisolism. The patient underwent total bilateral adrenalectomy
• He reported to you two months later with headache, visual field defects
and darkening of skin.
EXPLAIN THE PATHOPHYSIOLOGY BEHIND THE CURRENT
COMPLAINT
23

24. Name the condition.
Heart lung fistula
Smooth philtrum
Holoprosencephaly
mental retardation
Q20(1).
24

25. Q21.(1)**
25

26. This drug is an antisense nucleotide designed to bind to
exon 51 of______ pre mRNA. This results in exclusion
of this exon during mRNA processing in patients with
genetic mutation that is amenable to exon 51 skipping.
This drug is specifically indicated for which condition
and the name of the drug
Q22.(1)
26

27. Q23.(0.5*4)
MAb USE
Ustekinumab A
Alemtuzumab B
Eculizumab C
Ranibizumab D
27

28. Q24. CONNECT(1)
28

29. Q25. (1)
A 6 hour old boy is in the newborn nursery with tachycardia. He was
born at 38 weeks POG to a 30 year old woman with Grave’s disease that
was treated surgically with partial thyroidectomy approx. 6 months
before pregnancy. Subsequently, the mother became mildly hypothyroid
and was treated with levothyroxine during pregnancy. Infant’s weight is
2100g. Temperature is 99F and pulse 190bpm. Examination shows
irritable but consolable with warm, flushed skin.
Explain the pathophysiology for neonatal symptoms in this case.
29

30. 30

31. Q1.(0.5)
What does this Doodle celebrates?
31

32. Q2.(1)
• An 8 year old boy was referred to Pediatrics Clinic, due to developmental
delay and seizure attacks from 6 year ago. There was no evidence of seizure
or mental retardation in his family.
• He had a happy face and the parents noticed developmental delay at 2 year
old. He was admitted in a hospital because of tonic-colonic seizures and
valproate sodium was administered to him.
• On physical examination, he had mandibular prognathism, strabismus and
unusual laughing facial expression. His head circumference was 51 cm.
• His walking was unsteady, but muscles tone, force and deep tendon reflexes
were normal. Joints range of motion was normal. Besides, he had speech
disability and could walk independently, but could not run. He had
restricted communicative abilities and suffered from severe mental
retardation.
Laboratory findings were normal. Brain MRI and CBC test were normal.
32

33. What is the genetic basis for this syndrome?
33

34. Q3.
A 35 year old lady is evaluated by
his physician, who determines that
his blood pressure is significantly
elevated at 185/130 mmHg.
Lab test reveal –
Plasma renin activity …(1)…
Plasma aldosterone..(2)..
Left renal vein renin level…(3)…
Right renal vein renin is …(4)…
Identify 1,2,3,4 (4)
34

35. Q4. Out of these 3, which is the most
specific lesion for diagnosis of the case
constituted by this triad. (0.5)
35

36. Q5.(1)** A 37-year-old man without any significant
past medical history presented to emergency
room after he had an episode of dysphagia
while he was drinking water; at the same
time, he felt that the fluid was stuck and he
strained to push the fluid down. After a
while, he felt a sudden sharp, retrosternal,
stabbing chest pain.
The patient stated that he had intermittent
dysphagia but no hematemesis, hematochezia
or melena. Esophagogastroduodenoscopy
(see image)
Diagnosis?
36

37. Q6. Connect(1).
37

38. These two techniques
come under regional
anesthesia of the
airway and allow
awake intubation in
cases of suspected
difficult intubation ,
upper airway trauma
or cervical spine
fractures
Identify the two
procedures or
techniques.
A B
Q7.(1+1)
38

39. Q8.(1)
The patient is placed in a standing or sitting position, and the arms are
raised parallel to the ground in the scapular plane. The arm is rotated to
full internal rotation (thumb down) Once rotated, the clinician pushes
down on either the wrists or the elbow, and the patient is instructed to
resist the downward pressure.
Positive if weakness, pain or both are present during resistance.
What does the positive test signify?
39

40. Q9 Connect(1)**
• Terfenadine
• Ondansetron
• Arsenic
• Ziprasidone
40

41. Q10. This disease was first reported in Saudi Arabia in
2012 and spread across the globe thereafter .
Identify the disease.(1)
41

42. Q11.(1+1) Someone recently died from this disease.
a. What enzyme is deficient in the familial form of disease?
b. What is the location of this enzyme inside the cell?
42

43. Q12. Which of the following structure is most
prone to get damaged in Knee dislocation and
Why?(0.5*2)
43

44. Q13.(1)
You are working in a rural health clinic in northern India. You evaluate
an 8 year old boy who has never seen a physician. His mother tells you
that he is unable to keep up with peers in terms of physical activity. On
initial examination of his skin , you notice clubbing and cyanosis in his
feet, but his hands appear normal. Without any further examination, you
suspect that he has a congenital abnormality.
Diagnosis?
44

45. Q14.(1)**
A 65-year-old male with history of diabetes mellitus, hypertension,
atherosclerotic carotid disease, and three-vessel coronary artery disease
with CABG performed last month, who presented with moderate
intensity 5 out of 10 prolonged left-sided chest pain, worse with
physical activity involving the left upper extremity. The pain persisted
overnight and the patient presented the following day to the emergency
department. Since bypass surgery, the patient had been doing well with
no anginal symptoms and was maintained on aspirin 81 mg daily,
clopidogrel 75 mg daily, metoprolol 25 mg twice daily, enalapril 10 mg
daily, and metformin 500 mg twice daily.
Explain the cause for current complaint?
45

46. Q15. Name the technique developed lately with
the aim of treating asthma.(1)**
46

47. Q16.(1)
47

48. This maneuver’s main use is something else.
But it is also used to diagnose Arnold Chiari
malformation, palpation of supraclavicular
lymph nodes and arrest of SVT.
NAME THE MANEUVER
Q17(1)
48

49. A 30-year-old male, previously
diagnosed with Addison's
disease, on steroid
supplementation for 18 years,
presented to you with difficulty
walking, paraparesis, difficulty
speaking. No psychotic
symptoms or history of
substance abuse.
MRI is given in the image.
What is the inheritance
pattern of this disorder?
Q18.(1)
49

50. Q19. (1)
• A 50 year old male presented with increasing abdominal girth,
generalized weakness, easy fatigability, proximal muscle weakness,
decreased libido, erectile dysfunction, loss of pubic and axillary hairs and
diabetes and hypertension. Evaluation at this stage revealed
hypercortisolism. The patient underwent total bilateral adrenalectomy
• He reported to you two months later with headache, visual field defects
and darkening of skin.
EXPLAIN THE PATHOPHYSIOLOGY BEHIND THE CURRENT
COMPLAINT
50

51. Name the condition.
Heart lung fistula
Smooth philtrum
Holoprosencephaly
mental retardation
Q20(1).
51

52. Q21.(1)**
52

53. This drug is an antisense nucleotide designed to bind to
exon 51 of______ pre mRNA. This results in exclusion
of this exon during mRNA processing in patients with
genetic mutation that is amenable to exon 51 skipping.
This drug is specifically indicated for which condition
and the name of the drug
Q22.(1)
53

54. Q23.(0.5*4)
MAb USE
Ustekinumab A
Alemtuzumab B
Eculizumab C
Ranibizumab D
54

55. Q24. CONNECT(1)
55

56. Q25. (1)
A 6 hour old boy is in the newborn nursery with tachycardia. He was
born at 38 weeks POG to a 30 year old woman with Grave’s disease that
was treated surgically with partial thyroidectomy approx. 6 months
before pregnancy. Subsequently, the mother became mildly hypothyroid
and was treated with levothyroxine during pregnancy. Infant’s weight is
2100g. Temperature is 99F and pulse 190bpm. Examination shows
irritable but consolable with warm, flushed skin.
Explain the pathophysiology for neonatal symptoms in this case.
56

57. Submit sheets
• Grand total for score= 30
57

58. Answers

59. Q1.(0.5)
What does this Doodle celebrates?
59

60. • APGAR score
• Dr Virginia Apgar, an American obstetrical anesthetist on her 109th
birth anniversary.
60

61. Q2.(1)
• An 8 year old boy was referred to Pediatrics Clinic, due to developmental
delay and seizure attacks from 6 year ago. There was no evidence of seizure
or mental retardation in his family.
• He had a happy face and the parents noticed developmental delay at 2 year
old. He was admitted in a hospital because of tonic-colonic seizures and
valproate sodium was administered for him
• On physical examination, he had mandibular prognathism, strabismus and
unusual laughing facial expression. His head circumference was 51 cm.
• His walking was unsteady, but muscles tone, force and deep tendon reflexes
were normal. Joints range of motion was normal. Besides, he had speech
disability and could walk independently, but could not run. He had
restricted communicative abilities and suffered from severe mental
retardation.
Laboratory findings were normal. Brain MRI and CBC test were normal.
61

62. What is the genetic basis for this syndrome?
62

63. Angelman syndrome
•Paternal gene imprinted with maternal gene mutation
•Paternal uniparentral disomy (5%)
63

64. Q3(4)
A 35 year old lady is evaluated by his physician, who determines that
his blood pressure is significantly elevated at 185/130 mmHg.
Lab test reveal plasma renin activity …(1)…, plasma aldosterone..(2)..,
left renal vein renin level…(3)…and right renal vein renin is …(4)…
A.Identify 1,2,3,4
64

65. Left renal artery stenosis
• 1-increased
• 2-increased
• 3-decreased
• 4-increase
65

66. Q4. Out of these 3, which is the most
specific lesion for diagnosis of the case
constituted by this triad. (0.5)
66

67. •Genital ulcer
67

68. Q5.(1)** A 37-year-old man without any significant
past medical history presented to emergency
room after he had an episode of dysphagia
while he was drinking water; at the same
time, he felt that the fluid was stuck and he
strained to push the fluid down. After a
while, he felt a sudden sharp, retrosternal,
stabbing chest pain.
The patient stated that he had intermittent
dysphagia but no hematemesis, hematochezia
or melena. Esophagogastroduodenoscopy
(see image)
Diagnosis?
68

69. Eosinophilic esophagitis
• Swallowing difficulty, food impaction
• Chest pain that is often centrally located and does not respond to antacids
• Endoscopic image - Concentric rings are termed trachealization of the
esophagus
69

70. Q6. Connect(1)
70

71. Cutaneous T cell lymphoma
• Atypical CD4+ cells- cerebriform nuclei
• Intraepidermal neoplastic cell aggregate – pautrier microabscess
• Skin patches/ plaques
71

72. These two techniques
come under regional
anesthesia of the
airway and allow
awake intubation
suspected difficult
intubation , upper
airway trauma or
cervical spine fractures
Identify the two
procedures or
techniques.
A B
Q7.(1+1)
72

73. B- superior laryngeal nerve
block
A- Recurrent laryngeal nerve
block
73

74. Q8.(1)
The patient is placed in a standing or sitting position, and the arms are
raised parallel to the ground in the scapular plane. The arm is rotated
to full internal rotation (thumb down) Once rotated, the clinician
pushes down on either the wrists or the elbow, and the patient is
instructed to resist the downward pressure.
Positive if weakness, pain or both are present during resistance.
What does the positive test signifies?
74

75. Empty can test
• Positive test signifies – supraspinatus injury
75

76. Q9 Connect(1)**
• Terfenadine
• Ondansetron
• Arsenic
• Ziprasidone
76

77. QT prolongation
77

78. Q10. This disease was first reported in Saudi Arabia in
2012 and spread across the globe thereafter .
Identify the disease.(1)
78

79. MERS-CoV
• Middle East respiratory syndrome coronavirus- first identified in
Saudi Arabia in 2012.
79

80. Q11.(1+1) Someone recently died from this disease.
a. What enzyme is deficient in the familial form of disease?
b. What is the location of this enzyme inside cell?
80

81. Amyotrophic Lateral Sclerosis
• A- Superoxide dismutase 1 (SOD1) or copper zinc superoxide
dismutase
• B- Cytoplasm
81

82. Q12. Which of the following structure is most
prone to get damaged in Knee dislocation and
Why?(0.5*2)
A
B
C
D
82

83. A- Popliteal artery
• Reason:
• Tightly fixed proximal and distal to popliteal fossa by ADDUCTOR
MAGNUS and SOLEUS, making it more susceptible to tearing by traction
forces
• More commonly involved in both anterior and posterior dislocation
83

84. Q13.(1)
You are working in a rural health clinic in northern India. You evaluate
an 8 year old boy who has never seen a physician. His mother tells you
that he is unable to keep up with peers in terms of physical activity. On
initial examination of his skin , you notice clubbing cyanosis in his feet,
but his hands appear normal. Without any further examination, you
suspect that he has a congenital abnormality.
Diagnosis?
84

85. PDA+ Eisenmenger syndrome
85

86. Q14.(1)**
A 65-year-old male with history of diabetes mellitus, hypertension,
atherosclerotic carotid disease, and three-vessel coronary artery disease
with CABG performed last month, who presented with moderate
intensity 5 out of 10 prolonged left-sided chest pain, worse with
physical activity involving the left upper extremity. The pain persisted
overnight and the patient presented the following day to the emergency
department. Since bypass surgery, the patient had been doing well with
no anginal symptoms and was maintained on aspirin 81 mg daily,
clopidogrel 75 mg daily, metoprolol 25 mg twice daily, enalapril 10 mg
daily, and metformin 500 mg twice daily.
Explain the cause for current complaint?
86

87. Coronary subclavian steal phenomena
This syndrome is characterized by retrograde
blood flow from the LIMA to the distal
subclavian artery (SA) to perfuse the upper
extremity when a severe proximal SA stenosis
is present.
As a result, a coronary steal phenomenon may
develop whereby the myocardium perfused
by the LIMA graft can become ischemic
despite the patency of the grafted vessels.
Therefore clinical features of angina
87

88. Q15. Name the technique developed lately with
the aim of treating asthma.(1)**
88

89. Bronchial thermoplasty
• Treatment for severe asthma approved by the FDA in 2010
• The catheter delivers a series of 10-second temperature controlled bursts
of radio frequency energy which heat the lining of the lungs to 65 degrees
Celsius.
• It is this heat that destroys some of the muscle tissue which constricts
during an asthma attack, reducing the number and severity of
exacerbations
89

90. Q16.(1)
90

91. Splenectomy/ Asplenia
• Babesia – increased susceptibility
• Dactylitis- seen in SCD – cause
• Waterhouse–Friderichsen syndrome- due to disseminated Neisserial
infection
• Howell Jolly bodies
91

92. This maneuver’s main use is something else.
But it is also used to diagnose Arnold Chiari
malformation, palpation of supraclavicular
lymph nodes and arrest of SVT.
NAME THE MANEUVER
Q17(1)
92

93. VALSALVA Maneuver
93

94. A 30-year-old male, previously
diagnosed with Addison's
disease, on steroid
supplementation for 18 years,
presented to you with difficulty
walking, paraparesis, difficulty
speaking. No psychotic
symptoms or history of
substance abuse.
MRI is given in the image.
What is the inheritance
pattern of this disorder?
Q18.(1)
94

95. X linked Recessive
Adrenoleukodystrophy
95

96. Q19. (1)
• A 50 year old male presented with increasing abdominal girth,
generalized weakness, easy fatigability, proximal muscle weakness,
decreased libido, erectile dysfunction, loss of pubic and axillary hairs and
worsening of proximal muscle weakness, diabetes and hypertension.
Evaluation at this stage revealed hypercortisolism. The patient
underwent total bilateral adrenalectomy
• He reported to you two months later with complained headache, visual
field defects and darkening of skin.
EXPLAIN THE PATHOGENESIS.
96

97. Nelson syndrome
97

98. Name the condition.
Heart lung fistula
Smooth philtrum
Holoprosencephaly
Limb dislocation
Q20(1).
98

99. Fetal alcohol syndrome
99

100. Q21.(1)**
100

101. ependymoma-Perivascular rosette
white reflex (retinoblastoma)-Flexner wintersteiner
rosette
neuroblastoma of adrenals-Horner wright rosette
pineocytoma-Neurocytic rosette
all the conditions have diagnostic rosettes

102. This drug is an antisense nucleotide designed to bind to
exon 51 of______ pre mRNA. This results in exclusion
of this exon during mRNA processing in patients with
genetic mutation that is amenable to exon 51 skipping
This drug is specifically indicated for which condition
and the name of the drug
Q22.(1)
102

103. ETEPLIRSEN
used for Duchenne muscular dystrophy
103

104. Q23.(0.5*4)
MAb USE
Ustekinumab A
Alemtuzumab B
Eculizumab C
Ranibizumab D
104

105. • A- Psoriasis/ Crohns disease
• B- CLL/CTLL
• C- PNH
• D- ArMD
105

106. Q24. CONNECT(1)
106

107. RET mutation
• Medullary Ca thyroid
• Hirschsprung disease
• Pheochromocytoma
• Hyperparathyroidism
107

108. Q25. (1)
A 6 hour old boy is in the newborn nursery with tachycardia. He was
born at 38 weeks POG to a 30 year old woman with Grave’s disease that
was treated surgically with partial thyroidectectomy approx. 6 months
before pregnancy. Subsequently, the mother became mildly hypothyroid
and was treated with levothyroxine during pregnancy. Infant’s weight is
2100g. Temperature is 99F and pulse 190bpm. Examination shows
irritable but consolable with warm, flushed skin.
Explain the pathophysiology for neonatal symptoms in this case.
108

109. Neonatal thyrotoxicosis
• Maternal graves diseases leading to Ab transfer
109

110. Thank you.
110