This is the Mains Round quiz, for premier medillectuals. That was held in Maulana Azad medical college on 15th September, 2018.

2. MAINS

3. ROUND 1- DRY ROUND

4. RULES
• There are 6 questions in this round, one for each team.
• Pounce and Self Pounce is applicable.
• Correct answer: +15
• Incorrect answer/No answer: 0
• Correct pounce: +20
• Incorrect pounce: -10

5. Q. 1
A 1 year old male infant was suffering from bronchopneumonia, lethargy and delayed
development.
After successful treatment of bronchopnemonia, blood investigations revealed low
hemoglobin and TLC. Peripheral smear revealed Megaloblastic changes. No
hyperammonemia was noted.He did not show any improvement in response to Iron,
Folate or Vit B12 therapy.
Urine analysis showed needle shaped crystals on long standing.
After a diagnosis was made, patient was treated with the nucleoside uridine and he
made a remarkable recovery in all parameters .
• What is the likely diagnosis and causative enzyme defect?

6. SAFETY SLIDE

7. • Type 2 Orotic aciduria
• Orotidylate decarboxylase

8. Q. 2
• A 33 year old fit and well woman came to the emergency complaining of
diplopia and pain behind right eye. She had no other symptoms.
• On examination, right pupil is dilated, there was mild ptosis. Testing of eye
movements revealed that the eye was turned down and out and the
pupillary reflex was not present. An internal carotid angiogram was ordered.

9. • What is the most likely cause for her symptoms?
• What are the functional components of the nerve involved?

10. SAFETY SLIDE

11. • Posterior Communicating artery aneurysm
• GSE, GVE

12. Q.3
• Give scenarios in which the following amino acids can become essential
• 1) Tyrosine
• 2) Arginine
• 3) Cysteine

13. SAFETY SLIDE

14. • 1- Phenylketonuria
• 2- Preterm infants/Arginosuccinase deficiency
• 3- Cystathione beta synthase deficiency

15. Q.4

16. SAFETY SLIDE

17. • Hutchinson gilford progeria syndrome
• Defect in nuclear lamin A leads to nuclear membrane instability, leading to
abnormal nuclear shapes.

18. Q. 5
• A patient of head trauma presents to you in the emergency. On
fundoscopy, you see papilledema, confirming the presence of increased
intracranial tension. You intend to reduce his ICT by making him
hyperventilate. Explain why?

19. SAFETY SLIDE

20. • Hyperventilation leads to CO2 washout and an increase in CSF pH. This
causes cerebral vasoconstriction thus decreasing intracranial tension.

21. Q.6
A) Where is the lesion present?
B) During recovery from this condition, the patient develops paradoxical
lacrimation. What is this phenomenon called and why does this occur?

22. SAFETY SLIDE

23. • Right stylomastoid foramen (LMN type)
• Crocodile tears syndrome
During recovery from bell’s palsy, the regenerating salivary fibres innervate the lacrimal gland,
thus there is lacrimation every time the patient eats.

24. ROUND 2- CONNECT

25. RULES
• There are 6 questions in this round.
• Pounce and Self Pounce is applicable.
• Correct answer: +20 (+10 for answer and +10 for explanation of all images)
• Incorrect answer/No answer: 0
• Correct pounce: +20 (BOTH answer and explanation are compulsory)
• Incorrect pounce: -10

26. Q.1

27. SAFETY SLIDE

28. • Bicipital groove

29. Q.2

30. SAFETY SLIDE

31. Monoclonal antibodies

32. Q.3 CONNECT
Frequency of allele

33. SAFETY SLIDE

34. • G-6-PD deficiency

35. Q.4
CONNECT

36. SAFETY SLIDE

37. • Pontine hemorrhage

38. SAFETY SLIDE

39. Q.5

40. SAFETY SLIDE

41. • Kartagener’s syndrome

42. Q.6

43. SAFETY SLIDE

44. • Pectoralis major

45. ROUND 3- SYSTEMS

46. RULES
• There are two questions under every system.
• Pounce and Self Pounce is applicable.
• Correct answer: +20
• Incorrect answer/No answer: 0
• Correct pounce: +30
• Incorrect pounce: -15

47. SYSTEMS
• Endocrine
• CNS
• Renal
• Neuromuscular
• Genetics
• Respiratory
TO ROUND 4 

48. ENDOCRINE

49. Q.1
• A 12 year old child was brought to the paediatrics OPD by her mother in the
Dominican Republic, who had been noticing an abnormal growth pattern of
her daughter. She started to develop male body contours and her clitoris
had enlarged to a size of 4 cm.
● What is the basis of these findings?
● What is the special term given to this phenomenon?

50. SAFETY SLIDE

51. ● Congenital 5 alpha reductase deficiency (Male
pseudohermaphroditism)
● “Penis-at-12”

52. Q.2
• A 27-year-old woman had massive postpartum hemorrhage at her first
delivery due to atonic bleeding. She was transfused and treated with uterine
embolization, which successfully stopped the bleeding. The postpartum
period was uncomplicated through day 7 following the hemorrhage.
However, on day 8, the patient had sudden onset of seizures and
subsequently became comatose. Laboratory results revealed
hypothyroidism, hypoglycemia, hypoprolactinemia, and adrenal
insufficiency.
• Q. What is the most likely cause for this?
• Q. Why was the woman more susceptible to this condition?

53. SAFETY SLIDE

54. ● Sheehan’s syndrome (postpartum ischemic necrosis of pituitary)
● The pituitary enlarges during pregnancy, which may compromise the
blood supply which comes through the pituitary stalk.
BACK TO MENU

55. GENETICS

56. Q.1
You are called as a consultant for a child with a very small mandible
and ears that are represented by small protuberances bilaterally. The
baby has had numerous episodes of pneumonia and is small for its
age. The mother also gives history of seizures in the baby. On a
proper check up, serum calcium level is found to be low along with
low levels of PTH. What is your diagnosis? Give its embryological
basis.

57. SAFETY SLIDE

58. - DiGeorge syndrome (22q.11.2 deletion)

59. Q.2
1) What is the mode of inheritance of the above disorder?
2) Which gene is involved?

60. SAFETY SLIDE

61. 1) Autosomal dominant
2) RUNX2/CBFA1
BACK TO MENU

62. RENAL

63. Q. 1
A patient comes to you with jaundice and distended
abdomen.You observe multiple bruises as well as spider
angiomas on examination. The abdomen shows shifting
dullness and fluid thrill sign, indicating ascites. You
diagnose him to be a case of Chronic liver disease.
Why would it be a bad idea to give him Acetazolamide for
the ascites?

64. SAFETY SLIDE

65. Acetazolamide is a CA inhibitor, thus it causes urinary alkalosis. Since NH3
metabolism is already compromised, decreased formation and excretion oh
NH4+ in the gut can cause increased NH3 levels and precipitate hepatic
encephalopathy.

66. Q.2
The above figure is a Cystometrogram – a graph representing the relation between the
intravesical volume and pressure in the urinary bladder
1) Give reason for the flat nature of Ib.
2) Give any two other physiological phenomenon that can be explained on the same
basis.

67. SAFETY SLIDE

68. 1) Law of Laplace and plasticity of smooth muscle
2) dilated heart has to do more work, thin walled capillaries are more prone
to rupture, smaller alveoli are prone to collapse
BACK TO MENU

69. RESPIRATORY

70. Q.1
A 45 year old male presents to your office for a complaints of increased
dyspnea on exertion for the last several months. Lately he has had a great
deal of difficulty performing any activity without shortness of breath. He
denies cough, hemoptysis, chest pain, dysphagia, weight loss, night
sweats, or fevers. He states he has no significant past medical or surgical
history. He knows no family members who have died prematurely or who
have had asthma. The patient states he use to smoke a few cigarettes a
day while he was young but quit a few years ago. He does not drink
alcohol and takes no medication. On physical examination, you note mild
expiratory wheezes and clubbing but note no other abnormal findings.
Chest X-ray is significant for flattened diaphragm and large lung fields with
basal hyperlucency. Pulmonary function tests are significant for a lower
than expected FEV1/FEV ratio. All other blood work is within normal limits
except for mild to moderate elevation of liver transaminases.
1) What is the genetic basis for this condition?
2) Why is a history of smoking significant in this case?

71. SAFETY SLIDE

72. 1) alpha 1 antitrypsin- normal genotype (MM)- PiM
ZZ- PiZ / PiSZ: both produce considerably lesser antiprotease
2) Smoking oxidizes the methionine of A1AT (which binds to the proteases) to
methionine sulfoxide and hence inactivates it.

73. Q. 2
A 34 year old female gave birth to her second child, a 3.1 kg baby boy., born at
term. She was not a known case of hypertension. Epigastric pain, headaches or
blurry vision were not reported during pregnancy. She had been taking Insulin
for the last 7 years. The delivery took place under all aseptic precautions by a
Caesarean section. Two injections of X were given to the mother before
delivery, the baby was born healthy without any complications.
However, in her previous pregnancy, the prophylactic measures were not
taken, and the baby was born with respiratory distress.
1) What is X?
2) Why is there an increased risk of her babies developing respiratory
distress?

74. SAFETY SLIDE

75. ● X- Betamethasone/Dexamethasone (steroids)
● Maternal hyperglycemia leads to fetal hyperglycemia, hence increased
levels of insulin are produced in the fetus, which inhibits surfactant
production, hence precipitating ARDS.
BACK TO MENU

76. CNS

77. Q.1
A 32 year old woman presents for neurological evaluation after
experiencing a severe burn on the palm of her right hand. She had placed
her hand onto the hot surface of a smooth electric range. She did not feel
the burn when it occurred, and only when she picked her hand up did she
notice the burn. After that, it was discovered that the patient unknowingly
has bilateral loss of pain and temperature sensation in both hands.
However she does have touch and vibratory sense. Making of her kids of
sensation shows decreased pain sensation in the nape of her neck,
shoulders and upper arms as well in a cape like distribution. Deep tendon
reflexes are absent at the biceps and the triceps, and there is visible
wasting of the right biceps and shoulder musculature. What is the most
likely diagnosis?

78. SAFETY SLIDE

79. ● Syringomyelia (dissociative anaesthesia)

80. Q.2
When a lesion damages X in the categorical hemisphere
without affecting Wernicke’s/Broca’s areas, there is no
difficulty with speech or the understanding of auditory
information, instead there is trouble understanding
written language and pictures, because visual information
is not processed and transmitted to Wernicke’s area. The
result is a condition called Y.
● What are X and Y?

81. SAFETY SLIDE

82. ● X- Angular gyrus
● Y- Anomic aphasia
BACK TO MENU

83. NEUROMUSCULAR

84. Q. 1
Two autoimmune conditions affecting neuromuscular
transmission are Myasthenia Gravis and Lambert-Eaton
syndrome.
On repetitive stimulation, muscle strength improves in
one condition while in the other, fatigue may develop
with sustained activity .
Identify both, and give reasons for the same.

85. SAFETY SLIDE

86. Improves in LE because accumulation of
calcium in nerve terminal increases Ach
release. Worsens in MG because the
number of quanta released decreases with
repetitive stimuli

87. Q.2
It is relatively unusual for muscles and their tendons to rupture in the upper
limb; However, the tendon that most commonly ruptures is the tendon of X
muscle. In isolation, this has relatively little effect on the upper limb, but it
does produce a characteristic deformity- on flexing the joint,there is an
extremely prominent bulge of the muscle belly as it’s unrestrained fibres
contract, known as the Y sign.
● X and Y?

88. SAFETY SLIDE

89. ● X- Long head of biceps brachii
● Y- Popeye’s sign
BACK TO MENU

90. ROUND 4- BIDDING

91. RULES
● There are 6 questions in this round. All the teams will attempt them
simultaneously.
● The teams can bid a maximum amount equal to their current score or
they can choose not bid as well.
● Correct answer: +2x
● Incorrect answer: -x, where X is the amount that has been bid.
● A hint will be given before each question, following which the teams have
to place their bids, after which the question will be shown.

93. Q.
It is observed that osteomyelitis in children as a result
of hematogenous spread of bacteria most commonly
involves the metaphysis. What is the basis behind this?

94. SAFETY SLIDE

95. ● Since epiphyseal cartilage is avascular, the metaphyseal arteries make a
hair pain loop at the end. The blood flow is sluggish in this hair pain loop,
accompanied by poor phagocytic activity, hence seeding of organisms is
easier.

97. Q.
I comprehend, for without transfornation
Men become wolves on any slight occasion.
Byron:'DonJuan
The term 'werwolf' is probably derived from the Anglo-Saxon 'wer'
meaning man, and 'wolf'. In the history of alleged metamorphosis,
the trans-formation of man into wolf is the most prominent form of
the myth, though the further south one goes the more common
becomes the myth of wer-tigers, and further north wer-bears become
pre-eminent. I believe that the so-called werwolves of the past may,
atleast in the majority of instances, have been suffering from X.The
evidence for this lies in the remarkable relation between the
symptoms of this rare disease and the many accounts of werwolves
that have come down to us.
This is an excerpt from 'On X and the Etiology of Werwolves' by L Illis ,
published in January, 1964.

98. SAFETY SLIDE

99. ● 1) What is X?
● 2 ) Why is X being attributed as being a
werewolf?

100. 1) Porphyria
2) Hypertrichosis, Photosensitivity (nocturnal), pigmentation, mutilation,
reddish brown urine, agitated

102. Q.3
X
A
B

103. SAFETY SLIDE

104. 1) Identify X.
2) Describe how alterations A and B can lead to
X.

105. ● Rickets
● Vit D resistant rickets- A
● Renal rickets- B

107. Q.4
A 10 year old male child presented to the pediatrics OPD with signs and
symptoms of fine pill-rolling type tremors, bradykinesia, mask like facies and a
short, shuffling gait.
O/E: on his chest small spider angiomas were also found and abdomen was
distended. Ophthalmological examination showed:

108. ● Where is the defect present?
● What is the characteristic finding on ophthalmological examination?
● Levels of which biochemical markers would you like to assess?

109. SAFETY SLIDE

110. ● ATP7B
● Kayser-Fleischer ring
● Serum ceruloplasmin, Serum Copper,
Urinary 24h copper

112. Q.5
A patient presents with anaemia and complains of passing reddish brown urine
in the morning after waking up. The doctor orders a X test, after which a
provisional diagnosis of Paroxysmal Nocturnal Hemoglobinuria is made.
● What is X?
● Why is there such a diurnal variation for the appearance of symptoms?

113. SAFETY SLIDE

114. ● Ham’s test/Acidified Serum test
● At night, the pH of of the plasma slightly drops, which increases the
susceptibility to lysis by the complement system.

116. Q.6
• A truck driver presents to the OPD with difficulty walking and urinary
incontinence. On examination, his pupils were nonreactive to bright light
but constricted when focusing on a near object.
• Identify the ocular pathology.
• What is the suggested basis for it?

117. SAFETY SLIDE

118. Argyll Robertson pupils (Prostitute’s Pupil)
Attributed to dorsal midbrain lesion ( pretectal nuclei) that interrupts the
pupillary light reflex pathway but spares the more ventral pupillary near - reflex
(accommodation) pathway