AIIMS ESSENCE

(2019–2015)
AIIMS ESSENCE
(2019–2015)
Volume 1

Sixth Edition

Pritesh Kumar Singh

MBBS (MAMC), MS (Surgery), FMAS, FIAGES
Author of Surgery Essence, AIIMS Essence, NEET Essence

Director,
Chief Advisor of Editorial Board—PGMEE, Jaypee Brothers Medical Publishers
Guest Faculty of Surgery, Ningbo University, China;
Stavropol State Medical University, Russia
Ex. Senior Resident, Lady Hardinge Medical College and
Associated Sucheta Kriplani Hospital
Kalawati Saran Children's Hospital and Ram Manohar Lohia Hospital
New Delhi, India

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The Health Sciences Publisher
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AIIMS Essence (2019–2015) Volume 1

First Edition: 2015
Sixth Edition: 2020
ISBN: 978-93-89776-52-2

Printed at:
 Dedicated to

My Parents
and
Uncle, Dr CP Singh
 Director's Message
Dear Doctor,
Dr. Pritesh Institute is the fastest growing coaching institute for PG medical
coaching, NEET-PG/DNB/AIIMS/MCI. Dr. Pritesh Institute has the uniqueness of
devotion. It is the most student friendly institute with primary aim to educate and
counsel the students to become the best and confident doctors.
We provide specialized courses, which are especially designed by experts
in the respective fields and incorporate latest innovation in the field. Recent
advances, new topics, latest innovations, new pattern of questions and image‑
based questions are being posted on our page and discussed thoroughly by
our expert panel of faculty members. We feel proud to announce that our page
is having active interaction with serious and enthusiastic medicos from more than
80 countries across the globe.
We started to leave an indelible mark on the students who have undergone training with us. We started changing lives.
And all this was not a sheer coincidence. It was the urge, the compelling desire, to always aspire for perfection and in the
process; we continuously kept on setting newer benchmarks of excellence, which enabled us and our students to achieve, what
we have achieved. Today, aiming for the unachievable and continuously raising the bar has become a part of the Dr. Pritesh
Institute DNA.
The success of our students was inspiring and so was their faith in Dr. Pritesh Institute. It was this faith that was a catalyst
in the growth of this institution. It was this faith that prompted us to embark on a mission to provide wholesome education to the
students. The students will be trained to be the best in the world through methodologies and practices that are truly world class.
Dr. Pritesh Institute is supported by the faculty, who are not just masters of their subject but have keen interest in
teaching. Many of them are the authors of PG entrance examination books and therefore, they are well versed with all
the current hot topics, controversies and the latest pattern of NEET and DNB questions. Hence, they themselves put in
too much of labor in solving all the controversial questions and in preparing the best possible question papers. With the same
amount of effort, the students will feel that they are much better prepared for the exams.
About our publications, Dr. Pritesh Singh’s AIIMS ESSENCE is one of the finest book series, considered gold
standard book for PG preparation, which provide you with authentic questions along with clear and cogent answers,
the assurance given by the references provided with every answer. We take out our own solutions of AIIMS examination
in partnership with Jaypee Medical Publishers and our books are available throughout the country. Dr. Pritesh Singh’s
SURGERY ESSENCE is the best seller for the subject and appreciated by crowd across the globe. We have our team of
dedicated students who help us create an authentic recall.
Wishing you all the best for your examination and we are proud to be partners in success with so many PG aspirants for
years now.

Dr. Pritesh Kumar Singh

MBBS (MAMC), MS (Surgery),
FMAS, FIAGES
Author of Surgery Essence,
AIIMS Essence, NEET Essence
and Delhi PG Entrance Examination Book
Faculty of National Fame
 Preface to the Sixth Edition
First of all I would like to thank all my students for their help and contribution and making the book as bestseller and for their
constant feedback regarding the improvement of the book.
I can proudly say that all my students have contributed a lot to get me to this place, where I am today. They have helped me in
becoming a better teacher, a better author and most importantly a better human being. I take this opportunity to thank all of you. The
happiness you all give me keeps me telling always to work harder to bring a positive change in the life of my students. This will be
reflected in the pages of this book. I always strive to provide a winning edge to my students.
PG entrance examination has made the medical world very competitive and has made it imperative for the students to acquire
all the skills and competencies to deliver results. My aim as an author, as a teacher is to provide students with a learning experience
which when amalgamated with perseverance and commitment helps them in achieving goals.
Higher education has become necessary, as graduation alone is found inadequate in this highly competitive and dynamic
world. Trends in the way, the questions being asked are changing continuously. AIIMS is the most prestigious institute and the
dream destination of all medical PG aspirants. As an author, I closely follow the kind of questions being asked and the change
of pattern of questions in the AIIMS examination. I am pleased to present the 6th edition of AIIMS Essence replete with new
pattern of questions, image‑based questions and recent advances. To provide to an edge, image‑based questions are discussed
thoroughly. Triads, signs, investigation of choices and topics based on “most common” type of questions are included to save
your precious time and to help you in revision at the most crucial hours. The explanations are written in a cogent manner and
without any ambiguity. The explanations have been taken from standard text books available for super specialty and recent
journal review articles so that one can get the best preparation without wastage of precious time of going through all those
books. This has also helped me to prepare better for the controversial questions which always bring anxiety in the minds of
the students.
Another thing, which needs mention, is that it is very important to solve the latest AIIMS paper well in time before the
examination so that the students are aware of the current topics and therefore, can spend the appropriate amount of time on
them.
While writing the explanations I had all these things in my mind and hence, the approach was such that the students should not find
any difficulty solving this Question Paper and that they get ample time to revise this book and the related topics before the examinations.
The book possesses the truth of authenticity, which is reflected in the references provided along with each of the explanation. If
read with the proper attitude and confidence, one would realize that it is not a rocket science to crack the examination. I will be
indebted to those students who will understand the intentions and imbibe them to secure a great rank and a greater future.
Most of us are generally busy in marking the facts which are important in the books without realizing that the effort
would go in drain if we do not get the time to revise the same. So the practice of taking only a single reading from any book should
be avoided as the net output required to be produced during the examinations is not fulfilled. In this book, such key points and facts
have already been highlighted; Image‑based questions, colored tables and flow diagrams have been provided.
I am passionate about excellence. Excellence in the field of education and in my efforts to groom my students to make
them confident enough, that they lose the fear of failure. Being the director of Dr. Pritesh Institute, we follow the same
principle in our institute so that our students should be benefitted most with an extra edge.
I still am not sure about one thing that who is more happy, when a student achieves something, the student or the teacher, but
I am very sure that the teacher is more satisfied when he sees his students achieving what they deserve and desire. I am working day
and night to get that satisfaction and you have to work equally hard so that you do not let me down.
I always tell my students to dream big but not while sleeping. When you dream of moon, you will at least fall amongst stars.
But these dreams should always be accompanied with intelligence and hard work. To guide your work intelligently, this book and
the author, both are there with you throughout the year. But the hard work is totally in your hands. Accept responsibility for your life.
Know it is you who will get you where you want to go, no one else.
I believe that all my students should know the importance of challenges. Challenges are what make life interesting and overcoming
them is what makes life meaningful. For the time being the only challenge that you should be facing is to secure a good rank in the entrance
examination. One of the most important keys to success is having the discipline to do what you know you should do, even when you do not
feel like doing it. Nobody ever wrote down a plan to be broke, lazy or stupid. These things happen when you do not have a plan.
 viii AIIMS Essence

Extensive revisions have been made to minimize the chances of error but still some mistakes might be there which should be
brought to the notice of the authors through e-mail address or in writing.
This book would have remained a dream without the contributors. It is a pleasure now to give outlet to the overflowing
appreciation and thanks to all my colleagues, friends, teachers and family because this book is the result of encouragement and
guidance from all of them.
I am pleased to acknowledge the overwhelming love I have received from my students, who are my ultimate source of
inspiration. Wishing you all the best and looking forward for your feedback and suggestions.

— Pritesh Singh
AIIMS Essence
 Preface to the First Edition
I feel immense pleasure while writing the preface to the Review of AIIMS. This is not just a book, this is my child and I could
see the change in myself, the way I am maturing with this book as a mother matures seeing her child grow. All this is possible
because of all my students, the debt I owe to them is incalculable...this book is their book.
During the first year my work was modeled on the stimulus provided by my dreams. Then, in the second year I experi-
enced an elevated sense of responsibility because now I understand the meaning of a teacher and an author with a greater
depth. This reminds me what one of the student wrote about me after attending my lecture “It takes a big heart to help shape
little minds...The ordinary teacher tells, the good teacher explains, the supreme teacher demonstrates but the great teacher
inspires...”
The moment I read this I felt as if I am on cloud nine but a minute later I realized the gravity of the words which made me
realize that I am here for a greater purpose. The students all over the nation look up to me, respect me and my actions and words
have an influence on them. I cherish the kind of relationship which I have with my students and I strive to improve with
every passing day.
With this I want all my students to work hard to achieve their goals. Trust me, dreams do come true if nurtured in a proper
way. Although the seats are limited but are not hypothetical, so, the foremost thing is to realize that yes I can reach my dream
destination. Through this book I want to make a small contribution in your life and I shall feel extremely fortunate if I could
guide you to help you reach your goal. But the power to illuminate your future is with you only.
The relationship, which I have with this book and so, indirectly with all of the PG aspirants is just few years old but it
seems that I know you since ages. The reason being that I am always in touch with my students and now I realize what psy-
chology the students have when they take the AIIMS entrance exam. Being in the same profession I have also been through
this stage. AIIMS is definitely the dream destination of most of the PG aspirants but dreams do come true if nurtured in a
proper way.
Another thing, which needs a mention, is that it is very important to solve the latest AIIMS paper well in time before the
exam so that the students will be aware of the current topics and therefore, can spend the appropriate amount of time on
them.
While writing the explanations I had all these things in my mind and hence, the approach was such that the students should
not find any difficulty in solving the Question Papers and that they will get ample time to revise this book and the related topics
before the exams. The book possesses the truth of authenticity, which reflects in the references provided along with each of the
explanation. If read with the proper attitude and confidence, one would realize that it is not a rocket science to crack the exam. I
shall be indebted to those students who will understand the intentions and will imbibe them to secure a great rank and a greater
future.
The pattern of questions in postgraduate entrance examination has changed after introduction of NEET but when one is
thorough with the subject it is a lot easier to secure a good rank in the exam. For that matter, I have incorporated explana-
tions with every question to broaden the scope of the question. The explanations have been written in a cogent manner
and without any ambiguity. The sources have been mentioned in the references so that in case of a doubt one can always
go back to the textbooks. The explanations have been taken from standard textbooks available for superspecialty and recent
journal review articles so that one can get the best preparation without wastage of precious time of going through all those
books. This has also helped me to prepare better for the controversial questions which always bring anxiety in the minds of
the students.
Most of us are generally busy in marking the facts which are important in the books without realizing that the effort
would go in drain if we do not get the time to revise the same. So the practice of taking only a single reading from any book
should be avoided as the net output required to be produced during the exams is not fulfilled. In this book, such key points
and facts have already been highlighted; Tables and flow diagrams have been provided.
Extensive revisions have been made to minimize the chances of error but still some mistakes might be there which should be
brought to the notice of the authors through e-mail address or in writing.
 x AIIMS Essence

This book would have remained a dream without the contributors. It is a pleasure now to give outlet to the overflowing
appreciation and thanks to all my colleagues, friends, teachers and family because this book is the result of encouragement
and guidance from all of them.

I am pleased to acknowledge the overwhelming love I have received from my students, who are my ultimate source of
inspiration. Wishing you all the best and looking forward for your feedback and suggestions.

dr.pritesh@gmail.com Pritesh Kumar Singh

drpriteshsingh MBBS (MAMC), MS (Surgery)
FMAS, FIAGES
drpriteshsingh
Author of Surgery Essence,
drpriteshsingh AIIMS Essence, NEET Essence,
drpriteshsingh Director,
Chief Advisor of Editorial Board
/ PGMEE, Jaypee Brothers Medical Publishers
drpriteshsingh Guest Faculty of Surgery,
drpriteshsingh Ningbo University, China;
Stavropol State Medical University, Russia
www.drpriteshsurgeryclasses.com  www.drpriteshinstitute.com
AIIMS Essence
 Acknowledgments
I would like to express my gratitude to the people who have helped and supported me throughout my project.

I wish to thank my parents and family for their undivided support and interest who inspired me and encouraged me to go
my own way, without whom I would be unable to complete my project.

First of all I would like to thank my beloved wife Dr Usica Singh for her constant support and motivation.
She helped me in updating the book from the latest editions of standard textbooks. She helped me throughout this project by
giving her valuable advises and feedbacks regarding improvement of the book.

I am also thankful to the faculty members DREAM TEAM and other faculties of national fame who helped me in solving
difficult and controversial questions through out this project:
• Medicine: Dr Debdatta Majumdar (DM Cardiology), Dr Girish Soni (DM Neurology), Dr Vivek Bhardwaj, Dr
Rajeev Singhal, Dr Rajesh Gubba and Dr Prathap Bingi, Dr Deepak Marwah
• Obs and Gynae: Dr Puneet Bhojani, Dr Amit Gupta, Dr Mona Singh, Dr Jigyasa Singh, Dr Vidhya, Dr Prassan Vij
• Anesthesia: Dr Usica Singh, Dr Saurabh Mittal, Dr Swati
• Radiology: Dr Bipin Daga, Dr Virender Jain, Dr Kundan Patel, Dr Khalil
• Pediatrics: Dr Deepali, Dr Rahul Jain, Dr Jiwan Kinkar, Dr Anita Singh, Dr Meenakshi Bothra
• Ophthalmology: Dr Sudha Seetharam, Dr Shashwat Ray
• Pathology: Dr Parul Gautam, Dr Sushant Soni, Dr Parul Sobti, Dr Tarun Garg, Dr Raghu Ram, Dr Sparsh Gupta
• Pharmacology: Dr Gobind Rai Garg, Dr Ankit Gun, Dr Vikash Dhikav, Dr Ashish Ranjan
• PSM: Dr Rajat Vohra, Dr Vivek Jain
• Microbiology: Dr Rakesh Jha, Dr Shipra Goel, Dr Danish Khan, Dr Neetu Shri, Dr Sonu Panwar
• Forensic Medicine: Dr Sumit Tellwar, Dr Vishwajeet, Dr Magendran
• ENT: Dr Anuragini, Dr Sanjay Aggarwal, Dr Sarvejeet Singh
• Orthopedics: Dr Apurv Mehra, Dr Saurabh Rai, Dr Mukul Mohindra, Dr Himanshu Bhayana
• Anatomy: Dr Bijender, Dr Shrikant, Dr Dushyant, Dr Rajesh Kaushal
• Physiology: Dr Vivek Naglirker, Dr Naveen
• Biochemistry: Dr Namrata Bhutani, Dr Nilesh Chandra, Dr Smily Pahwa
• Skin: Dr Saurabh Jindal, Dr Pallavi Ailawadi, Dr Charu Singh, Dr Isha Narang, Dr Manish Soni
• Psychiatry: Dr Praveen Tripathi, Dr Prashant Aggarwal, Dr Neha Dua, Dr Manoj

I express my sincere thanks to my friends Dr Niket Harsh (MS, Surgery, MAMC) and Dr Saurabh Rai (MS, Orthopedics),
with whom I started this project. They provided me explanations for difficult and controversial questions. These two people
actually suggested me to start this AIIMS project.

I also express my sincere thanks to my friends and colleagues especially Dr Keerti Patel (MD, Gynae, LHMC), Dr Shivangi
Mishra (MD, Anesthesia, AIIMS), Dr Shipra Goel (MD, Microbiology, MAMC).

A special thank of mine goes to Dr Parul Gautam, (MD, Pathology, MAMC), who helped me in completing the project and
exchanged her interesting ideas, thoughts which made this project easy and accurate. Her help for topics related to tumor and
pathology is indispensable.
I am equally grateful to my friend Dr Sushant Bhanja (MD, Pediatrics), who gave me moral support and guided me in dif-
ferent matters regarding the topics related to Pediatrics. He has been very kind and patient, while suggesting me the outlines of
this project and correcting my doubts.
 xii AIIMS Essence

I would also like to thank Mr Varish Sharma and Mr Anurag Sharma of MAMC Bookshop for their encouragement for writ-
ing this book.
I would like to thank Dr Ashish Jakhetiya and Dr Inderjeet Yadav, who helped me a lot in gathering different information,
collecting data and guiding me from time-to-time in completing this project. Despite their busy schedules, they gave me differ-
ent ideas to help make this project unique.
I convey my sincere thanks to my staff members, Mr Sahil Mahajan (Senior Manager), and Mr Rajesh Jha (Business
Development Executive).
Last but not the least I want to thank all my students who appreciated me for my work and motivated me and finally to God
who made all the things possible.
I convey my sincere thanks to Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, for their efforts and suggestions,
especially Shri Jitendar P Vij (Group Chairman), for helping me through my idea.
AIIMS Essence

jppgmee@gmail.com
 Contents
Special AIIMS Pattern Questions xvii-xxxii
PART A
1. AIIMS November 2019 Questions 1-A–24-A
Explanations 25-A–255-A

2. AIIMS May 2019 Questions 257-A–276-A

Explanations 277-A–450-A

3. AIIMS November 2018 Questions 1–16

Explanations 17–183

4. AIIMS May 2018 Questions 193–208

Explanations 209–376

PART B
5. AIIMS November 2017 Questions 377–392
Explanations 393–573

6. AIIMS May 2017 Questions 577–600

Explanations 601–802

7. AIIMS November 2016 Questions 807–830

Explanations 831–1003

8. AIIMS May 2016 Questions 1007–1022

Explanations 1023–1211

9. AIIMS November 2015 Questions 1215–1230

Explanations 1231–1414

10. AIIMS May 2015 Questions 1415–1430

Explanations 1431–1596
 SPECIAL AIIMS PATTERN
QUESTIONS

Multiple Choice Questions

1. Which of the following supply the nasal septum? 5. Which of the following are seen in beta-thalassemia
i. Anterior ethmoidal artery major?
ii. Posterior ethmoidal artery i. Anisocytosis
iii. Sphenopalatine artery ii. Poikilocytosis
iv. Greater palatine artery iii. Codocytes
v. Superior labial artery iv. Dacrocytes
a. i, ii, iii v. Basophilic stippling
b. i, ii, iii, iv vi. Cabot rings
c. i, ii, iii, iv, v vii. Howell-Jolly bodies
d. ii, iii, iv, v
viii. Nuclear fragments
2. Which of the following is cartilaginous joint? a. i, ii, iii, vi, vii, viii
i. Costochondral joint b. i, ii, iii, iv, v, vi
ii. Chondrosternal joint c. i, iv, v, vi, vii, viii
iii. Spheno-occipital joint d. i, ii, iii, iv, v, vi, vii, viii
iv. Radioulnar joint 6. Match the poisonings and the drug of choices:
v. Manubriosternal joint i. Organophosphate A. Atropine
vi. Symphysis pubis ii. Dhatura poisoning B. Flumazenil
vii. Intervertebral joint
iii. Acetaminophen poisoning C. Naloxone
viii. Sternoclavicular joint
a. i, ii, iii, v, vi iv. Benzodiazepine poisoning D. Acetylcysteine
b. i, ii, iii, v, vi, viii v. Opioid poisoning E. Physostigmine
c. i, ii, iii, v, vi, vii
d. i, ii, iii, iv, v, vi, vii, viii vi. carbamate
3. Which of the following increases growth hormone vii. Atropine poisoning
secretion? viii. early mushroom poisoning
i. Hypoglycemia
a. i-A, ii-E, iii-D, iv-B, v-C, vi-A, vii-A, viii-A
ii. Cortisol
b. i-A, ii-E, iii-D, iv-C, v-B, vi-A, vii-E, viii-E
iii. Obesity c. i-A, ii-B, iii-D, iv-C, v-C, vi-A, vii-E, viii-D
iv. Somatostatin d. i-A, ii-E, iii-D, iv-B, v-C, vi-A, vii-E, viii-A
v. Glucagon 7. Match the techniques of sterilization and the
vi. Exercise indications correctly:
vii. Fasting i. Ethylene oxide A. Clinical thermometer
viii. Decreased blood free fatty acids
a. i, v, vi, vii, viii ii. Hot air oven B. Fumigation of OT
b. i, ii, iii, iv, v, vi, iii. Paracetic acid C. Glass syringe
c. i, ii, iii, vi, vii, viii
iv. Isopropyl alcohol D. Heart lung machine
d. i, ii, iii, iv, v, vi, vii, viii
4. What is the correct order of blood sampling? v. Beta propiolactone E. B
 lood & body fluid
1. Verification of patient’s profile spillage
2. Labeling at bedside vi. Sodium hypochlorite F. Flexible endoscopes
3. Sampling a. i-C, ii-D, iii-F, iv-A, v-B, vi-E
4. Identification of patient b. i-D, ii-E, iii-F, iv-A, v-B, vi-C
a. 1, 2, 3, 4 b. 4, 1, 3, 2 c. i-D, ii-C, iii-F, iv-A, v-B, vi-E
c. 4, 3, 1, 2 d. 1, 4, 2, 3 d. i-E, ii-C, iii-F, iv-A, v-B, vi-D
 xviii AIIMS ESSENCE

8. Match the following declarations with: 12. Which of the following statement is correct?
1. Geneva a. Torture Reasoning (R): Blue dye colors the afferent lymphatics
& sentinel lymph node, hence aids in the identification
2. Tokya b. Abortion
Assertion (A): Sentinel LN is the first LN, which
3. Oslo c. Human experimentation
receives lymph directly from tumor
4. Helsinki d. Ethics a. Both R and A are correct and A is correct explanation
a. 1 =a, 2=b, 3=c, 4=d for R
b. 1 =b, 2=c, 3=d, 4=a b. Both R and A are correct but A is not the correct
c. 1 =d, 2=a, 3=b, 4=c explanation for R
d. 1 =c, 2=d, 3=a, 4=b c. R is correct but A is incorrect
d. A is correct but R is incorrect
9. Match the following:
13. Match the following:
1. Cocaine a. Hunan hand
i.
2. LSD b. White lady
3. Abrus c. Purple haze
4. Capsaicin d. Gunchi
a. 1 = a, 2 = b, 3 = c, 4 = d
b. 1 = b, 2 = c, 3 = d, 4 = a
c. 1 = d, 2 = a, 3 = b, 4 = c
d. 1 = c, 2 = d, 3 = a, 4 = b
AIIMS ESSENCE

10. Which of the following statements are true (T) and

which of the following statements are true false (F).
i. Sensitivity: Proportion of persons with the
condition who test positive
ii.
ii. Specificity: Proportion of persons without the
condition who test negative
iii. Positive predictive value: Proportion of persons
with a positive test who have the condition
iv. Negative predictive value: Proportion of persons
with a negative test who do not have the condition
v. Prevalence, sensitivity, and specificity determine
predictive value
vi.  NPV = Prevalence × Sensitivity /(Prevalence ×
Sensitivity) + (1 − Prevalence)(1 − Specificity) iii.
vii. PPV = (1 − Prevalence)(Specificity) /(1 − Preva-
lence)(Specificity) + (1 − Sensitivity)(Prevalence)
a. i-T, ii-T, iii-T, iv-T, v-T, vi-F, vii-F
b. i-T, ii-T, iii-F, iv-T, v-T, vi-T, vii-F
c. i-T, ii-F, iii-T, iv-T, v-T, vi-F, vii-T
iv.
d. i-F, ii-T, iii-T, iv-T, v-T, vi-F, vii-T
11. Which of the following is increased in Sjögren’s
syndrome?
i. Salivary sodium
ii. Salivary chloride A. Deaver’s retractor
B. Babcok’s forceps
iii. Salivary IgA
C. Ovum forceps
iv. Salivary phosphate D. Czerny’s retractor
v. Unstimulated salivary flow rate E. Doyen’ retractor
vi. Stimulated salivary flow rate F. Morris retractor
a. i, ii, iii a. i-C, ii-B, iii-A, iv-D
b. ii, iii, iv,v b. i-C, ii-B, iii-A, iv-E
c. iii, iv, v, vi c. i-C, ii-B, iii-A, iv-F
d. i, ii, iii, iv, v, vi d. i-C, ii-B, iii-F, iv-A
 Special AIIMS Pattern Questions xix

14. Match the following: A. Aneurysmal bone cyst

i. B. Admantinoma
C. Ewing sarcoma
D. Simple bone cyst
E. Multiple myeloma
F. Acute osteomyelitis
G. Osteosarcoma
a. i-C, ii-F, iii-D, iv-B, v-G
b. i-C, ii-F, iii-A, iv-B, v-F
c. i-C, ii-F, iii-A, iv-B, v-G
d. i-C, ii-F, iii-A, iv-E, v-G
15. Match the following:
ii. i

SPECIAL AIIMS PATTERN

iii.

ii

iv. iii

v. iv
 xx AIIMS ESSENCE

A. Congenital diaphragmatic hernia iv.

B. Emphysema
C. Diaphragmatic eventration
D. Pneumothorax
E. Hydropneumothorax
F. Pleural effusion
G. Consolidation
a. i-D, ii-F, iii-A, iv-B
b. i-D, ii-F, iii-A, iv-C
c. i-D, ii-F, iii-A, iv-G
d. i-D, ii-F, iii-A, iv-E
16. Match the following:
i.
A. Normal thyroid scan
B. Hot nodule
C. Cold nodule
D. Toxic multinodular goiter
E. Grave’s disease
F. Autonomous nodule
a. i-B, ii-D, iii-A, iv-E
AIIMS ESSENCE

b. i-B, ii-D, iii-A, iv-C

c. i-B, ii-D, iii-E, iv-F
d. i-B, ii-F, iii-A, iv-D
17. An elderly female had her house destroyed in an
earthquake. Following this, she presented to your
ii. office with complaints of anxiety, sadness, lack of sleep,
anger, palpitations and despair. Consider the following
statements:
a. The lady is suffering from acute stress reaction
b. The defense mechanism involved is projection
c. Drug of choice in this situation is risperidone
d. She needs referral to a psychiatrist for psycho­
therapy
Which of the following statements are true?
a. a & c b. b & d
c. a, b & c d. a & d
18. A 22 years old male comes to your office with
complains of frequenting checking of doors even when
iii. they are locked. He is distressed about this fact. He is
subsequently diagnosed to have obsessive compulsive
disorder. Consider the following statements:
a. Repression and reaction formation are the defense
mechanisms involved
b. SSRIs are the drug of choice
c. Risperidone may be used in SSRI resistant cases to
augment the response
d. Systemic desensitization is the psychotherapy of
choice
Which of the above are correct statements?
a. a & b
 b. b & c
c. b, c & d
 d. a, b, c & d
 Explanations

1. Ans. c. (i, ii, iii, iv, v): (Ref: Gray’s 41/e p563, 40/e p554; Dhingra 7/e p197)
Blood Supply of Nasal Septum
Internal Carotid System External Carotid System
• Anterior & posterior ethmoidal • Sphenopalatine arteryQ (branch of maxillary arteryQ) gives nasopalatine &
arteryQ (Branch of ophthalmic posterior medial nasal branchesQ.
arteryQ) • Septal branch of greater palatine arteryQ (branch of maxillary arteryQ)
• Septal branch of superior labial arteryQ (branch of facial arteryQ).

2. Ans. c. (i, ii, iii, v, vi, vii): (Ref: BDC 7/e Vol-III/p164)
Classification of Joints
Fibrous joints • Suture: Skull
• Syndesmosis: Inferior tibiofibular jointQ
• Gomphosis: Tooth socket
Cartilaginous joints Primary Cartilaginous Joint Secondary Cartilaginous Joint
(Synchondrosis / hyaline cartilage) (Symphysis / fibrocartilaginous)
• Costochondral jointQ • Symphysis pubisQ
• 1st chondrosternal jointQ • Intervertebral jointQ
• Spheno-occipital joint • Manubriosternal jointQ
• Between epiphysis & diaphysis
Synovial joints Plane • Intercarpal & intertarsal joint
• Between articular process of vertebra
Hinge • Elbow, ankleQ & interphalyngealQ joint
Condylar • KneeQ, TM jointQ, atlanto-occipital joint
Pivot (trochoid) • Radioulnar joint & atlantoaxial joint
Ellipsoid • WristQ & MCP jointQ
Saddle (Sellar) • 1st carpometacarpalQ joint
• SternoclavicularQ joint
• Calcaneocuboid joint
Ball & socket (THIS) • Talo-calcaneo-navicular joint
• HipQ joint
• Incudostapedial joint
• ShoulderQ joint

3. Ans. a. (i, v, vi, vii, viii): (Ref: Ganong 25/e p328; Guyton 13/e p945)
Growth Hormone
• GH is most abundant anterior pituitary hormoneQ
• GH-secreting somatotrophs cells constitute upto 50% of total anterior cell populationQ
• GH is released in pulsatile fashionQ
Factors Stimulating GH Secretion Factors Inhibiting GH Secretion
• HypoglycemiaQ • Increased blood glucoseQ
• Decreased blood free fatty acidsQ • Increased blood free fatty acidsQ
• Increased blood amino acids (arginine) • ObesityQ
• Other conditions causing hypoglycemia: Stress, fasting & exerciseQ • SomatostatinQ
• Deep sleep (NREM stage II & IV)Q • Insulin like growth factor-1 (IGF-1)
• GlucagonQ • CortisolQ
• GhrelinQ • β adrenergic agonistsQ
• Hormones: Vasopressin, Androgen, Estrogen, Dopamine agonists, • REM sleepQ
Thyroid hormones, α adrenergic agonistsQ
 xxii AIIMS ESSENCE

Actions of Growth Hormone

Direct Actions of GH Actions of GH via IGF
• Decreased glucose uptake into cellsQ • Increased protein synthesis in chondrocytesQ
• Increased lipolysisQ • Increased linear growthQ (pubertal growth spurt)
• Increased protein synthesisQ • Increased protein synthesis in most organs
• Epiphyseal growthQ • Increased organ size
• GH promotes Na+, K+ & water retention and • AntilipolyticQ
elevates serum levels of inorganic phosphateQ

4. Ans. b. (4, 1, 3, 2): (Ref: Practical Medical Procedures at a Glance By Rachel K. Thomas (2015)/p29)

Correct order of blood sampling: Identification of patient; Verification of patient’s profile; Sampling; Labeling at bedside.
Procedure for drawing blood (WHO)
Step Procedure
1. Assemble equipment, include needle & syringe or vacuum tube, depending on which is to be used.
2. Perform hand hygiene (if using soap & water, dry hands with single-use towels).
3. Identify & prepare the patient.
AIIMS ESSENCE

4. Select the site, preferably at the antecubital area. Warming the arm with a hot pack, or hanging the hand down
may make it easier to see the veins. Palpate the area to locate the anatomic landmarks. Do not touch the site once
alcohol or other antiseptic has been applied.
5. Apply a tourniquet, about 4–5 finger widths above the selected venepuncture site.
6. Ask the patient to form a fist so that the veins are more prominent.
7. Put on well-fitting, non-sterile gloves.
8. Disinfect the site using 70% isopropyl alcohol for 30 seconds & allow to dry completely (30 sec).
9. Anchor the vein by holding the patient’s arm & placing a thumb below the venepuncture site.
10. Enter the vein swiftly at a 30 degree angle.
11. Once sufficient blood has been collected, release the tourniquet before withdrawing the needle.
12. Withdraw the needle gently and then give the patient a clean gauze or dry cotton-wool ball to apply to the site with
gentle pressure.
13. Discard the used needle & syringe or blood-sampling device into a puncture-resistant container.
14. Check the label & forms for accuracy.
15. Discard sharps & broken glass into the sharps container. Place items that can drip blood or body fluids into the
infectious waste.
16. Remove gloves & place them in the general waste. Perform hand hygiene. If using soap & water, dry hands with single-
use towels.

5. Ans. d. (i, ii, iii, iv, v, vi, vii, viii): (Ref: Harrison 19/e p81e-1, 638; Henry’s Clinical Diagnosis and Management by Laboratory
Methods 23/e p588; Robbins 9/e p640)
Pathologic Red Cells in Blood Smears in β-thalassemia major
• AnisocytosisQ • Cabot ringsQ
• PoikilocytosisQ • Howell-Jolly bodiesQ
• Target cells (codocytesQ) • Nuclear fragmentsQ
• Tear drop cells (DacrocytesQ) • SiderocytesQ
• Nucleated RBCsQ • AniosochromiaQ
• Basophilic stipplingQ • Extreme normoblastosisQ
• OvalocytosisQ
 Special AIIMS Pattern Questions xxiii

6. Ans. d. i-A, ii-E, iii-D, iv-B, v-C, vi-A, vii-E, viii-A

Drug of Choice in Poisoning
• Organophosphate, carbamate, early mushroom poisoning • AtropineQ
• Atropine, belladona & dhatura poisoning • PhysostigmineQ
• Acetaminophen poisoning • AcetylcystineQ
• Benzodiazepine poisoning • FlumazenilQ
• Opioid poisoning • NaloxoneQ
• Acute iron poisoning • DesferrioxamineQ
• Chronic iron poisoning • DeferiproneQ
• Cyanide poisoning • Amyl nitrateQ
• Beta-blocker poisoning • GlucagonQ
• TCA (Amitriptyline, clomipramine & imipramine) poisoning • IV sodium bicarbonateQ

7. Ans. c. i-D, ii-C, iii-F, iv-A, v-B, vi-E

Techniques of Sterilization
Steam (121°C for 15 minutes) Surgical instrumentsQ

SPECIAL AIIMS PATTERN

Ethylene oxide Heart lung machineQ, respirators, dental labs
Hot air oven Glass syringeQ, test tubes, flasksQ, cutting instruments
Irradiation (gamma rays) Industrial packagingQ
Paracetic acid (STERIS) Flexible endoscopesQ
Isopropyl alcohol Clinical thermometerQ
Beta propiolactone >Formaldehyde Fumigation of OT, labs, wardsQ
2% Glutaraldehyde Endoscope (cystoscope, bronchoscope)Q
Autoclaving Culture media, suture materials except catgutQ
Sodium hypochlorite Blood & body fluid spillage in the operation theatre

8. Ans. c. (1 =d, 2=a, 3=b, 4=c): (Ref: Reddy 33/e p26, 400, 647; Parikh 6/e p1.26)
1. Geneva Ethics
2. Tokyo Torture
3. Oslo Abortion
4. Helsinki Human experimentation

Declaration of Geneva (1948) Modernized version of Hippocratic oathQ

Declaration of London (1949) International code of medical ethics
Declaration of Helsinki (1964) Human experimentation & clinical trialsQ
Declaration of Sydney (1968) Definition of death & recovery of organs
Declaration of Oslo (1970) Therapeutic (legalized) abortionQ
Declaration of Munich (1973) Discrimination in medicine
Declaration of Tokyo (1975) Torture & medicineQ
Declaration of Lisbon (1981) Rights of patients
Declaration of Venice (1983) Terminal illness
Declaration of Malta (1992) Role of doctors in hunger strikes
Declaration of Istanbul (2008) Organ trafficking & transplant tourism
 xxiv AIIMS ESSENCE

9. Ans. b. (1 = b, 2 = c, 3 = d, 4 = a): (Ref: Reddy 33/e p602, 596, 555; Modern Medical Toxicology By Pillay (2012)/p 285;
APC Essentials of Forensic Medicine and Toxicology/p509, 536)
1. Cocaine White lady
2. LSD Purple haze
3. Abrus Gunchi
4. Capsaicin Human hand

“Cocaine: It is obtained from the leaves of Erythroxylum coca, which grows wild in South America, India, Java, etc. The leaves
contain about 0.5 to 1% cocaine. It is a colourless, odourless, crystalline substance with bitter taste. It contains alkaloids
ecgonine, hygrine, and cinnamyl cocaine. It is used as local anaesthetic. It is also known as coke, snow, Cadillac and
white lady. Crack is prepared by combining cocaine with baking soda and water, which is suitable for smoking.”-Reddy
33/e p602

“LSD Post-hallucinogen Perception Disorder: A persistent perceptual disorder often described by the person as if he
is residing in a bubble under water in a “purple haze” with trailing of lights and images. Associated anxiety, panic and
depression are common.”- Modern Medical Toxicology By Pillay (2012)/p 285

“Abrus precatorius (Ratti, Gunchi, Jequirity, Crab’s eye, Rosary pea) is a slender, perennial climber found all over India
that twins around trees, shrubs and hedges.”-APC Essentials of Forensic Medicine and Toxicology/p509

“Hunan Hand: Intense burning pain, hyperalgesia, erythema and dermatitis, after handling chili (Capsicum annuum)
AIIMS ESSENCE

powder with bare hands. Common in cooks, who prepare food with chilies without using gloves. Hunan hand is so named
because it was common in Hunan province of China. Capsaicin releases Substance P, an undecapeptide from afferent
sensory neurons causing pain. The symptoms are due to nerve receptor stimulation and not local injury to the skin.”-APC
Forensic Medicine and Toxicology/p536

10. Ans. a. i-T, ii-T, iii-T, iv-T, v-T, vi-F, vii-F: (Ref: Park 23/e p125; 22/e p131
Assessment & Value of A Diagnostic Test
Condition Present Condition Absent
Positive Test a (True positive) b (False positive)
Negative Test c (False negative) d (True negative)

Sensitivity Proportion of persons with the condition who test positive: a /(a + c)Q
Specificity Proportion of persons without the condition who test negative: d /(b + d)Q
Positive predictive Proportion of persons with a positive test who have the condition: a /(a + b)Q
value (PPV)
Negative predictive Proportion of persons with a negative test who do not have the condition: d /(c
value (NPV) + d)Q

Predictive Value
• Prevalence, sensitivity, and specificity determine predictive valueQ
• PPV = Prevalence × Sensitivity /(Prevalence × Sensitivity) + (1 − Prevalence)(1 − Specificity)Q
• NPV = (1 − Prevalence)(Specificity) /(1 − Prevalence)(Specificity) + (1 − Sensitivity)(Prevalence)Q

11. Ans. a. (i, ii, iii): (Ref: Harrison 19/e p2166; Oxford Textbook of Rheumatology 4/e p1049; Textbook of Oral & Maxillofacial
Surgery (Elsevier)/402
Salivary Analysis of Patients of Sjögren’s syndrome
Salivary sodium IncreasedQ
Salivary chloride IncreasedQ
Salivary IgA IncreasedQ
Salivary phosphate DecreasedQ
Unstimulated salivary flow rate Decreased (<0.1 mL/min)Q
Stimulated salivary flow rate Decreased (<0.5 mL/min)Q
 Special AIIMS Pattern Questions xxv

12. Ans. a. Both R and A are correct and A is correct explanation for R (Ref: Harrison 20/e p559; Sabiston 20/e p849-851;
Schwartz 10/e p305-306)
Sentinel Lymph Node Biopsy
• Sentinel LN: First LN which receives lymph directly from tumorQ
• Cabana demonstrated the concept of SLN first in carcinoma penisQ
• SLN biopsy in carcinoma penis is known as Cabana procedureQ

• SLN biopsy is usually done in: CA breastQ, CA penisQ & Malignant melanomaQ
• SLN biopsy is also applied successfully in cancers of head & neckQ and vulvaQ

• No special OT is requiredQ
• Indication of SLN biopsy in breast cancer: Clinically non-palpable axillary LNQ

• SLN biopsy is usually done intra-operatively by using isosulphan blue dyeQ (1% lymphazurin) or
radioactive (Tc-99 labelled sulphurQ) colloid. Accuracy of detection of SLN biopsy is best when both of
the methods are combinedQ.
• When radioactive colloid is used, the SLN is detected by gamma-cameraQ
• Blue dye colors the afferent lymphatics & SLN, hence aids in the identificationQ
• Most of the times >1 SLN in carcinoma breastQ

SPECIAL AIIMS PATTERN

Contraindication of SLN Biopsy in CA Breast
Palpable lymphadenopathyQ Prior axillary surgery, chemotherapy or radiotherapyQ Multifocal breast cancerQ

Complications of SLN Biopsy in CA Breast

• Skin tattooing (MC)
Q
• Urine discoloration Intercostobrachial nerve palsyQ (MC
• NecrosisQ • Anaphylaxis injured nerve in SLN biopsy)

13. Ans. c. (i-C, ii-B, iii-A, iv-F)

14. Ans. c. (i-C, ii-F, iii-A, iv-B, v-G):

“X-ray (Giant-cell Tumour): Radiolucent area situated eccentrically at the end of a long bone & bounded by subchondral
bone plate. The centre sometimes has a soap-bubble appearance due to ridging of the surrounding bone. Appearance of a
‘cystic’ lesion in mature bone, extending right up to the subchondral plate, is so characteristic that the diagnosis is
seldom in doubt.”- Apley 9/e p202

“Aneurysmal Bone Cyst: X-rays show a well-defined radiolucent cyst, often trabeculated and eccentrically placed. In a
growing tubular bone it is always situated in the metaphysis and therefore may resemble a simple cyst or one of the other
cyst-like lesions.”- Apley 9/e p201

Aneurysmal Bone Cyst Osteosarcoma

 xxvi AIIMS ESSENCE

“Osteosarcoma: The x-ray appearances are variable: hazy osteolytic areas may alternate with unusually dense
osteoblastic areas. The endosteal margin is poorly defined. Often the cortex is breached and the tumour extends into
the adjacent tissues; when this happens, streaks of new bone appear, radiating outwards from the cortex –the so-called
‘sunburst’ effect. Where the tumour emerges from the cortex, reactive new bone forms at the angles of periosteal elevation
(Codman’s triangle). While both the sunburst appearance and Codman’s triangle are typical of osteosarcoma, they may
occasionally be seen in other rapidly growing tumours.”- Apley 9/e p207

Acute Osteomyelitis Ewing Sarcomas Osteosarcoma

• No abnormality of bone during 1st • Area of bone destruction • Hazy osteolytic areas alternate with
week after the onset of symptoms on predominantly in mid- dense osteoblastic areasQ.
plain x-rayQ diaphysis on X-rays • Endosteal margin is poorly definedQ.
• Displacement of fat planes signifies • New bone formation may • Cortex is breached & tumour
soft-tissue swellingQ extend along shaft & appears extends into adjacent tissues; when
• 2nd week: Faint extra-cortical outline as fusiform layers of bone this happens, streaks of new bone
due to periosteal new bone formation around the lesion (Onion- appear, radiating outwards from
(classic x-ray sign of early pyogenic peel effectQ) cortex (‘sunburst’ effectQ)
osteomyelitis)Q • Tumour extends into • Tumour emerges from cortex,
• Periosteal thickening becomes more surrounding soft tissues, reactive new bone forms at angles
obvious later & patchy rarefaction of with radiating streaks of periosteal elevation (Codman’s
metaphysisQ of ossification (Sunray triangleQ).
• Regional osteoporosis with localized appearanceQ) & reactive • Sunburst appearance & Codman’s
periosteal bone at proximal
AIIMS ESSENCE

segment of apparently increased triangle are typical of osteosarcomaQ

density is important late signQ & distal margins (Codman’s (occasionally seen in other rapidly
trianglesQ) growing tumours)

Interrupted Type of Periosteal Reaction

Osteosarcoma Ewing sarcoma
Sunburst Pattern Codman Triangle Lamellated or Onion skin type
 Special AIIMS Pattern Questions xxvii

Simple Bone Cyst Admantinoma Multiple Myeloma

• Fills the medullary cavity but does • X-ray shows a typical bubble-like • X-rays: The ‘classical’ lesions are
not expand the boneQ defect in the anterior tibial cortex; multiple punched-out defects with ‘soft’
• X-rays: Well-defined radiolucent sometimes there is thickening of the margins (lack of new bone) in the skull,
cyst, often trabeculated & surrounding boneQ. pelvis and proximal femur, a crushed
eccentrically placedQ. vertebra, or a solitary lytic tumour in a
• In a growing tubular bone it is always large-bone metaphysisQ.
situated in the metaphysisQ.

SPECIAL AIIMS PATTERN

15. Ans. d. (i-D, ii-F, iii-A, iv-E):

Congenital Diaphragmatic Hernia Emphysema Diaphragmatic Eventration

• Indistinct diaphragm with • Flattened hemidiaphragm(s): Most • Elevation of affected portion of

opacification of part of or all the reliable signQ the diaphragm is usually seen as a
hemithoraxQ (typically left sidedQ) • Increased & usually irregular smooth hump, while the remainder
radiolucency of lungsQ of the hemidiaphragm contour is
• Increased retrosternal airspace normalQ.
• Widely spaced ribsQ • Frontal X-ray: ‘Double’ diaphrag-
• Tenting of diaphragm Q matic contourQ
• Saber-sheath tracheaQ
 xxviii AIIMS ESSENCE

Condition Chest X-ray Findings

Pneumothorax • Visible visceral pleural edge is seen as a
very thin, sharp white line
• No lung markings are seen peripheral to
this line
• Peripheral space is radiolucent compared
to adjacent lung
• Lung may completely collapse
• Mediastinum should not shift away from
the pneumothorax unless a tension
pneumothorax is present

Hydropneumothorax • An upright chest X-ray will show air fluid

levels.
• Horizontal fluid level is usually well-
defined & extends across the whole
length of hemithorax.
• Supine radiograph: Sharp pleural line is
AIIMS ESSENCE

bordered by increased opacity lateral to it

within the pleural space

Pleural effusion • Blunting of costophrenic angle &

cardiophrenic angle
• Fluid within horizontal or oblique fissures
• A meniscus will be seen, on frontal films
seen laterally & gently sloping medially
• With large volume effusions, mediastinal
shift occurs away from the effusion may
occur towards the effusion)
• Lateral films are able to identify a smaller
amount of fluid, as the costophrenic
angles are deepest posteriorly.

Consolidation Right middle lobe consolidation (RML):

• Opacification of RML abutting the
horizontal fissure
• Indistinct right heart border
• Loss of medial aspect of right hemidia-
phragm
• Air bronchograms
• When the fissures are outwardly convex,
the appearance is referred to as the bulging
fissure sign.
 Special AIIMS Pattern Questions xxix

16. Ans. b. (i-B, ii-D, iii-A, iv-C): (Ref: Grainger & Allison Diagnostic Radiology 5/e p860; Bailey 26/e p746; Essentials of
Nuclear Medicine Imaging by Fred A Milter/p605; Manual of Endocrinology and Metabolism by Norman Lavin 4/e p495)
“Scintigraphy: A single toxic nodule shows high uptake of tracer with the remaining normal thyroid tissue showing poor
or virtually no activity.”-Grainger & Allison Diagnostic Radiology 5/e p860

“Toxic adenoma (hyperfunctioning solitary nodule): Thyroid hormone from an adenoma is secreted independent of TSH
stimulation. The excessive release of thyroid hormone suppresses the pituitary release of TSH, resulting in diminished
activity in the remainder of the gland. On thyroid scan, the toxic adenoma appears as a hot nodule surrounded by little
or no thyroid tissue.”-Manual of Endocrinology and Metabolism by Norman Lavin 4/e p495

Normal Thyroid Scan Hot Nodule Cold Nodule

SPECIAL AIIMS PATTERN

Toxic Multinodular Goiter Grave’s Disease Autonomous Nodule

Ectopic Thyroid Tissue in Euthyroid Ectopic Thyroid Tissue in

Thyroiditis
Patient Hypothyroid Patient
 xxx AIIMS ESSENCE

17. Ans. d. a & d: (Ref: Kaplan & Sadock 11/e p421; Niraj Ahuja 7/e p111)
Acute stress reaction is a normal experience, usually short lasting and resolves in a few days. Denial is the main defense
mechanism. Projection is defense mechanism seen in hallucination and delusion. After acute trauma, psychological
intervention can help improving the outcome. When a clinician is faced with a patient who has experienced a significant
trauma, the major approaches are: support, encouragement to discuss the event, and education about a variety of
coping mechanisms (e.g., relaxation) and requires a psychiatric consultation. Hence, referral to psychiatrist is more
important than anti-psychotics like risperidone, though resperidone may be prescribed if the patient is having significant
psychosomatic symptoms like palpitations and interference with sleep and appetite.
In DSM-IV, diagnosis of Acute Stress Disorder requires marked symptoms of anxiety or increased arousal, re-
experiencing of the event, and three of the following five ‘dissociative’ symptoms;
• A sense of numbing or detachmentQ • Dissociative amnesiaQ
• Reduced awareness of the surroundingsQ • (Avoidance of stimuli that arouse recollections of trauma &
• DerealizationQ significant distress or impaired social functioningQ)
• DepersonalizationQ

Acute Stress Reaction

• It is a psychological condition arising in response to a terrifying or traumatic event, or witnessing a traumatic event
that arises a strong emotional response within the individualQ.
• It may develop into delayed stress reaction or better known as PTSD if stress is not correctly managedQ.
Risk factors:
AIIMS ESSENCE

• Physical exhaustion and in extremes of age, female genderQ.

Symptoms:
• Anxiety, depression, anger, despair, over-activity or withdrawal & constriction of field of consciousnessQ.
• Resolves rapidly on removal of stressful environmentQ
• If the stress continues or cannot be reversed, the resolution of symptoms begins after 1-2 daysQ

• Symptoms last for a minimum of 2 days & maximum of 4 weeks, after which point continued symptoms
may result in a diagnosis of PTSDQ.

Diagnosis:
• There must be a clear temporal connection between the impact of an exceptional stressor (such as death of loved
one, natural catastrophe, accident, rape) & onset of symptoms; onset is usually within a few minutes or days but
may occur up to one month after the stressor.
• Symptoms show a mixed & usually changing picture
• Symptoms usually resolve rapidly in those cases where removal from stressful environment is possible

• Avoidance is the most frequent coping strategy, where the person avoids talking or thinking about the
stressful events & avoids reminders of them. The most frequent defense mechanism is denialQ.

Treatment:
• This disorder may resolve itself with time or may develop into a more severe disorder such as PTSD.
• Removal of patient from stressful environment & helping the patient pass through.
• Medication (benzodiazepines/anti-psychotics) can be used for a short duration.
• Combination of relaxation, cognitive restructuring, imaginal exposure is useful

Post Traumatic Stress Disorder (PTSD)

Intense, prolonged & protracted or delayed response to exceptionally intense stressful eventsQ.
Etiology:
• Events involving actual or threatened serious injury or death of the person or other
• Natural disasters, man made calamities & serious physical assault or rapeQ

Predisposing Factors for PTSD

• Female gender , neuroticism
Q
• Previous history of trauma
• Lower intelligence & lack of supportQ • Personal history of mood & anxiety disorderQ

Contd…
 Special AIIMS Pattern Questions xxxi

Contd…
Neurobiological Factors:
• Monoamine neurotransmitters and HPA axis mediate defensive response to stressful events
• Small hippocampus leads to dysfunctional & inadequate memory processing while increased noradrenergic activity of
amygdala, increases arousal & facilitates automatic recall & encoding of traumatic events.
Clinical Presentation:
• May begin very soon after stressors or after an interval of days (usually), months (occasionally) or rarely >6 months.
• Symptoms must be present for at least 1 month, until then it is called acute stress disorder.
• Must leads to significant distress or impaired social functioning.

• Flash backs, nightmares & intrusive images collectively known, as painful re-experiencing symptoms along with
avoidance, emotional numbing & fairly constant hyper arousal are most characteristic featureQ.

Treatment:
• Structured psychotherapy is more effective than drug treatmentQ.
• Counseling is TOC for short term PTSDQ
• Cognitive behaviour therapy is TOC for severe long standing PTSDQ
• Drug treatment: Antidepressants & benzodiazepines (in low doses for short periods) are useful in treatment, if anxiety
and/or depression are important components of the clinical picture.

SPECIAL AIIMS PATTERN

Rational and Enotive Therapy It is a specialized type of CBT, proved to be useful for PTSD.
Eye movement desensitization and • Relatively new treatment, found to reduce the symptoms of PTSD.
reprocessing (EMDR) • EMDR involves making side- to-side eye movements, usually by
following the movement of therapist’s finger, while recalling the
traumatic incident.

18. Ans. b. b & c (Ref: Kaplan & Sadock 11/e p406; Niraj Ahuja 7/e 95-98)
Frequent checking of door locks is suggestive of OCD. Three major psychological defensive mechanisms that determine
the form and quality of obsessive-compulsive symptoms and character traits: Isolation, undoing, and reaction formation.
Repression is a primary mechanism and is not involved in OCD. Drug of choice for OCD is SSRI (Fluoxetine, fluvoxamine,
paroxetine, sertraline, citalopram). Psychotherapy of choice in OCD is exposure and response prevention rather than
systemic desensitization.
“Behavior Therapy: Although few head-to-head comparisons have been made, behavior therapy is as effective as
pharmacotherapies in OCD, and some data indicate that the beneficial effects are longer lasting with behavior therapy.
Many clinicians, therefore, consider behavior therapy the treatment of choice for OCD. Behavior therapy can be conducted in
both outpatient and inpatient settings. The principal behavioral approaches in OCD are exposure and response prevention.
Desensitization, thought stopping, flooding, implosion therapy, and aversive conditioning have also been used in patients with
OCD. In behavior therapy, patients must be truly committed to improvement.”- Kaplan & Sadock 11/e p406

Obsessive Compulsive Disorder (OCD)

• Characterized by recurrent, intrusive, and distressing thoughts, images or impulses (Obsession) and repetitive
mental or behavioral acts that the individual feels driven to perform (Compulsion) to reduce stress.’
• Defensive mechanisms for OCD: Isolation, undoing & reaction formationQ
Obsessive Compulsive Disorder (OCD)
Obsession Compulsion
• Recurrent & persistent thought intrudes into conscious • Irresistible repetitive behaviour
awareness • Acts are aimed at preventing or reducing distress
• Recognizes as one’s own idea but is Ego-alien (foreign • Failure to resist leads to marked distress
to one’s personality)
• Attempts to ignore or suppress but is unable

Types of OCD
1. Washers (MC) Q
2. Checkers Q
3. Pure obsessionQ 4. Obsession slownessQ

Contd…
 xxxii AIIMS ESSENCE

Contd…

Characteristic features:
• Persons with OCD are stubborn, rigid, over conscious and inflexible about matters or morality & ethics
• Person is preoccupied with rules, details, list, schedules to the extent that major point of activity is lost
• Shows perfection that interferes with task completionQ

Management of OCD
1. Behaviour Therapy (BT):
• Treatment of choice for OCD: Behaviour therapyQ

• Exposure & response prevention is the preferred & principal approach. It is most effective in
compulsionsQ.
• For covert compulsions (behaviour/rituals), imaginal flooding and thought stopping techniques have been used in
conjunction with exposure & response prevention.
• Systemic desensitization, implosion therapy, modeling, thought stopping flooding and aversive conditioning are other
behaviour techniques that can be used in OCD.
2. Pharmacotherapy:
• Drug of choice: SSRI (Fluoxetine, fluvoxamine, paroxetine, sertraline, citalopram)Q
• Best results are achieved when SSRIs are used in combination with behaviour therapyQ.
• Drug of 2nd choice: Clomipramine
AIIMS ESSENCE

3. Psychotherapy:
• Psychoanalytic psychotherapy is used in certain selected patients who are psychologically oriented.
• Supportive psychotherapy must include attention to family members through provision of emotional support,
reassurance, explanation and advice.
4. ECT:
• For extreme cases that are resistant & chronically debilitating, ECT & psychosurgery are considerations.
5. Psychosurgery:
• Used in treatment of OCD that has become intractable, and is not responding to other methods of treatment.
• Procedures: Stereotactic limbic leucotomy (cingulotomy), stereotactic subcaudate tractotomy (capsulotomy)