Previous year question on polio based on neet pg, usmle, plab and fmge or mci screening exams

All of the following statements are true regarding poliovirus except:
A: It is transmitted by feco-oral route
B: Asymptomatic infections are common in children
C: There is only a single serotype which cause infection
D: Live attenuated vaccine produces herd immunity
Correct Ans:C
Explanation
There are three serotypes of poliovirus. They are type 1, 2 and 3. Serotype 1 is
the most common type, it is the most common serotype causing polio epidemic.
Mutated Type 3 is the most common cause of vaccine induced paralysis.
Poliovirus belong to enterovirus group. It is a single stranded RNA virus. It has a
naked protein capsid and a dense central core of RNA. It is spread through feco-
oral route. Infection with poliovirus gives lifelong immunity to the homologous
virus type, but does not confer immunity to other two viral types.
Ref: Oski's Essential Pediatrics By Michael Crocetti, 2nd Edition, Page 322
Sample Previous Year Question on Polio from Pathology based on previous Year
Questions of NEET PG, USMLE,PLAB,FMGE (MCI Screening). Please visit
www.medicoapps.org for more such Quizzes
Which of the following viruses produce disease or sequelae that is/are more
severe if the infection occurs at a very young age?
A: Epstein-Barr virus
B:
Hepatitis B
virus
C: Measles virus
D: Poliovirus
Correct Ans:B
Explanation

Infection with Hepatitis B virus (HBV) at birth or a very young age is associated
with chronic HBV infection and the development of hepatocellular carcinoma later
in life. In fact, infants born to Hepatitis B surface antigen (HBsAg)-positive
mothers are commonly infected, and approximately 90% become chronic
carriers of the virus. Chronic carriers suffer from hepatocellular carcinoma at
an incidence over 200 times higher than a noncarrier.
The current recommendation for infants born of HBsAg-positive mothers is
administration of hepatitis B immunoglobulin (HBIg) in the delivery room, with
the first dose of the hepatitis B vaccine given at the same time or within 1 week.
The second and third dose of the vaccine are then given at 1 and 6 months. With
this protocol, 94% protection is achieved.
The Epstein-Barr virus is the agent of heterophile-positive infectious
mononucleosis. In children, primary EBV infection is often asymptomatic.
The measles virus often causes a more severe disease in adults. Over the age of
20, the incidence of complications, including pneumonia, bacterial superinfection
of the respiratory tract, bronchospasm and hepatitis, is much higher than in
children.
Poliovirus causes asymptomatic or inapparent infections 95% of the time. Frank
paralysis occurs in approximately 0.1% of all poliovirus infections. However, the
probability of paralysis increases with increasing age.
A 9-month-old child is brought to the Health Department to receive the second
dose of oral polio vaccine, 2 weeks after the first vaccination. The child has mild
diarrhea, so the decision is made to defer further immunizations. Bacteriologic
examination of a stool culture is unremarkable; however, a small, single-
stranded, positive RNA virus is isolated from the specimen. The viral isolate was
not inactivated by ether. Which of the following viruses was most likely isolated?
A: Adenovirus
B:
Hepatitis
C

C: Parvovirus B19
D: Poliovirus
Correct Ans:D
Explanation
Poliovirus, which is a single-stranded +RNA virus, is naked (i.e., non-enveloped)
and hence will not be inactivated by lipid solvents such as ether. The live virus
vaccine had colonized the intestinal tract of the infant and was still being shed 2
weeks after the earlier oral dose. This same virus, the vaccine strain, is likely to
be found in sewage, as all vaccinated infants will shed virus for a period of time
after immunization with OPV.
Adenoviruses and parvovirus B19 also may cause diarrheal disease and both are
non-enveloped; however, they both have a DNA genome.
Hepatitis C is an enveloped, single-stranded +RNA virus; its major target organ
is the liver, not the intestinal tract. It is a fragile agent that does not survive well
outside the body and would not be isolated from raw sewage effluent.
Which of the following statement is TRUE about polio?
A: Paralytic polio is most common
B:
Spastic
paralysis
C: Increased muscular activity leads to increased paralysis
D: Polio drop given only in <3 year
Correct Ans:C
Explanation
Most of the Polio infections(95%) are asymptomatic. Paralysis occurs in only
0.01% cases of all poliovirus infections. The risk factors found to precipitate an
attack of paralytic polio in individuals already infected with polio
include, fatigue, trauma, IM injections, operative procedures like tonsillectomy
undertaken especially during epidemics of polio and administration of

immunizing agents. Pulse polio immunization is given to all children less than 5
years of age and not 3 years of age.
Also Know:
 Vaccine-associated poliomyelitis is a remote risk with OPV.
 The hallmark of paralytic poliomyelitis is asymmetric flaccid
paralysis, with no significant sensory loss.
Ref: O.P. Ghai 6th Ed Page 210-212.
Which of the following viruses is capable of replication in enucleated cells?
A: Adenovirus
B: Cytomegalovirus
C: Poliovirus
D: Influenza virus
Correct Ans:C
Explanation
Most RNA viruses (eg, poliovirus) replicate in the cytoplasm and therefore can
replicate in enucleated cells. Poliovirus belongs to the
family Picornaviridae. These viruses are nonenveloped and have an icosahedral
nucleocapsid that contains positive-sense RNA.
The exception to the rule regarding RNA viruses is the family Orthomyxoviridae,
the influenza viruses. Orthomyxoviruses undergo transcription and RNA
replication in the nucleus of the host cell because they need to cannibalize the
capped 5' termini of cellular RNAs for use as primers for viral mRNA
transcription.
For most DNA viruses, transcription and DNA replication occur in the nucleus of
the host cell. The exception to this observation is the family Poxviridae, which
carries out its replication in the cytoplasm. Poxviridae includes variola virus,
vaccinia virus, molluscum contagiosum, and orf virus.

Adenoviruses are non enveloped and have an icosahedral nucleocapsid that
contains a double-stranded linear DNA genome.
Cytomegalovirus is a member of family Herpesviridae. It is an enveloped virus
with an icosahedral nucleocapsid that contains a double-stranded linear DNA
genome.
Ref: Ray C.G., Ryan K.J. (2010). Chapter 12. Enteroviruses. In C.G. Ray, K.J.
Ryan (Eds), Sherris Medical Microbiology, 5e.
A neonate is born in very poor condition, with a severe, generalized encephalitis.
Which of the following viruses is the most likely pathogen in this setting?
A: Eastern equine encephalitis virus
B:
Herpes simplex type
II
C: Herpes zoster-varicella virus
D: Poliomyelitis virus
Correct Ans:B
Explanation
Viral causes of neonatal encephalitis include three members of the herpes family of
viruses: herpes simplex I, herpes simplex II, and cytomegalovirus. All three types
can have devastating effects on the neonate, with extensive CNS damage leading to
mental retardation, seizures, and focal neurologic problems. Acyclovir may be of
some help in modifying these infections, but both treatment and prognosis
remain very problematic.
Eastern equine encephalitis virus and St. Louis encephalitis virus are causes of
epidemic encephalitis but are not the most likely cause of neonatal encephalitis.
Herpes zoster-varicella virus, unlike herpes simplex, is not usually a cause of
neonatal encephalitis.

Poliomyelitis virus is a gastrointestinally transmitted virus that is not usually
encountered in neonates.
Ref: Levinson W. (2012). Part IX. Brief Summaries of Medically Important
Organisms. In W. Levinson (Ed), Review of Medical Microbiology & Immunology,
12e.
An 8 year old boy is taken to a pediatrician because of behavioral changes, mild
intellectual deterioration, and "laziness." Over the next several months the boy
develops increasing clumsiness and periodic, involuntary, jerky movements every
3 to 6 seconds. Visual deterioration is apparent upon visual field testing, and
optic atrophy is evident on funduscopic examination. Cerebrospinal fluid studies
do not show significant pleocytosis, but oligoclonal bands of IgG are present on
CSF electrophoresis. The electroencephalogram shows periodic discharges that
are synchronous with the periods of myoclonus. Computed tomography (CT) of
the head shows low-density white matter lesions and cerebral atrophy. At the age
of 10, the boy dies. Prior infection with which of the following agents was
probably related to the patient's condition?
A: Measles virus
B:
Mumps
virus
C: Papillomavirus
D: Poliovirus
Correct Ans:A
Explanation
The rare disease illustrated is subacute sclerosing panencephalitis (SSPE), which
typically presents as in the question stem. SSPE appears to be due to a
combination of persistent, possibly abnormal measles virus and to autoimmune
damage caused by antibodies directed against the virus. Many patients
developing SSPE have had measles at 2 years of age or younger; there is typically
a six-year interval between measles infection and symptom development. A small
proportion of cases have followed vaccination with live measles virus.
Unfortunately, no effective therapy has been developed, although some

experimental work with drugs such as isoprinosine shows some promise.
Postinfectious encephalomyelitis, rather than SSPE, can follow mumps or
varicella. Latent infection with the varicella virus causes shingles (herpes zoster).
Papillomaviruses are associated with warts. They do not usually infect the
brain. Poliovirus causes gastrointestinal disturbances, viremia, and paralysis.
Ref: Ray C.G., Ryan K.J. (2010). Chapter 10. Mumps Virus, Measles, Rubella,
and Other Childhood Exanthems. In C.G. Ray, K.J. Ryan (Eds), Sherris Medical
Microbiology, 5e.
Which of the following strains of wild poliovirus forms the salk type 1 component
of inactivated polio vaccine?
A:
MEF –
1
B: Mahoney
C: Saukett
D: Leningrad – 3
Correct Ans:B
Explanation
IPV is usually made from Mahoney (salk type I), MEF – 1 (salk type II) and
saukett (salk type III) that are grown in cell culture. The harvested viral
components are inactivated with formaldehyde. Leningrad – 3 is a strain of
mumps virus used for making mumps vaccine.
Ref: Park, Edition 21, Page - 185

Cluster testing technique is useful in which of the following conditions?
A: Sexually Transmitted Diseases
B: Poliomyelitis
C: Measles
D: Smallpox
Correct Ans:A
Explanation
Explanation: Following methods are used for case detection of STD:
• CONTACT TRACING: Contact tracing is the term used for the technique by
which the sexual partners of diagnosed patients are identified, located,
investigated, and treated.
• CLUSTER TESTING: Here the patients are asked name other persons of
either sex who move in the same socio-sexual environment. These persons are
then screened.
Ref: Park’s textbook of Preventive and Social Medicine, 21stedition, Page 313
You are the medical officer of a PHC in Kerala and you confirm the diagnosis of
polio in one of your patients. This can be considered as:
A:
Endemi
c
B: Epidemic
C: Sporadic case
D: Pandemic
Correct Ans:B
Explanation

Here this disease is an unusual occurrence in the community and is clearly in
excess of the expected frequency. So even a single case of polio is an epidemic as
per definition. A sporadic case means the case occurs irregularly, haphazardly
from time to time and generally infrequent.
Ref: Park, Edition 21, Page – 89
Which of the following disease is NOT included under diseases considered as
eradicable by the International Task Force for Disease Eradication?
A: Polio
B: Measles
C: Rubella
D: Malaria
Correct Ans:D
Explanation
Other diseases considered for global eradication include Filariasis,
Dracunculiasis, Taeniasis and Mumps.
Ref: Park, 21st Edition, Page 38.
Which of the following are strategies of polio eradication in India?
A: Sustain high levels of routine immunisation coverage
B:
Monitor OPV coverage at district level and
below
C: Arrange follow up of all cases of AFP at 60 days to check for residual paralysis
D: All the above
Correct Ans:D

Explanation
The strategies for Polio eradication also include:
1) Conduct pulse polio immunisation days every year for 3 – 4 years or until Poliomyelitis is
eradicated.
2) Improve surveillance capable of detecting all cases of AFP due to Polio aetiology.
3) Ensure rapid case investigation, including collection of stool samples for virus isolation.
4) Conduct outbreak control for cases confirmed or suspected to be Poliomyelitis to stop
transmission.
Ref: Park, 17th Edition, Page 158
In 2013, which country is not polio endemic?
A: Afghanistan
B:
Pakista
n
C: Kenya
D: Nigeria
Correct Ans:C
Explanation
Polio (poliomyelitis) mainly affects children under five years of age.
One in 200 infections leads to irreversible paralysis. Among those paralysed, 5% to 10%
die when their breathing muscles become immobilized.
Polio cases have decreased by over 99% since 1988, from an
estimated 350 000 cases then, to 223 reported cases in 2012. The reduction is the result of
the global effort to eradicate the disease.
In 2013, only three countries (Afghanistan, Nigeria and Pakistan) remain polio-endemic,
down from more than 125 in 1988.
As long as a single child remains infected, children in all countries are at risk of contracting
polio. Failure to eradicate polio from these last remaining strongholds could result in as
many as 200 000 new cases every year, within 10 years, all over the world.
Ref: http://www.who.int/mediacentre/factsheets/fs114/en/index.html

If the probability of full recovery following polio is 0.3 and the probability of partial
recovery is 0.4, then the total probability of full or partial recovery following polio is:
A: 0.12
B:
0.
7
C: 1.2
D: 0.1
Correct Ans:B
Explanation
In case of mutually exclusive events, for example total and partial recovery, the total
probability can be calculated by applying the law of addition.
i.e. P (full or partial recovery)= P(full recovery)+ P(partial recovery) = 0.4+0.3=0.7
Ref: Medical biostatistics, 1st edition pg: 191
Vaccine associated paralytic poliomyelitis is suspected if AFP develops within how many
days of receipt of OPV?
A: 30
B:
4
5
C: 60
D: 90
Correct Ans:B
Explanation
Vaccine associated paralytic poliomyelitis: Acute onset flaccid paralysis within 4 to 30 days
of receipt of OPV or within 45 to 75 days of contact with a vaccine recipient and
neurological deficits remaining 60 days after onset or death.
Ref: Park 21st edition, page 105.

A case of acute flaccid paralysis must be observed for how many days for residual
weakness in poliomyelitis?
A: 30 days
B:
42
days
C: 60 days
D: 90 days
Correct Ans:C
Explanation
Poliomyelitis is an acute viral infection caused by a RNA virus which is primarily an
infection of the gastro-intestinal tract affecting the central nervous system. Acute flaccid
paralysis is a common presentation of poliomyelitis where the patient presents with
paralysis of acute onset (less than 4 weeks) and affected limbs are flaccid with decreased
tone and diminished or absent deep tendon reflexes.
Surveillance is done for all cases of AFP, where patients less than 15 years of age are
investigated and should be kept under observation for a minimum of 60 days to check if
there is any residual paralysis.
Ref: Park’s Textbook of Preventive and Social Medicine, 19th Edition, Pages 166-
172; Epidemiology and Demography in Public Health By Japhet Killewo, Kristian
Heggenhougen, Stella R. Quah, Pages 98–99; Recent Advances in Paediatrics, Pages 91–
97; Approach to Practical Pediatrics By Narang, Pages 262–268.
Dharmendra's index and Jopling's classification deals with:
A: TB
B: Leprosy
C: Syphilis
D: Polio
Correct Ans:B
Explanation

Dharmendra’s index is for grading the bacterial index in Leprosy. The Ridley and Jopling
classification is used for the classification of Leprosy.
Ref: Park Textbook of Preventive and Social Medicine, 19th Edition, Page 577; Essentials of
Dermatology, Venereology and Leprosy By Chattopadhyay, Page 159; Dermatology By Otto
Braun-Falco, Page 223
Which is not true about Polio vaccine?
A: Difficult to maintain cold chain
B: Salk vaccine doesn’t cause paralysis
C: Helps in increasing immunity
D: Immunity takes long time to develop
Correct Ans:D
Explanation
There is no long term carrier state for poliovirus in
immunocompetent individuals, polioviruses have no non-
primate reservoir in nature, and survival of the virus in the
environment for an extended period of time appears to be
remote. Therefore, interruption of person to person
transmission of the virus by vaccination is the critical step in
global polio eradication. The injected Salk vaccine confers
IgG-mediated immunity in the bloodstream, which prevents
polio infection from progressing to viremia and protects the
motor neurons, thus eliminating the risk of bulbar polio and
post-polio syndrome.
Which is the best way to prevent the spread of Polio during an epidemic?

A: OPV to all children
B: Isolation of the infected
C: Giving IPV to children
D: None of the above
Correct Ans:A
Explanation
Administration of OPV to all children is the best way to control polio epidemics. Other advantages of
OPV are ease of administration, induction of humoral and intestinal immunity, quick production of
antibodies in large proportion of vaccinees, it is inexpensive and excretion of virus by the vaccinee
which inturn infects others and immunize them.
Under national polio eradication programme, a case of acute flaccid paralysis is confirmed
as polio by surveillance after how many days after the onset of paralysis?
A: 15 days
B:
30
days
C: 60 days
D: 90 days
Correct Ans:C
Explanation
Acute flaccid paralysis is paralysis of acute onset (<4 weeks) duration in a child <15 years
of age. Cases of acute flaccid paralysis are confirmed as polio, if they:
1. Are associated with isolation of wild poliovirus from the stool of the case, or
2. Have residual neurologic sequelae at 60 days after the onset of paralysis, or
3. Died before follow-up could determine whether residual neurologic sequelae was
present at 60 days after onset of paralysis, or
4. If there was epidemiological linkage to a confirmed case
91-96% of polio virus infection causes belongs to:

A: Sub clinical infection
B:
Abortive
polio
C: Non paralytic polio
D: Paralytic polio
Correct Ans:A
Explanation
When an individual susceptible to polio is exposed, one of the following responses may
occur:
INAPPARENT/ SUBCLINICAL INFECTION: This occurs approximately in 91-96 per cent of
poliovirus infections. There are no presenting symptoms. Recognition is only by virus
isolation or rising antibody titres.
ABORTIVE POLIO: Occurs in approximately 4 to 8%. lt causes only a mild or self-limiting
illness due to viraemia. The patient recovers quickly. Recognition is only by virus isolation
or rising antibody titre.
NON-PARALYTIC POLIO: Occurs in approximately 1% of all infections with presenting
features of stiffness and pain in the neck and back. The disease lasts 2 to 10 days. Recovery
is rapid.
PARALYTIC POLIO: Occurs in less than 1 % infections. The virus invades CNS and causes
varying degrees of paralysis.
REMEMBER: India reported its last polio case on January 13, 2011 in West Bengal. In 2009,
it reported 741 polio cases, more than anywhere else in the world. In 2010 only 42 cases
were reported against 1.5 lakh in 1985.
Ref: Park’s textbook of Preventive and Social Medicine, 21stedition, page-185
Which of the following is the correct time for administration of zero dose polio vaccine?
A: Before giving DPT
B: Before the discharge from the hospital after the delivery
C: When child is having diarrhoea
D: When child is having Polio
Correct Ans:B
Explanation
The WHO Programme on Immunization (EPI) and the National Immunization Programme in
India recommend a primary course of 3 doses of OPV at one-month intervals, commencing

the first dose when the infant is 6 weeks old. It is recommended that a dose of OPV (zero-
dose) is required to be given to all children delivered in health institutions before their
discharge from the hospital.
Ref: Textbook of Preventive and Social Medicine by K Park, 19th edition, Page 170.
Which of the following vaccine is associated with Toxic Shock Syndrome?
A: Infected BCG vaccine
B:
Infected DPT
vaccine
C: Infected Polio vaccine
D: Infected Measles vaccine
Correct Ans:D
Explanation
Toxic shock syndrome (TSS) occurs when measles vaccine is contaminated or the same vial
is used for more than one session on the same day or next day. The vaccine should not be
used after 4 hours of opening the vial. TSS is totally preventable and reflects poor quality of
immunization services. Symptoms of TSS are severe watery diarrhoea, vomiting and high
fever within few hours of vaccination. This may cause death within 48 hours. Case fatality
rates are high.
Ref: Park’s Textbook of Preventive and Social Medicine, 19th Edition, Pages 129, 138, 161,
170; Textbook of Pediatrics By K.N Agarwal, Page 177
Regarding polio which of the following statement is TRUE?
A: Most of the cases are asymptomatic
B:
Spastic paralysis is
seen
C: IM injections and increased muscular activity increases the risk of paralytic polio
D: Pulse polio immunization is indicated in all children less than 3 years of age

Correct Ans:A
Explanation
95% of patients with polio infections are asymptomatic. Patients who become ill develop
manifestations such as abortive poliomyelitis, nonparalytic poliomyelitis and paralytic
poliomyelitis.
In patients with spinal poliomyelitis, flaccid paralysis occur over 2-3 days in an asymmetric
distribution and affects the proximal muscles of the lower extremities more frequently.
Paralysis of the shoulder girdle often precedes intercostal and diaphragmatic paralysis,
which leads to diminish chest expansion and decreased vital capacity.
The 4 doses of oral polio vaccine and inactivated parenteral vaccine are given at age 2, 4, 6-
18 and at 4-6 years.
Ref: CURRENT Medical Diagnosis & Treatment 2014 chapter 32.
A newborn has his leg inverted and the dorsum of his foot does not touch the front of tibia.
What is the diagnosis of this condition?
A: Congenital vertical talus
B: Congenital talipes equino varus
C: Cerebral palsy
D: Poliomyelitis
Correct Ans:B
Explanation
Congenital clubfoot (equinovarus foot; talipes equinovarus):
It is characterized by fixed ankle plantar flexion (equinus), inversion and axial internal
rotation of the subtalar (talocalcaneal) joint (varus), and medial subluxation of the
talonavicular and calcaneocuboid joints (adductus).

The typical radiographic findings of incompletely treated clubfoot include the following
features:
 Presence of hind foot plantar flexion;
 Lack of the normal angular relationship between the talus and calcaneus
(so-called parallelism of talus and calcaneus); and
 Residual medial subluxation or displacement of the navicular on the talus
and the cuboid on the calcaneus.
Ref: Rab G.T. (2006). Chapter 11. Pediatric Orthopedic Surgery. In H.B. Skinner (Ed),
CURRENT Diagnosis & Treatment in Orthopedics, 4e.
Vaccine contraindicated in pregnancy is the following:
A: Diphtheria
B: Hepatitis-B
C: MMR
D: Killed polio vaccine
Correct Ans:C
Explanation
Killed virus, toxoid, or recombinant vaccines may be given during pregnancy. Diphtheria
and tetanus toxoid, hepatitis B vaccine series, and killed polio vaccine may be administered
during pregnancy to women at risk.
Live attenuated vaccines (varicella, measles, mumps, polio, and rubella) should be given 3
months before pregnancy or postpartum. Live virus vaccines are contraindicated in
pregnancy secondary to the potential risk of fetal infection.
Secondary prophylaxis with immune globulin is recommended for pregnant women exposed
to measles, hepatitis A, hepatitis B, tetanus, chicken pox, or rabies.

Ref: Bernstein H.B., VanBuren G. (2013). Chapter 6. Normal Pregnancy and Prenatal Care.
In A.H. DeCherney, L. Nathan, N. Laufer, A.S. Roman (Eds), CURRENT Diagnosis &
Treatment: Obstetrics & Gynecology, 11e.
Which of the following vaccine is routinely given in pregnancy?
A:
Influenz
a
B: Oral polio
C: Tetanus
D: Rabies
Correct Ans:C
Explanation
Td vaccine should be given to pregnant women in the second or third trimester if they had
not been vaccinated in the past 10 years. If a pregnant women received Td in the past 10
years Tdap should be given postpartum.
American College of Obstetricians and Gynecologists recommend that influenza vaccine
should be given only to pregnant women with serious underlying diseases such as chronic
diseases or pulmonary problems.
Ref: The Vaccine Handbook: A Practical Guide for Clinicians: the Purple Book By Gary
S. Marshall page 252.
An 18-year-old male presented with acute onset descending paralysis of 3 days duration.
There is also a history of blurring of vision for the same duration. On examination, the
patient has quadriparesis with areflexia. Both the pupils are non-reactive. What is the MOST
probable diagnosis in this patient?
A: Poliomyelitis
B:
Botulis
m

C: Diphtheria
D: Porphyria
Correct Ans:B
Explanation
The presence of acute onset of descending paralysis together with diplopia and non reactive
pupils suggests a diagnosis of Botulism. Botulism is caused by the botulinum toxin
produced by Clostridium botulinum. This toxin cause inhibition of acetylcholine release at
the neuromuscular junction through an enzymatic mechanism.
Patients presents with symmetric cranial nerve palsies followed by symmetric descending
flaccid paralysis that may progress to respiratory arrest and death. Cranial nerve
involvement produces diplopia, dysphonia, dysphagia and dysarthria. It is followed by
flaccid, descending, symmetric paralysis of the voluntary muscles. Pharyngeal collapse
secondary to cranial nerve involvement can compromise the airway. Extraocular muscle
paralysis manifests as blurred vision or diplopia and an inability to accommodate near
vision. patients can have ptosis, facial paralysis, depressed pupillary reflexes with fixed,
dilated pupils.
Ref: Harrison's Principles of Internal Medicine, 18e chapter 141, By Jeremy Sobel; Susan
Maslanka.
A 33 year old male presented with homonymous hemianopia. He also has ataxia and
personality changes. Characteristic inclusions are seen in oligodendrocytes. What is the
MOST probable diagnosis in this patient?
A: Progressive multifocal leukoencephalopathy
B:
Cruetzfeld-Jacob
disease
C: Japanese encephalitis
D: Poliomyelitis
Correct Ans:A
Explanation
Progressive multifocal leukoencephalopathy(PML) is characterized pathologically by
multifocal areas of demyelination of varying size distributed throughout the brain but
sparing the spinal cord and optic nerves.
Characteristic microscopic feature:
1. Oligodendrocytes have enlarged, densely staining nuclei that contain viral inclusions
formed by crystalline arrays of JC virus (JCV) particles.
2. Astrocytes are enlarged and contain hyperchromatic, deformed, and bizarre nuclei and
frequent mitotic figures.

Clinical presentation:
 Visual deficits (45%), typically a homonymous hemianopia
 Mental impairment (38%) (dementia, confusion, personality change)
 Weakness, including hemi- or monoparesis
 Ataxia
Ref: Roos K.L., Tyler K.L. (2012). Chapter 381. Meningitis, Encephalitis, Brain Abscess,
and Empyema. In D.L. Longo, A.S. Fauci, D.L. Kasper, S.L. Hauser, J.L. Jameson, J.
Loscalzo (Eds), Harrison's Principles of Internal Medicine, 18e.
Uhthoff's symptom is seen in:
A: Multiple sclerosis
B:
Poliomyeliti
s
C: Guillain–Barré syndrome
D: Myasthenia gravis
Correct Ans:A
Explanation
Heat sensitivity refers to neurologic symptoms produced by an elevation of the body's core
temperature. Uhthoff's symptom is the unilateral visual blurring that may occur during a
hot shower or with physical exercise. It is also common in Multiple sclerosis. Such heat-
related symptoms probably result from transient conduction block.
Ref: Harrisons principles of internal medicine, 18th edition, Page: 3398.
Tonsillectomy is contraindicated in which of the following condition?
A: Small atrophic tonsils
B: Quinsy

C: Poliomyelitis epidemic
D: Tonsillolith
Correct Ans:C
Explanation
Performing tonsillectomy during poliomyelitis epidemic is an absolute contraindication.
Unimmunised children may develop polio following tonsillectomy. A tonsillectomy may be
performed long after the epidemic has passed and the child is immunised against polio.
Indications for Tonsillectomy:
 Recurrent episodes of acute tonsillitis that is more than four attacks a
year
 Patients with recurrent sore throats and rheumatic fever and when tonsils
cause repeated attacks of otitis media.
 Presence or history of a peritonsillar abscess or of diphtheria carriers.
 Massive tonsillar hypertrophy causing respiratory obstruction in children
 Sleep apnea
 Glossopharyngeal neuralgia
Ref: Textbook Of The Ear, Nose And Throat By De Souza, C. Et Al. page 177-8.
All are complications of ulcerative blepharitis, EXCEPT:
A: Poliosis
B: Madarosis
C: Tylosis
D: Trichiasis
Correct Ans:A
Explanation
Blepharitis is a chronic inflammation of lid margin. Some of the complications of ulcerative
blepharitis are madarosis, trichiasis, ectropion, epiphora, tylosis and milphosis.
 Madarosis is said to occur when eyelashes fall out of place and and are
either replaced or not replaced by few and scattered eyelashes.
 Trichiasis refers to misdirected and distorted cilia rubbing against the
cornea.
 Tylosis refers to hypertrophy of lid margin.
 Milphosis refers to permanent reddening of the lid margin.

Ref: Textbook Of Ophthalmology A 2Nd Ed. By E. Ahmed page 165.
In a post polio case, iliotibial tract contracture is most likely to result in which of the
following?
A: Flexion at the knee
B: Extension at the hip
C: Extension at the hip and knee
D: Flexion at the hip and the knee
Correct Ans:A
Explanation
Iliotibial tract is attached posteriorly and laterally to the axis of the knee joint, its
contracture cause flexion of the knee, external rotation and posterior subluxation of tibia.
Thus iliotibial contracture can cause flexion deformity of the knee, valgus of the knee,
external rotation and posterior subluxation of tibia.
Ref: Textbook of Orthopedics and Trauma By GS Kulkarni, Volume 1, 2nd Edition, Pages
567-8 ; Orthopaedics for The Physical Therapist Assistant By Mark Dutton, Page 520

Previous year question on polio based on neet pg, usmle, plab and fmge or mci screening exams

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Previous year question on polio based on neet pg, usmle, plab and fmge or mci screening exams