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(Oestrogen + Progesterone) (547-Dutta 6th)Pregnancy Failure Rate (H,W,Y) (PEARL - INDEX)**Number of accidental pregnancies x 1200Number of patients in 100 year1200 = Number of months in 100 years* Condome = 14 * IUCD = 2* Diaphragm = 20 LNG- IUS (0.2 H.W.Y)]* Rhythm method = 20-30 = 1-2 H.W.Y* Coitus interruptus = 20 * OCP = * Progesterone alone [0.5-2 H.W.Y
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Cisplati n It is a platinum coordination complex that is hydrolysed intracellularly to produce a highly reactive moiety which causes cross linking ofDNA. Theoured siteis N&;ofguanineresidue. It can also react with -SH groups in proteins and has radiomimetic propey. It is bound to plasma proteins, enters tissues and is slowly excreted unchanged in urine with a tlh about 72 hrs. Negligible amounts enter brain. Cisplatin is very effective in metastatic testicular and ovarian carcinoma. It has found use in many other solid tumours as well. Cisplatin is a highly emetic drug. Antiemetics are routinely administered before infusing it. The most impoant toxicity is renal impairment which is dependent on total dose administered. Renal toxicity can be reduced by maintaining good hydration. Tinnitus, deafness, neuropathy and hyperuricaemia are other problems. Shock like state sometimes occurs during i.v. infusion. ESSENTIALS OF MEDICAL PHARMACOLOGY K.D.TRIPATHI SIXTH EDITION PAGE NO:827,828
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Ans. is 'D' i.e., More common in girls * Autism is more common in boys and among low socio-economic groups.* Onset of symptoms of infantile autism (usual form of autism) is before 2.5 - 3 years. If onset of symptoms is after 3 years, it is referred to as childhood autism.* Presently, the cause of infantile autism seems to be predominantly biological.PresentationA. Marked impairment in social interaction: - There is no social smile or eye contact. These children prefer to play alone with inanimate objects and do not like to mingle with others (do not make friends). There is lack of attachment to parents and absence of separation anxiety.B. Impairment in communication (language as well as non-verbal communication): - Delayed or absence speech, lack of verbal or facial response to sounds or voices, abnormal speech patterns, echolalia, perseveration and prominent reversal (referring to self as 'you' and to others as 'I').C. Stereotyped and restricted repetitive behavior, interests and activities:- Mannerism, Stereotype behavior (head banging, body-spinning, rocking, clapping, watching own hand.D. Other features: - Mental retardation (in 50-75% patient), epilepsy (in 25-35%), Hyperkinesis, inability to concentrate.
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Ans. is a i.e. 1.2 cms Labour is said to active when : Cervix is dilated to at least 3 -- 4 cms.deg Regular uterine contractions are present.deg Rate of dilatation is at least 1.2 cm/hrdeg for nulliparous and 1.5 cm/hrdeg for parous women. The pattern of cervical dilatation during the latent and active phase of normal labour is a sigmoid curve. This curve is called as Friedman curve. Friedman subdivided the active phase into : Acceleration phase -- 3 - 4 cm of cervical dilatation Phase of maximum slope -- 4 - 9 cm Deceleration phase -- 9 - 10 cm Remember : Latent phase is mainly concerned with cervical effacement active chase with cervical dilatation and the second stage with descent of the head. In the nulliparous/ prirni gravida --> rate of cervical dilatation ranges between 1.2-6.8 cms/hr, minimum should be 1.2 cm/hr. In multipara minimum rate of cervical dilatation is 1.5 cms/hr. If dilatation is less than these, then it is called as protracted active phase. Abnormalities of active phase: Protracted active phase (Le. slow rate of cervical dilatation or descent of head). Features Cervical dilatation Descent of head Nulliparous < 1.2 cm/hr < 1 cm/hr Multiparous < 1.5 cm/hr < 2 crn/hr - Arrest of dilatation : Cessation of dilatation for 2 or more hours. - Arrest of descent : Cessation of descent for 1 nr mr)ro hnurs. - Precipitate labour : Nulliparous Dilatation and descent > 5 cm/hrdeg. Multiparous Dilatation and descent > 10 cm/hrdeg.
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The vaginal secretion is acidic due to the presence of lactic acid pH is 4.5 It is secreted by the bacteria in the vagina Ref: Shaw Gynecology 17 e pg 16.
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Ans.d. Phenol isbactericidaiand readily inactivated by organic matter Ref: Ananthanarayan 7/e p30, 31, 32; Jawetz 24/e p6]Phenols are bactericidal, but these are not readily inactivated by organic matter. Effective againstSusceptible to organic matterDisinfectantBacteriaSporesVirusFormaldehyde+++++++++-Glutaraldehyde+++++++++-Chlorine (hypochlorite)++++/-++++++Phenols++(+)-++/-
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Receptors can be classified into rapidly adapting (phasic) receptors and slowly adapting (tonic) receptors.Rapidly adapting receptorsSlowly adapting receptorsCutaneous mechanoreceptors such as:Meissner corpuscles (respond to changes in texture and slow vibrations)Pacinian corpuscles (respond to deep pressure and fast vibration)Cutaneous mechanoreceptors such as:Merkel cells (respond to sustained pressure and touch)Ruffini endings (respond to sustained pressure)ProprioceptorsNociceptors (free nerve endings - respond to thermal, chemical and thermal noxious stimuli)(Refer: Ganong&;s Review of Medical physiology 24th edition, pg no: 158)
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Ans. is 'a' i.e., Follicular Carcinoma "An increased incidence of cancer (usually follicular) has been reported from endemic areas. Dominant or rapidly growing nodules in longstanding goiters should always be subjected to aspiration cytology." - Bailey & LoveAbout Follicular Carcinoma (FTC)o FTC are second most common thyroid malignancies, more common in iodine-deficient areaso More common in women (Female: Male ratio of 3:1)o Mean age of presentation is later than papillary Ca (~ 50 yrs)o Multiple foci are rarely seen and lymph node involvement is much less common than in papillary carcinomao Blood borne metastasis is common with spread to bone, lungs, liver and elsewhere.o In less than 1% of cases, follicular cancers may be hyperfunctioning (warm nodule on scintiscan), leading to symptom of thyrotoxicosis.
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British Standard Classification of Incisor Malocclusion:
Class I: The lower incisor edges occluded on or lie below the cingulum plateau of the upper incisors.
Class II, division 1: The lower incisor edges occluded behind the cingulum plateau of the upper incisors and the upper incisors are normally inclined or proclined.
Class II, division 2: The lower incisor edges occluded behind the cingulum plateau of the upper incisors and the upper incisors are retroclined.
Class III: The lower incisor edges occlude anterior to the cingulum plateau of the upper incisors.
Ref: British Standards Institute. Glossary of Dental Terms (BS 4492). London: BSI; 1983.
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Ans. (b) Olfactory systemRef: Dhingra's ENT 5th ed. / 22* Requirements for balancing:# Vision# Vestibule and cochlea# Proprioception# Cerebellum
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Chylolymphatic cystEnterogenous cystUsually congenital as a result of sequestration of lymphaticsDerived from diveiculum of mesentric border that has become sequestrated The cyst wall is thin, lacks muscular wall, not lined by mucosa Thick wall lined by mucosa Usually solitary,often unilocular with clear lymph or chyleContent is mucinousMost frequently seen in the mesentery of ileum Independent blood supplyCommon blood supply as adjacent bowel Enucleation is enoughResection anastomosis needed(Refer: Schwaz's Principles of Surgery, 9th edition, pg no: 2010)
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* Lesbianism: female homosexuality is known as tribadism or lesbianism. The external genitals may showScratch marks, abrasions or teeth marks. It is a result of interactions of biological, psychologicaldevelopmental and sociologic factors. Lesbianism is not an offence in India.* Sodomy: Aka Greek love - anal intercourse b/w 2 males or b/w males and females. * Buccal coitus: Aka sin of Gomorrah.- Felatio - oral stimulation of penis, Cunnilingus - oral stimulation of vagina.* Nymphomania - Excessive sexual desire. * Among males Among females* Satyriasis Nymphomania * Transvestism : aka eonism. Transvestite is a person whose personality is dominated by the desire to be identified & thought of as a member of opposite sex. It is usually found in males who obtain sexual pleasure by wearing female dress.* Masochism: sexual gratification is obtained or increased by suffering pain usually found in males, but can be found in Females also.
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Patients are at increased risk for developing venous thromboembolism after: Major abdominal surgery Major ohopaedic surgery Has sustained major trauma Has prolonged immobility (>3 days) These patients need some form of prophylaxis. The prophylaxis can be mechanical or pharmacological. Prophylaxis for DVT Mechanical Prophylaxis include : Early ambulation It is the simplest method of prophylaxis It acts by activating the calf pump mechanism Pneumatic compression devices It is the most common method of prophylaxis Pneumatic compresses prevents the stasis by periodically compressing the calves. Pharmacological Prophylaxis include Use of unfractionated heparin - Now being replaced by fractionated low molecular weight heparin Use of fractionated low molecular - Better efficacy than unfractionated heparin weight heparin - No laboratory monitoring is necessary
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(C) Cobble stone # Crohn's disease shows: A characteristic sign of early disease is focal mucosal ulcers resembling canke sores (aphthous ulcers), edema, and loss of the normal mucosal texture.> With the progressive disease, mucosal ulcers coalesce into long, serpentine linear ulcers, which tend to be oriented along the axis of the bowel.> As the intervening mucosa tends to be relatively spared, the mucosa acquires a coarsely texture, cobblestone appearance> Crohn's disease or Regional enteritis is an inflammatory bowel disease involve commonly terrain however it may extend to caecum or into the ascending colon.> Crohn's disease involve the entire thickness of the affected segment of bowel wall i.e. transmural invasion, but distribution of lesions is segmental with normal skip area. Intervening surviving mucosa (Normal mucosa) is swollen and give "cobble stone" appearance.> "Garden hose pipe" appearance is found in ulcerative colitis. "Thumb imprinting" appearance is found in ischaemic colitis.
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Difference between ante-moem and post-moem wounds: Trait Ante-moem wounds Post-moem wounds Edges The edges are swollen, eveed, retracted, and wound gapes. Edges do not gape, but are closely approximated. Haemorrhage Abundant and usually aerial. Slight or more and venous Spuing Signs of spuing of aerial blood on the body, clothing or in its vicinity present. No spuing of the blood Extravasation Staining of the edges of the wound and extravasation in neighbouring subcutaneous and interstitial tissues which cannot be removed by washing. Edges and cellular tissues are not deeply stained. The stain can be removed by washing. Coagulation Firmly coagulated blood in wounds and tissues present. No clotting or soft clott Vital reaction Signs of vital reaction present. No signs of vital reaction Enzyme histochemistry Increased activity of esterases, adenosine triphosphate, aminopeptidases, acid and alkaline phosphatase Diminished or no enzyme activity Ref: The Essentials of Forensic Medicine and Toxicology by Dr. K. S. Narayan Reddy, 27th edition, Page 273.
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Ans. is 'a' Iodine "Amoebic infection is spread by ingestion of food or water contaminated with cysts, since an asymptomatic carrier may excrete upto 15 million cysts/day. Prevention of infection requires adequate sanitation and eradication of cyst carriage. In high risk areas infection can be minimized by avoidance of unpeeled fruits and the use of Bottled water.Because cysts are resistant to readily attainable levels of chlorine, disinfection by iodination (Tetraglycine hyperiodide is recommended)." - Harrison
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Newer classification of antitubercular drugs: Group IOral 1st line drugsIsoniazid (H)Rifampicin (R)Ethambutol (E)Pyrazinamide (Z)Rifabutin (Rfb)Rifapentine (Rpt) Group IIInjectable anti-TB drugs (injectable or parenteral agents)Streptomycin (S)Kanamycin (Km)Amikacin (Am)Capreomycin (Cm) Group IIIFluoroquinolones (FQs)Levofloxacin (Lfx)Moxifloxacin (Mfx)Gatifloxacin (Gfx)Ofloxacin (Ofx) Group IVOral 2nd line drugs Ethionamide (Eto)Prothionamide (Pto)Cycloserine (Cs)Terizidone (Trd)p-Aminosalicylic acid (PAS)p-Aminosalicylate sodium (PAS-Na) Group VDrugs with unclear efficacyBedaquiline (Bdq)Delamanid (Dlm)Linezolid (Lzd)Clofazimine (Cfz)Amoxicillin/clavulanate (Amx/Clv)Imipenem/cilastatin (Ipm/Cln)Meropenem (Mpm)High-dose isoniazid (high-dose H)Thioacetazone (T)Clarithromycin (Clr)
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Expansile Bone Metastasis / Blow Cut bone metastasis are typically seen in Renal Cell Carcinoma Thyroid Cancer Hepatocellular Carcinoma Above radiograph shows an expansive bone metastasis is seen in distal end of femur in case of RCC. Cookie Bite Metastases are characterized by eccentric lytic coical destruction in long tubular bones, typically seen in bronchogenic carcinoma. Prostrate cancer is most common cause for sclerotic bone metastasis. Breast cancer produces mixed lytic and sclerotic lesions.
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Hypertension compromises the integrity of cerebral arterioles by causing the deposition of lipid in, and hyalinization of, the arterial walls, an alteration referred to as lipohyalinosis. Further weakening of the wall leads to the formation of Charcot-Bouchard aneurysms, which are located mainly along the trunk of a vessel rather than at its bifurcation. Although the other choices affect blood vessels, they do not typically cause cerebral microaneurysms.Diagnosis: Hypertensive stroke, cerebral hemorrhage
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VISION 2020: The Right to Sight is the global initiative for the elimination of avoidable blindness, a joint programme of the World Health Organization (WHO) and the International Agency for the Prevention of Blindness (IAPB). ORBIS International is a member of the IAPB. VISION 2020: The Right to Sight was launched in 1999. It sought to promote: "A world in which nobody is needlessly visually impaired, where those with unavoidable vision loss can achieve their full potential."
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The most common supravital stain is performed on reticulocytes using new methylene blue or brilliant cresyl blue. It makes it possible to see the reticulofilamentous pattern of ribosomes characteristically precipitated in these live immature red blood cells.
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Ans. A: Hyperparathyroidism Carpal tunnel syndrome (CTS) is a compressive neuropathy of the median nerve at the wrist. The carpal tunnel is located at the base of the palm and is bounded on 3 sides by carpal bones and anteriorly by the transverse carpal ligament. Inside run the median nerve, flexor tendons, and their synol sheaths. Following may be the factors for CTS: Inflammation of the flexor tendon sheath caused by activities involving repetitive wrist flexion (e.g., assembly packing, computer keyboard work, playing a musical instrument, craftwork) Edema from trauma of any type (e.g., fractures), which can compress the median nerve Compression of the median nerve from pregnancy or oral contraceptive-related edema Strong association between being overweight or obese and the presence of CTS Acromegaly Rheumatoid ahritis Gout/ pseudogout TB Renal failure and hemodialysis Hypothyroidism Amyloidosis Wrist osteoahritis
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Refer Robbins page no 8th edition 1232Ewing sarcoma is a malignant bone tumor characterized by primitive round cells without obvious differentiation. Recently, Ewing sarcoma and primitive neuroectodermal tumor (PNET) have been unified into a single category: the Ewing sarcoma family tumors (ESFT) based on shared clinical, morphologic, biochemical and molecular features (discussed later). Although PNET demonstrates more neu- roectodermal differentiation than Ewing sarcoma
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Prostate
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Human Papilloma Virus (HPV) 16 is the most common cause of invasive squamous cervical cancer (followed by HPV 18). Squamous cell carcinoma is the most common cause of cervical cancer worldwide. Ref: COGDT, 10th Edition, Pages 834, 835; William's Gynaecology, 1st Edition, Page 619; Human Cancer Viruses : Principles of Transformation and Pathogenesis By John nicholas, 2008, Page 4; The Encyclopedia of Sexually Transmitted Diseases By Jennifer Shoquist, Diane Stafford, Page 59.
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Ans. D: All of the above Natural methods of contraception are: Abstinence Refraining from penetrative sex provides 100% protection from pregnancy, and offers effective prevention of transmission of sexually transmitted infections as well. Withdrawal or Coitus interruptus The withdrawal method of family planning is unlike other natural methods in that it is male-controlled. Calendar methods - based on calculations of cycle length In calendar rhythm methods, a woman makes an estimate of the days she is feile based on past menstrual cycle length. This involves setting the days of avoidance of unprotected intercourse. Methods based on symptoms and signs - Ovulation Method, Billings Method, Cervical Mucus Method These methods are based on the changes in cervical secretions due to the effects of circulating levels of estrogen and progesterone - Basal Body Temperature (BBT) Method Due to the actions of progesterone on the hypothalamus, a woman's body temperature rises slightly after she ovulates (0.2 to 0.5 degrees C) and remains elevated until the end of the cycle, until menstruation. Women who use this method must cha their temperature every day, immediately after waking up and before getting out of bed or drinking any liquids. - Sympto-Thermal Method - This method combines several techniques to predict ovulation. It typically includes monitoring and chaing cervical mucus and position and temperature changes on a daily basis and may include other signs of ovulation, such as breast tenderness, back pain, abdominal pain or "heaviness," or light intermenstrual bleeding. Lactational Amenorrhea Method (LAM) Breastfeeding to achieve contraception, called the lactational amenorrhea method, or LAM, is more than 98% effective during the first 6 months following delivery.
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Great deal of attention has been focused recently on the metabolic effects induced by the oral contraceptives It includes the ability to modify carbohydrate metabolism with the resultant elevation of blood glucose and plasma insulin, thereby causing carbohydrate intolerance Reference : Park&;s textbook of preventive and social medicine, 23rd edition, Page no: 502
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Follicular dendritic cells from tonsils can be infected by HIV without the involvement of CD4. REF:ANANTHANARAYAN AND PANIKER'S TEXTBOOK OF MICROBIOLOGY 9TH EDITION PAGE NO:574
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B i.e. Pemphigus folliaceous
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STRYCHNOS NUX VOMICA Strychnine ( kuchila) is a powerful alkaloid obtained from the seeds of strychnos nux vomica. The seeds contain two principal alkaloids; strychnine and brucine. Mech of Action: It competitively blocks ventral horn motor neurone postganglionic receptor sites in the spinal cord and brainstem and prevents the effects of glycine (the presumed inhibitory transmitter). Widespread inhibition in the spinal cord results in &;release&; excitation. The action is paicularly noted in the anterior horn cells. It stimulates the cerebralcoex. GABA, the neurotransmitter for presynaptic inhibitory neurons is not affected. Signs and Symptoms: When crushed seeds are taken, the symptoms are delayed for an hour or more. If the alkaloid is swallowed, the symptoms occur very rapidly, usually within five to fifteen minutes. Bitter taste in the mouth, sense of uneasiness and restlessness, feeling of suffocation and fear, and difficulty in swallowing occur. The convulsions are preceded by such prodromal symptoms as increased acuity of perception, increased rigidity of muscles, and muscular twitchings. Convulsions are produced due to direct action on the reflex centres of spinal cord, and affect all the muscles at a time. These are at first clonic, but eventually become tonic. During the convulsions, the face is cyanosed and has anxious look, eyes are staring, eyeballs prominent and pupils are dilated. Risus sardonicus results from contraction of the jaws and facial muscles in which the corners of the mouth are drawn back. The mouth is covered with froth, frequently bloodstained. The convulsions are most marked in anti-gravity muscles, so that the body typically arches in hyperextension (opisthotonos). In supine position, the body is suppoed by the heels and head. The legs are adducted and extended, the arms are flexed over the chest or rigidly extended, and the hands are tightly clenched. The head is bent backwards, and the whole of the body becomes rigid, often assuming a bow-like form. Sometimes, the spasm of the abdominal muscles may bend the body forward (emprosthotonos), or to the side (pleorosthotonos). Consciousness is not lost and the mind remains clear till death. Ref:- k s narayan reddy; pg num:-612,613, image plate14
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NADPH in extramitochondrial site helps in the production of steroids NADPH Formed mainly by HMP in cytoplasm Used in biosynthesis reactions like synthesis of Steroids, Fatty acids, Cholesterol Destruction of H2O2 in RBCs.
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Crural index is length of tibia/ femur x 100. It is impoant for determination of race. ref :k narayana reddy forensic medicine
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FMA angle is the angle formed by mandibular plane and Frankfort horizontal plane. Normal value is 25 Degree. Increase FMA angle or high angle cases indicate vertical growth pattern white decreased FMA or low angle cases indicate horizontal growth pattern.
FMA 16° to 28 ° - prognosis is good. Approximately 60% malocclusions have FMA between 16° to 28°
FMA from 28 - 35 ° - prognosis is fair. Extraction is necessary in majority of cases.
FMA above 35 ° — prognosis is bad. Extractions frequently complicate problems.
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Folic acid : Folic acid acts as a carrier of one-carbon units. The active form of folic acid (pteroyl glutamate) is tetrahydrofolate. Sources: Leafy Green Vegetables, Legumes, Seeds, Liver, The folates in foods may have up to seven additional glutamate residues linked by -peptide bonds. In addition, all of the one-carbon substituted folates may also be present in foods The extent to which the different forms of folate can be absorbed varies, and folate intakes are calculated as dietary folate equivalents--the sum of g food folates + 1.7 x g of folic acid (used in food enrichment). Prevents NTD in fetus, and Lowers homocysteine. Metabolism: The one-carbon fragment of methylene-tetrahydrofolate is reduced to a methyl group with release of dihydrofolate, which is then reduced back to tetrahydrofolate by dihydrofolate reductase.
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Ans. C: Liyrotoxicosis P-etibial myxedema/ thyroid dermopathy/ localized myxedema, nearly always occurs in patients who have severe Graves' ophthalmopathy. Pretibial myxedema is thought to be caused by the activation of dermal fibroblasts, the basic cell precursors that make up skin cells and by the stimulation of connective tissue cells by TSH receptor antibodies. In PTM, activated fibroblasts tend to produce excess deposits of hyaluronic acid, and it is this imbalance in glycosaminoglycan proteins that leads to dermal changes.
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Decidual casts
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WHO grading of VVM in OPV: (Marker of pofency)
Is based on colour changes in VVM: ONLY INNER SQUARE CHANGES COLOUR, circle always remain blue.
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Ans-Banteroinferior quadrantExplanationa. As.discussed- Ideal site for incision in ASOM is posteroinferior quadrantb. For serious otitis media/Grommet insertion, idea! the site is anterior inferior quadrant (though Dhingra says it can be posterior inferior also) as is proven by the following lines from Scotts brown:c. The site of insertion of the grommetd. "Insertion of the ventilation tube posterosuperiorly is not recommended because of the potential for damaging the ossicular chain. It makes no difference to the extrusion rate as to whether the tube is inserted through a radial or circumferential incision and whether sited anterosuperiorly rather than Antero-inferiorly.e. Placement Antero-inferiorly compared with placement posteroinferiorly lengthens the time a ventilation tube is in situ. To maximize the duration of potential tube function, the preferred insertion site is anteroinferior through a circumferential or radial incision. Ref. Scott Brown
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Ans. d (Leflunomide) (Ref. H - 16th ed. Table 295-14 & p. 1968).# LEFLUNOMIDE metabolized to an active metabolite that acts to inhibit dihydroorotate dehydrogenase, an essential enzyme in the pyrimidine biosynthetic pathway.# Its predominant action is to inhibit the proliferation of T lymphocytes.# It is as effective as methotrexate.# Leflunomide can be given alone or with methotrexate.# The major side effect is the associated increase in liver function enzymes.DMARDs# May slow or reverse joint damage# Indicated for the treatment of RA when an ati-inflammatory therapy insufficient to control patient's symptomatology# DMARDs usually do not show benefit for 6-8 weeks or longer; so, bridging therapy# DMARDs have severe and potentially fatal side effectsHydrochloroquine# Stabilizes lysosomes, chemotaxis# Also an antimalarialOphthalmic abnormalities, dermatologic reactions hematotoxicity, GI reactionsMethotrexate# Inhibits dihydrofolate reductase, immunosuppressant# Also an antineoplasticHemotoxicity, ulcerative stomatitis, renaltoxicity, elevated LFTsSulfasalazine# Metabolized to 5-aminosalicylic acid (5 ASA) and sulfapyridine; parent drug and/or metabolites have anti-inflammatory and/or immunomodulatory properties# Used in inflammatory bowel diseaseRash, GI distress, headache, hematotoxicityGold compounds# Macrophage and lysosomal functionsDermatitis, hematotoxicity, nephrotoxicityAzathioprine# Purine metabolism and nucleic acid synthesis# ImmunosuppressantHematologic, GI disturbance, secondary infection, increased risk of neoplasiaPenicillamine# T-cell activity and rheumatoid factor# Also a chelating agentGI disturbances, proteinuria, bone marrow suppression, neurotoxicityEtanerceptBinds TNFInjection site reactionsLeflunomideInhibits cell proliferation and anti-inflammatoryHepatotoxicity, immunosuppression, GI disturbance, alopecia, rash,teratogenInfliximab# Monoclonal antibody to TNF-a# Also used in inflammatory bowel diseaseInfusion reactions, infections, activation of latent TB Immunomodulatory Agents1Recombinant TNF-receptor-Ig fusion protein (etanercept)# Inhibit TNF-alpha# FDA approved for rheumatoid arthritis, juvenile rheumatoid arthritis, psoriasis2Anti-IL-6 monoclonal antibody# Inhibit IL-6, Tested in phase 1 trial in rheumatoid arthritis3Inferferon-ss# Inhibit IL-1, decrease synovial T cells# In trials for use in rheumatoid arthritis4Interferon-gamma# Induce monocyte/macrophage activation Agents# Effective in treating monocyte/macrophage phagocytic defects in chronic granulomatous disease.5IL-11# Inhibit TNF-a and IL-1 production# In trials for Crohn's colitis6IL-12# Stimulate anti-tumor and anti-viral or bacterial cytotoxic T lymphocyte responses# Trials underway for use in cancer patients# Trials planned in humans to prevent/treat severe infections7Anakinra # Inhibit IL-la and -ss FDA approved for rheumatoid arthritis. Anakinra is a recombinant IL2-1 receptor antagonist that competitively blocks the binding of IL-1ss and IL-la to the IL-1 receptor and thereby inhibits the activity of these two related proinflammatory cytokines.# Anakinra has been shown to improve the signs and symptoms of RA, to decrease disability, and to slow progression of articular damage associated radiographically.8Etanercept# A recombinant fusion protein consisting of two soluble TNF p75 receptor moieties linked to the Fc portion of human IgGl; it binds TNF-alpha molecules and also inhibits lymphotoxin- alpha.# Etanercept is approved for the treatment of rheumatoid arthritis, juvenile chronic arthritis, and psoriatic arthritis and ankylosing spondylitis.# While etanercept is ineffective for treatment of ulcerative colitis, it is being used in many rheumatic syndromes such as scleroderma, Wegener's granulomatosis, giant cell arteritis, and sarcoidosis.9Adalimumab# Adalimumab is a fully humanized antibody (IgGl) used in treatment of rheumatoid arthritis.# A recombinant human anti-TNF monoclonal antibody.# This compound complexes with soluble TNF-a and prevents its interaction with p55 and p75 cell surface receptors.# This results in down-regulation of macrophage and T cell function.# The compound is indicated for the treatment of rheumatoid arthritis and decreases the rate of formation of new erosions.# It is effective both as monotherapy and in combination with methotrexate.# The usual dose is 40 mg every other week, though increased responses may be evident at higher dosages.# Adalimumab is presently being tested in psoriasis, psoriatic arthritis, ankylosing spondylitis, and juvenile chronic arthritis.10Infliximab# A chimeric (25% mouse, 75% human) monoclonal antibody that binds with high affinity to soluble and possibly membrane-bound TNF-a.# Its mechanism of action probably is the same as that of Adalimumab.# Infliximab is effective in rheumatoid arthritis and ulcerative colitis and is being used in other diseases, including psoriasis, psoriatic arthritis, juvenile chronic arthritis, Wegener's granulomatosis, giant cell arteritis, and sarcoidosis.# Infliximab, etanercept, and adalimumab are new biologic agents that bind TNF-a, a proinflammatory cytokine. # Infliximab is currently approved for use in Crohn's disease of the colon and in rheumatoid arthritis.11 Leflunomide# Inhibits T cell proliferation and production of autoantibodies by B cells.# Effects include increases of interleukin-10 receptor mRNA, decreased interleukin-8 receptor type A mRNA, and decreased TNF-a-dependent NF-B activation.# Used in treatment of RA.RITUXIMAB (anti-CD20 antibody)# It is an anti-CD20 antibody that also has clinical activity: CLL, NHL (relapsed or refractory low-grade or follicular B cell non-Hodgkin's lymphoma.) and Ca colon.# Rituximab may be used in treatment of:- B cell chronic lymphoid leukemia,- Follicular lymphoma,- Mantle cell lymphoma,- Cold agglutinin disease,- Idiopathic thrombocytopenic purpura, and- Waldenstrom's macroglobulinemia- Rituximab is also used with methotrexate to treat moderate-to-severe forms of rheumatoid arthritis.
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Pharynx, the upper portion of gut tube, is funnel-shaped fibromuscular tube that extends from the base of the skull to the inferior border of the cricoid cartilage at the level of C6 vertebra.
It continues inferiorly as the esophagus.
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Often a single radiograph of a multirooted tooth made at the normal vertical and horizontal projection does not display all the roots. In these cases, when it is necessary to separate the roots on multirooted teeth, a second projection may be made.
The horizontal angulation is altered,
20 degrees mesially for maxillary premolars.
20 degrees mesially or distally for maxillary molars.
20 degrees distally for an oblique projection of mandibular molar roots.
Ref: ORAL RADIOLOGY Principles and Interpretation,Stuart C. White,Michael J. Pharoah Edition 7 page no 129
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History A detailed history is of paramount impoance. Asceain, if dysphagia is of: (a) Sudden onset: Foreign body or impaction of food on a pre-existing stricture or malignancy, neurological disorders. (b) Progressive: Malignancy. (c) Intermittent: Spasms or spasmodic episodes over an organic lesion. (d) More to liquids: Paralytic lesions. (e) More to solids and progressing even to liquids: Malignancy or stricture. (f) Intolerance to acid food or fruit juices: Ulcerative lesions. Oesophagoscopy(Endoscopic) It gives direct examination of oesophageal mucosa and permits biopsy specimens. Flexible fibreoptic or rigid scopes can be used. Ref : ENT textbook by Dhingra 6th edition Pgno : 347,348
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Palpable purpura is due to Vasculitis.
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Ans. is d, i.e. 16 yearsRef: Williams gynae 3rd/ed, p329This is a controversial questionWilliams gynae 3rd/ed, p329 says"Puberty is considered delayed if no secondary sexual characteristics are noted by age 13 or if menses have not commenced by age 16"As per Medicine uptodate - delayed puberty is if mensturation does not begin by 15 years of ageBut its better to go with Williams Gynae.
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Hairy cell leukemia express CD 19 ,CD2O, CD22 antigen. In addition to Bcell markers they are also positive for CD11,CD25,CD103 Reference : Harsh Mohan textbook of pathology, 7th edition.Pg no.358
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The best test for an ACL injury is Lachman's test
"When the preoperative examination (no anaesthesia) was analysed for patients with isolated ACL injuries, the authors found that 98% of the Lachmann tests, 54% of anterior drawer tests, and 27% of the pivot shift tests were positive. When the examination under anaesthesia was analysed for these isolated injuries, authors found that 100% Lachmann tests, 81% of anterior drawer tests, and 100% of the pivot shift tests were positive". -- Evidence base sports medicine
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Eth-A gene encodes Monoxygenase enzyme that activates both Ethionamide and Thioacetazone. Therefore mutation of Eth-A gene is responsible for resistance in both Ethionamide and Thioacetazone.
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Ans. Non-necrotizing anterior diffuse
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Robbins basic pathology 9th edition page no 34 Endothelial cell contraction leading to ntercellular gaps in postcapillary venules is the most common cause of increased vascular permeability. Endothelial injury occurs rapidly after the binding of histamine, bradykinin, leukotiens, and many other mediators to specific receptors.
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The duodenum develops paly from the foregut and paly from the midgut. The opening of the bile duct into the second pa of the duodenum represents the junction of the foregut and the midgut. Upto the level of the opening, the duodenum is supplied by the superior pancreaticoduodenal aery, and below it by the inferior pancreaticoduodenal aery. Ref : B D Chaurasia's Human Anatomy , seventh edition , volume 2 , pg. no., 288. ( fig . 20. 13 - 289 page ).
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(Ref: KDT 6/e p629) Cimetidine is rarely used now because: It is the leat potent H2 blocker It is a sho acting agent It is a potent inhibitor of microsomal enzymes It can cause gynaecomastia It produces more CNS adverse effects
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Interruption of the schedule with a delay between doses does not interfere with the final immunity achieved. Booster dose is sufficient. Ref: 25th edition, Park's Textbook of Preventive and Social Medicine, Page no. 134
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A i.e. 40 mmHg
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Patient is suffering from type V Glycogen Storage Disease (McArdle Disease).
Treatment:
Avoidance of strenuous exercise.
Glucose or sucrose given before exercise or injection of glucagon can markedly improve tolerance in these patients.
Vitamin B6 supplementation reduces exercise intolerance and muscle cramps.
Note - Specific enzyme replacement therapy (ERT) with recombinant human acid α-glucosidase (Myozyme) is available for treatment of Pompe disease.
Reference- Harper’s illustrated biochemistry. 30th edition page no: 179
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Predictive value of a test signifies the diagnostic power of the test.An attribute of an idea screening test is its repeatability or reliability or reproducibility.Sensitivity has been defined as the ability of the test to identify correctly all those who have the disease, that is truly positive (Hence determines the usefulness of the screening test).Specificity is not as impoant. After screening, we can apply a confirmatory test with high specificity.
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Ans. (b) K+(Ref: Ganong, 25th ed/p.35)At rest, cell membrane is freely permeable for potassium ionThis is the reason behind development of RMP which is due to potassium ion
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Ayre's spatula Used to take cervical smear(Pap smear) It is a wooden spatula with U shaped openings on one side and a flat surface on another. Takes sample from squamocolumnar junction.
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The unique feature of atracurium is inactivation in plasma by spontaneous non-enzymatic degradation (Hofmann elimination) in addition to that by alkaline ester hydrolysis Consequently, its duration of action is not altered in patients with hepatic/renal i9nsufficiency or hyperdynamic circulation - preferred muscle relaxant for such patients as well as for neonates and the elderlyAtracurium is metabolized to laudanosine that is responsible for seizures.(Refer: Morgan and Mikhail's Clinical Anaesthesiology, 5th edition, pg no. 216, 269)
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Fistula test: It induces nystagmus by producing pressure changes in the external canal which are then transmitted to labyrinth Normally the test is negative as the pressure changes in the external canal cannot be transmitted to labyrinth It is positive in the presence of the fistula which is attached to the lateral semicircular canal Ref: Dhingra 7e pg 43, internet sources.
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Ionizing radiation acts by two methods: Direct and IndirectDirect action is radiation directly causing DNA damage; example: neutrons and alpha paiclesIndirect action is radiation causing free radical production which acts on DNA; example: photons and gamma raysReference: Khan Physics of Radiation therapy; 5th edition
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These operations are done for hydrocele .Lord's operation or plication is suitable when the sac is small, thin walled and contains clear fluid. Here tunica is bunched into a 'ruff' at its attachment to the testis by using a series of multiple interrupted chromic catgut sutures to plicate the redundant tunica vaginalis, so as to make the sac to form fibrous tissue. Jaboulay's procedure - Eversion of the sac following paial excision with placement of the testis in a pouch prepared by dissection in the fascial planes of the scrotum.Reference : page 1072 SRB's manual of surgery 5th edition and page 1382 Bailey and Love's sho practice of surgery 25th edition
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Dorsal root ganglion REF: http://en.wikipedia.org/wiki/Pseudounipolar_neuronA Pseudounipolar neuron is a sensory neuron in the peripheral nervous system. This neuron contains an axon that has split into two branches; one branch runs to the periphery and the other to the spinal cord.By definition, a pseudounipolar neuron has one axon with two branches: central and peripheral. These axonal branches should not be confused with dendrites. Pseudounipolar neurons do not have dendrites. Each axon has a peripheral branch (from the cell body to the periphery: skin, joint and muscle) and a central branch (from the cell body to spinal cord)The soma (cell body) of each pseudounipolar neuron is located within a dorsal root ganglion. The axon leaves the cell body (and out of the dorsal root ganglion) into the dorsal root, where it splits into two branches. The central branch goes to the posterior (dorsal) horn of the spinal cord, where it forms synapses with other neurons. The peripheral branch travels through the distal dorsal root into the spinal nerve all the way until skin, joint, and muscle.
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Luminal A breast cancer Seen in elderly females M/c subtype ER/ PR positive Her 2 /Neu negative Low proliferation rate Ki 67 : low Best prognosis among subtypes Responsive to hormonal chemotherapeutic agents like tamoxifen and aromatase inhibitors, Respond poorly to non- hormonal chemotherapy drugs like paclitaxel. Immunohistochemistry staining of a tissue biopsy specimen of luminal type A breast cancer:
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Clinical conditions associated with either an increase in hydrostatic pressure (such as congestive heart failure) or a decrease in oncotic pressure (such as nephrotic syndrome) are associated with transudative pleural effusions. This patient's pleural fluid is exudative by all three of the Light criteria: pleural fluid/serum protein ratio is greater than 0.5, pleural fluid LDH/serum LDH ratio is greater than 0.6, and pleural fluid LDH is greater than two-thirds the upper limits of the normal serum LDH. The most likely explanation for an exudative pleural effusion in the setting of an acute pneumonia is a parapneumonic effusion. Parapneumonic effusions occur in about 40% of patients with bacterial pneumonia. Parapneumonic effusions are exudative due to the fact that there is increased permeability of the visceral pleural membrane capillaries, and interstitial fluid moves across the visceral pleura into the pleural space. Parapneumonic effusions may be simple or complicated. Simple parapneumonic effusions are sterile and free flowing. If bacteria invade the pleural space, neutrophils move into the pleural space and anaerobic metabolism of glucose results in a low pleural fluid pH (<7.20) and glucose (<60). The characteristics of this patient's pleural fluid suggest that bacterial invasion of the pleural space has not occurred, and that this is a simple parapneumonic effusion. Hemorrhage into the pleural space occurs with trauma, cancer, and pulmonary embolism, but rarely with pneumonia.
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Ans. a (Halothane) (Ref. Anaesthesia by Ajay Yadav, 2nd/pg. 60-62)DRUGS CAUSING SENSITIZATION OF HEART WITH ADRENALINE# Cyclopropane# Chloroform# Enflurane# Halothane# Trilene# NO# MethoxyfluraneAlso know:In terms of the extent of hepatic metabolism, the rank order for the inhaled anesthetics is methoxyflurane > halothane > enflurane > sevoflurane > isoflurane > desflurane > nitrous oxide.
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Angiosarcoma: Rare tumour that develops as a complication of long-standing (>10 years) lymphoedema. Stewa and Treves described lymphangiosarcoma of the upper extremity in women with ipsilateral lymphedema after radical mastectomy. (Stewa-Teres syndrome) Clinical Features: Acute worsening of edema. Appearances of sub-cutaneous nodules with propensity towards hemorrhage and ulceration. Treatment: Pre-operative chemotherapy and radiotherapy followed by surgical excision (radical amputation) Associated with poor prognosis. Ref: Sabsiton 20th edition Pgno: 766
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Ans. is 'b' i.e., 10-12 weeks Ref- o Earliest anomaly detected by USG is anencephaly. It can be detected at 10-11 weeks when cranium can be visualized ultrasonographically. Anencephaly is the most severe form of cranial neural tube defect (NTD) and is characterised by an absence of cortical tissue (although the brainstem and cerebellum may be variably present) as well as an absence of the cranial vault. The morphological spectrum within anencephaly ranges from holocrania (most severe form) to merocrania (mildest form) 2. Epidemiology Incidence is around 1:1000. There is a recognised female predilection with a F:M ratio of ~4:1. Clinical presentation In affluent nations, the diagnosis is usually made antenatally. At birth the diagnosis is made due to obvious malformation of the cranial vault. Pathology It results from a failure of closure of the antral end of the neural tube which is expected to occur at approximately day 24 of embryonal life. Associations As with many other malformations, a number of associated abnormalities are recognised: other neural tube defects: spina bifida (especially cervical) congenital heart defects cleft lip/palate diaphragmatic hernia(s) spinal dysraphism skeletal anomalies: e.g. clubfeet gastrointestinal abnormalities: e.g. omphalocele urinary tract abnormalities: hydronephrosis most common Markers maternal serum alpha-fetoprotein (MSAFP) levels are highly elevated (x2.5 MoM (multiples of the median)): of all the neural tube defects, anencephaly usually gives the highest elevation in MSAFP 7 Radiographic features Antenatal ultrasound Anencephaly may be sonographically detectable as early as 11 weeks. Ultrasound can be a non-invasive, cost effective and fast method to detect anencephaly and has an accuracy of approximately 100% at 14 weeks. Sonographic features of anencephaly include: no parenchymal tissue is seen above the orbits and calvarium is absent: parts of the occipital bone and mid brain may be present if a small amount of neural tissue is present, it is then termed exencephaly this may be seen at an earlier stage less than expected value for crown rump length (CRL) a "frog eye" or "mickey mouse" appearance may be seen when seen in the coronal plane due to absent cranial bone/brain and bulging orbits. may show evidence of polyhydramnios: due to impaired swallowing Treatment and prognosis Not surprisingly anencephaly is incompatible with life. Folic acid therapy may reduce the risk of recurrence. There is a slight risk (~2.5%) in recurrence of a neural tube defect in future pregnancies. Differential diagnosis amniotic band syndrome: if the band passes through the head severe microcephaly Anencephaly should not be confused with hydranencephaly in which the cranial vault is present and absence of cerebral tissue is due to antenatal vascular insult.
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Ans. is 'c' i.e., 33
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C. trachomatis is the most common cause of nongonococcal urethritis (NGU) and post gonococcal urethritis (PGU). NGU is diagnosed by documentation of a leukocytic urethral exudate and by exclusion of gonorrhea by Gram's staining or culture. Symptoms include urethral discharge (often whitish and mucoid rather than frankly purulent), dysuria, and urethral itching. Physical examination may reveal meatal erythema and tenderness as well as a urethral exudate. At least one-third of male patients with C. trachomatis urethral infection have no evident signs or symptoms of urethritis. Asymptomatic chlamydial urethritis has been demonstrated in 5-10% of sexually active male adolescents screened at school-based clinics or community centers. Such patients generally have pyuria (15 leukocytes per 400x microscopic field in the sediment of first-void urine), a positive leukocyte esterase test, or an increased number of leukocytes on a Gram-stained smear prepared from a urogenital swab. Ref: Gaydos C.A., Quinn T.C. (2012). Chapter 176. Chlamydial Infections. 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.
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Blood mixes with nitrazine to produce false positive results, as there is increase in ph. It turns the litmus paper to blue suggestive of PROM. TEXTBOOK OF OBSTETRICS, SHEILA BALAKRISHNAN, 2nd EDITION,pg:197
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Presence of both cysts and trophozoites in stools
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Pruritus vulvae
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Nephrogenic diabetes insipidus is characterised by unresponsiveness of renal tubules to ADH. It is caused by genetic defects, metabolic abnormality like hypokalemia, hypercalcemia, drugs like Lithium, Demeclocycline, Methoxyflurane, Amphotericin B, Aminoglycosides, Cisplatin, Rifampin, Foscarnet, vascular, obstruction of ureter or urethra, granulomas, neoplasms etc.. Reference : page 2277 Harrison's Principles of Internal Medicine 19th edition
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Phosphofructokinase is both inducible and subject to allosteric regulation and has a major role in regulating the rate of glycolysis.These reactions, catalyzed by hexokinase (and glucokinase), phosphofructokinase, and pyruvate kinase, are the major sites of regulation of glycolysis.Phosphofructokinase is considered key regulator.Harper 30th edition pg: 172
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DEFENCE MECHANISMS When an individual is faced with problems, difficulties or failures, he employs ceain ways or devices to achieve health, happiness or success. These are called defence mechanisms. Psychologists have identified a number of such defence mechanisms, which include the following 1. Rationalization: Instead of accepting failure and correcting himself, the individual tries to make excuses and justifies his behaviour. It is like the proverbial fox declaring that the grapes were sour, when it could not reach them. This is called rationalization. It is a face-saving device. 2. Projection: Sometimes the individual blames others for his mistakes or failures. It is just like the student saying that he could not score good marks in the examination because, his teacher did.not like him. 3. Compensation: Many people make use of compensation to enhance their self-esteem and prestige. The familiar example is that the student who is not good in his studies may distinguish himself in spos or dramatics, music or other activities. 4. Escape mechanism: Some individuals adopt what is known as an "escape mechanism" to overcome failure or defeat. Some students pretend illness and do not appear for examinations. This is an escape phenomenon. Then there are others who take to alcohol or drugs trying to solve their problems. This is also an escape phenomenon. 5. Displacement: An office clerk badly snubbed by his superior takes it out on his wife and children on reaching home. This is like a rebound phenomenon. It is trying to escape from one situation and fixing blame on another situation. 6. Regression: Some people reso to childhood practices (e.g., weeping when something goes wrong} as a mode of adjustment.
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Cytomegalovirus (CMV) infection is one of the congenital TORCH infections, and it can become widely disseminated to affect the CNS. Periventricular leukomalacia is characteristic of CMV infection. Group B Streptococcus infections cause premature rupture of membranes and sepsis without significant CNS findings. Heart failure in utero causes hydrops fetalis. Herpes simplex virus infection of neonates typically occurs during passage through the infected birth canal, not in utero. HIV infection produces no significant CNS findings in the perinatal period. Listeriosis can produce focal microabscesses in various organs, but usually, there is minimal necrosis.
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Deficiency of Vitamin B12 may occur in exclusive breastfed infants of mother who is on strict vegetarian diet.
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Ans. D. Ischial tuberosity.The pelvic apophyses appear in early adolescence and fuse around age 14-16. Avulsions therefore occur most commonly in teenagers during sporting activities. Football and gymnastics are commonly associated with these injuries. Avulsion of the ischial tuberosity is the commonest type caused by sudden hip flexion with knee extension such as striking a football. The diagnosis is usually apparent on plain radiographs. Avulsion injuries are best treated conservatively with a gradual return to sporting activity after 3 months. Unrecognized avulsions may heal with abundant callus and can be misdiagnosed as bone tumors. The situation can be clarified with CT or MR imaging.
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Ans. is 'd' i.e., Haustral valve Normal fecal continence requires - adequate rectal wall compliance to accommodate the fecal bolus. appropriate neurogenic control of the pelvic floor and sphincter mechanism, and - functional internal and external sphincter muscles At rest the puborectalis muscle creates a 'sling' around the distal rectum, forming a relatively acute angle (Anorectal angle). Anorectal angle distributes intraabdominal forces onto the pelvic floor and play an impoant role in the continence mechanism. At the time of defecation, this angle straightens, allowing the downward force to be applied along the axis of the rectum and anal canal. The internal & external sphincters are tonically active at rest. - the internal sphincter is responsible for most of the resting, involuntary sphincter force - the external sphincter is responsible for voluntary sphincter force. Both the internal and external sphincters are innervated by pudendal nerve. Finally, the hemorrhoidal cushions may contribute to continence by mechanically blocking the anal canal. Thus impaired continence may result from : - poor rectal compliance - injury to internal and/or external sphincter or puborectalis, or - nerve damage or neuropathy
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The medial surface of palatine tonsils is covered by non keratinizing stratified squamous epithelium which dips into the substance of tonsil in the form of crypts. One of these crypts is very large and deep and is called crypta magna or intratonsillar deft.
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Ans. is 'd' i.e., None
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<p>Davidson&;s principles and practice of medicine 22nd edition. Rome III criteria. * abdominal pain or discomfo at least 3 days in last 3 months associated with 2 or more of the following. #improvement with defecation. #change in frequency of stool. #change in appearance of stool. </p>
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Fragile X-syndrome is the most common "hereditary" cause of mental retardation.
Ovarall most common cause : "Down's syndrome".
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ANSWER: (C) Living/Housing conditionsREF: Park 20th edition page 601, First handbook of psychological and social instruments by Udai Pareek, T. Venkateswara Rao page 284Kuppuswami scale is widely used to measure the socio-economic status of an individual in urban community. It is based on three variables namelyEducationOccupationIncomeThe modification of Kuppuswami scale meant to determine the socioeconomic status of family based on education and occupation of head of the family and per capital income per month has also been widely used. Recently, Mishra et al have suggested an economic revision of Kuppuswami s scale in order to account for the devaluation of rupee and is proposed to measure the socioeconomic status of the family and is neither based on the individual nor on the head of the family.
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When splenectomy is performed, we are prone to injure the tail of pancreas, there is a high chance of Acute pancreatitis to occur or a duct maybecut leading to fistula. Sometimes, the blood may be collected below the diaphragm which may lead to sub-diaphragmatic abscess. Since, the spleen is in relation to the left dome of the diaphragm, due to pain post-operatively there is ipsilateral collapse of left lung leading to ATELECTASIS. Generally, after splenectomy, there is a rise in platelet count- if indicated for ITP, the patient is immobilized which increases the risk of DVT & Embolism. Complications of Splenectomy are: - 1. Lung related complications of Splenectomy: ATELECTASIS MC REACTIVE PLEURAL EFFUSION CONSOLIDATION 2. Pancreas related complications: ACUTE PANCREATITIS INJURY TO TAIL OF PANCREAS PANCREATIC FISTULA 3. Diaphragm related complications: SUB-DIAPHRAGMATIC ABCESS 4. Thrombo-embolic complications: STASIS THROMBOCYTOSIS | DVT - |PE 5.OPSI (Overwhelming Post Splenectomy Infection): Caused by capsulated organisms such as S. pneumoniae, N. meningitides, H. influenza
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Ans. is 'a' i.e., S phase o Repeat from previous sessions.
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Ans. Both 2nd and 3rd
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Ans. is 'c' i.e., GnRH analogues Drugs causing osteoporosis : o Glucocoicoids o Cytotoxic drugs o Excessive alcohol intake o Excessive thyroxine o Heparin o Cyclosporine o Anticonvulsants o Aluminum o GnRH agonist o Lithium
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Slime has a little affinity for basic dyes and is not visible in Gram stained smears . Special capsule staining techniques are available usually employing copper salts as mordants . Capsules may be readily demonstrated by negative staining in wet films with India ink , when they are seen as clear halos around the bacteria aganist a black background Methods used for demonstration of Capsule: 1.Indian ink(Negative staining) 2.Serological Methods 3.special capsular staining Ref :Ananthanarayan & paniker's Textbook of microbiology 9th edition pg no 18,C.p.Baveja pg no 17
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Primarily bacteriostatic:Sulfonamides ,Erythromycin Tetracyclines, Ethambutol Chloramphenicol ,Clindamycin Linezolid. Primarily bactericidal Penicillins Cephalosporins Aminoglycosides Vancomycin Polypeptides Nalidixic acid Rifampin Ciprofloxacin Isoniazid Metronidazole Pyrazinamide Cotrimoxazole Many infections in patients with normal host defence respond equally well to bacteriostatic and bactericidal AMAs. But several acute infections resolve faster with a cidal than a static drug, because the cidal drug directly reduces the number of bacteria at the site of infection, while the static drug only prevents increase in their number. Many bactericidal drugs exe prolonged postantibiotic effect so that maintenance of drug level continuously above the MIC is not essential. With bacteriostatic AMAs the bacteria sta multiplying quickly when drug level falls below the MIC, resulting in relapse of infection. A bactericidal antibiotic is clearly superior to bacteriostatic one in treating patients with impaired host defence, life-threatening infections, infections at less accessible sites (SABE) or when carrier state is possible (typhoid) . ESSENTIALS OF MEDICAL PHARMACOLOGY K.D.TRIPATHI SIXTH EDITION PAGE NO:676
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Fever in burn patients Many of the physiological criteria that has been claimed to reflect sepsis are non-infectious manifestations of post injury hypermetabolism Hypehermia (39degC or greater) is occasionally a febrile a response to infection, paicularly in children, but episodic elevation in temperature are common in uninfected burn patients The hypermetabolism phase mediated by greatly increased levels of catecholamines, prostaglandins, glucagon and coisol occurs after the acute phase and also produces pathophysiological changes Burn patients exhibit increased blood flow to organs and tissues, an increased internal core temperature, hypoproteinaemia and edema formation Ref: Sabiston 20th edition Pgno :516
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Methohexital is most commonly used as an anesthetic agent because of its shoer duration of action and lower association with postictal arrhythmias.
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Ans. Subarachnoid hemorrhage due to rupture cerebral aneurysm
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(A) (Enlargement of testes) (943- Davidson 22nd)Clnical features of hepatic cirrhosis* Hepatomegaly (although liver may also be small)* Jaundice* Ascites* Circulatory changes spider telangiectasia, palmar erythema, cyanosis* Endocrine changes; loss of libido, hair lossMen; gynaecomastia, testicular atrophy, impotenceWomen ; breast atrophy, irregular menses, amenorrhoea* Haemorrhagic tendency; bruises, purpura, epistaxis* Portal hypertension; splenomegaly, collateral vessels, variceal bleeding* Hepatic (portosystemic) encephalopathy* Other features; pigmentation, digital clubbing, Dupuytren's contractureCommon precipitants of Hepaic Encephalopathy includeA. Increased nitrogen load as in;B. Electrolyte and Metabolic imbalance such as in1. GI bleeding1. Hypokalemia2. Excessive dietary protein intake2. Alkalosis3. Azotemia3. Hypoxia4. Constipation4. HyponatremiaC. Drugs: CNS depressant agents like narcotics, tranquillizers, sedativesD. Miscellaneous conditions like; infection0, surgeryQ, superimposed acute liver disease0* Anaemia may lead to cellular hypoxia at the level of liver cells and thus ppt, encephalopathyQ* Barbiturates are CNS depressant drugs and their injudicious use, therefore may precipitate hepaticQ encephalopathy,* Hypothyroidism, though not mentioned as a diret precipitating, factor, may contribute towards precipitating encephalopathy by causing constipation' or slowing down the intellectual and motor activity* Cause of vasodilatation in spider nevi is - Estrogen* Most common cause of pyogenic liver abscese is Biliary Tract Infections**HIGH YIELD FACTS1. Octreotide / Somatostatin analogue are agents of choice for medical management of variceal bleed. **2. Desmopressin is the drug of choice for central Diabetes Insipidus (Pituitary DI or Neurohypophyseal DI)
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Menopause - Permanent cessation of mensturation. Clinical diagnosis- Stoppage of menses for 1 year without any other pathology Cessation of menses before the age of 40 is known as premature ovarian failure Investigation- Increase FSH> 40mIU/ml ( 3 values at weekly interval required) LH>20 IU Estradiol <20 pg Vaginal cytology: maturation index : 10/85/5
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Ans. is 'a' i.e., Lactose Lactose (g) Cow's milk 4.4 Human milk 7.4 Proteins (g) 3.2 1.1 Fat (g) 4.1 3.4 Calcium (mg) 120 28 Iron (mg) 0.2 1.0 Water (g) 87 Energy (Kcal) 67 65
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G: Greet the clients (make them comfortable, give attention)
A: Ask/ ascertain needs/ problems or reasons for coming
T: Telling different methods/ options/ choices to solve the problem
H: Help client to make voluntary decisions
E: Explain fully the chosen decision/ action/ method
R: Return for follow-up visit
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The integrity of the mitochondrial outer membrane is regulated by pro-apoptotic and anti-apoptotic members of the BCL2 family of proteins. The pro-apoptotic proteins BAX and BAK are directly promoting mitochondrial permeabilization. Their action is inhibited by the anti-apoptotic proteins BCL2 and BCL-XL. The third set of proteins, the so-called BH3-only proteins, which include BAD, BID, and PUMA, regulate the balance between the pro- and anti-apoptotic members of the BCL2 family.The BH3-only proteins promote apoptosis by neutralizing the actions of anti-apoptotic proteins like BCL2 and BCL-XL. When the sum total of all BH3 proteins expressed "overwhelms" the anti-apoptotic BCL2/ BCLXL protein barrier, BAX and BAK are activated and form pores in the mitochondrial membrane. Cytochrome c leaks into the cytosol, where it binds to APAF-1 and activates caspase-9. Like caspase-8 of the extrinsic pathway, caspase-9 can cleave and activate the executioner caspases. ( Robbins Basic Pathology, 9th edition, page 189 )
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Diffusion capacity for carbon monoxide (DLCO) is usually nirmln in chronic bronchitis and other obstructive lung disease with the exception of empyseemp where it is decreased. Ref Harrison 19th edition pg 1710
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Serum alkaline phosphatase (SAP) It is generally elevated, but is of no diagnostic significance. It has been considered a useful parameter for follow up of a case of osteosarcoma. A rise of SAP after an initial fall after tumour removal is taken as an indicator of recurrence or metastasis. Reference: Maheshwari; Essential Ohopaedics; Page no: 240
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