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Ans. Location on the greater curvature
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psychosis is a type of illness where the patient does not have touch with reality and beleives in fantacy. it is charecterstically mentioned that these patients does not have insight. insight is defined has patient not having any understanding about their illness this lack of touch with reality and accepting the fantacy usually presents as delusions and hallucinations. suspisousness is considered to be at the idea level which even normal people can have and that cannot be considered as a distinguishing feuture for the diagnosis of psychosis Suspiciousness may be seen in delusional/paranoid psychotic disorders as well as a paranoid personality disorder, whereas impaired reality testing is the hallmark of psychotic experience. obsessions and compulsions are pa of neurotic illness and it is not a feuture of psychosis severe depression can present even without psychosis and hence it is not a distinguishing feuture for psychosis Reference: Oxford Textbook of Psychiatry; 3rd edition
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Phallic stage (3-5 yrs)
• Child develops attraction towards opposite sex parent. It is called as Oedipus complex in boys and electra complex in girls.
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(3 x 109) (445 - Lippencott's 3rd) (321-HP27th)The human genome contains DNA with approximately three billion (109) base pairs that encode 30.000 to 40,000 genes located on 23 pairs of chromosomes
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Ans is `d' i.e Orphan Annie eye nuclei Orphan Annie eye nuclei is histological feature seen in Papillary Ca thyroid. "Characteristic histologic features of Hashimoto's thyroiditis include atrophy of thyroid follicles with oncocytic metaplasia (Huhle cell) of the follicular epithelium and abundant lymphoplasmacytic infiltrate with lymphoid follicles including germinal centres. In addition, there may be varying degrees of fibrosis and foci of squamous metaplasia associated within the atrophic follicles."- Endocrine pathology: differential diagnosis and molecular advances By Ricardo V. Lloyd 1/e p160
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No cytological test is available for screening in early phase of disease
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Cimetidine inhibits cytochrome P450 and reduces hepatic blood flow. As a result it inhibits the metabolism of OCP's and enhance their blood levels and increases their effectiveness. Phenytoin and Griseofulvin induces cytochrome P450 enzymes and thereby enhance the metabolism of oral contraceptive pills. Ampicillin suppresses the intestinal flora and decreases enterohepatic circulation of OCP. Ref: Essentials of Medical Pharmacology By K D Tripathi, 5th Edition, Page 590
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Human Development Index (HDI) is defined as "a composite index focusing on three basic dimensions of human development to lead a long and healthy life measured by life expectancy at birth; the ability to acquire knowledge, measured by mean years of schooling and expected years of schooling; and the ability to achieve a decent standard of living, measured by gross national income per capita in PPP US $. Thus the concept of HDI reflects achievements in the most basic human capabilities, viz, leading a long life, being knowledgeable and enjoying a decent standard of living. Hence, these three variables have been chosen to represent those dimensions. The HDI is a more comprehensive measure than per capita income. Income is only a means to human development, not an end. Nor is it a sum total of human lives. Thus by focussing on areas beyond income and treating income as a proxy for a decent standard of living. the HDI provides a more comprehensive picture of human life than income does.
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Fogay catheter is like a ureteric catheter, with a balloon tip and is introduced until it is deemed to have passed the limit of the thrombus.The balloon is inflated and the catheter is withdrawn slowly with the clot.Ref: Bailey and love 27e pg- 955
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RAS opathies:- Group of medical genetic syndrome caused by germ line mutation in genes that encode components or regulator of RAS or MAP kinase pathway: Clinical features:- Distinct Facial features Developmental delays Cardiac defect Growth delays Neurological issues GI difficulties Examples Noonan Syndrome Neurofibromatosis Type I Costello syndrome Cardia- facio cutaneous syndrome. Legius syndrome =Skin desquamation is not seen in RAS Opathies.
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Ans. is 'd' i.e., Convulsionso Infection of mastoid and middle ear may be complicated by the spread of infection within the temporal bone into petrous apex. Petrositis is an extension of infection from middle ear and mastoid to the petrous part of the temporal bone. Gradenigo's syndrome is the classical presentation and consists of a triad of: -External rectus palsy (Vlth nerve/abducent nerve palsy) causing diplopia.Deep seated orbital or retroorbital pain (Vth nerve involvement).Persistent ear discharge due to ipsilateral acute or chronic otitis media.o Associated symptoms of otitis media are also present e.g., conductive deafness. Other symptoms are fever, headache, vomiting, and sometimes neck rigidity. Some patient may get facial paralysis and recurrent vertigo due to involvement of facial and statoacoustic nerves.
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C i.e. Homocystinuria
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B i.e. Buprenorphine Ceiling effect means paicular effect of drug increases with dose of drug, and when the ceiling (roof) is reached fuher incriment in dose not result in increase in effect. Opioid agonist - antagonist compounds produce respiratory depression (& anelgesia) with a ceiling effectQ. which means higher doses do not produce fuher respiratory depression and may actually result in increased ventilation (d/t predominance of antagonist actions)
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Ans. is 'c' i.e., Middle meatus In dacryocystorhinostomy, medial wall of the lacrimal sac is connected to lateral nasal wall at middle meatus
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Indicators of severe pre- eclampsia. ABNORMALITY NON SEVERE SEVERE Diastolic BP <110 mm Hg >= 110 mm Hg Systolic BP <160 mm Hg >= 160 mm Hg Proteinuria none to positive none to positive Headache - + Visual disturbance - + Upper abdominal pain - + Oliguria - + Convulsion (eclampsia) - + Se. creatinine normal elevated Thrombocytopenia - present (<1 lakh/mcL) Se transaminase elevation minimal marked IUGR absent present Pulmonary edema absent present Gestational age late early
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Iodine 131 is a radioisotope with a very short half-life of 8.02 days, making it highly radioactive. Frequently used in small doses in thyroid cancers therapies, it is also one of the most feared fission products when accidentally released into the environment
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Ans. is 'a' i.e., Furosemide o Loop diuretics are called high ceiling diuretics because, progressive increase in dose is matched by increasing diuresis, i.e. they have a high ceiling effect. o Furosamide is a loop diuretics.
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Metaplasia is the reversible replacement of one differentiated cell type with another mature differentiated cell type. The change from one type of cell to another may be pa of a normal maturation process, or caused by some so of abnormal stimulus. In simplistic terms, it is as if the original cells are not robust enough to withstand their environment, so they transform into another cell type better suited to their environment. If the stimulus causing metaplasia is removed or ceases, tissues return to their normal pattern of differentiation. Metaplasia is not synonymous with dysplasia, and is not considered to be an actual cancer. It is also contrasted with heteroplasia, which is the spontaneous abnormal growth of cytologic and histologic elements. Today, metaplastic changes are usually considered to be an early phase of carcinogenesis, specifically for those with a history of cancers or who are known to be susceptible to carcinogenic changes. Metaplastic change is often viewed as a premalignant condition that requires immediate intervention, either surgical or medical, because metaplasia is associated with cancer.
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Ans. is 'a' i.e., Tubal ligation Minilaparoscopy method- Modified Pomeroy method Pomeroy method o Most popular method of tubal ligation o Failure rate is only 0.4% & is mainly due to spontaneous conization. Other methods used for minilaprotomy are: o Madlener operation o Irving method o Aldridge method o Cornual resection o Uchida method o Fimbriectomy.
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Ans. is c i.e. Sheehan's Syndrome Friends, here before arriving to any diagnosis lets first see the causes of : Empty Sella : Congenital incompleteness of the sellar diaphragm. Presentation : Women present with : * Galactorrheadeg Features of hypogonadism : Men present with : * Impotence Loss of libido Infeility. In both sexes they can cause : Cavernous sinus syndrome consisting Raised serum prolactin levels X-Ray sella shows space occupying lesion. Investigations : In all cases of hyperprolactinemia : - MRI should be performed - TSH levels should be measured. Management : Microadenoma with no desire of feility : Asymptomatic patients with microadenomas rarely progress to macroadenomas managed conservatinely. If patient has osteopenia. (due to hypoestrogenemia caused by TProlactin levels) estrogen replacement or OCP's. Monitor patients with regular serial prolactin levels and MRI (every 12 months). 216 * Secondary to Surgery / Radiotherapy or infarction of pituitary tumor. * Secondary to Infarction and Necrosisof pituitary gland. Now from the given causes : either pituitary tumor or Sheehans syndrome can cause an empty sells on x Ray. Pituitary Tumours (Micro / Macro adenoma) cause galactorrhoea (not lactationat failure) with amenorrhea and are so, ruled out. - So, the ObVious answer me by exclusion is Sheehan's Syndrome. Sheehan's syndro: It is the syndrome which results from ischaemic necrosis of most of the Anterior Pituitarydeg due to spasm in its aerioles occurring at the time of severe hemorrhage or shock complicatingchildbih. Only the anterior pituitary is affected because in paurient woman, blood supply to the pituitary gland is modified to the advantage of the posterior lobe and disadvantage of the anterior lobe so, when spasm occurs, posterior lobe is protected. When 75% of Anterior pituitary is destroyed, manifestations of Sheehan's syndrome appear and when 95% is destroyed -- fully developed Simmonds syndrome is seen. Hormones of Anterior Pituitary are affected in order of frequency = GH, FSH and LH, TSH and ACTH. Clinical Features : SymptomsQ Failure of lactation after deliverydeg Secondary amenorrhoeadeg Loss of libidodeg Increased sensitivity to cold (hypothydroidism)deg Signs : Absence of axillary sweatingdeg 1 Loss of axillary and pubic hairdeg Signs of adrenal coical failure Decrease in skin pigmentationdeg I Anemia due to lack of pituitary erythropoeitic factor Weakness, lethargydeg Hypothermiadeg Hypoglycemiadeg (due to decreased insulin tolerance)deg Hypothyroidismdeg All genital organs show atrophy, uterus is smaller than in postmenopausal womendeg as there is decrease in FSH, LH $ estrogen Although dormant ovaries retain their ova till menopausedeg Lab investigation : FSH LH TSH ACTH 1deg Oestrogens J.deg Urinary 17 keto steroids ,1,deg Management : The treatment of Sheehan's syndrome includes : Life long hormone substitute including estrogen,
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Sanger's reagent or di-nitro-fluoro-benzene (DNFB) is used for polypeptide sequencing. Other methods of Polypeptide sequencing: Edman's degradation (Edman's reagent is Phenyl-isothiocyanate) - Determine sequence from N-terminal end and can sequence 30-60 amino acid residues. But it cannot work if N-terminal amino acid is chemically modified. Use of various chemical or enzymes to cleave peptides - method used for large polypeptides Mass spectrometry - 3 pas of mass spectrometer are ionization source, mass analyzer and ion detector.
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Ans. MRI
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String of beads or pile of plates appearance is seen in fibromuscular dysplasia.
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ANSWER: (D) Cricothyroid and internal thyroarytenoid REF: Dhingra 4th ed p. 259 Intrinsic muscles acting on vocal cords: Abductors: Posterior cricoarytenoid Adductors: Lateral cricoarytenoid, Interarytenoid (transverse arytenoid) Thyroarytenoid (external part) Tensors: Cricothyroid, Vo calls (internal part of thyroarytenoid) Intrinsic muscles acting on laryngeal inlet: Openers of laryngeal inlet: Thyroepiglottic (part of thyroarytenoid) Closers of laryngeal inlet: Interarytenoid (oblique part), Aryepiglottic (posterior oblique part of inter arytenoid)
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FSGS is seen in cases of congenital renal anomalies (unilateral renal agenesis or renal dysplasia) and acquited causes like reflex nephropathy.
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Hemolytic uremic syndrome: Caused by deficiencies of complement regulatory proteins or agents that damage endothelial cells, such as a Shiga-like toxin elaborated by E. coli strain O157:H7. The endothelial injury initiates platelet activation, platelet aggregation, and microvascular thrombosis. Ref: ROBBINS BASIC PATHOLOGY 10th ed Pg no: 491
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Ans. b (10-12 mEq/L) (Ref. William's Obstetrics 22nd ed., p 789; Dutta Obstetrics, 6th ed., p 249)MAGNESIUM SULPHATE# Magnesium sulphate is the treatment of choice for the prevention and treatment of eclamptic seizures.# It reduces motor end plate sensitivity to acetylcholine.# It induces cerebral vasodilatation, dilates uterine arteries, increases production of endothelial prostacyclin and inhibits platelet activation.# Magnesium may prevent seizures by interacting with NMDA receptors in the CNS.# The therapeutic level of serum magnesium is 4-7 mEq/L. Eclamptic convulsions are almost always prevented by maintaining plasma magnesium levels between A--7 mEq/L (2.0-3.5 mmol/L).# Repeat injections are given only if:- Knee jerks are present,- Urine output is > 30 mL/hour, and- Respiration rate is > 12/min.# Loss of DTRs serves as the earliest warning sign of impending magnesium toxicity, because a further increase leads to respiratory depression.- Patellar reflex disappears when magnesium level reaches 10 mEq/L (12 mg/dL) - curariform action.- Respiratory depression develops - when magnesium levels go > 10 mEq/L,- respiratory paralysis and arrest follows when levels = 12 mEq/L, .# Rx:- With calcium gluconate 1 g IV and withholding magnesium sulphate reverses mild to moderate respiratory depression.- Usually magnesium sulphate is otherwise discontinued 24 hours after delivery.RegimenLoading doseMaintenance dosePritchard4 g IV over 3-4 min, 10 mg deep IM5 g IM in alternate buttockZuspan4 g IV over 5-10 min1-2 g/hour IV infusionSibai6 g IV over 20 min2 g/hour IV infusionRegimens for the administration of magnesium sulphate for seizure prophylaxis in women in labor with preeclampsia# Intramuscular- 10 g (5 g IM deep in each buttock)- 5 g IM deep q4h, alternating sides# Intravenous- 6-g bolus over 15 min- 1-3 g/h by continuous infusion pump- May be mixed in 100 mL crystalloid; if given by intravenous push, make up as 20% solution; push at maximum rate of 1 g/min- 40-g MgS04.7H,0 in 1000 mL Ringer's lactate; run at 25-75 mL/h (1-3 g/h).
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Ans. is 'b' i.e., Vitamin D deficiency Changes in vitamin D deficiency (Osteomalacia or Rickets)o Serum Ca++-Normal to decreaseo Serum P04-Decreasedo Alkaline phosphatase -Increasedo PTH -N/increase Serum CaSerum phosohorusAlkaline PhosphatasePTHPrimary Hyperparathy roiriismIncreaseDecreaseIncreaseIncreaseSecondary' hyper parathyroidismDecrease or NIncreaseIncreaseIncreaseOsteoporosisNNNNPaget's diseaseNNIncreaseNOsteomalacia (Vitamin D deficiency)DecreaseIncrease/ decreaseIncreaseN/Increase
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This patient has the classic presentation of gastroesophageal reflux disease (GERD) in association with scleroderma. These patients have the deposition of collagen in the body of the esophagus, as well as the lower esophageal sphincter (LES). This results in the typical pattern of decreased esophageal peristalsis and the reduced ability of the LES to maintain its high pressures between swallowing. These patients are therefore at risk for severe GERD and subsequent complications of peptic stricture and Barrett's esophagus. Although there is no corrective therapy to improve esophageal motility or increase LES pressure, aggressive treatment is generally aimed at reducing acid production with the use of high doses of proton pump inhibitors. Nevertheless, many of these patients develop the long-term consequences of GERD. Achalasia, in which impaired esophageal peristalsis is often accompanied by a lack of lower esophageal sphincter relaxation.
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Ans. A. Neural tube defectsa. Indications of Chorionic villus biopsy:i. Karyotyping is the most common indication--Down syndromeii. Hemoglobinopathies --Sickle cell disease, Thalassemia, etc.iii. Biochemical studies--Gaucher's disease, Niemann-Pick disease, Tay-Sachs' disease, etc.iv. Single gene defects--Myotonic dystrophy, Cystic fibrosis, Huntington's disease, Phenylketonuria, etc.b. Neural tube defects are diagnosed by ultrasound and estimation of alpha-fetoprotein in maternal serum/amniotic fluid.c. Chorionic villous biopsy can be done after 10th week (earlier than amniocentesis) i. Earlier results reduce maternal stress by going for a possible therapeutic abortion (if indicated) at an early stage.d. Initially a trans-cervical route is acceptable to take the sample.i. A trans-abdominal route is taken if the pregnancy exceeds 12th week.
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DIC is most likely to be associated with obstetric complications, malignant neoplasms, sepsis, and major trauma. Ref :Robbins pathologic basis of disease ; south east asia edition -9;pg:664
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B i.e. Premature ejaculation Master and Johnson's TechniqueIt is dual sex therapy i.e. patient alone is not treated but both paners are treated together.TypesSensate Focus TechniqueSqueeze or Semen's Technique- For treatment of impotenceQ- For treatment of premature ejaculationQ- The aim is to discover on body (excluding- When male paner feels ejaculatory inevitability,thegenitals) sensate focus (where manipulation leadsfemale paner squeezes the penis on coronal ridge thusto sexual arousal).delaying ejaculation.
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Ans. C: Diabetes Insipidus Many possible conditions and lifestyle factors can lead to hyponatremia, including: Syndrome of inappropriate anti-diuretic hormone (SIADH) - In this condition, high levels of the anti-diuretic hormone (ADH) are produced, causing the body to retain water instead of excreting it in urine. Cirrhosis - Liver disease can cause fluids to accumulate in the body. Kidney problems - Kidney failure and other kidney diseases can render the body unable to efficiently remove excess fluids from the body. Congestive hea failure - This condition causes the abdomen and lower extremities to retain fluids. Diuretics, especially thiazide diuretics- Diuretics work by making the body excrete more sodium in urine. Consuming excessive water during exercise (exeional hyponatremia or exercise-associated hyponatremia (EAH)). Because sodium is lost through sweat, drinking too much water during endurance activities, such as marathons and triathlons, can dilute sodium content in blood. Hormonal changes due to adrenal gland insufficiency (Addison's disease). Adrenal glands produce hormones that help maintain the body's balance of sodium, potassium and water. Hormonal changes due to an under active thyroid (hypothyroidism). Primary polydipsia- In this condition, thirst increases significantly, causing a person to drink excessive amounts of fluid. Some medications, paicularly selective serotonin reuptake inhibitors and some pain medications, cause a person to urinate or perspire more than normal. The recreational drug MDMA- This amphetamine causes a ripple effect on the body's ADH and water levels that-- especially in combination with heavy drinking--increases the risk of severe and even fatal cases of hyponatremia. Chronic, severe vomiting or diarrhea- This causes the body to lose fluids and electrolytes, including sodium. Dehydration- In dehydration, the body loses fluids and electrolytes. Diet- A low-sodium, high-water diet can disturb the proper balance between sodium and fluids in the blood
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SNRI * IMPOANCE Dual antidepressant like TCA but better than TCA has it has no dryness of mouth, hypotension, sedation * MECHANISM Inhibits the reuptake of both serotonin and dopamine * DRUGS VENLEFEXINE DESVENLEFEXINE DULOXETINE * USE Duloxetine===PAIN ASSOSIATED WITH DIABTIC NEUROPATHY and STRESS URINARY INCONTINENCE Milnacipran===Fibromyalgia * SIDE EFFECTS DIASTOLIC HYPEENSION DELAYED ORGASM WITHDRAWL SYNDROME ON DISCONTINUATION, hence should not be abruptly stopped. To try slow tapering Ref. kaplon and sadock, synopsis of psychiatry, 11 th edition, 955
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IPC section 191 defines perjury. "When a person, who is under legal obligation, either under oath or under any provision of law, to state the truth, to declare upon any subject, knowingly makes false statement, the statement which he believes that it is false or he believes that it is not true, commits the offence under this section." IPC Section 193 Punishment for false evidence.--Whoever intentionally gives false evidence in any stage of a judicial proceeding, or fabricates false evidence for the purpose of being used in any stage of a judicial proceeding, shall be punished with imprisonment of either description for a term which may extend to seven years, and shall also be liable to fine, and whoever intentionally gives or fabricates false evidence in any other case, shall be punished with imprisonment of either description for a term which may extend to three years, and shall also be liable to fine. Ref - Krishnan Vij 5th edition pg 11
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Migratory thrombophlebitis (Trousseau's syndrome) is paicularly associated with adenocarcinomas of:- Pancreas Colon Lung Because of associated paraneoplastic syndrome there is hypercoagulability.
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"Diet rich in polyunsaturated essential fatty acids have been reported to reduce the serum cholesterol and low density lipoprotein" - Park
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Ans. is 'a' i.e., TOF Tetralogy of falloto Cyanotic heart disease (MC).o Defect in infundibular septum leads to :Pulmonary stenosis.VSD (Not ASD)Dextroposition and overriding of aorta.Right ventricular hypertrophy (NOT LVH).o Pink TOF (Acyanotic TOF) when PS is mild to moderate balanced shunt tnt across the VSD, pt not have cyanosis.
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Sphingomyelins are the only sphingolipid that contains phosphate and have no sugar moiety. They are found in large quantities in the nervous system. Different sphingomyelins may be formed depending on the fatty acid attached. Common fatty acids found are--lignoceric (24 C), nervonic (24 C, one double bond) and cervonic (22 C, 6 double bonds) acids. Because of its amphipathic nature, sphingomyelin can act as an emulsifying agent and detergent. The relative propoion of lecithin and sphingomyelin is impoant in biological fluids like bile, amniotic fluid, etc. Sphingomyelin combined with fatty acid is called ceramide, which is a component of glycosphingolipids.Ref: DM Vasudevan - Textbook of Biochemistry, 8th edition, page no: 81
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Ans. is 'c' ie. Ureteral calculus The patient's clinical picture is typical of ureteric calculus.Colicky renal pain associated with hematuria is suggestive of ureteric stone although a clot from a bleeding renal tumor can cause the same type of pain.A ureteric calculus pain is almost invariably associated with hematuria.Leukocytes in urine can be seen with urolithiasis.
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In De-quervain's tenosynovitis, anterolateral boundaries of Anatomical snuff box are affected Abductor pollicis longus & extensor pollicis brevis are affected. Finkelstein test It is a provocative test used in diagnostic for De Quervain's tenosynovitis. Makes a fist with the thumb inside. Now ask the patient to bend the wrist toward little finger (ulnar detion) if ulnar detion is painful- Finkelstein's test is positive
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- NI-KSHAY-(Ni=End, Kshay =TB) is the web enabled patient management system for TB control under the Revised National Tuberculosis Programme (RNTCP). It is developed and maintained by the Central TB Division (CTD), Ministry of Health and Family Welfare, Government of India, in collaboration with the National Informatics Centre (NIC), and the World Health Organization Country office for India. Nikshay is used by health functionaries at various levels across the country both in the public and private sector, to register cases under their care, order various types of tests from Labs across the country, record treatment details, monitor treatment adherence and to transfer cases between care providers. It also functions as the National TB Surveillance System and enables repoing of various surveillance data to the Government of India.
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Respiratory insufficiency after upper respiratory tract infection is the classic presentation of bronchiolitis.
Treatment of Bronchiolitis -
Treatment is essentially symptomatic.
The child should be nursed in a humid atmosphere.
O2 remains the mainstay of treatment.
Antibiotics - Though antibiotics have no role* but Ribavirin can sometimes be used.
If fever is present antipyretics can be used.
Continuous positive airway pressure.
β2 adrenergic drugs and Ipratropium bromide are also not recommended for infants < 6 months.
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TEE - Transesophageal echocardiography Transesophageal echocardiography(TEE) is a test that produces pictures of your hea.TEEuses high-frequency sound waves (ultrasound) to make detailed pictures of your hea and the aeries that lead to and from it. For Air embolism diagnosis most sensitive monitor isTransesophageal echocardiography, then Doppler ultrasonography and then capnography, ECG, spo2
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Blaschkos lines are linear patterns of migration of keratiniocytes and other nevi cells. theydo not correspond to vascular lymphatic or neural distribution or langers lines. Lesions that follow lines of blaschko incontinentia pigmenti mc cune Albright syndrome child syndrome nevus sebaceous epidermal nevus linear verucous epidermal nevus nevus depigmentosus darriers disease lichen sriatus linear psoriasis segmental vitiligo linear morphea iadvl text book of dermatology, page 174.
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Chronic alcoholic with recurrent and long standing pain abdnomen might have dystrophic calcification over the residual pancreatic tissue. The following image shows calcification of pancreas. Figure: CALCIFICATION OF PANCREAS: Chronic pancreatitis.
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Centchroman
Non-hormonal contraceptive pill
It is a selective estrogen receptor modulator
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Elevation of the scapula (as in shrugging the shoulders)The movement is brought about by the upper fibres of the trapezius and by the levator scapulae. It is associated with the elevation of the lateral end, and depression of the medial end of the clavicle. Spinal accessory nerve supplies trapezius muscle and may get injured in trauma or damage during surgery, resulting in weakness of the trapezius muscle and drooping of shoulder.
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Answer is A (Poal Hypeension) Hemetemesis in a patient with palpable splenomegaly suggests a diagnosis of variceal blood secondary to poal hypeension. Hemetemesis from Gastric ulcer, Mallory Weiss tear and/or drug induced gastritis is not associated with splenomegaly.
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Ans. (d) HyponatremiaRef. D.C. Dutta's textbook of obstetrics 7le / 222HELLP syndrome is rare complication of pre-eclamsia (10- 15%), but can also develop without maternal hypertension.* H-Hemolysis (bilirubin >1.2 mg/dl)* EL-Elevated Liver enzyme (ASL and ALT >70 IU/L), LDH>600 IU/L, Bilirubin (>1.2mg/dl)* LP-Low Platelets (1,00,000/mm3)
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Ans. is 'a' i.e., Head injury o Head injury is a contraindication for morphine - KDT 6th/e p. 457. o In Bronchial asthma morphine should be avoided, but it is not given as contraindication to morphine.
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Lidocaine is a rapidly acting drug because of its rapid distribution to well perfused tissues such as brain and heart.
Circulatory failure is characterized by decreased cardiac output and a consequent decrease in hepatic blood flow. As a result metabolic clearance of Lidocaine in liver is diminshed and its elimination is increased. Consequently Lidocaine concentration is initially increased in these relatively well perfused tissues (brain and heart) even with usual doses and toxicity results.
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Ans. is 'd' i.e., Trunk A distinct topographic represention of the body can be demonstrated in somatosensory area-I. Each side of the coex receives sensory information from the opposite side of the body only (contralateral representation). The body is represented upside down (veical) in the postcentral gyms, i.e. the face is represented at the foot of the gyrus whereas the legs and feet are represented at the top extending on the medial surface. Some pas of body like face (especially lips, tongue) and fingers have a propoionately large representation than the other areas like the trunk. The coical representation of the pa of the body is propoionate to its innervation density (number of sensory receptors) rather than its size.
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Ans is 'a' i.e. Duration of use > 2 years Risk Factors of Chloroquine toxicity Duration of Disease > 5 years Daily dose Hydroxychloroquine: > 400 mg/day (> 6.5 mg/kg) Chloroquine: > 250 mg/day (> 3.0 mg/kg) Cumulative dose Hydroxychloroquine: > 1000 gm Chloroquine: > 460 gm Age Elderly (>60 years) Physique Sho stature, obese Systemic disease Liver or kidney dysfunction Ocular disease Retinal disease or Maculopathy.
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Ans. D. Chondroblastoma.Benign skeletal tumors rarely if ever metastasize to lung. The two exceptions to this rule are giant cell tumor (up to 10% metastasize to lung) and chondroblastoma
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Diagnostic criteria for human evsticercosis
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Ans. is c i.e. impacted cervical fibroid The patient in the question : Was being treated for infeility. Now H/0 a 6 weeks of amenorrhea. Presents with urinary retention. The first diagnosis which comes in our mind is Retroveed gravio uterus. Points which our the diagnosis are : The woman is pregnant and has complain of urinary retention. But friends, here it is impoant to understand that retroveed gravid uterus causes urinary retention at 14 - 15 weeks of gestation (not 6 weeks). Jeffcoate 7/e. p 299 So Option -a-. is ruled out Option "b" Pelvic hematocele "Pelvic hematocele is formed in a patient complaining of 6 weeks amenorrhea in case of ectopic pregnancy." Though pelvic hematocele causes urine retention but then other symptoms (pain) and signs of ectopic pregnancy should be present. Option "c" Impacted cervical fibroid "A cervical fibroid impacted in pouch of Douglas can cause retention of urine. The onset of retention is acute and usually occurs immediately before menstruation, when the uterus is fuher enlarged by congestion or during early pregnancy." Fibroid is associated with infeility. Thus an impacted cervical fibroid can explain all features seen this woman and is our option of choice.
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Drainage of CSF in some cases may often be elicited on endoscopy by having the patient perform a Valsalva maneuver or by compressing both jugular veins (Queckenstedt-Stookeytest) Ref : internet sources
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Laryngocele is an air-filled cystic swelling which occurs due to dilatation of saccule. Saccule is a diveiculum arising from anterior pa of ventricle/sinus of larynx. External laryngocele is one in which distended saccule herniates through the thyrohyoid membrane and presents as a reducible swelling in the neck, which increases in size on coughing or performing Valsalva.
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Options Associated with Uicaria Dermographism Smooth ms hamaoma Pseudo Darier sign Uicaria pigmentosa Darier's sign Atopic dermatitis White dermographism Darier's Sign - Mast cell release histamine - Histamine vasodilates vessels producing erythematous lesion.
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Ans. is 'a' i.e., Leprosy LEPROTIC UVEITIS It predominantly involves anterior uvea; more commonly in lepromatous than in the tuberculoid form of disease. Clinical types Lepromatous uveitis may occur as acute iritis (non-granulomatous) or chronic iritis (granulomatous). Acute iritis : It is caused by antigen-antibody deposition and is characterised by severe exudative reaction. Chronic granulomatous iritis : It occurs due to direct organismal invasion and is characterised by presence of small glistening'iris pearls' near the pupillary margin in a necklace form; small pearls enlarge and coalesce to form large pearls. Rarely, a nodular lepromata may be seen. Treatment : Besides usual local therapy of iridocyclitis antileprotic treatment with Dapsone 50-100 mg daily or other drugs should also be instituted.
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Ans. d (Glucose); (Ref Harper, Biochemistry, 26th ed., 145; Satyanaryan, Biochemistry, 2nd ed., 273)GLYCOGEN# Glycogen contains alpha-1-4 and alpha-1-6 links.# Degradation of glycogen to glucose involves 4 enzyme reactions:- Phosphorylase, which hydrolyses alpha-1-4 bond- Amylo 1-6-glycosidase, a debranching enzyme that removes alpha-1-6 bond to produce free glucose in muscle.- Phosphoglucomutase, which converts glucose-1-phosphate to glucose-6-phosphate.- Glucose-1-phosphatase, which converts glucose-6-phosphate to glucose.# Thus, amylo 1-6-glycosidase (debranching enzyme) breaks alpha-1-6 bond at branch with single glucose residue and releases free glucose.
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Stuporous (or Retarded) Catatonia Some Impoant Clinical Features of Retarded Catatonia 1. Mutism: Complete absence of speech 2. Rigidity: Maintenance of a rigid posture against effos to be moved 3. Negativism: An apparently motiveless resistance to all commands and attempts to be moved, or doing just the opposite 4. Posturing: Voluntary assumption of an inappropriate and often bizarre posture for long periods of time 5. Stupor: Akinesis (no movement) with mutism but with evidence of relative preservation of conscious awareness 6. Echolalia: Repetition, echo or mimicking of phrases or words heard 7. Echopraxia: Repetition, echo or mimicking of actions observed 8. Waxy flexibility: Pas of body can be placed in positions that will be maintained for long periods of time, even if very uncomfoable; flexible like wax 9. Ambitendency: Due to ambivalence, conflicting impulses and tentative actions are made, but no goal-directed action occurs, e.g. on asking to take out tongue, tongue is slightly protruded but taken back again 10. Other signs such as mannerisms, stereotypies (verbal and behavioural), automatic obedience (commands are followed automatically, irrespective of their nature) and verbigeration (incomprehensible speech). Ref: A Sho Textbook of Psychiatry, Niraj Ahuja, 7th Edition, pg. no. 59
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Responsibility for health
Individuals health is almost inseparable from the health of larger community and the health of every community in every state and territory determines the overall health status of the nation.
Therefore, it involves the joint efforts of the whole social fabric (the individual, the community, and the state) to protect and promote health.
1. Individual responsibility (Self Care)
Health has to be earned and maintained by the individuals by 'Self Care', a recent trend in health care.
Self care refers to those activities individuals undertake in promoting their own health, preventing their own disease, limiting their own illness, and restoring their own health. For example, measuring self BP, doing exercise, taking nutritious diet etc.
2. Community responsibility (Community participation)
Health can never be adequately protected by health services without active understanding and involvement of the communities whose health is at stake. This makes community participation a very important aspect of health care.
Therefore, emphasis has shifted from health care for the people to health care by the people.
3. State responsibility
Responsibility for health does not end with the individual and community effort.
The state assumes responsibility for the health and welfare of its citizen
State shall make proper state health policy.
4. International responsibility
The health of mankind requires, the cooperation of governments, the people, national and international organization both within and outside the United Nations system.
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The 1973 discovery of lingual lipase, which is secreted by lingual serous glands and hydrolyzes medium- and long-chain triglycerides in the stomach, has renewed interest in the gastric phase of fat digestion. In humans, lipase is present in the serous (von Ebner) glands of the tongue, where it is localized in zymogen granules. Ref: guyton and hall textbook of medical physiology 12 edition page number: 436,437,438
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Bow legs Mel: Ghai Paediatrics 6/e, p 128. Nelson 17/e,p 183; Apley's 8/e, p 119] Ghai states - "Long bones of legs get deformed when the child stas bearing weight. Therefore deformities of legs are unusual before the age of 1 year. Anterior bowing of legs, knock knee and coxa vera are the usual deformities." Clinical manifestation of Rickets: The main factor responsible for pathogenesis in Rickets: - In rickets the abdomen is protuberant (pot belly) because of marked hypotonia of abdominal wall muscles. Visceral proptosis and lumbar lordosis also occurs in rickets. More Questions on rickets: ? Earliest manifestation of Rickets Craniotabes Clinical manifestation of Rickets appears at later half of first year or in T.'d year. (Unusual below the age of 3 months) Questions on Radiological feature of Rickets: ? - Earliest radiological changes appear in long bones of radius and ulna - Cupping of inetaphyses - Large gap b/w epiphyses and metaphyses (widening of the phy.vis i.e. growth plate) - Irregular metaphyseal margins (ill-defined zone of provisional calcification) - Osteopenia
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A leiomyoma (fibroid) is a benign tumor of the smooth muscle of the uterus and thus is an example of a benign tumor of mesenchymal origin. Profuse, painful menses and infeility are major complications of this most common tumor of the female genital tract. A leiomyosarcoma is the malignant counterpa. Malignant tumors of epithelial cells are carcinomas, and these are known as Adenocarcinomas if they involve glandular epithelium. Benign tumors of surface epithelium are termed papillomas
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Movement of hydrophobic molecules/Lipid soluble substances occurs by Simple diffusion Movement of H2O occurs by osmosis Movement of Polar molecules/ions occurs through Channels
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Ans. is 'd' i.e., Biotin o Biotin is a coenzyme for carbon dioxide fixation reactions.o It serves as prosthetic group of ATP-dependent carboxylase, i.e., in carboxylation reactionQ,o It acts as coenzyme tor acetyl-CoA carboxylaseQ, propionyl-CoA carboxylaseQ, pyruvate carboxylaseQ and metbylcartonyl-CoA carboxylase.
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In this mutation, stop codon - UAG is replaced by another stop codon- UAA. So, this is silent mutation. In silent mutations, there is no change in primary structure of protein. OTHER QUESTIONS FREQUENTLY ASKED ON THIS TOPIC: Silent Mutation:The codon containing the changed base codes for the same amino acid.For example, if the serine (Ser) codon UCA is given a different third base, U, to become UCU, it still codes for Ser. This is termed a "silent" mutation. Missense Mutation:The codon containing the changed base codes for different amino acid. For example, if the Ser codon UCA is given a different first base, C, to become CCA, it will code for a different amino acid (in this case, proline ). This is called a "missense" mutation. Nonsense Mutation:The codon containing the changed base become a termination codon. For example, if the Ser codon UCA is given a different second base, A, to become UAA, the new codon causes termination of translation at that point and the production of a shoened (truncated) protein.
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Ehlers danlos syndrome *A genetic defect in the synthesis of fibrillar collagen*Of all the types, type IV (vascular type) is the most severe form as it involves internal organs*Common type - Type VI (kyphoscoliosis type) caused due to a defect in lysyl hydroxylase*Type VII - defect in type 1 collagen*Type IV - Defect in type 3 collagen*Type I and II - Defect in type 5 collagen ( Ref: Robbins 8/e p146)
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Ans. is 'c' i.e., Ligandin Bilirubin metabolism Bilirubin is the end product of heme degradation. The heme is derived from - i) Senescent erythrocytes by mononuclear phagocytic system in the spleen, liver and bone marrow (major source). ii) Turnover of hemoproteins (e.g. cytochrome p.450). Heme is oxidized to biliverdin by heme oxygenase. Biliverdin is then reduced to bilirubin by biliverdin reductase. Bilirubin is transpoed to liver in bound form with albumin. Bilirubin is transferred to hepatocytes where it is bound to ligandin. There is carrier mediated uptake of bilirubin in the liver. This bilirubin is conjugated with glucuronic acid by UDP glucuronyl transferase (UGT1A1) to from conjugated bilirubin (bilirubin glucronides). Conjugated bilirubin is excreted into bile. Most of the conjugated bilirubin is deconjugated and degraded to urobilinogen. The most of the urobilinogen is excreted in the feces.
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Leukocoria is a white eye reflex called as amaurotic cat eye reflex .coats disease is severe form of retinal telangectasia commonly seen in small boys
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Answer is D (High ESR) Elevated (High) ESR is a minor criterion and not a major criterion (Jones criteria) World Health Criteria for the diagnosis of Rheumatic fever and rheumatic hea disease Major manifestations * Carditis * Polyahritis * Chorea * Erythema marginatum * Subcutaneous nodules Minor manifestations * Clinical: fever, polyahralgia * Laboratory: elevated erythrocyte sedimentation rate or leukocyte count * Electrocardiogram: prolonged P-R interval Revised Jones criteria do not include elevated leucocyte count as a laboratory minor manifestation (but do include elevated C-reactive protein) Suppoing evidence of a preceding streptococcal infection within the last 45 days * Elevated or rising anti-streptolysin 0 or other streptococcal antibody, or * A positive throat culture, or * Rapid antigen test for group A streptococcus, or * Recent scarlet fever ( a )1992 Revised Jones criteria do not include recent scarlet fever as suppoing evidence of a recent streptococcal infection Diagnostic Categories Criteria Primary episode of rheumatic fever Two major or one major two minor manifestations plus evidence of preceding group A streptococcal infection Recurrent attack of rheumatic fever in a patient without established rheumatic hea disease Two major or one minor manifestations plus evidence of preceding group A streptococcal infection Recurrent attack of rheumatic fever in a patient with established rheumatic hea disease Two minor manifestations plus evidence of preceding group A streptococcal infection
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D i.e. DM
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Posteriorly on the lateral nasal wall is the area known as Woodruff's area. It is situated under the posterior end of inferior turbinate.Sphenopalatine aery anastomoses with posterior pharyngeal aery, in this area.
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Remember when the polarity of given DNA or RNA strand is not given in question always assume it as a 5' - 3' direction according to convention. So the given The DNA template strand is 5' GATCTAC 3'. So, the complementary DNA strand will be 3' CTAGATG 5'. The sequence of RNA formed will be exactly same to this strand. So Now for RNA, change T to U. So, we get 3' CUAGAUG 5'. Now in the options, polarity is not given so assume they are asking you RNA sequence in 5' - 3' direction. Now we have to arrange the RNA sequence from 5' - 3' direction. So the answer is 5' GUAGAUC 3'.
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However universal precaution is not needed for breast milk (no occupational hazard), Human breast milk has been implicated in perinatal transmission of HIV, and HBsAg has been found in the milk of mothers infected with HBV (REF: JAMA 1988; 259:1353-6. Lifson AR, Bond WW, Petersen NJ, Gravelle CR, Favero MS. Hepatitis B virus in peritoneal dialysis fluid: A potential hazard. Dialysis and Transplantation 1982; 11:592-600.) Harrison says that serum, semen and saliva are most infectious for hepatitis B transmission. Robbin's 7th ed says that hepatitis B antigen is present in all body secretions except stools CDC GUIDELINES: (REF: style="font-size: 12px; font-family: Verdana; background-color: transparent; veical-align: baseline; white-space: pre-wrap;">) Extension of blood and body fluid precautions to all patients is referred to as "Universal Blood and Body Fluid Precautions" or "Universal Precautions." Under universal precautions, blood and ceain body fluids of all patients are considered potentially infectious for human immunodeficiency virus (HIV), hepatitis B virus (HBV), and other bloodborne pathogens. BODY FLUIDS TO WHICH UNIVERSAL PRECAUTIONS APPLY: *Universal precautions apply to blood and to other body fluids containing visible blood. *Blood is the single most impoant source of HIV, HBV, and other bloodborne pathogens in the occupational setting *Universal precautions also apply to tissues and to the following fluids: semen and vaginal secretions, cerebrospinal fluid (CSF), synol fluid, pleural fluid, peritoneal fluid, pericardial fluid, and amniotic fluid. BODY FLUIDS TO WHICH UNIVERSAL PRECAUTIONS DO NOT APPLY: *Universal precautions do not apply to feces, nasal secretions, sputum, sweat, tears, urine, and vomitus unless they contain visible blood *The risk of transmission of HIV and HBV from these fluids and materials is extremely low or nonexistent. *Human breast milk has been implicated in perinatal transmission of HIV, and HBsAg has been found in the milk of mothers infected with HBV (10, 13). However, occupational exposure to human breast milk has not been implicated in the transmission of HIV nor HBV infection to health-care workers. *Whereas universal precautions do not apply to human breast milk, gloves may be worn by health-care workers in situations where exposures to breast milk might be frequent, for example, in breast milk banking. * Universal precautions do not apply to saliva. Saliva of some persons infected with HBV has been shown to contain HBV-DNA at concentrations 1/1,000 to 1/10,000 of that found in the infected person's serum. HBsAg-positive saliva has been shown to be infectious when injected into experimental animals and in human bite exposures
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Rapid fluid administration is often the key to successful trauma resuscitation. Some of the important factors affecting the rate of fluid resuscitation include the diameter of the intravenous tubing, the size and length of the venous cannulae, the fluid viscosity, and the site of administration. According to Poiseuille's law, flow is proportional to the fourth power of the radius of a catheter and inversely proportional to its length. Therefore, the shorter a catheter and the larger its diameter, the faster one can infuse a solution through it. Central venous placement alone does not assure rapid flow. Importantly, the diameter of the intravenous tubing employed may be the rate-determining factor in fluid delivery: blood-infusion tubing allows twice the flow of standard intravenous tubing and should be used when rapid fluid resuscitation is needed. Any patient who is suspected of having a major abdominal injury should immediately have at least two short, large-bore (16-gauge or larger) intravenous cannulae placed in peripheral veins. Longer, smaller catheters, such as standard 18-gauge central venous catheters, may take more time to place and will have lower flow rates. Once fluid resuscitation is under way, one may elect to place an 8- or 9-French pulmonary artery catheter-introducer via a central venous approach for further volume administration, as well as for measurement of central venous pressure or for Swan-Ganz catheter insertion. Lower-extremity venous cannulae, placed by saphenous vein cutdown or percutaneously into the femoral veins, are no longer advised as primary access for patients with abdominal trauma, since possible disruption of iliac veins or the inferior vena cava will render volume infusion ineffective. Studies have demonstrated that the flow rate of cold whole blood is roughly two-thirds that of whole blood at room temperature. Diluting and warming the blood by "piggybacking" it into infusion lines that are delivering crystalloid will decrease the blood's viscosity, enhance flow, and minimize hypothermia.
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"Although cobalt - 60 and cesium - 137 have been used in the past, iridium - 192 is the most commonly used radioisotope in HDR brachytherapy". — The physics of radiation therapy
Note - Cs-137 is used in HDR brachytherapy, while option c i.e. Cs - 133 (not Cs - 137).
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Answer- B. Swan neck deformitySwan neck deformity: Hyperextension of PIP joint and flexion at DIP joint.
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Enzyme defect Gaucher&;s disease. Beta glucosidase is deficient Salient features: -Glucocerebroside accumulate. adult, infantile, juvenile. Hepatosplenomegaly, erosion of bone, moderate anemia.Ref: DM Vasudevan, 7th edition, page no: 184
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Ans. is b i.e. Venous congestion "Ulceration of the prolapsed tissue is often said to be caused by friction with the thighs and clothing. Although this may be paly true, it is notable that the ulcer is nearly always on the most dependant pa of the cervix or vagina and not at the sides where friction is greatest. It is to be regarded, therefore more as a result of circulatory and nutritional changes than of trauma." Treatment of decubitus ulcer : Reduction of the prolapse into the vagina and daily packing with glycerine and acriflavine. Also know : Difference between Decubitus ulcer and Carcinoma Cervix : Decubitus ulcer shows a clean edge and heals on reposition and vaginal packing.
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[Cl (12-18 months) Ref: 525, 1974-Nelson 17,h1. Anterior fontanelle: Formed by joining of four sutures in the midline, Diamond shape, 2 by 2 cm measurements* The floor is formed by membranous and it becomes ossified 18 month after birth. It becomes pathological, if it fails to ossify even after 24 months (84 - Dutta 6th)* The average time of closure is 18 months but the fontanel may normally close as early as 9 months. The fontanele is normally slightly depressed and pulsatile and is best evaluated when an infant is held upright while asleep or feeding (1974-Nelson 17th)Disorders associated with a large anterior fontanel* Achondroplasia* IUGR* Apert syndrome* Kenny syndrome* Athyrotic hypothyroidism* Osteogenesis imperfecta* Cleidocranial dysostosis* Prematurity* Congenital rubella syndrome* Pyknodysostosis* Hallermann-Streiff syndrome* Russell - Silver syndrome* Hydrocephaly* 13 - 18, 21 trisomies* Hypophosphatasia* Vitamin D deficiency ricketsPersistently small fontanels suggest microcephaly, cranio synostosis congenital hyperthyroidism or wormian bones2. Posterior fontanelle: between the intersection of the occipital and parietal bones that may be closed at birth or at the most admit the tip of finger. The posterior fontanele is usually closed and nonpalpable after the first 6- 8 weeks of life.Its persistence suggests underlying hydrocephalus or possibility of congenital hypothyroidism
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Roseola infantum or exanthem subitum or sixth disease is caused by human herpes virus 6 and 7(HHV-6 and HHV-7) and echovirus 16. Classically the rash begins suddenly on the day the fever subsides, usually the sixth day ,thus called sixth disease. - pink almond shaped macules are the characteristic lesions. Rash first appears on trunk and then spreads to face , neck and proximal extremities. It is non pruritic and rarely becomes confluent . Infectious ness is low . Image : Roseola Infantum Clinical Presentation Reference :Op Ghai paediatrics 9 th edition pg : 212 IADVL&;s concise textbook of dermatology, first edition, pg no :75
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Management of salivary gland tumors1) Surgery (principle Rx) - Surgical excision alone or in combination with radiotherapy- For Parotid tumor: depending on the involvement* Superficial parotidectomy* Deep lobe parotidectomy* Total parotidectomy* Radical parotidectomy- Other salivary gland tumors - En block excision of tumor + gland 2) Neck dissection: performed in- Clinically palpable nodes- High grade malignancies3) Radio therapy - Indications* High Grade tumor* Large primary tumor* Perineural invasion* Invasion of Lymph node* Positive margins* Cervical lymph node metastasis 4) No role of chemotherapy- In salivary gland tumors due to* Incomplete & sho-lived response* No survival advantages Types of Parotidectomy1. Superficial or lateral or classical parotidectomy:* For benign and malignant tumors involving superficial lobe* Salivary tissue lateral to facial nerve is removed2. Deep lobe parotidectomy:* For benign and malignant tumor involving deep lobe* Salivary tissue deep to facial nerve is removed3. Total conservative parotidectomy* For benign and malignant tumor involving both superficial + deep lobe* All salivary tissue is removed* Facial nerve is preserved4. Radical parotidectomy* For tumors invading facial nerve* All salivary tissue is removed + excision of facial nerve5. Extended radical parotidectomy* Radical parotidectomy + removal of adjacent structures (mandible, temporal bone,muscles)
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Young female, with 2 years history of anemia and peripheral blood demonstrating spherocytes points towards the diagnosis of auto-immune hemolytic anemia.
Immune hemolytic (autoimmune hemolytic) anemia is the most common cause of spherocytes.
It is caused by auto antibodies against RBCs.
Detection of autoantibodies by Coombs test will establish the diagnosis.
About option b
Spherocytes are also seen in hereditary spherocytosis, in which diagnosis is established by osmotic fragility test.
However, hereditary spherocytosis is usually presents in childhood or infancy.
Whereas as autoimmune hemolytic anemia is common in young females and it is the most common cause of spherocytes in the blood.
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Ans: D (Onset only...) Meniere's disease is a disease of the inner ear, characterized by the clinical triad of recurrent vertigo, fluctuating sensorineural hearing loss, and tinnitus"- style="font-size: 1.04761904761905em; color: rgba(0, 0, 0, 1); font-family: Times New Roman, Times, serif"> articIes/PM C3098516/"Disease is seen in the age group of 35-60 years. Males are affected more than females"- Dhingra 6th/100"Drop attack: in most instances (64%), the cause of the drop attack is never definitively established. About 12% are due to the heart (a variant of syncope), 8% due to poor circulation to the brain, 8% due to problems with both the heart and brain, 7% due to seizures, 5% due to the inner ear (Menieres disease -- called the otolithic crisis of Tumarkin), and 1%, due to psychological probl emshttp://www. dizziness-and- balance.com/disorders/ central/drop.html"There is marked bulging of Reissner's membrane which may even herniate through the helicotrema into the apical part of sea I a tympani"- Dhingra 5th/111"Hearing improves after the attack & may be norma! during the periods of remission. Some HL is added during every attack. This fluctuating nature of HL is quite characteristic of the disease"- Dhingra 5th/112Menier's Disease (Endolymphatic Hydrop)Meniere's disease is characterized by a tetrad of symptoms of unknown cause: episodic vertigo, fluctuating sensorineural hearing loss; a sensation of aural fullness, and tinnitusThe tinnitus is usually low-pitched and roaring & is aggravated during acute attacks'-'The hearing loss is more severe in the lower frequencies, in many cases progresses over several years, and remains confined to one ear in most patients. The attacks are associated with nausea, vomiting, and prostration. Aural fullness is a manifestation always present in Meniere's attackPathologically, there is generalized dilation of the membranous labyrinth that includes the scala media and endolymphatic sac and is associated with occasional membrane breaks and intermingling of endolymph and perilymph.Circulating immune complexes may be involved in the pathogenesis of Meniere's diseasePatients with severe hydrops should be treated with diuretics, salt restriction, a low-caffeine diet, avoidance of nicotine, and labyrinthine sedatives such as diazepam, 5 mg three times daily, to prevent recurrent attacks.Surgical treatment is currently reserved for patients with severe incapacitating vertigo or tinnitus or to prevent further deterioration of hearing.
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C i.e. Loss of overhead abduction
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Ans. is 'a' i.e., Induces apoptosis when it engaged by fas ligand system
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In patent ductus aeriosus (PDA), the pulses are bounding, and pulse pressure is widened due to diastolic runoff through the ductus. PDA with left to right shunt is associated with necrotizing enterocolitis (NEC) due to bowel hypoperfusion. It is the most common acquired GI emergency in the newborn and it is most common in preterm infants, with an incidence of 10% in infants less than 1500 g. Pulmonary hemorrhage can occur in PDA from pulmonary over circulation with the pulmonary vascular resistance droping. Ref: Thilo E.H., Rosenberg A.A. (2012). Chapter 2. The Newborn Infant. In W.W. Hay, Jr., M.J. Levin, R.R. Deterding, J.J. Ross, J.M. Sondheimer (Eds),CURRENT Diagnosis & Treatment: Pediatrics, 21e.
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HISTORY * Medunna ====IM injection of camphor to induce seizures * Ugo cerletti and lucio bini==== ECT in a catatonic patient INDICATIONS * DEPRESSION SUICIDAL IDEAS-------------- first choice * CATATONIC SCHIZOPHRENIA * SCHIZOPHRENIA * MANIA * ELECTRODE PLACEMENT * Most commonly used=== bi fronto temporal * More cognitive side effects==bi fronto temporal * Less cognitive side effect======bi frontal * SIDE EFFECTS * RETROGRADE AMNESIA * BODY ACHE * MEDICATIONS USED IN THE PROCEDURE * ANAESTHETIC======Thiopentone / ethosuximide * MUSCLE RELAXANT====Succynyl choline CURARE IN PSEUDOCHOLINEESTERASE DEFICIENCY * ANTICHOLINERGIC=====Atropine CONTRA INDICATIONS * NO ABSOLUTE Contra indication * RELATIVE -----------------Brain tumour / arrythmia Ref. kaplon and sadock, synopsis of psychiatry, 11 th edition, 1055
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Ref: TEXTBOOK OF PATHOLOGY 6th EDITION - HARSH MOHAN PAGE NO: 261 TABLE 10.2: Storage Diseases (Inborn Errors of Metabolism). Lysosomal storage disorders: * Inherited * Mutation in genes that code lysosomal hydrolases. * Lysosomal enzymes are used for the intracellular digestion/degradation of many complex biological macromolecules. * Deficiency of lysosomal enzymes: Inherited deficiency of lysosomal enzyme may cause incomplete catabolism of its normal macromolecular substrate. This can lead to the accumulation of the paially degraded insoluble substrate within the lysosomes. The inherited disorders result from mutations in genes that encode lysosomal hydrolases are known as lysosomal storage disorders.
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A successful CABG reduces symptoms, prevents catastrophic and prolongs survival.
It does not prevent the progress of native blood vessel disease. In fact, restenosis of the grafted vessel is noted with time.
In CABG, anastomosis of one or both of the internal mammary arteries or a radial artery to the coronary artery distal to the obstructive lesion is carried out.
For additional obstructions that cannot be bypassed by an artery, a section of a vein (usually the saphenous) is used to form a connection between the aorta and the coronary artery distal to the obstructive lesion.
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Ans. is 'a' i.e., Occurs within hours after myocardial infarctiono It is a secondary form of pericarditis that occurs in the setting of injury to the hea or the pericardium. o It is also know as postmyocardial infarction syndrome or postcardiotomy pericarditis.o /t usually occurs 2-3 weeks after MI (but may also occur within 2-5 days).o It is an autoimmune inflammatory reaction to myocardial neo-antigens.o Anticoagulation therapy may precipitate it.o Clinical manifestations -4 Low grade fever, pleuritic chest pain, pericardial friction rub, pericardial effusion.o Dresseler's syndrome is typically treated with NSAIDs such as aspirin or with coicosteroids --> Because both these drugs reduce inflammation.In resistant cases colchicine may be used.
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Reactive ahritis (previously known as Reiter's disease) is predominantly a disease of young men, with a male preponderance of 15 : 1. It is the most common cause of inflammatory ahritis in men aged 16-35 but may occur at any age. Between 1 and 2% of patients with non-specific urethritis seen at genitourinary medicine clinics have reactive ahritis. Following an epidemic of Shigella dysentery, 20% of HLA-B27-positive men developed reactive ahritis. Classic triad** Non-specific urethritis* Conjunctivitis (~50%)* Reactive ahritis Additional extra-aicular features* Circinate balanitis(20-50%)* Keratodermablennorrhagica (15%)* Nail dystrophy* Buccal erosions (10%) Precipitated by* Bacterial dysentery, mainly Salmonella, Shigella,Campylobacter or Yersinia* Sexually acquired infection with Chlamydia REF:DAVIDSON'S PRINCIPLES AND PRACTICE OF MEDICINE 22nd EDITION PAGE NO 1107
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Duchenne muscular dystrophy (DMD) is a genetic disorder characterized by progressive muscle degeneration and weakness. It is one of nine types of muscular dystrophy. DMD is caused by an absence of dystrophin, a protein that helps keep muscle cells intact. Symptom onset is in early childhood, usually between ages 3 and 5. The disease primarily affects boys, but in rare cases it can affect girls.DMD has an X-linked recessive inheritance pattern and is passed on by the mother, who is referred to as acarrier.
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Hershey chase experiment To see whether it is DNA or protein which enters host cell to act as genetic material. Done on bacteriophages. Viruses don't have their own machinery of reproduction. So they attach to the host cells (bacteria) and transfer their genetic material into the host cell and bacteria then produce viruses. Host for infection was E.coli bacteria. E.coli bacteria that were infected by radioactive DNA viruses were radioactive but the ones that were infected by radioactive protein viruses were non-radioactive.
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Ans. (c) Retraction methodRef: Bailey 26th Edition Page 267There are three methods of putting PEG tube* Direct Stab technique (Introducer technique)* Push through technique!* Pull TechniqueThere is no retraction technique
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riboflavin deficiency causes glossitis , angular stomatitis, cheilosis Ref Harrison 20th edition pg 97e
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