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Ans. is 'b' i.e., IgE mediated reaction o The symptoms of the patient are d/t hypersensitivity type I reaction Type I is mediated by IgE and it flairs up within minutes. o There are typical features of anaphylaxis (systemic Type I hypersensitivity). Clinical manifestations of anaphylaxis o Flushing and tachycardia are usually the first and are invariant symptoms of anaphylaxis. o Uicaria (pruritis) o Angiodema o Respiratory distress and wheezing due to bronchoconstriction. o Confusion and alteration of mental status can occur.
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Ans. B: Ring Finger Dupuytren's contracture is more common among people with diabetes, alcoholism, or epilepsy. Dupuytren contracture, a disease of the palmar fascia, results in the thickening and shoening of fibrous bands in the hands and fingers. The ring finger is the one affected most commonly. It is usually limited to the medial three fingers. This disease entity belongs to the group of fibromatoses that include plantar fibromatosis (Ledderhose disease), penile fibromatosis (Peyronie disease), and fibromatosis of the dorsal proximal interphalangeal (PIP) joints (Garrod nodes or knuckle pads).
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Ans. Pigmented pupillary cyst
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Type I GSD (Von Gierke disease) is a liver glycogenoses i.e. involves liver Type 2 (Pompe disease), type V (McArdles disease) and type VII ( Tarui disease) involves muscles (Muscle Glycogenoses) Type 3 GSD (Cori's disease) is predominantly a liver glycogenoses but skeletal muscle involvement may also be seen.
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BOERHAAVE'S SYNDROME Spontaneous rupture usually occurs on the left posterolateral side of the distal esophagus into the left pleural cavity or just above the gastroesophageal junction. These patients are typically male (85%), 40 to 60 years of age, who have a history of recent emesis. Clinical features Mackler's triad is seen in spontaneous esophageal perforation Thoracic pain Vomiting and Cervical subcutaneous emphysema . Patients with an abdominal perforation have epigastric abdominal pain that is also often referred to the back and left shoulder.
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Vitamin C plays the role of a coenzyme in the hydroxylation of proline and lysine while procollagen is conveed to collagen (i.e. post-translational modification). The functions of vitamin K are concerned with the blood clotting process. It brings about the posttranslational (after protein biosynthesis in the cell) modification of ceain blood clotting factors ii, vii, ix, x ref Satyanarayana 4th ed page 130, 132
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Ans. (B) ACE-inhibitors(Ref: KDT 8th/e p617)*ACE inhibitors and ARBs have fetopathic potential, therefore are contra-indicated in pregnancy.
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Answer- A. Anti CCPThe presence of serum anti-CCP antibodies has about the same sensitivity as serum RF for the diagnosis of RA.However, its diagnostic specificity approaches 95% (most specific for RA), so a positive test for anti-CCP antibodies in the setting of an early inflammatory ahritis is usefrrlfor distinguishing RA from other forms of ahritis.
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Periodontitis becomes more prevalent with age, often secondary to the effects of dental plaque formation driven by oral flora. The gingival recession increases the risk for dental caries. Regular dental cleanings to remove the plaque and regular gentle tooth brushing help to slow the progression of periodontitis. Some periodontitis cases arise in the setting of systemic disease. Candidiasis is seen in immunocompromised individuals and often forms an inflammatory membrane on the tongue. Epstein-Barr virus has been associated with development of hairy leukoplakia. Herpes simplex virus results in vesicles that can rupture and form superficial ulcers on oral mucosa. Human papillomavirus can drive squamous epithelial hyperplasia, dysplasia, and carcinoma. Mucor has broad, non-septate hyphae and can result in sinusitis, particularly in the setting of ketoacidosis.
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Ref Robbins 8/e p253; 9/e p259 Amyloid replacement of islets is a characteristics finding in individual with long standing type 2 diabetes .it is believed that the islet amyloid protein is directly cytotoxic to isletsanalogous to the role played by amyloid plaques implicated in the pathogenesis of Alzheimer's disease
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Integration of viral genomes into host cell chromosome can cause an alteration in :
i) Host cell surface
ii) Metabolic function
iii) Cell growth and replication pattern
iv) Malignant transformation
v) Latent infection
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(Hydropic degeneration of the villous stroma) (193, 197, 201-Duta 6th)Hvdatidiform mole (vesicular mole) - It is abnormal condition of placenta where there are partly degenerative & partly proliferative changes in the young chorionic villi* It is best regarded as a benign neoplasm of the chorion with malignant potential* Vaginal bleeding is the commonest presentation (90%) "White currant in red currant juice"* Expulsion of grape like vesicles (rich in HCG) pe vaginum is diagnostic of vesicular mole.* Histology shows hydropic degeneration of the villous stroma with absence of blood vessels and trophoblastic proliferation.RISK FACTORS FOR MALIGNANT CHANGE* Patient above the age of 40 irrespective of parity* Patients having previous 3 or more births irrespective of age is more important than the parity.* Initial serum hCG > 100,000 mIU/ml.* Uterine size >20 weeks* Previous history of molar pregnancy* Large (> 6 cm) theca-leutin cyst
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80% of submandibular salivary gland stones are radiopaque. SIALOLITHIASIS 80% of all salivary gland stones occur in submandibular glandQ, 10% occur in parotid, 7% in sublingual and the remainder in minor salivary glands. MC site is Whaon's ductQ > submandibular gland substance Composition of stone: Calcium and magnesium phosphate or carbonateQ Due to deposition of calcium salts, 80% stones are radio opaqueQ
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ANSWER: (D) Causes nephrotic syndrome in childrenREF: Robbins 8th ed chapter 20, Nelson Pediatrics, 18th Edn Pg 2175, 2176Note: Loss of foot processes are seen on electron microscopy not light microscopy
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In skull, Ectocranial suture closure is very variable. Sometimes, there may not be ectocranial suture closure. This is called lapsed union. This occurs most often in the sagittal suture.
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Ans. is 'b' i.e., mRNA o Late mushroom poisoning (Amanita phalloides) is due to inhibition of RNA and protein synthesis.
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The spread of pellets from a fully choked barrel is given below: 10 meter - 25 cm 15 meter - 35 cm 20 meter - 45 cm 30 meter - 75 cm Note: In a choked-bore the distal 7-10 cm of the barrel is narrow. Ref: Textbook of Forensic Medicine and Toxicology by Narayan Reddy, Edition 21, Page -172, 181
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Answer is D (Surgery is usually indicated) There is no role of striven., in management of post cibal syndromes. Both types of postcibal syndrome are treated by dietary measures including: - limitation of sugar containing liquids and solids, - elimination of liquids at meal time, and - eating of frequent small meals. In severe cases, symptoms may improve, with the somatostatin-analogue Octreotide. There is no role of surgery in management of post cibal syndromes.
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IgG is the main serum immunoglobulin consisting of 80% of the total. equally distributed between intravascular and extravascular compaments. IgG paicipates in most immunological reactions such as complement fixation, precipitation a, d neutralization toxins and virus. REF:Anathanarayan & paniker's 9th edition, pg no:97 <\p>
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Ans. is 'a' i.e., Injection with foreign serum o Serum sickness is a type III hypersensitivity (immune complex mediated) reaction that results from the injection of heterologous or foreign protein or serum.o Certain medications (eg, penicillin, nonsteroidal anti-inflammatory drugs ) have also been associated with serum sickness-like disease.o When an antiserum is given, the human immune system can mistake the proteins present for harmful antigens. The body produces antibodies, which combine with these proteins to form immune complexes. These complexes precipitate, enter the walls of blood vessels, and activate the complement cascade, initiating an inflammatory response and consuming much of the available complement component 3 (C3). The result is a leukocytoclastic vasculitis. This results in hypocomplementemia, a low C3 level in serum. o Serum sickness is typically self-limited and resolves within days.
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Inferior alveolar nerve and vessels enter mandibular foramen on the medial aspect of the body of the mandible to emerge out through mental foramen on the lateral surface.
The site of injection is mandibular foramen.
The patient is asked to open the mouth and coronoid notch is palpated with index finger. The needle is introduced 1 cm above the surface of last molar medial to finger (coronoid notch) but lateral to pterygomandibular plica/ raphe/fold; between buccinator and superior constrictor.
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Ans: a (Neutron) Ref: Badhuri, Textbook of radiology; Tepper, Radiation oncology; O.P Tondon, General chemistry, http://en.wikipedia.org/wiki/Ionizing_radiationAuger electron, positron and nuclei are directly ionizing radiations whereas neutron is not a directly ionizing radiation.Ionizing radiation is composed of highly-energetic particles or waves that can detach (ionize) at least one electron from an atom or a molecule. Ionizing ability is a function of the energy of individual particles or waves, and not a function of their number. A large flood of particles or waves will not, in the most-common situations, cause ionization if the individual particles or waves are insufficiently energetic.Charged particles such as elections, positrons, and alpha particles interact strongly with electrons of an atom or molecule. Neutrons, on the other hand, do not interact strongly with electrons, and so they cannot directly cause ionization by this mechanism.However, fast neutrons will interact with the protons in hydrogen, and this mechanism produces proton radiation (fast protons). These protons tire ionizing because of their strong interaction with electrons.So neutrons cannot ionize directly. They can only ionize indirectly by the production of this 'proton radiation'.Auger electron spectroscopy (AES)It is a common analytical technique used specifically in the study of surfaces and, more generally, in the area of materials science.Underlying the spectroscopic technique is the Auger effect, which is based on the analysis of energetic electrons emitted from an excited atom after a series of internal relaxation events.The Auger effect is an electronic process. It is the heart of AES resulting from the inter- and intra-state transitions of electrons in an excited atom.When an atom is probed by an external mechanism, such as a photon or a beam of electrons with energies in the range of 2 keV to 50 keV, a core state electron can be removed leaving behind a hole.Ionizing radiationsNon ionizing radiationalpha raysBeta rays (electrons)Auger electronsGamma raysDelta raysUV radiationInfrared radiationRadiofrequency ablationMicrowave radiationProtonsFluoroscopy, DSASPECT, PETNuclear scans.MRI and USG are investigations which do not produce radiation.Tondon, General chemistry;http://en.wikipedia.org/wiki/Ionizing_radiation
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A i.e. Reticulated popcorn like configuration T2 gradient echo MRI is the investigation of choice for identification of cavernous angioma (cavernous hemangioma or cavernoma), which typically demonstrates a mass characterized as popcorn in appearance (mulberry shaped lesion)Q.
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Toll like receptor (TLR) - 5 is present in flagellin.
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FAT EMBOLISM and ARDS Fracture through a large marrow-filled cavity almost inevitably results in small showers of fat emboli being swept to the lungs. This can usually be accommodated without serious consequences, but in some cases (and especially in those with multiple injuries and severe shock, or in patients with associated chest injuries) it results in progressive respiratory distress and multi-organ failure (adult respiratory distress syndrome). Blood gases should be measured if this is suspected and signs such as shoness of breath, restlessness or a rise in temperature or pulse rate should prompt a search for petechial haemorrhages over the upper body, axillae and conjunctivae. Treatment is suppoive, with the emphasis on preventing hypoxia and maintaining blood volume. X RAY OF FAT EMBOLISM REF:Apley&;s system of ohopaedics- 9th edn- pg no 866.
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Levodepression is movement to the left and downside. It is caused by simultaneous action of left inferior rectus and right superior oblique muscle Dextroelevation: Right superior rectus and left inferior oblique Levoelevation: Left superior rectus and right Inferior oblique Dextroversion: Right lateral rectus and left medial rectus Levoversion: Left lateral rectus and right medial rectus Dextrodepression: Right inferior rectus and left superior oblique Ref; A K Khurana ; 6 th edition ; Page no: 339
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Chloramphenicol was initially obtained from Streptomyces venezuelae in 1947. It was soon synthesized chemically and the commercial product now is all synthetic. Adverse effects 1 . Bone marrow depression Of all drugs, chloramphenicol is the most impoant cause of aplastic anaemia, agranulocytosis, thrombocytopenia or pancytopenia. Two forms are recognized: (a) Non-dose related idiosyncratic reaction: This is rare (1 in 40,000), unpredictable, but serious, often fatal, probably has a genetic basis and is more common after repeated courses. Aplastic anaemia is the most common manifestation. Apparently, a longer latent period of onset of marrow aplasia is associated with higher moality. Many victims, even if they survive, develop leukaemias later. (b) Dose and duration of therapy related myelosuppression: a direct toxic effect, predictable and probably due to inhibition of mitochondrial enzyme synthesis. This is often reversible without long-term sequelae. Liver and kidney disease predisposes to such toxicity. 2. Hypersensitivity reactions Rashes, fever, atrophic glossitis, angioedema are infrequent 3. Irritative effects Nausea, vomiting, diarrhoea, pain on injection. 4. Superinfections These are similar to tetracyclines, but less common. 5. Gray baby syndrome It occurred when high doses (-100 mg/kg) were given prophylactically to neonates, especially premature. The baby stopped feeding, vomited, became hypotonic and hypothermic, abdomen distended, respiration became irregular; an ashen gray cyanosis developed in many, followed by cardiovascular collapse and death. Blood lactic acid was raised. It occurs because of inability of the newborn to adequately metabolize and excrete chloramphenicol. At higher concentration, chloramphenicol blocks electron transpo in the liver, myocardium and skeletal muscle, resulting in the above symptoms. It should be avoided in neonates, and even if given, dose should be - 25 mg/kg/day. ESSENTIALS OF MEDICAL PHARMACOLOGY,K.D.TRIPATHI,SIXTH EDIYION PAGE NO:715,717
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Botyromycosis is a chronic granulomatous condition similar to mycetoma, usually involves the skin and characterized by granules in the pus, consisting of masses of bacteria generally staphylococcus aureus.
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Ans. is 'a' i.e., Caused by HSV-II Neonatal herpes infection o It is commonly caused by HSV-2 (70% cases are caused by HSV-2 and 30% caused by HSV-1) Case fatality rate exceeds 60% in untreated neonatal herpes. The infection is acquired by passage through an infected genital tract at bih. The greatest risk i.e., 50% transmission rate occurs with a primary infection in the mother at time of delivery (because the antibodies have not yet developed, there is more virus present and no antibody transfer). With recurrent herpes at term, the transmission rate is only 8% or less. o Neonatal infections present on the 6th day postpaum. There are three major categories. Localized skin, eye and mouth infection CNS infection Dissenminated infection The hallmark of neonatal HSV infection - the vesicular, ulcerative skin lesions occur in only 30-43% children. If left untreated the virus dissenmination can occur to internal organs which is the most serious complication of neonatal herpes.
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Risk factors for PTS ID:- Low education, lower social class, female gender, low self-esteem/ neurotic traits, previous (or family) history of the psychiatric problem (depression /anxiety), previous traumatic events (childhood trauma).
Protective factor:- High IQ (Intellectuals), higher social class, male gender, psychopathic traits.
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Smallest helminth among the following is H nana also known as dwarf tapeworm with adult length of 15-44 mm. H. diminuta also known as rat tapeworm has a length of 20-60 cms. Balantidium coli is a large ciliated protozoan (50-130 um) and width 20-70 um) Diphyllobothrium latum can reach upto 30 fts.
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Non-absorbable, non-elastic suture (prolene) is the preferred suture material for vascular anastomosis.e.g. polypropylene."
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Vomer-sphenoid rostrum junction is schindylesis type of suture.
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Cardiac muscle consists of striated muscle fibers that branch and unite with each other. It forms the myocardium of the hea.Its fibers tend to be arranged in whorls and spirals, and they have the propey of spontaneous and rhythmic contraction. Specialized cardiac muscle fibers form the conducting system of the hea.Cardiac muscle is supplied by autonomic nerve fibers that terminate in the nodes of the conducting system and in the myocardium.
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MENKE DISEASE / kinky OR STEEL HAIR SYNDROME- deficiency of copper results in defective crosslinking of collagen and elastin by the copper-dependent enzyme lysyl oxidase. Defect in dietary absorption of copper Die with in 5 years of age Kinky hair and growth retardation. menke disease is X linked disease due to mutation in ATP 7 A gene. This gene is present on Xp 12-13.
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Reference Robbins page no Pg 1125 What are the symptoms of Cushing's syndrome? weight gain. thin arms and legs. a round face. increased fat around the base of the neck. a fatty hump between the shoulders. easy bruising. wide purple stretch marks, mainly on the abdomen, breasts, hips, and under the arms. weak muscles
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Stills disease is a variant of rheumatoid commonly occurring in adults in 20's and 30's.
Patients characteristics clinical features are:
High spiking fever often up to 40°C.
Sore throat
Evanescent salmon coloured non pruritic rash, seen on chest & abdomen
Lymphadenopathy
Pericardial effusion
Wrist joint involvement
Chances are that you might confuse it with Felty's syndrome so I am giving the important features of both these conditions together
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Ans. (a) Selective neck dissectionRef: Bailey- 26th edition Page 720* Supraomohyoid neck dissection involves removal of neck nodes at level 1,2,3.* It is done for No neck node palpable cases and for some cases of N1.* Extended Omohyoid Neck dissection removes - Level 1,2,3 and 4 nodes.
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Ref: Henry Gray. Anatomy of the Human Body. The lateral surface is formed of a thin, smooth, oblong plate, the lamina papyracea (os planum), which covers in the middle and posterior ethmoidal cells and forms a large pa of the medial wall of the orbit; it aiculates above with the orbital plate of the frontal bone, below with the maxilla and orbital process of the palatine, in front with the lacrimal, and behind with the sphenoid.
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The above case history is suggestive of Threatened aboion. Management - Bed Rest Avoid Coitus Avoid Lifting weights Progesterone is given to compliment the placental function
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Refer: Kanski s Clinical Ophthalmology: A Systematic Approach 8th edition pg 301 , AK KHURANA COMPREHENSIVE OPHTHALMOLOGY 6TH EDITION pg. No369
CONGENITAL DACRYOCYSTITIS
It is an inflammation of the lacrimal sac occurring in newborn infants
Treatment
It depends upon the age at which the child is brought.
Massage over the lacrimal sac area and topical antibiotics - up to 6-8 weeks of age, 4 times a day to be followed by instillation of antibiotic drops.
Lacrimal syringing (irrigation) with normal saline and antibiotic solution. It should be added
to the conservative treatment if the condition is not cured up to the age of 2 months, once or twice a week.
Probing of NLD with Bowman’s probe. It should be performed, in case the condition is not cured
by the age of 3-4 months, under general anaesthesia; may be repeated after an interval of 3-
4 weeks.
Intubations with silicone tube may be performed if repeated probings are failure.
Dacryocystorhinostomy (DCR) operations: When the child is brought very late or repeated probing
is a failure, after 4 years of age
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Ref. Robbins Pathology. 9th edition. Page. 1191
Paget Disease
Diagnostic features are increased osteoclastic and osteoblastic activity with supportive radiologic findings
Acute: primarily woven bone; focal mosaic pattern of lamellar bone, resembles jigsaw puzzle with prominent irregular cement lines; osteoclasts present at surface of bone but don’t tunnel; in osteolytic phase, osteoclasts may have up to 100 nuclei
Chronic: thick trabeculae and thicker bones; fine fibrosis of marrow (Osteosclerotic stage)
The picture is also known as mosaic pattern of bone
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Ans: B (Eustachian tube is always abnormal) Ref: Diseases of the Ear, Nose, and Throat by PL Dhingra 5th edn.2010. P. 98 Explanation: Eustachian tube function is normal in otosclerosis. Otosclerosis Irregular spongy bone replaces the dense endochondral layer of the bony labyrinth. Hereditary. Associated with Van der hoove's syndrome- osteogenesis imperfecta, otosclerosis and blue sclera. More common in females. Hearing loss worsens during pregnancy. Cochlear type presents with SNHL. The stapedial type has CHL and may have anterior (most common) posterior, circumferential, biscuit or obliterative focus. C/F Hearing loss. Paracusis willisi and tinnitus (indicates an active focus). O/E Schwartze sign-- reddish hue over the promontory because of the increased vasculature in active lesions. PTA will show the type of hearing loss and Carhart's notch which is a dip in the bone conduction at 2kHz. Impedance audiometry will show an As type curve. Medical treatment with sodium fluoride can be tried. Surgery is the treatment of choice and includes stapedotomy or stapedectomy followed by replacement with a piston made of Teflon or stainless steel or titanium.
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Ans. is 'b' i.e., Superior Orbital fissure Structures passing through superior orbital fissure* Superior and inferior divisions of oculomotor nerve (III)* Trochlear nerve (IV)* Lacrimal, frontal and nasociliary branches of ophthalmic (VI).* Abducens nerve (VI)* Superior and inferior divisions of ophthalmic vein. Inferior division also passes through the inferior orbital fissure.* Sympathetic fibers from cavernous plexus
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The folic acid is first reduced to 7, 8 - dihydrofolic acid and fuher reduced to 5,6,7,8- tetrahydro folic acid ( THFA ).Both reactions are catalyzed by NADPH dependent folate reductase. The THFA is the carrier of one- carbon groups.One carbon compound is an organic molecule that contains only a single carbon atom.The following groups are one carbon compounds are: 1.Formyl ( -CHO) 2.Formimino ( - CH=NH) 3.Methenyl ( - CH=) 4.Methylene (-CH2-) 5.Hydroxymethyl ( - CH2OH) 6.Methyl (- CH3 ). REFERENCE: DM.VASUDEVAN.TEXTBOOK SEVENTH EDITION PAGE NO 489
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2 patterns of autosomal recessive FSGS Steroid-resistant nephrotic syndrome Congenital nephrotic syndrome NPHS 2 gene mutation NPHS 1 mutation Maps to chromosome 1q25-q31 Maps to chromosome 19q13 Encodes the protein podocin Encodes the protein nephrin
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A i.e. Bone * Bone is kept shoer than soft tissue in flap method of amputation to facilitate closure of amputation stumpQ.* In guillotine amputation, limb is transected at one level through skin, muscle & bone.
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The term 'formal thought disorder' is a synonym for disorders of conceptual or abstract thinking that are most commonly seen in schizophrenia and organic brain disorders. In schizophrenia, disorders in the form of thinking may coexist with deficits in cognition.Schizophrenia is a disorder that includes a combination of hallucinations, delusions, disorder of thought, lack of motivation, flattening of affect, and disruptions in social functioning. Ref: Diseases and Disorders Set By Victoria J. Fraser, M.d., 2007, Page 756; Kaplan & Sadock's Synopsis of Psychiatry 10th Edition, Page 234, 277; Fish's Clinical Psychopathology: Signs and Symptoms in Psychiatry By Patricia R. Casey, Brendan D. Kelly, 2007, Page 46.
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Elevations in Beta-hCG are also found in patients with choriocarcinoma of the uterus, embryonal carcinomas, polyembryomas, mixed cell tumors, and, less commonly, dysgerminomas. Beta-hCG and human placental lactogen (hPL) are the most useful markers for trophoblastic disease. Calcitonin plays an impoant role as a tumor marker in monitoring patients with medullary carcinoma of the thyroid and in the diagnosis of multiple endocrine neoplasia type 2. Urinary and plasma catecholamines epinephrine, norepinephrine, dopamine, vanillylmandelic acid (VMA), homovanillic acid (HVA) are the tumor markers for pheochromocytoma. NSE is not a hormone. It is an enzyme. It is seen in AML.
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Most common causative organism for bacterial meningitis beyond 3 years of age is - Pneumococcus
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Answer- C. Aluminium toxicityAluminium intoxication is common in dialysis patients.It can cause anemia, osteomalacia and encephalopathy (dementia).
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Cells of transitional epithelium have an extra reserve of cell membrane in the form of plate-like areas of cytoplasm containing internalized membranes, which permits the stretching of the epithelium.
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a. Atrial Septal Defect (ASD)(Ref: Nelson's 20/e p 2211-2217, Ghai 8/e p 420-423)Pentalogy of Fallot = Tetralogy of Fallot + Atrial Septal defect.
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Ans. B: Ankylosing spondylitis Ankylosing Spondylitis (AS) is a chronic systemic inflammatory rheumatic disease, primarily affecting the axial skeleton of which sacroilitis is the hallmark. The disease pathogenesis is immune mediated as evident by raised IgA and close relationship with HLA B27. Immunologically there is interaction between class I HLA molecule B27 and T lymphocytes. Tumor necrosis factor has been identified as key regulatory cytokine.The age of onset is second or third decade of life and males are affected two to three times more than females. The risk factors for the disease are presence of HLA B27, male sex, positive family history, etc. Of them HLA B27 is most impoant as there is almost sixteen times increased chance of developing the disease amongst HLA B27 positive relatives. HLA B27 is present in almost 90%-95% cases. The clinical features are insidious onset, dull pain felt in lower lumber region, associated with morning stiffness lasting for few hours, there may be asymmetric ahritis of other joints mainly of lower limbs. Neck pain and stiffness is present in advanced cases. Physical findings include loss of spinal flexion, extension, lumber lordosis, diminished chest expansion, and exaggerated thoracic kyphosis.
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Ans. Grievous
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Ans. is 'b' i.e., Ranolazine Ranolazine Ranolazine is an effective newer anti-anginal drug but unlike CCBs and beta-blockers it does not significantly alter the hea rate or blood pressure. Ranolazine alters the trans-cellular late sodium current and affects the sodium-dependent calcium channels during myocardial ischemia thus prevents calcium overload, resulting in reduced oxygen demand, and prevent angina. Ranolazine is useful as add-on therapy in chronic stable angina which is refractory to more standard anti-anginal medication. However, it is not found to be useful in acute coronary syndrome.
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National anti-malaria Programme
The Programme began initially as National Malaria control Programme in 1953.
Because of the spectacular success achieved in the control of malaria, the control programme, was converted into an eradication programe in 1958 with the object of eradicating malaria once and for all from the country.
The programme went on well for sometimes.
The incidence of malaria declined from 75 million cases and 8 lakhs death in 1953 to about 1-2 million cases and no death in 1972.
But thereafter the programme suffered serious set backs.
There was a sharp increase in malaria incidence, in 1976, there were 6.47 million cases with 59 deaths.
The Govt of India in 1977 evolved a "Modified plan of operation" based on "effective control" rather than eradication.
The plan has since been implemented and the incidence of malaria began to decline.
However, there was gradual, increased in falciparum malaria incidence.
Hence a programme for containment of P.falciparum was also launched within the NMEP.
Note : Option 'c & d' were given in 19th/e. of Park : -
"The incidence of malaria had declined sharply from 75 million cases in 1953 to 2 million cases in 1958".
"The annual incidence of malaria cases in India escalated from 50000 in 1961, to a Peak of 6.4 million cases in 1976".
Strategic Action plan for malaria control in India (2007-2012)
Malaria control is now incorporated into the health service delivery programmes under the umbrella of NRHM.
The strategies of National malaria control programme are as follows : -
Malaria Control strategies
The strategies for prevention and control of malaria and its transmission are-:
1. Surveillance and case management
Case detection (passive and active).
Early diagnosis and complete treatment.
Sentinel surveillance.
2. Integrated vector management (IVM)
Indoor residual spray (IRS).
Insecticide treated bed nets (ITNs)/ Long Lasting Insecticidal Nets (LLINs).
Antilarval measures including source reduction.
3. Epidemic preparadness and early response
4. Supportive interventions
Capacity building
Behaviour change communication (BCC)
Intersectoral collaboration
Monitoring and evaluation
Operational research and applied field research.
Goals for strategic Plan 2007-2012
The main national goals for malaria control are given below : -
At least 50 percent reduction in mortality due to malaria by the year 2010, as per National Health Policy document 2002.
At least 80 percent of those suffering from malaria get correct, affordable and appropriate treatment within 24 hours of reporting to the health system, by the year 2012.
At least 80 percent of those at high risk of malaria get protected by effective preventive measures such as ITNs/LLINs or IRS by 2012.
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Ans. is 'b' i.e., Low fibero A high incidence of colorectal cancer occurs in economically prosperous, upper socioeconomic class. This observation led to attention on environmental factors, paicularly diet in the etiology of colon cancer.o Dietary factors associated with colon cancers are :(a) Animal fato Diet high in animal fats such as found in red meat (beef, pork, lamb) and processed meat (Sausages, hams & bacan etc) increases the risk of colon cancer.o Consumption of fish (including fresh, canned, salted and smoked fish) decrease the risk of colon cancer. This is because of the anti-cancer activity of omega-3 fatty acids found in fishes.o Note that consumption of chicken has no effect on colon cancer.(b) Fibres --> A high fibre diet has protective effect and a low fibre diet increases the risk.(c) Alcohol - is also a risk factor.(d) Ingestion of calcium, selenium, vitamin A, C & E, carotenoids, and plant phenols decrease the risk of colon cancer.(e) Insulin resistanceo A high calorie diet coupled with physical inactivity leads to excess weight gain and insulin resistance which fuher causes increased levels of insulin and insulin-like growth factors type I (IGF-I). This growth factor appears to stimulate proliferation of intestinal mucosa.
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The clinical picture of sho stature with low T4 and elevated TSH suggests primary hypothyroidism. The enlarged pituitary can be explained by the feedback provided by low T4 in the blood. To rule out other choices Pituitary adenoma Can produce any hormone and if it produces TSH , then T4 should be elevated TSH Secreting pituitary tumor Both TSH and T4 should be elevated Thyroid target receptor insensitivity Autosomal dominant disorder insensitivity. Characterized by elevated thyroid hormone levels and inappropriately normal or elevated TSH. The clinical features of H(Resistance to Thyroid Hormone) can include goiter, attention deficit disorder, mild reduction in IQ, delayed skeletal maturation, tachycardia, and impaired metabolic responses to thyroid hormone. The clinical features of H can include goiter, attention deficit disorder, mild reduction in IQ, delayed skeletal maturation, tachycardia, and impaired metabolic responses to thyroid hormone
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Ans. is 'a' i.e., ECF * The volume of the various body compartments can be measured by injecting into them an indicator substance (marker or dye) and estimating its volume of distribution.* Measurement of body fluid volumes is done by 'Dilution method' i.e., by knowing the diluted concentration of dye in the fluid. Suppose 5 gm of dye is added to a beaker containing unknown volume of water. After equilibrium, if the marker concentration in water is lg/100 ml, the waterin the beaker can calculated as follows : Volume of water =Total amount of marker--------------------Concentration of marker in water=5g-----1g/100 ml= 500 ml Volume of fluid =Total amount of marker injected------------------------------Concentration of marker in the fluid, to be measured* Most of the fluid are calculated directly by dilution method, except for intracellular fluid (ICF) and interstitial fluid. Both these are calculated indirectly by calculating other body fluids.ICF = Total body water volume - ECF volumeInterstitial fluid = ECF volume - Plasma volume* Dyes used for various fluid volume measurement are : -Fluid volumeDye/indicator usedTotal body water (TBW) volumeDeuterium oxide: D2O (most commonly used), tritium oxide (3H2O), Aminopyrine, AntipyrineExtracellular fluid (ECF) volumeInulin (most accurate), Sucrose, Mannitol, Sodium thiosulfate, Na22, I125- iothalamatePlasma volume (PV)Evans Blue (T-1824), Serum albumin labeled with radioactive iodine(I125)Blood cell volumeCr51 labeled RBC
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Prematurity
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Do not given Iron is Stabilization Phase. If given Iron releases free radical, causing injury to GIT.
Iron should be started in Rehabilitation Phase (after day 7)
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Ans. is 'c' i.e., Less chances of survival in environment
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The supraspinatus, infraspinatus, teres minor and subscapularis muscles comprise the rotator cuff muscle group. The main role of these muscles is stabilization of the humeral head in the glenoid fossa. Tendons of teres minor, supraspinatus, and infraspinatus inse on the greater tuberosity of the humerus, and subscapularis tendon inses on lesser humeral tuberosity. Actions of these muscles are internal rotation (subscapularis), external rotation (teres minor and infraspinatus) and early abduction from 0@ to 30@ (supraspinatus). The subacromial bursa lies between supraspinatus tendon and the acromion.
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Doppler effect: change in frequency because of relative motion between moving source of sound and observer. Example: Sound waves hitting resting parenchyma Sound wave hitting moving RBC The difference gives color coding doppler effect. Color coding: based on direction of flow Flow TOWARDS probe: RED Flow AWAYfrom probe:BLUE Color does NOT depend on aery or vein Intensity of color depends on velocity of flow
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As contact lenses tend to return the images to near normal size, the images are minifid in hypermetropia and magnified in myopia.
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Ans. (c) Post mastectomy arm(Ref: Cancer 1948; 1:64-81)*Lymphangiosarcoma is a misnomer because this malignancy seems to arise from blood vessels instead of lymphatic vessels.*Most commonly, this tumor is a result of lymphedema induced by radical mastectomy*Stewart-Treves syndrome is a rare, cutaneous angiosarcoma that develops in long-standing chronic lymphedema.
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DVT is the contraindication for surgery in varicose veins as superficial veins are only channel for drainage of venous blood .
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Ans. is 'b' i.e., Isoretinonine
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Ans-A ectopic pregnancy (Ref Dutta, 6/e, p 186 (5/e, p. 198, 4/e, pl98)).History of amenorrhoea and absence of gestational sac and collection of fluid in the pouch of Douglas leaves no doubt about the diagnosis of ectopic pregnancy.
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extranodal lymphomas can arise in viually any tissue, they do so most commonly in the gastrointestinal tract, paicularly the stomach Nearly 5% of all gastric malignancies are primarily lynphomas, the most common of which are indolent extranodal marginal zone B cell lymphomas- MALToma( mucosal associated lymphoid tissue). TEXT BOOK OF ROBBINS BASIC PATHOLOGY NINTH EDITION PAGE.571
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Some examples of sphingolipidoses Disease :Niemann-Pick disease Enzyme deficiency: Sphingomyelinase Lipid accumulating Sphingomyelin Clinical symptoms: Enlarged liver and spleen, mental.Ref: Textbook of Medical Biochemistry, Eighth Edition, Dr (Brig) MN Chatterjea, page no: 63 Table 4.2:
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Ans. is 'c' i.e., Facioscapulohumeral muscular dystrophy o The two most common forms of muscular dystrophy are X-linked: Duchenne muscular dystrophy and Becker muscular dystrophy. o Facioscapulohumeral muscular dystrophy is autosomal-dominant. o Emery-Dreifuss muscular dystrophy is X-linked.
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The mode
The mode is the value that occurs the most frequently in a data set.
For example the diastolic BP of 10 individuals 75, 71, 73, 84, 81, 75, 79, 75, 80, 90
The most frequently occurring value is 75, and therefore the mode.
If there are 2 most frequent value in the distribution, i.e., two modes → Bimodol distribution.
For example: For Hodgkin's lymphoma, there are two age groups around which most of the cases occur.
Advantage
Easy to understand and is not affected by extreme items (skewed deviation).
The concept of mode makes sense for nominal data (i.e., not consisting numerical values). For example, taking a sample of korean family names, one might find "Kim" occurs more often than any other name. Then "Kim" might be called the mode of the sample.
Disadvantage
Exact location is often uncertain and is often not clearly defined.
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Phenylalanine hydroxylase which conves phenylalanine to tyrosine is deficient in phenylketonuria. The most common cause of hyperphenylalaninemia is deficiency of the enzyme phenylalanine hydroxylase, which catalyzes the conversion of phenylalanine to tyrosine. Ref: Barsh G. (2010). Chapter 2. Genetic Disease. In S.J. McPhee, G.D. Hammer (Eds), Pathophysiology of Disease, 6e.
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Refer kDT 7/e p 641 Ezetimibe is a medication used to treat high blood cholesterol and ceain other lipid abnormalities. Generally it is used together with dietary changes and a statin. Alone, it is less preferred than a statin. It is taken by mouth. It is also available in the combination ezetimibe/simvastatin
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Recurrent laryngeal nerve supplies all intrinsic muscles of larynx except cricothyroid muscle which is supplied by superior laryngeal nerve (external laryngeal branch).
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Ref: Harpers Illustrated Biochemistry, 29th edition. Page no: 193.Explanation:Location of Glucose Transporters (GLUT] is frequently asked MCQ. GLUTs could be insulin dependent or independent. Please have a look at this table from Harper.TypeTissue locationFunctionsGLUT1Brain, kidney, placenta, RBCsUptake of glucoseGLUT 2Liver, pancreatic beta ceils, kidney, small intestine.Rapid uptake of glucose and release of glucoseGLUT3Brain, kidney, placentaUptake of glucoseGLUT 4Skeletal muscle, adepose tissue, heartInsulin stimulated uptake of glucoseGLUTSSmall intestineAbsorption of glucoseSGLT1Small intestine and kidneyActive absorption from small intestine as well as resorption from PCTNote: GLUT-4 is insulin dependent.Present in tissues which consume maximum glucose in our body like adipose tissue and skeletal muscles. GLUT-4 transporters will usually not present on the membranes they will be inside the cells.After insulin binds to the receptors on the membrane of these tissues there will be translocation of these GLUT 4s to the membrane to allow entry of glucose in to the cells. It doesn't happen in a person with insulin resistance.
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Hallucinogens (Psychotomimetics, psychedelics, psychotogens) are drugs which alter mood, behaviour, thought and perception in a manner similar to that seen in psychosis. These are as:1. Lysergic acid diethylamide (LSD) 2. Psilocybin3. Harmine 4. Bufotenin5. Mescaline (Phenyl alkyl amines) 6. Phencyclidine7. Lysergic acid amide.
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There is no epitheliunm on posterior surface.
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In Asthma FEV1(forced expiratory volume in 1 second), FVC(forced vital capacity, is the total volume exhaled), FEV1/FVC decreases. To daignose Asthma: Compatible clinical history plus either : 1)FEV1>12% increase following administration of a bronchodilator or glucocoicoids. 2)FEV1>15% decrease after 6min of exercise 3)>20% diurnal variation on >3days in a weeks on PEF(peak expiratory volume). Reference : Davison, 23rd Edition, page no : 569,555
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Verrucous carcinoma is a low grade malignancy and is seen more frequently in the southern pa of the United States. It is found most commonly on the gingival buccal junction in tobacco chewers. It is grayish white and exophytic. wide local excision is Treatment of choice .Radiation may be tried for very large lesions.If not excised, the lesion tends to invade locally
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Ans. is 'd' i.e., Obscuration of disc margins Ophthalmoscopic signs of papilloedemao The blurring of disc margin (first sign)o Venous Engorgement, congestion, loss of pulsationo Hyperemia of the disc with capillary dilatation.o Filling of the physiological cup with gradual obliteration of physiological cup.o Gradual elevation of the disc (mushroom or dome-shaped) with sharp bending of vessels over its margins.o Cotton- wool spots (soft exudates) and both flame shaped (superficial) and punctate (deep) hemorrhageso Macular fan or macular star due to hard exudates.o Late findings in long-standing ( vintage) papilloedemaMarkedly elevated disc with champagne cork appearance, post neuritic optic atrophy.corpora amylacea deposits on disc margin, generalized retinal pigmentation.
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Causes of contracted kidneys ; Chronic glomerulonephrits Benign nephrosclerosis Chronic pyelonephrits
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Perisinusoidal space of Disse is seen in liver.
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Lesions of optic tract: These are characterised by incongruous homonymous hemianopia associated with contralateral hemianopic pupillary reaction (Wernicke's reaction). These lesions usually lead to paial descending optic atrophy and may be associated with contralateral third nerve paralysis and ipsilateral hemiplegia. Common causes of optic tract lesions: Include syphilitic meningitis or gumma, tuberculosis and tumours of optic thalamus and aneurysms of superior cerebellar or posterior cerebral aeries. Ref:- A K KHURANA; pg num:-290
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"A corneal dystrophy is classically bilateral, progressive, and isolated to the cornea. The disorder is inherited, characteristically in a dominant fashion, and often appears clinically to involve only one layer of the cornea "...Yanoff
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Ans. is 'd' i.e., Cg T, KIAMPKE'S PARALYSISo Site of injury : Lower trunk of the brachial plexuso Cause of injury : Undue abduction of the arm, as in clutching something with the hands after a fall from a height, or sometimes in birth injury.o Nerve roots involved : - Mainly T1 and partly C8.o Muscles paralysedi) Intrinsic muscles of the hand (T1).Ulnar flexors of the wrist and fingers (C8).Deformity (position of the hand). Claw hand due to the unopposed action of the long flexors and extensors of the fingers. In a claw hand there is hyperextension at the metacarpophalangeal joints and flexion at the interphal angeal joints.o Disability'Claw handCutaneous anaesthesia and analgesia in a narrow' zone along the ulnar border of the forearm and hand,Homer's syndrome if T1. is injured proximal to white ramus communicans to first thoracic sympathetic ganglion. There is ptosis, miosis, anhydrosis, enophthalmos, and loss of ciliospinal reflex-may be associated. (This is because of injury to sympathetic fibres to the head and neck that leave the spinal cord through nerve T1).Vasomotor changes : The skin area with sensory loss is warmer due to arteriolar dilation. It is also drier due to the absence of sweating as there is loss of sympathetic activity.Trophic changes : Long standing case of paralysis leads to dry and scaly skin. The nails crack easily with atrophy of the pulp of fingers.
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In competitive inhibition, Drug binds to enzyme only .So, Velocity remains unchanged and Conc- km increases. In non- competitive inhibition, drug binds to enzyme substrate complex deceasing velocity unaffecting km. Ref: K.D.Tripati.7th ed. Pg 39
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P mirabilis and Proteus vulgaris share the ability to swarm over the surface of media, rather than remaining confined to discrete colonies. This characteristic makes them readily recognizable in the laboratory--often with dismay because the spreading growth covers other organisms in the culture and thus delays their isolation. Swarming along with motility could facilitate the production of UTIs by movement of Proteus up urinary catheters. Ref: (2010). Chapter 33. Enterobacteriaceae. In Ryan K.J., Ray C (Eds), Sherris Medical Microbiology, 5e.
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Anatomical snuff box boundaries: Lateral wall Abductor pollicis longus Extensor pollicis brevis Medial wall Extensor pollicis longus Roof Cephalic vein Sup branch of radial nerve Floor Radial styloid, scaphoid, trapezium,1st meta carpal Content Radial Aery Ref: Gray's Anatomy The Anatomical Basics of Clinical Practice 41 e pg 893.
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Ref: CMDT 2013, Pg 1417-1418Explanation: Kawasaki Disease (mucocutaneous lymphnode syndrome):Autosomal DominantAutosomal RecessiveX- linked dominantX-linked recessiveHuntington's disease, Neurofibromatosis type 1, Myotonic dystrophy, Tuberous sclerosis, PCKD, Familial polyposis edi, Hereditory spherocytosis, Von Wiflebrard disease. Marfan's, Osteogenesis imperfecta, achondroplasia, Familial hypercholesterolemia. Acute intermittent porphyriaHemochromatosis, cystic fibrosis, a-1 antitrypsin deficiency, thaiass emia, sickle cell anemia, CAH. F reidrick's ataxia, spino muscular atrophy. alkaptonuria, Wilson's disease. homocystinuriaVit-D resistant rickets Fragile X syndrome Alports, Charcot-marie tooth diseaseRett syndromeBeckers & Duchen's MD, Haemophila A & B,Fabry's diseaseLesch NyhanHunter's, Menke's Wiskott-AldrichColor blindnessG6PD deficiencyY - linked inheritance: Hairy pinnaMultisystem, medium vessel vasculitisChildren 3monihs-5yrsInfectious agents implicated- Corona virus, parvovirus, bocavirus, CMV, y.pseudotuber- culosis, meningococcusFever + 4 of the following for 5 days:1. Bilateral nonexudative conjunctivitis2. Mucous membrane -injected pharynx, erythema, swelling & fissuring of the lips, strawberry tongue3. Peripheries- edema, desquamation, erythema of the palms & soles, induration of hands & feet. Beau lines4. A polymorphous rash5. Cervical Ivmphadenopathy >1.5 cmRemember:Thrombocytosis may be present. Not ThrombocytopeniaCoronary vessel arteritis & aneurysms. MIEspecially in males, high fever, high CRP. anemiaHypoalbuminemia, hyponatremia, urticariaTreatment- IVIG, AspirinTNF blockers-linfliximab, Etanercept.Cyclophosphamide, methotrexate, plasmapheresisSurgical correction of the coronary aneurysms, oral anticoagulation in large aneurysms.Types of vasculitis:1. Ijargc vessel vasculitis:Takayasu's arteritisGiant cell arteritis2. Medium vessel vasculitis:Polyarteritis Nodosa (PAN)Kawasaki disease3. Small vessel vasculitis:Microscopic poly angitisWegner's granulomatosisChurg-Strauss syndromeHenoch Schoniein Purpura (HSP)Mixed essential cryoglobulinemia
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Saint's triad is a medical condition in which there is concurrence of gallstones,hiatus hernia,diveiculosis of colon. Reference:SRB's manual of surgery,5th edition,page no:641.
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Ans. D. THE entire range of regulation shifts to higher pressuresThe autoregulatory range is shifted to higher pressures because the arteries and arterioles increase their resistance. The functional and structural changes increase the arterial pressure at which autoregulation of blood flow occurs, but increase the lowest pressure at which blood flow can be maintained.
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pH < 7.35 and PaCO2 < 40 mm Hg indicate metabolic acidosis
pH < 7.35 and PaCO2 > 40 mm Hg signify respiratory acidosis
pH > 7.45 and PaCO2 > 40 mm Hg indicate a metabolic alkalosis
pH > 7.45 and PaCO2 < 40 mm Hg signify respiratory alkalosis
The pH is > 7.35 Therefore, it is a case of alkalosis.
The PaCO2 is > 40 mm Hg; Therefore, the process is metabolic alkalosis. (pH > 7.45 and PaCO2 > 40 mm
Hg indicate a metabolic alkalosis) This is confirmed by the bicarbonate level (32 mEq/L)
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Ans. is 'B' i.e., TrK-B
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To prevent dehydration of periosteal surface of the flap, it should be irrigated frequently with saline (0.9% NaCl), and not with water, as it is hypotonic.
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'a' i.e. Lyme's disease
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Pyruvate kinase deficiency would be most likely cause of patient's anemia | lactate production in the erythrocyte indicates a defect in glycolysis. Pyruvate kinase deficiency 2nd most common cause (after glucose 6-phosphate dehydrogenase deficiency) of enzyme deficiency related to hemolytic anemia. In G6PD deficiency - Heinz bodies
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