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Ans. is 'a' i.e., Brachiradialis Cubital fossaLateral boundryBrachioradialisMedial boundryPronater teresBaseLine joining the two epicondyles of humerusApexPoint joining lateral and medial boundriesFloorBrachialis, supinatorRoofSkin, superficial fascia (containing medial cubital vein, lateral and medial cutaneous nerve of forearm), deep facia, bicipital aponeourosisCONTENTS* Median nerve* Brachial artery termination and begining of radial and ulnar arteries.* Biceps tendon* Radial nerve and* Radial collateral artery
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Ans. is 'd' i.e., Unstable compound on storage Bleaching powder o Bleaching powder or chlorinated lime is white amorphous powder with pungent smell of chlorine. o It contains about 33% of available chlorine. o Used for disinfection of water, feces, & urine, and as a deodorant. o 5% solution is suitable for disinfection of faeces and urine allowing a period of one hour for disinfection. o Action is rapid but brief. o The chief drawback is that it is an unstable compound and loses its chlorine content on storage.
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The pneumococcus is the most common cause of adult meningitis. In the immunocompromised patient, however, gram-negative meningitis with Pseudomonas is seen. Haemophilus influenzae is the most common cause in children over a month old. Staphylococcal meningitis is seen with penetrating head wounds. Ref: Brooks G.F. (2013). Chapter 16. Pseudomonads, Acinetobacters, and Uncommon Gram-Negative Bacteria. In G.F. Brooks (Ed), Jawetz, Melnick, & Adelberg's Medical Microbiology, 26e.
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Depressors of mandible are :-
Muscle of mastication : Lateral pterygoid (major depressor).
Suprahyoid muscles : Digastric, mylohyoid, geniohyoid.
Elevators of mandible are :-
Muscles of mastication : Masseter, temporalis, medial pterygoid.
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Galtons system or dermatoglyphics is study of impressions formed by papillary ridges of fingeips. It was first used in India by William Herschel and modified by Sir Francis Galton ref :.Dr.K.S.Narayana Reddys Synopsis of Forensic Medicine & Toxicology 27th edition pg. 47.
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Superior oblique muscle/obliquus oculi superiorIt is a fusiform muscle originating in the upper, medial side of the orbit which abducts, depresses and internally rotates the eye.It is the only extraocular muscle innervated by the trochlear nerve (the fouh cranial nerve).
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Ans. is 'a' i.e., Amilorides
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a1-Antitrypsin deficiency Autosomal recessive disorder of protein folding marked by very low levels of circulating a1-Antitrypsin (a1AT). Neonatal hepatitis with cholestatic jaundice appears in 10% to 20% of newborns with the deficiency. In adolescence, presenting symptoms may be related to hepatitis, cirrhosis or pulmonary disease (emphysema).
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Ans. A. Renal vessels* Amyloid is abnormal pathological protein resulting from improper folding of proteins and deposited extracellularly as fibrils and disrupt their normal function.* The most common site of deposition is kidney, followed by, liver, spleen, lymph nodes, adrenals, thyroid, GIT, heart etc.* In systemic amyloidosis, any organ can show deposition of Amyloid. Among all organs, kidneys are most commonly and most seriously get affected by Amyloidosis.
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Meconium ileus in the newborn represents the earliest clinical manifestation of CF and affects roughly 15% of patients with this inherited disease Cystic FIbrosis Diagnosis The diagnosis of CF is usually confirmed in the postoperative period The pilocarpine iontophoresis sweat test revealing a chloride concentration >60mEq/L is the most reliable and definitive method to confirm the diagnosis of CF. This test may not be reliable in infants and is usually performed later. A more immediate test includes detection of the mutated CFTR gene. This test, coupled withh a careful family history and clinical presentation, permits confirmation of the diagnosis in most infants Ref: Sabiston 20th edition Pgno: 1875
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Ans. (b) Oral cavity of patient for intubation* Mallampati score, also known as Mallampati classification is used to assess the oral cavity of patient to predict the ease of intubation.* It is assessed by looking at the anatomy of the oral cavity; specifically, it is based on the visibility of the base of soft palate, uvula, fauces, and pillars.* A high Mallampati score (class 3 or 4) is associated with more difficult intubation as well as a higher incidence of sleep apnea.MODIFIED MALLAMPATI SCORING* Class I: Soft palate, uvula, fauces, pillars visible.* Class II: Soft palate, uvula, fauces visible.* Class III: Soft palate, base of uvula visible.* Class IV: Only hard palate visible
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Oesophageal opening
- Level- T10
- At muscular portion derived from right crus
- Structures transmitted
Oesophagus
Oesophageal branch of the left gastric artery
Vagus nerve
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Sequence of Events Involved in the Activation of Plasminogen
During intravascular clotting, the endothelium of the blood vessel secretes a thrombin-binding protein, the thrombomodulin. It is secreted by the endothelium of all the blood vessels, except the minute vessels of brain.
Thrombomodulin combines with thrombin and forms a thrombomodulin-thrombin complex.
Thrombomodulin-thrombin complex activates protein C.
Activated protein C inactivates factor V and VIII in the presence of a cofactor called protein S.
Protein C also inactivates the t-PA inhibitor.
Now, the t-PA becomes active.
Activated t-PA and lysosomal enzymes activate plasminogen to form plasmin. Plasminogen is also activated by thrombin and u-PA.
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Most common organisms in infants and young children are Streptococcus pneumonia (30 c/o ), Haemophilus influenza(20%) and Moraxella catarrhalis(12%). Other organisms include Streptococcus pyogenes, Staphylococcus aureus and sometimes Pseudomonas aeruginosa. (Ref: Textbook of diseases of ENT, PL Dhingra, 7th edition, pg no. 67)
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Ans. is 'a' i.e., Increases HDL Nicotinic acid (Niacin) There arc three main type of lipases related to metabolism of lipoproteins ? Lipoprotein lipase - Present in blood vessels and causes hydrolysis of tryglyceride content of VLDL and chylomicrones. Hepatic lipase - Conves IDL to LDL by hydrolysing the triglyceride content of IDL. Hormone sensitive lipase - Present intracellularly in peripheral tissue and causes intracellular lipolysis by hydrolysing triglycerides. Niacin (Nicotinic acid) inhibits intracellular lipolysis by inhibiting hormone sensitive lipase - intracellular FFA to liver - 4 .1, triglyceride synthesis. Niacin also increases the activity of lipoprotein lipase - T hydrolysis of VLDL triglyceride. Nicotinic acid also reduces the production of VLDL in liver by inhibiting TG-synthesis - indirectly the VLDL degradation products IDL and LDL are also reduced. Nicotinic acid is the most effective drug to raise HDL-CH. Increased HDL is due to interference of direct pathway of HDL cholesterol to liver which involves apo-Ai - Niacin decreases apo- A, mediated hepatic clearance. Nicotinic acid is used in type I, III, IV & V hyperlipoproteinemias.
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following a single massive imfection the p24Ag is the earliest marker appear in blood REF:MICROBIOLOGY ANANTHA NARAYANAN NINTH EDITION PAGE.577
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Ans. A. Increase the lower esophageal sphincterMetoclopramide is prokinetic drug. It acts on D2 and 5Ht3 receptor. There is increase in acetylcholine level and there is increase in LES and gastric motility.
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Clinical findings stem mainly from:
The effects of plasma cells on the skeleton.
The production of excessive immunoglobulins, which often have abnormal physicochemical properties.
The suppression of humoral immunity.
Bone resorption often leads to pathologic fractures and chronic pain. The attendant hypercalcemia can give rise to neurologic manifestations, such as confusion, weakness, and lethargy, and contributes to renal dysfunction. Decreased production of normal immunoglobulins sets the stage for recurrent bacterial infections. Of great significance is renal insufficiency, which trails only infections as a cause of death.
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Ans. a (2.0) (Ref. Park PSM 22nd/pg. 443)Relation between growth rate and population:RatingAnnual rate of growth %Number of years required for the population to double in sizeStationary populationNo growth Slow growthLess than 0.5More than 139Moderate growth0.5 to 1.0139-70Rapid growth1.0 to 1.570-47Very rapid growth1.5 to 2.047-35"Explosive" growth2.0 to 2.535-28"Explosive" growth2.5 to 3.028-23
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Ans. is 'c' i.e., Serial interval Latent period, serial interval and generation time, all are approximate measure of incubation period, i.e., these period can give some idea about incubation period. Latent period The period from disease initiation to disease detection. It is used in non-infectious disease as the equivalent of incubation period in infectious disease. Serial interval The gap time between onset of primary case and secondary case. By collecting information about a whole series of such onset, we get a distribution of secondary cases from which we can guess the incubation period. Generation time Interval between receipt of infecton by host and maximal infectivity of the host. Generation time is roughly equal to the incubation period. About option 'b' Communicable period The time during which an infectious agent may be transferred directly or indirectly from an infected person to another person. The period of communicability has no relation with incubation period, it merely reflects the duration when the infectious agent may be transferred. This may occur during incubation period, during actual illness or during convalsescence. Generally communicable diseaes are not communicable in incubation period except - measles, Chicken pox, Peussis hepatitis A, i.e., these diseases are communicable during their late incubation period.
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Alginate
The freshly spatulated material has low viscosity, although this can be varied to some extent by alterations in the amount of inert filler incorporated by the manufacturer. The low viscosity, coupled with a degree of pseudoplasticity, classifies alginates as mucostatic impression materials. They are able to record soft tissues in the uncompressed state. For some applications low viscosity may be a disadvantage, for example, when trying to record the depth of the lingual sulcus. A higher viscosity is required to displace the lingual soft tissues in order that the full depth can be recorded.
Materials which are initially very fluid are often classified as mucostatic impression materials because they are less likely to compress soft tissues, whilst materials which are initially more viscous are classified as mucocompressive.
KEY CONCEPT:
Alginate impression material is less mucostatic than ZOE.
Reference: Applied Dental Materials Ninth Edition McCabe and Walls; page no :159, 136
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Cobalt units produce stable, dichromatic gamma beams of 1.17 and 1.33 MeV, resulting in an average beam energy of 1.25 MeV. The cobalt-60 isotope has a half-life of 5.3 years Reference: Eric J Hall Textbook of Radiobiology for Radiologist; 5th edition
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Sezary disease is a type of cutaneous lymphoma that was first described by Albe Sezary. The affected cells are T-cells (so it is a T-cell lymphoma) that have pathological quantities of mucopolysaccharides. Sezary disease is sometimes considered a late stage of mycosis fungoides with lymphadenopathy. There are currently no known causes of Sezary disease.Sezary syndrome and mycosis fungoides are T-cell lymphomas whose primary manifestation is in the skin. The disease's origin is a peripheral CD4+ T-lymphocyte,] although rarer CD8+/CD4- cases have been observed. Epidermotropism by neoplastic CD4+ lymphocytes with the formation of Pautrier's microabscesses is the hallmark sign of the disease.[ The dominant symptoms of the disease are: Generalized Lymphadenopathy Atypical T-cells ("Sezary cells") in the peripheral blood Hepatosplenomegaly
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Ans. is 'a' i.e., Zero order kinetics
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Surgery
Orthopedic, thoracic, abdominal andgenitourinary procedures
Neoplasms
Pancreas, lung, ovary, testes, urinary tract, breast, stomach
Trauma
Fractures of spine, pelvis, femur, or tibia; spinal cord injuries
Immobilization
Acute myocardial infarction, congestive heart failure,stroke,postoperative convalescence pregnancy
Estrogen
For replacement of contraception;
selective estrogen replacement modulators Hypercoagulable states
Resistance to activated protein C, prothrombin or2021OA gene mutation
deficiencies of antithrombin ill, protein C, or protein S; antiphospholipid antibodies; myeloproliferative diseases;
dysfibrinogenemia;
Venulitis
Thromboanglitis obliterans, behpet's disease, homocysteinuriaq
previous deep vein thrombosisldiopathic
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This patient has a classic presentation of an acute community acquired bacterial pneumonia, as demonstrated by the findings of acute onset of fevers, rigors, and a productive sputum. His physical examination is consistent with a right lower lobe pneumonia and consolidation in this region. A sputum Gram's stain may demonstrate the organism responsible for this patient's pneumonia. The next step would then be a chest x-ray to confirm the presence of a pneumonia and identify its size and any associated parapneumonic effusions. A chest x-ray film is also indicated, but may take an hour or more to actually be obtained. For this reason, collecting sputum for a Gram's stain, before the x-ray, may shoen the time to definitive therapy. Chest CT scan is usually reserved for evaluation of suspected masses. Pulmonary function tests and peak expiratory flow rate measurement are usually reserved for evaluation of chronic lung diseases, such as emphysema, chronic bronchitis, pulmonary fibrosis, and asthma. Ref: Leeper, Jr. K.V., Moss M. (2003). Chapter 36. Bacterial Pneumonia. In M.E. Hanley, C.H. Welsh (Eds), CURRENT Diagnosis & Treatment in Pulmonary Medicine
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Ans: b (Smooth muscle)Ref: Ganong, 21st edi., Pg. 70-84Ca influx in smooth muscle is mainly via Ca channels unlike skeletal and cardiac muscle where most of the calcium comes from sarcoplasmic reticulum.This is the reason why after taking calcium channel blockers there is on smooth muscle relaxation (arterial vessel) rather than skeletal and cardiac muscle.Summary of smooth muscle contractionAction potential causes release of stored Ca which thenbinds to calmodulin and activates the calmodulin dependentmyosin light chain kinase.It phosphorylates myosin. Phosphorylation of myosin is essential for contraction.In smooth muscles, troponin is not required for contraction.
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The Galvanic Skin Response (GSR), also named Electrodermal Activity and Skin Conductance , is the measure of the continuous variations in the electrical characteristics of the skin, i.e. for instance the conductance, caused by the variation of the human body sweat glands. Ref guyton and hall textbook of medical physiology 12/e p73
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Parafolliculor cells derived from neural crest and ultino - brachail body.
Neural crest is the best option.
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Nilotinib is a tyrosine kinase inhibitor given in CML. This is a case of metastatic renal cell carcinoma with cannon ball metastasis in lungs. Chest x-ray shows multiple, bilateral, rounded soft tissue density massessuggestive of cannon ball metastasis in renal cell carcinoma. CT image shows the classical renal cell carcinoma. HPE image is classical of clear cell renal carcinoma. DRUGS APPROVED FOR RENAL CELL CARCINOMA: - Cytokines: - High dose interleukin-2, Interferon-alpha Tyrosine kinase inhibitors: - Sorafenib, Sunitinib, Pazopanib, Axitinib, Carbozantinib, Lenvatinib VEGF ligand antibody: - Bevacizumab mTOR inhibitors: - Temsirolimus, Everolimus PD-1 inhibitor: - Nivolumab
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Chassarmoir technique Used for repair of vesicovaginal Fistula Technique: Flap splitting method Bladder and vaginal are widely separated and sutured in two layers Ref: SHAW&;S TEXTBOOK OF GYNECOLOGY; 15th edition; Pg no:187
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Trichuris humans acquire the infection by eating foods contaminated with infective eggs. Once eggs are swallowed, the larvae hatch in the small intestine, where they mature and migrate to the colon. Trichuris infections with a low worm burden are usually asymptomatic, but infections of moderate to heavy worm loads present with lower abdominal pain, distention, and diarrhea. Severe infection may lead to profuse bloody diarrhea, cramps, tenesmus, urgency, and rectal prolapse. Occasionally worms migrate to the appendix, causing appendicitis. Jawetz microbiology 27e 724.
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Ans. Butch
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Cryptosporidium induces severe and protracted diarrhea in AIDS patients.
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Ans. is 'a' i.e. Rifampicin
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Severity of event or accident is the most impoant predictor for development of PTSD.
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Schwaz says "Because the majority of Colorectal cancers are thought to arise from Adenomatous polyps, preventive measures focus upon identification and removal of these premalignant lesions. In addition, many cancers are asymptomatic and screening may detect these tumors at an early and curable stage American cancer society Recommendations for early detection of cancer in Average - Risk, Asymptomatic individuals Cancer site - Colorectal Population to be screened - Men and women aged >= 50 years Test or procedure - Fecal occult blood test(FOBT( or fecal immunochemical test (FIT) Flexible sigmoidoscopy FOBT and Flexible sigmoidoscopy Double - Contrast barium enema (DCBE) Colonoscopy Frequency Annual, staing at age 50 Every 5 years, staing at age 50 Annual FOBT, (or FIT) and flexible sigmoidoscopy every 5 years, staing at age 50 DCBE every 5 years, staing at age 50 Colonoscopy every 10 years, staing at age 50 Ref: Harrison's 19th edition Pgno : 481 Schwaz 10th edition Pgno : 298
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The receptors for several protein hormones like insulin are themselves protein kinases which are switched on by binding of hormone.The kinase activity associated with such receptors results in phosphorylation of tyrosine residues on other proteins.Insulin is an example of a hormone whose receptor is a tyrosine kinase.Ref: DM Vasudevan, 7th edition, page no: 656, 318, 323
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Deduction of 1D for lm and 1.5D when retinoscopy is performed at 2/3rd m (67 cm) distance.
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The increased vascular permeability is the hallmark of the disease. Diagnostic criteria include acute onset, PaO2 /FiO2 < 200 mm Hg (regardless of positive end-expiratory pressure level), bilateral infiltrate on frontal CXR, and pulmonary artery occlusion pressure < 18 mmHg (or if not measured, no evidence of left atrial hypertension).
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Formation of bag of waters is almost a ceain sign of onset of labour. During dilatation of the cervical membrane the unsuppoed lower pole of the fetal membranes tends to bulge into the cervical canal. It is called bag of waters when this bulging membrane contains amniotic fluid. When uterine contractions occur this bag becomes tense and convex, and it disappears when the contraction passes off. Features of true labour pains: Occurrence of painful uterine contractions at regular intervals Contraction with increasing intensity and duration Show Progressive effacement and dilatation of cervix Formation of bag of waters Ref: Textbook of Obstetrics By D.C Dutta, 6th edn, page 117.
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Ans. is 'a' i.e., Henoch Schonlein purpura o There is deposion of IgA, sometimes with IgG and C3, in the mesangial region in HSP.o IgA is deposited in the glomerular mesangium in a distribution similar to that of IgA nephropathy. This has led to the concept that IgA nephropathy and Henoch-Schonlein purpura are spectra of the same disease.
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Horner’s syndrome is caused by damage to the sympathetic trunk.
The symptoms occur on the same side as the lesion of the sympathetic trunk.
It is characterized by
Miosis (a constricted pupil),
Ptosis (drooping of eyelids due to weakness of superior tarsal muscle which is a part of levator palpebrae superioris)
Apparent enophthalmos (ptosis due to weakness of orbicularis oculi makes it appear that the eyes are sunken in enophtalmos, exophthalmos doesn’t occur in Horner’s syndrome),
Anhidrosis (decreased sweating) and
Loss of cilio-spinal reflex (pinching nape of neck leads to pupillary dilation).
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Chromoblastomycosis - histological they appear as yeast like bodies and septate, called as sclerotic bodies. Botryomycosis - caused by staph aureus, clinically resembling mycetoma. Ref: Textbook of Microbiology, Ananthanarayan and Paniker; 9th edition
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(Type II) (161 -AN7th) (201-CP)Type II reaction - The antibody is directed against an epitope that can be microbial product passiely adsorbed on to a cell or a drug or a self molecule. Both IgG and IgM antibodies are produced in type II reaction. The antibody attaches to the antigen via Fab region of Ab. As a result, Type II reaction may be complement mediated lysis of cells as occurs in Autoimmune hemolytic anemia, ABO transfusion reaction or Rh haemolytic disease.Examples1. Isoimmune reaction - such as ABO transfusion reactions Eiythroblastosis foetalis2. Autoimmune reaction - Autoimmune haemolytic anemia, agranulocytosis or thrombocytopenia.
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Intellectual Disability (ID), formerly known as Mental retardation. ID is defined as a disability characterised by significant limitations in both intellectual functioning and in adaptive behaviour that emerges before the age of 18 years. Wide acceptance of this definition has led to the international consensus that an assesment of both social adaptation and intelligenc quotient (IQ)are necessary to determine the level of intellectual disability. Ref: Synopsis of Psychiatry, 11e, pg 1118
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Stage III of anaesthesia is also called stage of surgical anaesthesia because most surgeries are done in this stage.
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There is hypertension.
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ANSWER: (B) Venous bleedingREF: Textbook of Forensic Medicine and Toxicology by Nagesh Kumar Rao Page 252Antemortem Vs Postmortem injury: AntemortemPostmortemHemorrhageArterialVenousLaminatedNot laminatedFirmly adherentWeakly adherentFirm rubbery variegatedSoft friable, chicken fat tikeDeep stainingSuperficial stainingCannot wash awayCan be washed awayEdges & MarginsGaping presentNo gapingMargins evertedMargins apposedSwollenNot swollenVital reactionInflammation presentNo inflammationInfection (pus) presentNo PusHealing (granulation) presentHealing absentWound serotonin & histamineIncreasedNot increasedMicrobiologyClot has plateletsClot lacks platelets Infiltration of RBC, LeucocytesNo infiltration
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selenium def cause cardiomyopathy in children known as Keshan's disease which is endemic cardiomyopathy Ref Harrison 20th edition pg 99e
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Ans: b) PancreasDuring development some organs grow into the peritoneal cavity and become intraperitoneal. Eg: Stomach, small intestine, liver, spleenSome organs develop behind the peritoneum and are called retroperitoneal organs like ureters and kidneySecondarily retroperitoneal organs are part of gastrointestinal tract begin as intraperitoneal organs then become attached to the abdominal wall during development. These are duodenum, pancreas, ascending colon and descending colon.INTRAPERITONEALRETROPERITONEALEsophagusDuodenumStomachPancreasJejunumAscending colonIleumDescendin colonCaecumUretersAppendixKidneySigmoid colonTransverse colon
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The apnea observed in this patient following her removal from the ventilator resulted from a lowered cerebrospinal fluid carbon dioxide tension (PCO2), which, in turn, reduced central chemoreceptor activity. Doubling the frequency of breathing while maintaining the tidal volume doubles alveolar ventilation, according to the formula:VA = (V T - VD) f,where VA is the alveolar ventilation per minute, VT is the tidal volume, VD is the volume of the dead space, and f is the frequency of breathing.Increasing alveolar ventilation increases the aerial oxygen tension (Pao2) and lowers the aerial and cerebrospinal fluid PCO2. It is the low cerebrospinal fluid PCO2 and the concomitant alkalosis in the cerebrospinal fluid that is responsible for the apnea observed after periods of hyperventilation. Ventilation resumes after the cerebrospinal fluid PCO2 increases and returns the cerebrospinal fluid pH to normal. The peripheral chemoreceptors are relatively inactive at a normal Pao2 of 100 mm Hg. Hyperventilating and raising the Pao2 does little to influence the peripheral chemoreceptors and, therefore, ventilation.
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Ans. Nitrocellulose
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Diagnostic criteria for diabetes include:1. A fasting plasma glucose >= 126 mg/dL, 2. A random plasma glucose >= 200 mg/dL (in a patient with classic hyperglycemic signs, as discussed later), 3. 2-hour plasma glucose >= 200 mg/dL during an oral glucose tolerance test (OGTT) with a loading dose of 75 gm, and4. A glycated haemoglobin (HbA1C) level >= 6.5%Impaired glucose tolerance (prediabetes) is defined as:1. A fasting plasma glucose between 100 and 125 mg/dL2. 2-hour plasma glucose between 140 and 199 mg/dL following a 75-gm glucose OGTT, and/or3. A glycated haemoglobin (HbA1C) level between 5.7% and 6.4%Robbins pathology pg: 1106
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Prophylactic administration of oral probiotics given to preterm infants reduces the incidence and severity of Necrotizing Enterocolitis'. Ref: Nelson 18th Edition, Page 1618
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- HELLP syndrome is a complication of severe pre-eclampsia, happening during Third trimester ,characterized by Hemolysis (characterized by schistiocytes in blood film, Bilirubin = 1.2 mg/dl, absent plasma haptoglobin) Elevated liver enzymes (SGOT > 72 IU/L) low platelet count < 1 lakhs
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.
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Medial surface of each tonsil has 15-20 crypts, the largest of which is called Intratonsillar cleft or crypta Magna (which represents the persistence of the ventral poion of the second pharyngeal pouch)'.Ref: PL Dhingra, Diseases of Ear, Nose & Throat, 7th edition, pg no. 291
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*The H reflex is basically an electrophysiologically recorded Achilles' tendon stretch reflex. *It is performed by stimulating the tibial nerve in popliteal fossa. *It is recorded over the soleus or gastrocnemius muscle. *It is used most commonly to evaluate S1 radiculopathy or to distinguish it from an L5 radiculopathy. REF:Ref: Text book of Neurology p.781
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Four components of RCH programme are
Family planning;
Child survival and safe motherhood:
Client approach to health care, and
Prevention of RTT/STD/AIDS. Reproductive and Child health Programme
RCH programme was launched in October 1997.
Reproductive and child health approach has been defined as : -
People have the ability to reproduce and regulate their fertility'.
Women are able to go through pregnancy and child birth safety.
The Outcome of pregnancies is successful in terms of maternal and infant survival and well being.
Couples are able to have sexual relaons free of fear of pregnancy and of contracng disease, o RCH phase I programme incorporated the following components.
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Due to fixity of urethra to adjacent structure membrnous urethra rupture.
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Pulpal Necrosis
As stated before, pulp is encased in rigid walls, it has no collateral blood circulation, and its venules and lymphatics collapse under increased tissue pressure. Therefore irreversible pulpitis leads to liquefaction necrosis
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The thoracic duct is the largest lymphatic vessel in the body.It extends from the upper pa of the abdomen to the lower pa of the neck,crossing the posterior and superior pas of the mediastinum.It is about 45 cm long.It has a beaded appearance because of the presence of many valves in its lumen. It begins as a continuation of the upper end of cisterna chyli near the lower border of the twelth thoracic veebra and enters the thorax through the aoic opening of the diaphragm. <img src=" /> REF.B D Chaurasia's human anatomy vol.1,fifth edition.pg 270
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Type IV is total obstruction of the OS and hence C.S is the only method of termination Breech, Previous CS and Mento-anterior face can all deliver vaginally when conducted in an institute by an experienced obstetrician
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Ans. is 'c' i.e., Atheroma
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(B) Vitamin D resistant rickets # X-linked Dominant:; Amelogenesis imperfects; Bipolar depressive psychosis; Goltz's syndrome; hypophosphatemia; Oral-facial- digital syndrome; Vitamin D resistant rickets.
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Ans. is 'a' i.e., Clunk of entry on abduction and flexion of hip Clinical tests for CDH/DDH In infancy two tests are used. Barlow's test This test is done within 2-3 days of bih. The test has two pas :? Pa 1 :- Infant is in supine position with hip and knee in 90deg of flexion, The hip is slowly adducted & pushed to dislocate the hip and one can hear a clunck of exit of femoral head out of the acetabulum. Pa 2 :- Now the hip is gentely abducted and pulled to reduce the hip. This will cause 'clunk' indicating reduction of hip. It is quite obvious that pa 1 can be done only dislocatable hip; but not in already dislocated hip as the head is already out of the acetabulum. Oolani's test This test is similar to 2nd pa of Barlow's test, i.e. slow abduction of hip in flexed position of hip & knee to reduce the hip.
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Analyse each option:- Nutritionally non-essential amino acids can be synthesised in the body. So, their absence from the diet in proteins is not deleterious to human health - option a is correct statement. Selenocysteine is present in Thioredoxin reductase, Glutathione peroxidase, 5' deiodinase, Selenoprotein P - option c is correct statement. Oxaloacetate and alpha ketoglutarate are precursors of aspaate and glutamate. 3-phosphoglycerate is the precursor of serine which in turn can produce glycine - option d is also correct. We are left with option b. Tetrahydrobiopterin is needed for tyrosine biosynthesis, not for tryptophan. Moreover, tryptophan cannot be synthesized in human body!
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Drug Action Thiopentone Decreases systemic vascular resistance, |BP,|HR,myocardial depression Propofol Decreases systemic vascular resistance,|BP, |HR, myocardial depression Etomidate CVS stable, adrenal insufficiency Ketamine In the presence of catecholamines it |HR, |BP
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Out of the given options, injury to bladder neck and hypogastric plexus are associated with hysterectomy which can lead to urinary retention Injury to the bladder neck can result in a retention or even incontinence, but the more common cause is the injury to the hypogastric plexus of nerves with carries the efferents for bladder control
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Ans. (a) Cotrimoxazole* VUR is the MC inheritable disease of genitourinary tract* Autosomal dominant.* 75% cases are asymptomatic.* MCU is the IOC* DOC for VUR for prophylaxis - Table t- Septran (Clotrimoxazole) for age > 6 weeks.* For age < 6 weeks - Amoxycillin is given.* Surgical Management - Ureteric reimplantation or STING (Subureteric transurethral injection of Teflon paste)
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Insulin signals the cells of insulin-sensitive peripheral tissues, primarily skeletal muscle, to increase their uptake of glucose.Secondly, insulin acts on the liver to promote glycogenesis.Finally, insulin simultaneously inhibits glucagon secretion from pancreatic a-cells, thus signalling the liver to stop producing glucose glycogenolysis and gluconeogenesis Ref: DM Vasudevan, 7th edition, page no: 165, 318, 323
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Chest x-ray in VSD
Pulmonary vasculature is increased → Pulmonary plethora (not oligemia).
Aorta is normal or smaller
Left atrial enlargement
If defect is small Normal sized heart.
If defect is large → Cardiomegaly.
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The elaboration of H-Y antigen complex in the sho arm of Y chromosome is known as sex determining region(SRY), which induces testicular development Ovarian determinant : Unless SRY is expressed ovarian development ensues in the presence of XX karyotype SHAW&;S TEXTBOOK OF GYNAECOLOGY,Pg no:106,15th edition
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B i.e. Renal Cell carcinoma
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Ans. is 'd' i.e. Lipopolysaccharide Distinguishing feature of Exotoxin and endotoxiinsExotoxinsEndotoxins* Proteins** Lipopolysaccharide** Heat labile** Heat stable** Secreted by cells** forms part of cell wall** Action enzymic** No enzymic action** Active in minute dose ** Active only in large dose** Highly antigenic** Weakly antigenic** Action specifically neutralised by antibody* Neutralisation of antibody ineffective* Specific pharmacologic effect for each toxin ** Effect nonspecific** Can be toxoided* Cannot be toxoided
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Ans. is 'b' i.e., Glanzmann thrombbastenia Normal PT and APTT exclude option a and c because PT is raised in factor X deficiency and APTT is raised in Von willebrand disease. o So we are left with Glanzmann's thromboasthenia and Bernard Soulier syndrome. o Both these disorder are platelet function disorders and can result in neonatal bleeding. o Disorders of platelet function produce defects in the formation of hemostatic plug and thus results in bleeding. o Both are congenital disorders. o There is little to differentiate between these two disorders. o Between these two Glanzmann's thromboasthenia can present as bleeding since bih. Glanzman's thromboasthenia o Glanzmann's thrombasthenia is a rare autosomal recessive disorder. o The disease is characterized by deficiency of glycoprotein lib/Ilia which acts as receptor for fibrinogen. The disease manifests at bih with increased bleeding from the umbilical cord stump. There is life long mucocutaneous bleeding tendency in the form of epistaxis, eschymoses and bleeding from the gums. Episodes of G.I. bleeding genitourinary bleeding or post surgery/trauma may occur. However, bleeding episodes decrease with increasing age. Bernard soulier syndrome o It is a rare autosomal disorder characterized by mild thrombocytopenia, giant platelets and defective adhesion. The striking abnormality is giant platelet in peripheral smear. The membrane abnormality is GPIb/IX/V complex in platelets and megakaryocytes. o Bleeding usually begins at an early age. There is moderate bleeding in the form of purpuric rash, bruising epistaxis, gingival bleeding and men. The main lab findings are increased in bleeding time without any coagulation abnormality.
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Paradoxical carrier - A person gets infected from another carrier and himself becomes Carrier. Carriers are of 6 major types: Content carrier - Carrier gets infection from a case Paradoxical carrier - Carrier gets infection from another carrier Chronic carrier - Carrier for duration of more than 6 months Incubatory carrier - can transmit the agent during the incubation period before clinical illness begins. Convalescent carrier - can transmit the agent during recovery phase Pseudo carrier - asymptomatic carrier with avirulent organismsm.( no need to worry about it)
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Clostridium difficile is the major known cause of nosocomial antibiotic-associated diarrhea and colitis. The organism elaborates at least four toxins, including toxin A (an enterotoxin) and toxin B (a cytotoxin). Symptoms and signs include diarrhea, which is usually watery, occasionally bloody, and has a characteristic foul odor; abdominal cramps; vomiting; fever; and leukocytosis. Demonstration of C difficile cytotoxin in the stool is sensitive and specific. Ref: Chang G.J., Shelton A.A., Welton M.L. (2010). Chapter 30. Large Intestine. In G.M. Dohey (Ed), CURRENT Diagnosis & Treatment: Surgery, 13e.
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Note the swelling of his face first thing in the morning (left) and its resolution after being upright all day (right). Specialty. Pulmonology.
Superior vena cava syndrome (SVCS), is a group of symptoms caused by obstruction of the superior vena cava
(a short, wide vessel carrying circulating blood into the heart).
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LAM may be effective up to six months if:- she is exclusively breastfeeding and Her menses have not returned. - Contraception of choice during lactation is progesterone only pills.
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The CarieScan PRO (CarieScan, LLC, Charlotte, NC) is a device for the detection and monitoring of caries by the application and analysis of AC (alternating current) impedance spectroscopy (ACIST).
The CarieScan PRO claims to enable clinicians to evaluate demineralized tooth structure using ACIST by providing information about tissue being healthy, in the early stages of demineralization, or already significantly decayed.
The device provides a color scale and a numerical scale to determine the severity of the caries lesion and is accompanied by management recommendations that range from therapeutic prevention to operative intervention appropriate for the extent of the demineralization.
Reference- Sturdevant 6th ed Pg- 96
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(Dengue fever): Ref: 111, 1164-H (1230-H17th)DENGUE FEVER: - Caused by (4 - serotype) Aedes - aegpti (flavi virus)* Headache, musculoskeletal pain ("break bone fever"): leukopenia occasionally biphasic ( "saddleback") fever* Macular rash on the first day, as well as adenopathy, palatal vesicles and scleral injection* Epistaxis and scattered petectiae are often noted in uncomplicated dengue, and preexisting GI lesion may bleed during the acute illness* Leucopenia, thrombocytopenia and increased aminotransferase
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Ans. B. ThymusHassall's corpuscles are structures found in the medulla of the human thymus, formed from eosinophilic type VI epithelial reticular cells arranged concentrically. These concentric corpuscles are composed of a central mass, consisting of one or more granular cells, and of a capsule formed of epithelioid cells.
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LITIHIUM* Well absorbed orally(peal level in 2- 3 hours)* Not protein bounded * Handled by kidney * Very narrow therapeutic index * Lithium concentration for optimizing therapy - 0.5 -0.8meq/l - bipolar disorder - 0.8 -1.2meq/l - acute mania - >1.5meq/dl -toxicity * S/E - fine tremors - CNS toxicity - coarse tremors ,ataxia , hyperflexion, mental confusion - >2meq/l -muscle twitching , drowsiness ,convulsions ,coma* Diabetes insipidus * Weight gain * C/I - pregnancy - congenital defect (Ebstein anomaly is associated with lithium exposure)* USE - bipolar disorders - Acute mania
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Hemobilia is bleeding commonly from the liver or occasionally from the gallbladder into the biliary tract.Accidental trauma,iatrogenic trauma (50%) is the most common cause.In accidents,Hemobilia is more commonly caused by blunt trauma than penetrating one.Other causes include Vascular diseases of hepatic aery,malignant and benign liver diseases,poal hypeension,parasitic liver diseases,etc. Reference:SRB's manual of surgery,5th edition,page no:662
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Ref: Bailey & Love's Short Practice of Surgery 25th Edition Chapter 66 Intestinal Obstruction Pages 1191-12 & Donald A, Antonio!i, " Gastrointestinal Autonomic Nerve Tumors, expanding the spectrum of gastrointestinal stromal tumors," Arch Pathol Lab Med: 1989: 113: 831-833.Explanation:IntussusceptionInvagination of an intestinal segment (the intussusception) into the next distal part of the intestine forms a sheath around it (the intussuscipiens) producing a form of intestinal obstruction called 'intussusception'.The most common cause is hypertrophy of the Peyer's patches in the terminal ileum from an antecedent viral infection.The hypertrophied lymphatic patch becomes drawn into the lumen of the terminal ileum and is moved progressively into the ascending and transverse colon.Other predisposing factors includePolypsMeckel's diverticulumBenign tumors like lipomaLeiomyomaMalignant tumors such as lymphoma which may act as lead points for intussusception.GI lipomas, most common in the ileum, are single intramural lesion, submucosal in location and usually small.One portion of the gut becomes invaginated within an immediately adjacent segment: almost invariably, it is the proximal into the distal.The condition is encountered most commonly in children, with a peak incidence between 5 and 10 months of age.About 90% of cases are idiopathic but an associated upper respiratory tract infection or gastroenteritis may precede the condition.It is believed that hyperplasia of Peyer's patches in the terminal ileum.Weaning, loss of passively acquired maternal immunity and common viral pathogens have all been implicated in the pathogenesis of intussusception in infancy.Children Pathological lead pointsMeckel's diverticulumPolypduplication,Henoch-Schonlein purpuraAppendixAdult cases lead pointA polyp (e.g. Peutz-Jeghers syndrome)A submucosal lipomaother tumoursPathologyAn intussusception is composed of three parts:The entering or inner tube (intussusceptum)The returning or middle tube:The sheath or outer tube (intussuscipiens).The part that advances is the apex, the mass is the intussusception and the neck is the junction of the entering layer with the mass.An intussusception is an example of a strangulating obstruction as the blood supply of the inner layer is usually impaired.The degree of ischaemia is dependent on the tightness of the invagination, which is usually greatest as it passes through the ileocaecal valve.Intussusception may be anatomically defined according to the site and extent of invagination.In most children, the intussusception is ileocolicIn adults, colocolic intussusception is commonIntussusceptionMost common in childrenPrimary or secondary to intestinal pathology, e.g. polypMeckel's diverticulumIleocolic is the commonest varietyCan lead to an ischaemic segmentRadiological reduction is indicated in most casesThe remainder require surgery
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Joint pain is a feature of Reiter's syndrome. It's a triad of urethritis, ahritis and conjunctivitis. It is causes by Chlamydia(m/c), Salmonella, Yersinia, Campylobacter, Ureaplasma, Shigella OTHER OPTIONS: Behcet syndrome: inlude mouth and genital soresa, inflamed eyes and rashes. Sarcoidosis: symptoms vary depending on the organs affected SLE : can affects skin, kidney, joints, brain and other organs.
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Ans. (c) PandemicRef: K. Park 23rd ed. / 93, 21sted. Z88-89* ENDEMIC: constant presence of a disease or an infectious agent within a given geographical area or a population group.* EPIDEMIC: sudden occurrence and rise of a particular health related behaviour/event which is in excess of "expected occurrence"* SPORADIC: Scattered cases, which occur irregularly, haphazardly from time to time. These cases are few and separated widely in space and time that they show little or no connection with each other, nor a recognizable common source of infection.* PANDEMIC: An epidemic usually affecting a large proportion of population, occurring over a wide geographic area such as a section of nation, the entire nation, a continent or the world.
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Arnold-Chiari malformation results from herniation of the medulla and cerebellum into the foramen magnum. Meningocele is a small defect in the cranium in which only the meninges herniate. Klippel-Feil syndrome results from an abnormal number of cervical vertebral bodies. Hydrocephalus results from an overproduction of cerebrospinal fluid, obstruction of its flow, or interference with CSF absorption. Tethered cord syndrome is a congenital anomaly caused by a defective closure of the neural tube. This syndrome is characterized by a low conus medullaris and a thick filum terminale.
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ref : ak khurana 7th ed
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Microaerophilic streptococci (Burrowing ulcer / Maleny's ulcer is caused by synergistic infection of microaerophilic non hemolytic streptococci and aerobic hemolytic streptococci)
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Glucose and amino acids are reabsorbed from PCT by sympo along with sodium. Ref: Ganong's review of medical physiology; 24th edition; page no; 682 Ref of image;
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Ans. is 'c' i.e., More protein bound
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Ans. is 'c' Assessment of child for the presence of heart disease The assessment of a child for the absence or presence of Heart disease can be done with the help of some guidelines suggested by NAD A and are called NADA's criteria.NADA's criteriaEither one major or 2 minor criteria are necessary for indicating the presence of heart diseaseMajor criteriaSystolic murmur grade HI or more in intensityPansystolic murmur of any grade is always organicEjection systolic with thrill is always organicDiastolic murmur is always organic Two exceptionsSevere systemic hypertension (AR)Anemia (MS, TS)Cyanosis (Central Cyanosis)CHF always indicates heart disease except in infants who can have CHF from anemia or hypoglycemiaMinorSystolic murmur less than grade IIIAbnormal Ibid heart soundAbnormal B.P.Abnormal x-rayCardiomegaly in inspiration is highly suggestive of heart disease.Abnormal ECG.
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Mitochondrial pyruvate carboxylase catalyzes the carboxylation of pyruvate to oxaloacetate, an ATP- requiring reaction in which the vitamin biotin is the coenzyme.
Biotin binds CO2 from bicarbonate as carboxybiotin prior to the addition of the CO2 to pyruvate.
The resultant oxaloacetate is reduced to malate, exported from the mitochondrion into the cytosol and there oxidized back to oxaloacetate.
Key Concept:
Biotin is the co-enzyme for pyruvate carboxylase which carboxylates pyruvate into oxaloacetate
Ref : Harper’s illustrated biochemistry, 31st edition.
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In Coronary Aery Disease (CAD) the cholesterol level (mg/dl) recommended is below 200. Desirable High risk of Hea disease Total cholesterol <200 > 240 HDL > 60 <40 LDL <100 >200 TG <150
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Ans. C. Miller's lung disease. (Ref. Table 249-1; pg. 1608).# Thermophilus actinomycetes is NOT a causative agent for Miller's lung disease.# The causative agent of Miller's lung is Sitophilus granarius (wheat weevil).# Thermophilus actinomycetes is causative agent of:Baggasosis, Mushroom Workers lung disease, Farmer lung disease.Selected Examples of Hypersensitivity Pneumonitis (HP):DiseaseAntigenSource of AntigenBagassosisThermophilic actinomycetes"Moldy" bagasse (sugar cane)Bird fancier's, breeder's, or handler's lungParakeet, pigeon, chicken, turkey proteinsAvian droppings or feathersCephalosporium HPContaminated basement (sewage)CephalosporiumCheese washer's lungPenicillium caseiMoldy cheeseChemical worker's lungIsocyanatesPolyurethane foam, varnishes, lacquerCoffee worker's lungCoffee bean dustCoffee beansCompost lungAspergillusCompostDetergent worker's diseaseBacillus subtilis enzymes (subtilisins)DetergentFamilial HPBacillus subtilisContaminated wood dust in wailsFarmer's lungThermophilic actinomycetes"Moldy" hay, grain, silageFish food lungUnknownFish foodFish meal worker's lungFish meal dustFish mealFurrier's lungAnimal fur dustAnimal peltsHot tub lungCladosporium spp., Mycobacterium avium complexMold on ceiling; contaminated waterHumidifier or air-conditioner lung (ventilation pneumonitis)Aureobasidium pullulans, Candida albicans,Thermophilic actinomycetes, mycobacterium spp., other microorganismsContaminated water in humidification or forced-air air-conditioning systemsJapanese summer-type HPTrichosporon cutaneum , T. asahii, and T. mucoidesHouse dust? Bird droppingsLaboratory worker's HPMale rat urineLaboratory ratLycoperdonosisLycoperdon puffballsPuffball sporesMalt worker's lungAspergillus fumigatus or A. clavatusMoldy barleyMaple bark diseaseCryptostroma corticateMaple barkMetalworking fluid lungMycobacterium spp., Pseudomonas spp.Contaminated metalworking fluidMiller's lungSitophilus granarius (wheat weevil)Infested wheat flourMiscellaneous medicationAmiodarone, bleomycin, efavirenz, gemcitabine, hydralazine, hydroxyurea, isoniazid, methot rexate, paclitaxel, penicillin, procarbazine, propranolol, riluzole, sirolimus, sulfasalazineMedicationMushroom worker's lungThermophilic actinomycetes, Hypsizigus marmoreus, Bunashimeji, and other exotic mushroomsMushroom compost; mushroomsPituitary snuff taker's lungAnimal proteinsHeterologous pituitary snuffPotato riddler's lungThermophilic actinomycetes, Aspergillus"Moldy" hay around potatoesSauna taker's lungAureobasidium spp., otherContaminated sauna waterSausage worker's lungPenicillium nalgiovenseDry sausage moldSequoiosisAureobasidium, Graphium spp.Redwood sawdustStreptomyces albus HPStreptomyces albusContaminated fertilizerSuberosisPenicillium g la brum and Chrysonilia sitophilaCork dustTap water lungMycobacteria spp.Contaminated tap waterThatched roof diseaseSacchoromonospora viridisDried grasses and leavesTobacco worker's diseaseAspergillus spp.Mold on tobaccoWinegrower's lungBotrytis cinereaMold on grapesWood trimmer's diseaseRhizopus spp., Mucor spp.Contaminated wood trimmingsWoodman's diseasePenicillium spp.Oak and maple treesWoodworker's lungWood dust, AlternariaOak, cedar, pine, and mahogany dustsAdditional Educational points:# "Farmer's lung" is the term most commonly used for HP due to inhalation of antigens present in moldy hay, such as thermophilic actinomyces, Micropolyspora faeni, and Aspergillus species.
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Ans. is 'd' i.e., All of the above Histopathology in Lichen planus The basic pathology in lichen planus is the damage to the basal cell layer of epidermis leading to hydropic degeneration of basal cells. Epidermal thickening especially of granular cell layer --* Hypergranulosis. Hyperkeratosis (Thickening of stratum cornuem) Acanthosis (Thickening of Stratum) malpighi. Subepidermal - lichenoid band due to deposition of lymphocytes & histiocytes in upper dermis. Dropping of melanin pigment from damaged keratinocytes of epidermis into dermis -->pigment incontinence. This melanin is engulfed by macrophages which results information of cytoid bodies (civatte or colloid bodies). Mox Joseph Histological cleft --> Separation of epidermis in small clefts.
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Ans. A: Small cell carcinoma
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