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Final Assessment Categories Category Management Likelihood of cancer 0 Need additional imaging of prior examinations Recall for additional imaging and /or await prior examinations N/A 1 Negative Routine screening Essentially 0% 2 Benign Routine screening Essentially 0% 3 Probably Benign Sho interval-follow-up (6 month) or continued >0% but< 2 % 4 Suspicious Tissue diagnosis 4a. low suspicion for malignancy (>2% to <10%) 4b. moderate suspicion for malignancy (>10% to< 50%) 4c. high suspicion for malignancy (>50% to <95%) 5 Highly suggestive of malignancy Tissue diagnosis > 95% 6 Known biopsy proven Surgical excision when clinical appropriate N/A
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Ans. is 'c' i.e., Syndromic diagnosis by medical officer Integrated disease surveillance project (IDSP) IDSP is a decentralized state based surveillance system intended to detect early warning signals of impending outbreaks and helps initiate an effective response in a timely manner in urban and rural areas. It will also provide essential data to monitor progress of on-going disease control programme and help allocate health resources more efficiently. It is a 5 years project and was launched in November 2004.
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Kaolin cephalin clotting time is the older term to describe activated paial thromboplastin test, which is aimed at detecting the function of intrinsic pathway. In Kaolin cephalin clotting test, kaolin is used as a surface activator, it binds directly to Factor XII resulting in surface activation to XIIa. XIIa cleaves Factor XI to XIa. Cephalin is a phospholipid substitute that replaces platelet phospholipid in the test. Ref: Haematology By Main R. Howard, Peter J. Hamilton, Page 22
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Ans. is 'b' i.e., Black bag
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Pellagra Niacin deficiency (B complex)Night blindnessVitamin A deficiencyOsteomalacia Vitamin D deficiencySpinocerebellar ataxiaVitamin E deficiency(ref:Harrison's 17/e p442)
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In PCOD with Hirustism,drugs given are; a.oral contraceptive b.anti androgens Antiandrogens in PCOD Used are spironolactone, cyproterone acetate, Flutamide and Finasteride Spironolactone in a dose of 100-200 mg daily, blocks the androgen receptors, reduces it production and increases its metabolism and thus prevents hirsutism in 60%cases. It is best given with combined oral pills to avoid irregular menstruation and possible feminisation of male fetus during therapy Maintainance dose after 6-12 months is 50mg of spironolactone with oral pills Ref : SHAW'S TEXTBOOKOF GYNECOLOGY; 15th edition; Pg no:117
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hypokalemia due to excessive potassium depletion in body ( Harrison 17 pg 2260)
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Polysaccharides such as starch & glycogen yield glucose units on hydrolysis. The major carbohydrate in diet is Starch. Starch on hydrolysis yield Glucose units. Also, most of the disaccharides yield glucose units on hydrolysis. Sucrose on hydrolysis yields glucose and fructose. Hence carbohydrates are mainly absorbed from gut in the form of glucose
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Because chylomicrons contain the most triacylglycerol, they are the least dense of the blood lipoproteins. Because VLDL contains more protein than chylomicrons, it is denser than chylomicrons, but less dense than LDL. Because LDL is produced by the degradation of the triacylglycerols of VLDL, LDL is denser than VLDL. HDL is the most dense of the blood lipoproteins. It has the most protein and the least triacylglycerol (see Tables below).The Four Major Statin Benefit GroupsPatient StatusStatin TreatmentPatient exhibits clinical atherosclerotic cardiovasculardisease (ASCVD)aIf age<=75 years, a high-intensity statina; if >75 years, or not a candidate for a high-intensity statin, a moderate-intensity statincPatient with LDL-cholesterol >=190 mg/dL; no ASCVDHigh-intensity statin (moderate-intensity statin if not a candidate for high-intensity statin)Patients with type 1 or 2 diabetes aged 40-75 years with LDL- cholesterol between 70 and 189 mg/dL, no ASCVDModerate-intensity statin; if the calculated 10-y ASCVD risk is >=7.5%, a high-intensity statinNo clinical ASCVD or diabetes with LDL-cholesterol between 70 and 189 mg/dL, and an estimated 10-y ASCVD risk of >=7.5%Moderate-to high-intensity statin Characteristics of the Major LipoproteinsLipoproteinDensity Range (g/mL)Particle Diameter (mm) RangeElectrophoretic MobilityLipid(%)a TGCholPLFunctionChylomicrons0.93075-1,200Origin80-952-73-9Deliver dietary lipidsChylomicron remnants0.930-1.00630-80Slow pre-b Return dietary lipids to the liverVLDL0.930-1.00630-80Pre-b55-805-1510-20Deliver endogenous lipidsIDL1.006-1.01925-35Slow pre-b20-5020-4015-25Return endogenous lipids to the liver; precursor of LDLLDL1.019-1.06318-25b5-1540-5020-25Deliver cholesterol to cellsHDL2 1.063-1.1259-12a5-1015-2520-30Reverse cholesterol transportHDL3 1.125-1.2105-9a Reverse cholesterol transportLp(a)1.050-1.12025Pre-b aThe remaining percent composition is composed of apolipoproteins. Chol, the sum of free and esterified cholesterol; HDL, high-density lipoprotein; IDL, intermediate-density lipoprotein; LDL, low-density lipoprotein; Lp(a), Lipoprotein "little" a; PL, phospholipid; TG, triacylglycerols; VLDL, very low-density lipoprotein.
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Ans. C: Ganciclovir Antiretroviral (ARV) drugs are broadly classified by the phase of the retrovirus life-cycle that the drug inhibits. Nucleoside and nucleotide reverse transcriptase inhibitors (NI) inhibit reverse transcription by being incorporated into the newly synthesized viral DNA and preventing its fuher elongation (Zidovudine, Didanosine, Zalcitabine, Stavudine, Lamivudine, Abacavir) Non-nucleoside reverse transcriptase inhibitors (NNI) inhibit reverse transcriptase directly by binding to the enzyme and interfering with its function (Nevirapine, Eirenz, Delavirdine) Retroviral Protease inhibitors (PIs) target viral assembly by inhibiting the activity of protease, an enzyme used by HIV to cleave nascent proteins for final assembly of new virons (Ritonavir, indinavir, Nelfinavir, Saquinavir, Amprenavir, Lopinavir) Entry inhibitors (or fusion inhibitors) interfere with binding, fusion and entry of HIV-1 to the host cell by blocking one of several targets. Maraviroc and enfuviide are the two currently available agents in this class. Ganciclovir is an anti-herpes drugs.
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Guillain-Barre syndrome often appears days to weeks after a viral upper respiratory or gastrointestinal (GI) infection. The initial symptoms are due to symmetric limb weakness. Paresthesia may be present. Unlike most other neuropathies, proximal muscles may be affected more than distal muscles early in the disease. Tendon reflexes are usually lost within a few days. Protein content of the CSF is usually high within a few days of onset. Diabetic and alcoholic neuropathy do not have an acute onset type presentation as this patient did. Cyanide poisoning can cause paralysis, but it is generalized not just localized to the lower limbs.
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An invasive mole rarely develops metastasis and hence presence of suburethral nodule should not be regarded as an indicator of conversion of hydatiform mole into an invasive mole. Ref: Donald School Textbook of Ultrasound in Obstetrics and Gynecology By Kurjak, 2nd Edition, Page 251, 252; Essentials of Human Disease By Leonard Crowley, 2011, Page 313.
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C i.e. Gallow's traction
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Ans. is 'd' i.e., All of the above Pollutant Sources Carbon monoxide Combustion equipment,stove, Gas heater. Nitrogen dioxide Gas cookers, Cigarattes Sulphur dioxide Coal combustion Carbone dioxide Combustion, respiration Ozone Electric arcing, UV light sources
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Obstetric complications associated with twin pregnancy are polyhydramnios, pregnancy-induced hypeension, premature rupture of membranes, abnormal fetal presentations, and prolapse of the umbilical cord. Other complications of multiple bihs are IUGR and preterm delivery. Features of Monochorial twins: They are always monozygous and same sex. Can be diamniotic or monoamniotic. They are risk for twin twin transfusion, congenital anomalies, neurodevelopmental problems, and cerebral palsy. Features of Dichorial twins They can be either dizygous or monozygous. Can have growth restriction due to abnormal placental implantation. They are not at risk for twin transfusion syndrome and have less risk for anomalies and neurodevelopmental problems than monochorial twins. Ref: Thilo E.H., Rosenberg A.A. (2012). Chapter 2. The Newborn Infant.
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Comparing the given history & options one by one: Reduced values of MCV and MCHC: microcytic hypochromic anemia (G6PD deficiency is ruled out) 6 year old and Punjabi ethnicity, history of repeated blood transfusions- in our of thalassemia Osmotic fragility is reduced: in our of thalassemia again though it may be seen in sickle cell also Also, the hemoglobin level in the question is more suggestive of severe anemia with positive history of multiple blood transfusions both being impoant pointers towards thalassemia major. Please note that apa from Punjabis, other ethnic groups having high prevalence of thalassemia are Sindhis, Gujaratis, Parsis, Begalis and Lohanas.
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Becks triad is the cognitive triad of depression
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Treatment of choice is removal of foreign body by rigid bronchoscope with appropriate antibiotics.
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Desflurane is an irritant if used for induction can cause larygospasm. Desflurane is the most pungent of the volatile agents and may result in a cough, laryngospasm, and bronchospasm and so is not routinely used for induction in children.
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Ans. is 'c' i.e., Terfanadine Terfanadine is a second generation antihistaminics. Advantages of second generation Antihistaminics. o Higher H1 selectivity, no anticholinergic side effects. o Absence of CNS depressant propey o Additional antiallergic mechanism apa from histamine block. o No impairment of psychomotor performance (driving etc. need not be contraindicated) o No subjective effect, No sleepiness. (Some patients complain of sedation, but the incidence is similar to placebo) o Do not potentiate alcohol or benzodiazepene
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Ans. is 'c' i.e., Subjective feeling of well being Ouality of life o The level of living and standard of living are objective criteria of well being, while quality of life comprises the individual's own subjective evaluation of these. o Recent definition of quality of life is as follows "a composite measure of physical mental and social well being as perceived by each individual or group of individuals." o WHO definition is as follows "the condition of life resulting from the combination of the effects of the complete range of factors such as those determining health, happiness, education, etc."
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Mid-esophageal diveicula caused by traction from adjacent inflammation classically tuberculosis. They are true diveicula involving all layers of the esophageal wall. Reference: Harrisons Principles of Internal Medicine, 18th Edition
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A i.e. Paralysis of accommodation In diptheria ciliary muscle never escape, hence there is almost always paralysis of accommodation Q. Pupils often escapes hence pupillary reflex is normal. Isolated ocular palsies are common External opthalmoplegia is rare.
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Therapeutic misadventure is a mischance or an accident or a disaster. Therapeutic misadventure is a case in which n individual has been injured or had died due to some unintentional act by a doctor or agent of the doctor or hospital. Vicarious liability is liability for act of others i.e. an employer is responsible not only for his own negligence but also for the negligence of his employee by the principle of respondent superior (let the master answer), provided there (1) Must be employer-employee relationship, (2) While on job, (3) Employee conduct within the job of employment. Therapeutic privilege is an Exception to the rule of 'full disclosure' i.e. the doctor can use his discretion as to the facts that he discloses or of not telling the patient about the risks involved in treatment or about the diagnosis, e.g. in cases where patient is fearful, emotionally disturbed, psychotic or psycho-neurotic. The doctor should carefully note his decision in the patient's records mentioning the reasons. Ref: Krishnan vij Textbook of Forensic Medicine and Toxicology; 5th ed; Page no: 189
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The clinical features are those of pericarditis with effusion, and the most common causes of hemorrhagic pericarditis are metastatic carcinoma and tuberculosis. An effusion of this size is sufficient to produce some cardiac tamponade that diminishes cardiac output; the paradoxical drop in pressure (more than 10 mm Hg) is called pulsus paradoxus and can be caused by pericarditis and by tamponade. Candida is a rare cardiac infection in immunocompromised individuals. Coxsackieviruses are known to cause myocarditis. Group A streptococci are responsible for rheumatic fever; in the acute form, rheumatic fever can lead to fibrinous pericarditis, and in the chronic form, it can lead to serous effusions from congestive heart failure. Staphylococcus aureus is most often a cause of infective endocarditis.
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Trachea: - Trachea is a flexible tube that extends from veebral level C6 in the lower neck to veebral level T 4 / 5 in the mediastinum where it bifurcates into a right and a left main bronchus. Measurement of trachea: - Parameters Average Minimum Maximum A - P diameter (mm) Male Female Male Female Male Female 18.82 13.25 10.15 10.72 22.92 17.25 Transverse diameter 16.30 14.92 11.02 10.57 19.98 17.22
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air borne contact dermatitis is diagnosed by patch testing with the specific allergen. eg: pahenium is the common allergen tested using patch test. IADVL TEXTBOOK OF DERMATOLOGY, INDIAN PATCH TEST SERIES PAGE 581.
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b. Mumps(Ref: Nelsons' 20/e p 1552-1553, Ghai 8/e p 217-218)CNS complications of Mumps include Meningoencephalitis, transverse myelitis, aqueductal stenosis & facial palsy.
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Dermatiphytids - Hypersensitivity to dermatophyte antigen may occur which leads to appearence of secondary eruption in sensitized patients because of circulation of allergic products. These lesions are indistinguishable , but these lesions are distinct from the primary ringworm lesion as they occur distal to primary site and fungal culture often turns negative.
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Ans. is 'b' i.e., Measure of dispersion Mean detion is an absolute measure of variation or dispersion. Mean detion (MD) It is the average of the detion from the arithmetic mean. MD -- E (x - )1) 11 o To calculate the mean detion following steps to be followed - First calculate the arithmetic mean. Then every single value is deducted from arithmetic mean to calculate detion from mean (x - x). Now each of these values of detion from mean are added and then divided by the numbers of value (r1) to obtained mean detion. Example ---> The diastolic blood pressure of 10 individuals is as follows - 83, 75, 81, 79, 71, 95, 75, 77, 84 and 90. The mean detion is calculated :? Mean detion Diastolic B.P. Arithmetic Mean Detion from the mean (x - 83 81 2 75 81 -6 81 81 0 79 81 -2 71 81 -10 95 81 14 75 81 -6 77 81 -4 84 81 3 90 81 9 Total = 810 Total = 56 (ignoring +- sign) 8 10 56 Mean = 10-- 81 The Mean detion 10-- 5.6
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(A) (Burkitt's lymphoma) (456 - HM) (453- Basic pathology 8th)Burkitt's lymphoma - The tumour cells have a very high mitotic rate, and therefore high cell death. This features accounts for presence of numerous macrophages in the background of this tumour containing phagocytosed tumour debris giving it a "starry sky appearance"
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Zonation from the central immature zone of undifferentiated highly active cells to the peripheral mature zone of well-oriented bone is characteristic.
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Ans. is 'a' i.e., Malaria o All components, including RBCs, WBCs, platelet concentrates, granulocyte concentrates, fresh plasma and cryoprecipitate can transmit malaria.
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Ans. is 'c' i.e., Fungus * Tissue specimens such as skin scarpings, are generally examined as wet mounts after treatment with 10% KOH.* KOH (alkali) digests cells and other tissue materials, enabling the fungus elements to be seen clearly.
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The given image shows lucency along the medial pa of left hemi-diaphragm and lateral aspect of aoa - known as Naclerio V sign. Seen in Boerhaave syndrome Naclerio V sign (X- ray) CT Hilum Overlay Sign - If the pulmonary vessels are visible through the lesion/mass (not obscured by the mass) then it means that the mass/lesion is in either Anterior or posterior mediastinum but not in the hilum Hilum Overlay Sign Spinnaker Sign/ Thymus Sail Sign/ Angel wing sign - Seen in Pneumomediastinum Spinnaker Sign
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HIV PCR, a nucleic acid amplification test for HIV RNA, has recently been shown to be the most valuable test for: monitoring a patient's progress during triple drug therapy and determining the chances of progression to AIDS. A viral load of 750,000 copies per ml significantly increases the chance of progression to AIDS within 5 years. The other tests listed do not accurately predict progression to AIDS.
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Case fatality rate represents the killing power of the disease. It's simply the ratio of deaths to diseases. Ref: 25th edition, Park's Textbook of Preventive and Social Medicine, Page no. 66
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The morphologic consequences of embolic occlusion of the pulmonary arteries depend on the size of the embolic mass and the general state of the circulation.
Large emboli may impact in the main pulmonary artery or its major branches or lodge at the bifurcation as a saddle embolus. Sudden death often ensues, owing largely to the blockage of blood flow through the lungs. Death may also be caused by the acute failure of the right side of the heart (acute cor pulmonale).
Smaller emboli can travel out into the more peripheral vessels, where they may cause infarction. In patients with adequate cardiovascular function, the bronchial arterial supply can often sustain the lung parenchyma despite obstruction to the pulmonary arterial system. Under these circumstances, haemorrhages may occur, but there is no infraction of the underlying lung parenchyma.
Only about 10% of emboli actually cause infarction. Although the underlying pulmonary architecture may be obscured by the suffusion of blood, haemorrhages are distinguished by the preservation of the pulmonary alveolar architecture; in such cases, resorption of the blood permits reconstitution of the preexisting architecture.
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Effects of lipoxins (LXA4, LXB4) are
Inhibit neutrophil chemotaxis and leukocyte recruitment (major action).
Vasodilatation
Promote monocytic phagocytosis of apoptotic neutrophils.
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Answer is B (Diabetes mellitus): Insulin is a pancreatic hormone, not under the control of pituitary. Transection of the pituitary stalk would therefore in no way affect glucose levels or lead to diabetes mellitus.
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Ans. is 'd' i.e., Fat necrosis Fat necrosisFat necrosis may be of two types : -Enzymatic fat necrosiso This is due to the action of lipase on adipose tissue,o It occurs most frequently in acute pancreatitis due to leakage of lipase,o Depending on the severity of acute pancreatitis, fat necrosis may occur in : -Adipose tissue contiguous to patter ease, i. e., retroperitoneal fat.Adipose tissue in the anterior mediastinum.Bone marrowOmental and abdominal fatNonenzymatic or Traumatic fat necrosiso Occurs due to traumao Is seen in the subcutaneous tissue of breast, thigh, and abdomen.
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Mucosa is involved only in P.vulgaris not in P.Foliaceous
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Ans. B i.e. Stores spermsSperms are stored in epididymis
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Onlay restorations have many clinical applications and may be desired by many patients. These restorations have a well-deserved reputation for providing excellent service. The cast-metal onlay restoration spans the gap between the inlay, which is primarily an intracoronal restoration, and the full crown, which is a totally extracoronal restoration.
The full onlay by definition caps all of the cusps of a posterior tooth and can be designed to help strengthen a tooth that has been weakened by caries or previous restorative experiences.
It can be designed to distribute occlusal loads over the tooth in a manner that greatly decreases the chance of future fracture.
It is more conservative of the tooth structure than the full crown preparation, and its supragingival margins, when possible, are less irritating to the gingiva.
Sturdevant operative dentistry 7th Edition, Page No:e116
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Ans. 'd' i.e., Optic chiasma o Characteristic visual field defect of the central chiasmatic lesion is bitemporal hemianopia. Pituitary tumor causes a central chiasmatic lesion. o Bitemporal hemianopia results due to central (sagittal) lesion of the optic chiasma. common causes of which are tumors of the pituitary gland (most common), craniopharyngioma, suprasellar meningioma, glioma of the third ventricle, chiasmal arachnoiditis, and third ventricular dilatation. The site of lesion Visual field defect Optic nerve Optic chiasma Optic tract Lateral geniculate body Optic radiation (Total) Optic radiation lower fibers (temporal lobe) Optic radiation upper fibres (parietal lobe) Visual cortex (anterior occipital cortex) Occipital cortex tip Blindness Bitemporal hemianopia Incongruent homonymous hemianopia Homonymous hemianopia Homonymous hemianopia, sometimes with macular sparing Homonymous upper quadrantanopia Homonymous lower quadrantanopia Homonymous hemianopia with macular sparing Homonymous macular defect
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- Among the given options, only diclofenac sodium is acidic and remains unionized in the acidic medium of the stomach. Other drugs are basic in nature. So diclofenac has higher chances of getting absorbed from gastric mucosa.
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• The usual media employed for cultivation of diphtheria bacillus are
1) Loeffler’s serum slope
■ It is used for rapid diagnosis as growth is shown within 4-8 hours.
2) Tellurite blood agar (Tinsdale medium)
■ It acts as selective media, as tellurite inhibits the growth of most other bacteria.
■ Growth may take two days to appear.
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Cutaneous T cell lymphoma (CTCL) represents a spectrum of lymphoproliferative disorders affecting the skin. Two different clinical types of malignant T-cell disorders were originally recognized: mycosis fungoides, a chronic proliferative process; and a more aggressive nodular eruptive variant, mycosis fungoides d'emblée. Lesions of mycosis fungoides usually involve truncal areas and include scaly, red -brown patches; raised, scaling plaques that may even be confused with psoriasis; and fungating nodules. In some individuals, seeding of the blood by malignant T cells is accompanied by diffuse erythema and scaling of the entire body surface (erythroderma), a condition known as Sézary syndrome. The histologic hallmark of CTCL of the mycosis fungoides type is the presence of the Sézary-Lutzner cells. These are T-helper cells (CD4+) that characteristically form band-like aggregates within the superficial dermis ( Fig. 25-19B ) and invade the epidermis as single cells and small clusters (Pautrier microabscesses). These cells have markedly in folded nuclear membranes, imparting a hyperconvoluted or cerebriform contour. Although patches and plaques show pronounced epidermal infiltration by Sézary-Lutzner cells (epidermotropism), in more advanced nodular lesions the malignant T cells often lose this epidermotropic tendency, grow deeply into the dermis, and eventually spread systemically.
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Ans. is 'b' i.e., Strangulation
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Motor neurons (option 2) develop from neural tube (Neural plate ectoderm), hence may not be affected in dysgenesis of neural crest cells (NCCs). Melanocytes (option 1) , Parafollicular cells (option 3) or spinal ganglion cells (option 4) are derived from NCCs, and are compromised in this scenario.
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Parasites causing malabsorption are Giardia lamblia E.histolytica Strongyloides Cyclospora Capillaria philippinensis Adult Ascaris are large: females are 20-50 cm long, and males are 15-30 cm long. Humans acquire the infection after eggs are ingested; larvae hatch in the duodenum, penetrate through the mucosa, migrate in the circulatory system, lodge in lung capillaries, penetrate the alveoli, and migrate from the bronchioles to the trachea and pharynx; larvae are swallowed and return to the intestine and mature into adults. If present in high numbers, adult worms may cause mechanical obstruction of the bowel and bile and pancreatic ducts. Worms tend to migrate if drugs such as anesthetics or steroids are given, leading to bowel perforation and peritonitis, anal passage of worms, vomiting, and abdominal pain. Larvae migrating through lungs induce an inflammatory response (pneumonitis), especially after second infection, leading to bronchial spasm, mucus production, and Loeffler syndrome (cough, eosinophilia, and pulmonary infiltrates). It does not cause malabsorption.
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Ans. (A) Nicorandil(Ref: Harrison 12th/1862)Nicorandil is the agent that causes coronary dilation by activating myocardial ATP sensitive K+ channels. Inaddition it possesses NO releasing property; to which tolerance does not develop.
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Ans. (b) Ankyrin(Ref: Robbins 9th/pg 632; 8th/pg 642)Most common mutation:Hereditary spherocytosis is Ankyrin>Band-3>spectrinHereditary elliptocytosis is Spectrin
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o Resting cells are in G0 phase of cell cycle and need to be recruited into the G, stage and beyond in order to replicate. The entry and progression of cells through the cell cycle is controlled by changes in levels and activities of cyclins and cyclin dependent kinases (CDKs), and their inhibitors.
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(A) Lords' procedure # Hydrocele is a collection of serous fluid that results from a defect or irritation in the tunica vaginalis of the scrotum. Hydroceles also may arise in the spermatic cord or the canal of Nuck.> Structurally, hydroceles are classified into 3 principal types.> In a communicating (congenital) hydrocele, a patent processus vaginalis permits flow of peritoneal fluid into the scrotum. Indirect inguinal hernias are associated with this type of hydrocele.> In a noncommunicating hydrocele, a patent processus vaginalis is present, but no communication with the peritoneal cavity occurs.> In a hydrocele of the cord, the closure of the tunica vaginalis is defective. The distal end of the processus vaginalis closes correctly, but the mid portion of the processus remains patent. The proximal end may be open or closed in this type of hydrocele.> Hydroceles are located superior and anterior to the testis, in contrast to spermatoceles, which lie superior and posterior to the testis.> Hydrocele is bilateral in 7-10% of cases.> Hydrocele often is associated with hernia, especially on the right side of the body.> The size and the palpable consistency of hydroceles can vary with position. Hydrocele usually becomes smaller and softer after lying down it usually becomes larger and tenser after prolonged standing.> Systemic signs of toxicity are absent. The patient is usually afebrile with normal vital signs.> Abdominal or testicular tenderness are absent; no abdominal distension is present.> Bowel sounds cannot be auscultated in the scrotum unless an associated hernia is present.> Unless an infection causes an acute hydrocele, no erythema or scrotal discoloration is observed.> Transillumination A light source shines brightly through a hydrocele. Transillumination is common, but it is not diagnostic for hydrocele. Transillumination may be observed with other etiologies of scrotal swelling (eg, hernia).> The hallmark of treatment is eversion of the tunica through a surgical procedure called 'Lord's procedure' or an alternative 'Jsboulay's procedure'
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Trans peptidases, or penicillin-binding proteins (PBPs) (c), are inactivated when bound to penicillin. Altered PBPs no longer bind the b-lactam antibiotic. The acquisition of a new PBP or modification of the existing one is the mechanism by which S. pneumoniae, the most likely etiologic of this child's meningitis, become resistant to b-lactams. Altered PBPs are also seen in N. gonorrhoeae, S. aureus, and other bacteria. Bactoprenol (a) is not known to be involved in antibiotic resistance. Fluoroquinolones target the DNA gyrase (b), while rifamycins target the bacterial RNA polymerase (e). Bacteria do not utilize reverse transcriptase (d).
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ANSWER: (D) DiverticulosisREF: Sutton 7th ed vol 1 page 645See PLATE R-39 KEY PLATE R-39 KEYDIVERTICULAR DISEASE: Diverticulosis & DiverticulitisDiverticulosis: Mucosal herniation through vascular entry sites into the pericolic fat often between the mesenteric and antimesenteric taeniae.Diverticulitis: Superimposed inflammation on diverticulosis DIVERTICULOSIS: Commonest cause of lower GI bleeding(A) Diverticulosis specimen: A section of colon reveals numerous diverticula which protrude from the edge of the taenia coli US: Abnormal wall thickening of more than 4 mm involving a segment 5 cm or longer at the point of maximal tenderness.(B) Barium enema: Lower GI showing Diverticula as flask like rounded out pouchings (arrow'). Distribution and severity is best demonstrated on barium enema. They produce ring shadow when seen en face. Differentiation from polyps is done on the basis of projection beyond the bowel wall and presence of air fluid level. Muscular changes results in Concertina like or Serrated appearance.(C) Diverticulitis With Abscess: Diverticulitis is a condition that occurs when diverticula become infected and inflamed. Complications of diverticulitis are Abscess, Bleeding, Fistula, Obstruction, Perforation. White arrowheads: Diverticula, White arrow: Narrowed lumen, Black arrow: Perforation with intramural abscess(D) CT scan: Arrowheads point to multiple diverticula arising from the recto sigmoid. CT is the imaging procedure of choice to evaluate diverticular disease, as it can show many aspects of disease that are net recognizable by other studies. CT scan can assess complications better. For inflammation or abscess, helical CT with colonic contrast has a sensitivity and specificity of 97 and 100%.CT BASED CLASSIFICATION OF DIVERTICULITISStage 0Mural thickeningStage 1Abscess/phlegmon <3 cm in diameterStage 2Abscess 5-15 cm in diameterStage 3Abscess beyond confines of pelvisStage 4Fecal peritonitis
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Hepatic urea synthesis takes place in pa in the mitochondrial matrix and in pa in the cytosol. Ref: Harper 28th edition, chapter 28.
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(FDA-NDA-Post marketing survillance)
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Foification spectra are more complicated images that can float in your vision during a migraine. These get their name from their resemblance to an aerial view of an intricately built fo. Ref ganong's review of medical physiology 25e p874
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ANSWER: (B) Women in reproductive age group in a given yearREF: Parks textbook 20th edition page419Repeat from December 2008General fertility rate: Number of live births per 1000 women in reproductive age group in a given yearGeneral marital fertility rate: Number of live births per 1000 married women in reproductive age group in a given yearAge specific fertility rate: Number of live births in a year to 1000 women in any specified age groupAge specific marital fertility rate: Number of live births in a year to 1000 married women in any specified age group
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A i.e. Associated with muscle tendon rupture Myositis Ossificans (M.O) / Hetrotropic Ossification It is hetrotropic calcification and ossification in muscle tissue. The name is misnomer as there is no myositis (inflammation of muscle) and rarely ossification in the muscle (because the mineral phase differs from that in bone and no true bone matrix is formed). Etiology Injury (trauma) is an impoant factor and m.o. associated with trauma is better k/a post traumatic ossification it is seen in - Elbow > hipQ are commonly involved joints. - Trauma around elbowQ eg. fracture supracondylar humerus, dislocation or surgery. - Surgical trauma specially total hip replacement, - Massage to the elbow and vigorous passive stretchine to restore movements is aggravating factor. - Repeated micro trauma and overuse injuries. This type usually involve soleus muscle in ballerians. It occurs in muscles which are vulnerable to tear under heavy loads, such as quadriceps, adductors, brachicilisQ, biceps, and deltoid. M. 0. not associated with traumatic injury is termed as Pseudomalignant mysitis ossificans. And it is seen in Neurological disorders eg.G.B syndrome, AIDS encephalopathy, closed head injury, hypoxic brain injury & burns. Pathogenesis - Bone formation in muscle represents metaplasia of fibroblast at the site of injury. - Paial rupture & avulsion of muscle , ligament & joint capsule from bone usually cause periosteal elevation with the formation of subperiosteal hematoma and the wide exposure of cells with osteogenic potential. It inevitably lit subperiosteal ossification. - It has four microscopic zones (Ackerman Zonation) with centre most zone of undifferentiated, highly active (mitotic) cells and the outermost zone of well oriented hone encapsulated by fibrous tissue. - It must be distinguished from extaskeletal osteosarcoma. The latter usually occur in elderly, lacks zonationQ, and the most peripheral regions of osteosarcoma are most cellular & primitive, which is reverse of m.o. - It is distinguished from calcinosis, which is a metabolic disorder, often associated with collagen diseases - scleroderma & dermatomyositis. It is distinguished from ectopic calcification, which occurs in the capsule of joints, commonly the shoulder and is caused by inflammatory reaction around deposits of hydroxy - appetite crystals. And it is seen in CRF, hypo/hyper Clinical feature - Mostly asymptoma tic but may present with tenderness, palpable swelling, pain on range of motion, stiffness, and increased warmth. Imaging - Radiographs initially are normal, but by 10 days to 4 weeks fine calcification (dotted veil/ cotton wool appearance) is seen. - There is peripheral ossification and central lucencyQ of the mass. - The mass is usually seperated from underlying bone by at least a thin lineQ & lesion are usually located in the diaphysis. If the lesion is in continuity with the bone it is not myositis ossificans and the possibility of tumor or infection arises. - Calcification may first be noted on USG (focal hypoechoic mass located with in the muscle). - CT is better than x - ray - Biopsy before 4 weeks is usually in accurate. Treatment of Myositis Ossificans - Treatment is normally by 'watchful inactivity'. It must be emphasised that it is a passive stretching and not active exercise that is responsible for stimulating new growth formation. The worst treatment is to attack an injured and stiffish elbow with vigorous mucle stretching exercises; this is liable to precipitate or aggrevate the condition. So any physical therapy should be discontinuedQ. - Relative rest of the affected extremity is helpfulQ, with motion & activity gradually resumed as the acute phase subsides. In acute phase the treatment consist of limiting motion & icing the extremity while avoiding heat or massage - Low dose irradiation & indomethacin may prevent hetrotopic ossification, but the radiation should be avoided in children. - Surgical excision in toto is not done until a year or 2 after the acute phase of disease, at a time when radiograph reveal that the bone is fully mature and bone scan show either a return to normal uptake or decreasing activity in the lesion.
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Collimation is a process by which x-ray beam size is reduced and thereby decrease the patient exposure.
It is made up of metallic barrier usually Pb with an aperture in the middle to reduce the size of the x-ray beam.
Most state regulations require that the x-ray beam used in intraoral radiography be collimated so that the field of radiation at the patient’s skin surface is no more than 7 cm (2.75 inches) in diameter.
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In 20-30 year old patients Minimum Alveolar Concentration(MAC)for Halothane. 0.75 Isoflurane. 1.15 Sevoflurane. 1.85 Desflurane. 6 From Tripati 7th edition
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The circumcision that is done soon after bih in infancy gives almost complete immunity against Ca penis, but that done later in life does not have the same effect, so Muslims circumcised between the ages of 4 and 9 years are still liable to the disease. About Ca Penis Most common histological type is - sq. cell Ca (98%) Erythroplasia of Queret is precancerous condition. It's the in-situ form of Ca Penis. Premalignant lesions of Ca Penis Penile cutaneous horn Balanitis xerotica obliterans Leukoplakia Viral (Human papilloma virus) related Dermatologic lesion Condyloma acuminata (also k/a genital was) Bowenoid papulosis The one etiological factor most commonly associated with penile carcinoma is poor hygiene. Clinical features Age - Penile Ca occurs most commonly in the sixth decade of life, but its presentation in younger age group is not uncommon ("40% of pts are under 40 years of age" - Bailey) Most common complaint at presentation is the lesion itself. Pain is rare. Most common site of involvement (% from Cambell's Urology 8/e, p 29.53) Glans - ~48% Prepuce - ~21% Both Glans & Prepuce - 9% Coronal sulcus - ~6% Shaft - ~2% Lymph node involvement More than 50% of patients present with enlarged inguinal lymph nodes (but half of these are reactive enlargement d/t sepsis). The presence and the extent of metastasis to the inguinal region is the most impoant prognostic factor for survival in patients with Ca Penis. Distant metastasis is infrequent Diagnosis is made by biopsy of lesion. Treatment is discussed ahead. Ref : Bailey & Love 25/e p1374
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Ans. is 'd' i.e., At any time he wishes The judge may ask any question, in any form, about any fact, relevant or irrelevant, at any stage of the examination to clear up doubts. Recording of evidence After oath administration, the evidence is recorded under following steps :- Examination in chief (direct examination) : It is the examination of the witness by lawyer of the pay calling the witness. In government prosecutions, it is done by public prosecutor (PP)/district government pleader(DGP). The objective is to elicit all relevant, and convincing facts. No leading questions are permitted. Leading question means the question, which leads the witness to desired answer. However, if the witness is declared hostile, leading questions can be asked. Cross-examination : Examination of the witness is conducted by the lawyer ofthe opposite pay. In government prosecutions it is done by defence lawyer. The objective is to elicit, remove or modify facts and to test the accuracy of statement or witness. Leading questions are allowed. Re-examination (Redirect examination) : It is conducted like examination in chief and so by the lawyer of same pay. The objective is to clear out any discrepancies/doubt, that have arisen during cross-examination. Leading questions are not allowed. The witness should not tell any new thing at this stage, otherwise opposing lawyer is permitted for re-cross examination. Cou questions : At any stage, during the recording of evidence, the judge may ask questions to clear his doubts.
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Tensor tympani is called as Toynbee muscle origin, the cailaginous pa of the pharyngotympanic (auditory) tube and the walls of its hemicanal just above the bony poion of the pharyngotympanic tube; inseion, handle of malleus; action, draws the handle of the malleus medially tensing the tympanic membrane to protect it from excessive vibration by loud sounds. nerve supply, branches of trigeminal through the otic ganglion Ref - Pubmed.com
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Answer is B (Ventricular fibrillation) Asynchronous cardioversion is ito ino.st reliable method for terminating V.F. Electrical cardioversion and defibrillation are the most reliable methods for termination of arrhythmias. These methods depolarize all or at least a large poion of excitable myocardium in a near homogenous fashion. Thereby interrupting reequitant rhythms.
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CRUCIATE LIGAMENTS: Very thick and strong fibrous bands. Direct bonds of union between tibia and fibula. Maintain anteroposterior stability of knee joint. Anterior cruciate ligament:- Begins from anterior pa of intercondylar area of tibia, runs upward, backward and laterally and is attached to the posterior pa of medial surface of lateral condyle of femur. Taut during extension of knee. The anterior cruciate ligament is more commonly damaged than the posterior.It may be injured in violent hyperextension of knee or anterior dislocation of tibia. Posterior cruciate ligament:- Begins from posterior pa of intercondylar area of tibia, runs upwards, forwards and medially and is attached to lateral surface of medial condyle of femur. Taut during flexion of knee. The posterior cruciate ligament is injured in posterior dislocation of tibia. Both these are supplied by middle genicular nerves and vessels. <img src=" /> {Reference: BDC 6E vol 2 pg 142}
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Ans. is 'b' i.e., Radio-ulnar joints o Forearm rotation (supination & pronation) occurs at radio-ulnar joint complexQ i.e.y Superior (proximal) radioulnar jointInferior (distal) radioulnar jointMiddle radioulnar joint
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Ans. Injury
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Ans. A (Arylsulfatase B). (Ref. Harrison, Medicine, 18th/ Chapter 361. Lysosomal Storage Diseases) Maroteaux-Lamy syndrome (MPS type VI) is due to deficiency of N-acetyl galactosamine (arylsulphatase B enzyme). Mucopolysaccharidoses (MPS) Disorder Enzyme Deficiency Stored Material Inheri- tance Neuro- logic Liver Spleen Enlarge- ment Skeletal Dysplasia Ophthal- mologic Hemato- logic Unique Features MPS I, Hurler -L-lduroni- dase Dermatan sulfate Heparan sulfate AR Mental retardation Mental retardation None + + + ++++ Corneal clouding Vacuola- ted lympho- cytes Coarse facies; cardiovas- cular involve- ment; joint stiffness MPS II, Hunter Iduronate sulfatase Dermatan sulfate Heparan sulfate X-linked Mental retardation, less in mild form + + + ++++ Retinal degene- ration, no corneal clouding Granula- ted lympho- cytes Coarse facies; cardiovas- cular involve- ment; joint stiffness; distinctive pebbly skin lesions MPS III, Sanfi- lippo A =Heparan -N-sulfa- tase. B=N-Acetyl -alpha-glu- cosamini- dase. C=Acetyl- CoA: Alpha -glucosa- minide N-acetyl- transferase. D=N-Acetyl glucosa- mine-6- sulfate sulfatase. Heparan sulfate AR Severe mental retarda- tion + + None Granula- ted lym- phocytes Mild coarse facies MPS IV A, Morquio N-Acetyl- galactose mine-6- sulfate sulfatase Keratan sulfate Chondroi- tin-6 sulfate AR None + ++++ Corneal clouding Granu- lated neutro- phils Distinctive skeletal deformity; odontoid hypopla- sia; aortic valve disease MPS IV B, Morquio Beta- Galacto- sidase AR None +- + + + + MPS VI, Marote- aux-Lamy Arylsulfa- tase B Dermatan sulfate AR None + + + + + + Corneal clouding Granula- ted neutron phils and lym- phocytes Coarse facies; valvular heart disease MPS VII Beta-Glu- curoni- dase Dermatan sulfate Heparan sulfate AR Mental retardation, absent in some adults + + + + + + Corneal clouding
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Ans: A (Frank breech) Ref: DC Dutta's textbook of obstetrics, 7th edn, pg 374Explanation:BreechMC malpresentationMC cause - prematurityEtiologyPrematurity* Maternal factors* Fetal factors* Uterine factors- multi- anomalies (hydrocephalus)- bicomuate, septate, arcuate uterus* Pelvic factors* Placental factors- contracted pelvis- placenta praevia, cornuo fundal attachment* Cord factors* Liquor factors- short cord- polyhydramnios, oligohydramniosTypes of breechComplete breechdegMore common in multi with lax abdominal wallIncomplete breechdeg Frank breech (extended breech) - MC in primideg Footling breech/knee presentationCord prolapse Incidencedeg Frank breech -- 0.5%deg Flexed breech - 5 %deg Footling breech - 15%Complicated breech - breech associated with other obstetric complications like p LSCS, placenta praevia. contracted pelvis etc.Complicated breech delivery - difficulties encountered during a vaginal breech delivery Ike extended arm etcRecurrent breech presentation - can occur in uterine anomalies like bicornuate or septate uterusDenominator - sacrumEngaging diameter- Buttocks- Shoulder- Head- bitrochanteric- bisacromial- suboccipito frontal(10 ems)(12 ems)(10 ems)
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Yellow fever
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Benzodiazepines are the drug of choice in alcohol withdrawal. If the question asks to choose a specific benzodiazepine, the best choice would be chlordiazepoxide.
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Ans. is 'a' i.e., CytosolNADPH is produced mainly in HMP shunt, which occurs cytosol.HMP is an alternative route for the oxidation of glucose (beside glycolysis).It is also called as "pentose phosphate pathway", "Dickens - Horecker pathway", "Shunt pathway" or "phosphogluconate oxidative pathway".HMP shunt is required for provision of reduced NADPH and fiver-carbon sugars e.g. ribose (Pentose phosphates) for nucleic acid synthesis.Normally, 90% of glucose is oxidized by glycolysis and 10% is oxidized by HMP shunt.However, in liver and RBCs HMP shunt accounts for oxidation of 30% glucose.HMP shunt occurs in the cytosol.It is highly active in liver, adipose tissue, adrenal coex, lens, cornea, lactating (but not the nonlactating) mammary gland. Gonads (testis, ovary) and erythrocytes.Activity of this pathway is minimal in muscle and brain, where almost all of the glucose is degraded by glycolysis.
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Ans. a. Levetiracetam (Ref: Harrison 19/e p2544, 18/e p3265. 3253)Levetiracetam can be prescribed as monotherapy in a female patient of childbearing age is on valproate for JME, because of no known significant drug interactions. Treatment of Juvenile Myoclonic Epilepsy:Valproate is often used to treat juvenile myoclonic epilepsy.Other epilepsy drugs are effective in juvenile myoclonic epilepsy:LevetiracetamTopiramateLamotrigine Juvenile Myoclonic EpilepsyJuvenile myoclonic epilepsy (JME) is a generalized seizure disorder of unknown cause that appears in early adolescenceCharacterized by bilateral myoclonic jerks that may be single or repetitive.Myoclonic seizures are most frequent in the morning after awakening and can be provoked by sleep deprivation.Consciousness is preserved unless the myoclonus is especially severe.Many patients also experience generalized tonic-clonic seizures, and up to one-third have absence seizures.Although complete remission is relatively uncommon, the seizures respond well to appropriate anticonvulsant medication.There is often a family history of epilepsy, and genetic linkage studies suggest a polygenic cause.Treatment:Valproate is often used to treat juvenile myoclonic epilepsy.Other epilepsy drugs are effective in juvenile myoclonic epilepsy:LevetiracetamTopiramateLamotrigineFor most people with JME, treatment is long-term, and often lifelong.However, treatment is effective, allowing most people with juvenile myoclonic epilepsy to go five years or more between seizures.
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Ans. (b) 30Ref: K. Park 23rd ed. / 907* PHC level: 4 to 6 bed and staff 15 and 1 MBBS and medical officer* CHC level: 30 beds and 30 staff including 7 doctors MD/MS/OBS/GYNE/ PEDIA/ OPTHA/ANES/PSM* Sub center level: zero bed and 3 staff. MPW (1 male and l female)/ ANM (auxiliary nurse midwife).
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For calculating hea rate: HR-300/ Number of large squares(0.20 secs) in one R-R interval HR-1500/no of small squares (0.04 secs) in one R-R interval
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Chromosome 22q11.2 deletion syndrome Small deletion of band q11.2 on the long arm of chromosome 22 Congenital hea defects(conotruncal abnormalities) Abnormalities of the palate Facial dysmorphism Developmental delay Variable degrees of T-cell immunodeficiency and hypocalcemia -The patient suffering from DiGeorge syndrome -High risk of development of ADHD and Schizophrenia.
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Kyasanur forest disease: KFD is an example of tick-borne hemorrhagic fever. It was first repoed in Kyasanur forest of Karnataka, Shimoga district, n 1957. Vector: Hard ticks (Haemaphysalis spinigera). Hosts: Reservoirs are the rats and squirrels, Amplifier hosts are the monkeys (KFD is known as Monkey's disease). Man is an incidental host and considered as dead end. Clinical Manifestation: Incubation period varies from 3-8 days. First stage (hemorrhagic fever) occurs followed by second phase of meningoencephalitis. Killed KFD vaccine: It is recommended in endemic areas of Karnataka (all villages within 5 km of endemic foci).
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(Cyanide): Ref: 296-KH (92-P)TOBACCO AMBLYOPIA: -Toxic agent involved cyanide fond in tobacco.Excessive tobacco smoking Decreased cyanide detoxification due to alcoholics dietary deficiency of sulphur rich proteins| |Excessive cyanide in blood | Degeneration of ganglion cells particularly of the macular region | Degeneration of papillo-macular bundle in the nerve | Toxic amblyopia * Bilateral gradually progressive impairment in the central vision* Visual field examination - Bilateral centrocaecal scotomas* Fundus examination is essentially normal or there may be slight temporal pallor of the disc.
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Nernst equation: A freely diffusible ion, having different concentrations on either side of a membrane, would diffuse through the membrane and reach equilibrium. Charge created by diffusion on the membrane, when ion reaches equilibrium, can be calculated by Nernst equation. EMF (mV) = +/- 61 X log (C1/C2) C1 and C2: are the concentrations of the ion on either side of the membrane. Goldman-Katz equation is an expanded Nernst equation. It calculates the potential created by more than one ion, when these ions move from their higher to lower concentrations. Henderson Hasselbach equation: used to estimate the pH of a buffer solution Gibbs donnan equillibrium: In the presence of a non- diffusable ion, the diffusable ion distributes themselves so that at equilibrium their concentrations ratios are equal
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The latissimus dorsi acts on the humerus causing powerful adduction, extension, and medial rotation of the arm. Superior fibers of the trapezius cause scapular elevation and upward rotation. Middle fibers causes scapular retraction. Inferior fibers causes scapular depression and upward rotation. The levator scapula muscle attaches to the cervical veebrae and the superior angle of the scapula, causing elevation and downward rotation of the scapula. The rhomboid muscles attach to the spinous processes of C7-T5 and the medial border of the scapula, resulting in scapular retraction also also helps in elevation of scapula. Ref: Moon D.A., Foreman K.B., Albeine K.H. (2011). Chapter 1. Back. In D.A. Moon, K.B. Foreman, K.H. Albeine (Eds), The Big Picture: Gross Anatomy.
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For an elective cesarean section, We need a level upto T4 which cannot be achieved by Saddle Anaesthesia. Advantages of spinal anesthesia over general anesthesia are: Less neonatal exposure to potentially depressant drugs A decreased risk of maternal pulmonary aspiration An awake mother at the bih of her child Spinal opioids can be used for postoperative pain relief Advantages of spinal anesthesia over epidural anesthesia: Rapid and predictable block Complete block (lesser failure rate) Lesser risk of systemic toxicity or high spinal due to accidental intravascular or intrathecal injection seen with epidural anesthesia More cost effective Disadvantages of general anesthesia:General anesthesia is associated with greater risk of - Pulmonary aspiration of gastric contents Difficult or failed intubation Drug exposure to the fetus Indications of general anesthesia:General anesthesia is preferred in ceain emergency conditions such as - Massive bleeding (placenta pre or accreta, abruption placentae, or uterine rupture) Coagulopathy Hemodynamic instabilty Severe fetal distress Paracervical blockis used for labour analgesia but not for elective cesarean section. Side effects include transient fetal bradycardia, maternal local anesthetic toxicity and accidental injection of local anesthetic into the presenting fetal head. For an elective cesarean section, Spinal anesthesia is preferred over other techniques Advantages of spinal anesthesia over general anesthesia are: Less neonatal exposure to potentially depressant drugs A decreased risk of maternal pulmonary aspiration An awake mother at the bih of her child Spinal opioids can be used for postoperative pain relief Advantages of spinal anesthesia over epidural anesthesia: Rapid and predictable block Complete block (lesser failure rate) Lesser risk of systemic toxicity or high spinal due to accidental intravascular or intrathecal injection seen with epidural anesthesia More cost effective Disadvantages of general anesthesia:General anesthesia is associated with greater risk of - Pulmonary aspiration of gastric contents Difficult or failed intubation Drug exposure to the fetus Indications of general anesthesia:General anesthesia is preferred in ceain emergency conditions such as - Massive bleeding (placenta pre or accreta, abruption placentae, or uterine rupture) Coagulopathy Hemodynamic instabilty Severe fetal distress Paracervical blockis used for labour analgesia but not for elective cesarean section. Side effects include transient fetal bradycardia, maternal local anesthetic toxicity and accidental injection of local anesthetic into the presenting fetal head.
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When ultrasound examination reveals a sac without an embryo or yolk sac, the diagnosis is limited to one of three entities:
A normal early intrauterine pregnancy (IUP).
An abnormal intrauterine pregnancy (IUP).
A pseudogestational sac in a patient with an ectopic pregnancy.
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Ans. is a, b and c i.e. Vaginal bleeding; ECV; Mid trimester aboion; and After amniocentesis As explained in the previous question : Anti D prophylaxis should be given after all types of aboions (threatened, medical. MTP) molar pregnancy, ectopic pregnancy, delivery (+manual removal of placenta), procedures performed antenatally (Amniocentesis. Chorionic villous sampling. External cephalic version) and in cases of antepaum hemorrhage (Vaginal bleeding in this case).
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By 11th to 12th-day cells appear between the inner surface of the cytotrophoblast and the outer surface of the yolk sac.
These cells lie loosely and are called extraembryonic mesoderm. A cavity formed within it called the extraembryonic coelom or chorionic cavity.
This covers both the yolk sac and amniotic cavity except where the embryoblast is connected to trophoblast through the connecting stalk
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Ans: a (Macrophages) Ref: Robbins,7th ed, p. 71; Ananthanarayan, 7th ed, p. 144; Table 16-2TNF and IL1 are the main mediators of inflammation. They are produced mainly by the activated macrophages.Cytokines and their main sourcesILl, IL 8- MacrophagesIL 2, 3, 9, 10, 12, 13- T cellsIL 4, 5, 6- Helper cellsIL 7, 11- Stromal cells (7 spleen also)IFN a- Leucocyte -| MHC 1 - activate NK cellsIFNb- Fibroblast - | MHC 1 - activates NK cellsIFN g- T cell - | MHC 1 & 2 -| Ag presentationTNF a- Macrophage/ MonocyteB for both TNF b- T cellsLIF-T TGF b- Both B & T cells LIF- T cells
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Acquisition of milestones in a sequence that is different from the usual -Dence. Ex: Walking may come before crawling in cerebral palsy. Dissociation- Significant variations in attainment of milestones in different developmental domains. Delay is when child does not reach their developmental milestones at the expected time. Developmental disabilities are a group of conditions due to an impairment in physical, learning, language, or behavior areas.
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Iris melanomas may be of two types :-
Circumscribed/ Nodular: - It is the most common type which presents as a pigmented spot on the iris. Glaucoma is less common and usually treatable.
Diffuse iris melanoma: - Present as a unilateral dark iris (hyperchromic hetrochromia). The tumor has diffusely infiltration pattern of growth and invades the intertrabecular spaces, and plugs the drainage mechanism. This results in intractable secondary glaucoma.
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Ans. is 'a' i.e., Right atrium Veinous drainage of heart1. Coronary sinus: Opens into right atrium and has following tributries : (i) Great cardiac vein, (ii) Middle cardiac vein, (iii) Posterior vein of left ventricule, (iv) Small cardiac vein, (v) Oblique vein of left atrium and (vi) Sometimes right marginal vein.2. Anterior cardiac vein: Opens into right atrium.3. Venae cordis minimi (thebasian veins): Open into right atrium.4. Right marginal vein: More often opens into right atrium but sometimes into coronary sinus.
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*Toxoplasmosis and CNS lymphoma are the major differentials for a Ring Enhancing lesion in AIDS Patients Toxoplasmosis produces Eccentric target sign within a ring Enhancing lesion
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Mechanism of Action: Vigabatrin is an irreversible inhibitor of GABA aminotransferase (GABA-T), the enzyme responsible for the degradation of GABA. It may also inhibit the vesicular GABA transpoer. Vigabatrin produces a sustained increase in the extracellular concentration of GABA in the brain. This leads to some desensitization of synaptic GABA A receptors but prolonged activation of nonsynaptic GABA A receptors that provide tonic inhibition. A decrease in brain glutamine synthetase activity is probably secondary to the increased GABA concentrations. Vigabatrin is useful in the treatment of paial seizures and infantile spasms Reference: Katzung Pharmacology; 13th edition; Chapter 24; Antiseizure drugs
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A shift of the oxygen-hemoglobin dissociation curve to the right in response to increases in blood carbon dioxide and hydrogen ions has a significant effect by enhancing the release of oxygen from the blood in the tissues and enhancing oxygenation of the blood in the lungs. This is called the Bohr effect,
Deoxyhemoglobin binds more H+ than oxyhemoglobin does and forms carbamino compounds more readily, binding of O2, to hemoglobin reduces its affinity for CO2 (Haldane effect).
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a. Morphine(Ref: AAP guidelines 2015)Causes of respiratory depression in neonateIntrapartum asphyxia (most common causeQDrugs: Morphine anestheticsSepsisPrematurity: CNS immaturity, surfactant deficiencyRespiratory: Diaphragmatic hernia, obstructive lesionsCNS abnormalities: Malformation, trauma, myopathy
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Submental triangle is bounded by anterior belly of digastric (laterally), midline of the neck b/w the mandible & the hyoid bone (medially) & base of hyoid bone.Mylohyoid muscle is at the floor & submental lymph nodes are the content.
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the synopsis of forensic medicine & toxicology; Dr k.s narayan reddy ;28th edition; pg.no.143 Mechanism of contrecoup injury when a moving head is suddenly decelerated by hitting a firm surface.
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Lateral border of tongue is the most common site of squamous cell carcinoma.
Carcinoma of the tongue accounts for more than 50% of intraoral cancers in the United States. Two-thirds of lingual carcinomas appear as painless, indurated masses or ulcers of the posterior lateral border; 20% occur on anterior lateral or ventral surfaces, and only 4% occur on the dorsum. For unknown reasons, the oral tongue represents an increasingly common site of involvement in young patients.
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Klinefelters syndrome
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