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Ans. is c i.e. After 8 weeks
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OT4a: Extension to the chest wall, not including pectoralis muscleOT4b: Edema (including peau d'orange) or ulceration of the skin, or satellite skin nodules confined to the same breastOT4c: Both T4a and T4bT4d: Inflammatory carcinoma
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Ans. A. Nerve stimulation therapyIf symptoms are not severe and there is not significant and progressive neuropathy, then non-operative management must be considered. This includes splint age, hand therapy, steroid injection and even yoga has been proven to be beneficial. Alternatively, a patient could be referred for either open or endoscopic release
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Ans. (c) 7.36-7.44Ref: Harper's Biochemistry 30th edn. 110-13Well I think this one is too simple for an explanation.Also remember pH of urine=4.6-8.0Also KnowValues of pH going above 7.4 is alkalosis and value of pH going below 7.4 is acidosis* pH of Aqueous Humor - 7.2 Conditions arising due to low and high pHLow pHHigh pH* Metabolic acidosis* Respiratory acidosis* Metabolic alkalosis* Repiratory alkalosis
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A i.e. Trauma Blunt trauma (concussion or contusion) to eye 1/t formation of vossius ringQ on anterior surfaceQ of lens and rosette shaped cataractQ usually in the posterior coex. Penetrating trauma (with retention of copper or copper alloy like brass) 1/t golden brown ring (cu deposited in peripheral pas of descemet's membrane layer of cornea) resembling Kayser-Fleischer ring of wilsons diseaseQ and Sunflower cataractQ
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ANSWER: (D) Purkinje fibersREF: Guyton's physiology 22nd edition page 105Velocity of Signal Conduction in Cardiac Muscle:The velocity of conduction of the excitatory action potential signal along both atrial and ventricular muscle fibers is about 0.3 to 0.5 m/sec, or about 1/250 the velocity in very large nerve fibers and about 1/10 the velocity in skeletal muscle fibers. The velocity of conduction in the specialized heart conductive system-in the Purkinje fibers-is as great as 4 m/sec in most parts of the system, which allowTs reasonably rapid conduction of the excitatory signal to the different parts of the heart
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Ans. is 'c' i.e., Renal Amyloidosis commonly presents with Hypeension Most common presentation is proteinuria. o Hypeension may occur but it is not common, it occurs in 20-50% of the patients. "Although earlier it was thought that hypeension was an infrequent complication, more recently up to 50% of patients have been detected hypeensives".
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Ans. is 'c' i.e., Myeloperoxidase deficiency Patients with myeloperoxidase deficiency are paicularly liable to candida infection"--Ananthanarayan Immunodeficiency Infection * Chronic-granulomatous disease Catalase positive pyogenic infections * Chediak-Higashi syndrome Pyogenic infections * Myeloperoxidase deficiency Candida albicans infection * Lazy leucocyte syndrome Recurrent bacterial infection
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Ans. (a) RanulaRanula is a pseudocyst that is associated with mucus extravasation into the surrounding soft tissues. These lesions occur as the result of trauma or obstruction to the salivary gland excretory duct and spillage of mucin into the surrounding soft tissues.
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Ans. is 'c' i.e., Defect in splicingm-RNA processingo Prokaryotic mRNA is functional immediately upon synthesis, i.e. prokaryotic primary transcript of mRNA is functional. Thus it does not require post-transcriptional modification. In Eukaryotes the primary transcript of mRNA is the hn RNA (hetrogeneous nuclear RNA). After transcription hnRNA is extensively modified to form functional mRNA. These modifications are as follows.The 51-cappingThis is the first processing reaction. 5l-end of mRNA is capped with 7-methylguansosine. This cap helps in initiation of translation (protein synthesis) and stabilizes the structure of mRNA by protecting from 5'-exonuclease.Addition of poly 'A' tail As the name suggests, multiple4A' (adenylate) residues are added at 31 end.This poly-A tail is not transcribed from DNA. but rather added after transcription. These tails helps to stabilize the mRNA (by protecting from 31-exonuclease), facilitate exit from the nucleus, and aid in translation. After mRNA enters the cytosol, the poly-A tail is gradually shortened. Some mRNAs do not have poly-A tail, e.g. mRNAs of histones and some interferons.Removal of introns (splicing) Eukaryotic genes contain some coding sequences which code for protein and some intervening non-coding sequences which do not code for protein. The coding sequences are called 'exons'and intervening non-coding sequences are called 'introns'. The process by which introns are excised and exons are linked to form functional mRNA is called splicing. Thus mature mRNA does not contain introns.# Spitcesome :- Splicesome is an assembly made up of small nuclear RNA (snRNA), some proteins and hnRNA. snRNA combines with proteins to form small nuclear ribnonucleoprotein particles (snRNPs or snurps) that mediate splicing. It is snRNA component of snurps that catalyzes splicing. Snurps are U1, U2, U3, U4, U5 and U6-o Only about 1[?]5% of human DNA has coding sequence (exons). Remaining is non-coding (introns).Alternate splicing :- The hn-RNA molecules from some genes can be spliced in alternative way in different tissues. Thus two or more different mRNA (and therefore 2 or more proteins) can be synthesized from same hnRNA. For example, difference isoforms of tropomyosin in different tissues in due to alternate splicing.
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"The typical picture of B/L symmetrical inflammatory polyarthritis involving small joints initially and large joints later on, with sparing of the axial skeleton except the cervical spine is very likely, rheumatoid arthritis".
RA causes pleural effusion with low glucose & pH.
Enthesopathy is not seen in RA.
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UAC, a tyrosine can be mutated to a termination codon, UAA or UAG. This leads to premature termination of the protein, and so functional activity may be destroyed. This process is called nonsense or terminator codon mutation. Frameshift mutation is due to addition or deletion of bases. Missense mutation is due to a change in amino acid may be produced in the protein. These are the effects of mutation, whereas deletion, substitution, inseion are classification of mutation.Ref: DM Vasudevan - Textbook of Biochemistry, 7th edition, page no: 613
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Ans. (b) Chronic CuS04 poisoningRef. Forensic medicine and toxicology R.N. Karmakar, 3/e, p 94, Clinical immunotoxicology by David S. Newcombe, p 233
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NALGONDA TECHNIQUE:- Developed by National environment engineering research institute (NEERI), Nagpur for Defluoridation of water. It involves 'addition of Lime, Alum, and Bleaching powder' (Mnemonic: LAB) followed by Flocculation, Sedimentation and Filtration. In Nalgonda technique, Aluminum is major de-fluoridating agent.
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Nephritic syndrome associated withlow C3 : Immune complex glomerulonephritis Post streptococcal glomerulonephritis Lupus nephritis Cryoglobulinemia Bacterial endocarditis Shunt nephritis Membranoproliferative glomerulonephritis Crescenteric glomerulonephritis Idiopathic proliferative glomerulonephritis Atheroembolic renal disease Sepsis Acute Pancreatitis/ advanced liver disease
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Ans. is 'd' i.e., IMN(Ref: Harrison, 18th/e, p. 1491; Ananthanarayan, 9th/e, p. 482 and 8th/e, p. 480 - 481)* Hemorrhagic cystitis - Adenovirus serotype 11, 22.* Diarrhea and vomiting - Adenovirus serotype 40, 41.* Respiratory tract infection - Adenovirus serotype 1 to 7, 14, 14a, 21.
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Ans. C: Preserving traditional lifestyle Preserving traditional lifestyles is a primordial level of prevention Levels of Prevention Model This model, advocated by Leaven and Clark in 1975, has influenced both public health practice and ambulatory care delivery worldwide. This model suggests that the natural history of any disease exists on a continuum, with health at one end and advanced disease at the other. The model delineates three levels of the application of preventive measures that can be used to promote health and arrest the disease process at different points along the continuum. The goal is to maintain a healthy state and to prevent disease or injury. It has been defined in terms of four levels: Primordial prevention Prevention of the emergence or development of risk factors in population or countries in which they have not yet appeared. Effos are directed towards discouraging children from adopting harmful lifestyles. Primary prevention An action taken prior to the onset of disease, which removes the possibility that the disease will ever occur. It includes the concept of positive health, that encourages the achievement and maintenance of an "acceptable level of health that will enable every individual to lead a socially and economically productive life. A holistic approach Secondary prevention Action which halts the progress of a disease at its incipient stage and prevents complications. The domain of clinical medicine An imperfect tool in the transmission of disease More expensive and less effective than primary prevention Teiary prevention All measures available to reduce or limit impairment and disabilities, minimize suffering caused by existing depaures from good health and to promote the patient's adjustment to irremediable conditions. Modes of intervention Health promotion Specific protection Early diagnosis and treatment Disability limitation Rehabilitation Health promotion The process of enabling people to in areas to control over and to improve health Health education Environmental modifications Nutritional interventions Lifestyle and behavioral changes Specific protection Immunization Specific nutrients Chemoprophylaxis Protection against occupational hazards Protection from carcinogens Avoidance of allergens Rehabilitation The combined and coordinated use of medical, social, educational and vocational measures for training and retraining the individual to the highest possible level of functional ability. Examples-schools for blind, reconstructive surgery in leprosy, provision of aids for the crippled
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Thiophorase (acetoacetate – succinyl CO A, Co A transferase) is the enzyme responsible for transfer of Co A to acetoacetate converting it into acetoacetyl Co A which is responsible for utilization of ketone bodies.
Liver cells do not have enzyme thiophorase and so they can not utilize ketone bodies
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Ans. Compressing the thigh after putting between two rods
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Ans. is b i.e., Corneal xerosis WHO classification (1982) The new xerophthalmia classification (modification of original 1976 classification) is as follows : XN Night blindness X1A Conjunctival xerosis X1B Bitot's spots X2 Corneal xerosis X3A Corneal ulceration/keratomalacia affecting less than one-third corneal surface. X3B Corneal ulceration/keratomalacia affecting more than one-third corneal surface. XS Corneal scar due to xerophthalmia XF Xerophthalmic fundus.
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The essential characteristics of a representative sample are:
Its size should be 30 or more–the larger the sample, lesser would be the error due to chance.
It should randomly be selected by an appropriate sampling technique so that each member of the population has an equal opportunity of being selected.
The rules for selection should be independent of the observation to be made. If the sample represents the population, its values or statistics like Mean, SD(s) or proportion (p) will not differ significantly from population parameters or true value μ, σ or P, respectively. Difference found will not exceed the chance error. If you pick up an apple of any size from a heap, it does not represent the entire lot. It may be of big, small or medium size. Its size and weight may not be equal to the mean size and weight of the lot. If you pick up 30 at random after mixing all sizes, you will get a representative sample of 30 apples representing the entire heap (sufficiently large and unbiased). The seller can then fix the rate of 30 apples from any side of the heap, not allowing the customer to choose.
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Embryonically the gastrosplenic ligament is derived from the dorsal mesogastrium. The gastrosplenic ligament is a made of peritoneum that connects the greater curvature of stomach with the hilum of the spleen. It contains sho gastric vessels and left gastro-epiploic vessels.
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The baroreflex or baroreceptor reflex is one of the body's homeostatic mechanisms that help to maintain blood pressure at nearly constant levels. The baroreflex provides a rapid negative feedback loop in which an elevated blood pressure reflexively causes the hea rate to decrease and also causes blood pressure to decrease. Decreased blood pressure decreases baroreflex activation and causes hea rate to increase and to restore blood pressure levels. The baroreflex can begin to act in less than the duration of a cardiac cycle (fractions of a second) and thus baroreflex adjustments are key factors in dealing with postural hypotension, the tendency for blood pressure to decrease on standing due to gravity. The baroreceptors are stretch-sensitive mechanoreceptors. At low pressures, baroreceptors become inactive. When blood pressure rises, the carotid and aoic sinuses are distended fuher, resulting in increased stretch and, therefore, a greater degree of activation of the baroreceptors. At normal resting blood pressures, many baroreceptors are actively repoing blood pressure information and the baroreflex is actively modulating autonomic activity. Active baroreceptors fire action potentials ("spikes") more frequently. The greater the stretch the more rapidly baroreceptors fire action potentials. Many individual baroreceptors are inactive at normal resting pressures and only become activated when their stretch or pressure threshold is exceeded. Ref: guyton and hall textbook of medical physiology 12 edition page number:216,217,218
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Fructose-2,6-bisphosphate(F-2,6-BP) increases the activity of phosphofructokinase.F-2,6-BP formed from fructose-6-phosphate by the action of an enzyme called PFK2Ref: DM Vasudevan, 7th edition, page no: 113
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Methods by which vectors transmit an infectious agents are: Biting Regurgitation Scratching in infected faeces Contamination of host by body fluids of vectors Ref: Preventive and Social Medicine, by K.Park, 19th edition, Page 92.
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Here the aim is to prevent injury to the femoral head while it is soft. If the head remains in the acetabulum it will gradually revascularise.
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Single-agent chemotherapy is used as palliative therapy in head and neck cancers with the recurrent or metastatic form of cancer. The drugs which are used are - Cisplatin Methotrexate 5 Fu Paclitaxel Docetaxel Sometimes combinations of these drugs are used . a) Treatment of localized head and neck cancers - These tumors are treated with curative intent either with surgery or radiotherapy. The choice of modality differs according to anatomic location and institutional expeise. In early laryngeal cancer generally, radiotherapy is done to preserve voice while in early oral cavity cancers, surgery is preferred to avoid the long-term complication of radiation such as xerostomia and dental decay. b) Locally or advanced regional disease - Combined modality therapy including surgery, radiation therapy, and chemotherapy is used. Concomitant chemotherapy and radiotherapy appear to be most effective. c) Recurrent or metastatic disease - chemotherapy is used. Management of neck lymph nodes The neck lymph nodes should be treated when there are clinically positive nodes or the risk for occult disease is high based on the location and stage of the primary lesion. The decision to perform neck dissection or irradiate the neck is related to the treatment of the primary lesion. If the primary tumor is being treated with radiation and the neck is N0 or N1, the nodes are usually treated with irradiation. For surgically treated primary lesions, N0 or N1 neck disease may be treated surgically as well (Radical neck dissection/Modified neck dissection/Selective neck dissection). Negative prognostic factors such as extracapsular spread of tumor, perineural invasion, vascular invasion, fixation to surrounding structures, and multiple positive nodes are indicators for postoperative adjuvant radiation therapy. For N2 or N3 neck disease, neck dissection with planned postoperative radiation therapy is performed.
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Role of smoking and development of nasopharyngeal carcinoma is still not clear. Ref: Diet, Nutrition and Cancer: Proceedings of The 16th International Symposium on Mycotoxins By Takamatsu No Miya, Page 51; Carcinomas of The Head and Neck: Evaluation and Management By Charlotte Jacobs, Page 275; Cancer Prevention: The Causes and Prevention of Cancer By Graham A. Colditz, David John Hunter, Page 327
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Absolute contraindications Relative contraindications Uncontrolled hepatobiliary infection Age >70 Sepsis Poal vein thrombosis AIDS Severe obesity Cholangiocarcinoma HIV sero-positivity with low CD4 counts Metastasis to liver PAH Advanced cardiopulmonary disease Psychiatric disorders Active substance/ alcohol abuse Congenital anomaly (Uncorrectable)
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Ans. is 'c' i.e., cGMP
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Ans. A. More Common in malesCAUSES OF TORSADES DE POINTES:I. CongenitalII Acquired: BradycardiaHypokalemiaDrugs- Quinidine, procainamide, sotalol, amiodaroneDisopyramide, phenothiazine, TCATorsades de pointes is more common in females (because of |QT)Mechanism - Initiation by early after depolarization- Perpetuation by transmural entryTreatment-I. Congenital: Betablocker, pacing, ICII Acquired: I.V Magnesium, pacing
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LOW-DENSITY LIPOPROTEINS (LDL) LDL transpos cholesterol from liver to peripheral tissues. The only apoprotein present in LDL is apo B100. Most of the LDL paicles are derived from VLDL, but a small pa is directly released from liver. The half-life of LDL in blood is about 2 days.Ref: DM Vasudevan - Textbook of Biochemistry, 8th edition, page no: 153
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Ans. (a) MagistrateRef.: The Essentials ofFSM by K.S. Narayan Reddy 31st ed. / 5, 272Inquest: inquiry into the cause of death* Police Inquest# Most common type of inquest in India# Investigating officer usually is sub inspector or officer not below the rank of (senior) head constable.Magistrate Inquest: Court of Trail* Usually conducted by DM, SDM or Executive Magistrate (i.e. collector, Deputy Collector or Tahsildar)* Magistrate inquests are usually done in following circumstances:# Dowry deaths i.e. unnatural deaths within 7 years of marriage# Death in prison# Death in police custody or interrogation or during police firing# Death in any psychiatric hospital* Exhumation i.e. digging out of an already buried body also done upon order of magistrate.Coroner's Inquest: Court of inquiry* Coroner is an advocate, attorney, pleader, or first class magistrate with 5 years experience or metropolitan magistrate* Coroner court is a court of inquiry & accused need not be present.* Coroner court can't impose fine or punishment; but it can punish those guilty of contempt of his court when the offence is committed in the premises of his court (i.e. city limit only)* In India it is practiced only in Mumbai
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Ans. is 'b' i.e. When the headache is followed by partial paralysis of the IIIrd nerve on the same side as the hemicrania with out any scotoma. Parson writes- "Occasionally people who suffer from ordinary migraine have attacks in which without any scotoma, the headache is followed by partial paralysis of the third nerve (ophthalmoplegic migraine) on the same side as hemicrania. Slight ptosis, diplopia, and sluggishness of the pupillary reactions continue for some hours and gradually disappear."
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SGOT/SGPT ratio greater than 2 is highly suggestive of alcoholic hepatitis and cirrhosis. AST is synonymous with SGOT & ALT is synonymous with SGPT In general AST and ALT levels rise parallel to each other. In alcoholic liver disease the AST rises out of propoion to ALT such that the ratio of AST and ALT may become greater than 2: Stigmata of Alcoholic hepatitis / cirrhosis that aid in diagnosis : Bilateral enlarged parotids Gynaecomastia Testicular atrophy with loss of body hair Wasting of muscle mass Duputyrens contracture AST (SGOT) out of propoion to ALT (SGPT) seen in Alcoholic hepatitis Fatty liver in pregnancy Gamma Glutamyl transferase levels correlate with levels of Alkaline phosphatase and are a sensitive indicater of biliary tract disease -- obstructive jaundice. It is not an indicator of alcoholic liver disease. REF: Harrison book of internal medicine 21ST EDITION
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Ans. a. 136 (Ref: Park 23/e p849, 21/e p788)
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Ans. d (Tuberculosis). (Ref. Park, Textbook of PSM, 17th ed., 100)INDICATIONS FOR CHEMOPROPHYLAXIS DiseaseChemoprophylaxis1.Bacterial conjunctivitisErythromycin ointment2.DiphtheriaErythromycin and 1st dose vaccine3.InfluenzaAmantadine4.MalariaChloroquine 300 mg/wkProguanil 200 mg/wkMefloquine 250 mg/wkDoxycycline 100 mg/day5.Meningococcal meningitisSulphadiazine6.PlagueTetracycline7.CholeraTetracycline or furazolidine
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Ans is 'd' i.e., Transcription factoro The activated G protein effects one of the following effect pathway (activated stimulatory G protein stimulates, or activated inhibitory G protein inhibits) -Adenylyl cyclase (AC)o Activation of AC results in increased synthesis and intracellular accumulation of cAMP (by stimulatory G protein). cAMP acts through cAMP dependent Protein Kinase 'A', which phosphorylate and alters the function of many enzymes, ion channels and structural proteins. Inhibitory G protein inhibits AC and has opposite effects.o Examples - Corticotropin releasing hormone (CRH), FSH, LH, TSHACTH (corticotropin), ADH, Vasopressin (V2 receptors), Parathormone, Catecholamines (fi, CL2) e.g., adrenaline (most actions), Glucagon, hCG, Calcitonin, Somatostatin, acetylcholine (M2), Dopamine (Dj, D2), Angiotensin II(epithelial cells), GABAb, Histamine (H2).Phospholipase IP3 - DAG systemo Activation of phospholipase (by stimulatory G protein) hydrolyses the membrane phospholipid phosphatidyl inositol 4, 5 bisphosphate (PIP2) to generate \hc second messenger inositol 1,4, 5 - triphosphate (IP3 ) and diacytglycerot (DAG). IP3 mobilizes Ca+2 from intracellular organelles increased cytosolic Ca+2 DAG enhances Protein Kinase 'c' activation by Ca+2. Ca+2 acts as third messenger in this type of transduction mechanism and mediates the physiological effects of drugs.o Example - Growth hormone releasing hormone (GHRH), Thyrotropin releasing hormone (TRH), GnRh, A DH/Vasopressin (VI receptor, vasopressor action), oxytocin, cholecystokinin, PDGF, Gastrin, Catecholamines (some actions via Of/ receptors), Angiotensin II (vascular smooth muscle), Substance P, Histamine - H1, muscarinic M1, M3C) Channel regulationo Activated G-proteins can open or close ion channels - Ca , K7 or NaLo Examples -(1)|Ca+2-b1-adrenergic, (2) -|Ca+2-Dopamine D2, GABAB,(3) |K+-Adrenergic a2, muscarinic M2, Dopamine D2, GABAB.
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Inhibition of the enzyme succinate dehydrogenase by malonate illustrates competitive inhibition by a substrate analog. Succinate dehydrogenase catalyzes the removal of one hydrogen atom from each of the two-methylene carbons of succinate. Both succinate and its structural analog malonate can bind to the active site of succinate dehydrogenase. However, since malonate contains only one methylene carbon, it cannot undergo dehydrogenation. Ref: Kennelly P.J., Rodwell V.W. (2011). Chapter 8. Enzymes: Kinetics. In D.A. Bender, K.M. Botham, P.A. Weil, P.J. Kennelly, R.K. Murray, V.W. Rodwell (Eds), Harper's Illustrated Biochemistry, 29e.
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When a person arrested on a charge of commiting an offence of such anature & under such circumstances that there are reasonable grounds for believing that an examination of his person will offer some evidence , it shall be lawful for a registered medical practioner acting at the request of a police officer not below the rank of sub inspector.sec 363 is kidnapping. From Textbook of forensic medicine, V.V.Pillai, pg no 15 (16 edition)
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Ans: A (AR) Ref: Robbins Pathologic Basis of Disease, 8th edition.Explanation:(Refer to explanation in 2011 Pediatrics Question) Jeune syndrome ( Familial asphyxiating thoracic dystrophy)Autosomal recessive disorderClassic manifestations in infancy includeDw arfism with short ribsShort limbsCharacteristic radiographic changes in ribs and pelvisSmall chestsRespiratory insufficiencyLung hypoplasia (Due to a restricted thoracic cage) Major cause of death in infancy.Renal and pancreatic insufficiency (in those w ho survive newborn period)Other Clinical FeaturesRespiratory distressChest deformity of varying degreeShort-limbed dwarfismFailure to thriveGastroenteritisRecurrent rectal prolapseDiarrheaCongestive cardiac failurePuffy face, andAnkle swelling
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Macrolide antibiotics such as erythromycin directly stimulate motilin receptors on gastrointestinal smooth muscle and promote the onset of a migrating motor complex. Intravenous erythromycin (3 mg/kg) is beneficial in some patients with gastroparesis; however, tolerance rapidly develops. It may be used in patients with acute upper gastrointestinal hemorrhage to promote gastric emptying of blood before endoscopy. Ref: Katzung 11th edition Chapter 60.
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Ans: C (Isotope renogram) Ref: Harrison's Principles of Internal Medicine, 18th ednExplanation:Imaging Studies in Chronic Kidney DiseaseThe most useful imaging study is a Renal ultrasound.Advantages of Renal Ultrasoundo Verify the presence of two kidneyso Determine if they are symmetrico Provide an estimate of kidney sizeo Rule out renal masseso Evidence of obstruction.Since it takes time for kidneys to shrink as a result of chronic disease, the finding of bilaterally small kidneys supports the diagnosis of CKD of long-standing duration, with an irreversible component of scarring.If the kidney size is normal, it is possible that the renal disease is acute or subacute.The exceptions are diabetic nephropathy {where kidney size is increased at the onset of diabetic nephropathy before CKD with loss of GFR supervenes). Amyloidosis and HIV nephropathy, where kidney size may be normal in the face of CKD.Polycystic kidney disease that has reached some degree of renal failure will almost always present with enlarged kidneys with multiple cysts.A discrepancy >1 cm in kidney length suggests either a unilateral developmental abnormality or disease process or renovascular disease with arterial insufficiency affecting one kidney more than the other.The diagnosis of renovascular disease can be undertaken with different techniques, including Doppler sonography, nuclear medicine studies, or CT orMRI studies.If there is a suspicion of reflux nephropathy (recurrent childhood urinary tract infection, asymmetric renal size with scars on the renal poles), a voiding cystogram may be indicated.However, in most cases by the time the patient has CKD, the reflux has resolved, and even if still present, repair does not improve renal function.Radiographic contrast imaging studies are NOT particularly helpful in the investigation of CKD.Intravenous or intraarterial dye should be avoided where possible in the CKD patient, especially with diabetic nephropathy, because of the risk of radiographic contrast dye- induced renal failure.When unavoidable, appropriate precautionary measures include avoidance of hypovolemia at the time of contrast exposure, minimization of the dye load, and choice of radiographic contrast preparations with the least nephrotoxic potential.Additional measures thought to attenuate contrast-induced worsening of renal function include judicious administration of sodium bicarbonate-containing solutions and W-acetyl-cysteine.A retrograde pyelogram may be indicated if a high index of clinical suspicion for obstruction exists despite a negative finding on renal ultrasonography.Intravenous pyelography is not commonly performed, because of the potential for renal toxicity from the intravenous contrast; however, this procedure is often used to diagnose renal stones.A renal radionuclide scan can be used to screen for renal artery stenosis when performed with captopril administration; it also quantitates differential renal contribution to total glomerular filtration rate (GFR). However, radionuclide scans are unreliable in patients with a GFR of less than 30 mL/min/1.73 m2.Magnetic resonance angiography (MRA) is becoming more useful for the diagnosis of renal artery stenosis, although renal arteriography remains the criterion standard. However, MR! contrast is problematic in patients with existing chronic kidney disease (CKD) because they have a low, but potentially fatal, risk of developing nephrogenic systemic fibrosis.
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c. Constitutional delay in growth and pubertyHe had short stature during childhood, but the final adult height attained is normal.
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Splenic atrophy—sickle-cell disease due to infarction, celiac disease, dermatitis herpetiformis, ulcerative colitis, essential thrombocythemia.
In infective endocarditis—splenomegaly (40%).
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schwartz formula for creatinine clearance :
= k X length / serum creatinine
( k = 0.42)
GFR = 0.42 X 85/2 = 17.8 ≈ 18.
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Ref - semantischolar.org
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First-generation H1 antagonists (e.g., dimenhydrinate, cyclizine, meclizine, and promethazine) can prevent motion sickness, although scopolamine is more effective. Antiemetic effects of these H1 antihistamines can be beneficial in treating veigo or postoperative emesis. Cimetidine, ranitidine, famotidine, and nizatidine are selective competitive inhibitors of histamine on H2 receptors. These receptors modulate smooth muscle, vascular tone, and gastric secretions and may be involved in clinical effects associated with anaphylactic and anaphylactoid reactions as well as ingestion of histamine or histamine-like substances. FIRST-GENERATION H1 BLOCKERS Hydroxyzine Diphenhydramine Promethazine Cyproheptadine Doxepin SECOND-GENERATION H1 BLOCKERS Cetirizine Levocetirizine Loratadine Desloratadine Fexofenadine Acrivastine Ref: Burkha C., Morrell D., Goldsmith L. (2011). Chapter 65. Dermatological Pharmacology. In L.L. Brunton, B.A. Chabner, B.C. Knollmann (Eds), Goodman & Gilman's The Pharmacological Basis of Therapeutics, 12e.
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Gilbert syndrome may be associated with impaired hepatic uptake of bilirubin. It is caused by hereditary decrease in the activity of glucuronosyltransferase in the uridine diphosphate glycosyltransferase 1 (UGT1) family. More severe enzyme deficits are the cause of the two variants of Crigler-Najjar syndrome and usually present in the neonatal period with very high elevations in unconjugated bilirubin, making it not the correct answer in this patient. She does not have Dubin-Johnson or Rotor syndrome since both of these entities have elevations of conjugated bilirubin.
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Ans. is 'c' i.e., 21 hydroxylase deficiency Major causes of hyponatremiaDecreased causes of hypokalemiaIncreased entry into cellso An elevation in extracellular pHo Increased availability of insulino Elevated b-adrenergic activity - stress or administration of beta agonistso Hypokalemic periodic paralysiso Marked increase in blood cell productiono Hypothermiao Chloroquine intoxicationIncreased gastrointestinal losseso Vomitingo Diarrheao Tube drainageo Laxative abuseIncreased urinary losseso Diureticso Primary mineralocorticoid excesso Loss of gastric secretionso Nonreabsorbable anionso Renal tubular acidosiso Hypomagnesemiao Amphotericin Bo Salt-wasting nephropathies - including Bartter's orGitelman's syndromeo PolyuriaIncreased sweat lossesDialysisPlasmapheresis
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Lung Graft versus host disease Graft versus host disease occurs in any situation in which immunologically competent cells or their precursors are transplanted into immunologically crippled patients and the transferred cells recognize alloantigens in the host. Graft versus host disease occurs most commonly in the setting of allogenic bone marrow transplantation but may also follow transplantation of solid organs rich in lymphoid cells (e.g. the liver) or transfusion of unirradiated blood. Recipients of bone marrow transplants are immunodeficient because of either their primary disease or prior treatment of the disease with drugs or irradiation. When such recipients receive normal bone man-ow cells from allogenic donors, the immunocompetent, T cells present in the donor marrow recognizes the recipient's HLA antigen as foreign antigen and react against them. Both CD4+ and CD8+T cells recognize and attack host tissues. In clinical practice GVH can be so severe that bone marrow transplants are done only between HIA matched donor and recipient. Acute GVH disease occurs within days to weeks after allogenic bone marrow transplantation. Although any organ may be affected, the mayor clinical manifestation results from involvement of the immune system and epithelia of the skin, liver and intestines. Involvement of the skin in GVH disease is manifested by a generalized rash leading to desquamation in severe cases. Destruction of small bile ducts gives rise to jaundice and mucosal ulceration of the gut results in bloody diarrhoea. Immunodeficiency is a frequent accompaniment of GVH disease the immunodeficiency may be a result of prior treatment, myeloablative preparation for the graft, a delay in repopulation of the recipient's immune system and attack on host's inunune cells by grafted lymphocytes. Affected individuals are profoundly immunosuppressed and are easy prey to infections. Although many different types of organisms may infect patients, infection with cytomegalovirus is paicularly impoant.
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C i.e. Erythromycin Distinguishing Features of Genital Ulcers Features Syphilis (1degchancre) Chancroid (soft chancre) Lymphogranuloma Venereum Donovanosis Granuloma venerum/inguinale) Herpes genitalis Causative agent Treponema Haemophilus Chlamydia Calymmatobacterium Herpes simplex pallidiumQ ducreyiQ trachomatisQ granulomatisQ virus type HQ (LI,L2,L3) (rarely type I) Incubation period 9 - 90 daysQ 1 - 7 days rarely > 10 days 3 days - 6 weeks 1-4 weeks (upto 6 months) 2-7 days No. of attacks Only one (1) 1 or 2 Only one (1) Only one (1) Reccurent No. of lesions Usually 1 Usually multipleQ may coalesce Usually 1 Variable MultipleQ, may coalesce Early 1deg lesion Papule Pustule Papule, pustule Papule VesicleQ Diameter 5-15 mm Variable 2-10 mm Variable 1-2 mm Depth Superficial or deep Excavated Superficial or deep Elevated Superficial Edges Sharply demarcated, elevated, round or oval Undermined, ragged, sloughedQ irregular Elevated, round or oval Elevated, irregular serpiginous Erythematous Base Smooth, non- purulent, non- vascula,Q (relatively) Purulent, bleeds easily Variable, nonvascular Red & velvety (beefy red), bleeds easily with exuberant granulation tissueQ Serous, erythematous, nonvascular. Induration FirmQ SoftQ (mostly) Occasionly firm Firm None Pain UncommonQ Usually very tender Variable Uncommon Frequenctly tenderQ Lymphadenopathy Firm, non tender, shotty, bilateralQ Tender, may suppurate, loculated, usually unilateral (Bubo) Tender, may suppurate, loculated, usually unilateral (Bubo) No lymphadenopathy pseudobuboesQ (subcutaneous nodules in inguinal region, may ulcerate) Firm, tender, often bilateral Diagnosis - Dark field - Clinical features - Demonstration of - On tissue smear & - Multinucleate microscopyQ - Serologicaltests - Gram staining (gram -ve cocco- baccili with rail road appearance) LGV as elementary & inclusion bodies - Frie's testQ - Hyper gamma- globulinemia - Complement fixation +ve histopathological microscopy using Giemsa, Wrights or Silver stain or Leishman Stain 1. Gram negative C. granulomatis may be seen within characteristic large mono nuclear cell as d giant cell on Tzank smear - Culture is confirmatory Donovan bodies 2. Donovan bodies are seen in vacuolated cytoplasm of large mono nuclear cells as bipolar inclusionsQ (safety pin or telephone handle appearance) measuring 1 to 2 um x 0.5 to 0.7 um. Drug - Benzathine/procaine - Azithro/ - Doxy / tetra DoxycyclineW tetracycline AcyclovirQ Penicillin in all erythromycin cyclineQ Azithromycin / except neurosyph- ilis & congenital syphilis in which crystalline penicillin - Ciftriaxone . - Ciprofloxacin - Erythromycin erythromycin (in pregnancy) (aqueous benzyl penicillin) is used - In penicillin sensitive patient, Tetracycline or erythromycin is used
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B i.e. IllusionIllusion is sensory stimulation given a false interpretation i.e it is a false perception (misinterpretation /bizarre interpretation/misperception) of external stimuliQ. Eg. misinterpretating cord for snake or rug for bear.Most likely to occur when clarity of sensory stimulation is reduced (e.g at night or eyes bandaged)Q, when attention is not focused or mind is under the sway of an emotionally determined ideational set (eg. anxious, frightened, vigilance for intruder), or when the level of consciousness is reduced (as in delirium), or all working together. For example a frightened anxious elderly in night (or with both eyes bandaged d/ t surgery) who is vigilant for intruders is more likely to misperceive fluttering cuain as intruder or bush as a man.Illusions may also occur in hysteria, depression, schizophrenia or an emotions of great force (eg abandonment or erotic yearning).Illusions may be visual, auditory (eg slamming door misinterpreted as a repo of a pistol), tactile (eg skin sensation thought to be caused by vermin), gustatory (eg. position detected in taste of food), kinesthetic (eg flying) or visceral (eg. abdominal pain thought to be caused by ground glass).
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Aschners reflex is called oculocardiac reflex. TheOculocardiac reflex, also known asAschner phenomenon, Aschner reflex, or Aschner-Dagnini reflex, is a decrease in pulse rate associated with traction applied to extraocular muscles and/or compression of the eyeball. The reflex is mediated by nerve connections between the ophthalmic branch of the trigeminal cranial nerve the ciliary ganglion, and the vagus nerve of the parasympathetic nervous system. Nerve fibres from the maxillary and mandibular divisions of the trigeminal nerve have also been documented. These afferents synapse with the visceral motor nucleus of the vagus nerve, located in the reticular formation of the brain stem. The efferent poion is carried by the vagus nerve from the cardiovascular centerof the medulla to the hea, of which increased stimulation leads to decreased output of the sinoatrial node. This reflex is especially sensitive in neonates and children, paicularly during strabismus correction surgery.However, this reflex may also occur with adults. Bradycardia, junctional rhythm and asystole all of which may be life-threatening,can be induced through this reflex. This reflex has been seen to occur during many pan facial trauma surgeries due to stimulation of any of the three branches of trigeminal nerve.
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ANSWER: (C) Fracture middle cranial fossaREF: Dhingra 4th ed page 399See previous question for explanation
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.epidemiological studies are usually employed for a period of twice the incubation period .it is done so so thzt most of the cases and associated risk factors are identified in such a way that it may help in the interpretation of data collected and thus the epidemiological analysis. ref:park&;s textbook,ed 22,pg no 67
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Only 10% are malignant. They are also called 10 % tumors because 10% are bilateral, 10% are extra adrenal, 10% occur in pediatric patients, 10% are familial. One "traditional" 10% rule that has now been modified peains to familial cases. It is now recognized that as many as 25% of individuals with pheochromocytomas and paragangliomas harbor a germline mutation in one of at least six known genes
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The earliest signs of left atrial enlargement are straightening of the upper left border of the cardiac silhouette and posterior displacement of the esophagus.
The earliest sign of left atrial enlargement on PA view → Straightening of left heart border.
The earliest sign of left atrial enlargement on lateral view → Posterior displacement of the esophagus.
The overall earliest sign of left atrial enlargement → Straightening of left heart border on PA view.
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- The given X ray shows cardiac shadow occupying almost entire hemithorax, giving rise to a 'BOX SHAPED' hea which is a feature of Ebstein's anomaly - EBSTEIN ANOMALY: It is d/t downward displacement of posterior & septal leaflets of tricuspid valve resulting in atrialization of right ventricle Huge cardiomegaly is seen especially right atrium ECG - shows Himalayan P waves - PPHN: Aka Persistent pulmonary hypeension in newborn Failure of normal circulatory transition that occurs after bih resulting in hypoxemia. - TTNB: Aka Transient Tachypnea of New Born MCC of respiratory distress in a term neonate BASIC DEFECT - Delayed clearance of lung fluids RISK FACTOR - Delivery by cesarean section X-ray shows - Fluid in interlobar fissure , Pleural effusion , Perihilar streaking -TOF: MC congenital cyanotic hea disease in children 4 COMPONENTS: 1. Large, unrestricted VSD 2. Pulmonary infundibular stenosis 3. Overriding of aoa 4. Right ventricular hyperophy X-ray shows --> Boot shaped hea / coeur en sabot
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Bloody CSF is seen in SAH and herpes encephalitis pt's. Cerebral malaria manifests as diffuse symmetric encephalopathy; focal neurological signs are unusual. Convulsions, usually generalized and often repeated On Routine Fundoscopy:- Discrete spots of retinal opacification (30-60%) Retinal hemorrhage Papilledema
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Ans. is 'd' i.e., Chicken pox fRef: Ananthnaravan 9th/e p. 461 & 8th/e p. 4611Poxviruses causing disease in humanso Variola (small pox )o Vacciniao ButTalopoxo Monkeypoxo Cowpoxo Orfo Molluscum contagiosumo Tanapoxo Chicken pox is caused by varicella - zoster virus, which is a herpes virus.
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Ans. is 'b' i.e., Associated with misfolding of protein Prions are small protein-containing infectious particles with no detectable nucleic acid. They were suspected to be viruses but otherwise do not conform to the standard definition of viruses. They differ from the viruses in their many properties. The prions show following characteristics:1. Prions like viruses are filterable.2. They apparently lack any virion structure or genome.3. Unlike viruses, they are unusually resistant to inactivation by heat, disinfectants and radiation.4. They do not elicit any specific immune response in the infected host.
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Ans. is 'b' i.e., Group A streptococcus from other Beta hemolytic streptococci The bacitracin susceptibility test is used to distinguish Group A streptococci, from other streptococci. This test is used to determine the effect of small amount of bacitracin (0.04U) on an organism.
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Ans. D: Enopthalmos Complications of trachoma include: Inward-turning eyelashes (trichiasis) Cloudiness of the cornea (pannus) Drooping eyelids (ptosis) Ulceration of the cornea Progressive scarring of the cornea that can result in blindness.
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Ans. (c) 3 DRef.: A.K. Khurana 6th ed. /578* By pinhole test visual acuity can be neutralized till 3 D. It can't accommodate more than that.* It is a test to distinguish a refractive error from organic disease.* A refractive error may, be corrected with glasses, whereas organic disease may signal the development of preventable blindness. If visual acuity is improved after pin hole test, the defect is refractive; if not, it is organic.# Pinhole improves vision: refractive error, peripheral cataract# Pinhole worsen vision: Macular diseases, central lens opacities# Vision static with pinhole: Amblyopia
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hyperophic pulmonary osteoahropathy, hyperkeratosis of palms and soles, erythema annulare centrifugum, syndrome of inappropriate secretion of antidiuretic hormone (SIADH), and ectopic andrenocoicotrophic hormone (ACTH) and calcitonin production.these are all paraneoplastic manifestations of bronchogenic carcinoma Ref Harrison 20th edition pg 536
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Troponin and Its Role in Muscle ContractionAttached intermittently along the sides of the tropomyosin molecules are additional protein molecules called troponin.These protein molecules are actually complexes of three loosely bound protein subunits, each of which plays a specific role in controlling muscle contraction.One of the subunits (troponin I) has a strong affinity for actin, another (troponin T) for tropomyosin, and a third (troponin C) for calcium ions. This complex is believed to attach the tropomyosin to the actin. The strong affinity of the troponin for calcium ions is believed to initiate the contraction process.Guyton 13e pg: 78
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The apex (apex pulmonis) is rounded, and extends into the root of the neck, reaching from 2.5 to 4 cm. above the level of the sternal end of the first rib. A sulcus produced by the subclan aery as it curves in front of the pleura runs upward and lateralward immediately below the apex. Ref: Anatomy of the Human Body Henry Gray.
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Acute malnutrition is manifested by weight for height which is a result of more recent food deficit or illnessRef: Ghai Essential Pediatrics 8th edition
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Refer Miller's anesthesia 5/e p 892 Among the given options Rapacuronium IA the shoest acting drug Rapacuronium has been withdrawn from the market because it produces intense bronchospasm in a significant number of patients Mivacurium is shoest acting NDMR
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Ans. is 'c' i.e., No role of inorganic phosphate
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Non-granulomatous uveitisGranulomatous uveitisBehcet disease HLA - B27 associated ankylosing spondylitis Reiter syndrome Inflammatory bowel disease Idiopathic Infections - Lyme disease, Kawasaki disease, rickettsia, mumps, measles, Chlamydia, influenza, adenovirusPsoriatic ahritis Secondary syphilis Trauma UGH syndrome Glaucomatocyclitic crisis Lens-induced uveitis Corneal graft rejection Sarcoidosis Sympathetic ophthalmitis Phacoanaphylaxis Vogt - Koyanagi - Harada syndrome Infections - Tuberculosis, Leprosy, Syphilis, Leptospirosis, Brucellosis, Herpes simplex, herpes zoster, varicella, systemic mycosisKoeppe' s nodules- situated at papillary border -posterior synechiae smaller in sizeBusacca' s nodules- situated at the collarette; larger in size(Refer: AH Khurana, Comprehensive Textbook of Ophthalmology,5thedition, pg no: 149)
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Ans. Zonular
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Amaurosis fugax, one type of TIA, is a manifestation of carotid bifurcation atherosclerotic disease. It is manifested by unilateral blindness, being described by the patient as a window shade across the eye, lasting for minutes or hours. It is caused by micro emboli from a carotid lesion lodging in the retinal artery, the first intracerebral branch of the internal carotid artery.
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ITP is proposed to be secondary to antibodies directed against the platelate glycoprotein 2b/3a complex. mmune thrombocytopenia (ITP) is a disorder that can lead to easy or excessive bruising and bleeding. The bleeding results from unusually low levels of platelets -- the cells that help blood clot. Formerly known as idiopathic thrombocytopenic purpura, ITPcan cause purple bruises, as well as tiny reddish-purple dots that look like a rash. Children may develop ITP after a viral infection and usually recover fully without treatment. In adults, the disorder is often long term. If you don&;t have signs of bleeding and your platelet count isn&;t too low, you may not need any treatment. If your symptoms are more severe, treatment may include medications to boost your platelet count or surgery to remove your spleen. Reference : Ghai essential of pediatrics, eighth edition, p.no:351
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- a single oral dose of doxycycline 300mg for adults and 6mg/kg for children under 15 years has been proved effective for chemoprophylaxis for cholera. Reference : Park's textbook of preventive and social medicine, 23rd edition, pg no:233 <\p>
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Boundaries of anatomical snuff box :
Anterior / Lateral wall - Extensor pollicis brevis and abductor pollicis longus tendons.
Posterior / medial wall - Extensor pollicis longus tendon.
Floor - Styloid process of radius, trapezium, scaphoid and base of first metacarpal.
Roof - Skin, fascia, starting of cephalic vein, superficial branch of radial nerve.
Content - radial artery.
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A properly placed retrobulbar injection is effective within seconds and blocks all extraocular muscles except the superior oblique muscle, affects the ciliary ganglion and anesthetizes the entire globe.
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Neuroleptic malignant syndrome is psychiatric emergency CLINICAL CRITERIA * 106:F * Abrupt onset * Any of the two * Diaphoresis * Tachycardia Labile bp ETIOLOGY Introduction of Dopamine antagonists or Abrupt Discontinuation Of an antipsychoticRef. kaplon and sadock, synopsis of psychiatry, 11 th edition, pg no.925
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Image shown is of an infant with Umbilical hernia - Hernia occurring directly through umbilicus Closes spontaneously in majority of cases by 2 years. Treatment - Indications of surgery If it persists beyond 5yrs age Symptomatic patients Strangulation Size > 2 cm Progressive enlargement of hernia after 1-2 years Maximum time to wait- 5 years - Small defects - Closed primarily - Size of defect >3cm - Prosthetic mesh - MAYO'S REPAIR
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aoic regurgitation R ALAGAPPAN TEXT BOOK.OF GENERAL MEDICAL PRACTICE PAGE.156
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Any steroid hormone that promotes male secondary sex characters. The two main androgens are androsterone and testosterone. The androgenic hormones are internal endocrine secretions circulating in the bloodstream and manufactured mainly by the testes under stimulation from the pituitary gland.Ref: Ganong&;s review of medical physiology; 24th edition; page no:-428
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Ans. (a) EBV Paul Bunell test is the standard diagnostic procedure of infectious mononucleosis which is caused by EBV. Paul Bunell test detects heterophile antibody. I'aul buneii lest Heterophile agglutination test: In this test inactivated serum (56degC for 30 minutes) in doubling dilutions is mixed with equal volumes of a 1% suspen- sion of sheep erythrocytes. An agglutination titre of 100 or above is suggestive of infectious mononucleosis. For ti confirmation, differential absorption of agglutinins with guinea pig kidney and ox red cells is necessary Infectious monoucleosis antibody is removed by ox red cell but not guinea pig kidney. The Paul Bunell antibody develops early during the course of infectious mononucleosis, and disappears within two months. False-positive: In patient with lymphoma, hepatitis, malaria, connective tissue disease. Differential absorption test for Paul-Bunnell antibody Guinea pig kidney Ox red cells Normal serum Absorbed Not absorbed Antibody after serum therapy Absorbed Not absorbed Infectious mononucleosis Not absorbed Absorbed Remembe! - MC cause of heterophile antibody (+)ve infectious mononucleosis is EBV. MC cause of heterophile antibody (-) ye infectious mononucleosis is CMV. Heterophile (-) ve IM is also caused by toxoplasmosis, Listeria, non-infectious stimuli.
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Exposure to nonoccupationally exposed individuals (e.g., someone occupying an adjacent office) is no greater than 100 µGy per week.
White and Pharoah's Oral Radiology Principles and Interpretation 8th edition
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Highly resistantHighly sensitiveMaligant melanomaOsteosarcomaSeminomaMultiple myelomaEwings sarcomaWilms tumourLymphoma(Ref: Harrison's principals of Internal medicine, 17th Ed page 612)
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Plasmodium species P. falciparum infects RBC's of all ages P. vivax infects RBC's < 14 d. P. malariae infects old RBC's. P. ovale selectively infect reticulocytes.
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Ans. (a) IgM
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Ans. is 'a' i.e.,Vitamin B12Dietary sources of vitamin B12 are of animal origin only and include meat, eggs, milk, diary products, fish, poultry etc. Vitamin BI2 is absent in plant foods. Small amount of vitamin B 12 is synthesized in the intestine by the action of intestinal flora.
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Actinomyces - on ZN staining- central pa as non-acid fast surrounded by acid-fast clubs( antigen-antibody complex ). Nocardia- on ZN staining - acid-fast. Nocardia species are aerobic. Reference: Textbook of Microbiology; Ananthanarayan and paniker's; 10th edition; Pg: 398
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Ans. is 'b' i.e., Herpesviridae
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HPV 6 Most common human papilloma virus associated with genital was is HPV-6. Human papilloma virus is a DNA virus. There are more than 70 types of human papilloma virus. A fairly good association exists between HPV type and the clinical lesions caused by them Was can present clinically as : Type Verruca vulgaris (common was) Verrucous papule son hands and feet 2, 4, 27, 29 Palmoplanar was Superficial mosaic was on palms and soles Deep myrmecia was on palms and soles 1. 2, 4 Verruca plana Flat smooth papules on face 3, 10, 28, 49 Epidermodysplasmia Verrucoformis Plane wa like lesions on face and acral pas Pityriasis versicolar like lesions on trunks 3, 6, 10 Anogenital was Sexually transmitted genital was 6, 11, 16, 18, 31, 33 Genital was are a cutaneous manifestation of infection with epidermotropic, sexually transmitted human papilloma virus. HPV is transmitted sexually in most cases. An individuals lifetime risk of HPV infection exceeds 50% but most are asymptomatically infected with only 1-2% developing genital was. About 90% of genital was are caused by infection with HPV types 6 and 11. Human papilloma virus also has oncogenic potential. According to consensus panel gathered by the WHO a large body of epidemiologic and biologic data has established that some HPV infections cause cervical cancer. For example, 95% of cervical cancers contain HPV DNA of oncogenic (high risk) types such as 16, 18, 31, 33 and 45. Human papilloma virus associated with Genital was --> 6, 11 Cervical cancer --> 16, 18, 31
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Human povey index for developing countries (HPI-1) The following three dimensions are taken into account: Deprivation of longevity, measured as a percentage of the individuals with a life expectancy lower than 40 years (P1). Deprivation of knowledge, expressed as a percentage of illiterate adults (P2). Deprivation of decent living standards (P3) HPI-2 also considers a fouh dimension, social exclusion, measured with the long-term unemployment rate (P4), that is the percentage of those unemployed for 12 months or over compared to the total work force (the sum of those working and those seeking a job). Ref : Park&;s textbook of preventive and social medicine; 23rd edition
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Harshmohan textbook of pathology 7th edition. *seminoma malignant tumor of testes-it is associated with elevated hCG level in blood. *choriocarcinoma- hCG level increases in blood. *yolk sac tumor/endodermal sinus tumor -alphafetoprotien increases.
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Ans. is a, b and c i.e. MTX; Actinomycin D; RU 486; and KCI
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Thermoregulatory centre to shift to new level
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The infectious agent for epidemic forms of typhus fever is Rickettsia prowazekii, which is transmitted from person to person by the human body louse, Pediculus humanus corporis. Disruptions of social and economic institutions by war, famine, or natural catastrophes are associated with declining standards of personal hygiene and spread of lice. Even before social and economic recovery after World War II, epidemic typhus was controlled by mass application of DDT powder. This insecticide killed the body lice; thus, the transmission cycle was interrupted. Widespread resistance to DDT and lindane now exists, and other products such as permethrin should be used. Effective antibiotic therapy with chloramphenicol and tetracycline was not available until the early 1950s. Anopheles mosquitoes are vectors in the transmission of malaria, not typhus.
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Stapedius muscle dampens excessive vibrations of the stapes caused by high pitched sounds in order to protect the internal ear.
If this protective reflex is not elicited, it indicates stapedius paralysis and results in hyperacusis.
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In fetal life, RBC is produced in 3 phases according to growth of foetusMesoblastic stage: In yolk sacHepatic stage: In Liver and spleenMyeloid phase: In bone marrowRef: Medical Physiology Indu Khurana 2015 edition page No:104
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Impotence and erectile dysfunction disorders are seen with the usage of beta-blockers and thiazide diuretics among antihypeensives. ARBs, CCBs are v v rarely involved in producing sexual dysfunctions among antihypeensive drugs. ESSENTIALS OF PHARMACOLOGY 6 TH EDITION PG NO: 139
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Developmental defect of the Mullerian ducts resulting in the condition described as the Mayer-Rokitansky-Kuster-Hauser (MRHK) syndrome. The MRHK syndrome occurs in 1:5000-1:20,000 women at bih, and is diagnosed in approximately 1:1500 gynaecologic admissions. The clinical features include primary amenorrhoea, paial or complete absence of vagina, a wide array of uterine abnormalities, skeletal/renal and other associated abnormalities, a normal female appearance and secondary sexual characteristics and a normal 46 XX karyotype. The ovaries are anatomically and functionally normal. These patients seek medical consultation because of primary amenorrhoea or in case of presence of functional uterus (1:10 cases)--because of cyclic abdominal pain occurring as a result of occult menstruation. Pelvic ultrasonography/MRI and laparoscopy help to establish the diagnosis. Mullerian duct agenesis may result in the uterus represented by a nodule (rudimentary uterus) with hypoplastic or dimple vagina. Reference: Shaw's Textbook of gynaecology,16th edition page no 132
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