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Ans. is 'b' i.e., Respiratory route Myxoviruses Myxoviruses are enveloped RNA viruses. They are characterized by ability to adsorb on to mucoprotein (affinity for mucin) on erythrocytes causing agglutination of erythocytes.
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Ans. (b) Normal Tension GlaucomaRef: Kanski 7/e, p. 346; Yanoff 3/e, p. 1159Glaucomatous cupping (large and deep cup) along with glaucomatous visual field defects (paracentral scotomas are the most frequent) in patients with normal intraocular pressure suggests a diagnosis of Normal Tension Glaucoma (NTG).
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Hemophilia is an X-linked recessive hemorrhagic disease due to mutation in the F8 gene (Hemophilia A or Classic Hemophilia) or F9 gene (Hemophilia B). Males subjects are clinically affected; women who carry single mutated gene are generally asymptomatic. Ref: Kliegman, Behrman, Jenson, Stanton (2008), Chapter 476, "Hereditary Clotting Factor Deficiencies", In the book, "NELSON TEXTBOOK OF PEDIATRICS", Volume 2, 18th Edition, New Delhi, Page 2066; Harrison's Internal Medicine, 19th Edition, Page 975.
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inJune 2009 a new strain of H1N1 influenza called swine flu was declared to be a global pandemic by the WHO REF : ANANTHNARYANA
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The minimum recommended concentration of free chlorine is 0.5 mg/L for one hour. The free residual chlorine provides a margin of safety against subsequent microbial contamination such as may occur during storage and distribution. The sum of the chlorine demand of the specific water plus the free residual chlorine of 0.5 mg/L constitutes the correct dose of chlorine to be applied.
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Ans. is 'a' i.e., AL In Multiple myeloma the amyloidosis is AL type (primary amyloidosis). Primary amyloidosis o It is the most common form of amyloidosis. o It occurs when there is immunocyte dyscrasias. o Best defined example is multiple - myeloma. o But, The great majority of patients with primary (AL) amyloid do not have classic multiple myeloma or any other ove B-cell neoplasma. o These patients have an underlying B-cell dyscrasia in which production of an abnormal protein rather than production of tumor mass, is the predominant manifestation.
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Answer- D. HypoglycemiaLocal side effects include hoarseness (dysphonia) and oral candidiasisgrowth retardation in children or to osteoporosis in adults.bruising, petechiaeHyperglycemia & pituitary- adrenal suppression
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The above image is that of cellulitis of the leg.Cellulitis is a non-suppurative, invasive infection of tissues, which is usually related to the point of injury.Typically caused by B haemolytic streptococci, staphylococci and Clostridium perfringens. Streptococci being the commonest.Necrotising fasciitis is mostly polymicrobialGas gangrene is caused by Clostridium perfringens.Ref: Bailey and love 27th edition PG: 48
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Ans. D >170 mm HgRef: Harrison's, 19th ed. pg. 1616Guidelines for threshold values between normal and high blood pressure Clinic measurement (mm Hg)Home measurement (mm Hg)Optimal control<140/85<130/80Mild hypertension140-150/90-100135-145/85-95Moderate hypertension150-170/100-110145-165/95-105Severe hypertension>170/110>165/105The question mentioned was severe hypertension, however if the grading of hypertension is asked, then answer must be according to this table:BP classificationSystolic mm HgDiastolic, mm HgNormal<120and <80Pre-hypertension120-129<80Stage 1 HTN130-13980-89Stage II HTN>140>90Isolated systolic HTN>140and <90
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Ans. is 'b' i.e., Air-conditioning
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Bilious vomiting is the most common symptom of intestinal obstruction in newborn Proximal obstruction- history of polyhydramnios is common Obstruction high in the intestinal tract results in frequent, bilious emesis with little or no abdominal distention. Distal obstruction- Abdominal distension and constipation are more common, while vomiting is less common. In neonates proximal intestinal obstruction are more common. So, bilious vomiting is the most common presentation of neonatal intestinal obstruction.
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Health risks associated with Polycystic ovary syndrome (PCOS) Type II Diabetes Hypeension Coronary aery disease Lipidaemias Premature Ovarian failure Breast Cancer Endometrial cancer Pregnancy risks associated with Poly-cystic ovary syndrome (PCOS) Gestational diabetes (diabetes that occurs during pregnancy) Pregnancy induced hypeension (PIH) Pre-Eclampsia Preterm bih Babies from PCOS mothers have a higher rate of admission to the neonatal intensive care unit & perinatal death
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Mixed Coho Studies Combination of Retrospective Coho study + Prospective coho study The coho is identified from past records and is assessed till date for the outcome. (Retrospective coho) The same coho is followed up prospectively into future for fuher assessment of outcome. (Prospective coho)
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Gallamine
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Metacercaria larva are the infective form for all the trematodes, expect Schistosoma where cercarial larva are the infective form.
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Sho head of the biceps brachii arises from the lateral pa of the tip of coracoid process and gets attached to the posterior rough pa of radial tuberosity . B D Chaurasia 7th edition Page no : 91
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Delayed-type hypersensitivity is defined as a tissue reaction involving lymphocytes and mononuclear phagocytes,which occurs in response to a soluble protein antigen and reaches greatest intensity 24 to 48 hours after initiation. In the initial phase, foreign protein antigens or chemical ligands interact with accessory cells bearing class II HLA molecules. Protein antigens are actively processed into sho peptides within phagolysosomes and are presented on the cell surface in conjunction with the class II HLA molecules. Diagnosis: Delayed-type hypersensitivity
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Hippocratic facies--bright, hollow eyes; pale, pinched face; cold perspiration in eye brows; dry, fissured tongue; blue lips. Patient will be in severe shock. It signifies terminal status with high moality rate. It is a typical facial sign of severe end stage peritonitis.Reference : page 572 SRB's manual of surgery 5th edition
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Ans. is 'b' i.e., Streptococcus pyogenes Infections caused bv streptococcus pyogenes1) Respiratory infectionso Sore throat is the most common of streptocococcal disease. It may be localised as tonsillitis as in older children and adults or it may involve the pharynx more diffusely (pharyngitis) as in younger children,o Otitis mediao Mastoiditiso Quincyo Ludwig's anginao Suppurative adenitiso Pneumonia as a complication of influenza or other respiratory viral disease.Skin and soft tissue infectionso Erysipelas- Diffuse infection involving the superficial lymphatics.- Occurs in older patients.o Impetigo- Superficial infection of skin(Pyoderma)- Occurs in young patients- Usually involves face and leg.o Cellulitiso LymphangitisDeep soft tissue infectionso Necrotizing fascitis (hemolytic streptococcal gangrene)o Myositis - (Most common organism causing myositis is S. aureus)Abscesses - in brain, lungs, liver, and kidney.Scarlet fevero Consists of pharyngitis, accompanied by a characteristic rash,o Caused by production of erythrogenic toxin.Puerperal sepsiso More often caused by group B streptococci.BacteremiaStreptococcal toxic shock syndromeo Str. Pyogenes strains M type 1 and 3 forming pyrogenic exotoxin A are responsible,o These strains also known as [flesh eating bacteria \Nonsuppurative complicationso Acute Rheumatic feverFollows persistent or repeated streptococcal throat infections (not skin infection).o GlomerulonephritisMay occur after throat or skin infection perhaps, in the tropics skin infections are more important than throat infections.
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temperment is a genitically related body biases in the modulation of conditioned behavioral responses to various external stimuli. there are 4 types of temperment namely novelty seeking reward dependence harm avoidance persistence this is a impoant question that is asked in entrance examinations Ref.Kaplon and sadock, synopsis of psychiatry, 11 th edition, pg.no.744
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ANSWER: (A) Involved in apoptosisREF: Robbins pathology 7th edition page 27-29Caspases are essential in cells for apoptosis, or programmed cell death, in development and most other stages of adult life, and have been termed "executioner" proteins for their roles in the cell Some Caspases are also required in the immune system for the maturation of lymphocytes
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Answer- C. Haemolytic disease of the newbornHemolytic disease of thefetus and newborn (HDFN), also known as alloimmune HDFN or erythroblastosis fetalis, is caused by the destruction of reil blood cells (RBCs) of the neonate or fetus by maternal IgG antibodies.
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Foamy appearance or frothy cytoplasm is a feature associated with the presence of lipid/mucinous material in the cell cytoplasm. It is seen in mucous secreting goblet cells or lipid phagocytizing macrophage eg Touton giant cell (but not in paneth cells).
Paneth (zymogen) cells are rich in zinc, rough endoplasmic reticulum (RER) and secretory granules containing lysozyme, defensins or cryptidins such as TNF-a. It exceptionally migrate towards the base of the crypt of Lieberkuhn instead of going towards the tip of villi.
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Decreased aldosterone causes metabolic acidosis
+
Hyponatremia
Hyperkalemia
Hypotension.
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Teeth and bones
Tetracyclines have chelating property. Calcium-tetracycline chelate gets deposited in developing teeth and bone. Given from mid pregnancy to 5 months of extrauterine life, tetracyclines affect the deciduous teeth.
Brown discolouration, ill-formed teeth which are more susceptible to caries are produced. Tetracyclines given between 3 months and 6 years of age affect the crown of permanent anterior dentition. Repeated courses are more damaging.
Given during late pregnancy or childhood, tetracyclines can cause temporary suppression of bone growth.
Doxycycline 100 mg once or twice daily is the most commonly used tetracycline.
Reference: Essentials of Medical Pharmacology Eighth Edition KD TRIPATHI page no 760,786
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Ans. is 'a' i.e., PPP Source of NADPH for lipogenesis NADPH is involved as donor of reducing equivalentse in both the reduction of 3-ketoacyl by 3 ketoacyl reductase and of 2,3- unsasturated acyl by enoyl reductase. The main source of NADPH for lipogenesis is the pentose phosphate pathway: PPP (Hexose monophosphate shunt: HMP shunt)deg. Other sources of NADPH include:- The reaction that conves malate to pyruvate catalyzed by malic enzyme. Exramitrochondrial isocitrate dehydrogenase.
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Causes of hypocalcemia Hypoparathyroidism
DiGeorge syndrome PTH receptor defect (pseudohypoparathyroidism)
Magnesium deficiency Exogenous organic phosphate excess Vit D difecidecien
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Procaine belongs to ester group. Since Ester links are more prone for hydrolysis than amide links generally esters have a shoer duration of action. Other three are amide group. From padmaja 4th edition Page no 199
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Ans. is 'a' i.e., Zenker's diveiculum
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Hormonal therapy in Carcinoma in breast Ovarian suppression or ablation Bilateral oophorectomy. Medically by LHRH agonist (Goserelin, leuprolide) SERM: Tamoxifen and Raloxifen Aromatase Inhibitors Non-steroidal : Letrozole & Anastrazole Steroidal : Exmestane Anti-Estrogens Fulvestrant Progestins Megesterol & Medroxyprogesterone acetate Ref: schwaz's principle of surgery 10th edition Pgno : 552-553
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Ans. is 'c' i.e., 90% of non familial cases are bilateral Pheochromocvtomao Pheochromocytoma is a neoplasm of chromaffin ceils which usually arise from adrenal medulla,o About 10% of these tumors arise at extraadrenal sites, where they are called paraganglioma :-o When pheochromacytomas arise at extra-adrenal site, they are referred to as paraganglioma.o Paravertebral paragangliomas secrete catecholamines.Pheochrom ocvtomao The tumor is composed of polygonal to spindle shaped chromaffin cells or chief cells, clustered with sustentacular cells into small nests or alveoli (zellballen) by a rich vascular network. The nuclei are usually round to ovoid, with a stippled " salt & pepper" chromatin that is characteristic of most neuroendocrine tumors,o Zellballen pattern are seen in paraganglioma.Pheochromacytomas usually subscribe to a convenient "rule of 10s" :-10% of pheochromocytomas arise in association with one of several familial syndromes. These include the MEN-2A & MEN-2B syndromes, type I neurofibromatosis, von Hippel-Lindau syndrome & Sturge-Weber syndrome. 10% of pheochromocytomas are extra-adrenal, occurring in sites such as organ of Zuckerkandl & carotid body, where these chromaffin-negative tumors are usually called paragangliomas to distinguish them from pheochromoc ytomas.10% of nonfamilial adrenal pheochromocytomas are bilateral: this figure may rise to 70% in cases that are associated with familial syndromes.10% of adrenal pheochromocytomas are biologically malignant although the associated hypertension represents a serious & potentially lethal complication of even "'benign"tumors.10% of adrenal pheochromocytomas arise in childhood, usually the familial subtypes, and with a strong male preponderance. The nonfamilial pheochromocytomas most often occur in adults between 40 & 60 years of age, with a slight female preponderance.
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Dry socket is also known as Sicca Dolorosa, alveolar osteitis, localized alveolar osteomyelitis, fibrinolytic alveolitis.
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Vanillyl Mandelic acid (V.M.A) is an end product of catecholamine metabolism and is used for screening for pheochromocytoma. In carcinoid syndrome, the 5HT derivative histamine results in flushing episodes. Neuroendocrine tumors along the GI tract use tryptophan as the source for serotonin production, which limits the available tryptophan for niacin synthesis. In normal patients, only one percent of dietary tryptophan is conveed to serotonin; however, in patients with carcinoid syndrome, this value may increase to 70%. Carcinoid syndrome may thus produce Niacin deficiency and clinical manifestations of pellagra. 5HT derivative histamine released by carcinoid causes bronchospasm and rhonchi.
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Ans. is 'b' i.e., 3-4 cm The lower esophageal sphincter (LES) is a bundle of muscles at the low end of the esophagus, where it meets the stomach.When the LES is closed, it prevents acid and stomach contents from traveling backwards from the stomach.The LES muscles are not under voluntary control.Lower esophageal splincter is at diaphragmatic constriction.Normal abdominal LES length (3.1cm)The basal pressure of the LES is 10-45 mmHg.
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The respiratory rate is essentially unchanged, but tidal volume and resting minute ventilation increase significantly as pregnancy advances. The functional residual capacity and the residual volume are decreased as a consequence of the elevated diaphragm. Lung compliance is unaffected by pregnancy, but airway conductance is increased and total pulmonary resistance reduced, possibly as a result of progesterone. Ref: Cunningham F.G., Leveno K.J., Bloom S.L., Hauth J.C., Rouse D.J., Spong C.Y. (2010). Chapter 5. Maternal Physiology. In F.G. Cunningham, K.J. Leveno, S.L. Bloom, J.C. Hauth, D.J. Rouse, C.Y. Spong (Eds), Williams Obstetrics, 23e.
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Odontoid fractures usually result from flexion forces. Odontoid fractures are classified as type I, II, or III. Type I fracture involves the tip only. Type II fracture passes through the base of the odontoid process. Type III fracture passes through the body of C2. Types II and III are considered unstable and should be externally immobilized by a halo vest or fused surgically. Surgery often is undeaken for widely displaced fractures (poor chance of fusing) and for those that fail external immobilization. Type I fractures usually fuse with external immobilization only. Ref: Schwaz's principle of surgery 9th edition, chapter 42.
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Amyloidosis of SpleenAmyloid deposition in the spleen, for some unknown reasons, may have one of the following two patterns:1. SAGO SPLEEN. The splenomegaly is not marked and cut surface shows characteristic translucent pale and waxy nodules resembling sago grains and hence the name.Microscopically, the amyloid deposits begin in the walls of the aerioles of the white pulp and may subsequently replace the follicles.2. LARDACEOUS SPLEEN. There is generally moderate to marked splenomegaly (weight up to 1 kg). Cut surface of the spleen shows map-like areas of amyloid (lardaceous-lard-like; lard means fat of pigs)Microscopically, the deposits involve the walls of splenic sinuses and the small aeries and in the connective tissue of the red pulp. Confirmation is by seeing Congophilia in Congo Red staining and demonstration of apple-green birefringence under polarising microscopy in the corresponding positive areas. HARSH MOHAN Textbook of pathology 6th edition pg no 90
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The cervix protrudes into the vagina. The uterus is held in position within the pelvis by condensations of endopelvic fascia, which are called ligaments. These ligaments include the pubocervical, transverse cervical ligaments or Mackenrodt's ligaments or cardinal ligaments, and the uterosacral ligaments. Ref - BDC 6e vol2 pg 391
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C i.e. 7.33 CSF sugar is 2/3 of plasma sugarQ. So CSF/plasma glucose ratio is -. 0.6667. CSF pH is 7.33Q (less than plasma pH 7.4) and its pressure is maintained by its absorption at arachnoid villQ. Hypehyroidism cause decreased whereas, hypothyroidism/myxoedema is associated with increased CSF protein. Substance CSF concentration Plasma cone CSF/plasma ratio. Mg" 2.2 1.6 1.39 PCO2 50.2 39.5 1.28 Creatinine 1.5 1.2 1.25 Cl- 113 99 1.14 HCO3- 25.1 24.8 1.01 Osmolality 289 289 1 Na' 147 150 0.98 Urea 12 15 0.80 Inorganic-P 3.4 4.7 0.73 Glucose 64 100 0.64 2.9 4.6 0.62 Cat+ 2.3 4.7 0.49 Uric Acid 1.5 0.3 Protein 20 6000 0.003 Cholesterol 0.2 175 0.001 pH 7.33 7.40 Regulation of CSF pressure by arachnid villi - Rate of CSF formation is nearly constant, so it is seldom a factor in pressure control. - Whereas, arachnoid villi function like valves that allow CSF to flow readily into blood in venous sinuses while not allowing blood to flow backward in opposite direction - CSF flow begins when its pressure is 1.5 mmHg higher than the pressure of blood in venous sinuses. The valve opens more widely, when this pressure difference is higher, which in normal conditions never allows CSF pressure to rise more than few mm Hg higher than cerebral venous sinus pressure. - Absorption is propoional to pressure. At a pressure of 112 mm H20, which is average normal CSF pressure, filteration & absorption are equal. Below a pressure of 68 mm H20, absorption stops.
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Lead poisoning may occur in children or adults due to accidental or occupational ingestion. In children, the following are the main sources of lead poisoning:Chewing of lead-containing furniture items, toys or pencils.Eating of lead paint flakes from walls.In adults, the sources are as follows:Occupational exposure to lead during spray painting, recycling of automobile batteries (lead oxide fumes), mining, and extraction of lead.Accidental exposure by contaminated water supply, house freshly coated with lead paint and sniffing of lead-containing petrol (hence unleaded petrol introduced as fuel).Lead is absorbed through the gastrointestinal tract or lungs. The absorbed lead is distributed in two types of tissuesa) Bones, teeth, nails and hair representing a relatively harmless pool of lead. About 90% of absorbed lead accumulates in the developing metaphysis of bones in children and appears as areas of increased bone densities ('lead lines') on X-ray. Lead lines are also seen in the gingiva. b) Brain, liver, kidneys and bone marrow accumulate the remaining 10% lead which is directly toxic to these organs.It is excreted kidneys. Lead toxicity occurs in the following organs predominantly:1. Nervous system: The changes are as under:In children, lead encephalopathy; edema of the brain, flattening of gyri and compression of ventricles.In adults, demyelinating peripheral motor neuropathy which typically affects radial and peroneal nerves resulting in wristdrop and footdrop respectively.2. Hematopoietic system: The changes in the blood are quite characteristic:Microcytic hypochromic anemia due to inhibition of two enzymes: delta-aminolevulinic acid dehydrogenase required for haem synthesis, and through inhibition of ferroketolase required for incorporation of ferrous iron into the porphyrinring.Prominent basophilic stippling of erythrocytes. 3. Kidneys: Lead is toxic to proximal tubular cells of the kidney and produces lead nephropathy characterized by the accumulation of intranuclear inclusion bodies consisting of the lead-protein complex in the proximal tubular cells.4. Gastrointestinal tract: Lead toxicity in the bowel manifests as acute abdomen presenting as lead colic. Signs and symptoms of lead poisoning in children include: Developmental delay Learning difficulties Irritability Loss of appetite Weight loss Sluggishness and fatigue Abdominal pain Vomiting Constipation Hearing loss Seizures Eating things, such as paint chips, that aren't food (pica) Signs and symptoms in adults might include: High blood pressure Joint and muscle pain Difficulties with memory or concentration Headache Abdominal pain Mood disorders Reduced sperm count and abnormal sperm Miscarriage, stillbih or premature bih in pregnant women HARSH MOHAN Textbook of pathology 6th edition pg no 240-241
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Ans. is 'c' i.e. Ampulla of vater
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Focus on Dopamine Scientists probed fuher to see if they could link the brain's reward systems to a paicular set of chemical mechanisms. They soon found that blocking the neurotransmitter dopamine seems to reduce an animal's pleasure-seeking drives. For example, depleting dopamine in the brain causes animals to become oblivious to food and other normally pleasurable rewards. Ref: guyton and hall textbook of medical physiology 12 edition
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Negri bodies are seen in the Pyramidal neurons within Ammon's horn of the Hippocampus and Purkinje cells in the cerebellar coex on postmoem of the rabied person.
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Hypotension is the most common acute complication of hemodialysis. It is paicularly common among patients with diabetes mellitus. The factors that appear to increase the risk of hypotension, are excessive ultrafiltration with inadequate compensatory vascular filling, impaired vasoactive or autonomic responses, osmolar shifts, overzealous use of antihypeensive agents, and reduced cardiac reserve. Ref: Harrisons principles of internal medicine, 18th edition, Page: 2324.
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CSOM is of Two Types
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Parietal skull fractures are more suggestive of accidental injury.
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The transmission of HIV from mother to infant has decreased in recent years, due in large part to perinatal administration of antiretroviral medications to the mother and a course of zidovudine to the exposed infant. Studies suggest that a better than 50% decrease in transmission can be seen with appropriate medications as outlined.IVIG has not been shown to have a role in decreasing perinatal transmission. Healthy asymptomatic term infants born to HIV-infected mothers do not need special monitoring, nor do they need routine radiographs.An HIV ELISA is an antibody test and will be positive in the infant born to an HIV-infected mother due to maternal antibodies that are passed through the placenta; it is not a useful test in the newborn infant to determine neonatal infection because of this expected transfer of maternal (and not infant) immunoglobulin. The confirmatory Western blot also assays for antibodies to HIV and is similarly unhelpful in the newborn period.
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Internal carotid beginning, course and termination it is a terminal branch of common carotid aery. It first runs through the neck ( cervical pa) then passes through the petrous bone ( petrous pa) then courses through the sinus ( cavernous pa) and lastly lies in relation to the brain ( cerebral pa). Area of distribution Cervical pa of the aery does not give any branch.Petrous pa gives branches for the middle ear,cavernous pa supplies hypophysis cerebri.The cerebral pa gives ophthalmic aery for orbit,anterior cerebral,middle cerebral,anterior choroidal and posterior communicating for the brain. Ref BDC volume 3;sixth edition pg 312
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Answer- C. 6 - 8 weeksThe half-life of an erythrocyte is typically 60 days, the level of glycated hemoglobin (HbA1c) reflects the mean blood glucose concentration over the preceding 6-8 weeks.
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Congenital Syphilis - Caused by Treponema pallidum. Congenital syphilis is a cause of hydrops fetalis, or stillbih due to fluid accumulation in the fetus. If the newborn survives, it can develop various abnormalities. Classic facial anomalies - Hutchinson's incisors Mulberry molars, Saddle nose Frontal bossing Sho maxilla Hutchinson's triad : Deafness(VIII nerve damage) Interstitial keratitis Hutchinson's teeth
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Ans. is 'b' i.e., 1987 o The Mental Health Act was passed on 22nd May, 1987.
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Trigone is derived from mesoderm although bladder is endodermal in origin. Intermediate mesoderm forms the Genito urinary system. Endoderm forms the urogenital sinus which forms urinary bladder and urethra.
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Fractures commonly showing cubitus valgus deformity due to malunion :
Fracture lateral condyle humerus
Monteggia Fracture Dislocation
Complications of lateral condylar humerus fractures
Cubitus valgus
Cubitus Pseudovirus (lateral spur)
Tardy ulnar nerve palsy
Osteonecrosis of the trochlea
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Cholangiocarcinoma is classified into two: 1.Intrahepatic 2.Extrahepatuc: which is divided into- Perihilar tumors: these are known as Klatskin tumors and are located at the junction of the right and left hepatic ducts forming the common hepatic duct. Distal bile duct tumors: they arise near the ampulla of Vater REF: GENERAL AND SYSTEMIC PATHOLOGY RAMDAS NAYAK FIRST EDITION PAGE 468 IMAGE REF:
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Ans. is 'a' i.e., Intraosseus cannulation Intraosseus transfusiono For patients in respiratory failure or shock, securing vascular access is crucial, along with establishing an airway and ensuring adequacy of breathing and ventilation. Peripheral intravenous catheter insertion is often difficult, if not impossible, in infants and young children with circulatory collapse. An intraosseous line is as efficient as an intravenous route and can be inserted quickly, even in the most poorly perfused patientso The marrow of long bones has a rich network of vessels that drain into a central venous canal, emissary veins, and, ultimately, the central circulation. Therefore, the bone marrow functions as a noncollapsible venous access route when peripheral veins may have collapsed because of vasoconstriction. This approach is particularly important in patients in shock or cardiac arrest, when blood is shunted to the core due to compensatory peripheral vasoconstriction. The intraosseous (IO) route allows medications and fluids to enter the central circulation within secondso Intraosseous (IO) insertion was typically recommended for use in children younger than 6 years; however, it is now recognized to be both safe and effective in older children and adultso The problems with IO use in older patients arise from the increased difficulty of insertion through thicker cortex of the bone and the smaller marrow cavity. Inability to enter the marrow may increase the likelihood of fracturing the bone.
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Rovsing's sign, Obturator sign and Psoas sign are seen in appendicitis. Positive Murphy's sign is seen in acute cholecystitis. It is an ultrasonographic sign in which there is an area of maximum tenderness directly under the probe. Rovsing's sign refers to pain in the right lower quadrant when palpatory pressure is exeed in the left lower quadrant. Obturator sign refers to presence of hypogastric pain on stretching the obturator internus due to its irritation in the pelvis. This test is performed by passive internal rotation of the flexed right thigh with the patient supine. Psoas sign is positive in retrocecal appendicitis. In this, irritation of the of the psoas muscle gives rise to pain when the patient's right thigh is extended from the flexed position. Ref: Abdominal Ultrasound By Mike Stocksle, page 77 ; Schwaz's Principles of Surgery, 9e, chapter 30
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Ans is 'b' ie Mucosal folds below the carina
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In DCT: - The sympoer is NCC (Na+-Cl- cotranspoer) In the PCT, the apical membrane has Na+/H+-antipoer, which couples H+ secretion with the Na+ movement across the apical membrane. In the TAL of loop of Henle: - The sympoer NKCC moves 1 Na+, 1 K+, 2 Cl- through the apical membrane into the cell. In the late distal tubule and collecting duct: - Na+ diffuses across the apical membrane through the epithelial Na+ channel (ENaC).
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Ans. is a, i.e. Increased birth weightRef: Williams gynae 3rd/ed, p397Risk factors for PCOS in ad descent girls* Low birth weight* Premature adrenarche* Obesity with acanthosis nigricans* Atypical sexual precocity
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Ans. is 'b' i.e., Postganglionic sympathetic fibres except in sweat glandsNeurotransmitter in all preganglionic autonomic nerves (both sympathetic and parasympathetic) is acetylcholine (A CH)Neurotransmitter in all ganglia (both sympathetic and parasympathetic) is acetylcholine.Neurotransmitter in postganglionic parasympathetic fibres is acetylcholine.In posganglionic sympathetic fibres, the major neurotransmitter is noradrenaline (NA) except in renal and mesentric vasculature where it is dopamine, in sweat glands, some blood vessels where it is acetylcholine and in adrenal medulla where it is adrenaline.Most of the visceral organs are supplied by both sympathetic and parasympathetic system except;Blood vessels, spleen, sweat glands and hair follicles receive only sympathetic innervation.Ciliary muscle gastric and pancreatic glands receive only parasympathetic innervation.In general sympathetic and parasympathetic systems are antagonistic except :Refractory period of atrial fibres is decreased by both.At almost all organs except hea, cholinergic system has excitatory activity and adrenergic system has relaxing propeies Sympathetic system stimulates (Tachycardia, Positive inotropic) and parasympathetic system depresses (Bradycardia, Negative inotropic) the hea.
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The features of Arachnida which includes ticks, mites, scorpions and spiders etc are four pairs of legs, absence of wings and antennae. Their bodies are divided into cephalothorax and abdomen. Ref: Park's Textbook of Preventive Medicine, 20th Edition, Page 672.
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Ans. c. Intellectual disabilityRef: First Aid for the Psychiatry Clerkship 4th Ed; Page No-122-23Intellectual disability (ID, intellectual developmental disorder) replaces the term mental retardation (MR) as per US law (Rosas Law), with the intention of decreasing stigmatization.ID is characterized by severely impaired cognitive and adaptive/social functioning.Severity level is currently based on adaptive functioning, indicating degree of support required.A single IQ score does not adequately capture this and is no longer used solely to determine ID severity.CAUSES OF MENTAL RETARDATIONCauseExamplesGenetic*. Down syndrome: Trisomy 21 (1/700 live births)*. Fragile X syndrome: Involves mutation of X chromosome, second most common cause of intellectual disability, M > F*. Others: Phenylketonuria, familial mental retardation, Prader-Willi syndrome, Williams syndrome, Angelman syndrome, tuberous sclerosisPrenatalInfection and toxins (TORCH):*. Toxoplasmosis*. Other (syphilis, AIDS, alcohol/illicit drugs)*. Rubella (German measles)*. Cytomegalovirus (CMV)*. Herpes simplexPerinatalAnoxia, prematurity, birth trauma, meningitis, hyperbilirubinemiaPostnatalHypothyroidism, malnutrition, toxin exposure, trauma, psychosocial CausesEXTRA MILECHARACTERISTIC PHYSICAL FEATURES OF GENETIC SYNDROMESDown syndrome: Epicanthic folds, flat nasal bridge, and palmar creaseFragile X syndrome: Macrocephaly, joint hyperlaxity, and macroorchidism in post pubertal males.Prader-Willi syndrome: Obese, small stature, and almond-shaped eyes.Fragile X syndrome facts and statisticsMost common inherited form of ID2nd most common cause of IDDue to FMR-1 gene mutationMales>femalesDown syndrome facts and statistics1/700 live birthsMost common chromosomal disorderTrisomy 21=3 copies of chromosome 21
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Corneal hysteresis assesses the biomechanical strength of the cornea and is assessed by Dynamic Contour Tonometry(DCT). Dynamic contour tonometry (DCT) is a contin- uous (dynamic) and direct tonometric principle. It reads the IOP at the interface between the sensitive tonometer tip and the surface of the cornea. Ref khurana 6th edition pg 345
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Ans. c (Excision of tumor [surgical removal) (Ref. Bailey and Love Surgery 25th/pg. 762)PLEOMORPHIC ADENOMA# Initially described as a 'mixed' salivary gland tumor# Accounts for 75% of parotid and 50% submandibular tumors# Believed to have both epithelial and mesothelial elements# Now appears to arise from ductal myoepithelial cells# Slight female predominance known# May undergo malignant change but risk is small# Little is known about the origins of these neoplasms except that radiation exposure increases the risk. Equally uncertain is the histogenesis of the various components. A currently popular view is that all neoplastic elements, including those that appear mesenchymal, are of either myoepithelial or ductal reserve cell origin (hence the designation pleomorphic adenoma).# Requires excision with 5-10 mm margin as local implantation of cells can lead to recurrence.# Treatment of choice for pleomorphic adenoma is superficial parotidectomy but, if the deep lobe of parotid is involved -Total parotidectomy is done.
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Ans. is 'b' ie Avascular necrosis of hip "The femoral head is the commonest site of symptomatic osteonecrosis (avascular necrosis), mainly because of its peculiar blood supply which renders it vulnerable to ischemia.Non traumatic osteonecrosis is seen in association with infiltrative disorders of the marrow, Gaucher's ds Sickle cell ds. coagulopathies, Caisson's ds., SLE and more commonly - high dosage of corticosteroids administration and alcohol abuse."Clinical features of avascular necrosis of hip"The presenting complaint is usually pain in the hips (or in over 50% of cases, both hips), which progresses over a period of 2-3 yrs to become quite severe."On examination the pt. walks with a limp and may have a positive Trendelenburg's sign.The thigh is wasted and the limb may be 1-2 cm short.Movements are restricted, particularly abduction and internal rotation."A characteristic sign is a tendency for the hip to twist into internal rotation during passive flexion. This corresponds to Sectorial sign in which, with the hip extended, internal rotation is almost full, but with the hip flexed it is grossly restricted."
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Ans. is 'b* i.e., Negative correlation o This is a negative correlation. Le. when height increases the mosquitoes decrease,First read about these two related terms :-o Association - Association may be defined as the concurrence of two variables more often than would be expected by chance. That mean 2 variables exist simultaneously,o Correlation - Correlation indicates the degree (strength) of association between two variables, i.e. relationship between two quantitative variables.o Height to weight is an association and the strength of this association is indicated by correlation.
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Ans. b. Cytoplasmic membrane
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Ans. is 'a' i.e., Multiple sclerosis Treatment of multiple sclerosiso Multiple sclerosis is an autommune disease characterized by chronic inflammatory demylination that affects the CNS.o The most common course of the disease is the relapsing-remitting subtype, which is characterized by unpredictable acute attacks (relapses) followed by periods of relative remission with no new signs of disease activity. The other type (less common) is progressive subtype, which is characterized by a steady functional decline from disease onset.o Therapy for MS can be divided into several categories:-Treatment of acute attackCorticosteroids (Methyiprednisolone, prednisolone) are usedTreatment with disease-modifing agents that reduce the biological activity of MSy Disease modifying agents for multiple sclerosis are (i) IFN-fi la; (ii) IFN-fi lb, (iii) Glatiramer; (iv) Natalizumab: (v) Finoglimod: (vi) Mitoxantrone; (vii) Cladaribine.Other treatment optionsOther off-label treatment options are (i) methotrexate; (ii) cyclophosphamide; (iii) IV immunoglobulins; (iv) azathioprine.Symptomatic TreatmentIt includes healthy diet, regualr exercise, and:Treatment of rigidity (baclofen, diazepam, tizanidine, dantroline)Treatment of weakness (Potassium channel blockers like 4-aminopyTidine)Treatment of pain by anticonvulsants (carbamezapine, phenytoin, gabapentin, pregabalin), or antidiepressants (mexiletin).Treatment of UTI, bladder dysfunction, constipation, depression, fatigue and cognitive problems.
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Ans. C i.e. p24 antigen. HIV infection is identified either by the detection of HIV-specific antibodies in serum or plasma or by demonstrating the presence of the virus by nucleic acid detection using polymerase chain reaction (PCR), p24 antigen testing or, rarely these days, by growing virus in cell culture. Antibody testing is the method most commonly used to diagnose HIV infection. With the highly sensitive HIV-1/HIV-2 enzyme immunoassay (EIA) tests currently on the market, seroconversion can be detected within two to three weeks of infection in the majority of cases. In a small number of early seroconveers who are still in the 'window period', the p24 antigen may become positive before antibody is detectable.
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"Acute tonsillitis usually occurs as a component of a widespread acute bacterial pharyngitis, usually due to hemolytic streptococci. The tonsils are swollen red due to mucosal hyperaemia and partly covered by creamy acute inflammatory exudate (acute parenchymatous tonsillitis). Sometimes there are scattered, creamy yellow spots on the surface (acute follicular tonsillitis) due to beads of pus extruding from the mouth of the infected epithelial-lined crypts".
From the above statement, it seems that acute parenchymatous tonsillitis is more common than follicular tonsillitis. But not sure.
It is worth noting that, overall most common type of acute tonsillitis is acute catarrhal/superficial tonsillitis as it is an early stage of upper respiratory tract infection and acute infectious viral fevers like measles and IMN. Most common cause of sore throat is viral, therefore acute catarrhal tonsillitis is the most common form.
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Initial Management of the Burned Airway Early Elective Intubation is safest Delay can make Intubation very difficult because of swelling Be ready to perform an Emergency Cricothyroidotomy if Intubation is delayed
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Inguinal canal- Posterior wall formation
- Medial 2/3- Conjoint tendon and reflected part of inguinal ligament
- Whole- Fascia transversalis, extraperitoneal connective tissue, parietal peritoneum.
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ROOTS OF OTIC GANGLION: Sensory root is by auriculotemporal nerve Sympathetic root is by sympathetic plexus around middle meningeal aery Secretomotor root is by lesser petrosal nerve from tympanic plexus formed by tympanic branch of cranial nerve IX Motor root is by a branch from nerve to medial pterygoid Ref BDC volume 3,sixth edition pg 311
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The child has a form of galactosemia. The elevated galactose enters the lens of the eye, is reduced to galactitol, and is trapped. The difference in osmotic pressure across the lens of the eye leads to cataract formation. Galactose is phosphorylated by galactokinase to galactose-1-phosphate, which reacts with UDP-glucose in a reaction catalyzed by galactose-1-phosphate uridylyl transferase to form UDP-galactose and glucose-1-phosphate. An epimerase converts UDP-galactose to UDP-glucose. Deficiencies in either galactokinase (nonclassical) or galactose-1-phosphate uridylyl transferase (classical) result in galactosemia, with elevated levels of galactose and galactitol (reduced galactose) in the blood. An intracellular measurement of galactose-1-phosphate can allow a definitive diagnosis to be obtained (such levels would be nonexistent if the defect were in galactokinase, and the levels would be greatly elevated if the galactose-1-phosphate uridylyl transferase enzyme were defective).
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Clinical features Coeliac disease can present at any age. In infancy, it occurs after weaning on to cereals and typically presents with diarrhoea, malabsorption and failure to thrive. In older children, it may present with non-specific features, such as delayed growth. Features of malnutrition are found on examination and mild abdominal distension may be present. Affected children have growth and pubeal delay, leading to sho stature in adulthood. In adults, the disease usually presents during the third or fouh decade and females are affected twice as often as males. The presentation is highly variable, depending on the severity and extent of small bowel involvement. Some have florid malabsorption, while others develop non-specific symptoms, such as tiredness, weight loss, folate deficiency or iron deficiency anaemia. Other presentations include oral ulceration, dyspepsia and bloating. Unrecognised coeliac disease is associated with mild under-nutrition and osteoporosis. Coeliac disease is associated with other HLA-linked autoimmune disorders and with ceain other diseases (Box 21.42). In some centres, people at higher risk of developing coeliac disease, such as those with type 1 diabetes, may undergo periodic antibody screening. Such screening may identify people with asymptomatic or minimally symptomatic disease; there is controversy about the optimum management strategy for such individuals Ref Davidson edition23rd pg 806
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Otoacoustic Emissions (OAEs) They are low intensity sounds produced by outer hair cells of a normal cochlea and can be elicited by a very sensitive microphone placed in the external ear canal and an analysis by a computer. Sound produced by outer hair cells travels in a reverse direction: Outer hair cells-basilar membrane- perilymph- oval window- ossicles- tympanic membrane- ear canal. Otoacoustic emissions arise from the outer hair cells. Otoacoustic emissions (OAE) are objective, non-invasive and rapid measures used in determining cochlear outer hair cell function. OAE are inaudible sounds that are a byproduct of the biomechanical motility of the outer hair cells.
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Ans. (d) Granuloma formationRef: Robbiris pathology 9th ed. 197* Granuloma formation is characteristic of chronic granulomatous inflammation and is not seen in acute inflammation.* Vasodilation, increase in permeability, exudation, margination, rolling etc. are seen in acute inflammation.
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Transvaginal ultrasound Diagnosis of Ectopic pregnancy Pregnancy is definitely diagnosed by demonstrating intrauterine sac. - A normal intrauterine sac appears regular and well defined on ultrasound. So ectopic pregnancy can be diagnosed by demonstrating the absence of the intrauterine sac. In a woman in whom ectopic pregnancy is suspected because of pain, bleeding and positive pregnancy test, performance of vaginal sonography is the logical first step. If the sonography demonstrates live intrauterine fetus then ectopic pregnancy is extremely unlikely. Alternatively if the uterus is empty, an ectopic pregnancy can be diagnosed based on the visualization of an adnexal mass separate from the ovaries. 3-hCG hormones also play an impoant role in the diagnosis of pregnancy. fi HCG is a hormone secreted during pregnancy. It is positive in viually 100% of ectopic pregnancies. However, a positive test only confirms pregnancy and does not indicate whether it is intrauterine or extrauterine. In normal pregnancy pHCG should double up every 2 days but in ectopic pregnancy the rate of increase of fl hCG is slow. 13 hCG litres and ultrasound complement one another in detecting ectopic pregnancy and have led to earlier detection. By correlating fl hCG titres with ultrasound .findings an ectopic pregnancy can often be differentiated.from intrauterine pregnancy. An intrauterine sac should be visible by transvaginal ultrasound when the p hCG is approximately 1000 ml p/m1 and by transabdominal ultrasound approximately 1 week later when the fi hCG is 1800-3600 ?nip/int. Thus when an empty uterine cavity is seen with a 13 hCG litre above this threshold, the patient is likely to have an ectopic pregnancy. An empty cavity is less of a concern when a fihCG below this threshold is obtained. Serum progesterone measuremen A single measurement of serum progesterone may sometimes clarify the diagnosis when ectopic pregnancy is suspected, but Its accuracy is crude and the customary thresholds are < 5 ng/m and > 25 'tend. i.e.a value exceeding 25 ng/m1 excludes ectopic pregnancy with 97.5% sensitivity, value below 5 ng/ml occur in only .3 percent of normal regnancies. So normal pregnancies can be excluded if the progesterone level is below 5%. Surgical diagnosis of ectopic pregnancy :- Laparoscopy Direct visualization of the ,fallopian tubes and pelvis by diagnostic laparoscopy offers a reliable diagnosis in most cases of suspected ectopic pregnancy and a ready transition to definitive operative therapy. At times, identification of an early unruptured tubal pregnancy may be difficult even if the tube is .fully visualized. Inspite of the low morbidity and quick recovery time, laparoscopy usually is performed when, on the basis of noninvasive test or curettage results, the diagnosis of ectopic pregnancy is fairly ceain and medical therapy is not planned. In these cases laporoscopy is used both for therapeutic and diagnostic purpose. Laparotomy Open abdominal surgery is preferred when the woman is hemodynamically unstable or when laparoscopy is not feasible. Laparotomy should not be delayed while laparoscopy is performed in a woman with obvious abdominal hemorrhage that required immediate definitive treatment. Culdocentesis Culdocentesis is the transvaginal passage of a needle into the posterior cul-de-sac in order to determine whether free blood is present in the abdomen. This procedure is useful in the diagnosis of intraperitoneal bleeding. This procedure will reveal nonclotting blood if intra-abdominal bleeding has occurred. If culdocentesis is positive, laparoscopy or laparotomy should be performed immediately. Indeed, some argue that the main purpose of culdocentesis is, not in diagnosis but to better prioritize patients so that those with positive culdocentensis are taken immediately to the operating room. More on imaging procedures used in the diagnosis of ectopic pregnancy Vaginal sonography There has been much improvement in the early diagnosis of ectopic pregnancy using vaginal sonography. Its use results in earlier and more specific diagnosis of uterine pregnancy than abdominal sonography and it has become the imaging method of choice in early pregnancy. Abdominal sonography:- Id entification of pregnancy products in the fallopian tube.
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The role of vitamin K is in the post-translational modification i.e, gcarboxylation of glutamic acid residues in proteins such as : Coagulation factors : Factor II, VII, IX, X Protein C and S Osteocalcin Nephrocalcin Reference: Harpers illustrated biochemistry 30th edition
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Ans. a. Breast Imaging Repoing and Data System BIRADS stands for Breast Imaging Repoing and Data System BIRADS (Breast Imaging Repoing And Data System) Category Definition 0 Incomplete assessment, need additional imaging evaluationQ 1 Negative, routine mammogram in 1 year is recommendedQ 2 Benign findings, routine mammogram in 1 year is recommendedQ 3 Probably benign findings, sho term follow-up suggestedQ 4 Suspicious abnormality, biopsy should be consideredQ 5 Highly suggestive of malignancy, appropriate action should be takenQ 6 Known biopsy-proven malignancy
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<p> - positron emission tomography is a functional diagnostic imaging technique, taking note of the fact that malignant cells have a greater glycolysis as ccompared to normal tissue. - it helps in staging , management and follow up of cancer growth. - it is now used in diagnosis of cancer in its early stage, detect its extent and severity. Reference : Shaw&;s textbook of gynaecology,16th edition, pg no: 120 <\p>
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Ans. D. Following Rifampicin ingestionHematuria is defined as the presence of 5 or more red blood cells (RBCs) per high-power field in 3 of 3 consecutive centrifuged specimens obtained at least 1 week apart. Hematuria can be either gross (i.e., overtly bloody, smoky, or tea- colored urine) or microscopic. However ingestion of certain drugs like Rifampicin and Pyridium may impart red colour to urine which may be mistaken for hematuria. Uric acid crystals may also impart a pink tinge to the nappy.
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Canal exploration: 8, 10 K file used.
In calcified canal exploration: 6 K file, C+ file, profinder.
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In non-primate mammals, end product of purine metabolism is allantoin due to presence of enzyme uricase. Uricase convees uric acid to allantoin. Humans lack the enzyme uricase. Therefore, end product of purine catabolism in humans is uric acid REF: Lippincott book of biochemistry 6th ed.
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Ans. is 'a' i.e., Trichophyton Hair perforation test . The hair perforation test consists of inoculating colonies of an organism into a dish containing a small amount of water, a few drops of yeast extract solution and some human hair. The dish is incubated at 300C and after 7 days, some of the hair are taken and are kept on a slide with a coverslip and are observed under a microscope. The test is considered positive if the hair has deep, narrow wedge shaped perforation in it. . Hair perforation test is done to distinguish between isolates of dermatophytes, paicularly trichophyton mentagrophytes and its variants.
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Yoke assembly system belongs to high pressure system of anaesthetic machine.
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(A) Spleen# Largest lymphatic organ in the human body is the spleen.> Primary function of the spleen is to purify the blood and store blood cells. It helps the immune system identify and combat foreign antibodies.> The spleen consists of white pulp and red pulp. The white pulp generates blood cells and synthesizes antibodies, and the red pulp removes old blood cells and filters the blood.
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Ref. The Short Textbook of Pediatrics. Pg 754
A fact based question. Answer 200
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Ref KDT 6 /e p606 Anticoagulants are the most mainstay for the treatment of pulmonary embolism Thrombolytic therapy is indicated bin massive pulmonary embolism with hemodymica instability and in hemodymically stable patients but with compromised right ventricular function
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Ans. is 'b' i.e., Crohn's Disease Features of CD In the affected segment, mesentric fat wraps around the bowel surface --> creeping fat o The intestinal wall is rubbery and thick, as a consequence of edema, inflammation, fibrosis, and hyperophy of the muscularis propria --> lumen is almost always narrowed --> string sign on barium meal. o A classic feature of CD is the sharp demarcation of diseased bowel segments from adjucent uninvolved bowel. o When multiple bowel segments are involved, the intervening bowel is normal --> skip lesions. o There are serpentine linear ulcer along the axis of bowel. As the intervening mucosa tends to be relatively spared, the mucosa acquires a coarsely textured Cobblestone appearance. o Narrow fissures develop between the folds of the mucosa. Fissures can penetrate deeply through the bowel wall and leading to bowel adhesions and serositis. o Fuher extension of fissures leads to fistula or sinus tract formation. o There is transmural inflammation affecting all layers of bowel wall. Sarcoid like noncaseating granulomas may be present in all tissue layers. o Neutrophilic infiltration into the crypts results in formation of crypt abscess. o Fibrosis of the submucosa, muscularis propria, and mucosa eventually leads to stricture formation. There is an increased incidence of cancer of GIT in patients with long-standing CD, but the risk of cancer in CD is considerably less than in patients with chronic UC.
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Predisposing factors for Black stones Hemolytic disorders(Heriditary spherocytosis, sickle cell anemia) Mechanical prosthetic hea valves Cirrhosis Gilbe's syndrome Cystic fibrosis Ileal disease or resection Brown stones Related to stasis and infection Gram negative bacteria (E.coli and Klebsiella) secretes beta-glucuronidase, which deconjugate soluble conjugated bilirubin Free unconjugated bilirubin precipitates and combines with calcium and bile to form brown pigment stones Stones form whenever static foreign bodies are present in the bile duct (stents or parasites such as clonorchis sinensis and Ascaris limbricoides) Ref: Sabiston 20th edition Pgno :1492
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Ans. (b) HyponatremiaRef: Bailey 26th Edition, page 1349* Most common electrolyte abnormality during TURP is HYPONATREMIA due to water intoxication.
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Pehes&; disease, the osteochondritis of the epiphysis of the head of the femur is the commonest osteochondritis.Maheswari 5e pg: 318
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C, i.e. D-glucose - Carbohydrate isomers that differ in configuration around only one carbon atom are called epimers. D-glucose and Dmannose are C2 epimers whereas D- glucose and D- galactose differ only at C4. However, D-mannose & D- galactose are not epimersQ as they differ at 2 carbons (2 & 4). Enantiomers (optical isomers or stereoisomers) are pairs of structures that are mirror images of each other but not identical , similar to left and right hand which are the same but opposite. These are non super imposable and are designated as D and L-sugar. Each enantiomer often shows different chemical reactions with other enantiomers. Because of presence of many enantiomers in living beings, there is usually a marked difference in effects of two stereoisomers. For example only one of drug stereoisomer produces desired effect while the other does not.
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After pellets of gold are rolled, they may be conveniently stored in a gold foil box, which is divided into labeled sections for various sizes of pellets.
Cylinders of foil and selected sizes of other types of gold also may be stored in the box. Preferential contamination is suggested by placing a damp cotton pellet dipped into 18% ammonia into each section of the box
This serves to prevent deleterious oxides from forming on the gold until it is used.
Key Concept
Contamination of direct filling gold is done by 18% ammonia.
Sturdevant's art and science of operative dentistry. 7th edition page e69
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RA with Hepatitis B??? We are still not sure of the answer. Anti TNF-a drugs can be used in all of the conditions mentioned in the question. Anti TNF a the therapy in Hepatitis B For the treatment of HBV, Anti TNF- atherapy showed cases of fulminant HBV reactivation. But any HBV reactivation was treated success fully with lamivudine therapy, thus it was concluded that physicians should consider antiviral therapy in patients with HBV (with or without active viral replication) and initiated treatment should continue for 3-6 months after stopping anti TNF- therapy. Both published British society of Rheumatology guidelines and British society of Gastroenterology guidelines concludes:- Successful treatment of active RA with anti TNF a in patients chronically infected with HBV is possible and can be safe. Our findings together with those of others, suggest that chronic HBV infection need not preclude therapy with anti TNF a where clinically indicated but an individualized approach is required including careful counseling, collaboration with colleagues in gastroenterology and intensive monitoring. HIV and anti TNF- a therapy As of now there are only eight patients treated with HIV and Rheumatoid disease. Retrospective series of eight patients suggests that treatment with anti TNF- a therapy can be used in HIV patients without advanced disease with associated rheumatic diseases. HCV and anti TNF-- cc therapy Anti TNF- a therapy is safe in patients with HCV and Rheumatoid ahritis. In a study involving 31 patients with RA with concomitant HCV infection, TNF a blocker seemed to be safe provided there is close monitoring of clinical virological data. Pulmonary fibrosis and anti TNF- a therapy Anti TNF-a therapy is considered safe in patients with Rheumatoid ahritis and pulmonary fibrosis. In some cases pulmonary. fibrosis seems to have improved with anti-TNF- atherapy.
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B. henselae is associated with Cat-scratch disease, bacillary angiomatosis, bacillary peliosis, bacteremia, endocarditis
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Ans: b (Atrial fibrillation) Ref: Davidson, 20th ed, p. 555This is a direct pick from Davidson.Cardiac arrest may be due to ventricular fibrillation, ventricular tachycardia, electromechanical dissociation or ventricular asystole.Cause of cardiac arrest1) VF and pulseless VT -- Most common and most easily treatable cause of sudden death.2) Ventricular asystole -- This occurs when there is no electrical activity in the ventricles resulting in absent cardiac output.3) Electromechanical dissociation -- This occurs when there in no effective cardiac output despite the presence of normal electrical activity.
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Ans. is 'a' i.e., Staphylococcal pneumonia Staphylococcal pneumonia is the most common cause of (amongst all pneumonia) Pneumatoceles Pneumothorax Lung abscess Purulent pericarditis Empyema Other organisms commonly causing empyma --> Streptococcus pyogenes, Pneumococci
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Ans. b (Diamond-Blackfan syndrome) (Ref. Nelson Paediatrics 18th12047; Table 468-1)Diamond-Blackfan syndrome (DBS), also called congenital hypoplastic anemia, is a macrocytic pure red aplasia associated with several congenital anomalies such as short stature, webbed neck, cleft lip, shielded chest and triphalangeal thumbs. Therapy is mainly corticosteroids. For unresponsive patients, transfusion therapy is indicated.CONSTITUTIONAL (INHERITED) PANCYTOPENIA# It is defined as decreased marrow production of the 3 major hematopoietic lineages on an inherited basis, resulting in anemia, neutropenia, and thrombocytopenia.0# Constitutional pancytopenias account for approximately 1/3 of cases of pediatric marrow failure. 0# Fanconi anemia is the most common constitutional disorder. 0# Causes of constitutional pancytopenia:- Fanconi anemia- Shwachman-Diamond syndrome- Dyskeratosis congenital- Amegakaryocytic thrombocytopenia- Down syndrome- Dubowitz syndrome- Seckel syndrome- Reticular dysgenesis- Schimke immune-osseous dysplasia- Familial aplastic anemia (non-Fanconi)- Pearson syndrome- Noonan syndromeFanconi (Aplastic) Anemia# Fanconi's anemia is an autosomal recessive disorder characterized by progressive pancytopenia and macrocytosis. Cell fusion of Fanconi cells with normal cells or with cells from unrelated patients with Fanconi anemia produces a corrective effect on chromosomal fragility, a process called complementation. No other constitutional pancytopenia is associated with an abnormal chromosomal breakage study.0 The average age at diagnosis is 8 years.# The most common anomaly is Hyperpigmentation of the trunk, neck, and intertriginous areas, as well as cafe-au-lait spots and vitiligo, alone or in combination. Other associated deformities include microcephaly, microphthalmia, short stature, horseshoe kidneys and absent thumbs (not triphalangeal thumbs).# The most frequent solid tumors are carcinomas of the head, neck, and upper esophagus, followed by carcinomas of the vulva and/or anus and lower esophagus.# Hematopoietic stem cell transplantation is the only curative therapy for the hematologic abnormalities. Androgens produce a response in 50% of patients. Oral oxymetholone is used most frequently once a day. Low-dose prednisone orally every 2nd day may be added. Transposons are nonviral vectors that have been used successfully for gene delivery hold promise in humans.Shwachman-Diamond sxndrome (Autosomal recessive) - Essential diagnostic criteria are:# Exocrine pancreatic insufficiency# Variable hematologic cytopenias due to marrow failure.# Chromosomes are normal, and there is no increased breakage after DEB clastogenic stress testing.# The mutant gene SBDS maps to chromosome 7qll.Dyskeratosis congenita (DC)# Mucocutaneous and hematopoietic systems involved in association with somatic abnormalities.# The diagnostic ectodermal triad is:- Reticulate skin pigmentation of the upper body- Mucosal leukoplakia, and- Nail dystrophy.# DC is a constitutional pancytopenia; aplastic anemia occurs in approximately 50% of cases, usually in the 2nd decade of life. Patients also have a predisposition to cancer and MDS.# Approximately 85% of patients are male, compatible with X-linked recessive inheritance.# The X-linked recessive form of DC maps to Xq28.
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