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MC cause of peritonitis in adult male: Peptic ulcer perforation * The most common cause is a perforation of the abdominal viscus-most commonly, a perforated ulcer, may occur as a result of perforation of any pa of the bowel; other causes include a benign ulcer, a tumor, or trauma.* MC cause of peritonitis in adult male: Peptic ulcer perforation
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Ans. is 'a' i.e., Increases cobalamin absorption o Intrinsic factor is a small glycoprotein secreted by the parietal cells of the gastric mucosa.lt is essential for vitamin B12 absorption.o Gastric acid and pepsin release the vitamin from protein binding in food and make it available to bind to cobalophilin, a binding protein secreted in the saliva.o In the duodenum, cobalophilin is hydrolyzed, releasing the vitamin for binding to intrinsic factor,o Intrinsic factor binds only the active vitamin Bi: vitamers and not other corrinoids.o Vitamin Bn is absorbed from the distal third of the ileum via receptors that bind the intrinsic factor vitamin B12 complex, but not free intrinsic factor or free vitamin,o Vitamin Bi; is also called as ''extrinsic factor of castle".
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Ans. (a) Diabetes mellitus(Ref: Robbins 9th/pg 1118)Most specific histological lesion in diabetic nephropathy (see chapter 18 Endocrine system) is Nodular glomerulosclerosis or Kimmelsteil -Wilson lesions
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Differential RNA processing decides whether an immunoglobulin will remain membrane bound or secreted. Ref: Textbook of biochemistry by DM Vasudevan3rd edn/page 354.
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Red line: Right ear Blue line: Left ear Continuous line: Air Conduction Dotted line: Bone conduction Ref: Dhingra; 6th Edition; pg no 30
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Ans. D. Bulbocavernosus reflexThe bulbocavernosus reflex is an oligosynaptic reflex mediated through the S2-S4 spinal cord segments that is elicited by electrical stimulation of the dorsal penis/clitoris nerves with the reflex response recorded from any pelvic floor muscles.The afferent paths of the bulbocavernosus reflex are the sensory fibers of the pudendal nerves and the reflex center in the S2-S4 spinal segment. The efferent paths are the motor fibers of the pudendal nerves and anal sphincter muscles.The bulbocavernosus reflex (BCR) is clinically elicited by squeezing the glans penis and digitally palpating the contraction of the bulbocavernosus (BC) muscle.The test involves monitoring internal and external sphincter contraction in response to squeezing the glans penis or clitoris or tugging on an indwelling Foley catheter.This reflex can also be tested electrophysiologically by stimulating the penis or vulva and recording from the anal sphincter.
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Chemotaxis is unidirectional locomotion of leukocytes towards the site of injury, oriented along a chemical gradient. This chemical gradient is created by substances called chemoattractants (chemotactic agents), which may be exogenous (bacterial products) or endogenous (C5a, LTB-4, IL-I, TNF, IL-8). C5a is the most powerful chemo-attractant (chemokine REF: ROBBINS pathology 10th edition
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Early after the onset of acute cholecystitis, the plane of dissection may be facilitated because of early inflammatory response. Between the seventh and fourteenth day after admission, surgery may be extremely difficult because of resolving infection and adhesions. Where possible surgery should be avoided during this period.
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A recent development in the pharmacologic treatment of affective disorders, especially bipolar disorder, has been the use of anticonvulsant drugs. The first to be tried, carbamazepine (Tegretol) often is the next line of treatment for bipolar disorder for persons unresponsive to lithium therapy. Carbamazepine has various side effects, although most are dose related and can be avoided by judicious clinical practice. The most worrisome side effect is aplastic anemia, which occurs very rarely but in an idiosyncratic manner. Ref: Kaplan et al, Page 553- 554
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Blood Level: Normal folic acid level in serum is about 20 nanograms/ml and about 200 microgram/ml of packed cells. The level is measured by radioimmunoassay. Histidine load test or FIGLU excretion test: Histidine is normally metabolised to formimino glutamic acid (FIGLU) from which formimino group is removed by THFA. Therefore in folate deficiency, FIGLU is excreted in the urine. AICAR excretion: In the purine nucleotide synthesis, the last step is the addition of C2 with the help of N10-formyl THFA, the precursor, aminoimidazole carboxamide ribosyl-5-phosphate (AICAR) accumulates and is excreted in the urine. Peripheral blood picture. Ref: DM Vasudevan - Textbook of Biochemistry, 8th edition, page no: 475, 297
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B i.e. Lepromin test Lepromin test has no diagnostic value; it has only prognostic significanceQ as it tells about cell mediated immunity & classify the type of disease. Lepromin test is most positive in TT because cell mediated immunity is least suppressedQ
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Subacute Granulomatous (de Quervain) thyroiditis: - Self-limited disease, probably secondary to viral infection & is characterized by presence of painful & granulomatous inflammation in thyroid. - It is MCC of tender thyroid - Lab findings : increased serum T4, decreased TSH, decreased radioiodine uptake - Early stages of De Quervain thyroiditis shows - micro abscesses formation - Late stages - granuloma formation - Rx - NSAID's
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Procaine is an ester linked local anaesthetic. Bupivacaine, Lignocaine and Mepivacaine are amide linked local anesthetics. Other ester linked anesthetics are cocaine, chloroprocaine, tetracine and benzocaine. Ref: Essentials of Medical Pharmacology By K D Tripathi, 5th Edition, Page 320.
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Ans. is 'b' i.e., Light chains . Bence jones proteins coagulate at 50degC but redissolve at 70degC. . Bence Jones proteins are light chains of immunoglobulins, so may occur as the Kappa or lambda forms. . Bence jones proteins are found typically in multiple myeloma. . In multiple myeloma patients, large amount of Bence jones proteins are excreted in the urine. . Bence - jones proteins are not detected by dipstick, which detects albumin. . Light chains (B.J. proteins) are precipitated by sulfosalicylic acid.
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Subcutaneous implant
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Fallopian tube has no submucosa. It lies in upper margin of broad ligament. Epithelium is responsive to hormones.
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The roots of the brachial plexus are the anterior rami of spinal nerves Cs-T1. These five roots form the three trunks of the plexus. Each trunk divides into an anterior and a posterior division. The divisions form the three cords of the brachial plexus. The dorsal scapular nerve is a branch of the C, root. The supra scapular nerve is a branch of the upper trunk. The upper subscapular nerve and the thoracodorsal (middle subscapular) nerve are branches of the posterior cord. The lateral pectoral nerve is a branch of the lateral cord.
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Answer-(a) DNA footprinting DNA footprinting- An in-vitro technique to find out protein binding regions on a DNA molecule. The technique is also called as DNAse I footprinting.Thousands of proteins (enzymes) are interacting with DNA in the nucleus for regulating activities like replication, transcription, translation etc.DNA Footprinting is a molecular technique used to identify the specific DNA sequence (binding site) that binds to a protein.This technique mainly used to identify the transcription factors which bind to promoter, enhancer or silencer region of gene to regulate its expression. Therefore the regulation of transcript ion of a gene can be studied using this method.
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Mallory-Denk bodies: These are usually present as clumped, amorphous, eosinophilic material in ballooned hepatocytes. They are made up of tangled skeins of intermediate filaments such as keratins 8 and 18 in complex with other proteins such as ubiquitin They are a nonspecific finding and can be found in patients with several diseases other than alcoholic hepatitis, such as Wilson's disease ref:-basic pathology robbins 9th ed, page 858
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Median lobe of prostate
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Ans. C. Kartagener syndromea. Kartagener syndrome is the inheritable disorder of dextrocardia, infertility, chronic sinusitis (with the formation of nasal polyps), and bronchiectasis.b. Patients may also present with situs inversus.c. The disorder is due to a defect that causes the cilia within the respiratory tract epithelium to become immotile (Axonemal dynein).d. Cilia of the sperm are also affected.
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Thinking characterised by the ability to grasp the essentials of a whole, to break a whole into its pas, and to discern common propeies. To think symbolically. Ref: Synopsis of Psychiatry, 11e, pg 1407.
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Answer- D. PregnancyPregnancy is a relative contraindication for thrombolytic therapy in acute ST segment elevation myocardial infarction and not an absolute contraindication.Historv of any intracranial hemorrhagicHistory of ischemicl stroke within the preceriing thrse months, with the impoant exception of acute ischemic storke seen within three hours, which may be treated with thrombolytic therapy.Presence of a cerebral vascular malformation or a primary or metastatic intracranial malignancy.Symptoms or signs suggestive of an aoic dessection-A bleeding diathesis or active bleeding, with the exception of menses. thrombolytic therapy may increase the risk of moderate bleeding, which is offset by the benefits of thrombolysis.
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Ans. is 'a' i.e., Spheno-ethmoidal recess Part of lateral nasal wallOpeningsInferiorNasolacrimal ductMiddleFrontal sinus, Maxillary sinus. Anterior ethmoidal sinusSuperiorPosterior ethmoidal sinusSphenoethmoidal recessSphenoid sinus
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.neuroblastoma is the commonest abdominal tumor . it is the tumor of adrenal medulla.. clinical features-chilg presents with huge abdominal mass,in the groin which is non mobile.not moving with respiration. nodular surface,crosses the midline.dancing eye syndrome and opsomyoclonus racoon&;s eye sign is infra orbital ecchymosis due to secondaries in retroorbital region (Ref: SRB&;s Manual of Surgery, 5th edition, pg no.509)
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Genital ridge Friends, I am giving you a very impoant tabls. Many questions can be solvod trom lhis very table. Male and female derivatives of embryonic urogenital structures. Embryonic structures Derivatives Male Female Labioscrotal swelling Scrotumo Labia majorao Urogenilal folds Ventral aspect ot penis Labia minora Geniial tubercleo Peniso Clitoriso Urogenital sinus Urinary bladder Urinary bladder Urethra except navicular lossa Urethral and paraurethral glands Prostate gland Vagina Prostatic utricle Baholin's glands Bulbo-uretheral glands ParamesoneDhric duct Appendix of tesies Hvdatid ol moroaoni. uterus. cewix fallopian tubes Mesonephric duct Ductus eoididvmis Duct of epoophoron Garlner's cvsl Seminal vesiclos Mesonephric tubules Ductuli etterentes Epoophoron Paradidymis Paraoophoron Undifferenliated gonads/ Testis Ovary Genital / gonadal ridge Coex Seminiferous tubules Ovarian tollicle Medulla Rete testis Rete ovarii Gubernaculum Gubernaculum testis Ovarian ligament Round ligament Also know : Germ cells are of endodermal origin and migrate from yolk sac to genital ridge between 20 - 30 days.deg Until the seventh week of development gonads do not develop male or female characteristic (i.e. are bipotential in nature).deg SRY gene located on the sho arm of Y chromosome, directly control the development of testis from the bipotential gonads.deg In a XX individual, without the active influence of Y chromosome, the bipotential gonad develops into an ovary two weeks later than testicular development.deg
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Ans. is 'a' i.e., Drug concentration above which it appears in urine Renal Thresholdo The renal threshold is the concentration of a substance dissolved in the blood above which the kidneys begin to remove it into the urine. When the renal threshold of a substance is exceeded, reabsorption of the substance by the proximal convoluted tubule is incomplete; consequently, part of the substance remains in the urine,o Thus renal threshold is the Drug concentration above which it appears in urine.
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Bulbourethral glands are located posterior and lateral to the membranous poion of the urethra at the base of the penis, between the two layers of the fascia of the urogenital diaphragm, in the deep perineal pouch. They are enclosed by transverse fibers of the sphincter urethrae membranaceae muscle. Ref - BDC 6e vol2 pg376
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In the third phase grey hepatisation, no new erythrocytes are extravasating, and those already present have been lysed and degraded.
The neutrophil is the predominant cell, fibrin deposition is abundant, and bacteria have disappeared. This phase corresponds with successful containment of the infection and improvement in gas exchange.
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Ans. Warm moist atmosphere
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B ref: Ahuja, 4th/e p. 118 and 5th/e p. 130
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Surface discolorations because of fluorosis can also be removed by microabrasion, if the discoloration is within 0.2 to 0.3 mm removal depth limit.
In 1984, McCloskey reported the use of 18% HCI swabbed on teeth for the removal of superficial fluorosis stains.
Subsequently, in 1986, Croll modified the technique to include the use of pumice with the HCl to form a paste applied with a tongue blade.
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Adrenalin and histamine and glucagon, insulin are physiological antagonists Physiological antagonism - opp effect on the same physiological system by two drugs glucagon increases blood glucose, insulin decreases- blood glucose adrenaline- bronchodilatation histamine- broncho constriction Ref KD Tripathi 8th ed.
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Ans. (c) Removal of fragments of bone Missile injury management*Wound excision and leave wound opened* Foreign materials to be removed.* Excise the skin edge around the entry and exit point* Unhealthy dead muscle must be removed.* Bone shattered by high energy transfer may still have attachment to periosteum or muscle. Such fragments must not be discarded as it may result in mal union or non-union.
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Adequate breathing ensures that sufficiently oxygenated blood is in circulation. Breathing is assessed by the Look-Listen feel technique. The clinician observes the rise and fall of the chest and at the same time feels and listens to the breath sounds.
If the child is breathing adequately, then maintain the head tilt chin-lift and monitor the child. Alternatively, the child can be turned to a lateral position.
If the child does not show any signs of breathing, then oxygen has to be administered to the child under positive pressure using an Ambu bag. Care should be taken to see that the airway is held open using the head tilt chin lift during the process. The mouth to mouth or the mouth to nose techniques are not described here, because it is prudent that every dental setup be equipped with the indispensable and inexpensive Ambu bag.
In addition to being more hygienic, the Ambu bag also delivers 21% oxygen as compared to 18% using the mouth to mouth technique. It can also be attached to an oxygen cylinder to deliver 100% oxygen. Give two full puffs before proceeding to assess circulation.
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Ans. is 'c' pulmonary T.B. (Ref. CMDT, 2002/e, p. 310; API, 6/e, p. 244; Harrison, 16/e, p 961 (15/e, p. 1030))The history and tuberculin test strongly suggests the diagnosis of T.B.Do not get confused by negative sputum cytology because negative sputum cytology does not rule out pulmonary tuberculosis."Sputum cytology is just a presumptive diagnosis" - Harrison, 15/e, p. 1030."The definitive diagnostic of T.B. depends upon the culture of bacteria obtained from respiratory specimen" - Harrison, 15/e, p. 1030.The presence of induration > 15 mm in size strongly indicates T.B. infection.About tuberculin testTuberculin is injected in forearm. If positive, an induration is seen after 48-72 hrs*. The maximum diameter of the induration is measured by palpation and is interpreted as follows:>15 mm - Strongly positive*> 10 mm - Positive*5-9 mm - Indeterminate*< 5 mm - Negative*A positive tuberculin test indicates* that a mycobacterium has replicated in the tissues of the individual at some time but does not indicate clinical disease.
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Axillary nerve
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Fish Tank Granuloma * Caused by atypical mycobacterial infection * Recreational or occupational exposure to contaminated freshwater or saltwater * Affects elbows, knees, feet, knuckles or fingers * Often single lump which causes crusty sore or abscess * Other lumps on course of lymphatic drainage * More widespread if immuno-compromised * Treated with long course of minocycline or co-trimoxazole 6-12 weeks ref : ananthanaryana 9th ed
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Aspiration is prevented
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When even a relatively minor noxious stimulus is applied to the skin it may activate autonomic neurons and produce evacuation of the bladder and rectum, sweating, pallor, and bp swings in addition to withdrawal response. This distressing mass reflex can sometimes be used to give paraplegic patients a degree of bladder and bowel control. Ref: Ganong&;s review of medical physiology;23rd edition; pg:250
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ANS. BEmergency contraception:1. Yuzpe method (within 72 hours: High dose OCP 2 + 2 (12 hours apart) or low dose OCP 4 + 4 (12 hours apart).2. LNG 0.75 mg 1 tab immediately, 2nd tab after 12 hours.3. Mifepristone (RU 486).4. Ulipristal 30 mg tab--5 days.5. Copper-TIUDImages of copper containing IUDCU-T380AImage of Mirena (total LNG is 52 mg and is released at a rate of 20 mg/ day for a period of 5 years)
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ATP Generating Steps in TCA Cycle - There are 3 NADH molecules generated during one cycle, each of them will give rise to 2 1/2 ATPs on oxidation by electron transpo chain (ETC); so altogether they will give 3 x 2 1/2 = 7 1/2 (7.5) high energy phosphates. The FADH2 will generate 1 1/2 molecules of ATP. In addition, one molecule of GTP (equivalent to one molecule of ATP) is formed by substrate level phosphorylation. Hence, per turn of the cycle, 10 high energy phosphates are produced. STEP NO. REACTIONS COENZYMES ATPs 3 Isocitrate - alpha ketoglutarate NADH 2.5 4 Alpha ketoglutarate - succinyl CoA NADH 2.5 5 Succinyl CoA - Succinate GTP GTP 1 6 Succinate - Fumarate FADH2 1.5 8 Malate - Oxaloacetate NADH 2.5 TOTAL = 10 REF :DM VASUDEVAN TEXTBOOK OF BIOCHEMISTRY, EIGHTHEDITION,PG.NO.,305,307.
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Parasites entering through feco-oral route:ProtozoaTrematodeCestodeNematodeHistolyticaGiardia lamblia Balantidium coli Sarcocystis hominids Sarcocystis suihominis Isospora Cyclospora Cryptosporidium parvum MicrosporidiaFasciola hepatica Fasciolopsis buski Clonorchis sinensis Opisthorchis felineusParagonimus westermaniGastrodiscoides hominis Watsonius watsoniMetagonimusTaenia solium T.saginataMulticepsDiphyllobothrium latum Spirometra Echinococcus granulosus MultilocularisH. nanaH. DiminutaDipylidium caninumAscaris lumbricoidesTrichuris trichiuraEnterobius vermicularis Trichinella spiralis Dracunculus medinensis Capillaria philippinensisAngiostrongylusTrichostrongylusOesophagostomumAnisakis simplexGnathostoma(Refer: Harrison's Principles of Internal Medicine, 18th edition, pg no: 1730, 1739-1744)
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Ans. D i.e. Graze or impact injury
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Ans. D. SuccinateVitamin C plays an important role as a co enzyme in the hydroxylation of Proline. The reaction is dependent on proline and requires vitamin C, alpha ketoglutarate, molecular O2 and Fe2+
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Ans. is 'a' i.e.,Oral paracetamol for 2 - 3 days Shoulder tip pain after laproscopic surgery:* The patient should be warned about this preoperatively and told that the pain is referred from the diaphragm and not due to a local problem in the shoulders.* It can be at its worst 24 hours after the operation.* It usually settles within 2-3 days and is relieved by simple analgesics such as paracetamol.
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Okazaki fragments are sho segment of DNA synthesised on lagging strand, during the process of replication of a double stranded DNA. Ref: Biochemistry By Mary K. Campbell, Shawn O. Farrell, 7th Edition, Pages 258, 275; Harper Textbook of Biochemistry, 27th Edition, Pages 335-37; Lewin's Genes X By Benjamin Lewin, Page 341; Lippincott's Biochemistry, 4th Edition, Page 406; Microbial Genetics, Page 154
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Leukemia is most common radiation induced cancer.
Others: Thyroid, Breast Carcinoma
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The patient has diabetes-induced nephropathy. As the kidneys lose function, the ability of creatinine to be absorbed into the urine decreases, and its excretion would be low. Creatine is synthesized from glycine, arginine, and SAM. In muscle, creatine is converted to creatine phosphate, which is nonenzymatically cyclized to form creatinine. The amount of creatinine excreted by the kidneys each day depends on the body muscle mass. Weightlifting and increasing muscle mass would increase the levels of creatinine in the urine. A low-protein diet would not reduce the muscle mass, nor affect the creatinine excretion.
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Ans. is 'b' i.e., 2 ASA GradePatient conditionASA 1Normal healthy patient (no physical or mental illness)ASA 2Mild systemic disease not limiting functional activity(mild heart disease, DM, Mild hypertension, Anemia, Old age, obesity, mild chronic bronchitis)ASA 3Severe systemic disease that limits activity but not incapaciating (Angina, Severe DM, cardiac failure)ASA 4Severe systemic disease that is life-threatening(Marked cardiac insufficiency; presistent angina; severe renal, respiratory or hepatic insufficiency)ASA 5Moribund patient who is not expected to survive without operationASA 6Brain dead patient (for organ donation).
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UNITS OF RADIATION Physical quantity S.I. Unit Non S.I. Unit Conversion Radioactivity Becqueral (Bq) Curie (Ci) 1 Ci = 3.7 X 1010 Bq Absorbed dose Gray (Gy) Rad 1 Gy = 100 rads 1 rad = 0.01 gy Dose equivalent Sieve (SV) Rem 1 SV = 100 rem 1 Rem = 0.01 Sv Exposure coulomb/kg Roentgen 1R= 2.58 x 10-4coulomb/kg of air
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The most important cause of bulging fissure is klebsiella pneumonia. Other causes are legionella pneumonia, streptococcal pneumonia, TB, Yersinia pestis, lung abscess, carcinoma bronchus
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Splenic aery itself is not an end aery - splenic branches of splenic aery are end aeries. Splenic branches do not have an anastomosis once they enter the substance of spleen. Splenic aery branches to stomach and pancreas, do anastomose within the substance of the respective organ (not end aeries). An end aery (or terminal aery) is the only supply of oxygenated blood to a specific poion of tissue. It does not anastomose with the neighbors aeries. There is no collateral circulation present besides the end aeries. Any block leads to iscahemia and infarction. Note: Functional end aeries have anatomical anastomosis existing but is incapable of providing a sufficient supply of blood (Ineffectual anastomoses). Functional end aeries supply segments of the brain, liver, kidneys, spleen and intestines; they may also exist in the hea.
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Ans. is 'd' i.e., Bronchiolitis
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All the given drugs are used for neuromuscular blockade reversal, However neostigmine is the most commonly used one.
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Ans. Heteronymous
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Answer is A (Cerebellum) Hemangioblastomas associated with Von-Hippel-Lindau Disease are most commonly seen in the cerebellum. The hallmark lesion of Von-Hippel-Lindau (VHL) disease is the hemangioblastoma. These are most commonly seen in the cerebellum but occasionally seen in the medulla oblongata (most common brainstem site), spinal cord and supratentorially in the optic nerves and cerebral hemispheres' - MR1 of the Brain and spine (Lippincott). 'The most common CNS manifestation of VHL is the charachteristic cerebellar hemangioblastoma. Approximately 6080% of VHL patients ultimately develop a CNS Hemangioblastoma. Three quaers of these are cerebellar in location with the majority of the remaining hemangioblastomas located in the spinal cord. Hemangioblastomas of the cerebral hemisphere account for only a small minority of lesions '
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Lupus vulgaris is the most common type of cutaneous TB. Presence of apple jelly nodules at the edge of a plaque. Apple jelly nodules on diascopy- erythematous lesions will turn from pink to golden brown. They do not exhibit this color on Indian skin. In European cases the lesions occur on face paicularly about the nose and on the cheek with frequent involvement of the mucous membrane of then nose and the lips. In India, buttocks, thighs, and legs are common site of involvement. These nodules are not invariably found in all cases and their presence is not pathognomonic of lupus vulgaris.
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HDL
The HDL particles are referred to as scavengers because their primary role is to remove free (unesterified) cholesterol from the extrahepatic tissues.
HDL particles transport cholesterol from extrahepatic tissues to liver (i.e. reverse cholesterol transport) which is then excreted through bile.
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Serological tests are the most sensitive and specific tests; includes Immunoblast test, arcs test, ELISA and indirect hemagglutination tests. "The immunoblast test, where available, is the test of choice." - CMDT, 2005, p 1463. Casoni's test - Intradennal injection of 0.2 ml of fresh sterile hydatid fluid produces a wheal of 5 cm in diameter within half an hour in pts with hydatid disease. It has been abandoned because of poor specificity. Ref : CMDT, 2005, p 1462, 1465
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Various strains of the human papilloma virus (HPV, notably types 16, 18, 31, 33, 35, and 39) have been implicated as causing a variety of genital lesions, including genital was, cervical dysplasia, cervical cancer, vaginal dysplasia, vaginal cancer, and penile cancer. The koilocyte is the term used to describe the characteristic nuclear alterations and perinuclear halo seen with HPV infection in the cervical squamous epithelial cells. Infection with the AIDS virus cannot be recognized by cytologic changes. Cytomegalovirus infection causes nuclei to be large, eosinophilic, and "smudged"; cytomegalovirus is uncommonly seen in Pap smears. Herpes simplex I and II infections cannot be distinguished cytologically, as both produce multinucleated cells whose nuclei develop a characteristic "ground-glass" appearance. Ref: Hoffman B.L., Schorge J.O., Schaffer J.I., Halvorson L.M., Bradshaw K.D., Cunningham F.G., Calver L.E. (2012). Chapter 29. Preinvasive Lesions of the Lower Genital Tract. In B.L. Hoffman, J.O. Schorge, J.I. Schaffer, L.M. Halvorson, K.D. Bradshaw, F.G. Cunningham, L.E. Calver (Eds), Williams Gynecology, 2e.
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Retinoblastomas are the most common intraocular neoplasm found in childhood and with modern treatment modalities, are, in most cases, curable. On imaging, they are generally characterized by a heterogeneous retinal mass with calcifications, necrotic components and increased vascularization on Doppler ultrasound/enhancement on CT/MRI. IMAGE A IS FLEXNER-WINTERSTEINER ROSETTE (M/C IN RETINOBLASTOMA) IMAGE B IS HOMER-WRIGHT ROSETTE IMAGE C IS PSEUDOROSETTE IMAGE D IS TRUE EPENDYMAL ROSETTE.
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The left umbilical vein becomes the round ligament of the liver after bih. The right umbilical vein did not leave a fibrous remnant because it was degenerated during the early embryonic period. The ductus venosus forms the ligamentum venosum; the ductus aeriosus forms the ligamentum aeriosum; Umbilical aery forms the medial umbilical ligament.
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Ans. is a i.e. Stage lb Ca cervix Radiotherapy is recommended in advanced stages of Ca cervix i.e. stage IIB onwards.deg Brachytherapy is commonly used. For larger tumours initially external radiation then brachytherapy is given In small tumours brachytherapy is given first followed by external radiation. For stage IB and IIA - both surgery and radiotherapy yield similar results. There is very little scope of radiotherapy in ovary tumors. Only Granulosa cell tumour and dysgerminoma are radiosensitive and external radiotherapy is instituted for elderly woman. Vaginal Squamous cell Ca is only moderately sensitive to irradiation. In all advanced cases exenteration operation is done. Fallopian tube carcinoma -Total hysterectomy with Bilateral Salpingo-oophorectomy along with omentectomy followed by external pelvic radiation is the Treatment of Choice in Ca of Fallopian Tube.
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Imiquimod is an immune response modifier shown to be effective in the topical treatment of external genital and perianal was Ref: Katzung 11th edition Chapter 49.
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In carbon monoxide poisoning, the colour of post moem staining is cherry-red. In poisoning by nitrites, potassium chlorate, potassium bicarbonate, nitrobenzene, acetanilide, bromates, and aniline the colour is chocolate brown. In asphyxia, the colour of the stains is deeply bluish-violet or purple. A bright pink colour is seen in hypothermia and bodies taken from cold water. Ref: The Essentials of Forensic Medicine and Toxicology by KS Narayan Reddy, 27th edition, Page 139.
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Ans. is 'a' ie. Ruptured typhoid ulcer The clue to this answer is presence of this clinical sign in the pt. --) Obliteration of liver dullness. Obliteration of liver dullness : Right mid-axillary line is percussed from above downwoards. The percussion note will be resonant in the upper pa of the mid-axillary line. At the upper border of the liver the resonant note in replaced by the dull note. If the liver dullness is replaced by a resonant note it indicates presence of free gas under the diaphragm as occurs in the perforation of the gastro-intestinal tract." - S.Das Manual, 4/e, p344 No other condition is able to cause obliteration of liver dullness.
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5-nucleotidase is a marker in the mitochondria It cleaves 5 - nucleotides Ref:Guyton and Hall textbook of medical physiology 12th edition ,pag number: 20,21,22
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Doxorubicin an antitumor antibiotic is highly cardiotoxic. It causes acute cardiotoxicity in the form of atrial and ventricular dysrythmias and cumulative doses more than 550 mg/m2 is associated with a 10% incidence of chronic cardiomyopathy. Cardiotoxicity is related to the iron catalyzed oxidation and reduction of doxorubicin. Cardiotoxicity is related to peak plasma dose so lower dose and continuous infusions are less likely to cause cardiac damage.
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Malignant glaucoma occurs following an iridectomy, filtering surgery (Trebaculectomy) or laser irodotomy. It may also occur after cataract surgery, capsulotomy or even spontaneously.
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Division of distribution :
No of Intercept
Divides into
Testile
2
3 equal parts
Quartile
3
4 equal parts
Pentile
4
5 equal parts
Octile
7
8 equal parts
Centile
99
100 equal parts
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Compound fracture
Compound fracture also called open fracture, in which fracture communicates with the external environment, i.e., overlying soft tissue coverage (skin and muscles) is breached.
Open fractures are typically caused by high energy injuries such as car crashes, falls, or sports injuries.
Gustila and Anderson classified open fracture into following types.
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This intrinsic ability of the hea to adapt to increasing volumes of inflowing blood is called the frank starling mechanism. Basically, the Frank-Starling mechanism means that the greater the hea muscle is stretched during filling, the greater is the force of contraction and the greater the quantity of blood pumped into the aoa.Ref: Guyton and Hall textbook of medical physiology 13th edition. Page: 119
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OCPS predispose Fibromuscular dysplasia affects mainly medium and large aeries. Sometimes alteration of the normal normal structure of the aerial wall gives rise to true aneurysms. There is also associated irregular hyperplasia. Muir's Textbook of pathology Edited by JR Anderson, 12 th edition, page no 14.36 Answer is option 2
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Pseudomonas aeruginosa species, in particular, colonize the lower respiratory tract, first intermittently and then chronically.
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The common fibula (peroneal) nerve divides into the superficial fibula (peroneal) nerve, which supplies the fibula (peroneal) compartment, and the deep fibula (peroneal) nerve, which supplies the extensor compartment of the leg. This injury may occur because of a fracture of the proximal fibula or because of compression of the nerve by a tightly applied plaster cast in this region.
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Anterior Horn of Medial Meniscus is the most anterior structure attached on the Intercondylar Area on the Superior Surface of Tibia. fig:- structure attached on the Intercondylar Area of Tibia. mnemonicfor remembering ligaments anterior to posterior-"Medical College Lucknow, Lucknow Medical College"
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Ans. (b) Superior obliqueRef: Grays Anatomy 41st Ed; Page No- 232* Superior oblique muscles supplied by trochlear nerve.* The marked nerve is Oculomotor Nerve.* Oculomotor Nerve emerges at the midbrain on the medial side of the crus of the cerebral peduncle and passes between the superior cerebellar and posterior cerebral arteries and run forward in the interpeduncular cistern on the lateral side of the posterior communicating artery to reach cavernous sinus.* It enters the cavernous sinus by piercing the posterior part of the roof on the lateral side of the posterior clinoid process, descends along the lateral dural wall of the cavernous sinus, dividing into superior and inferior divisions which run beneath the trochlear and ophthalmic nerve.Nerve supplies of the eyes musclesOculomotorSuperior divisionSuperior rectus and levator palpebrae superioris muscles (LPS)NerveInferior divisionMedial rectus, inferior rectus, and inferior oblique musclesTrochlear Nerve* It passes through the lateral wall of the cavernous sinus, and enters the orbit through the superior orbital fissure.* Nerve supplies the superior oblique muscle.Abducens Nerve* It enters the orbit through the superior orbital fissure.* Nerve supplies the lateral rectus muscle.Cranial Nerves - Components & FunctionNumberNameComponentsFunctionOpening in skullIOlfactory nerveSensory (SVA)Smell sensationOpenings in cribriform plate of ethmoidIIOptic nerveSensory (SSA)VisionOptic canalIIIOculomotorMotor (GSE, GVE)Turns eyeball upward, downward, and medially; Raises upper eyelid, also constricts pupil; accommodates eyeSuperior orbital fissureIVTrochlear nerveMotor (GSE)It helps in turning eyeball downward and laterallySuperior orbital fissureVTrigeminalMaxillary divisionSensory (GSA)Supplies dura mater of anterior part of middle cranial fossa, conjunctiva of inferior eyelid, Skin of face over maxilla; teeth of upper jaw; mucous membrane of nose, the maxillary sinus, and palatePasses through foramen Rotundum to enter pterygopalatine fossa. Ophthalmic divisionSensory (GSA) onlySupplies Cornea, superior conjunctiva, skin of dorsum of external nose, forehead, scalp, Superior eyelids, and also mucous nasal cavity, ethmoid, frontal and sphenoid sinusesSuperior orbital fissure Mandibular divisionSensory (GSA)Skin of lower lip, buccal, parotid and temporal regions of face, external ear (Auricle, tympanic membrane and acoustic meatus), mucous membrane of mouth and anterior two-third part of tongue. Supplies 4 muscles of mastication, mylohyoid, anterior belly of digastric, tensor tympani and tensor veli palatiniPasses THROUGH Foramen Ovale into infratemporal fossa. VIAbducent Motor (GSE)Lateral rectus muscle turns eyeball laterallySuperior orbital fissureVIIFacial Sensory (SVA)Taste from anterior two-thirds of tongue, from floor of mouth and palate Motor (SVE)Muscles of face and scalp, stapedius muscle, posterior belly of digastric and stylohyoid musclesInternal acoustic meatus, facial canal, stylomastoid foramen Secretomotor (GVE) parasympatheticSubmandibular and sublingual salivary glands, the lacrimal gland, and glands of nose and palate VIIIVestibulo-CochlearSensory (SSA)Organ of Corti-- hearing cochlearVestibularSensory (SSA)From utricle and saccule and semicircular canals--position and movement of headInternal acoustic meatusIXGlossopharyngealSensory (GVA, SVA, GSA)General sensation and taste from posterior one-third of tongue and pharynx; carotid sinus (baroreceptor); and carotid body (chemoreceptor) Motor (SVE)Stylopharyngeus muscle--assists swallowingJugular foramen Secretomotor (GVE)parasympathetic Parotid salivary gland XVagus Motor (GVE, SVE)Sensory (GVA, SVA, GSA)Heart and great thoracic blood vessels; larynx, trachea, bronchi, and lungs; alimentary tract from pharynx to splenic flexure of colon; liver, kidneys, and pancreasJugular foramenXISpinal accessorySpinal rootMotor (SVE)Sternocleidomastoid and trapezius muscles Cranial rootMotor (SVE)Muscles of soft palate (except tensor veli palatini), pharynx (except stylopharyngeal, and larynx (except cricothyroid in branches of vagusJugular foramenXIIHypoglossal Motor (GSE)Muscles of tongue (except palatoglossus) controlling its shape and movementHypoglossal canal
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Ans. is 'c' i.e., Anhidrosis Sympathectomy is used for the treatment of hyperhydrosis and would worsen anhydrosis rather than treating it.
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Ans. is 'b' i.e., Catalase test(Ref: Ananthanarayan, 9th/e, p. 200 and 8th/e, p. 196)* Coagulase test is used to differentiate the different species of staphylococci (staph, aureus, staph, epidermidis).* Catalase test is used to differentiate staphylococci from streptococci.* Coagulase test cannot be used to differentiate streptococci from staphylococci because certain species of staphylococci are coagulase negative (coagulase negative staphylococci) as streptococci.
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Herpes viruses replicate in the host cell nucleus, and both replication and assembly occur in the nucleus. The herpes virus encodes for several glycoproteins that facilitate viral attachment, fusion, and immune evasion.
The virus buds from nuclear membrane and is released by exocytosis and cell lysis.
Parija SC. Textbook of Microbiology & Immunology. Elsevier Health Sciences; 2014. Page:473
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Ans. is 'b' i.e., Hyaline membrane disease (HMD)
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Ans. is 'a' i.e., Plane o There are two types of atlanto-axial joints, both of which are synovial joints - i) One median atlanto-axial joint - Pivot joint. ii) Two lateral atlanto-axial joints - Plane synovial joint (flat joint).
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Ans. is 'a' i.e. Infancy Campbell's Urology writes - "Definitive treatment of an undescended testis should take place between 6 and 12 months of age. Because spontaneous descent occurs in most boys by 3 months of age and uncommonly thereafter, earlier interventions should be considered in order to theoretically prevent the complication of cryptorchidism that may be manifested before 1 yr. of age".
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Ans. is. b. Beta lysin
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Ans. is 'a' i.e., Stratum malpighi
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The area under Normal curve with ± 1 SD is 0.68.
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C i.e. Tachycardia Sinus tachycardia is most commonly occurring arrhythmia in the perioperative period.
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D i.e. ECT
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Estrogens are the principal medications used to relieve hot flushes. Estrogen blocks both perceived symptoms and physiological changes. Ref: Shaw's Textbook of Gynaecology, 12th Edition, Page 43 ; Current Obs and Gynae Diagnosis and Treatment 9th Edition, Page 1024
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Ans. is a, i.e. Stage IAs discussed in chapter 7 of the book, first stage of labor is from the time when a female starts perceiving true labor pains and uptil 10 cm of dilatation.
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Answer is D (None -- All are seen): Cushing's syndrome may be associated with all features mentioned in the question.
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Answer is C (Water deprivation test is required) : Diagnosis of diabetes insipidus often requires a water deprivation test. Water deprivation test is used to establish the diagnosis of diabetes insipidus and to differentiate Central and Nephrogenic forms of Diabetes Insipidus. Patients with diabetes insipidus have a normal or increased plasma osmolality (> 280 mosm/l) and decreased urine osmolality (<300mosm/1). 'Water deprivation test' typically demonstrates an increase in plasma osmolality with failure of urinary osmolality to increase (no change) during H20 deprivation in cases of diabetes insipidus thereby suggesting the diagnosis. Diabetes Insipidus is associated with plasma osmolality > 280 mosm/kg and urinary osmolalitv < 300 mosm /kg In normal subjects the plasma osmolality ranges from 275-295 mosm /kg while the range of urine osmolality is wide, from 40 to 1000 mosm/kg depending on the state of hydration. After water deprivation the urine osmolality will normally rise to exceed 800 mosm/kg while the plasma osmolality remains below 295 mosm/kg (U/P >2) In Diabetes Insipidus subjects the plasma osmolality ranges from normal to high (>275 mosm/kg) while the urine osmolality is typically < 300 mosm/1. After water deprivation plasma osmolality rises to > 295 mosm/kg while urinary osmolality fails to rise appropriately (Fails to rise to >300 mosm/kg) (U/P Ratio < 2.0) Water deprivation test is often required to establish a diagnosis of Diabetes insipidus Water deprivation test is indicated in patients with hypotonic polyuria (Uosm < 300 mosm/kg) and a plasma osmolality 410 within the normal range (Posm = 275 -- 295 mosm/kg) to establish the diagnosis of diabetes insipidus and differentiate central & nephrogenic forms.
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Multiple papilloma Although multiple laryngeal papillomas are a rare laryngeal disease they are the most common laryngeal tumors in childhood. They may be present at bih but more commonly they arise around the age of 2 years. Cause is unknown but ceain viruses have been blamed. At laryngoscopy the papilloma look like bunches of wa like disfiguring outgrowths which are pinkish white in color and are always multiple. Symptoms depend upon position and size le. If they are big enough to compromise the airway they will cause stridor otherwise they will produce dysphonia. The principal of treatment is to remove the papillomas without damaging the larynx and to wait for normal resolution of the condition. Laser beam microlaryngeal techniques are highly successful and reduce the recurrence.
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ANSWER: (B) AtracuriumREF: Lee synopsis of anesthesia 12th e p. 215Repeat in December 2011Muscle relaxantRoute of eliminationPancuronium , Vecuronium , RapacuroniumLiverVecuronium , RocuroniumBiliarySch , MivacuriumPseudocholinesteraseGallamine , MetocurineRenalAtracurium, cis-atracuriumHoffman's elimination Obtain AMPLE' history and examine patinet |PrepareEquipment. Personnelmedications|Monitor and preoxygenateECG and oulse oximeter|Premedicate* Gve atropine- Indicateo to' all children <5 years of age- Indicated for all patients wen suociny choline is used* If succinycholine to be used; consider defasciculation (0.01 mg/kg of Vecuronium or Pancuromjmj* Give ildocaine for head injury or increased ICP|Secsle (choose ore option eased onccnd tion of patent)|||||Nomotensive* Midazolam or* E:oir cate or* Thiopental or* PropofolHypotensive/hypovolemicHead injury or status epilepticusStatus asthmaticus* Ketamine or* MidazolamMidSevereNormotensiveHypotensive* Etonidale or* Etorrcateor* T-opentalor* Etomdate or* Ketamine or* Ketam-e cr* Propofol cr* Lew-dose thiopental* Midazolam* None* Tetomidate |||||| | Apply criood pressure when patient is unconscious|Paralyze .(choose one)* Rocurcnium* Vecuronium* Suoclnylcholine|* intubate Irachea* Evaluate and confirm tube placement (eg. exhaled CO2)* Secure tracheal tube* Observe and monitor* Administer additonal sedaton and paralytics PRN 'AMPLE r stony allergy medications, past history, last meal and events leading to need for intubation.
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Various structural components of Streptococcus pyogenes exhibit antigenic cross-reaction with different tissues of the human body. Antigenic relationships have been demonstrated between capsular hyaluronic acid and human synol fluid, cell wall protein and myocardium, group A carbohydrates and cardiac valves, cytoplasmic membrane antigens and vascular intima and peptidoglycans and skin antigens. It has been postulated that these antigenic cross-reactions may account for some of the manifestations of rheumatic fever and other streptococcal diseases, the tissue damage being of an immunological nature. Antigenic cross-reactivity: Streptococcal antigen Human antigen Disease Hyaluronic acid Synol fluid Reactive ahritis Cell wall M protein Myocardium Acute rheumatic fever Peptidoglycan Skin antigens Guttate psoriasis Cell wall C carbohydrate Cardiac Valves Acute rheumatic fever Cytoplasmic membrane Glomerular vascular intima Acute glomerulonephritis Reference: Textbook of Microbiology; Anathanarayan and paniker's; 10th edition; Page no: 213
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Barbiturates such as amobarbital inhibit electron transpo Complex I by blocking the transfer from Fe-S to Q. At sufficient dosage, they are fatal in vivo. Reference: Harper; 30th edition; Page no: 132
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BICEPS BRACHII:-Origin: Two heads-Long head-supraglenoid tubercle of scapula and glenoid labrum.Sho head-coracoid process of scapula.Inseion:-posterior rough pa of radial tuberosity Nerve supply:-musculocutaneous nerve.Action: supination of forearm when elbow is flexed.Flexion of forearm when elbow is extended.Biceps reflex:-Tapping tendon of biceps brachii by reflex hammer with forearm pronated and paially extended at elbow. Normal reflex confirms the integrity of musculocutaneous nerve and C5 and C6 spinal segments.{Reference: Vishram Singh, pg no.105}
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Ref:Park's Text book of Preventive and Social Medicine 25th ed
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The majority of nephrons are coical, with glomeruli located in the mid-to-outer coex. Fewer nephrons are juxtamedullary, with glomeruli at the boundary of the coex and outer medulla. Coical nephrons have sho loops of Henle, whereas juxtamedullary nephrons have long loops of Henle. Ref: George, A.L., Neilson E.G. (2012). Chapter 277. Cellular and Molecular Biology of the Kidney. In D.L. Longo, A.S. Fauci, D.L. Kasper, S.L. Hauser, J.L. Jameson, J. Loscalzo (Eds), Harrison's Principles of Internal Medicine, 18e.
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