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Ans. is 'c' i.e., Increased calcium release from saroplasmic reticulum Peusis toxin . Peussis toxin is an exotoxin that has A and B subunits. . B subunit binds to the target cells whereas A subunit acts on the target. . First, the peussis toxin itself gets activated by glutathione and ATP. . Once the toxin gets activated it activates cell membrane bound G proteins. . Peussis toxin catalyzes the ADP ribosylation of the G proteins and activates them. . The activated G protein in turn activates adenylate cyclase, this results in an outpouring of cAMP which activates protein kinase and other intracellular messangers.
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Ans. is 'b' i.e, Angina o The drug that inhibit fatty acid oxidation is Trimetazine. o These drugs are paial inhibitors of FA oxidation o These drugs also inhibit lipid peroxidation ---> Reduce the generation of free radicals o These drugs are indicated for the treatment of chronic angina pectoris who failed to respond to standard antianginal therapy.
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Chronic osteomyelitis is the most common complication. Other complications are : septicemia and pyemia septic ahritis metastatic infection to other body pas pathological fractures altered growth from damage to epiphyseal growth plate recurrence. malignancy can be seen in chronic osteomyelitis. image of acute osteomylitis ref : maheswari9th ed
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A
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Ans. D. 20ml/min.rate of elimination = amount of drug excreted per hour concentration in urine x urine flow 2mg/min = 100 mg% x 2 ml/minNow Cl = RoE/Plasma concentration Therefore, Clearance =2mg/min/10mg%=20ml/min.
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Von Gierke's disease is a glycogen storage disease caused by a deficiency of glucose-6-phosphatase. It typically presents with neonatal hypoglycemia, hyperlipidemia, lactic acidosis, and ketosis. Failure to thrive is common in early life; convulsions may occur due to profound hypoglycemia. The glycogen accumulation in von Gierke's disease occurs primarily in the liver and kidneys, accounting for the enlargement of these organs. Gout may develop later because of the derangement of glucose metabolism. Even if you do not remember all of the details of the presentation of these genetic diseases, you should be able to narrow the choices: Gaucher's disease and Niemann-Pick disease are lipid storage diseases, and would not be expected to produce hypoglycemia. The other diseases are glycogen storage diseases, but McArdle's and Pompe's disease affect muscle rather than liver and would not be expected to produce profound hypoglycemia, since the liver is the major source for blood glucose.
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Endemic typhus is is caused by Rickettsia typhi and is transmitted to humans by the rat flea Xenopsylla cheopis. When the flea bites humans it defecates and the organism enter through the bite wound into the blood. After an incubation period of 1-2 weeks patients gets headache, fever and myalgia. They develop a maculopapular rash which stas on the trunk and spreads to the extremities. Epidemic Louse-Borne Typhus Fever is caused by Rickettsia prowazekii, and is transmitted to humans by the body louse. Scrub typhus is caused by Orientia tsutsugamushi a rickettsial organism. It is transmitted by rodent mite larvae. Ref: Ray C.G., Ryan K.J. (2010). Chapter 40. Rickettsia, Ehrlichia, Coxiella, and Baonella. In C.G. Ray, K.J. Ryan (Eds), Sherris Medical Microbiology, 5e.
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Ans. (b) EndocytosisEndocytosis is the process of taking contents inside the cell. It involves fusion of two cell membranesExocytosis is release of contents from inside of the cell to outside. It involves fusion of vesicles inside the cell to its cell membrane
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C i.e. Krait
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Ans. a. Submental disorderMajority of children with Down syndrome function in mild to moderate range of mental retardation.Down syndrome/Trisomy 21:Genetic disorder caused by presence of all or part of a third copy of chromosome 21.Typically associated with physical growth delays, characteristic facial features and mild to moderate intellectual disability.
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X0 is indicative of Turner’s Syndrome.
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BFHI was launched in 1992 by the UNICEF and was adopted in India in1993. Ref: Nutrition and Child Development, K.E. Elizabeth, 4th edition pg: 1
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Ans: C (Type IIIA) Ref: Rockwood and Green 's Fractures in Adults, 7th EditionExplanation:Compound fractures are classified under the Gustilo Anderson Classification of Open FracturesTYPE ILow-energy clean woundcl cm with minimal soft tissue injury and comminutionTYPE IIWound >1 cm with moderate soft-tissue damage and fracture comminution.Soft tissue component is often defined as disruption <10 cm and without periosteal strippingTYPE IIIThe Type III open fractures include higher energy injuries. Substantial soft tissue injury, with periosteal stripping, has occurred, and a crush component is typically present.The fracture pattern, such as segmental comminution, reflects the higher forces imparted.TYPE IIIaFracture wound >10 cm with crushed tissue and contamination but usually with adequate soft tissue coverageTYPEIIIbFracture wound >10 cm with crushed tissue and contamination having inadequate soft tissue cover associated with periosteal stripping and often requiring transfer of vascularized tissue for soft tissue coverageTYPE IIIcOpen fractures associated with a major vascular injury that requires repair for limb salvageNotes:Type I fractures are those with minimal soft tissue injury.Skin lacerations are less than or equal to one cm, and are clean, without evidence of deep muscle crushing or foreign debris contamination.Additionally, the underlying fracture pattern must he consistent with a low energy injury.Examples include spiral diaphyseal fractures or rotational periarticular injuries.Higher energy fracture patterns, such as segmental or bending wedge fractures, should be considered as higher grade open fractures.Injury being a farm injury is suggestive of contamination. Hence this case would go into Type IIIA.In the event of segmental comminution being present, it would be classified as Type IIIB since segmental comminution is suggestive of more extensive soft tissue and periosteal injury irrespective of the size of the wound.
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Perilymph fistula: In this condition, perilymph leaks into the middle ear through the oval or round window.
It can follow as a complication of stapedectomy or ear surgery when stapes is accidentally dislocated.
It can also result from sudden pressure changes in the middle ear (e.g. barotrauma, diving, forceful Valsalva) or raised intracranial pressure (weightlifting or vigorous coughing). A perilymph fistula causes intermittent vertigo and fluctuating sensorineural hearing loss, sometimes with tinnitus and sense of fullness in the ear (compare Ménière’s disease).
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Epiploic foramen of Winslow is the passage of communication, or foramen, between the greater sac and the lesser sac (omental bursa).It has the following borders:1.Anterior: the free border of the lesser omentum, with the common bile duct, hepatic aery, and hepatic poal vein between its two layers. 2.Posterior: the peritoneum covering the inferior vena cava on T12.3.Superior: the peritoneum on the caudate lobe of the liverInferior: the second pa of the duodenum and the hepatic aery.
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Once infected with HIV ,it is infected for life.strictly speaking,the term AIDS refers only to the last stage of the HIV infection.so the moality is 100%(Ref.PARK'S TEXTBOOK OF PREVENTIVE AND SOCIAL MEDICINE 21st Edition page no.316)
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Ans. D. Endometrial cancer and breast cancerNulliparity and late menopause are factors associated with increased exposure to estrogen, hence they are operative in endometrial hyperplasia, Unopposed estrogen stimulation is not operative in endometrial polyps, cervical cancer, or vulvar cancer
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Ans. C: Hyperophic cardiomyopathy Pulsus paradoxus (PP), also paradoxic pulse or paradoxical pulse, is an exaggeration of the normal variation during the inspiratory phase of respiration, in which the blood pressure declines as one inhales and increases as one exhales. It is a sign that is indicative of several conditions including cardiac tamponade, pericarditis, chronic sleep apnea, croup, and obstructive lung disease (e.g. asthma, COPD)
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A i.e. Nicotinic cholinergic receptorReceptors with intrinsic ion channelThese cell surface receptors enclose ion selective channels (Na+, Ca2+, CO within their molecule. Agonist binding opens the channels & causes depolarization / hyperpolarization depending on the ion that flows through.This includes: - Nicotinic cholinergic receptorQ Glutamate receptor Glycine receptor GABAA receptorQ - 5HT3 receptorReceptorActs'ThroughMuscarinic receptor, opioid andG- protein coupledGABABreceptorMl, M3 (muscarinic)IP3-DAGM2 muscarinic, Opioid 11,6CAMP TIC+, Ca+2,1.GABAB
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Most Commonly used Piezoelectric Crystal in Ultrasound probe is Lead Zirconate Titanate. Quaz is a natural piezoelectric crystal. Piezoelectric Crystals conve electrical energy into sound waves and sound waves back into electric current. Ultrasound transducers act as both transmitter and receiver. Other impoant points for USG: - USG uses Harmonic imaging (better image quality) - USG uses Pulse echo principle - Frequency of USG waves in USG is 2-20 MHz NOTE Lead Lead is m/c agent used for radiation shielding. Lead aprons safeguard workers from effects of scattered radiations TLD badgesthat are worn under the aprons, to monitor radiation dose are made up of Lithium flouride/dysprosium. Walls and glass of CT scan room are made up of lead.
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Ans. (c) SteroidsRef: Harrison's 18/e, chapter 295
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Dhat syndrome is seen in some Indian communities, where patient believes he is passing semen in urine and that leads to weakness.
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Ans. Irritation by hair of caterpillar
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Penetrating wounds produce hemorrhage and blast effects. The "blast effect" of a high-velocity projectile causes an immediate increase in supratentorial pressure and results in death because of impaction of the cerebellum and medulla into the foramen magnum. A low-velocity projectile increases the pressure at a more gradual rate through hemorrhage and edema. The other choices do not represent areas of herniation.Diagnosis: Bullet wound
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c. 16 years(Ref: Nelson's 20/e p 2673, Ghai 8/e p 534)Delayed puberty is defined as absence of secondary sexual characters by 14 yrs age or absence of menarche by 16 years.
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The technique employed in radiotherapy to counteract the effect of tumour motion due to breathing is known as gating. In gated radiotherapy, beam is turned on only during a ceain phase of respiratory cycle, generally at the end of expiration. Respiration is monitored using external markers placed on the patients chest, which are assumed to move similarly to the tumor. This is done in patients who can breathe regularly and reproducibly. Advantage of this technique is that, it decreases the internal target volume and reduce the volume of normal tissue that is irradiated. Disadvantage of this approach is prolonged treatment time and lack of direct imaging of tumor position during treatment. Ref: Lung Cancer By Kemp H. Kernstine, Page 209; Biomedical Physics in Radiotherapy for Cancer By Barry Allen, 2012
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Ans. is 'd' i.e., Standardized moality rate Special incidence rates i) Attack rate (case rate) ii) Secondary attack rate iii) Hospital admission rate
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Ans. (d) Fall in blood pressure by adrenaline pretreated with phentolamine(Ref: Ganong, 25th ed/p.353)If the subject is given a blocker and then if epinephrine is injected, vasodilation and decrease in BP is seen. This effect is called "Vasomotor reversal of Dale"
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Thromboxane A2, prostacyclin, and prostaglandins are formed by the cyclooxygenase pathway whereas leukotrienes are formed by the lipooxygenase pathway.Ref: Textbook of medical physiology by N Geetha, 2nd edition, page no. 103
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Endonuclease Exonuclease Cut in between the DNA sequence Cut from the sides either from 5' or from 3' side Cut ds DNA Cut ss & ds DNA
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Most common cause of mental retardation is Down syndrome followed by Fragile X syndrome.
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Ans. a. Kennedy phenomenon (Ref : Reddy's 33/e p231, 31/e p 214)'Kennedy Phenomenon: Surgical alteration or suturing of gunshot wounds creates problems. The evaluation of the wound, whether it was an entrance or an exit wound becomes difficult.'Mac-Naughten's rule (The right or wrong test; The legal test):An accused person is not legally responsible, if it is clearly proved that, at time of committing the crime, he was suffering from such as defect of reason from abnormality of mind, that he did not know the nature and quality of the act he was doing or that what he was doing was wrong.
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Pellagra is characterised by deficiency of tryptophan, leading to photosensitivity on exposure to uv light three D'sof pellagra diarrhoea dermatitis dementia some impoant cutaneous features gauntlet of pellagra-sun burn over Dorsum of hands castles necklace- dermatitis over neck extending to anterior chest. cheliosis scarlet glossitis and stomatitis Ref Harrison20th edition pg 1345
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Most common type of cutaneous tb is lupus vulgaris iadvl textbook of dermatology , page 245
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Cervical was are seen with HPV type 6,11 which are of low oncogenic potential and HPV type 16,18 which are of high oncogenic potential. From illustrated synopsis of dermatology and sexually transmitted diseases neena khanna 5th edition page no 287
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High affinity but low intrinsic activity. The activity is mainly governed by affinity , intrinsic activity of a drug. iagonist has high affinity and intrinsic activity,antagonist has affinity but no intrinsic activity zero. Paial agonist has high affinity and low intrinsic activity. KDT 6/e pg 37
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The course of muscle necrosis in dermatomyositis can be best followed by repeated CK determinations. Repeated muscle biopsies are rarely required. However, the goal of therapy is to increase muscle strength and function, so following muscle strength is the key clinical assessment of response to therapy.
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Bushke - Lowenstein tumour (verrucous carcinoma): Tumor destroy adjacent tissue by compression, No metastasis usually (Locally malignant) Verrucous carcinoma is a locally aggressive form of condyloma acuminata. Wide local excision is TOC Topical immunomodulators- Imiquimod (Aldara)can be given Very large lesions may respond to external beam radiation, but resection is almost always required.
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Ref: Pal GK. Cardiac output. In: Textbook of Medical Physiology. Ahuja Publishing House. 2007Explanation:Parameters increased with AgeingBlood pressureFat proportionADHProstateParameters decreased with AgeingLung complianceGlucose toleranceGFRRenal clearanceAcid secretionColonic motilityNo change with AgeingHematocrit
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The most common site is posterior part of nasal cavity close to the margin of sphenopalatine foramen.
The tumor starts adjacent to the sphenopalatine foramen. Large tumors are frequently bilobed or dumbbell-shaped, with one portion of tumor filling the nasopharynx and the other portion extending to the pterygopalatine fossa.
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Montelukast, zafirlukast and pranlukast are Cys-LT1 receptor antagonists.
Zileuton inhibits the production of leukotrienes by inhibiting the enzyme 5-lipoxygenase.
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Causes of SIADH = 1. CNS infection 2. Trauma 3. Meningitis 4. Encephalitis 5. Ectopic Ca tumor Option B: Pit Adenoma = Prolactinoma (increase prolactin), | GH Option C: Lithium = Causes Nephrogenic diabetic insipidus -Manifestation of SIADH- Dilutional Hypernatremia Treatment of SIADH = Vaptan tolvaptan
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Ans. B) Obturator nerveObturator nerve is the chief nerve of the medial (adductor) compament of thigh.
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Answer is B (Basal ganglia): The basal ganglia is the most common site of hypeensive haemorrhage The most common site of hypeensive haemorrhage within basal ganglia is the Putamen. The most common sites of hypeensive haemorrhage are : The basal ganglia (putamen, thalamus and adjacent deep white matter)- commonest Deep cerebellum Pons The most common site of hypeensive haemorrhage within basal ganglia is the Putamen. External capsule refers to a thin layer of white matter that separates the lateral pa of lentiform nucleus (putamen) from claustrum and is invariably damaged along with the putamen.
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Egg shell calcification of Hilar Lymph nodes is not seen in Aspergillosis.
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Ans. is "a* i.e., Achondroplasia o Trident hand is seen in achondroplasia.Important radiological featuresDiseaseo Trident Hando Champagne glass pelviso Scottish terrier dog orScottish dog wearing a col loro Be-headed scotty dog signo Inverted napoleon's Hat signo Gulfs wing appearanceo Opera glass deformityo Cup and pencil deformityo Chondrocalcinosiso Bamboo spineo Trolly tract signo Dagger signo Licked candy stick appearanceo Lincoin - Log appearance of vertebraeo Flowing candle wax or molten wax appearance o Marble bone diseaseo Flowing candle wax appearanceAchondroplasiaAchondroplasiaOblique x-ray of ofSpondylolysisSpondylolisthesisSpondylolisthesisPsoriatic arthritisPsoriatic arthritisPsoriatic arthritisPseudogout (CPPD)Ankylosing spondylitisAnkylosing spondylitisAnkylosing spondylitisLeprosySickle cell anemiaMelorheostosisOsteopetrosisDISH (Foresteier's disease)
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ANSWER: (A) ImatinibREF: Harrison s 17th ed, CMDT 2008 p. 444The drug treatment of choice for CML when Allogenic SCT (stem cell therapy) is not feasible is IMATINIBIFN-tz used to be the drug treatment of choice for CML when IMATINIB was not available
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Compression of communication between medial and lateral plantar nerves is a common cause for neuralgic pain in foot. At the flexor retinaculum, the tibial nerve divides into the lateral and medial plantar nerves, compression here results in tarsal tunnel syndrome. Tarsal tunnel is located deep to the flexor retinaculum and posterior and inferior to the medial malleolus. It contains the posterior tibial nerve, tibialis posterior, flexor or digitorum longus and flexor hallucis longus tendons along with posterior tibial aery and vein. Posterior tibial nerve divides within the tarsal tunnel into 3 branches: medial calcaneal nerve, lateral plantar nerve and medial plantar nerve. Tarsal tunnel syndrome result from the entrapment of posterior tibial nerve and one of its branches. Patients presents with poorly localized burning pain and parasthesia along the plantar surface of the foot and toes. Ref: Musculoskeletal Diseases 2009-2012: Diagnostic Imaging By J. Hodler, Page 55.
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The mRNAs, rRNAs, and tRNAs are directly involved in protein synthesis while the other RNAs paicipate in either mRNA splicing (snRNAs) or modulation of gene expression by altering mRNA function (mi/siRNAs) and/or expression (lncRNAs).The miRNAs do not encode proteins; instead, they function primarily to modulate the translation of target mRNAs into their corresponding proteins.Reference: Robbins and Cotran Pathologic basis of disease; 9th edition; Chapter 1; The genome; Page no:4
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Ans. D: Median Nerve Supracondylar humerus fracture: Most common < 10 years, peak age 5-8 years Constitutes 80% of all pediatric distal humerus fractures 2:1 males to female ratio Classificatio: Extension type: Extension type accounts for 90-98% of all supracondylar fractures Flexion type Galand Classification is commonly used to classify extension type of injuries: I: Nondisplaced IIA: displaced, posterior coex intact; rotationally stable, intact posterior coex acts like a hinge IIB: displaced, posterior coex intact; rotationally unstable III: completely displaced, no coical contact, most often a medial periosteal sleeve intact when medially displaced and vice-versa Management: i. Closed Reduction is done for type I and type II fractures. Closed reduction is not attempted in type III fractures. Assessing adequacy of reduction: Jones view: hyperflexion shoot through elbow Baumann's Angle: comparison to uninjured side, difference of more than 5degrees is unacceptable Anterior Humeral Line Type III fracture: Increased swelling and soft tissue injury Proper neurovascular and compament assessment Closed reduction and percutaneous pinning is the management of choice, 2 pins may achieve stability Neurologic Injury: 5-19% of supracondylar farctures More in type III supracondylar fractures Median nerve 52% (especially posteromedial displacement) Radial nerve: 28% Most are neuropraxic injuries Motor Recovery may take 7-12 weeks Sensory recovery may take nearly 6 months
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Ans- (Ulcerative lesion in the tonsil) (202-D) (87-LT)Ulcerative gingivitis - is a highly infectious and ulcerative lesion of the tonsils.It was common during the first world war, being called Trench mouth of Vincent's angina .
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b. Marasmus(Ref: Nelson's 20/e p 295-306> Ghai 8/e p 96-107)Clinical findingMarasmusEdemaAbsentActivityActiveAppetiteGood, VoraciousLiver enlargementAbsentMortalityLess than KwashiorkorRecoveryRecover earlySkin & hair changesLess common
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Ans. is 'a' small cell Ca of lung Small cell Ca of lung causes SIADH due to ectopic secretion of ADH.SyndromeSIADHChiefly associated withSmall cell lung Ca*Head & Neck cancer*Cushing's syndromeSmall cell lung Ca*Carcinoid Tumour*Hypercalcemia of malignancyNon-small cell lung Ca* (Squamous)Breast Cell*'Renal Ca Ca*Myeloma*Bladder CaHead & Neck CaAcromegalyCarcinoid tumors*Small cell Lung CA*pancreatic Islet tumourGynecomastiaTesticular Ca*Lung Ca*Carcinoid tumour of lung and GIT.Non islet tumour hypoglycemia* Sarcomas*
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Ans. is 'a' i.e., Bone
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Cervical cancer is the most common genital tract malignancy in females in India Predisposing factors: Young age at first intercourse Multiple sexual paners Delivery of first baby before the age of 20yrs Multiparity with poor bih spacing between pregnancies Poor socio-economic status Sexually transmitted diseases and HIV Reference :Textbook of Gynaecology; Sheila balakrishnan; 2nd edition; Pg no: 256
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(b) Fracture zygoma(Ref. Scott Brown, 8th ed., Vol 1; 1196)Enophthalmos can be present in fracture zygoma or blow out fracture of orbit.Fracture maxilla, i.e. Le Fort fracture are caused by high velocity injuries.Fracture nasal bone class 3, i.e. including ethmoid are also caused by high velocity injuries and will cause predominantly nasal manifestations which are not mentioned.
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Sclerosing osteomyelitis of Garre typically develops in the jaw and is associated with an extensive new bone formation that obscures much of the underlying osseous structure.
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Anterior interosseous aery pierces the interosseous membrane at the upper border of pronator quadratus to enter the extensor compament. Posterior interosseous aery passes through a gap above the interosseous membrane to the back of forearm . Anterior interosseous nerve is the branch of median nerve. Posterior interosseous nerve is the deep terminal branch of radial nerve. B D Chaurasia 7th edition Page no: 112,114
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Answer is D (Post streptococcal glomerulonephritis): While, IgA Nephropathy presents within three days, presentation of poststreptococcal GN is usually delayed to more than 10 days'.
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Medroxy progesterone acetate
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(ECTA) (41 7-Reddy 29th) (2.38, 7.7-Parikh 6th)DNA-FINGER PRINTINGIdentification of person by genetic analysis*** DNA is extacted from the nuclei of white blood cells or of spermatozones or of the hair follicles cells that cling to the roots of hair that have fallen, or been pulled.* DNA finger printing is based on variable number Tandem repeats (VNTR) and short tandom repeats (STR)*** The fragments are separated according to size by gel electrophorasis*** DNA finger printing was founded by A.Jeffrey** (1985)* Currently the most important tool used to make a paternity determination is a blood test called a human leucocyte antigen (HLA) test*** Sample of DNA testing must Contain nucleated cells ig leuocytes, seminal fluid, brain, bone marrow, muscle skin, dental pulp, hair with root sheeth cells, and dried stains.Liquid blood - in case of paternity, maternity disputes, biological relationship-2-5 ml- blood is collected in sterile leakproof preferably screw - capped tubes containing heparin or EDTA as anticoagulant. EDTA extracts metallic ions, prevents clotting inhibiting enzymes in blood or micro organisms which may breakdown DNA during storageThe sample should reach the laboratory within 24 to 48 hours* Visceral samples sends in Normal saline or 20% solution of dimethyl sulphoxide (DMSO) saturated with sodium chloride * Preservative used for toxicological specimen - saturated sodium chloride* Sodium fluoride is used for preservation of - Alcohol* In all cases of poisoning inclusive of carbolic acid but exclusive of other acids saturated solution of common salt should be used* In cases where poisoning by acids is suspected except(i) Carbolic acid (phenol) (ii) Alcohol (iii) Acetic acid (iv) phosphorus (v) paraldehyde, rectified sprit should be used*** Temporary modification or obliteration of ridge pattern may be seen in variety of other conditions such asIncomplets Ridge atrophyRidge alterationIncreased distance between Ridge with preserved pattern* Dermatitis* Eczema* Infantile paralysis* Celiac disease* Acanthosis nigricans* Rickets * Scleroderma* Acromegaly * Dry / atrophic skin * Permanent impairment ot the linger print pattern occours in - leprosy, electric injury and after exposure to radiation**IMPORTANT POINTS1. Uric crystal (Gouty tophus) would be submitted to the pathology laboratoryin Alcohol**2. Preservation of brain is NOT required in - Heavy metal poisoning** (Bone)3. Finger print Bureau was first established in India (Calcutta in 1897)4. In autopsy, preservative used for vitreous is - Fluoride fluoride is added to vitreous as preservative if alcohol estimation is required and also for analysis of cocaine, cyanide , and Co-poisoning5. Virological examination of autopsy specimen - sample freazed or preserved in 80 glycerol in buffered saline6. Brain finger printing - is a technique that measure recognition of familiar stimuli by measuring electrical responses to words, phrases or pictures that are presented on a computer screen.Brain finger printing uses electrical brain responses to detect the presence or absence of information stored in brain 7. Polygraph (lie-detector)- which measures emotion- based physiological signals such as heart rate, sweating and blood pressure1
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Primary hyperparathyroidism is a disease characterized by excessive secretion of parathormone which results in increased osteoclastic activity therby causing bone loss . The bone loss predisoses to microfractures and secondary hemorrhages that elicit an influx of macrophages and an ingrowth of reparative fibrous tissue, creating a mass of reactive tissue known as brown tumor . Ref: Robbins and cotrans 9e Pg 1102
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Pulled elbow or Nursemaid's elbow occurs in children under 4 years old. It is caused by a sudden pull on the extended pronated arm, usually by an adult tugging on a reluctant toddler. The pronated radial head slips paially under the annular ligament and displaces into the radiocapitellar joint. The child suddenly stops using the arm, holding it in a flexed and pronated position. Radiographs show no abnormalities, since positioning for elbow films will often reduce the subluxation. Reduction is achieved by firmly supinating the forearm and flexing the elbow while pressing down on the radial head. Often, a "click" is felt when reduction is achieved. Soon after reduction the child becomes less apprehensive and gradually resumes use of the arm. Ref: Srinivasan R.C., Tolhurst S., Vanderhave K.L. (2010). Chapter 40. Ohopedic Surgery. In G.M. Dohey (Ed), CURRENT Diagnosis & Treatment: Surgery, 13e.
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KROLL → “MICROABRASION technique“18% HCl.
Indication of microabrasion:
Fluorosis stains/any stains–limited to depth, not more than 0.2 to 0.3 mm.
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Non-canalisation of nasolacrimal duct
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Ans. is 'c' i.e., HbF* Adult haemoglobin is made up of a2b2* Foetal haemoglobin is made up of a2g2* Adult haemoglobin undergoes denaturation in the presence of alkali to form alkaline hematin. Alkaline hematin is insoluble and precipitates.* On the contrary foetal haemoglobin is resistant to alkali denaturation.* This is the basis of estimation of foetal haemoglobin, wherein HbF is quantitated by measuring the hemoglobin concentration before and after denaturation.* It is also the basis of alkali denaturation test or Apt test or Apt - Downey test used to differentiate foetal blood from maternal blood in a new born stool or vomitus.* After treatment with alkali, foetal hemoglobin will appear as a pinkish colour under the microscope while the adult hemoglobin will appear as a yellow-brownish colour.* A positive result is when pink colour is observed and is diagnosed as foetal bleeding.* A negative result is when yellow brownish colour is observed and is diagnosed as the neonatal swallowing of maternal blood.
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Calories are calculated by catabolism of glucose (not proteins) Glucose: Amount of glucose in 20% glucose in 3000 ml of solution: 3000*20/100 = 600 gms. 1 gm glucose on catabolism produces: 4.2 KCal. 600 gms of glucose would produce: 600*4.2 = 2520 KCal. Protein: Percentage of protein in fluid: 4.25% Percentage of protein in 3000ml of fluid: 3000*4.25/100= 127.5 gms. Calories required for the patient: 40*65 = 2600 KCal Proteins required for the patient: 2*65 = 130 gms. Required amount Supplied by solution Calories 2600 KCal 2520KCal Proteins 130 gms 127.5 gm Ref: Sabiston 20th edition Pgno: 119
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Ans. is 'a' i.e., Convex Presbvopia Presbyopia is a vision condition in which the crystalline lens of eye loses its flexibility, which make it difficult to focus on the objects closer to the eye. Presbyopia is not an error of refraction but a condition of physiological insufficiency of accommodation leading to a progressive fall in near vision. Presbyopia is an age related problem, therefore also called eye sight of old age. Symptoms are usually seen after 40 years of age. Presbyopia is not a disease, rather a natural pa of the aging process of the eye. The treatment of presbyopia is the prescription of appropriate convex glasses for near work.
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Ans. is 'c' i.e., Capsular hyaluronic acid
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Given Abd X-ray - Coffee bean sign / Omega sign / Bent inner tube | Sigmoid volvulus TREATMENT:- Colonoscopic detorsion After 3 days sigmoid colectomy Ischemia / strangulation / perforation - Emergency condition | Immediate colonic resection
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(4 months) (43-Dutta 6th) (2154-Nelson 17th)* At 16th week (4 month) lanugo (downy thin colourless hairs) appears but near term almost completely disappears.The homy layer of epidermis is absent before 20th week.
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Milk contains calcium which Inhibits absorption of Iron by binding to Intestinal DMT-2 (Divalent Metal transpoer-2). Hence, iron tablets should never be taken with milk. Components impeding/ inhibiting iron absorption are: Phytates Tannates Oxalates Calcium Tetracycline. Vitamin C (ascorbic acid) is a facilitator of iron absorption. Diseases like celiac disease, tropical sprue interferes with iron absorption.
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This a case of phase II block, caused by a high dose of succinylcholine.
"After administration of 7-10 mg/kg or 30-60 minutes of exposure to succinylcholine, non-deplarizing dual or phase II block occurs".
— Millers
Option a requires specific mention here because prolonged paralysis with succinylcholine administration may also occur in pseudocholinesterase deficiency. But, this is due to the phase II block.
So, Sch can cause phase II block in two conditions:-
When Sch is administered in high doses
Patients with atypical or deficient pseudocholinesterase. It these patients it occurs at usual doses as usual amount of Sch is not metabolized.
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In the olfactory bulbs, the axons of the olfactory sensory neurons contact the primary dendrites of the mitral cells and tufted cells to form anatomically discrete synaptic units called olfactory glomeruli. The olfactory bulbs also contain periglomerular cells, which are inhibitory neurons connecting one glomerulus to another, and granule cells, which have no axons and make reciprocal synapses with the lateral dendrites of the mitral and tufted cells.
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Ref: Robbins Pathologic Basis of Disease, 8th: editionExplanation:HASHIMOTO THYROIDITISMost common cause of hypothyroidism in areas of the world where iodine levels are sufficient. Gradual thyroid failure due to autoimmune destruction of the thyroid gland.Common age group (45 - 65)Female predominance (10: 1 to 20: 1)Can occur in children and is a major cause of nonendemic goiter.It is associated with polymorphisms in multiple immune regulation-associated genes, the most significant of which is the linkage to cytotoxic T lymphocyte--associated antigen-4 (CTLA4) polymorphisms & Also functional polymorphism in protein tyrosine phosphatase-22 fPTPN22J gene that encodes a lymphoid tyrosine phosphatase, which is also thought to inhibit T- cell function.Susceptibility to other autoimmune diseases, such as type 1 diabetes has been associated w ith polymorphisms in both Cl'LA 4 and PTPN22.PathogenesisHashimoto thyroiditis is caused by a breakdown in self-tolerance to thyroid auto-antigens.presence of circulating autoantibodies against thyroglobulin and thyroid peroxidaseInduction of thyroid autoimmunity is accompanied by a progressive depletion of thyrocytes by apoptosis and replacement of the thyroid parenchyma by mononuclear cell infiltration and fibrosis.MorphologyDiffusely enlargedThe capsule is intact, and the gland is well demarcated from adjacent structures. .Microscopic examination reveals extensive infiltration of the parenchyma by a mononuclear inflammatory infiltrate containing small lymphocytes, plasma cells, and w ell-developed germinal centersThe thyroid follicles are atrophic and are lined in many areas by epithelial cells distinguished by the presence of abundant eosinophilic, granular cytoplasm, termed Hurthle cells. This is a metaplastic response of the normally low cuboidal follicular epithelium to ongoing injury.In fine-needle aspiration biopsy samples, the presence of Hurthle cells in conjunction with a heterogeneous population of lymphocytes is characteristic of Hashimoto thyroiditis.In "classic'" Hashimoto thyroiditis, interstitial connective tissue is increased and may be abundant.A fibrous variant is characterized by severe thyroid follicular atrophy and dense "keloid - like*' fibrosis, broad bands of acellular collagen encompassing residual thyroid tissue.Unlike Reidel thyroiditis, the fibrosis does not extend beyond the capsule of the gland. The remnant thyroid parenchyma demonstrates features of chronic lymphocytic thyroiditis.Clinical CoursePainless enlargement of the thyroid associated with some degree of hypothyroidismThe enlargement of the gland is usually symmetric and diffuseIn some cases, however, it may be preceded by transient thyrotoxicosis caused by disruption of thyroid follicles, with secondary release of thyroid hormones ("hashi toxicosis"). During this phase, free T4 and T3 levels are elevated, TSH is diminished, and radioactive iodine uptake is decreased.As hypothyroidism supervenes. T4 and T3 levels fall, accompanied b\ a compensatory increase in TSH.Increased risk for developing other autoimmune diseases- Endocrine (type 1 diabetes, autoimmune adrenalitis)- Nonendocrine (systemic lupus erythematosus. myasthenia gravis, and Sjogren syndrome)Increased risk for the development of B-eell non-Hodgkin lymphomas, especially marginal zone lymphomas of mucosa-associated lymphoid tissuesThe relationship between Hashimoto disease and thyroid epithelial cancers remains controversial, with some morphologic and molecular studies suggesting a predisposition to papillary carcinomas.
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Ans. (b) Methenamine silver Ref. Ananthanarayan 8/e p 601; DR Arora 3/e 656 Stains for funp. Gomori methenamine silver (GMS) (Better contrast) Gridley fungus (GF) Periodic acid Schiff (PAS) Giemsa Alcian blue Meyer's mucicarmine Out of these GMS is the best stain for fungi. For studying tissue response secondary to fungal infection, Haematoxylin and eosin (H&E) is best. Remember Commonly used culture media for fungus are: - Sabouraud's glucose agar - Corn meal agar - Czapek - Dox medium
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Ref BDC volume 3,6th edition pg 208NERVE SUPPLY:The superior oblique is supplied by trochlear nerveThe lateral rectus is supplied by abducent nerveThe superior rectus, medial rectus, inferior rectus and inferior oblique is supplied by occulomotor nerve
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Epinephrine markedly stimulates glycogen breakdown in muscle and, to a lesser extent, in the liver. The liver is more responsive to glucagon, a polypeptide hormone that is secreted by the a cells of the pancreas when the blood-sugar level is low Ref: guyton and hall textbook of medical physiology 12 edition page number:419,420,421
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A i.e. Fine touchProprioceptive information is transmitted up the spinal cord in the dorsal columnQ. Majority of the proprioceptive input goes to the cerebellum but some passes to the coex also (conscious Propriocetion). There is some evidence that propioceptive information passes to consciousness in the antero-lateral columns of the spinal cord. Conscious awareness of the position of various pas of body in space depends in pa on impulses from sense organ in and around the joints. The organs involved are slowly adapting spray endings, structure that resemble golgi tendon organs, & probably pacinian corpuscles in the syno & ligament.Dorsal column/medial lemniscal system: Fibers mediating fine touch & proprioception ascend in the dorsal column to the medulla, where they synapse in gracile & cuneate nuclei. The second order neurons from the gracile & cuneate nuclei cross the midline & ascend in the medial lemniscus to end in the thalamus. This ascending system is called dorsal column.Sensation carried byDorsal Column-Medial Lemniscal system Anterolateral Spinothalamic Tract- Fine (light) touchQ (requiring a high degree of- Sensations that signal movement against the skin- Two point discrimination (discriminative touch,- Joint-position senseQ fine gradations of intensity) Fine (light) pressureQlocalization of stimulus or requiring transmission of Phasic sensations such as vibration (pallesthesia) tactile discrimination or discrete localization) - Crude pressureQ Spinothalamic Tract Anterior (Ventral) localizing ability on the surface of body) Crude touchQ- - TemperatureItch, Tickle/ Thermal sensation (both warm & cold)Proprioceptionc2 (static position sense i.e. conscious * Sexual sensations also travel in anterolateral perception of orientation of different pas of body system.with respect to one another; and rate of movement sense /kinesthesia or dynamic proprioception).
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Renal tract anomalies coexist with Mullerian duct anomalies. Hence it is every case of congenital malformation of genital tract, it is wise to perform IVU to exclude urinary tract abnormalities.
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Lets have a look at each option:
Option a: Stenosis of external os would result in hematometra, i.e. uterus would be large and non functioning (hence ruled out).
Option c: Partial agenesis of vagina
In parital agenesis of vagina a segment of vagina may be atretic in the upper-third. It is often associated with hypoplasia or even absence of cervix. Uterus may be normal and functioning or malformed.
Option d: Complete absence of vagina is almost always associated with absence of uterus.
Hence by exclusion our answer is b i.e. uterine synechiae (Asherman syndrome)
In Uterine syechiae–the uterus does not function normally due to presence of adhesions size of uterus is normal.
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viral hemirrhagic fever caused by 2 families-Arenavirus and Filovirus.Filovirus invludes marburg anf ebola virus. REF:ANANTHANARAYAN AND PANIKER'S TEXTBOOK OF MICROBIOLOGY 9TH EDITION PAGE NO:558
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(B) 2 mg/kg > The dose of Propofol is 2-2.5 mg/kg for induction.> The lower dose should be used in the elderly.> The effective blood concentration for anaesthesia (ED 90 - the dose at which the effect is seen for 90% of patients) is 3.4 mg/mL when used with 67% nitrous oxide.> Sedation may be produced with a 0.2 mg/kg bolus dose intravenously or an infusion of 2 mg/kg/h, which produces a blood concentration of about 2 mg/mL.> Co-induction with either an opioid or midazolam enables the induction dose and initial target level for TCI to be reduced.> Myoclonic movements are common on induction, especially with slow injection. Emergence is more rapid than with thiopentc , with less 'hangover'.
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ganong's review of medical physiology 24th edition . *mesencephalic periaqueductal gray(PAG) is pa of descending pathway that modulates pain transmission by inhibition of primary afferent transmissiion in the dorsal horn of spinalcord *PAG neurons project directly to and activate two groups of neurons in brainstem:neurons in nucleus raphe magnus and in rostral ventromedial medulla . *neurons from both region project to dorsal horn and inhibit dorsal horn neuron activity.
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The nohern blot is used to demonstrate specific RNA. The total RNA is isolated from the cell, electrophoresed and then blotted to a membrane. This is then probed with radioactive cDNA. There will be RNA-DNA hybridization, if the specific RNA is present in the cell. For DNA analysis southern blot technique is used, western blot analysis is used to identify proteins.Also Know:A fouh hybridization technique, the Southwesternblot, examines protein-DNA interactions. In this method, proteins are separated by electrophoresis, blotted to a membrane, renatured, and analyzed for an interaction with a paicular sequence by incubation with a specific labeled nucleic acid probe. Ref: Weil P. (2011). Chapter 39. Molecular Genetics, Recombinant DNA, & Genomic Technology. In D.A. Bender, K.M. Botham, P.A. Weil, P.J. Kennelly, R.K. Murray, V.W. Rodwell (Eds), Harper's Illustrated Biochemistry, 29e.
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(A) B cell immunodeficiency # DiGeorge syndrome or 22q11.2 deletion syndrome, which has several presentations including DiGeorge syndrome (DGS), DiGeorge anomaly, velo-cardio-facial syndrome, Shprintzen syndrome, conotruncal anomaly face syndrome, Strong syndrome, congenital thymic aplasia, and thymic hypoplasia, is a syndrome caused by the deletion of a small piece of chromosome 22.> Salient features Mnemonic CATCH-22 of DiGeorge's syndrome, with the chromosomal abnormality is found on the 22 chromosome: Cardiac Abnormality (especially tetralogy of Fallot) Abnormal facies Thymic aplasia Cleft palate Hypocalcemia/Hypoparathyroidism.
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.Gram -ve septicaemia is common in acute abdomen like peritonitis, abscess, urinary infections, biliary infections, postoperative sepsis. It is commonly seen in malnutrition, old age, diabetics, immunosuppressed people. Diabetic acute abdomen -Patient with diabetes mellitus may present as acute abdomen. Free fluid in the flank may not be present. Patient may be ketotic also.the investigation of choice in a case of acute abdomen is ultrasound. ref:SRB&;s manual of surgery,ed 3,pg no 502
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Ans. (a) Phrenic nerveRef: Internet sourcesCauses of Diaphragm paralysis:* Neurological causes:# Phrenic nerve palsy# Motor neuron disease# Neuropathies# Myopathies* Viral infections* Tumors* Trauma* Surgical Operations
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Ans. b. Otoacoustic Emissions The screening investigation of high-risk neonates in ICU for suspected hearing loss is otoacoustic emissions. Uses of OAE Screening test of hearing in neonatesQ Help to differentiate between cochlear and retrocochlear lesionsQ Used to diagnose retrocochlear pathologies especially auditory neuropathyQ
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Haematoma (not hamartoma) causes lung cavitation.
Pulmonary infarct, squamous cell carcinoma of lung, RA & Caplan's syndrome can also cause lung cavitation.
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When a toxic amount of acetaminophen is ingested, the first two processes are overwhelmed and more acetaminophen is metabolized by the cytochrome P450 system to a hepatotoxic metabolite (N-acetyl-p-benzoquinoneimine, NAPQI). In therapeutic acetaminophen ingestions, the liver generates glutathione, which detoxifies NAPQI. However, in overdose, the glutathione is depleted, leaving the metabolite to produce toxicity. The antidote for acetaminophen toxicity, N-acetylcysteine (NAC), initially works as a glutathione precursor and glutathione substitute and assists with sulfation.
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B i.e. NinhydrinAmino acids can be detected and quantified by reaction with ninhydrin after seperation of amino acid from mixtures. The test requires intact peptide bondsQ.
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Answer is D (Aoic Dissection) Aoic Dissection is not a known cause for digital clubbing: Digital clubbing results from long standing conditions that take months to develop. It is not associated with acute event like aoic dissection Cardiovascular causes of Digital clubbing (Ultra medicine (2005)/285) Subacute Bacterial Endocarditis(SBE) Cyanotic congenital Hea Disease - Tetralogy of Fallot (TOF) - Transposition of Great vessels (TGV) - Total Anomolous pulmonary venous circulation (TAPVC) - Ebstein's Anomaly - Tricuspid Atresia Atrial Myxoma Aerio venous malformations (Brochial aeriovenous fistula) Axillary aery Aneurysms Clubbing is a feature of Subacute Bacterial Endocarditis (SBE) and is not seen in Acute Bacterial Endocarditis Acute endocarditis is a fitIminant event while clubbing takes months to develop. Acute bacterial endocarditis is not associated with clubbing.
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Infectious mononucleosis is a benign lymphoproliferative disorder caused by infection with the Epstein-Barr virus (EBV). It typically occurs in young adults and presents with systemic symptoms, lymphadenopathy, and pharyngitis. Hepatosplenomegaly may be present. Peripheral blood shows an absolute lymphocytosis, and many lymphocytes are atypical with irregular nuclei and abundant basophilic vacuolated cytoplasm. These represent CD8+ T killer cells induced by EBV-transformed B lymphocytes. These atypical lymphocytes are usually adequate for diagnosis, along with a positive heterophil or monospot test (increased sheep red cell agglutinin). Administration of ampicillin for a mistaken diagnosis of streptococcal pharyngitis results in a rash in many patients. Reference: Robbins & Cotran Pathologic Basis of Disease, 9edition.
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Occurs due to the retina being pushed away by a neoplasm or accumulation of fluid beneath the retina following inflammatory or vascular lesions. Etiology: Systemic diseases- toxaemia of pregnancy, retinal HTN, blood dyscrasias. Ocular diseases- scleritis, central serous retinopathy, orbital cellulitis, retinoblastoma, malignant melanoma of choroid. Ref: Khurana 5th edition , page no 298
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Hypoventilation always causes both hypoxemia and hypercapnia. If the hypoventilation syndrome is caused exclusively by impaired respiratory drive (e.g., drug overdose), then the alveolar-arterial PaO2 gradient remains normal. Often, hypoventilation results from more than one disorder in the respiratory system (e.g., COPD plus metabolic alkalosis secondary to diuretics and glucocorticoids).
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In a DNA double helix, two polynucleotide strands come together through complementary pairing of the bases, which occurs by hydrogen bonding.Each base forms hydrogen bonds readily to only one other -- A to T and C to G -- so that the identity of the base on one strand dictates what base must face it on the opposing strand.Thus the entire nucleotide sequence of each strand is complementary to that of the other, and when separated, each may act as a template with which to replicate the other.
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Rickets is characterized by the continued formation of the collagen matrix of bone, but incomplete mineralization results in soft, pliable bones.
In osteomalacia, demineralization of pre-existing bones increases their susceptibility to fracture. Insufficient exposure to daylight and/or deficiencies in vitamin D consumption occur predominantly in infants and the elderly.
Vitamin D deficiency is more common in the northern latitudes, because less vitamin D synthesis occurs in the skin as a result of reduced exposure to ultraviolet light.
Loss-of-function mutations in the vitamin D receptor result in hereditary vitamin D-deficient rickets.
Vitamin D deficient rickets leads to epiphyseal swelling with beaded ribs known as Rachitic rosary.
Key Concept:
Vitamin D deficient rickets leads to epiphyseal swelling with beaded ribs known as Rachitic rosary.
Ref: Lippincott’s illustrated reviews for biochemistry, 7th edition.
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Queckenstedt maneuver IJV: Venous outflow Brain | ICP: Patent subarachnoid space i.e. no spinal block present If presence of sagittal vein thrombosis/spinal block then this maneuver will not increase in the pressure of manometer reading because entire circuit is blocked. Queckenstedt or Tobey- Ayer test: Compression of I.J.V. - rapid rise of C.S.F. pressure (50-100 mm water - rapid fall on release of compression. In L.S.T. no rise/ rise by only 10-20 mm water. Low sensitivity and specificity
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Ans. is 'c' i.e., Epididymis Spermatozoa leaving the testis (seminiferous ubules) are not fully mobile. They continue their maturation and acquire their mobility during their passage through epididymis. From epididymis they come to vas deference, distal end of which also receives the secretions of seminal vesicle, and continues as the ejeculatory duct. The ejeculatory duct joins the prostatic urethra. Once ejeculated into the the female, vaginal secretions improve the motility and feilizing ability of sperms. Fuher exposure to secretions of female genital tract (in uterus and/or fallopian tube) fuher improves the mobility and feilizing ability of the sperms. The beneficial effects of stay in the female genital tract are collectively called capacitation, from the isthmus, capacitated sperms move rapidly to the ampullas, where feilization takes place.
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