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The prophylactic blood level of Lithium is 0.5 - 0.8 mEq/L.
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(C) FSH # Pituitary gland divided into anterior and posterior:> From Anterior lobe: TSH, ACTH, FSH, LH, GH, Prolactin, B-Lipotropin> From Intermediate lobe: Melanocyte stimulating hormone> From Posterior Lobe: Vasopressin, Oxytocin
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During this procedure, areas which can be palpated are: the bulb of the penis, the urogeital diaphram-, the annorectal ring, and other nearby anatomical landmarks. However, structures like the ureter(the two tubes that run from each kidney to the urinary bladder), and the urethra (which, in a male, is divided into three pas, and is inside the penis) cannot be palpated. Ref - researchgate.net
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Ans: c (CMV) Ref: Harrison, 16th ed, p. 1119Most common ocular infection in HIV - CMV retinitisMost common ocular lesion in HIV - HIV microvasculopathyMost common ocular neoplasm in HIV - Kaposi sarcomaEarliest/ most common abnormal/ most consistent finding in HIV - cotton wool spots
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Cirsoid aneurysms are rare aerio-venous fistulas of the scalp. They are usually congenital in aetiology. In 90% of the patients, the superficial temporal aery is the main supply to the fistula ref - pubmed.com <a href=" <p>
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It is a secondary mode of prevention. Primary prevention:To avoid occurrence of disease. Secondary prevention:To diagnose and treat existent disease in early stages before it causes significant morbidity Teiary prevention:To reduce negative impact of extant disease by restoring function and reducing disease-related complications. Quaternary prevention:To avoid results of unnecessary or excessive interventions in the health system
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A reduction in the number of granulocytes in blood is known as neutropenia or, when severe, agranulocytosis.
Neutropenic persons are susceptible to severe, potentially fatal bacterial and fungal infections.
The risk of infection rises sharply as the neutrophil count falls below 500 cells/μL.
Kumar V, Abbas AK, Aster JC. Robbins basic pathology. Elsevier Health Sciences; 2017. Page 459
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Bell's palsy
■ The most common form of facial paralysis is Bells palsy. Bell’s palsy is idiopathic palsy of facial nerve. Clinical Manifestations
■ The onset of Bell’s palsy is fairly abrupt, maximal weakness being attained by 48 h as a general rule.
■ Pain behind the ear may precede the paralysis for a day or two.
■ Taste sensation may be lost unilaterally, and hyperacusis may be present.
■ In some cases there is mild cerebrospinal fluid lymphocytosis.
■ MRI may reveal swelling and uniform enhancement of the geniculate ganglion and facial nerve, and, in some cases, entrapment of the swollen nerve in the temporal bone.
■ Approximately 80% of patients recover within a few weeks or months.
■ The presence of incomplete paralysis in the first week is the most favorable prognostic sign. Pathophysiology
■ Bell’s palsy is associated with the presence of herpes simplex virus type 1 DNA in endoneurial fluid and posterior auricular muscle,
suggesting that a reactivation of this virus in the geniculate ganglion may be responsible. However, a causal role for herpes simplex virus in Bell’s palsy is unproven.
Differential Diagnosis
■ Tumors that invade the temporal bone (carotid body, cholesteatoma, dermoid).
■ The Ramsay Hunt syndrome, presumably due to herpes zoster of the geniculate ganglion, consists of a severe facial palsy associated with a vesicular eruption in the pharynx,
external auditory canal, and other parts of the cranial integument; often the eighth cranial nerve is affected as well.
■ Acoustic neuromas frequently involve the facial nerve by local compression.
■ Infarcts, demyelinating lesions of multiple sclerosis, and tumors are the common pontine lesions that interrupt the facial nerve fibers; other signs of brainstem involvement are usually present.
■ Bilateral facial paralysis (facial diplegia) occurs in Guillain-Barre' syndrome and also in a form of sarcoidosis known as uveoparotid fever (Heerfordt syndrome).
■ Lyme disease is a frequent cause of facial palsies in endemic areas.
■ The rare Melkersson-Rosenthal syndrome consists of a triad of recurrent facial paralysis, recurrent—and eventually permanent—facial (particularly labial) edema, and less constantly,
plication of the tongue;
■ Leprosy frequently involves the facial nerve, and facial neuropathy may also occur in diabetes mellitus.
■ All these forms of nuclear or peripheral facial palsy must be distinguished from the supranuclear type.
■ In the latter, the frontalis and orbicularis oculi muscles are involved less than those of the lower part of the face, since the upper facial muscles are innervated by corticobulbar pathways from both motor cortices, whereas the lower facial muscles are innervated only by the opposite hemisphere. Treatment
■ Symptomatic measures include use of paper tape to depress the upper eyelid during sleep and prevent corneal drying, and Massage of the weakened muscles.
■ A course of glucocorticoids, given as prednisone 60 to 80 mg daily during the first 5 days and then tapered over the next 5 days,
appears to shorten the recovery period and modestly improve the functional outcome.
■ In one double-blind study, patients treated within 3 days of onset with both prednisone and acyclovir (400 mg five times daily for 10 days) had a better outcome than patients treated with
prednisone alone.
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Harshmohan textbook of pathology 7th edition. Familial retinoblastoma comprises 40% of cases and may be bilateral . In this cases all somatic cells inherit one mutant RBgene from a carrier parent. Later during life the other mutational event of 2nd allele affecting the somatic cells occurs. This forms the basis of two hot hypothesis given by Knudson in 1971..
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Ans. is 'b' i.e. Sheets of atypical plasma cells Age of the patient along with cystic, circumscribed punched out X-ray appearance suggests multiple myelomaMultiple myeloma most often presents as multifocal destructive bone tumours composed of plasma cells throughout the skeletal system.The bone lesions appear radiographically as punched out defects, usually 1-4 cm in diameter and grossly consists of gelatinous soft red tumour masses.Microscopic examination of the marrow reveals an increased number of plasma cells which usually constitute more than 30% of marrow cellularityThe plasma cells can infiltrate the marrow diffusely or be present in sheet like masses that completely replace normal elements.Cytologic ally, the cells may be indistinguishable from normal plasma cells, but they usually show abnormal chromatin such as less clumping of nuclear chromatin, large nucleoli, lack of perinuclear clear zone, lighter blue cytoplasm and varying degrees of anaplasia.The dissociation of nuclear and cytoplasmic maturation is a distinctive feature of myeloma cells.
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Monitoring of Neuromuscular block Done by nerve stimulator Different stimulation - Single Twitch Tetanus Train of four stimulus (most common) Double burst stimulation Post - tetanic count Nerves used - ulnar nerve (most common) (Adductor pollicis muscle ) Facial nerve Posterior tibial nerve External peroneal nerve Response of stimulation
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Teriparatide stimulates osteobalsts and hence contraindicated in Osteosarcoma and Paget's disease.
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The most common clinical feature is headaches due to paroxysmal hypeension. The mnemonic to remember triad for suspecting pheochromocytoma is PHD- Palpitations, Hypeension,Hypercalcemia Diaphoresis. Note: Remember it is a mnemonic and does not imply that most common feature is palpitations.
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Ans. Judge
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Ans. (a) AscitesRef: Bailey & Love 26th ed. / 980* A peritoneo-venous shunt (also called Denver shunt) is a shunt which drains peritoneal fluid from the peritoneum into veins, usually the internal jugular vein or the superiorvena cava.* It is sometimes used in patients with refractory ascites.* It is a long tube with a non-return valve running subcutaneously from the peritoneum to the internal jugular vein in the neck, which flows ascitic fluid to pass directly into the systemic circulation.
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Azithromycin This new azalide congener of erythromycin has an expanded spectrum, improved pharmacokinetics, better tolerability and drug interaction profiles. It is more active than other macrolides against H. influenzae, but less active against gram-positive cocci. High activity is exeed on respiratory pathogens-Mycoplasma, Chlamydia pneumoniae, Legionella, Moraxella and on others like Campylobacter, Ch. trachomatis,H. ducreyi, Calymm, granulomatis, N. gonorrhoea However, it is not active against erythromycin.resistant bacteria. Penicillinase producing Staph aureus are inhibited but not MRSA. Good activity is noted against MAC. Because of higher efficacy, better gastric tolerance and convenient once a day dosing azithromycin is now preferred over erythromycin as first choice drug for infections such as: (a) Legionnaires&; pneumonia: 500 mg OD oral/ i.v. for 2 weeks. Erythromycin or a FQ are the alternatives. (b) Chlamydia trachomatis: nonspecific urethritis and genital infections in both men and women- 1 g single dose is curative, while 3 weekly doses are required for lymphogranuloma venereum. It is also the drug of choice for chlamydia! pneumonia and is being preferred over tetracycline for trachoma in the eye. (c). Donovanosis caused by Calymmatobacterium granulomatis: 500 mg OD for 7 days or 1.0 g weekly for 4 weeks is as effective as doxycycline. (d) Chancroid and PPNG urethritis: single 1 .0 g dose is highly curative. The other indications of azithromycin are pharyngitis, tonsillitis, sinusitis, otitis media, pneumonias, acute exacerbations of chronic bronchitis, streptococcal and some staphylococcal skin and soft tissue infections. In combination with at least one other drug it is effective in the prophylaxis and treatment of MAC in AIDS patients. Other potential uses are in typhoid, toxoplasmosis and malaria. ESSENTIALS OF MEDICAL PHARMACOLOGY K.D.TRIPATHI SIXTH EDITION PAGE NO:730,731
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Ans. (C) (Rifampicin 450 mg + Clofazimine 150 mg) once monthly + Dapsone 50 mg daily + Clofazimine 50 mg alternate day(Ref: National Leprosy Eradication programme)This is a case of multibacillary leprosy. The multi drug therapy for in adults (15 years or above) is Rifampicin 600 mg plus clofazimine 300 mg once monthly and Dapsone 100 mg plus Clofazimine 50 mg daily for 12 monthsAs the patient is child, the doses used are less, rest of the treatment is similarRifampicin 450 mg and Clofazimine 150 mg monthly and dapsone 50 mg daily. As clofazimine less than 50 mg tablet is not available, so 50 mg is given on alternate day.
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Ans. (d) They may be associated with InsulinomasRef: Sabiston 20th edition Page 954* Zollinger Ellison syndrome is a manifestation of Gastrinoma* Secretin Stimulation test - is used a provocative test in cases of borderline elevation of Gastrin* ZES is associated with unusual location of ulcers like in Jejunum.
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Ans. a. Ascending LOH
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Abundance of acidfast bacilli rules out indeterminate and Tuberculoid leprosy.
The choice is between lepromatous leprosy and borderline lepromatous leprosy.
Hypoaesthesia points towards borderline lepromatous as sensation are not lost in lepromatous leprosy.
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Ans. A: Making endometrium unreceptive There are 2 categories of intrauterine contraceptive devices: Ine and copper -based devices, and Hormonally-based devices that work by releasing a progestogen. Most non-hormonal IUDs have a plastic T-shaped frame that is wound around with pure electrolytic copper wire and/or has copper collars (sleeves). All copper-containing IUDs have a number as pa of their name. This is the surface area of copper (in square millimeters) the IUD provides. Hormonal intra-uterine devices Hormonal uterine devices do not increase bleeding as ine and copper-containing IUDs do. They alter the cervical mucus, makes it thick which prevents penetration of sperm and causes atrophy of the endometrium .Rather, they reduce menstrual bleeding or prevent menstruation altogether, and can be used as a treatment for menorrhagia. Contraindications of IUCD Postpaum between 48 hours and 4 weeks (increased IUD expulsion rate with delayed postpaum inseion) Suspected pregnancy Distoions of the uterine cavity by fibroids or anatomical abnormalities Current PID IUDs may safely be inseed at any time during the menstrual cycle as long as it is reasonably ceain the woman is not pregnant. Inseion may be more comfoable if done midcycle, when the cervix is naturally dilated. Side Effects and Complications The inseion process carries a small, transient increased risk of PID in the first 20 days following inseion. After IUD inseion, Menstrual periods are often heavier, more painful, or both - especially for the first few months after they are inseed. On average, menstrual blood loss increases by 20-50% after inseion of a copper-T IUD. Increased menstrual discomfo is the most common reason for IUCD removal. Complications include expulsion and uterine perforation. The risk of ectopic pregnancy: pregnancies that do occur during IUD use a higher than expected percentage (3-4%) is ectopic.
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Hyaluronidase is an enzyme that breaks down intracellular cement. It is added to LA to speed both the onset of anesthesia and the area of anesthesia especially in inferior alveolar nerve block.
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Criticalangle for the cornea-air interface is approximately 46 degrees. Total internal reflection prevents direct visualization of ang le in nearly all eyes. Ref khurana 6/e
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The wall of the vagina from the lumen outwards consists firstly of the mucosa of non keratinized stratified squamous epithelium with an underlying lamina propria of connective tissue, secondly a layer of smooth muscle with bundles of circular fibers internal to longitudinal fibers, and thirdly an outer layer of connective tissue called the adventitia. ref - BDC 6e vol2 pg395
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* Extremities are warm to touch and full peripheral pulses. (WARM SHOCK) Option C- No survival advantage for the patients Option D- Already the patient is afebrile, so no point in checking the sensitivity of bacteria to antibiotics. Patient has a condition k/a DISTRIBUTIVE SHOCK Hydrocoisone is given in this case. * Hydrocoisone is not given in Septic shock Always consider adrenal insufficiency in the differential diagnosis of distributive shock, paicularly when no other cause is present or an original cause appears to be under effective treatment, as in this patient. Refractory hypotension suggests adrenal insufficiency, especially with concomitant HIV infection in the face of effective treatment of sepsis. Searching for a second source of infection would be appropriate in an HIV-infected patient.
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Ans. is 'a' i.e., Panic attack * Sudden onset of breathlessness, anxiety, palpitation and feeling of impending doom suggest the diagnosis of panic attack (severe anxiety)* A panic attack has following characteristics: -A. Discrete episode of intense fearB. Abrupt onset (sudden onset)C. Reaches as maximum within few minutes and lasts for some minutes.D. At least four of the following symptoms : - 1) Palpitation 2) Sweating 3) Shortness of breath (Breathlessness) 4) Feeling of choking 5) Chest pain or discomfort (chest constriction) 6) Nausea or abdominal distress 7) Trembling or shaking 8) Dizziness, unsteady, fainting 9) Derealization or depersonalization 10) Fear of losing control 11) Fear of dying (impending doom) 12) Paresthesias 13) Chills or hot flushesE. At least one of the attack is followed by 1 month (or more) of one (or more) of the following ; - a) Persistent concern of future attacks, b) Worry about the consequences of attacks (Heart attack, Stroke) c) Significant change in behavior related to attack.
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Ans. Foreign body retained is the fornix
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In HIV the patient has to visit ICTC (Integrated Counselling and Testing Centre); Where a private counselling session is done. It holds valid for both pre-test and post-test counselling.
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Ans. a (Diarrhea) (Ref. H - 18th/pg. ch. 47)ANION GAP# The anion gap may be calculated by using (sodium + potassium) - (bicarbonate + chloride)# Normal =10-12 mmol/L# Causes of a normal anion gap or hyperchloraemic metabolic acidosis- Gastrointestinal bicarbonate loss: diarrhea, ureterosigmoidostomy, fistula- Renal tubular acidosis- Drugs: e.g., acetazolamide- Ammonium chloride injection- Addison's disease# Causes of a raised anion gap metabolic acidosis- Lactate: shock, hypoxia- Ketones: diabetic ketoacidosis, alcohol- Urate: renal failure- Acid poisoning: salicylates, methanolAlso know:Ethylene glycol, methanol, and isopropyl alcohol - all cause an elevated osmolal gap, but only the first two cause a high- AG acidosis.
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Mineralocoicoid excess increases net acid excretion and may result in metabolic alkalosis, which may be worsened by associated K+ deficiency. ECFV expansion from salt retention causes hypeension. The kaliuresis persists because of mineralocoicoid excess and distal Na+ absorption causing enhanced K+ excretion, continued K+ depletion with polydipsia, inability to concentrate the urine, and polyuria.
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Ans. is 'b' i.e., A pateint who returns sputum postive which was curved by previous treatment Some definitions of tuberculosis cases and treatment Case of tuberculosis : A patient in whom tuberculosis has been confirmed by bacteriology or diagnosed by a clinician. Sputum smear examination - Laboratory technique to screen sputum for tuberculosis, where acid fast bacilli (AFB) are stained red by the Ziehl Neelsen method, and then identified and counted. using microscopy. Smear positive tuberculosis - At least one initial sputum smears positive for AFB or one AFB positive. Smear negative tuberculosis - At least two negative smears, but tuberculosis suggestive symptoms and X-ray abnormalities or positive culture. Adherence - Person takes appropriate drug regimen for required time (also known as compliance). New case - A patient with sputum positive pulmonary tuberculosis who has never had treatment for tuberculosis or has taken anti - tuberculosis drugs for less than 4 weeks. Relapse - A patient who returns smear positive having previously been treated for tuberculosis and declared cured after the completion of his treatment. Failure case - A patient who was initially smear positive, who began treatment and who remained or became mear positive again at five months or later during the course of treatment. Return after default - A patient who returns sputum smear positive, after having left treatment for at least two months. Transfer in - A patient recorded in another administrative area register and transferred into another area to continue treatment (treatment results should be repoed to the district where the patient was initially registered). Transfer out - A patient who has been transferred to another area register and treatment results are not known. Cured - Initially smear positive patient who completed treatment and had negative smear result on at least two occasions (one at treatment completion). Treatment completed - Initially smear negative patient who received full course of treatment, or smear positive who completed treatment, with negative smear at the end of initial phase, but no or only one negative smear during continuation and none at treatment end. Coho - A group of patients in whom TB has been diagnosed, and who were registered for treatment during a specified time period (e.g. the coho of new smear-positive cases registered in the calender year 2003). This group forms the denominator for calculating treatment outcomes. The sum of the treatment outcomes, plus any case for which no outcome is recorded (eg. still on treatment) should equal the number of cases registered. Case detection rate : - The case detection rate is calculated as the number of notification of new and relapse cases in a year divided by the estimated incidence of such cases in the same year.
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The gastrocolic reflex or gastrocolic response is one of a number of physiological reflexes controlling the motility, or peristalsis, of the gastrointestinal tract. Ref: guyton and hall textbook of medical physiology 12 edition:443,444,445
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IgA nephropathy may occur following an episode of mucus membrane infection of the respiratory or gastrointestinal tract. Genetically susceptible individuals show increased amounts of IgA production following a viral or bacterial infection of the mucous membrane. Circulating IgA containing immune complexes are formed which later are deposited in the mesangium of the glomeruli of the kidney resulting in glomerulopathy. Ref: Diseases of the Kidney & Urinary Tract: Edited by Robe W. Schrier, Volume 1, Page 1544
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46XX chromosomal pattern In a female most common cause of ambiguous sex is congenital adrenal hyperplasia. Intact cases of ambiguity of sex, detected at bih are due to adrenogenital syndrome (congenital adrenal hyperplasia) unless proved otherwise. Congenital adrenal hyperplasia (Very Imp.): It is an Autosomal Recessivedeg disorder (if any couple has had one affected child, subsequent baby has 1 in 4 chance of having the same disability).deg
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Stem memory TSCM cells, like naive cells, are CD45RO-, CCR7+, CD45RA+, CD62L+ (L-selectin), CD27+, CD28+ and IL-7Ra+, but they also express large amounts of CD95, IL-2Rb, CXCR3, and LFA-1, and show numerous functional attributes distinctive of memory cells Reff: www.mayoclinic.com
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Ipra and tiotropium bromide are m3 receptor blockers more selective for bronchial muscle causing bronchial dilatation, so used in bronchial asthma and COPD M3 receptors are present on bronchial smooth muscle Ref: KDT 6th ed pg 113
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The musculocutaneous nerve arises from the lateral cord of the brachial plexus, opposite the lower border of the pectoralis major, its fibers being derived from C5, C6 and C7. In its course through the arm it innervates the coracobrachialis, biceps brachii, and the greater pa of the brachialis.
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Narcolepsy is characterized by bouts of sudden sleep each lasting for 10-30 minutes occurring during the daytime. Age of onset is between 10-20 years.
Accessory symptoms in Narcolepsy are cataplexy, hypnagogic hallucination, sleep paralysis.
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Answer is C (Urinary A/C Ratio in a spot voided sample) The preferred method to establish microalbuminuria is to determine Albuma / Creatinine Ratio (A/C Ratio) in a spot voided urine sample. `The presence of albumin in the urine in the range of microalbuminuria is best determined by a urinary A /C Ratio in a spot voided sample. The A/C ratio correlates closely with 24 hour urine albumin estimation and this measure has the advantage of avoiding in accuracies in urine collection and the unpleasentness of having to store urine during the collection process'- Hypeension Primer' 4th/384
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Volkmann's ischaemia is an ischemic injury to the muscles and nerves of the flexor compament of the forearm. This occurs due to the occlusion of the brachial aery following a supracondylar fracture. The muscles supplied by the anterior interosseous aery are most susceptible to ischemic damage because this aery is an end aery. Most commonly affected muscles are the flexor pollicis longus and flexor digitorum profundus (medial-half). Severe pain will be present over forearm usually over the flexor aspect of the forearm when the fingers are extended passively. Ischemic pain is much severe than the pain due to the fracture. Ref: Essential Ohopaedics by Maheshwari, 3rd edition, Page 83-84.
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(Refer: Ganong's Review of Medical Physiology 24thedition, pg no: 483-484)
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Gartners duct cyst lies in anterolateral wall of vagina.
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Ans. a. Hypothalamic hamaoma Uncontrollable laughing and precocious pubey are suggestive of hypothalamic hamaoma. Hypothalamic Hamaoma Central precocious pubey staing before the age 3 years is often due to hypothalamic hamaomaQ . Seizures, especially laughing spells (gelastic seizures)deg are seen in children with hypothalamic hamaoma. Hypothalamic Hamaoma Central precocious pubey staing before the age 3 years is often due to hypothalamic hamaomaQ Hypothalamic hamaoma picked up by MRIQ Seizures, especially laughing spells (gelastic seizures)Qare seen in children with hypothalamic hamaoma Precocious Pubey Central precocious pubey is a.lso known as true precocious pubeyQ, peripheral precocious pubey is called pseudo-precocious pubeyQ. McCune-Albright syndrome causes pseudo-precocious pubey (Peripheral precocious pubey).
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Primary prevention aims at preventing the progression of risk factors to disease. It includes health promotion and specific protection. Immunization comes under specific protection. Ref : Park&;s Textbook of Preventive and Social Medicine; 23rd edition - Pgno. 42
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A,B,C All Correct
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Answer is A (Size of stone less than 15mm) Medical therapy for gall bladder stone is amenable for stones < 15 mm (preferably Prerequisites for medical therapy : Gall bladder should he functioning Stones should be radiolucent Size should be small preferably < 15 mm Q -Harrison 14'h (<10n/in-Harrison 16th) Stones should be 'cholesterol stones' only Obvious by thier mechanism of action)Q (Newer edition of Harrison has mentioned the size of stone to be preferably < 10 mm rather than < 15 mm but we will go with same answer because the question was framed in older times). Medical therapy for Gall stone dissolution consists of administration of : UDCA (Ursodeoxycholic acid)Q CDCA (Choledeoxycholic acid)Q Mechanism of action: Inhibit HMG-CoA reductase activityQ, which in turn results in decreased hepatic cholesterol synthesis. Allows dispersion of 'cholesterol' from stones by physicochemical means.
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Ans. is 'a' i.e., Study of drug movement in the body Pharmakokinetics Pharmakokinetics is the quantitative study of drug movement, in through and out of the body. That means, it is the study of the effect of body on the drug. So, it is also known as ADME study as it deals with Absorption, Distribution, Metabolism and Excretion of a drug.
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The axial length of the eyeball at bih 70% of an adult eye. Anteroposterior diameter is 24 mm in adult & Anteroposterior diameter of the eyeball is about 16.5 mm at bih (70% of the adult size which is attained by 7-8 years). Reference : A K KHURANA OPHTHALMOLOGY, Edition4, Page-11
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Lubiprostone :- selectively stimulates type 2 chloride channels in epithelial cells thereby causing an efflux of chloride into the intestinal lumen. - The resultant fluid secretion into the gastrointestinal lumen provides a bolus effect that softens stool, increases intestinal transit, and improves symptoms of constipation. - Lubiprostone acts locally within the intestinal tract, is rapidly metabolized, and has very low systemic bioavailability.
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Buccal frenum of maxilla contains levator anguli oris (caninus), buccinator and orbicularis oris.
Buccal frenum of mandible contains triangularis or depressor anguli oris.
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Ans. is 'c' i.e., Bacterial surface polysaccharide o There are four pathways of complement system1) The classical activation pathway activated by antigen / antibody immune complexes.2) The mannose - binding lectin activation pathway activated by microbes with mannose terminal groups.3) The alternative activation pathway activated by microbes or tumor cells.4) The terminal pathway that is common to first three pathways and leads to the membrane attack complex that lyses cells.Microbial surface polysaccharide / lipopoly sacchoride (including endoxin) activates alternative pathway.
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• Ischemic time for digits is upto 8 hours.
• Ischemic time for extremities is 4-6 hours.
• Organ containing bag should be placed in a solution of saline with ice.
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Wide excision REF: Devita 8th ed chapter 45 Aggressive fibromatosis is a rare condition marked by the presence of desmoid tumors, which are benign, slow-growing tumors without any metastaticpotential. However, Aggressive Fibromatosis is locally aggressive. Despite their benign nature, they can damage nearby structures causing organ dysfunction. Most cases are sporadic, but some are associated with familial adenomatous polyposis (FAP). Approximately 10% of individuals with Gardner's syndrome, a type of FAP with extracolonic features, have desmoid tumors. Histologically they resemble low-grade fibrosarcomas Desmoid tumors may be classified as extra-abdominal, abdominal wall, or intra-abdominal (the last is more common in patients with FAP). It is thought that the lesions may develop in relation to estrogen levels or trauma/operations Treatment: Surgery with wide excision is the treatment of choice
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8 essential components of primary health care are1)Education concerning prevailing health problems and the methods of preventing and controlling them2)Promotion of food supply and proper nutrition3)An adequate supply of safe water and basic sanitation4)Maternal and child health care, including family planning5)Immunization against major infectious diseases6)Prevention and control of locally endemic diseases7)Appropriate treatment of common diseases and injuries8)Provision of essential drugsPark 23e pg: 891
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Ans. (b) P. aeroginosa Etiology of bacteremla associated with IV catheters Staph. epidermidis 85% S. aureus 7% Candida albicans 3% Enterococcus 2% Others - E. coli - Keibsieila - P. aerqinosa - Viridans streptococci 3%
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The silver-copper eutectic alloy may be classified as the 3rd generation amalgam.
Reference: Marzouk Operative dentistry, pg-106
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In infants with scabies the symptoms are itch or pruritus which is intense at night or nap-time. It can be so severe that the child can be so irritable and even refuse to eat. The characteristic lesions are burrows but they are not commonly seen. The papular, pruritic rash is most pronounced around abdomen, lower poion of buttocks, the axillary folds and the elbows. Treatment includes treating all the members of the family. Dispose clothes or laundry with good sunlight exposure is essential. Scabicidal treatment can be commenced. Antihistamines help reduce the pruritus. Although secondary infection is a complication, an IV antibiotic is not indicated in this case. Ref: Clinical Pediatric Dermatology, By Thappa, Pages 38-39, Elsevier India 2009.
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Oligodendrocytes are the myelin forming cells of the cns One cell can myelinate 30 neurons Ref:Guyton and Hall textbook of medical physiology 12th edition,page number:72,73
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A i.e.Preoptic nucleus - Sexual behavior is integrated in anterior-ventral hypothalamusQ; plus piriform coex (in males only) - Ganong - Sexual drive can be stimulated from several areas of hypothalamus, especially the most anterior and most posterior poions of hypothalamusQ (Guyton) - Medial preoptic area (MPOA) or the most anterior poion of hypothalamus is most impoant integrative nucleus involved in sexual behavior regulation of males in all veebratesQ. It integrates the male sexual behavior by receiving all indirect inputs from every sensory organ and sends efferents to structures that are critical for initiation and patterning of copulation. Therefore, stimulation of MPOA enhances sexual activity in males, whereas its damage consistently impairs male sexual behavior. Integrating Areas of Hypothalamus Function Anterior hypothalamus (response to heat), Temprature regulation (anteriorly Posterior hypothalamus (response to cold) hot, posteriorly cold) Suprachiasmatic nuclei Control of circadian body rhythm Punishment centers (esp periventricular zone of hypothalamus adjacent to 3rd ventricle, lateral Defensive reactions (fear, anger, rage, punishment, fighting)= hypothalamus & central grey area of mesencephalon) are stimulatory and ventromedial nuclei of hypothalamus, hippocampi, anterior limbic coex (esp anterior cingulate gyri and subcallosal gyri) are inhibitory to fear (punishment) Unpleasant sensation (Aversion) Reward centers locatd along the course of medial Calmness (Placidity, tameness & forebrain bundleQ especially in lateral and ventromedial tranquility) = Pleasant sensation nuclei of hypothalamus are self stimulatory (Reward or satisfaction) Appetitive Behavior Lateral (superior) hypothalamusQ Thirst Lateral hypothalamus activity level Hunger (eating) & increased Venteromedial nucleusQ, arcuate & paraventricular nuclei Satiety (Decreased eating) & tranquility Anterior ventral hypothalamus; most anterior (medial preoptic area=MPOA) & most posterior poions of hypothalamusQ; piriform coex (in males only) Sexual drive Neuroendocrinal control of Preoptic area FSH & LH Gn RH Supraoptic & paraventricular nuclei Vasopressin, Oxytocin Paraventricular nuclei TSH (thyrotropin) TRH ACTH & [3- lipotropin 03-LPH) CRH Paraventricular nucleus and arcuate nucleus GH somatostatin & GRH Arcuate nucleus; (hypothalamus inhibits secretion) Prolactin PIH & PRH Dorsal & posterior hypothalamus Catecholamines
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Ans. is 'b' i.e., Stricture of CBD Routes of infection to liverAlong the bile ducts (MC)Stone impacted in CBDStricture of CBD - benign, malignantCryptogenicVia the portal veinVia the hepatic arteryBy direct extensionFrom a subdiaphragmatic abscessFrom an empyema in chestFrom suppuratative cholecystitisFrom perinephric abscessPenetrating or blunt traumaAlso knowo MC organisms (Ref. Sabiston, Schwartz)Escherichia coliKlebsiella pneumoniaAlso noteo Sabiston 18th ed. writes that now there are 2 most common cause of liver abscess i.e. Cryptogenic and infections from the biliary tree. It writes- "Along with cryptogenic infections, infections from the biliary' tree are presently the most common identifiable cause of hepatic abscess ".
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Ref - researchgate.net
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Ans. is 'b' i.e., Mitochondria o Outer mitochondrial membrane has protein to lipid ratio of 1.1.
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Tc-99m labellee rbc is used in assessment of GI bleeding .
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Ans. (b) Specific protectionRef : K. Park 23rd ed. / 41, 370-73* Iodised salt is given in an area which has risk of developing goiter. This is a primary level of prevention done by specific protection.* Primordial prevention is done before the emergence of risk factor.
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Ans. is 'b' i.e., SH groups in the enzyme o Tolerance develops to hemodynamic and antiischaemic effects of nitrates if they are continuously present in the body. No significant tolerance develops when nitrates are used intermittently. However; significant tolerance develops when nitrates are used continuously. This mechanism of nitrate tolerance is not well understood. The mechanism proposed is --> "Reduced ability to generate NO due to depletion of cellular SH radicals".
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MECHANISM OF FLUOROQUINOLONES (FQ) In gram negative bacteria, FQ inhibit DNA gyrase by binding to its A subunit and interfere with cutting and resealing function. In gram positive bacteria, FQ inhibit similar enzyme DNA topoisomerase IV.
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Response to treatment is the most impoant prognostic marker in ALL. Leucocyte count> 50000/ul Poor prognosis Hyperploidy Favorable prognostic factor Response to treatment Remission status at 14 days of chemotherapy is best guide to prognosis. Organomegaly Poor prognosis. Lymph node, liver, spleen and testis enlargement indicate spread of cancer Unorable prognostic factors for ALL: Extreme age group: <1 year or >10 years Black males TLC>1 lac/cu.mm Organomegaly CNS Leukemia L2 ALL, pre B cell and mature B cell ALL Hypoploidy t(9:22) and t(4:11) Remission> 14 days
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Ans. is 'd' i.e., Migraine * Meniere's disease is a disorder of the inner ear which is characterized byi) Episodes of vertigoii) Tinnitus (ringing in the ears)iii) Fluctuating sensorineural hearing lossiv) Feeling of fullness or pressure in ear (aural fullness)* A typical attack of Meniere's disease is preceded by fullness in one ear. Hearing fluctuation or changes in tinnitus may also precede an attack.
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Generally, the aery divides into an anterior division and a posterior division, with the posterior division giving rise to the superior gluteal, iliolumbar, and lateral sacral aeries. The rest usually arise from the anterior division. umbilical aery superior vesical aery obturator aery vaginal aery inferior vesical aery uterine aery middle rectal aery internal pudendal aery inferior gluteal aery Imageref - pubmed.com
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Ans. (d) Grave's ophthalmopathyRef: Parson's, 22/e, p. 487Thyroid eye disease produce typical Fusiform enlargement of extraocular muscles and spares the tendon.
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Ans. Exudates seen in basal cistern
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Ans. is 'c' i.e., Stapes ArchSkeletal elementMuscle archNerve of archIMaxilla, zygomatic bone, part of temporal and vomer, sphenoid, mandible,Malleus, incusMylohyoidMastication musclesAnterior belly of digastricsTensor veli palatineTensor tympaniMandibular division of trigeminalIIStapesStyloid processStylohyoid ligamentSmaller cornu of hyoidSuperior part of body of hyoid (AII 'S')StapediusStylohyoidPosterior belly ofdigastricFacial expressionMusclesFacialIIIGreater cornu of hyoidLower part of body of hyoidStylopharyngeusGlossopharyngealIVCartilages of larynx except arytenoidsPharyngeal musclesCricothyroidSuperior laryngeal branch of vagusVIArytenoid cartilages of larynxIntrinsic muscles of larynxRecurrent laryngeal nerve
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The coronary sinus receives blood mainly from the small, middle, great and oblique cardiac veins. It also receives blood from the left marginal vein and the left posterior ventricular vein. It drains into the right atrium. The anterior cardiac veins do not drain into the coronary sinus but drain directly into the right atrium. Some small veins known as smallest cardiac veins drain directly into any of the four chambers of the hea.
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Ans. is 'b' i.e. coarctation of Aorta. Cold extremities, high B.P. in upper extremity with marked diminution of pulsations and B.P. in lower extremity is characteristic of Coarctation of Aorta.More facts about Coarctation of AortaMost patients are asymptomatic.Symptomatic patients usually present with foilwing features.Headache dizziness *Epistaxis*Cold extremities and weakness in legs *Claudication with exercise. *Hypertension in upper extremities with marked diminution of pulsation in lower extremities.Mid systolic or continuous murmur over anterior part of chest and back.*Enlarged and pulsatile collateral vessels in intercostal spaces anteriorly in axilla or posteriorly in interscapular area.Upper extremity is more developed than the lower extremity. *Remember that the Cardiac output responds normally to exercise.*Most common site* of Coarctation of Aorta is just distal to origin of left subclavian artery.If it arises above subclavian artery, blood pressure elevation is evident only in right arm.Bicuspid aortic valve* is the most common abnormality associated with coarctation of Aorta.Radiographynotching of inferior surface of ribs*indentation of aorta at site of coarctation and '3' sign* on para mediastinal shadow.Complications:cerebral aneurysmleft ventricular failure*infective endocarditis
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Endoscopy is useful for evaluation and treatment of some forms of gastrointestinal obstruction. An impoant exception is a small-bowel obstruction due to surgical adhesions, which is generally not diagnosed or treated endoscopically. Oesophagal, gastroduodenal, and colonic obstruction or pseudo-obstruction can all be diagnosed and often managed endoscopically.Harrison 19e pg: 1891
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Satyanarayan -562
Leukotrienes are implicated in asthma, inflammatory reactions, hypersensitivity and heart attacks. Leukotrienes cause contraction of smooth muscles, bronchoconstriction, vasoconstriction, adhesion of white blood cells and release of lysosomal enzymes. Lipoxins are involved in vasoactive, and immunoregulatory functions. There is a strong evidence to support that lipoxins act as counter regulatory compounds of immune response.
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Ref-KDT 6/e p101 Neostigmine and pyridostigmine are reversible chlolinesterase inhibitors that can cause cholinergic adverse effects like diarrhea and increase secretions
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image shows red man syndrome which is a side effect of vancomycin usage which increases histamines and causes flushing of the skin Vancomycin: Red Man Syndrome * Constellation of symptoms : Pruritus, flushing, erythroderma common : Hypotension uncommon * Due to nonspecific histamine release that is rate related (rare repos of IgE-anaphylaxis) * Severity correlates with amount of histamine released into plasma * Severity reduced by reducing rate to < 500 mg/hr and premedication with H1-antagonists ref : kd tripathi 8th ed
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Answer is B (CK-MB) CK-MB is the Cardiac Biomarker of Choice for diagnosis of Re-infarction 8 days after the initial ischemic event. The CK-MB level will increase approximately 4-8 hours after a myocardial infarction and return to normal after 72 hours (3 days). This makes it useful for the detection of re-infarction in the 4-10 day time window after the initial insult since troponins may remain elevated for 10-14 days making it less useful for this purpose.
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Referred pain in ovarian pathology
- T10-T11 area, which is a periumbilical area, due to sensory fibers which travel along with sympathetic fibers to aortic plexus.
- Along cutaneous distribution of obturator nerve on the inner side of the thigh.
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Answer is C (Altered mental status) : `Early signs of elevated ICP include drowsiness and a diminished level of consciousness (altered mental status). Coma and unilateral papillary changes are late signs and require immediate intervention.' -Harrisons
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Ans. is 'c' i.e., Discovery of M. Tuberculosis . Louis pasteur is associated with . Development of live vaccine (first was anthrax) . Development of vaccine for rabies (hydrophobia) . Introduction of technique of sterilization . Disprove the theory of spontaneous generation (abiogenesis) . Established the different growth need of different bacteria (helped in complex media) . Coined the term vaccine M. tuberculosis was discovered by Robe Koch
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Ans. D. Muir-Torre syndrome*Muir-Torre syndrome is a rare autosomal dominant disorder of DNA repair.*M-Torre syndrome occurs due to mutation in one of the DNA mismatch repair genes (MSH-2, MLH-1, and more recently MSH-6).*The disorder is characterized by sebaceous gland neoplasms, keratoacanthomas associated with gastrointestinal and genitourinary malignancies.Important DNA Repair Disorders Associated with Cutaneous FeaturesS. NoDisorderDNA Repair Defect1Xeroderma pigmentosumNucleotide excision repair2Cockayne syndromeNucleotide excision repair3Cerebro-Oculo-facio-skeletal syndromeNucleotide excision repair4UV-sensitive syndromeNucleotide excision repair5TrichothiodystrophyNucleotide excision repair6Rothmund-Thomson syndromeRecombination Q helicase7Bloom syndromeRecombination Q helicase8Werner syndromeRecombination Q helicase9Ataxia telangiectasiaDouble strand break repair10Fanconi anaemiaInterstrand cross-link repair11Muir-Torre syndromeMismatch repair
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Both UL included 18% of burns according to wallace’s rule of 9.
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Interleukin -1
Also known as leucocyte activating factor (LAF) or B cell activating factor (BAF).
Principally secreted by macrophages and monocytes, and epithelial cells.
Other sources are B lymphocytes, fibroblasts and endothelial cells.
Immunological effects-
- Activation of T cells for the production of IL - 2.
- B cell proliferation and antibody synthesis
- Neutrophil chemotaxis and increased PMN release from bone marrow.
- Increases body temperature (important endogenous pyrogen).
- Bone marrow cell proliferation
- Induction of acute phase protein.
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The dead body cools at an average rate of 1.5 degree F per hour in temperate climate and 0.75 degree F in a tropical climate. According to Simpson, the cooling of the body is the only reliable indicator of the lapse of time during the first 18 hours after death. Factors controlling the cooling rate are: Condition of the body Clothing Atmospheric temperature Mode of death Medium Ref: Forensic Medicine By P.V. Guhara page 62.
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Ans. is ai.e. B/L chocolate cyst of ovary "The ovary is the commonest site and is involved in 30-40% of cases. The lesion is nearly always bilateral. It sometimes appears as multiple burnt match head spots on the surface of the ovary and sometimes as the typical tarry cysts in a disorganised organ surrounded by dense adhesinos." They are true cystsdeg with columnar lining epithelium.deg The cysts enlarge with cyclic bleeding. The serum gets absorbed in between periods and the content inside becomes chocolate, tarry brown in colourdeg. Histology - Lining epithelium is columnar epitheliumdeg. - Beneath the epithelium are large macrophages called as Pseudoxanthoma cells which have brown cytoplasm due to ingested blood pigments like hemosiderin. Treatment of chocolate cyst / endometrioma. Small < 3cm Large > 3cm Laparoscopic aspiration/ Associated with extensive adhesions to other pelvic Laparoscopic cystectomy structures and therefore laparotomy is necessary. Other conditions associated with Endometriosis Anovulationdeg Abnormal follicular development Reduced circulating E2 levels during pre ovulatory phasedeg Disturbed LH surge patternsdeg Premenstrual spottingdeg Luteinized unruptured follicle syndromedeg Hyperprolactinemiadeg Galactorrheadeg Before concluding lets rule out other options. Adenomyosis is associated with endometriosis but vice versa is not true: similarly fibroid uterus is associated with endometriosis but vice versa is not true (Ruling out options "b" and "c"). Multiple luteal cysts in the ovary are seen in case of : a. Pregnancy Multiple pregnancydeg HCG therapydeg H. Moledeg Chorio carcinomadeg Thus option "d" is incorrect. There is no association between endometritis and endometriosis.
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Ans. (a) Meningitis Strains of Hemophilus which lacks polysaccharide capsule are referred as Non-typable Strains Non-typable H. influenza is the commonest bacterial cause of exacerbations of COPD. They also cause community acquired pneumonia, otitis media (3rd most common cause after pneumococci, and Moraxella catarrhalis ), puerperal sepsis, neonatal bacteraemia, sinusitis.
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Ans. Megalocornea
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The petrous pa of the temporal bone is pyramid-shaped and is wedged in at the base of the skull between the sphenoid and occipital bones. Directed medially, forward, and a little upward, it presents a base, an apex, three surfaces, and three angles, and houses in its interior, the components of the inner ear . A total of six group of ossification centers appear in the petrous pa during 5th fetal month, and they form the petrous bone at 6th fetal month. The firstly-appeared ossification center is just above the round window, and the second is on the ampulla of anterior semicircular canal. Other ossifications are observed between the cochlea and semicircular canals, on the brim of internal acoustic porus, on the superior surface of the petrous apex, and on the summit of posterior semicircular canal. The ossification of the facial canal stas at 6th fetal month, though the geniculate pa and tympanic pa do not complete until one year old after bih. Even in adults, the facial canal dehiscence are found at more than 10% of cases, mainly locating in the tympanic pa. On the basis of these results, formation of the petrous bone including facial canal and other bony structures was discussed from the viewpoints of the ossification and pre- and postnatal middle ear development Ref - pubmed.com
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White piedra is caused by Trichosporon beigelli
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Ans. (b) Breast cancer(Ref Internet source)Bloom and Richardson grading for cancer breast is based on* Tubules formation* Nuclear pleomorphisms* Mitotic counts
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Ans. is 'b' i.e., Peptic ulcer Contraindications of Aspirin Peptic ulcer Prostaglandin has cytoprotective function for gastric mucosa by inhibiting acid secretion and promoting secretion of mucus. Aspirin inhibits synthesis of cytoprotective PG -3 bleeding & perforation may occur. Children with chicken pox & influenza Aspirin can cause Reye's syndrome (hepatic encephalopathy). Acknowledging this aspirin should not be given to children < 12 years, e.g. in JRA. Bleeding tendencies By its antiplatelet action, aspirin can exacerbate bleeding. Chronic liver disease Long-term therapy with high dose aspirin can cause insidious onset hepatic injury.
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Ans. is 'b' i.e., Lower 1/3 leg and ankle o Venous ulcers usually lie just proximal to the medial or lateral malleolus.o Venous ulcers are accompanied by lipodermatosclerosis and hemosiderosis (if these are not present then the ulcer is probably not of venous origin).
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Ans. B i.e. Urine FSH Physiology Best predictor of ovulation: Pre-ovulatory rise in LH In normal menstrual cycle, progesterone is secreted by: Corpus luteum Inhibin is secreted by: Graffian follicle LH precedes ovulation by: 24 hours (Ovulation coincides with LH surge) Ovulatory period: Corresponds to 14 days before next menstruation FSH stimulates: Growth of granulosa cells (measure of ovarian reserve) LH stimulates: Follicle rupture and ovulation.
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Finally, although orthodontic treatment can be carried out during pregnancy, there are risks involved. Gingival hyperplasia is likely to be a problem, and the hormonal variations in pregnancy sometimes can lead to surprising results from otherwise predictable treatment procedures. Because of bone turnover issues during pregnancy and lactation, an orthodontist theoretically should be vigilant about loss of alveolar bone and root resorption at these time-but radiographs to check on the status of bone and tooth roots are not permissible during pregnancy. Treatment for a potential patient who is already pregnant should be deferred until the pregnancy is completed. If a patient becomes pregnant during treatment, the possible problems should be discussed, and it is wise to place her in a holding pattern during the last trimester, limiting the amount of active tooth movement.
Ref: Proffit-4th ed pg no 319
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Neural tube - upper pa: Brain CNS neural plate lower pa: Spinal cord ectoderm Neural crest - ganglia of PNS ARCH. NERVE MUSCLES SKELETON I. Main: CNV (III)Additional: chorda Tympani: (CNVII) Muscles of mastication (temporal, masseter & the pterygoids) ant. Belly of digastric, tensor palatini, tensor tympani. Premaxilla, maxilla, zygomatic, Mandible, malleus, incus, anterior, ligament of malleus, sphenomandibular ligament, meckel's cailage. II. Main: CN VII Additional: tympanic branch of glossopharyngeal nerve (CN IX) Muscles of facial expression, posterior belly of digastric, stylohyoid, stapedius Stapes, styloid process, stylohyoid ligament, lesser horn & upper poion of body of hyoid bone. III. CN IX - glossopharyngeal Stylopharyngeus Greater horn & lower pa of hyoid bone V-VI CNX - vagusSuperior laryngeal n - 4th arch Recurrent laryngeal n - 6th arch Cricothyroid, levator palatine, constrictors od pharynx intrinsic muscles of larynx Laryngeal cailage (thyroid, cricoid, arytenoid, corniculate, uniform) Nerves of pharyngeal arches : each arch has a main nerve derived from the neural plate and an additional nerve derived from NCC. The additional nerves are the nerves of pharyngeal clefts. (Derived from NCC) Fig. Each pharyngeal arch is supplied by its own cranial nerve. The trigeminal nerve supplying the first pharyngeal arch has three branches: the ophthalmic, maxillary, and mandibular. The nerve of the second arch is the facial nerve; that of the third is the glossopharyngeal nerve. The musculature of the fouh arch is supplied by the superior laryngeal branch of the vagus nerve, and that of the sixth arch, by the recurrent branch of the vagus nerve.
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Ans:A i.e. Phosphofructokinase.Rate-Limiting Enzymes Rate-limiting enzyme of Glycolysis :Phosphofructokinase-1 (PFK-1)Rate-limiting enzyme of Gluconeogenesis :Fructose-1,6,biphosphataseRate-limiting enzyme of TCA cycle :Isocitrate dehydrogenaseRate-limiting enzyme of Glycogen Synthesis :Glycogen synthaseRate-limiting enzyme of Glycogenolysis :Glycogen phophorylase (phophorylase breaks phosphate bond, which means activated glycogen releases a lot of energy)Rate-limiting enzyme of HMP Shunt :Glucose-6-Phosphate dehydrogenase (bad to lose this in RBCs)Rate-limiting enzyme of de novo pyrimidine synthesis :Carbamoyl phosphate synthase II (CPS I is involved in urea cycle)Rate-limiting enzyme of de novo purine synthesis :Glutamine-PRPP amidotransferaseRate-limiting enzyme of Urea cycle :Carbamoyl phosphate synthetase I (CPS II is involved in pyrimidine synthesis)Rate-limiting enzyme of fatty acid synthesis :Acetyl-CoA carboxylase (ACC)Rate-limiting enzyme of fatty acid oxidation :Carnitine acyltransferase IRate-limiting enzyme of Ketogenesis :HMG-CoA synthaseRate-limiting enzyme of Cholesterol synthesis :HMG-CoA reductase
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Presence of haematuria with SNHL with anterior lenticonus as shown in the slit lamp suggests the diagnosis of Alpo's syndrome. Alpo's syndrome is and X linked disorder characterized by defect in alpha 5 chain of type IV collagen. Electron microscopy reveals thinning of basement membrane (<150nm) as the earliest feature and 'basket weave appearance' is characteristic on EM.
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Ref: Basic & Clinical Pharmacology Katzung 12th ed. p.8J8Explanation:Tetracycline inhibits bacterial protein synthesis by- binding to 30S ribosomal subunit. The remaining drugs are matched correctly with their mechanism of action.
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