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Aconite is monk's hood or blue rocket or mitha zaher or bish or bikh.
Signs and symptoms include sweet taste, numbness and tingling of mouth, tongue and pharynx, salivation, nausea, and vomiting and diarrhea. Headache, giddiness, pallor, and profuse sweating, subnormal temperature, and patient becomes weak.
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Ans. is 'b' i.e., Trigeminal ganglion o Trigeminal ganglion (Gasserion ganglion or semilunar ganglion) lies in a dural pouch, the cavum trigeminale (Meckel's cave).
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In bimodal series Mode = 3xmedian - 2xmean= 3x3 - 2x2 = 5 Ref : Park&;s Textbook of Preventive and Social Medicine; 23rd edition - Pgno. 847
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Ca"
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EIEC produce disease similar to shigellosis, i.e. invasion of mucosa. OPTION 1 Persistent diarrhea especially in developing countries is most often caused by EAEC. OPTION 2 Enterohemorrhagic E. coli (EHEC): Serotypes associated with EHEC are: - O157: H7 (most common serotype). - Manifestations: HC (hemorrhagic colitis) and Hemorrhagic uremic syndrome (HUS). OPTION 3 EIEC produce disease similar to shigellosis, i.e. invasion of mucosa. - EIEC show atypical biochemistry (biochemically similar to Shigella spp. i.e, NLF, anaerogenic and non-motile) -Atypical E. coli. OPTION 4 ETEC is the most common cause of traveler's diarrhea.
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Ans: c (SAAG >1.1 gm/dl) Ref: Harrison, 16th ed, p. 245,17th ed, p.In exudative ascites SAAG <1.1SAAG is serum ascites albumin gradient. It is the difference between serum albumin and ascitic fluid albumin. In exudative ascites, the ascitic fluid albumin is more so S AAG is less than 1.1 gm/dlExudative ascitesProtein concentration > 2.5 gm/dlSpecific gravity >1.016SAAG< 1.1 gm/dlTransudative ascitesProtein concentration < 2.5 gm/dlSpecific gravity < 1.016S AAG > 1.1 gm/dlCauses of exudative ascitesTuberculousMalignantBacterial peritonitisPancreatic ascitesCauses of transudative ascitesCirrhosis and portal hypertensionCongestive cardiac failureNephrotic syndromeConstrictive pericarditisBeriberiHypoproteinaemiaInferior venacaval obstructionCauses of chylous ascitesTraumaTumorTuberculosisFilariasisNote:Ascitic amylase activity > 1000 U/l is suggestive of pancreatic ascitesIn spontaneous bacterial peritonitis polymorphonuclear leucocyte count > 250/cubic mm-Mucinous ascites is seen in Pseudomyxoma peritonei
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Ans. is 'a' i.e., Bile duct paucity
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Ans. C. Cerebellar degenerative diseaseParaneoplastic cerebellar degenerationa. Pure paraneoplastic cerebellar degeneration:i. Breast & Gynecological cancer (Anti Yo antibodies)ii. Hodgkin's lymphoma (Anti Tr antibodies)b. Subacute cerebellar degenerationi. Small cell carcinoma lungii. Thymomaiii. Neuroblastoma
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50% of the focal nodular hyperplasia shows presence of Kupfer cells (phagocytes). So uptake of sulphur colloid is noted in these lesions. No uptake is seen in HCC, hepatic adenoma and metastases
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Ans. At the lamina cribrosa
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Pierre Robbin’s Sequence includes unilateral cleft lip.
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DNA and RNA Acridine orange is a nucleic acid selective metachromatic stain useful for cell cycle determination Acridine orange interacts with DNA and RNA by intercalation or electrostatic attraction respectively - DNA intercalated Acridine orange fluoresces green - RNA electrostatically bound acridine orange fluoresces red It may distinguish between quiescent and activated proliferating cells and may also allow differential detection of )multiple GI compaments. - Acridine orange is also a useful method for measuring apoptosis and for detecting intracellular pH gradients and the measurement of proton pump activity. Uses of Acridine orange Demonstration of mucin Staining of DNA and RNA As a stain for electron microscopy study of mitochondria) osteoclasts Distinguish proliferating and resting cells Genetic determination of plasmodium falciparum and H. Pylori Also know D.N.A. can be best demonstrated by --> Feulgen Other methods of demonstrate D.N.A --> Methyl green pyronin, Gallocyanin chrome alum method Method of choice for demonstrating R.N.A --> Methyl green pyronin Other methods to demonstrate R.N.A. - Gallocyanin chroms alum, Acridine orange
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Epidemic: Number of cases of a disease clearly in excess of normal frequency. An area is declared free of epidemic; if on search , no new cases are repoed for 'twice the incubation period of the disease since the occurrence of last case'.
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SRS is a dual record system initiated to provide reliable estimates of bih and death rates.It consists of a continuous enumeration of bihs and deaths by an enumerator and an independent survey every 6 months by an investigator-supervisor.Park 23e pg: 841
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Kuntsher&;s clover leaf intra medullary nail (K nail). Fixation of the K nail is based on 3 point fixation. It fixes bone at 3 points, at either ends and at isthmus. REF:Essential ohopaedics- 5th edn- pg no 373.
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Ans. is `d' i.e., All of the above Impoant risk factors and their outcomes/diseases which have been studied by case-control study are :- Cigarette smoking and lung cancer. Maternal smoking and congenital malformation. Radiation and leukemia. OCP used and hepatocellular carcinoma. Herpes-simplex and Bells palsy. Aificial sweeteners and bladder cancer. DES exposure in fetal life and vaginal adenocarcinoma. OCP use and thromboembolic disease. Thalidomide use in pregnancy and teratogenicity.
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Best prognosis : Duodenal adenocarcinoma >Ampullary carcinoma >Distal Bile duct adenocarcinoma >Head of pancreas >Body and tail of pancreas (DAD Head Body and Tail) Ref: Shackelford 7th edition Pgno : 1201
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Ans. C. Nucleotide Excision RepairDisorder shown: Xeroderma pigmentosuma. Xeroderma pigmentosum (XP) is a rare autosomal recessive genetic disorder of DNA repair in which the ability to repair damage caused by ultraviolet (UV) light is deficient.b. In extreme cases, all exposure to sunlight must be forbidden, no matter how small; as such, individuals with the disease are often colloquially referred to as "Moon child".c. Multiple basal cell carcinomas (basaliomas) and other skin malignancies frequently occur at a young age in those with XP; metastatic malignant melanoma and squamous cell carcinoma are the two most common causes of death in XP victims.d. This disease is present in both genders and in all races, with an incidence of 1:250,000 in the United States. XP is roughly six times more common in Japanese people than in other groups.e. Normally, damage to DNA in epidermal cells occurs during exposure to UV light. The absorption of the high-energy light leads to the formation of pyrimidine dimers, namely cyclo butane-pyrimidine dimers and pyrimidine-6-4- pyrimidone photoproducts.f. In a healthy, normal human being, the damage is first excised by endonucleases. DNA polymerase then repairs the missing sequence, and ligase "seals" the transaction. This process is known as nucleotide excision repair.
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Vital capacity is sum of ERV + TV + IRV. All these lung volumes are Reduced in Restrictive lung disease due to pulmonary fibrosis. Do not mix with Timed vital capacity which is a ratio of FEV1/ FVC and is increased in restrictive lung disease.
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Datura is atropine .antidote is physostigmine because it is a teiary amine which can cross BBB and neutralize central effects produced by atropine Ref: KDT 6th ed pg 101-102
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32 - 34 weeks : sta feed by spoon or paladai ( Total enteral nutrition ) Ref : Ghai pediatrics eighth edition pg no 159
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(Richter's hernia) (1274-Baily & Love 24th) (970-B &L 25th)1. Richter's hernia - is a hernia in which the sac contains only of portion of the circumference of the intestine (usually small intestine). It usually complicates femoral and obturator hernias2. Littre's hernia - A meckel's diverticulum3. Spigelian hernia - This is a variety of interparietal hernia occurring at the level of the arcuate line4. Lumber hernia - Most primary lumber hernia occurs through the inferior lumbar triangle of Petit. Bounded below by the crest of the ilium, laterally by the external oblique and medially by the latissmus dorsi.
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Ascending loop of Henle has Na+ - 2Cl - K+ cotranspoer. Ref: Ganong's review of medical physiology; 24th edition; page no; 685 ref of image :
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Answer- B. TetrodotoxinThe toxin involved is tetrodotorin.Syrnptoms of pufferfish poisoning include initial tingling, numbness of lips, tongue and fingers. trading to the paralysis of the extremities, ataxia, difficulty in speaking, and finally death by asphpiation sue to respiratory paralysis.
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Stem cell therapy has the potential to provide treatment for a wide range of diseases, including spinal cord injury and neurodegenerative conditions, cardiovascular disease, degenerative retinal conditions, type I diabetes and diseases of the musculoskeletal system.Risks of cell-based therapy.Tumour formationGenetic and epigenetic abnormalitiesTransmission of infectionPoor bility and loss of functionDifferentiation to undesired cell-typesRejection (allogeneic cells)Side effects of immunosuppression (allogeneic cells)Ref: Bailey and Love 27e pg: 40
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Ans. is `d' i.e., Phallic
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2 molecules of CO2 which are lost in TCA, are from Oxaloacetate. Acetyl CoA in one turn of the cycle gives it's carbons to oxaloacetate, not CO2. In the 2nd turn of the cycle , these two carbons from Oxaloacetate will be lost in the form of CO2. Answer oxaloacetate >>Acetyl CoA.
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Human genome: Size: 3 billion base pairs Number of genes: <25,000 At least 30% of the genome consists of repetitive sequences Alu family constitutes ~10% of human genome Largest gene: DMD gene coding for dystrophin protein Only around 1.5 % of human genome is made of protein-coding (exonic) DNA
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In x-ray of mechanical obstruction, there will be absence of rectal gas shadow.
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Tegmen tympani forms the roof of the middle ear and it also extends posteriorly to form a roof of aditus and antrum.
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In the first trimester, placental growth is more rapid than that of the fetus. But by approximately 17 weeks, placental and fetal weights are approximately equal. Ref:Williams Obs 24e pg 95.
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Mercury
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Beta-2 microglobulin and not beta macroglobulin may be used as a tumor marker (as in multiple myeloma).
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8th day
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The phenomenon of 'nuclear induction', later to be termed 'nuclear magnetic resonance' (NMR), was described by Bloch and Purcell and their colleagues in 1946. NMR has been used extensively for studying the propeies of matter at the molecular level (NMR spectroscopy). In applications to medicine, the term 'nuclear' has been dropped, leaving it as magnetic resonance or MR(Ref: Grainger&;s diagnostic radiology, 6th ed; page 90)
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Respiratory rate is not a component of Apgar score; however, respiratory effo is: The Apgar score is an objective method of evaluating the newborn&;s condition using the 5 parameters stated below It is performed at 1 minute and 5 minutes after bih Components of APGAR score: Color (A Appearance) Hea rate (P Pulse) Response to a catheter in nostril (G Grimace) Muscle tone (A activity) Respiratory effo (R) (not respiratory rate) Apgar score is not used to guide resuscitation, and resuscitation must be initiated before the 1-minute score The change of score at sequential time points following bih reflects how well the baby is responding to resuscitative effos. Ref: Nelson textbook of pediatrics 21st edition Pgno: 872
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- Neonatal tetanus can be prevented by giving: Primigravida - 2 doses of td as soon as possible. Multigravida- If pregnancy occurs within 3 years of 1st pregnancy -1 dose of td booster is given. If pregnancy occurs after 3yrs of 1st pregnancy- 2doses should be repeated.
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. Prader -Willi syndrome
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Talon cusps appear to occur more frequently in Asians, Native Americans, the Inuit, and those of Arab descent. Both sexes may be affected, and the occurrence may be unilateral or bilateral.
In isolated cases, genetic influences appear to have an effect, because identical talon cusps occasionally have been documented in twins.
Talon cusps also have been seen in patients with Rubinstein-Taybi syndrome, Mohr syndrome, Ellis-van Creveld syndrome, incontinentia pigmenti achromians, Berardinelli-Seip syndrome, and Sturge-Weber angiomatosis. Although the strength of association between the presence of talon cusps and these syndromes generally is not clear, Rubinstein-Taybi syndrome is strongly correlated as demonstrated by a study of 45 affected patients in which 92% demonstrated talon cusps.
Reference: ORAL AND MAXILLOFACIAL PATHOLOGY, Neville, FOURTH EDITION page no 81
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Barrier method
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Ans. Squamous cell carcinoma
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85 dB
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Ans. is 'd' i.e.. All the above Treatment of ADHDPharmacotherapy Pharmacological treatment is considered to be the first line of treatment of ADHD. Drugs used for ADHD areCNS stimulants: - These are drugs of choice for ADHD. Methyiphenidate is the drug of choice. Other CNS stimulants used are dexmethyiphenyldate. dextroamphetamine , Dextroamphetamine + amphetamine, and modafinil (Provigil). Methyiphenidate should be used in children of 6 years or above and amphetamines should be used in children of 3 years & above.Nonstimulant drugs Atomoxetine, Bupropion, venlafaxine, alpha-adrenergic agonists (Clonidine, guanfacine).Psychological treatment : - The child and parents should be educated with regard to the ways in which ADHD can affect learning, behavior, self esteem and skills. Goal should be set for the family to improve the child's interpersonal relationships, develop study skills, and decrease disruptive behaviors.Behavior therapy : - The goal of behavior therapy is to identify targeted behavior that cause impairment in child's life so that child can work on pregressively improving his or her skill in these area. It includes management of disruptive behavior at home & class room and improving academic performance.
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Acidosis (↓ pH) precipitate sickling.
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A cancer that stas in the bone. In the ends of bone where new bone forms as the person grows. Thigh, upper arm, shin are the common sites.
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Ans. is `d i.e., AndrogensThe adrenal coex is divided into three zones (outer to inner) : Zona glomerulosa, zona fasciculata and zona reticularis.All three coical zones secrete coicosterone, but the active enzymatic mechanism for aldosterone biosynthesis is limited to the zona glomerulosa whereas the enzymatic machanisms for forming coisol and sex hormones are found in the two inner zones. Fuhermore, subspecialization occurs within the inner two zones, the zona fasciculata, secreting mostly glucocoicoids and the zona reticularis secreting mainly sex hormones.
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G(s) alpha mutations in fibrous dysplasia and McCune-Albright syndrome. Weinstein LS1. Author information Abstract Fibrous dysplasia (FD) is a focal bone lesion composed of immature mesenchymal osteoblastic precursor cells. Some FD patients also have hyperpigmented skin lesions (cafe-au-lait spots), gonadotropin-independent sexual precocity, and/or other endocrine and nonendocrine manifestations (McCune-Albright syndrome ). MAS results from somatic mutations occurring during early development, resulting in a widespread mosaic of normal and mutant-bearing cells, which predicts that the clinical presentation of each patient is determined by the extent and distribution of abnormal cells. These mutations encode constitutively active forms of G(s)alpha, the ubiquitously expressed G protein alpha-subunit that couples hormone receptors to intracellular cAMP generation. These mutations lead to substitution of amino acid residues that are critical for the intrinsic GTPase activity that is normally required to deactivate the G protein. It also may lead to pseudo and psuedopseudohypoparathyroidism.
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A density of 15 microfilaria / drop of blood are needed to make it infective.
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C i.e. Multiple myeloma Features Disease Multiple punched out lesions Multiple myelomaQ Hair on end skull vault ThalessemiaQ, Sickel cell Anemia Erosion of dorsum sella Raised ICT (earliest & most common) Silver Beaten app. of vault Raised ICT Sunray calcification with spicules Meningioma
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Ans. is 'b' i.e., ARAutosomal recessive disordersMetabolicHematologicalEndocrineSkeletalNarvouso Cystic fibrosiso Phenylketonuriao Galactosemiao Homocystinuriao Lysosomal storage diso a1-antitrypsin deficiencyo Wilson diseaseo Hemochromatosiso Glycogen storage disorderso Sickle cell anemiao Thalassemiaso Congenital adrenal hyperplasiao Albinismo EDS (some variants)o Alkaptonuriao Friedreich ataxiao Spinal muscular atrophyo Neurogenic muscular atrophies
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Ans. D: Atracurium Suxamethonium should be avoided if hyperkalaemia is present. Some non-depolarising muscle relaxants depend on the kidney for elimination. Atracuriuin is the agent of choice as it undergoes spontaneous Hoffman degradation at body temperature. Vecuronium and mivacurium are safe to use in renal failure as only small percentages are excreted renally. Gallamine should be avoided and pancuronium, alcuronium, pipecuronium, curare and doxacurium should be used with caution. Potentiation of neuromuscular blockade may occur in the presence of a metabolic acidosis, hypokalaemia, hypermagnesaemia, or hypocalcaemia and with medications such as aminoglycosides. Monitor neuromuscular blockade whenever possible.
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Marasmus is characterized by gross wasting of muscle and subcutaneous fat. The body weight is less than 60% of the expected weight for age. The affected child will be active and has a voracious appetite. Ref: Page 104; Ghai Essential Pediatrics; 6th edition
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Ans. (d) Absent P waves.In hypokalemia, the ECG shows1. Increased amplitude and width of the P wave2. Prolongation of the PR interval3. T wave flattening and inversion4. ST depression5. Prominent U waves (best seen in the precordial leads)6. Apparent long QT interval due to fusion of the T and U waves = long QU interval.
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Sclerosing adenosis is a type of proliferative fibrocystic disease that is often seen with other variants of fibrocystic disease. It is a proliferation of small ducts and myoepithelial cells near the terminal duct lobular unit. It also is characterized by fibrosis that distos the glands and lobules into a whorled pattern. The demonstration of this on biopsy, as with other proliferative fibrocystic changes, implies an increased risk for subsequent invasive breast cancer. Apocrine metaplasia is the term used to describe a transformation of ductal epithelial cells to eosinophilic cells resembling apocrine sweat gland epithelium. This is a benign, common, non-proliferative change that is not associated with increased cancer risk. A blue-domed cyst of Bloodgood is a fluid-filled cyst, sometimes up to 5 cm in size, that appears blue grossly before it is incised. When incised, the fluid is serous and dark- colored. These cysts are pa of benign non-proliferative fibrocystic disease and do not carry increased cancer risk. Duct ectasia is characterized by a large dilated duct with inspissated material. it is associated with periductal inflammation and fibrosis of the large collecting ducts under the areola. It is common in elderly women, although the cause is not clear. There is no increased risk of cancer. Ref: Wyatt C., Kemp W.L., Moos P.J., Burns D.K., Brown T.G. (2008). Chapter 17. Pathology of the Male and Female Reproductive Tract and Breast. In C. Wyatt, W.L. Kemp, P.J. Moos, D.K. Burns, T.G. Brown (Eds), Pathology: The Big Picture.
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Spectrophotometry is not a rapid serological test it is a quantitative measurement of the reflection or transmission propeies of a material as a function of wavelength. A spectrophotometer is commonly used for the measurement of transmittance or reflectance of solutions, transparent or opaque solids, such as polished glass, or gases. Ref: www.mayoclinic.com
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Ans. is 'd' i.e., Velocity of bullet > 'a' i.e., Weight of bullet o Tissue damage (or destructive power of bullet) is dependent on striking (kinetic) energy of bullet, which is proportional to its mass and square of velocity (KE = 1/2 mv2). So modem bullets are designed to have smaller mass allowing transportation of large amount of ammunition and high velocity, as velocity is more important determinant in destructive power of bullet.
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(Ref: Harrison 18/e p866, 17/e p645-646, Tejinder Singh 2/e p54-61)
Peripheral blood picture
Bone marrow picture
Macrocytosis (↑ MCV, MCH. Normal MCHC)
Peripheral smear
Macroovalocytes
Few nucleated RBCs
Evidence of dyserythropoiesis like-
Basophilic stippling
Cabot ring
Howell- Jolly bodies
↓ Hb
↓ Hematocrit
Reticulocyte count – Normal or mild decrease
White cells- Leucopenia
Hypersegmented neutrophils/ Macropolycytes- First manifestation
↓ Platelets
Pancytopenia (10-20%)
Lab investigations:
Serum iron, ferritin - ↑ in pure VitB12/ Folate defect
Serum bilirubin & LDH ↑- due to hemolytic component
Schillings test: Used to assess status of intrinsic factor (IF) & Vit B12 to distinguish pernicious anemia from other causes of Vit.B12 deficiency.
Moderate- marked hypercellularity
Erythroid hyperplasia
M:E ratio reversal
Erthropoiesis- Megaloblastic
Giant metamyelocytes
Mildly reduced megakaryocytes
BM iron moderately increased in pure Vit B12/ Folate defects.
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Heroin is a semi synthetic derivative of opium. Withdrawal symptoms are lacrimation, sweating, yawning,anxiety,restlessness, rhinorrhoea and tremors seen 8-12 hours after last dose. All the other drugs donot have the above set of side effects. Ref: KD Tripathi 8th ed.
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Depersonalization / Derealisation is a type of dissociative disorder where patient feels detached from himself and world. He feels as if he is an external observer of his body.
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Ans. is c, i.e. Endometrial cultureRef: Williams Gynae 1st/ed, p420; Leon Speroff 7th/ed, p419Asherman's syndrome:* It is an acquired uterine defect characterized by the presence of uterine synechiaes and subsequent destruction of the lining endometrium.* M/C cause for asherman syndrome -Postpartum curettage* 2nd M/C cause - curettage done for MTP* Other causes - uterine surgery like cesarean section, myomectomy, Sheehan's syndrome* Infectious causes - TB, Schistosomiasis* Most characteristic symptom = Hypomenorrhea (scanty bleeding <20ml or <2 days) or 2deg amenorrhea* Others - Infertility* Abortion* Diagnosis: ... Williams Gynae 1st/ed, p420-l* When Asherman syndrome is suspected, HSG is indicated. Intrauterine adhesions, characteristically appear as irregular, angulated filling defects within the uterine cavity.* At times, uterine polyps, leiomyomas, air bubbles and blood clots may masquerade as adhesions.* Transvaginal USG or saline infusion sonography may help clarify these difficult cases.* A definitive diagnosis requires hysteroscopy. (Investigation of choice)Treatment:* Adhesiolysis via hysteroscopy.* Placement of an intrauterine device or Pediatric foley's catheter with the bulb filled with 3ml of fluid, to avoid contact between the ends of the adhesions.* Treatment with estrogen to stimulate endometrial growth. (Since estrogen alone can lead to endometrial, cancer. Estrogen and progesterone should be given together).Prognosis:* Approximately 70-80% of patients with this condition have achieved successful pregnancy. But pregnancy can be complicated by premature labor, placenta accreta, placenta previa and/or PPH.* Recurrence rate is high.
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Presence of uniocular diplopia together with the finding of the golden crescent on oblique illumination (edge of subluxated lens) or black crecent line on coaxial illumination (edge of subluxated lens) suggests a diagnosis of `subluxation' of the crystalline lens. Ectopic lens refers to the displacement of shows lens from its normal position (subluxation, dislocation).
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This female patient's symptoms are classic for a primary elevation of ACTH (Cushing's Disease). Exogenous steroids would produce similar symptoms, except that circulating ACTH would be low because of negative feedback suppression at both hypothalamic (CRF) and anterior pituitary levels (ACTH). Addison's Disease is caused by glucocoicoid deficiency, not excess. Hypophysectomy would lead to a decrease in ACTH or remove the source of it.
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Achondroplasia
Trident hand
Champagne glass pelvic inlet
Bullet vertebra.
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Screening of all blood donations should be mandatory for the following infections and using the following markers:
HIV-1 and HIV-2: Screening for either a combination of HIV antigen-antibody or HIV antibodies.
Hepatitis B: Screening for hepatitis B surface antigen (HBsAg).
Hepatitis C: Screening for either a combination of HCV antigen-antibody or HCV antibodies.
Syphilis (Treponema pallidum): Screening for specific treponemal antibodies.
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In immediate hypersensitivity (type I hypersensitivity), the injury is caused by TH2 cells, IgE antibodies, and mast cells and other leukocytes Mast cells release mediators that act on vessels and smooth muscle and proinflammatory cytokines that recruit inflammatory cells. In antibody-mediated disorders (type II hypersensitivity), secreted IgG and IgM antibodies injure cells by promoting their phagocytosis or lysis and injure tissues by inducing inflammation In immune complex-mediated disorders (type III hypersensitivity), IgG and IgM antibodies bind antigens usually in the circulation, and the antigen-antibody complexes deposit in tissues and induce inflammation In cell-mediated immune disorders (type IV hypersensitivity), sensitized T lymphocytes (TH1 and TH17 cells and CTLs) are the cause of the tissue injury ref robbins pathology 9th ed page 201
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C3 def can lead to recurrent pyogenic infections C1 inhibitor deficiency can lead to hereditary angioneurotic edema Ref: Textbook of Microbiology Baveja 5th ed Pg 125
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Subpoena/ summons is a document compelling the attendance of a witness in a cou of law, under penalty, on a paicular day, time and place for the purpose of giving evidence. Sec. 61-69 CrPC deals with the summons. A subpoena can be of two types: i. Subpoena duces tecum: Person is required to bring ceain documents or other evidence to the cou (usually the postmoem or the medico-legal repo) specified in the subpoena. ii. Subpoena ad testificandum: Requires the individual to testify before the cou ref - <a href="
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Typical Neisseria are gram-negative diplococci. Neisseria gonorrhoeae contain pili, hair-like appendages that may be several micrometers long. They enhance attachment of the organism to mucous membranes, helping to make the organism more resistant to phagocytosis by WBCs. Gonococci isolated from clinical specimens produce small colonies containing piliated bacteria. Capsules appear to be less important in gonococcal infection than N. meningitidis infections. Flagella, peptidoglycan, LPS, and F pili do not significantly relate to pathogenesis, other than that LPS (endotoxin) release may become significant later in infection.N. gonorrhoeae showing pili and the three layers of the cell envelope
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Hypokalemic periodic paralysis is a familial condition caused by missense mutations of voltage sensor domains within L-type calcium channels or the skeletal Na+ channel. Must know: Thyrotoxic Periodic Paralysis: Redistributive hypokalemia occurs in the setting of hypehyroidism. It can cause periodic attacks of hypokalemic paralysis - (TPP). Patients typically present with weakness of the extremities and limb girdles. Paralytic episodes occur most frequently between 1 and 6 a.m. Signs and symptoms of hypehyroidism are usually not seen. Ref: Harrison, Edition-18, page- 352.
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The common site of relapse of ALL → i) Bone marrow (most common - 20%), ii) CNS (5%) iii) Testis (3%)
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In hydrocution (immersion syndrome / submersion inhibition) death occurs as a result of cardiac arrest which in turn is due to vagal inhibition of the hea. The cold water may stimulate nerve endings on the body surface, ear drum, nasal passage, larynx etc. leading to vagal stimulation resulting in cardiac death. Ref: Essentials of Forensic Medicine and Toxicology By Dr.K S Narayan Reddy, 21st Edition, Page 313
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Ref: KDT 6/e p444 'Weight gain ( not weight loss) in seen with TCAs.
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Percussion is one of the oldest pulp vitality tests used because it requires no armamentarium. Generally, patients who have a tooth sensitive to mastication have already percussed the tooth in question with their own finger tip(s) and informed the dentist which teeth are sensitive. Percussion is an indirect means of testing pulp vitality because teeth that are sensitive to percussion often have existing periapical lesions associated with a necrotic pulp. However, this is not always the case, and false positives can result if the clinician is evaluating a cracked tooth or a ‘‘high’’ restoration. If a crack has developed in the crown of a tooth with a vital pulp, the tooth can still be exquisitely sensitive, because of the crown segments, moving microscopically causes pain due to the movement of fluid in the odontoblastic tubules. The tooth is sensitive to thermal stimuli as the pulp is vital. These mutually exclusive diagnostic findings, pain to percussion/mastication and thermal sensitivity, are pathognomonic for a cracked tooth.
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In aging or debilitating diseases the phospholipid end-products of membrane damage mediated by oxygen free radicals to get eliminated by intracellular lipid peroxidation. These, therefore, persist as collections of indigestible material in the lysosomes; thus lipofuscin is an example of residual bodies. Ref: Textbook of Pathology HARSH MOHAN 7th Edition page no.25
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The prevention of legionellosis involves minimizing production of aerosols in public places from water that may be contaminated with Legionella. Prevention is complicated by the fact that, compared with other environmental bacteria, Legionella bacteria are relatively resistant to chlorine and heat. The bacteria have been isolated from hot water tanks held at over 50degC. Methods for decontaminating water systems are still under evaluation. Some outbreaks have been aboed by hyperchlorination, by correcting malfunctions in water systems, or by temporarily elevating the system temperature above 70degC. The installation of silver and copper ionization systems similar to those used in large swimming pools has been effective as a last reso in hospitals plagued with recurrent nosocomial legionellosis. Ref: Ray C.G., Ryan K.J. (2010). Chapter 34. Legionella. In C.G. Ray, K.J. Ryan (Eds), Sherris Medical Microbiology, 5e.
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Ans. is 'b' i.e., WPW syndrome o In WPW, the bundle of Kent is an accessory pathway which allows fast conduction to the ventricles and consequently leads to complaints of palpitations and reduction of PR interval.PR interval has an inverse relation with heart rateo All other options are characterized by bradycardia therefor PR interval increased.
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Loco Parentis: In an emergency involving children, when parents or guardians are not available, consent is taken from the person in charge of the child. Paternalism: Is an abuse of medical knowledge so as to disto the doctor-patient relationship in such a way that the patient is deprived of his autonomy, or his ability to make a rational choice. Vicarious liability (Liability for act of another): An employer is responsible not only for his own negligence but also for the negligence for his employees. Novus Actus Interveniens: A person is responsible not only for his actions, but also for the logical consequences of those actions. This principle applies to cases of assault and accidental injury. Ref: The Essentials of Forensic Medicine and Toxicology 29th Ed Page 45.
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ref : maheswari 9th ed
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Monochorionic pregnancies have dividing membrane that is 2 layer thick. Monozygous twins can be dichorionic as well.
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During post disaster phase, All vaccines are contraindicated especially typhoid, cholera and tetanus toxoid. (except measles) Whereas post disaster, typhoid, cholera and tetanus toxoid are mandatory in health workers.
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“The most common virus causing sporadic cases of encephalitis in immunocompetant adult are HSV-1, VZV, EBV and less commonly enterovirus.”
Remember: Epidemic of encephalitis are caused by Arbovirus which include:
Alphaviruses
Toga viruses
Bunyaviruses
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Ans) a (Hallucination) Ref Ahuja 6/E page 59Perception of objects without stimulus is hallucination.Delusion-Are false unshakable beliefs which are not in keeping with the patients sociocultural and educational background and not amenable to reasoningIt is a disorder of thoughtTypes of delusions in the following conditionDepression - nihilistic delusionDelirium - transient delusionSchizophrenia - delusion of persecution/ reference/control/infidelityMania - delusion of grandeurNote:delusions are not seen in compulsive disorder, anxiety and dementiaHallucinationsFalse perception experienced without external stimulus to the sense organsAuditory hallucinations are the commonest in non organic psychiatric disordersVisual hallucinations are commonest in organic psychiatric disordersHallucinations is involuntary, does not depend on will of observerIt occurs in inner subjective spaceIt is vivid sensory perceptionIllusionsIllusions are misconceptions of external stimuli
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Popliteus has an intracapsular origin from the lateral femoral epicondyle. It inses on the posterior surface of the tibia, just proximal to the soleal line. Popliteus tendon is intracapsular but Extra-aicular and Extra-synol. Tendon of Long head of Biceps brachii is intracapsular and intra-aicular but extra-synol.
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Ans. (b) Organophosphate poisoningRef Katzung Pharamacology 10th ed. Ch 7* In organophosphate poisoning, the organophosphate cholinesterase inhibitors are well absorbed from the skin, lung, gut, and conjunctiva--thereby making them dangerous to humans and highly effective as insecticides.* These organophosphates irreversibly block acetylcholine esterase enzyme, thereby increasing the acetylcholine level.* The patient therefore will present with cholinergic symptoms: (Mn: SLUDGE)* Salivation, Lacrimation, increased urination, Diarreha, GI distress, Emesis* DOC for this poisoning: ATROPINEAlso Know* OXIMES (Pralidoximes, Di-Acetyl monoxime) are known as AchE enzyme reactivators. These are used only in organophosphate poisoning.Pin-point pupil is seen in poisoning with: (Mn: POMP)* Pontine hemorrhage, Organophosphate, Morphine and Phenol poisoning
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Monospot test is also known as Paul Bunnel test.
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b. Type 7(Ref: Nelson's 20/e p, Ghai 8/e p 200-201)Quadrivalent HPV vaccine contains serotypes 16, 18, 6 & 11 with aluminium containing adjuvant.
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The answer is D: Reactive oxygen species. Ischemia/reperfusion (I/R) injury is a common clinical problem that arises in the setting of occlusive cardiovascular disease, infection, transplantation, shock, and many other circumstances. The genesis of I/R injury relates to the interplay between transient ischemia and the re-establishment of blood flow (reperfusion) Initially, ischemia produces a type of cellular damage that leads to the generation of free radical species. Subsequently, reperfusion provides abundant molecular oxygen (O2 ) to combine with free radicals to form reactive oxygen species Oxygen radicals are formed inside cells through the xanthine oxidase pathway and released from activated neutrophils.Diagnosis: Myocardial infarction Ischemia/reperfusion (I/R) injury IN hea causeCONTRACTION BAND NECROSIS a.Hemorrhage and contraction bands, visible as prominent hypereosinophilic cross-striations spanning myofibers are seen microscopically.
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Testicular descent through the inguinal canal is controlled in pa by Leydig cell production of insulin-like factor 3 (INSL3), which acts a receptor termed GREAT ( G protein-coupled receptor affecting testis descent). Ref Harrison 20th edi page no 2769
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Antipsychotic drugs Extrapyramidal symptoms- dur to D2 blockade in limbic system Extrapyramidal symptoms Clinical features Special DOC Acute dystonia Oculogyric crisis ocular muscles spasm and opisthotonos Toicollis Protrusion of tongue leading to laryngospasm Grimacing Earliest to develop (days) Anticholinergic drugs Acute akathisia Constant purposeless involuntary movement from one place to another Most common EPS Days to week Propranolol Tardive dyskinesia chewing and sucking movements Grimacing Choreoathetoid movements Akathisia Seen after long(years) use of anti-psychotic Tetrabenazine Malignant neuroleptic syndrome Fluctuating level of consciousness Hypehermia -muscles rigidity Increase level of CPK Increase level of liver enzyme Confusion Diaphoresis Most common cause of death in this syndrome is acute renal failure Most serious side effect dantrolene DRUG induced parkinsonism Few weeks anticholinergics
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Ans. Doctor-cou
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Dinitrophenol is an uncoupling agent, that disconnects electron transport from phosphorylation and generates lot of heat at the cost of ATP. Other options are inhibitors of electron transport chain.
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(A) Naloxone # Typical syndrome, which includes shallow and slow respirations, pupillary miosis (with mydriasis once brain anoxia develops), bradycardia, hypothermia, and stupor or coma is seen in Opioid Toxicity and Overdosage.> If not treated rapidly, respiratory depression, cardiorespiratory arrest, and death can ensue.> The first step in managing overdose is to support vital signs, using intubation if needed. Definitive treatment is the administration of a narcotic antagonist such as 0.4 mg to 2 mg intravenous or intramuscular naloxone.
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CRISPR is acronym for clustered regularly interspaced short palindromic repeats.
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The curve is shifted downward and to the right (compliance is decreased) by pulmonary edema and interstitial pulmonary fibrosis. Pulmonary fibrosis is a progressive restrictive airway disease in which there are stiffening and scarring of the lung. The curve is shifted upward and to the left (compliance is increased) in emphysema. Reference: Ganong's Review of Medical Physiology; 25th edition; Page no: 630
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The most common location of a Meckel's is the terminal ileum usually located 45-90 cm from the ileocecal valve.The location on the antimesenteric border is normal and is not an indication for surgical resection. Also Know:The most common complication from Meckel's diveiculum is bleeding secondary to ulceration of the heterotopic gastric tissue. It is the most commonly encountered diveiculum of the small intestines and represents a true diveiculum. It is the direct result of persistence of the omphalomesenteric duct. Technetium scans can be used to identify diveicula with heterotopic gastric tissue. Acute diveiculitis although not the most common presentation can mimic acute appendicitis clinically. There is much controversy about the treatment of an incidentally found Meckel's diveiculum. The general principles are that it should be removed if there is evidence of heterotopic tissue and/or there is a narrowed neck. Other relative indications include unexplained abdominal symptoms and evidence of prior inflammation. Ref: Tavakkolizadeh A., Whang E.E., Ashley S.W., Zinner M.J. (2010). Chapter 28. Small Intestine. In F.C. Brunicardi, D.K. Andersen, T.R. Billiar, D.L. Dunn, J.G. Hunter, J.B. Matthews, R.E. Pollock (Eds), Schwaz's Principles of Surgery, 9e.
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Ans. is `B' i.e., Supraclavicular Brachial plexus block This is the second most commonly practised block after central neuraxial block (spinal & epidural anaesthesia). Brachial plexus block is used for upper limb surgeries. Brachial plexus can be blocked by 4 approaches : - 1. Interscalene approach Brachial plexus is blocked between anterior and middle scalene. This approach is not used routinely due to close proximity of vital structures. Ulnar nerve is usually spared by this approach because injection is given in close proximity of upper nerve roots and inferior nerve roots (C8-T 1) may be spared. This technique provides excellent anaesthesia and analgesia for shoulder and upper arm procedures. (in contrast to other three approaches which do not provide adequate shoulder anaesthesia). Complications include Horner syndrome (due to stellate ganglion block), phrenic nerve block, intravascular injection into carotids and epidural or intrathecal injections. 2. Supraclavicular approach This is the most commonly used approach. It involves the injection of local anaesthetic in close proximity to the trunks of the brachial plexus by inseing the needle lateral to subclan vessels. The supraclavicular block is performed where the brachial plexus is most compact, consequently, it produces reliable and rapid onset anaesthesia and is paicularly useful in a fast paced ambulatory surgery centre. Pneumothorax is the most common complication. Other complications include phrenic nerve block, intravascular injection in subclan aery or vein, Horner syndrome, hematoma formation. 3. Infra-clavicular approach Infraclavicular block involves the injection of local anaesthetic in close proximity of cords of the brachial plexus. The axillary nerve may be spared as this nerve exits the brachial plexus sheath proximal to the level of infraclavicular block. 4. Axillary approach Axillary block involves the injection of local anaesthetic in close proximity of terminal branches of the brachial plexus. The major disadvantage of this approach is that mucocutaneous and intercostobrachial nerves are spared. So arm surgery cannot be performed. In contrast to interscalene approach, most intense block occur in (C7-T1) ulnar dermatomes and least in C5-C6 dermatomes.
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Ans. is 'c' i.e., Hypoglycemia Problems of full term small for date infants (IUGR) o Bih asphyxia o Hypoglycemia o Hypocalcemia o Meconium aspiration syndrome o Infections o Hypothermia o Polycythemia & Hyperviscocity
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Ans. is 'b' i.e., Occurs immediately after death Cadaveric spasm (instantaneous rigor or cataleptic rigidity)o Instantaneous rigor is defined as the condition wherein a group of muscles, which were in contracted state at the time of death, continue to be in spasm after death, without the stage of primary relaxation. It develops immediately after death. Therefore, this stage preserves the attitude of the person at the time of death.o Cadaveric spasm affects voluntary muscles and is limited to single group of muscles.o It tells the mode of death, suicide/homicide.o Preconditions for cadaveric spasm are :1) Sudden somatic death (no molecular death)2) A group of muscles in contraction, i.e. physical activity at the time of death.3) Extensive emotional activity at the time of death, e.g. excitement, fear etc.
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Erythema annulare centrifugum (EAC) Epidemiology :- * Peaks in fifth decade Pathogenesis:- * Unknown, but may be an immune reaction to an antigen such as infection (e.g., tinea pedis, other dermatophyte infections, other fungi, viruses, and parasites), drug, pregnancy, and neoplasms (usually lymphoproliferative malignancies) Clinical features :- * Sta as firm pink papule - erythematous annular lesions that migrate centrifugally (outward; up to 6 cm diameter in 2 weeks). * Trailing scale (inner margin desquamation) is common in superficial lesions, but not deep lesions. * Most commonly on thighs/hips, but can become more generalized. Histopathology :- * Superficial EAC: mild spongiosis, focal parakeratosis, and perivascular lymphohistiocytic infiltration, which is tight and dense ("coat sleeve") * Deep EAC: deep and tight perivascular lymphohistiocytic inflammation Treatment :- * Treat underlying disorder if present; otherwise topical steroids Prognosis/clinical course :- * Lesions last days to month. Ref:- Review of Dermatology by Alikhan; pg num:-148
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-Vitamin C plays the role of a coenzyme in hydroxylation of proline and lysine while protocollagen is converted to collagen (i.e. post-translational modification). The hydroxylation reaction is catalysed by lysyl hydroxylase (for lysine) and prolyl hydroxylase (for proline).
-Hydroxylation of glycine is carried out by peptidylglycine hydroxylase which requires vitamin C.
-Ascorbic acid is required for the oxidation of p-hydroxy phenylpyruvate (enzyme hydroxylase) to homogentisic acid in tyrosine metabolism.
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