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Ans. is `c' i.e. Parvovirus
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Media which are used for the cultivation of Mycobacterium tuberculosis are LJ media which is most common media used in which growth is seen in 6 to 8 weeks and the colonies are Rough, Buff and tough. The other media used car door fitting media Petragnini media, Saula media, Dubois media or Middlebrook's media. Note-Extra edge M . tuberculosis M. bovis Rough , buff and tough colonies on LJ media Flat , moist and smooth colonies on LJ media Aerobic Microaerophile Shows glycerol and niacin enhancement No such enhancement
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Ans. is d, i.e. Umbilical cordRef. Williams Obs. 22/e, p 68, 69; 23/e, p 61, 62; 23/e, p 61, 62Here are few named structures frequently asked and the organ/structure where it is found.Named structureSeen in* Nitabuch's layerIt is the zone of fibroid degeneration where trophoblast and decidua meet. Seen in basal plate of placenta.* Hofbauer cellsPhagocytic cell seen in connective tissue of chorionic villi of placenta.* Folds of HobokenUmbilical arteries* Wharton's jellyConnective tissue of umbilical cord* Peg cellsFallopian tube* Langhans cellsCytotrophoblast
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Aspiration of sperms from testes is done in Testicular sperm aspiration(TESA). In this technique, an aspiration needle is inseed percutaneously to the testis parenchyma to aspirate fluid or small pieces of seminiferous tubules to obtain sperm. Ref: Feility Cryopreservation By Ri-Cheng Chian, Page 52-3; Feility Preservation: Emerging Technologies and Clinical Applications By Emre Seli, page 305.
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Ans. (a) CaExocytosis is a calcium dependent process where in the cellular contents are moved out of the cell in the form of vesicles (Cell Vomiting)
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Duration of cardiac cycle (at hea rate of 75/min) is 0.80sec. Out of which duration of systole is 0.27sec and diastole is 0.53sec.
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Because the number of growing follicles is correlated to the size of the primordial follicle pool size, a marker such as antimullerian hormone (AMH) or mullerian-inhibiting substance that reflects all follicles that have made the transition from the primordial follicle pool to the growing pool has been proposed to be a good indirect marker of ovarian reserve. FSH and inhibin B levels have also been proposed to serve as predictors of the ovarian reserve. Ref: Molina P.E. (2013). Chapter 9. Female Reproductive System. In P.E. Molina (Ed), Endocrine Physiology, 4e.
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Ans. is 'd' i.e., Disorder of phagocytosis Jobs syndrome is defect in phagocytic function. It is characterized by cold staphylococcal abscess, atopic eczema, otitis media; serum immunoglobulins are normal except IgE that is elevated
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The clavipectoral fascia is a thick sheet of connective tissue that connects the clavicle to the floor of the axilla. It encloses the subclavius and pectoralis minor muscles and spans the gap between them. Impoant structures that pass between the subclavius and pectoralis minor muscles include,Cephalic veinThoraco-acromial aeryLateral pectoral nerve The lateral thoracic aery leaves the axilla by passing through the fascia inferior to the pectoralis minor muscle.
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A i.e. Diazepam; B i.e. Scopolamine; C i.e. Morphine
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Aortic coarctation is common, accounting for 6% of all cases of congenital heart disease. Coarctation usually occurs in the thoracic portion of the descending aorta, distal to the takeoff of the left subclavian artery at the site of the ductus arteriosus. The incidence of a bicuspid aortic valve in association with coarctation is 80% to -85%. The cardinal physical finding is diminution or absence of femoral pulses and hypertension in the upper extremities. Notching or scalloping of the ribs caused by marked enlargement of the intercostal collaterals can be seen on X-ray. None of the other choices exhibit these characteristics. Aortic valve stenosis (choice A) does not present with hypertension in the upper extremities.Diagnosis: Coarctation of aorta
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Cysticercus cellulosae is the larval form of Taenia solium. It is found in the tissues of the intermediate host, pig. However, it can also be found in human tissues in cysticercosis. Cysticercosis is usually acquired by eating food or drinking water contaminated by tapeworm eggs from humanfeces or by autoinfection.
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Ans is 'b' ie Ascending infection through biliary tract "Along with cryptogenic infections, infections from the biliary tree are presently the most common identifiable cause of hepatic abscess. Biliary obstruction results in bile stasis, with the potential for subsequent bacterial colonization, infection and ascension into the liver. This process is k/a ascending suppurative cholangitis. The nature of biliary obstruction is mostly related to stone disease or malignancy. In Asia, intrahepatic stones and cholangitis (recurrent pyogenic cholangitis) are a common cause, whereas in the Western world, malignant obstruction is becoming a more predominant factor" - SabistonRoutes of infection to liver:along the bile ducts (MC)* stone impacted in CBDstricture of CBD - benign, malignantCryptogenicvia the portal veinvia the hepatic arteryby direct extension from a subdiaphragmatic abscess from an empyema in chest from suppurative cholecystitis from perinephric abscessPenetrating or blunt traumaAlso know:MC organisms (Ref. Sabiston, Schwartz)Escherichia coli Klebsiella pneumonia
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The reading of the genetic code during the process of protein synthesis does not involve any overlap of codons. Thus, the genetic code is nonoverlapping. Features of the Genetic Code: Degenerate Unambiguous Nonoverlapping Not punctuated Universal Ref: Weil P. (2011). Chapter 37. Protein Synthesis & the Genetic Code. In D.A. Bender, K.M. Botham, P.A. Weil, P.J. Kennelly, R.K. Murray, V.W. Rodwell (Eds), Harper's Illustrated Biochemistry, 29e.
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The herpesvirus has double-stranded linear DNA, which is unusual because it has terminal and internal repeated sequences. The DNA of some of its members (e.g., herpes simplex viruses) can undergo genetic rearrangement, which results in four different genomic isomers. In an isomer, there is the same molecular formula but different arrangement. The DNA of herpesviruses is large (molecular weight = 90-150 x 106), encoding at least 100 proteins. There is little sequence homology in the DNA among the various members of the family (30% to 50%), Except between herpes simplex virus types 1 and 2 and between human herpes 6 and 7. Morphologically, however, they are indistinguishable. The nucleocapsid of herpesviruses has icosahedral symmetry. The lipid envelope, which is derived from the nuclear membrane of the infected cell during budding, contains viral glycoproteins. The area between the capsid and the envelope is the tegument, and it contains several viral proteins. Poxviruses have double-stranded, linear DNA. Rabies viruses, ohomyxoviruses (influenza), and retroviruses have single-stranded, linear RNA. Ref : Ananthanarayana textbook of Microbiology 9th edition Pgno : 467
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Treatment of multiple carboxylase or biotinidase deficiency is biotin.Oral dose is 10-40 mg/kg/day Reference:Essential pediatrics-Ghai,8th edition,page no:650
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Niemann-Pick diseases are genetic diseases which are classified in a subgroup of LSDs called sphingolipidoses or lipid storage disorders in which harmful quantities of fatty substances, or lipids, accumulate in the spleen, liver, lungs, bone marrow, and brain.In the classic infantile type A variant, a missense mutation causes complete deficiency of sphingomyelinase. Sphingomyelin is a component of cell membrane including the organellar membrane and so the enzyme deficiency blocks degradation of lipid, resulting in the accumulation of sphingomyelin within lysosomes in the macrophage-monocyte phagocyte lineage.Histology demonstrates lipid laden macrophages in the marrow, as well as "sea-blue histiocytes" on pathology.
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The orbit appears as quadrangular pyramid in shape, i.e. Resembles a four-sided pyramid, which has an apex, base, four walls - roof, floor, medial and lateral walls.
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Indications of tracheostomy: 1- Upper respiratory tract obstruction; Laryngeal, supralaryngeal ,and tracheal causes.( Causes of stridor ) 2- Lower respiratory tract obstruction: (Secretory obstruction, Wet lung syndrome). ref: hazarika 4th ed
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Toll-like receptors * TLRs in humans recognize PAMPS (pathogen associated molecular pattern) and are usually expressed on APCs. * Interaction between TLRs on APCs and PAMPS on pathogens activation of APCs and presentation of pathogen-derived antigen to T-cells forms a link between the innate and adaptive immune systems. * Activation of TLRs phagocytosis of the pathogen followed by activation of a proinflammatory environment with secretion of cytokines and chemokines. Ref:- Review of Dermatology by Alikhan; pg num:-17,19
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Ans. D i.e. Clinical examination, Mammogram & FNAC
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Fluid and electrolyte replacement is central to the treatment of diarrheal illnesses. Indications for therapy include high fever, bloody diarrhea, severe diarrhea, persistence for >1 week, and worsening of symptoms. A 5- to 7-day course of erythromycin (250 mg orally four times daily or--for children--30-50 mg/kg per day, in divided doses) is the regimen of choice. Both clinical trials and in vitro susceptibility testing indicate that other macrolides, including azithromycin (a 1- or 3-day regimen), also are useful therapeutic agents. An alternative regimen for adults is ciprofloxacin (500 mg orally twice daily) or another fluoroquinolone for 5-7 days, (Harrison's Principles of internal medicine, 20 th edition, page 1288)
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Nodular lesions of diabetic glomerulosclerosis are also called as Kimmelstiel- Wilson (KW) lesions or intercapillary glomerulosclerosis. These lesions are specific for type 1 diabetes (juvenile onset diabetes) or islet cell antibody-positive diabetes mellitus. The pathologic changes consist of one or more nodules in a few or many glomeruli. the nodule is an ovoid or spherical, laminated, hyaline, acellular mass located within a lobule of the glomerulus. Ref: Harsh Mohan textbook of pathology 6th edition page678
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Ans. is 'c' i.e., Neonatal jaundice Phenobarbitone* Phenobarbitone is a long acting barbiturate.* Barbiturates induce several hepatic microsomal enzymes and increase the rate of metabolism of other drugs.* This property of phenobarbitone can be used as an adjuvant in treatment of neonatal jaundice.* In cases of unconjugated hyperbilirubinemia, phenobarbitone induces liver microsomal enzymes, which convert it into conjugated bilirubin and is excreted in urine. Thus it can be used in cases of neonatal jaundice.Other Uses of Phenobarbitone* Phenobarbitone is one of the cheapest and least toxic antiepileptics.* It has broad spectrum efficacy in generalized tonic - clonic (GTC), simple partial (SP) and complex partial (CP) seizures.* However, it has become less popular than carbamazepine, phenytoin or valproate.* Status epilepticus: Phenobarbitone may be injected im or i.v but response is slow to develop.* It is not effective in absence seizures.
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Digoxin is eliminated mainly via excretion through kidney whereas digitoxin is metabolized by the liver. The dose of digoxin, therefore, does not require an adjustment in hepatic failure whereas it has to be reduced in renal failure. The arrhythmogenic dose of digitalis is reduced in MI. It should be used after MI only when CHF is accompanied with AF and rapid ventricular rate.
Hypokalemia, hypomagnesemia and hypercalcemia predisposes to digitalis toxicity.
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(Refer: AK Khurana Comprehensive Ophthalmology, 6th edition, pg no. 381) Fasanella-Servat operation: It is performed in cases having mild ptosis (1.5-2mm) and good levator function. In it, upper lid is eveed and the upper tarsal border along with its attached Muller's muscle and conjunctiva are resected. Fasanella Servat procedure. 4-0 silk suture is placed through the eyelid margin for a traction suture. The eyelid is eveed over a Desmarres retractor. Additional local anesthesia is placed transconjunctivally. It is determined that a 3 mm tarsal resection and a 3 mm conjunctival and mullers muscle resection will be performed. These marks are made with the monopolar cautery corresponding to the central third of the eyelid. Tooth forceps are then used to grasp the superior border of the tarsus. A 4-0 silk traction suture is then placed at the superior boarder of the tarsus in a locking running fashion. The traction suture then holds the eyelid in position and in this case curved hemostats are used to clamp at the previous markings on the tarsus. A Putterman clamp can be used here as well which is probably more efficient. A 6-0 chromic suture is then placed in a running mattress fashion on the other side of the curved hemostats. This suture is placed across the eyelid and then turned around to complete the passes. There is significant discussion around the most appropriate suture to use as well as whether to place these sutures transcutaneous. The 15 blade is then used to make metal on metal contact with the curved hemostats to excise the tissue. The tissue is removed and the suture is tied. Since the knot is on the inside of the eyelid, a contact lens will be placed later. Inspection of the resected tissues shows the tarsus as well as the conjunctiva and mullers muscle. Measurement of this shows an approximate height of 6-7 mm. The contact lens is placed, the traction sutures are removed, and antibiotic drops are placed into the eye. Ref khurana 6th edition pg 344
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RBCs shape and size malaria: P. vivex - Enlarged, Round and Bizarre form P. falciparum - Normal in size P. malariae - Normal in size P. ovale - Enlarged, Oval and Fimbriated margin Relapse: Seen in P. vivax and P. ovale Recrudescence: Seen in P. falciparum and P. malariae infections Definitive host: Female Anopheles mosquitoes (not male anopheles) Intermediate host: Man. Rod forms are seen in P. falciparm not in P. malaiae
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Ans. is 'a' i.e., Gene expe GeneXpe MTB/RIF The Xpe MTB/RIF detects DNA sequences specific for Mycobacterium tuberculosis and rifampicin resistance by polymerase chain reaction. It is based on the Cepheid GeneXpe system, a platform for rapid and simple-to-use nucleic acid amplification tests (NAAT). The Xpe MTB/RIF purifies and concentrates Mycobacterium tuberculosis bacilli from sputum samples, isolates genomic material form the captured bacteria by sonication and subsequently amplifies the genomic DNA by PCR. The process identifies all the clinically relevant rifampicin resistance inducing mutations in the RNA polymerase beta (rpoB) gene in the mycobacterium tuberculosis genome in a real time format using fluorescent probes called molecular beacons. Results are obtained from unprocessed sputum samples in 90 minutes, with minimal biohazard and very little technical training required to operate.
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Ans. is 'c' i.e., Mid - arm circumference
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Ans. is b, i.e. Anthropoid pelvisRef. Dutta Obs. 9/e, p 325, Table 24.1, 8/e, p 403, Table 24.2As discussed in the text in Table 7.2 face-to-pubis delivery is common in anthropoid pelvis.
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Ehlers-Danlos syndromes are characterized by defects in collagen (i.e., connective tissues).
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Ref: Grays Anatomy, 40th ed., Dhingra PL. s ENTExplanation:BOUNDARIESThe laryngopharynx is situated behind the entire length of the larynx (known clinically as the hypopharynx) and extends from the superior border of the epiglottis, w'here it is delineated from the oropharynx by the lateral glossoepiglottic folds, to the inferior border of the cricoid cartilage, where it becomes continuous with the oesophagus.The laryngeal inlet lies in the upper part of its incomplete anterior wall, and the posterior surfaces of the arytenoid and cricoid cartilages lie below this opening.Pyriform fossaA small pyriform fossa lies on each side of the laryngeal inlet, bounded medially by the aryepiglottic fold and laterally by the thyroid cartilage and thyrohyoid membrane.Branches of the internal laryngeal nerve lie beneath its mucous membrane.At rest, the laryngopharynx extends posteriorly from the low:er part of the third cervical vertebral body to the upper part of the sixth.During deglutition it may be elevated considerably by the hyoid elevators.Inlet of larynxThe obliquely sloping inlet of the larynx lies in the anterior part of the laryngopharynx and is bounded above by the epiglottis, below by the arytenoid cartilages of the larynx, and laterally by the aryepiglottic folds,Below the inlet, the anterior wall of the laryngopharynx is formed by the posterior surface of the cricoid cartilageThe hypopharynx is clinically subdivided into three regions: the pyriform sinus. Post cricoids region, and posterior pharyngeal wall.Pyriform fossae are smooth depressions on either side of the larynx, acting as passages that guide swallowed food into the esophagus avoiding the larynx.Sensory innervations to pyriform sinus is internal laryngeal nerveMost common foreign body to get impacted in pyriform sinus is fish boneThe postericoid region is the part of the hypopharynx directly behind the cricoid cartilage. Cancers often occur in the hypopharynx.Carcinoma in the region of pyriform sinus remains silent until it reaches cervical group of lymph nodes.
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Fluoxetine is a selective serotonin Reuptake Inhibitor (SSRI) and SSRIs have shown the greatest efficiency in PMS treatment. Premenstrual syndrome (PMS), also called Premenstrual Tension (PMT), is a symptom complex, recognised primarily by cyclic changes, associated with ovulatory cycles. It occurs 7 to 14 days prior to menstruation and spontaneously resolves after menses. It always occurs in the luteal phase of the cycle. Symptoms include: Pain: Headache, breastpain, abdominal cramps, muscle stiffness, backache and generalise body ache. Water retention: Breast volume increase, bloating and weight gain. Behavioural changes: Low performance, difficulty in concentration, irritability, depression, forgetfulness, low judgement, anxiety, loneliness, feeling like crying, hostility, increased appetite and cravings and sleeplessness. Autonomic changes: Dizziness, faintness, nausea, vomiting and hot flushes Treatment: Psychosomatic symptoms: SSRIs, Vitamin B1, B6 and E Breast pain: Danazol, Bromocriptine and GnRH analogues Pelvic pain and bloatedness: OCP and Mirena IUCD General measures: Excercise, relaxation and hobbies like Meditation and Yoga Ref: Shaw&;s textbook of Gynaecology 17th edition PGno: 127
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Patient suffers from Urinary tract infection, Dapagliflozin is the causative drug here. Dapagliflozin It is a sodium-glucose co-transpoer-2 inhibitor Improve glycemic control by inhibiting glucose Inhibit glucose reabsorption in the proximal tubule of the nephron | result in Glucosuria | result in urinary tract infections(High glucose concentration in the urine can provide a rich source of nutrients for bacteria. Therefore, bacteria can multiply and make foundation for infection) S/E: UTI Dehydation Polyuria Exacerbate tendency to hyperkalemia and DKA
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Ans. is 'c' i.e., Distal fragment In distal third shaft fracture or supracondylar femur fracture, the distal fragment is tilted backward due to strong gastrocnemius pull. This posteriorly tilted distal fragment can cause popliteal aery injury.
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D i.e. Transverse perenii superficialis- Superficial perineal muscles include bulbospongiosus, ischiocavernosus & superficial transverse perinei- Perineal body is formed by superficial & deep transverse perini, levator ani, bulbospongiosus, sphincter urethrae & external anal sphincter.Superficial transverse perinii muscle is a pa of perineal body & is cut in episiotomy but is not a pa of urgenital diaphragm, which is formed by deep transverse perinii, sphincter urethrae and perineal membrane
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RIFLED GUN RIFLING: Interior of bore has spiral grooves which run parallel to each other, but twisted spirally from breech to muzzle end. These grooves are called 'rifling' Impas Spinning motion to the bullet Greater power of penetration Straight trajectory Increases accuracy & range Paradox gun: A smooth bore gun with small terminal pa rifled.
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Rosai Dorfman disease: Massive cervical lymphadenopathy, usually bilateral and painless, is the most common manifestation. It is generally a benign disorder in spite of its propensity to form large masses and to disseminate to both nodal and extranodal sites.
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Ans. A i.e. Vitamin E Vitamin E is the collective name for a set of eight related tocoplzerols and tocotrienols, which are fat-soluble vitamins with antioxidant propeies.
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Ans. is 'd' i.e., Platelete count o Bleeding from mucosal surface suggests thrombocytopenia or defect in platelet function. o First do platelet count, if there is thrombocytopenia, fuher investigation will be required.
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parks textbook of peventive and social medicine 23rd edition. *relevant aicles for the right of child are : aicle 24 prohibits employment of children below the age of 14 in factories aicle 39 prrevents abuse of children of tender age aicle 45 provides for free and compulsory education for all children until they complete the age of 14years .
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LDL receptors
Familial hypercholesterolemia (type IIa) is due to deficiency of functional LDL receptors as a result of different types of mutations.
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Ref. Guyton. 13th edition. Page. 435
Countercurrent multiplication in the kidneys is the process of using energy to generate an osmotic gradient that enables you to reabsorb water from the tubular fluid and produce concentrated urine.
The three segments of the loops of Henle have different characteristics that enable countercurrent multiplication.
The thin descending limb is passively permeable to both water and small solutes such as sodium chloride and urea. The tubular fluid becomes steadily more concentrated or hyperosmotic (compared to blood) as it travels down the thin descending limb of the tubule.
The thin ascending limb is passively permeable to small solutes, but impermeable to water, which means water cannot escape from this part of the loop. The tubular fluid becomes steadily more dilute or hyposmotic as it moves up the ascending limb of the tubule.
The thick ascending limb actively reabsorbs sodium, potassium and chloride. this segment is also impermeable to water, which again means that water cannot escape from this part of the loop. This segment is sometimes called the “diluting segment”
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Answer is B (Presentation is Unilateral): The presentation in Polycystic disease of kidney is characteristically bilateral - The bilateral enlargement can hardly be mistaken on routine examination - Bailey - USG and CT show multiple cysts in both kidneys - Bailey The disease may present at any age but the most common age ofpresentation is in the 3rd or 4th decade. Both the kidney are grossly enlarged and situated with multiple cysts. Intracranial berry aneurysms are seen in 5-10 % of patients.
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Ref:Textbook of forensic medicine and toxicology (V.V.Pillay) 17th edition, page no.367 The MTP Act of 1971 was passed to liberalise aboions in india , on the basis of clearly specified guidelines. This liberalization was decided upon with idea of saving the lives of millions of women, who would other wise reso to criminal aboion out of desperation, thereby succumbing to its complications. As per this Act, pregnancy can be terminated on the following: Therapeutic Eugenic Humanitarian Social
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Prions disease is produced due to miss folded proteins Most common type of prions disease is: creutzfeldt-jakob disease Ref:Guyton and Hall textbook of medical physiology 12th edition,page number:10,11,12
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Barrett's esophagus
Is metaplastic change of distal esophageal mucosa from normal squamous epithelium to columnar epithelium, in response to chronic gastro-esophageal reflux.
The junction between squamous esophageal mucosa and gastric mucosa moves proximally
Three types of columnar epithelium have been described in Barrett's esophagus:
intestinal type - the most common type
the junctional type and
the gastric fundic type
Barrett's esophagus is a premalignant condition for adenocarcinoma esophagus
"The definition of Barrett's esophagus (BE) has evolved considerably over the past decade. Traditionally, BE was identified by the presence of columnar mucosa extending at least 3 cm into the esophagus. It is now recognized that the specialized intestinal type epithelium found in the Barrett's mucosa is the only tissue predisposed to malignant degeneration. Consequently, the diagnosis of BE is presently made given any length of endoscopically indentifiable columnar mucosa that proves on biopsy to show intestinal metaplasia." - Schwartz 9/e p831 (8/e, p868)
Also remember
The hallmark of intestinal metaplasia is the presence of intestinal goblet cells.
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Helium ion (alpha rays) has maximum ionisation potential Gamma rays have maximum penetration power.
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A i.e. It has lower threshold than rest of axonAxon hillock is the initial segment of neuron, nerve impulses begin in this initial segment of axon because it has lowest threshold potential.QAxon hillock:- This is a thickened area of cell body from which originates the long fibrous axon.AP is generated in this segment because the membrane at the axon hillock has grater concentration of voltage gated Na+ channels and therefore the threshold for excitation is lower than the rest of neuronsQ
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Answer is C (Injury to coical bridging veins): Subdural hemorrhage is caused by the rupture of bridging veins that connect the brain and the dural sinuses i.e. coical bridging veins. Memo: Most common cause of extradural hemorrhage is Rupture of middle meningeal aery.
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Ans. is 'b' Autistic Disorder Symptoms of the child and H/o Birth Asphyxia strongly suggests the diagnosis of Autistic Disorder.Birth Asphyxia is a common came of this disorderAutistic Disorder1. Impairment in social and interpersonal interactions.2. Impairment in language and nonverbal communication3. Mental retardation4. Decreased Physical GrowthHyperkinetic child is characterized by1. Poor attention span with distractibility*2. Hyperactivity*3. Impulsivity*Attention deficit disorder & Hyperkinetic child are one and same thing.Schizophrenia is an absurd option (only a schizophrenic can go for it)
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Ans. Vasculotoxic
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It includes increase in pulmonary ventilation, increases in RBC count and hemoglobin content, increase in 2,3-DPG.(Ref. Textbook of physiology N Geetha 2nd edition page no.265)
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Patchy loss, exclamation mark hair, autoimmune - Alopecia areata Alopecia areata is the commonest cause of patchy alopecia. Loss of Hair following a stress, infection etc - Telogen effluvium Loss of hair after Chemotherapy - Anagen effluvium Frontotemporal Recession - Androgenetic alopecia
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Clinical features in an HIV infected infant is:Recurrent GI infection and oral thrush is commonly foundClinical features in older children:Growth failureFeverDiarrheaSecondary infection(Refer: OP Ghai's Textbook of Pediatrics, 8th edition, pg no. 202)
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Ans/. Weight
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Close to 90% of episodes of otitis media with effusion (glue ear) resolve spontaneously after an acute otitis media episode is diagnosed. The American Academy of Pediatrics 2004 consensus guideline recommends watchful waiting without immediate use of antibiotics for children with uncomplicated otitis media with effusion.
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Ref. Rook's Textbook of Dermatology, Pg 35
Histology of skin
Basal layer:
Mitotically active, produces other keratinocytes
Contains low molecular weight keratin
Separated from dermis by continuous basal membrane; keratinocytes are attached to this membrane by hemidesmosomes
Also contains melanocytes
Squamous layer (stratum spinosum):
Also called prickle or malpighian layer
Has several layers of cells, larger than basal layer, which become flat and eosinophilic as they approach the surface due to an increase in keratin and reduction in ribosomes
May have clear vacuolated cytoplasm
Cells are attached to each other by fine spiny bridges with central dot-like desmosomes (Bizzozero’s nodule)
Loss of spiny bridges causes acantholysis
Granular layer (stratum granulosum):
1 - 3 layers of flattened cells with intensely basophilic keratohyaline granules, which contain precursors of filaggrin protein, which causes aggregation of keratin filaments
Malphigian layer includes – spinosum and granulosum
Stratum lucidum:
Present only in soles and palms, between granular and cornified layer
Homogenous eosinophilic zone
Cornified layer (stratum corneum):
Also called horny layer
Basket weave pattern of multiple layers of polyhedral cells without nuclei
Region is thicker and more compact in acral region (peripheral body-limbs, fingers, ears)
Rete ridges:
Undulating forms of epidermis and dermal papillae at dermoepidermal junction - flattens with aging
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HHV 4 or Epstein Barr virus can cause nasopharyngeal carcinoma.
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(Acute epiglottitis): (309-Dhingra 5th; 599-P-Hazarika 3rd/edition)ACUTE EPIGLOTTITIS(Syn - Acute supraglottic laryngitis)* Caused by Hemophilus influenza type BClinical FeaturesSymptomsSignsGeneral - usually starts as URTISigns* High grade fever* General - fever, toxic appearance and flushed skin, lethargic* Dribbling saliva* On auscultation decreased air entry Local* Sore throad* Dysphagia/odynophagia* Muffled (Hot potato) voice* F B sensation in the throat* Breathing difficulty -Inspiratory stridor is variably present and may be associated with expiratory rottles ORAL* Pharynx is usually congested and pooling of saliva* Red and edematous epiglottis popping up "Cherry red epiglottis"* Stridor is inspiratory and increases on supine position. Patient tends it sit up leaning forward supporting on upper limbs (Tripod sign) which relieves stridor to some extent* Inspiratory stritor if severe causes intermittent retraction, active accessory respiratory muscles and perioral cyanosis Differences between acute epiglottis and acute laryngo-tracheo-bronchitis in children Acute epiglottisAcute laryngo-tracheo-bronchitis (or group)* Causative organismHaemophilus influenza type BParainfluenza virus type I and II* Age2-7 years3 months to 3 years* PathologySupraglottic larynxSubglottic area* Prodromal symptomsAbsentPresent* OnsetSuddenSlow* FeverHighLow grade or no fever* Patient's lookToxicNon-toxic* CoughUsually absentPresent, (Barking seal-like)* StridorPresent and may be markedPresent* OdynophagiaPresent with drooling of secretionsUsually absent* RadiologyThumb sign on lateral viewSteeple sign on anteroposterior view of neck* TreatmentHumidified oxygen, third generation cephalosporin (ceftriaxone) or amoxicillinHumidified 02 tent, steroids
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Ref: Goodman eft Gillman, The pharmacological basis of therapeutics. 12th edition, Pp-1294.1298, 1300Explanation:In Paget's disease. Calcitonin is administered by subcutaneous route and intranasal spray is not preferred because of the limited bioavailabilitv.It reduces serum calcium and phosphate levels in paget's disease by retarding the osteoclastic activity.In post menopausal osteoporosis, once daily Calcitonin nasal spray is recommended.Bisphosphonates like second and third generation drugs are used for both prevention and treatment of osteoporosis.Alendronate. Risedronate and ibemdronate.Dinosumab, a monoclonal antibody which binds with the RANK ligand blocks the osteoclast activity, administered subcutaneously once in 6 months.Teriparatide can also be used in treatment of osteoporosis, acts by increasing the new bone formation.
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-Sacral agenesis or Caudal regression syndrome is the most specific congenital abnormality in a baby born to a diabetic woman.
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Timing of elective delivery in twin pregnancy Uncomplicated dichorionic: 38 weeks Uncomplicated monochorionic diamniotic: between 34 to 37 weeks Monoamniotic: 32-34 weeks, To be done by LSCS only due to high risk of conjoint twins, cord entanglement No role of prophylactic tocolytics, progesterones or prophylactic cervical encirclage in twins
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Carney triad (CT) is characterized by the coexistence of three types of neoplasms, mainly in young women, including gastric gastrointestinal stromal tumor, pulmonary chondroma, and extra-adrenal paraganglioma. The underlying genetic defect remains elusive. Ref - Davidson 23rd edition pg 545
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Ans. (c) Terminal ileum(Ref: Robbins 9th/pg 375-376)Extrapulmonary TB:MC site is lymph node Q, MC cervical & supraclavicular ("Scrofula") QPleural involvement: Exudative Q Pleural effusion, tuberculous empyema, or obliterative fibrous pleuriticGenitourinary TB: sterile pyuria Q; Preferentially involves fallopian tube Q in females & epididymis Q in malesSkeletal TB: Most common site spine Q (Pott's disease) Q > hip > kneeTB meningitis (paresis of cranial nerves especially ocular, is frequent finding) QIn Gastro-intestinal (GI) TB: MC site terminal ileum and caecum Q
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Runt disease is Graft versus host disease.
Runt disease occurs when immunologically competent donor cells are transplanted into immunologically crippled (immunocompromised) hosts and the transferred cells recognize host cells as alloantigens.
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Ans. is 'a' i.e., Lucio leprosy Lucio phenomenon It is found in lucio leprosy with type 2 lepra reaction. It is prevalent in mexico. Characterized by painful tender red patches paicularly on extremities which later on become necrotic and finally develop into brown black eschar. Ulcers are more persistent on legs. Tuberculoid and indeterminate leprosy are characterized by hyperpigmented macule with impairment of sensations. In histoid leprosy, classical feature is erythematous shiny red subcutaneous or cutaneous nodules, esp over the extensor aspect of extremities, back, buttocks & face. Ulceration is unusual.
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Ans. A:Osteogenesis imperfecta Osteopetrosis is also known as Marble bone disease or Albers-Schonberg disease. Paget's disease is known as Osteitis deformans. Osteogenesis imperfecta is known as Brittle bone disease. Osteoporosis is known as Fragile bone disease.
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Acetohexamide is a first generation sulfonylureas which acts by stimulating insulin release from pancreas. Sulfonylureas block K+ channels in beta cells leading to depolarization, increased calcium entry voltage dependent calcium channels and increased secretion. It also increases insulin sensitivity by increasing the number of insulin receptors. 1st generation sulfonamides: Tolbutamide Acetohexamide Tolazamide Chlorpropamide 2nd generation sulfonamides: Glyburide Glipizide 3rd generation sulfonamides: Glimepiride Ref: Pharmacology By Gary C. Rosenfeld, page 251
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Blepharitis * Sub-acute or Chronic inflammation of lid margins * Can be bacterial, seborrheic, parasitic * Symptoms: Irritation, itching, lacrimation, gluing of cilia, mild photophobia. * Yellow crusts are seen at the root of cilia which glue them together * Can lead to abnormalities like madarosis, trichiasis and poliosis Chalazion: chronic non infective lipogranulomatous inflammation of the meibomian gland. Orbital cellulitis: Inflammation of eye tissues behind the orbitalseptum Stye A.K.A Hordeolum externum externum: Acute suppurative inflammation of lash follicle and its glands of zeis or moll by staphylococcus Note - Hordeolum internum-suppurative inflammation of a meibomian gland( 2* tochalazion) It is more violent as meibomian gland is larger and embedded in dense fibrous tissue
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The most specific way to make a diagnosis of acute gout is to aspirate the involved joint and to identify negatively birefringent, needle shaped crystals under red-compensated polarized light. The next best way to make a diagnosis of gout is to give oral colchicine hourly until the patient develops significant improvement in joint inflammation or gastrointestinal side effects that prevent fuher colchicine use. Rarely do patients with other diagnoses respond to colchicine trial. The other tests are too nonspecific to be of diagnostic use.
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A i.e. Alters gene expression; B i.e. Genetic code remains intact; C i.e. Role in carcinogenesis and Protective mechanism against cleavage by restriction endonuclease DNA methylation alters the gene expression pattern in cells-for example it may cause X-chromosome inactivation, tumor suppressor gene silencing (in cancer cells)Q, suppression of expression of repetitive elements / deleterious elements / viral genes that have been incorporated into genome of host over time E. coli has 2 prominent DNA methylation system, both using S-adenosyl methionine (SAM) as a methyl group donor. Adenine or cytosine methylation in restriction - modification system, serves as a pa of defence mechanism against cleavage by restriction endonucleaseQ. I t helps the cell to distinguish its DNA from foreign DNA by marking its own DNA with methyl group and destroying (foreign) DNA without the methyl group. Mismatch repair mediated by Dam methylase improves the overall fidelity of DNA replication by fctor of 102 -103. Dam (DNA adenine Methylation) methylase, methylates adenosine residue to N6- methyl adenosine within the palindromic (51) GATC (3) sequence. This can serve to distinguish parent/template strand (which is methylated) from unmethylated (transient state) newly synthesized strand. So replication mismatch in vicinity of hemi-methylated GATC sequence are then repaired a/ t the information the methyated parent strand. In eukaryotic cells - 5% of cytidine in DNA are methylated to 5 Methyl cytidine. Methylation is most common it CpG islands (a C G rich region, upstream of promoter region and P signifies phosphodiester bond between them) producing methyl -CpG symmetrically on both strands of DNA.
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<p>In cold agglutinin disease, antibody is usually IgM which reacts with red cells poorly or not at all at 37 degree celsius ,whereas it reacts slowly at lower temperature . Donath - Landsteiner antibody is involved in paroxysmal cold hemoglobinuria. Warm antibody immunohemolytic anemiaa are caused by UgH ir rarely ItS antibodies that are active at 37 degree celsius .</p><p>Harrison&;s principles of internal medicine 18 th edition 882.</p>
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B i.e. pain on passive extension of finger
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Chlolinometic drug will cause bradycardia as an adverse effect and thus cannot be used for its treatment Ref-KDT 6/e p104
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Kocher's maneuver is used for the reduction of shoulder dislocation. These are methods of Closed hip reduction: Allis maneuver Stimson maneuver Lefkowitz maneuver East Baltimore lift maneuver Bigelow maneuver
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This is a case of brachial neuritis following an injection of tetanus toxoid. Here there is dysfunction of the nerves supplying the arm or shoulder without involvement of the rest of the nervous system. The sensory loss is less prominent than the weakness. There may also be bilateral involvement of muscles with wasting. Ref: Park, Edition 21, Page 105.
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Randomization is a statistical procedure by which the paicipants are allocated into groups usually called 'control' and 'study', to receive or not to receive an experimental, preventive or therapeutic procedure manoeuvre or intervention. Ref: 25th edition, Park's Textbook of Preventive and Social Medicine, Page no. 90
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The Transplantation of Human Organs Act 1994, amended in 2011, and 2012 Chapter VI and VII deals with the trial and punishment of offences under this act. Under this act, doctors involved will be punished for a period of 2-5yrs. Ref: FORENSIC MEDICINE AND TOXICOLOGY Dr. PC IGNATIUS PAGE NO: 389
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Glanzmann's thrombasthenia - It is an autosomal recessive disorder due to deficiency/dysfunction of glycoprotein Ilb-IIla (Gp Ilb/IIIa).
Thus there is defective platelet aggregation.
Platelet aggregation is normal to ristocetin(ln constant to Bernard Soulier syndrome) but no aggregation occurs in response to standard agonists (collagen, A DP, thrombin). Other differentiating features include normal platelet count and morphology. BT is prolonged. VWF is normal.
The disease manifests at birth with increased bleeding from umbilical cord stump.
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"Cystoid macular edema is a common cause of visual loss in patients with uveitis and may be observed in the setting of severe anterior or intermediate uveitis. Long-standing or recurrent macular edema can cause permanent loss of vision due to cystoid degeneration".
- Lange Ophthalmology
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In humans carnitine is synthesized from protein-derived trimethyllysine in liver, brain and kidney.Muscles take up carnitine from the blood in an exchange-diffusion process with endogenous deoxycarnitine, the immediate precursor of carnitine.Besides catalysing the transpo of long-chain acyl groups in mitochondria, carnitine is necessary for the expo of intramitochondrially produced sho-chain acyl residues and for the trapping and the elimination of unphysiological compounds (benzoic, pivalic, valproic acids etc.).
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Ans. is 'a' i.e., Staph Aureus o MC organism is staph aureus >> str. viridans >> pneumococcus.
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Ans. is 'a' i.e., Plasmin Streptokinaseo Fibrinolytic drugo Obtained from group C streptococcio Streptokinase is inactive as such. It combines with circulating plasminogen molecules to form an activator complex, which then causes limited proteolysis of other plasminogen molecules to generate active enzyme plasmin.
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Ans. is 'd' i.e., Varenicline o Varenicilline is a direct acting nicotine agonist with selective action on a4 b2 isoform of Nm receptors. It is an antismoking drug.
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Ans. (c) VIII(Ref: Wintrobe's 13th/pg 1389)vWF is required for normal platelet adhesion, and also acts as a carrier of factor VIII in the plasma
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HCG has the same stimulatory effect as LH on the corpus luteum. Administration of HCG would cause the corpus luteum to continue to secrete estrogen and progesterone, preventing degradation of the endometrium and the onset of menstruation
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(Aldosterone): Ref: 258-H (280- H178th) (358- Ganong 23rd)Aldosterone is secreted by the zona glomerulasa cells of the adrenal cortex in response to high renin and angiotensin II or hyperkalemia (258-H)Plasma K+ level needs increase only 1 mEq/L stimulate aldosterone secretion
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Answer is None "A skin specimen containing Paget cells secures the diagnosis and can be obtained by nipple scrape cytology or biopsy."
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Ans. is 'b' ie pressure abrasion (Ref: Parikh; 6/e, p4.3).An abrasion is a superficial injury involving only the superficial layers of the skin (epidermis only), caused by friction and / or pressure between the skin and some rough object or surface. It bleeds very slightly, heals rapidly in a few days and leaves no scar.They can be classified into 3 types, depending on the manner they are created.ScratchIs a linear injury produced by a sharp object, such as pin, thorn or finger nail.Graze (Sliding, scraping or grinding abrasion).Is produced when a broad surface of skin slides against a rough surface.It is also known as brush or friction burn because it is caused by the frictional force and resembles a burn after dryingIt is commonly found in road traffic accidents.Imprint, Pressure or contact abrasion.Is produced as a result of direct impact or pressure of or contact with some object at right angles to the skin surface.The cuticle is crushed, and the object marks a reproduction of its shape and pattern on the to the skin, therefore it is known as patterned abrasion.Example are ligature marks in hanging and strangulation, nail and thumbs marks in throttling, teeth marks in biting, radiator, grill or tyre mask in vehicular accidents.
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Glucagon is produced by the alpha cells of the pancreass. The same gene for glucagon also code for glucogagon like peptide - GLP 1 and GLP 2. GLP 1 1. Stimulates insulin secretion 2. Augments insulin releasing effects of glucose This effect is responsible for enteroinsular axis ALSO NOTE: GLP 1 analog: Stimulates insulin secretion and augments insulin releasing effects of glucose. Ref: Sleisenger and Fordtran's, Edition-9, Page-7
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Erythema multiforme is a skin reaction that can be triggered by an infection or some medicines. It's usually mild and goes away in a few weeks. There's also a rare, severe form that can affect the mouth, genitals and eyes and can be life-threatening. This is known as erythema multiforme major .Additional symptoms of erythema multiforme can include: a high temperature. a headache. feeling generally unwell. raw sores inside your mouth, making it hard to eat and drink. swollen lips covered in crusts. sores on the genitals, making it painful to pee. sore, red eyes. sensitivity to light and blurred vision. Ref Harrison 20th edition pg 1211
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- The image shows mass on top of kidney, indicative of adrenal pathology. Since hypeension is present with hypokalemia, increased aldosterone from adrenal adenoma is diagnostic of Conn syndrome. - Pheochromocytoma has hypeension but hypokalemia is not seen. - Liddle syndrome is autosomal dominant disorder with over activity of epithelial sodium channel, but does not present as an adrenal mass.
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ICD-10 (International Classification of Diseases, 10th revision on January 1, 1993).
ICD does uniform classification of diseases which can be used throughout the world to make accurate comparisons of morbidity and mortality data for decision making in prevention, facilitation and management of health care system.
ICD-10 consists of 3 volumes:
Volume-I: contains reports of the international conference of 10th revision, classification of morphology of neoplasms, special tabulation list for mortality and morbidity, definition and nomenclature regulation.
Volume-II: Instruction manual
Volume- III: Alphabetical Index
NOTE: there are 21 major chapters in ICD-10
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Causes of Hypehermia Syndromes: Heat Stroke Exeional: Exercise in higher than normal heat and/or humidity Nonexeional: Anticholinergics, including antihistamines; antiparkinsonian drugs; diuretics; phenothiazines Drug-Induced Hypehermia Amphetamines, cocaine, phencyclidine (PCP), methylenedioxymethamphetamine (MDMA; "ecstasy"), lysergic acid diethylamide (LSD), salicylates, lithium, anticholinergics, sympathomimetics Neuroleptic Malignant Syndrome Phenothiazines; butyrophenones, including haloperidol and bromperidol; fluoxetine; loxapine; tricyclic dibenzodiazepines; metoclopramide; domperidone; thiothixene; molindone; withdrawal of dopaminergic agents Serotonin Syndrome Selective serotonin reuptake inhibitors (SSRIs), monoamine oxidase inhibitors (MAOIs), tricyclic antidepressants Malignant Hypehermia Inhalational anesthetics, succinylcholine Endocrinopathy Thyrotoxicosis, pheochromocytoma Central Nervous System Damage Cerebral hemorrhage, status epilepticus, hypothalamic injury Ref: Kruidering-Hall M., Campbell L. (2012). Chapter 27. Skeletal Muscle Relaxants. In B.G. Katzung, S.B. Masters, A.J. Trevor (Eds), Basic & Clinical Pharmacology, 12e.
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This is a case of pulled elbow.
Treatment is simple. The child's attention is diverted, the elbow is quickly supinated and then slightly flexed.
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Ans. is 'b' i.e., Hyponatremia Causes of status epilepticus in children o Idiopathic o Drug intoxication o Congenital/Developmental neurological abnormalities o Hypoglycemia o Meningitis, Encephalitis o Hyponatremia o Head trauma o Pyridoxin deficiency
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Prolactin- a hormone secreted by the anterior pituitary gland that promotes the growth of breast tissue and stimulates and sustains milk production in postpaum mammals, and shows luteotropic activity in ceain mammals. Called also lactogenic hormone and mammotropin.Ref: Ganong&;s review of medical physiology;24th edition; page no:-416
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One of earlier symptoms of ammonia intoxication is haziness of vision and slurring of speech Other clinical features of urea cycle defects:- Increased blood glutamine Decreased BUN (Blood Urea Nitrogen) Cerebral oedema Vomiting Lethargy hyperventilation Note:-Severe ammonia toxicity can lead to coma and eventually death.
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Olfaction is greater in female then in males Ref: guyton and hall textbook of medical physiology 12 edition page number:645,646,647
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