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Ans. a. Capnography Capnography is the surest confirmatory sign of correct intubationQ So, the fastest and accurate method to confirm intubation in the above mentioned infant is capnography Capnography Capnography is the continuous measurement of end tidal carbon dioxide (ETCO,) and its waveform. Normal: 32 to 42 mmHe (3 to 4 mmHg less than aerial pCO, which is 35 to 45 mmHg) Principle: Infrared light is absorbed by carbon dioxide Uses of Capnography It is the surest confirmatory sign of correct intubation (esophageal intubation will yield ETCO2=0) Intraoperative displacement of endotracheal tubedeg (ETCO2 will become zero) Diagnosis of malignant hypehermie (ETCO, may rise to more than 100 mm Hg) For detecting obstructions and disconnections of endotracheal tubes (ETCO, will fall) Capnography Uses of Capnography Diagnosing pulmonary embolism by air, fat or thrombus (sudden fall of ETCO2 occurs. It may become zero if embolus is large enough to block total pulmonary circulation) Exhausted sodalime or defective valves of closed circuit will show high ETCO2 values. To control level of hypocapnia during hyperventilation in neurosurgery Indicator of cardiac output. In cardiac arrest ETCO, is zero.
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Ans. B: Primary response IgM is the immediate antibody that is produced once a human body is exposed to bacteria, virus or a toxin.Their demonstration in the serum indicates recent infections. IgG is found throughout the body, mainly in most of the bodily fluids, while IgM is found mainly in the blood and lymphatic fluids. Antibodies formed in primary response are predominantly IgM and in the secondary response is IgG. IgM is temporary and disappears after a few weeks. It is then replaced by IgG.
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Best's disease is an autosomal dominant disorder with variable penetrance and expressivity. Bassen-Kornzwig disease is an autosomal recessive inherited disorder of lipoprotein metabolism. Gyrate atrophy is an autosomal recessive dystrophy with peripheral choroidal degeneration. Laurence-Moon-Biedle syndrome is also inherited in autosomal recessive manner. Best's disease: It is caused by a mutation in the BEST1 (VMD2) gene, which encodes a transmembrane calcium-sensitive chloride channel (bestrophin) expressed in retinal pigment epithelium. Fundus examination ranges from a mild pigmentary disturbance within the fovea to the typical vitelliform or "egg yoke" lesion located in the central macula. Visual acuity is good and electro retinogram is normal. An abnormal electro-oculogram (EOG) is the hallmark of the disease. Ref: Vaughan & Asbury's General Ophthalmology, 18 Edition, Chapter 10
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Ring scotoma involves the point of fixation. Conditions resulting in ring scotoma are pigmentary retinopathies, retinitis, choroiditis, myopia, open angle glaucoma and optic neuropathies. Bilateral annular scotomas occur due to bilateral retinal or optic nerve disease but may also occur with bilateral occipital pole damage or occur on a functional basis. Scotomas are abnormal blind spots in visual fields. Types of scotomas: Central scotomas: In this the point of fixation is involved and central visual acuity is impaired. Centrocecal scotoma: It involve the point of fixation and extend to the normal blind spot. Paracentral scotoma: It involves the area adjacent to the point of fixation. Scintillating scotoma: They are subjective experiences of bright colorless and colored lights in the line of vision. They are often repoed by patients as pa of the aura preceding migraine headache. Ref: Waxman S.G. (2010). Chapter 15. The Visual System. In S.G. Waxman (Ed),Clinical Neuroanatomy, 26e. Clinical Pathways in Neuro-Ophthalmology: An Evidence-Based Approach By Andrew Lee, Paul Brazis page 2018.
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Primary sclerosing cholangitis (PSC) is characterized by inflammation and obliterative fibrosis of intrahepatic and extrahepatic bile ducts, with dilation of preserved segments. Approximately 70% of patients with PSC have longstanding ulcerative colitis, although the prevalence of PSC in such patients is only 4%. PSC tends to occur in the third through fifth decades of life, with a significant male predominance (2:1). The clinicopathologic findings are complemented by a characteristic radiographic appearance of a beaded biliary tree, representing sporadic strictures. Cholangiocarcinoma is a late complication of PSC. The other choices are not complications of PSC.Diagnosis: Primary sclerosing cholangitis
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Ans: b (Basement membrane)Ref: Robbin's, 7th ed, p. 105 & 6thed, p. 100
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Ans. c. Laveran
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Ventricular rate : 1500/10 = 150 ECG shows HR of 150/min with normal axis. Saw tooth waves are noted with 2:1 AV block. Ventricular rate is 150/min therefore the atrial rate would be 300/min.
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retroorbital pain due to pain in the area supplied by the ophthalmic branch of the trigeminal nerve (fifth cranial nerve), abducens nerve palsy (sixth cranial nerve)and otitis media.
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The factor tend to increase lymph flow is increase in capillary hydrostatic pressure. Since the lymph is derived from the interstitial fluid, any factor that increases interstitial fluid pressure also increases lymph flow provided, the lymph vessel are functioning normally. The factors which increase interstitial fluid pressure include: Increased capillary hydrostatic pressure Increased interstitial fluid colloid osmotic pressure Increased permeability of the capillaries Decreased plasma colloid osmotic pressure All of the above factors increase the filtration at the capillary-interstitium interface and therefore increase the interstitial fluid volume and pressure. Ref: Guyton and Hall 13th edition Pgno: 200
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The retropharyngeal space is divided by a midline fibrous raphe into two spaces known as space of Gillette. Peritonsillar space is the space between the capsule of tonsil and the circular muscles of the pharynx. This contains a loose areolar tissue. Infection of this space is known as quinsy.
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Ans. (d) EthambutolRef. KDT/742* Ethalmbutol is selectively tuberculostatic and clinically as active as Streptomycin.1st Line ATT Drugs action on bacteria and hepatoxictyDrugBactericidal/ BacteristaticHepatotoxicityIsoniazidCidal+RifampicinCidal+PyrazinamideCidal++++EthambutolSTATIC-NoStreptomycinCidal-No
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Visual hallucinations are characteristic of organic conditions. The other choices mentioned in the question - Primary delusions, Made phenomena and third person auditory hallucinations are all examples of First rank symptoms, hence more characteristic of Schizophrenia.
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Ans. A. Drug is not extensively distributed in organs and tissuesVolume of distribution (Vd ) is defined as ratio of the amount of drug in the body and the plasma concentration of drug (Cp)Vd = Total dose administered to patient/Cp Volume of distribution can be determined by various factors:A. More plasma protein binding restricts drug to plasma, hence there will be less distribution to extravascular space and tissues (least Vd ).B. Polar compounds have slightly more volume of distribution (Vd :0.2L/kg)C. More tissue binding capacity or more lipid solubility will make drug to cross most of the membranes, including blood-brain barrier making volume of distribution more.D. Sequestration of drugs in the particular tissue makes its volume of distribution even more than whole blood volume (e.g., Chloroquine has large volume of distribution as it gets sequestered in the liver)Water (0.6 L/kg)Lipid soluble molecules: e.g., EthanolExtracellular water (0.2L/kg)Water-soluble molecules: e.g., Gentamicin Polar compoundsBlood (0.08L/kg)Plasma (0.04L/kg)Strongly plasma protein-bound molecules and very large molecules: e.g., heparin
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B i.e. Palatal branch of maxillary aery
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Ans. A. NarcissisticGrandiosity and admiration from others are feature of Narcissistic personality disorder.
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Ans. b (Transformation) (Ref. Q. 102 of MHPGM-2003).TRANSMISSION OF GENETIC MATERIAL IN BACTERIA IS BY-ConjugationThe exchange of chromosomal or plasmid genes from one bacterium to another through conjugal bridgeTransductionThe delivery of bacterial genes from one bacterium to another via a virus vectorTransformationThe uptake and incorporation of free DNA from the environmentLysogenyThe stable association between a bacterium and a temperature phage. It imparts the important traits:O = Salmonella O antigen, B = botulinum toxin, E = erythrogenic toxin of Streptococcus pyogenes,D = diphtheria toxin, mnemonic: OBED (or a little pregnant with phage)TransposonA motile genetic element capable of transposition within a cell; these are responsible for the formation of multiple drug-resistance plasmidsTransfectionTransfer of a gene into a cell, enabling the transfected cell to form a new gene product.
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- clinical diagnosis of rabies can be made on the basis of history of bite by rapid animal and characteristic signs and symptoms. - rabies can be confirmed in patient early in the illness by antigen detection using immunofluorescene of skin biopsy. Reference : Park's textbook of preventive and social medicine, 23rd edition, pg no:278 <\p>
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2 year REF: Nelson Textbook of Pediatrics 17th edition page 1178, WHO website: vaccines/en/hepatitisa.shtml Hepatitis A vaccines "Hepatitis A vaccine is recommended at 24 months of age in states and regions with an increased incidence of disease. A second dose is administered 6-12 months later to complete the series"' The vaccines are given parenterally, as a two-dose series, 6-18 months apa. Four vaccines are available commercially; three vaccines are manufactured from cell-cultureadapted HAV propagated in human fibroblasts (One vaccine is formulated without preservative; the other two are prepared with 2-phenoxyethanol as a preservative). The fouh vaccine is manufactured from HAV purified from infected human diploid cell cultures and inactivated with formalin. A combination vaccine containing inactivated hepatitis A and recombinant hepatitis B vaccines has been licensed since 1996 for use in children aged one year or older in several countries. The combination vaccine is given as a three-dose series, using a 0, 1, 6 month schedule. Hepatitis A vaccines are all highly immunogenic. Nearly 100% of adults will develop protective levels of antibody within one month after a single dose of vaccine. 99%-100% of vaccinated individuals had levels of antibody indicative of protection five to eight years after vaccination. Kinetic models of antibody decay indicate that the duration of protection is likely to be at least 20 years, and possibly lifelong.
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(A) Proximal convoluted tubule Transport Proteins Involved in the Movement.of Na+ and CI-Across the Apical Membranes of Renal Tubular Cells.3SiteApical TransporterFunctionProximal tubuleNa/glucose CTNa+ uptake, glucose uptake Na+/Pi CTNa+ uptake, Pi uptake Na+ amino acid CTNa+ uptake, amino acid uptake Na/lactate CTNa+ uptake, lactate uptake Na/H exchangerNa+ uptake, H+ extrusion CI/base exchangerCI- uptakeThick ascending limbNa-K-2CI CTNa+ uptake, CI- uptake, K+ uptake Na/H exchangerNa+ uptake, H+ extrusion K+ channelsK+ extrusion (recycling)Distal convoluted tubuleNaCI CTNa+ uptake, CI- uptakeCollecting ductNa+ channel (ENaC)Na+ uptake# In the proximal tubules, the thick portion of the ascending limb of the loop of Henle, the distal tubules, and the collecting ducts, Na+ moves by cotransport or exchange from the tubular lumen into the tubular epithelial cells down its concentration and electrical gradients and is actively pumped from these cells into the interstitial space. Thus, Na+ is actively transported out of all parts of the renal tubule except the thin portions of the loop of Henle. Na+ is pumped into the interstitium by Na+-K+ ATPase. It extrudes three Na+ in exchange for two K+ that are pumped into the cell.
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Ref: Textbook of Forensic medicine and toxicology (V.V.Pillay) 17th edition, page no.355 As a result of sexualintercourse, hymen is usually torn posteriorly, with unilateral or bilateral tears extending to the point of its attachment to the vaginal wall. These ruptures bleed freely when, heal by scar formation.
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The complement proteins can be activated by 3 pathways;
Classical,lectin and alternate pathways. Terminal pathway is common to the first three pathways and is present ar the level of the post-activation stage of C3. It eventually leads to the membrane attack complex that lyses cells.
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Ans. (b) Diffuse esophageal spasmRef: SRB Manual of Surgery 4th ed. /1323* Cork screw appearance on barium swallow is seen with diffuse esophageal spasm.* Bird beak appearance is seen with achalasia cardia.* Rat tail appearance as per bailey and love is seen with carcinoma esophagus.
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Answer is D (Foregut carcinoids are usually argentaffin positive): Foregut tumors (carcinoids) have low serotonin levels and are argentaffin negative. Carcinoid Syndrome Typical Carcinoid Syndrome Elevated levels of plasma serotonin Elevated levels of urinary 5HIAA Atypical Carcinoid Syndrome Plasma serotonin levels are normal Plasma and urinary levels of 5HTP are increased (Urinary 5HIAA may he normal or mildly elevated) Typical carcinoid syndrome is charachteristic of Midgut carcinoids Midgut Carcinoids: Typical Carcinoid Syndrome Midgut tumors have high serotonin content are Argentaffin positives Most frequently cause a 'typical' carcinoid syndrome when they metastize. Release serotonin and tachykinins (neuropeptide K. substance K, substances P) Rarely secrete 5HTP or ACTH Metastatis to bone is uncommon (less common) Atypical carcinoid syndrome is charachteristic of foregut carcinoids Foregut Carcinoids: Atypical Carcinoid Syndrome Foregut tumor have low serotonin content, are argentaffin negative but argyrophillicQ Usually do not produce carcinoid syndrome but when they produce a carcinoid syndrome it is charachtristically usually an Atypical carcinoid syndrome Occasionally secrete ACTH or 5HTP May metastize to bone Are often multihormonal
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Ans. is 'a' i.e., IDDM of 5 years duration o Complication of Retinopathy/nephropathy taks 5 years to develop in type 1 diabets.o Complication of Retinopathy/nephropathy takes 15-20 years to develop in type 2 diabetes.
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Bond strength of enamel is higher than bond strength to dentin.
Enamel is 20-50 MPa.
Dentin is 15-25 MPa depending on agent used.
Reference-Sturdevant 6th ed Pg: 116
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Barrett's oesophagus is a metaplastic change in the lining mucosa of the oesophagus in response to chronic gastro-oesophageal refluxThis adaptive response involves a mosaic of cell types, probably beginning as a simple columnar epithelium which becomes 'specialised' with time. The hallmark of 'specialised' Barrett's epithelium is the presence of mucus-secreting goblet cells (intestinal metaplasia).Ref: Bailey and Love 27e pg: 1081
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Ans. Acamprosate
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(At mesentery) (301 - BDC - 2) (370 - Snell 7th)URETERS - The ureter enters the pelvis by crossing the bifurcation of the common iliac artery in front of the sacroiliac joint. Each ureter then runs down the lateral wall of the pelvis infront of the internal iliac artery to the region of the ischial spine and turns forward to enter the lateral angle of the bladder. Near its termination. It is crossed by the vas deferens. The ureter passes obliquely through the wall of the bladder for about 0.75 in (1.9cm) before opening into the bladder.Three Constrictions (Snell)BDC(i) Where the renal pelvis joins the ureter in the abdomen(ii) Where it is kinked as it crosses the pelvic brim to enter the pelvis(iii) Where it pierces the bladder wall(i) At the pelvi ureteric Junction(ii) At the brim of the lesser pelvis(iii) At its passage through the bladder wall.
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Ans. is c, i.e. Hysteroscopic myomectomyThis patient is having heavy menstrual bleeding due to fibroid, i.e. she is symptomatic and hence management has to be done. Best management in fibroid is surgery. Since she is only 36 years and has one child We will go for myomectomy.Submucous fibroid <5cm, should be removed hysteroscopically. [?] Best management is hysteroscopic myomectomy.
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Anti-D immune globulin is given prophylactically to all Rh D-negative, unsensitized women at approximately 28 weeks, and a second dose is given after delivery if the infant is Rh D-positive. Before the 28-week dose of anti-D immune globulin, repeat antibody screening is recommended to identify individuals who have become alloimmunized.Provision of anti-D immune globulin at 28 weeks gestation reduces the third-trimester alloimmunization rate from approximately 2 percent to 0.1 percent (Ref: William's Obstetrics; 25th edition)
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Ans: b (Exocytosis) Ref: Vasudevan, 4th ed, p.107Insulin is secreted by exocytosis.Secretion of insulin:The insulin is packed in to granules in the Golgi apparatus.The insulin molecules associate into a hexamer with two zinc ions and one calcium ion. The contents of granules are released by exocytosis; both insulin and C-peptide are released into circulation.Degradation of insulin:Insulin is rapidly degraded in liver. Plasma half life is less than 5 minutes.An insulin specific protease (insulinase) and a hepatic glutathione- insulin- trans hydrogenase are involved in degradation of insulin.Note:Glucose is the major stimulant of insulin secretion.Pro insulin has about one third biological activity of insulin.
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Normal pressure Value given ( in mmHg) Interpretation RA = 2-6 mmHg 12 Elevated RV = 25/5 mmHg 50/12 Elevated Pulmonary aery = 25/10mmHg 50/15 Elevated PCWP = 8 -12 mmHg 8 Normal Aoa = < 120/80 80/60 Hypotension The presence of Normal PCWP rules out the primary involvement of left side hea.so,Acute MI with LVF is ruled out. Hypovolemic shock following Gastroenteritis will lead to under-filling of the right side of hea but this patient has elevated pressure values on the right side of the hea. Early septic shock will lead to increased cardiac output but this patient has hypotension.(ruled out) Increased RA, PV pressure with PAH indicates RV malfunction. Less flow to lungs will lead to systemic hypotension. Hence, the patient has presentation of Acute Cor-Pulmonale.
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* The ECG shows patient in sinus Rhythm, normal QRS axis * Upsloping ST-segment elevation is seen in V2-V5 and aVL * In extreme left, premature ventricular beats can be noticed in Lead II and Lead III * Rhythm strip lead II shows ST depression (right at the bottom) Brugada syndrome has ST elevation in VI-V3 and can present with sudden collapse during physical exeion but the collapse occurs due to ventricular tachycardia. ECG strip, however, does not show any tachyarrhythmia. Arrhythmogenic right ventricular dysplasia shows the presence of epsilon waves.
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Answer- D. Peri-follicular rashAreflexiaProgression to an ataxic gaitDecreased vibration and position sensationsOphthalmoplegiaSkeletal myopathyPigmented retinopathy
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The concentration of O2 in the expired air is 16%. That air is is transferred by mouth to mouth respiration.
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RMP of nerve cell is equal to - 70mV. (REF: GANONG&;S REVIEW OF MEDICAL PHYSIOLOGY 24 EDITION, PAGE NO - 88)
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Ans. (d) Stimulated by exercise(Ref: Ganong, 25th ed/p.325)Growth hormone secretion is pulsatileCortisol and somatostatin inhibit growth hormone secretionExercise increases growth hormone secretion
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An area located on either side of the human back between the lateral borders of the erector spinae muscles and inferior borders of the twelfth rib, so called because the kidney can be felt at this location. iamgeref - researchgate.net
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Mumps virus is the most common cause of parotid gland enlargement in children. Transmission:-respiratory route droplets, saliva, and fomites. Clinical Manifestations of Mumps: 1. Bilateral parotitis: It is the MC manifestation (70-90%). 2. Epididymo-Orchitis is the next MC manifestation (15-30%). of mumps. 3. Aseptic meningitis occurs in <10% of cases, with a male predominance. 4. Oophoritis occurs in about 5% of women. 5. Pancreatitis occurs in 4% of infections and may lead to diabetes. Hepatitis is not associated with Mumps virus. The most common causes of viral hepatitis are the five unrelated hepatotropic viruses hepatitis A, B, C, D, and E.
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Ans. is 'b' i.e., Epidemic conjunctivitisVision 2020 : The Right to Sight : Global Initiative for Elimination of Avoidable Blindnesso After the realization that unless blindness control efforts are intensified, the prevalence of blindness will double by 2020 AD, the WHO along with an International Partnership committeee launched the Vision 2020 Initiative in 1995.o The diseases identified for global elimination include : -Cataract blindnessTrachoma blindness and transmissionOnchorerciasisAvoidable causes of childhood blindnessRefractive errors and low visiono Targets have been set up for each of the component diseases for the next 20 years,o Above 5 diseases were for global vision 2020. Indian vision 2020 includes following seven diseases.i Cataract blindnessii Trachoma blindness and transmissioniii Childhood blindnessiv Refractive errors and low visionv. Glaucomavi Diabetic retinopathyviiCorneal blindness
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Earliest nerve involved by acoustic neuroma - Vth nerve/trigeminal nerve.
The earliest manifestation of Vth nerve involvement is decreased corneal sensitivity leading to loss of corneal reflex.
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Paial pressure of O2 in alveolar air (PA O2) - 100 mm Hg. Gaseous concentration & its paial pressure in alveoli: 1. Oxygen: Concentration & paial pressure controlled by, Rate of absorption of O2 into blood Rate of entry of new O2 into lungs by ventilatory process. Values: Paial pressure of O2 in inspired air (Pi O2) 158 mm Hg Paial pressure of O2 in alveolar air (PA O2) 100 mm Hg Calculated by "Alveolar gas equation". Paial pressure of O2 in expired air (PE O2) 116 mm Hg
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Splenic aery branches from the celiac aery and follows a course superior to pancreas. Splenic aery gives off branches to the stomach and pancreas before reaching the spleen. Sho gastric aery is through the upper pa of greater curvature of stomach and fundus of the stomach. Some other branches are: Branch to the pancreas,Left gastro epiploic, Posterior gastric. Ref - BDC vol2 pg296
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Small deposits of neuroendocrine cell hyperplasia in scarred lungs are known as Tumorlet. Pulmonary tumorlet is an incidental finding at histopathologic examination of lung parenchyma that is often located adjacent to bronchogenic tumors or carcinoid tumors or paicularly in lung scarred by bronchiectasis or other chronic inflammatory processes.
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(IOL are made of (i) PMMA (ragid IOL); (ii) Silicon, acrylic, hydrogel, collamer (foldable IOL). Ref: Khurana 7th/e p.213 & 4th/e p.195)
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1.Irregular branching aseptate and broad hyphae belong to Zygomycota phylum and cause Zygomycosis. *Zygomycota are aseptate fungi that cause serious infections, primarily in ketoacidotic diabetic patients and cancer patients. 2. Agents of Zygomycosis - - Rhizopus, Mucor, Lichtheimia (Old name: Absidia), Apophysomyces - Candida: Yeast like fungi. - Aspergillus: Narrow septate hyaline hyphae with acute angle branching molds. - Pencillium: Hyaline thin septate hyphae, vesicles are absent, and conidia arranged as brush border appearance molds.
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The major purpose of the pentose phosphate pathway is generation of reduced NADPH and pentose phosphates for nucleotide synthesis.Ref: DM Vasudevan, 7th edition, page no: 130
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Intracerebral hemorrhage Intraventricular bleed occurs in all types of severe head injury. CSF may be blood stained by the leakage of the subarachnoid hemorrhage through the foramen of Magendi. Bleeding may also occur from the choroid plexus or venues on septum pellucidum. Sudden onset of massive bleeding in the brain is called apoplexy. ref: FORENSIC MEDICINE AND TOXICOLOGY Dr PC IGNATIUS THIRD EDITION PAGE 176
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The hypothesis that more intensive long-term antiplatelet therapy reduces MACE in patients with prior MI has been demonstrated with P2Y12 inhibitors such as clopidogrel in CHARISMA, clopidogrel and prasugrel in the DAPT trial,1 and ticagrelor in Prevention of Cardiovascular Events in Patients With Prior Hea Attack Ref Davidson edition23rd pg 463
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Repeat questions
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Answer is D (Extensor plantar with brisk lower limb reflexes): Friedreich's Ataxia, is characteristically associated with an extensor plantar response but absent lower limb reflexes. Lower limb reflexes are characteristically absent (in most patients) and not brisk. Cardiomyopathy is a common association seen in up to 90% of patients Diabetes mellitus may be associated in up to 25% of cases Progressive ataxia is the most common presenting symptom.
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The abrupt cessation of menstruation in a healthy reproductive-aged woman who previously has experienced spontaneous, cyclical, predictable menses is highly suggestive of pregnancy. But there is appreciable variation in the length of the ovarian--and thus menstrual--cycle among women, and even in the same woman. Thus, amenorrhea is not a reliable indication of pregnancy until 10 days or more after expected menses onset. Ref: Cunningham F.G., Leveno K.J., Bloom S.L., Hauth J.C., Rouse D.J., Spong C.Y. (2010). Chapter 8. Prenatal Care. In F.G. Cunningham, K.J. Leveno, S.L. Bloom, J.C. Hauth, D.J. Rouse, C.Y. Spong (Eds), Williams Obstetrics, 23e.
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Generalized body aches, high grade fever followed by clinical deterioration and bleeding diathesis with raised hematocrit (65%) and low platelet and leucopenia strongly suggest dengue haemorrhagic fever, although meningococcemia is always a close diagnosis and many times requires serological confirmation. Complicated malaria usually has anemia and splenomegaly Leptospirosis may occur in icteric as well as nonicteric form. In nonicteric form shock and skin rashes are uncommon. Prominent features are severe myalgias and exquisite tenderness.
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Ligamentum Venosum
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The pathogens known to cause pneumonia in patients with chronic alcoholism are: Streptococcus pneumoniae Oral anaerobes Klebsiella pneumoniae Acinetobacter spp Mycobacterium tuberculosis Ref: Harrison, E-18, P-2132
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Hereditary pancreatitis: Early age of onset Hereditary pancreatitis gene is located on chromosome 7. Mutations in ion codons 29 (exon 2) and 122 (exon 3) of the cationic trypsinogen gene Autosomal dominant pattern C/F- Recurring attacks of severe abdominal pain Patients frequently develop pancreatic calcification, diabetes mellitus, and steatorrhea Increased incidence of pancreatic carcinoma Serum amylase and lipase levels may be elevated during acute attacks but are usually normal.
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5' nucleotidase level is elevated in obstructive or cholestatic liver disease, liver metastasis and biliary cirrhosis. 5' nucleotidase is found in or near the bile canalicular membrane of hepatocytes. Alkaline phosphatase, 5'-nucleotidase, and gamma-glutamyl transpeptidase (GGT) are the liver enzymes which are usually elevated in cholestasis. Alkaline phosphatase and 5'-nucleotidase are found in or near the bile canalicular membrane of hepatocytes, while GGT is located in the endoplasmic reticulum and in bile duct epithelial cells. Note: ALP will be elevated in bone diseases, pregnancy and cholestatic liver diseases. To confim the elevation is due to liver disease, do GGT and if both are elevated it is clear that elevation is due to cholestasis. Ref: Clinician's Pocket Reference By Leonard G. Gomella, Steven A. Haist, 11th Edition, Chapter 4; Textbook of Biochemistry for Dental Students By Vasudevan, 2nd Edition, Page 29; Harrison's Internal Medicine, 18th Edition, Chapter 302
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Once the pneumoencephalum has developed nitrous oxide should not be used for 1 week.
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Niacin can result in Insulin resistance and lead to hyperglycemia. Hence, it must be used cautiously in Diabetics.
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With the Valsalva maneuver, most murmurs will decrease. The location and radiation of this patient's murmur suggests aortic stenosis. The exceptions are the murmurs of HOCM and mitral valve prolapse, which increase.After release of the Valsalva maneuver, right-sided murmurs tend to return to baseline more rapidly.
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Answer is B (Results from an expansion of Neoplastic T lymphocytes) Hairy cell leukemia ica 'B' cell neoplasm and is characterked by expansion of neoplasticB cells (not T lymphocytes) Hairy cell leukemia: Hairy cell leukemia is a rare but distinctive form of chronic B cell leukemia that derives its name from the appearance of fine 'hair like projectionsdeg on the leukaemic cells (large B cells) * Characteristic cytochemical feature: Presence of tarate resistant acid phosphatase 'TRAP' 0 in neoplastic B cells * Cellular features/ Markers * Hairy cells express the pan B cell markers CD 19 and CD 20 and monocyte associated antigen CD 11 * Plasma cell associated antigen ( PCA-1) is also present - Robbins * Expression of CD 25, IL2 and specific adhesion molecules - Harrison 14th/695 * Clinical features * Present predominantly in the older age group > 40 yearsdeg result largely from infiltration of bone * Massive splenomegalydeg (hepatomegaly is less common) marrow liver and spleen * Lymphadenopathy * PancytopeniaQ * Recurrent infections * Treatment Q * Current treatment of choice is with purine analogues - Cladribinedeg * Other drugs used - Pentostotindeg - Interferon c(0 * Splenectomy used to be the standard treatment earlier
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Ans: a (Left vagus)In case of unilateral palatal palsy, the palatal arch on that side is at a lower level than on the healthy side. On saying 'ah', the uvula is pulled to the healthy side by the normal palate.Remember the code--Cranial nerve palsies 12 & 5 (12+5=17) cause movement towards the side of weakness, and weakness of cranial nerves 7 and 10(10+7= 17) cause movement towards opposite or healthy side.Don't get surprised this was asked in the morning session of the exam in anatomy.......
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The preparticipation sports physical examination is important in that it allows the physician to screen patients for potential risks associated with the sport they intend to play. That said, there are few real contraindications to sports participation. Having one eye is typically seen as a contraindication to playing contact sports like football or soccer. There are eye shields available, but in general these children are advised to avoid contact sports. Stable, repaired congenital heart disease; obesity; girls with a single ovary; and controlled diabetics are routinely allowed to participate. Other reasons to recommend against contact sports participation include hemophilia, single kidney, and unexplained syncope (until evaluated).
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A i.e. Walls of uterus are convex from inside Walls are concave from inside forming a wide & rounded uterine cavity in parous uterus; while the walls of nulliparous uterus are convex on inner side.Q
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Ans. is 'c' i.e., Endoscopic removal Treatment of antrochoanal polyp o There is no medical treatment for antrochoanal polyp. The treatment of choice is complete surgical removal of polyp along with removal of lining of maxillary sinus to prevent the recurrence. Surgeries for antrochoanal polyp include Avulsion of a polyp The stalk of the polyp is grasped and gently moved around to tease out the antral lining. Most of the time, avulsion fails to remove the polyp and antral lining completely. I ntranasal polypectomy It was the treatment of choice for all age groups prior to the advent of endoscopic sinus surgery and is still the treatment of choice in those setups where endoscopic surgery is not practised. Caldwell Luc operation It is indicated if there is a recurrence and the age of the patient is more than 17 years. Now a days with FESS available - Caldwell luc operation is avoided. Functional endoscopic sinus surgery (FESS) This is the treatment of choice for all polyps, whenever available and has superceded other methods of polyp removal.
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A i.e. Median nerve
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Ans. is 'a' i.e., Se
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TCA * MECHANISM This is an antidepressant with three rings. It acts by blocking the transpoers of neurotransmitters resulting in increased neurotransmitters in synapse DRUGS AMITRYPTILLINE IMIPRAMINE CLOMIPRAMINE DESIPRAMINE NORIPTILLINE DOXEPINE * USE AMITRYPTILLINE========PAIN WITH DEPRESSION IMIPRAMINE==========CHILDHOOD ENEURESIS CLOMIPRAMINE========OCD * SIDE EFFECTS ANTI HISTAMINERGIC==== sedation, weight gain ANTI MUSCURANIC=======dryness of mouth ANTI ADRENERGIC========hypotension, giddiness SWITCH TO MANIA when used in BIPOLAR DEPRESSION Ref. kaplon and Sadock, synopsis of psychiatry, 11 th edition, pg no.955
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(c) Squatting is easy- SACH foot does not allow ankle movements (required for squatting), subtalar movements (inversion and eversion movements for walking on uneven grounds). Hence more suitable for western lifestyle and in Jaipur foot these movements are permitted. Hence more suitable for Indian scenario also Jaipur foot is appropriate for walking barefoot and SACH foot barefoot is not possible
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HP of pemphigus vulgaris shows a suprabasal cleft with bulla formation just above the basal layer with a tomb stone appearance and with blister cavity containing acantholytic cells and inflammatory cells.Page no 282. Reference IADVL's concise textbook of dermatology
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The Narcotic Drugs and Psychoactive Substances Act 1985 (NDPS) This Act repeals and renders obsolete three Acts namely - 1. The Opium Act 1857 2. The Opium Act 1878 3. The Dangerous Drugs Act 1930 * According to this Act, a narcotic drug refers to the cocoa leaf, cannabis (hemp), opium, poppy straw and includes all manufactured drugs. A manufactured drug means all the cocoa derivatives, medicinal cannabis, opium derivatives and poppy straw concentrate and any other narcotic substance preparation, which the Central Government may by notification, declare to be manufactured drug. * The Act defines psychotropic substance as any substance, natural or synthetic, included in the list of psychotropic substances specified in a Schedule to the Act. The Schedule lists 77 psychotropic substances. * Under section 27 of the Act, if a person possess in a small quantity, any narcotic drug or psychotropic substance intended for personal use and not for sale or distribution, or consumes any narcotic or psychotropic substance, he shall be punished with imprisonment for a term, which may extend to one year or with fine or with both. The small quantity as quoted in the definition means: 1. 5 gm of hashish 2. 250 mg of heroin, smack and brown sugar 3. 5 gm of opium 4. 125 mg of cocaine 5. 500 gm of ganja * NDPS Act prohibits the cultivation of poppy, cannabis and coca plants, however restricted cultivation is allowed for medicinal or scientific purpose. * The minimum punishment for any offense committed under the Act is 10 years rigorous imprisonment and fine of Rs. 1 lakh while maximum punishment is 20 years rigorous imprisonment and fine of Rs. 2 lakh. REF:THE SYNOPSIS OF FORENSIC MEDICINE AND TOXICOLOGY:K S NARAYANA REDDY;PAGE NO 277
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Ans. is 'b' i.e., Less than 1 year
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Moclebemide is a reversible, competitive, selective MAOa inhibitor. Ref: KD Tripathi 8th ed.
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(A) Glycogen storage disorders # Glycogen storage disease (GSD, also glycogenosis and dextrinosis) is the result of defects in the processing of glycogen synthesis or breakdown within muscles, liver, and other cell types. GSD has two classes of cause: genetic and acquired. Genetic GSD is caused by any inborn error of metabolism (genetically defective enzymes) involved in these processes.> The mucopolysaccharidoses share many clinical features but have varying degrees of severity. These features may not be apparent at birth but progress as storage of glycosaminoglycans affects bone, skeletal structure, connective tissues & organs> Xanthomatosis is the deposition of yellow-orange colour lipids in liver, spleen and flat bones of the skull.
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Squamous cell carcinoma is MC carcinoma in burns. SCC commonly occurs in long standing ( Marjolin's ulcer) , old scar or keloid. Both Marjolin's ulcer & keloid are complications that arise after burns
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there is potassium depletion causing hypokalemia ( Harrison 17 pg2260)
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Curve A - increased in Emphysema Curve B - normal Curve C--> decreased in pulmonary fibrosis
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The main purpose of a myelin layer (or sheath) is to increase the speed at which impulses propagate along the myelinated fiber. Along unmyelinated fibers, impulses move continuously as waves, but, in myelinated fibers, they "hop" or propagate by saltatory conduction. Myelin decreases capacitance and increases electrical resistance across the cell membrane (the axolemma). Thus, myelination helps prevent the electric current from leaving the axon. It has been suggested that myelin permits larger body size by maintaining agile communication between distant body pas.Myelinated fibers lack voltage-gated ion channels (approximately 25 mm-2) along the myelinated internodes, exposing them only at the nodes of Ranvier. Here, they are found far more abundantly (between 2,000 and 12,000 mm-2). Myelinated fibers succeed in reducing sodium leakage into the extracellular fluid (ECF), maintaining a strong separation of charge between the intracellular fluid (ICF) and the ECF. This increases sodium's ability to travel along the axon more freely. However, the sodium diffuses along the axolemma rapidly but is decremental by nature. The sodium cannot trigger the opening of the voltage-gated sodium channels as it becomes weaker. The nodes of Ranvier, being exposed to the ECF every 1 mm or so, contain large amounts of voltage-gated sodium channels and allow enough sodium into the axon to regenerate the action potential. Each time the action potential reaches a node of Ranvier, it is restored to its original action potential (+35 mV).When a peripheral fiber is severed, the myelin sheath provides a track along which regrowth can occur. However, the myelin layer does not ensure a perfect regeneration of the nerve fiber. Some regenerated nerve fibers do not find the correct muscle fibers, and some damaged motor neurons of the peripheral nervous system die without regrowth. Damage to the myelin sheath and nerve fiber is often associated with increased functional insufficiency.Unmyelinated fibers and myelinated axons of the mammalian central nervous system do not regenerate.Some studies have revealed that optic nerve fibers can be regenerated in postnatal rats. This regeneration depends upon two conditions: axonal die-back has to be prevented with appropriate neurotrophic factors, and neurite growth inhibitory components have to be inactivated. These studies may lead to fuher understanding of nerve fiber regeneration in the central nervous system.Ref: Ganong&;s review of medical physiology, 23rd edition, Page no:82
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First, see the sensory distribution of the lower neck & upper trunk.
C2 dermatome →Occiput & top part of the neck.
C3 dermatome → Lower part of neck upto the clavicle.
C4 dermatone →Area just below the clavicle (Area which coincides with the upper border of the sternum)
Motor supply of upper-limb is C5_8 T,
Motor supply of diaphragm (Phrenic nerve) is C3_5
Now the findings of the patient in question:-
Li Patient has quadriparesis (i.e. weakness of upper as well lower limbs) →p lesion should be above or at C5 dermatome (upper limb has motor supply C5_8 T1)
Sensory loss up to the upper border of sternum → C4 area
Respiratory rate 35/minute → preservation of respiratory function with increased rate. Lesion at C4_5 level is consistent with preserved respiratory function and increased respiratory rate.
So, the lesion is at C4_5 level.
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Ans. C i.e. 2850 Energy requirement of woman Sedentary work: 1900 Kcal/day (35 Kcal kg/day) Moderate work: 2230 Kcal/ day (41 Kcal/kg/day) Heavy work: 2850 Kcal/day (52 Kcal/kg/day) Pregnant woman: + 350 Kcal/day Lactation: +600 Kcal/day
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Recovery from Propofol is more rapid and is accompanied with less "hangover" then recovery from often intravenous anaesthetic agents. Intravenous induction agent of choice forambulatory anesthesiaispropofol. Propofol hasrapid onset of action and a faster recoverymaking it an ideal induction agent for outpatient/ambulatory anesthesia. Besides, propofol hasantiemetic propeies which help reduce post-operative nausea and vomiting and recovery is pleasant
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Answer is A (Hypoglycemia): Cushing's syndrome is characterised by Hy perglycemia. Increased hepatic gluconeogenesis and insulin resistance causes increase in blood glucose. Hypeension is common, & emotional changes may be profound, ranging from irritability & emotional liability to severe depressions, confusion or even frank psychosis. Hvpokalemia. hypochloremia and metabolic alkalosis may be seen
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.GARDNER'S SYNDROME * It is commonly associated with FAP - 10%. * Presents with bone, skin, soft tissue and dental abnormalities. Jaw osteomas are very common. Other features are epidermoid cysts (50%), exostoses, fibromas, lipomas. * Associated with desmoid tumours seen in the scar, abdomen, intraabdominal region and mesenteric fibromatosis. * Congenital hyperophy of pigment layer of retina (seen as pigment spots)--commonly seen. * Often associated with MEN IIb syndrome. ref:SRB&;s manual of surgery,ed 3,pg no 834
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The chromosomal alterations in multiple myeloma include translocations in t(11;14) & t(4;14) & deletion of 13q.Reference : Harsh mohan textbook of pathology 6th edition pg no 381.
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Ans. A. Dopaminergica. There is a system of dopaminergic neurons in nigrostriatal dopaminergic system with cell bodies in substantia nigra and axon endings in caudate nucleus.b. In Parkinson's disease there is loss of dopaminergic cells in the substantia nigrawhich leads to striatal dopamine depletion.c. As DOPAMINE activates excitatory D1 receptors in the direct pathway and represses inhibitory D2 receptors in the indirect pathway, this depletion leads to decreased activity of the direct pathway and increased activity of the indirect pathway
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Ref: Sharma & Sharma 3rd ed. P 742-43; Katzung, 14th ed. pg. 809* Vancomycin (oral) is now considered as the drug of choice for pseudomembraneous colitis.* Metronidazole also used for pseudomembraneous colitis in mild cases.* Ampicillin has been associated with pseudomembranous colitis* Ceftriaxone is DOC for typhoid/enteric fever. Should be given IV.* METRONIDAZOLE is also the drug of choice in the treatment of amebiasis, trichomoniasis, Giardiasis and extraluminal amebiasis.* For serious pseudomembranous colitis not responding to metronidazole, DOC is Vancomycin
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Hemobilia Bleeding into the biliary tract from an abnormal aerial source to intrahepatic biliary tract fistula Poal venous bleeding into the biliary tree is rare, minor and selflimited Aerial hemobilia is the most common source Etiology Trauma : Iatrogenic (PTC) is the most common cause, blunt trauma is more common cause than penetrating trauma Gallstones Vascular pathology : Aneurysm, angiodysplasia, Parasitic infestation, liver abscess, cholangitis Ref: Sabiston 20th edition Pgno :1472-1474
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Good pasture's syndrome causes glomerulonephritis that results in rapidly progressive renal failure.
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ALZHEIMER'S DISEASE : It is a progressive neurodegenerative disorder of old age, primarily affecting cholinergic neurons in the brain. These drugs act by inhibiting acetylcholinesterase, thus increasing the availability and prolonging the action of ACh. Tacrine was the drug of choice for Alzheimer's disease but due to several limitations (frequent dosing requirement, hepatotoxicity, diarrhea), other drugs like donepezil, rivastigmine and galantamine are now the preferred agent. Memantine- For moderate to severe disease Cholinesterase inhibitors and memantine have effect on behavioral and psychiatric symptoms No disease modifying treatment is available at present
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B i.e. Dactylography
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Ans. is. 'd' i. e., Endemic typhus
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Ans. is 'c' i.e., Post transplantation Relative risk of developing T.B. Post transplantation 20-70 HIV 30 Silicosis 30 Recent infection 12 Diabetes 3-4 Malnutrition 2-3
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According to 'The registration of bihs & Deaths act 1969' both the bihs and deaths are to be registered with 21 days each. Marriages within 30 days/ 60 days/ 90 days. Child born to NRI couple abroad, bih registration is done within 60days of arrival. Bih registration is responsibility of hospital.
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Life span of micro filaria in human blood is 3 Months.
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<p>90% of patients with meningococcal meningitis will have two of the following features : fever,neck stiffness,altered consciousness & typical morbiliform,petechial or purpuric rash(due to hemorrhagic diathesis. Ref Harrison20th edition pg 1107
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Salmonella enteritidis Gram negative, facultative anaerobe Causes nontyphoidal salmonellosis (NTS) but Enteric fever is caused by S.typhi/S.paratyphi Causes non-bloody diarrhoea which may be copious In healthy adults, disease is usually self-limiting and as the antibiotic therapy doesn't change the disease course it is not recommended Antibiotic therapy is advised in neonates and elderly people, who have more chances of developing bacteremia. Bacteremia occurs in < 10% cases Metastatic infections can occur in bones and joints No vaccination for Non Typhoidal Salmonellosis (NTS)
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Ans. is 'a' i.e., Retropharyngeal node o Retropharyngeal nodes are divided into medial and lateral groups,o Most superior node of the lateral group is called the node of Rouviere.Also knowo Krause 's node Lymph nodes situated at the jugular foramen.
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Ref, Robbins 9/e p63
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Ans. is 'b' i.e., Altered sensorium Essentials of diagnosis of hemolytic uremic syndromeo Microangiopathic hemolytic anemia.o Thrombocytopenia and renal failure (may cause | K+)o Elevated serum LDHNo Normal coagulation tests.o Absence of neurological abnormalities."Hyperkalemia is seen in hemolytic urenic syndrome as a result of renal failure."ABOUT NEUROPSYCHIATRIC MANIFESTATIONSo Neurological manifestations are used to distinguish between Hemolytic uremic syndrome and Thrombotic Thrombocytopenic Purpura.o Both H.U.S. and T.T.P are thrombotic microangiopathy.o Both H.U.S and T.T.P present with thrombocytopenia and microangiopathic hemolytic anemia.o "H.U.S. is distinguished from T.T.P by the Absence of neurological symptoms and the prominence of acute renal failure."o Recent studies, however have tended to blurr these clinical distinctions.o Many adult patients with "T.T.P." lack one or more of the five criteria and patients with "HUS" have fever and neurological dysfunction.
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