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Ans. B. EpiglottitisEpiglottitis is characterized by inflammatory edema of the epiglottis along with upper airway obstruction. It is usually a cause of severe respiratory distress in young children and is associated with sudden onset high fever, drooling of saliva and the child in a typical "tripod position". Cause is usually S. pneumonia, or less frequently, H. influenza.
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Duloxetine is antidepressant -SNRI-Serotonin norepinephrine reuptake inhibitorRef: Katzung 13thed.Pg 528
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Grasp is best as..~ by offering a red cube to the ol.j)d. A 6-month-old infant reaches and holds the cul-e {b.rg? object) in a crude manner usincr the ulnar asf'C'l-'i: of r~ hand (Fig. 3_27). He can transfer ~bjects from one h.md t::i oth~ by 6-1 months. The child is able to grasp from the radial side of hand at 8-9 months (Fig. 328). B\* the ab'" ci 1 year, mature grasp (index finuer and thumb) is e,iJo.t (Fig. 3.29). 0 By offering pellets (smaller object), finer hand skills;.:~ assessed. By 9-10 months, the child approaches the pelletby an index finger and lifts it using finger thumb apposition, termed 'pincer' gras
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Pneumatic bones are one which contain large air spaces lined by epithelium e.g.: maxilla, sphenoid, ethmoid, Frontal etc. They make the skull light in weight, help in resonance of voice, and act as air conditioning chambers for the inspired air.
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(Leukocyte adhesion deficiency) (1289- B & L 24th) (61-62-Basis pathology 7th) (985-Baily & Love 25th)* Leukocyte adhesion deficiency (LAD-1)- Defects in b chain of CD 11 /CD 18 integrins- Characterised by recurrent bacterial infections and impaired wound healing* Leukocyte adhesion deficiency (LAD-2)- Defect in fucosyl transferase required for synthesis of sialylated oligosaccharide- Characterised by recurrent bacterial infections* Raspberry tumour - (Umbilical adenoma) - due to a partially (occasionally completely) unobliterated vitellointestinal duct. Mucosa prolapsing through the umbilicus gives rise to a raspberry like tumour, which is moist and tends to bleed - Treatment umbilectomy
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After bilateral adrenalectomy due to increased ACTH levels hyper pigmentation is seen. Pituitary tumor enlargement along with low pituitary harmones is present.
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According to Escobar staging, stage of neurocysticercosis in which a cyst is visible with scolex and with minimal perilesional edema is Vesicular. In Colloidal stage, the cyst stas to disintegrate, with maximum edema. In Granular stage, it becomes thicker and the edema subsides. In the Calcific nodular stage, it becomes densely calcified with no edema.
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Ans. is 'c' i.e., Both of above Osteoid Osteoma Osteoid osteoma is the most common true benign tumor of the bone. This is a benign circumscribed lesion that may arise in the coex of long bones or occasionally in the cancellous bone of spine. The characteristic feature is the formation of a small nidus of osteoid tissue, surrounded by a reactive zone of dense sclerosis (Sclerotic new bone formation). Microscopically, the tumor is composed of thin, irregular, trabeculae within a cellular granulation tissue containing osteoblasts and osteoclasts.Trabeculae are more mature in the center, which is often paially calcified. Reactive, sclerotic bone surrounds the nidus. Clinical features of osteoid osteoma The tumor occurs between 10-30 years of age and is more common in males. The diaphysis of long bones is involved, most common bone involved is the tibia followed by femur. Posterior elements of the veebrae may also be involved. The presenting complaint is a nagging pain, worst at night, and is relieved by salicylates or other NSAIDs, a diagnostic feature. On X-ray, there is a small radiolucent area (nidus) surrounded by dens sclerosis. X-ray, in some cases, show local sclerotic thickening of the shaft that may obscure the small central nidus within the area of rarefaction. Bone scan shows increased uptake in the nidus. The only treatment is wide en block excision along with internal fixation with or without bone grafting.
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A i.e. Chancroid
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Ans. is 'b' i.e., Hepatitis C virus is a small, enveloped, positive-sense single-stranded RNA virus of the family Flaviviridae.
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Ans. b. Concurrent chemoradiotherapy (Ref: Harrison 19/e p504-505, 18/e p 734-735; com/ article/ 2047862-overview style="font-size: 1.04761904761905em; font-family: Times New Roman, Times, serif">)An elderly male presents with T3N0 laryngeal carcinoma. Treatment is concurrent chemoradiotherapy.'Advanced laryngeal cancers are often treated by combining radiation with concurrent chemotherapy for larynx preservation and total laryngectomy for bulky T4 disease or salvage.''Concurrent radiation therapy plus Cisplatin resulted in a statistically higher percentage of patients with an intact larynx at 10 years.''Concomitant Cisplatin with radiation therapy resulted in a 41% reduction in risk of locoregional failure compared with radiation therapy alone.' Cancer Larynx* It is 10 times more common in malesQ than females.* Disease is mostly seen in the age group of 40-70 yearsQ.* Both tobaccoQ and alcoholQ are well established risk factor in laryngeal cancer.* Cigarette smoke contains benzopyrene and other hydrocarbons which are carcinogenic in man.* About 90-95% of laryngeal malignancies are squamous cell carcinomaQ with various grades of differentiation.* Cordal lesions are often well-differentiatedQ while supraglottic ones are Anaplastic.1. Supraglottic Cancer:- Supraglottic cancer is Jess frequent than glottic cancerQ.- Nodal metastases occur earlyQ, upper and middle jugular nodes are often involved.- Bilateral metastases may be seen in cases of epiglottic cancer.- Pain on swallowing is the most frequent initial symptomQ.- Mass in the neck may be the first sign.- Hoarseness is a late symptom.- Pain may be referred to ear by way of vagus nerve and auricular nerve of ArnoldQ.2. Glottic Cancer:- It is MC site of CA LarynxQ- Mostly originates from free edge and upper surface of anterior 1/3rd of true vocal cordQ followed by middle third 1 /3rd. Spread locally to anterior commissure than to opposite cord (conus elasticus initially acts as barrier for subglottic spreadQ).- Fixation of vocal cord indicates spread of disease to thyroaretenoid muscle and is a bad prognostic signQ.- As vocal cord is free of lymphatics, nodal metastases is never seen in cordal cancer, unless the disease spread beyond membranous cord.- Hoarseness is MC and the earliest symptomQ because of this glottic cancer is detected early.3. Subglottic Cancer:- Least common siteQ.- Subglottic region extends from glottic area to lower border of cricoid cartilage.- Spreads locally around anterior wall to opposite side or down wrards to trachea, upwrard spread to vocal cord is late and hoarseness is not an early symptomQ- Lymphatic metastases to prelaryngeal, pretracheal (Delphian nodeQ) and lower jugular nodes.- Earliest and most prominent symptom is stridorQ, but it appears only in advanced stage. Hoarseness is late feature.
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Ischemia leads to less ATP formation and therefore increased entry of sodium and calcium ions inside the cell.
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The medial meniscus is firmly attached to the medial (tibial) collateral ligament. Damage to the medial collateral ligament often causes concomitant damage to the medial meniscus because of this relationship. The anterior cruciate ligament may be torn when the knee is hyperextended. The lateral meniscus is not attached to the medial collateral ligament but receives muscular attachment to the popliteus muscle. The posterior cruciate ligament also lies outside of the synol cavity and limits hyperflexion of the knee.
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Curative components under IMNCI
Diarrhoea
Pneumonia
Measles
Malaria
Severe malnutrition.
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Ref: THE ESSENTIALS OF FORENSIC MEDICINE AND TOXICOLOGY- Dr. K.S.NARAYAN REDDY 32 EDITION page no-432 This method determines whether the blood derived from human being or from lower animal. It is an immunological test(serological examination). Principle: Blood serum contains proteins in colloidal suspension ,and when human serum is injected into an animal,the animal become immunised against these proteins and antibodies develop in its blood .If human serum is then brought into contact with this animal serum,the antibodies in the animal serum react with the proteins in the human serum and a visible precipitate forms. The antibodies causing this reaction are known as precipitins and the animal serum is known as antihumam precipitin serum.A rabbit or a fowl is injected with human blood every third day for 3 to 5 injections. after thuis animal is killed and the antiserum is collected. A suitable antiserum should react immmediately or within a minute on the 1:1000 dilution Application of the test: It is a specific protein test, and the reaction demonstrates the presence of albuminous substances obtained from any pa of human body. the origin of skin, flesh,bone or even secretions such as saliva ,milk and semen is determined by this test.
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Potent topical coicosteroids . Narrow band UVB . Psoralens+ PUVA is the treatment. Systemic chemotherapy and biological response modifiers are used in stage 3. From illustrated synopsis of dermatology and sexually transmitted diseases neena khanna 5th edition page no 406
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Hereditary retinoblastomas develop from the deletion of Rb gene, located on chromosome 13q14. Retinoblastoma gene is a tumor suppressor gene, which serves as a break on the advancement of cells from the G1 to S phase of cell cycle.Ref: Robbins Pathologic Basis of Disease, 7th Edition, Pages 287, 289, 1372.
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c. Holt-Oram syndrome(Ref: Nelson's 20/e p 746, Ghai 8/e p 413)Discussing about the options one by one,Name of the syndromeClinical featuresa. Lesch-Nyhan syndromeHyperuricemia, intellectual disability, dystonia, choreoathetosis, spasticity, dysarthric speech and compulsive self-biting, usually beginning with eruption of teethb. Rasumussen syndromeIt is an immune mediated disease associated with intractable unilateral seizures, progressive hemiparesis and intellectual dysfunctionc. Holt-Oram syndromeASD & bony abnormalities, with a strong familial tendency (autosomal dominant inheritance)d. LEOPARD syndromeLentigines (multiple), Electrocardiographic conduction abnormalities, Ocular hypertelorism, Pulmonary stenosis, Abnormalities of genitalia, Retardation of growth, Deafness
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Park's textbook of preventive and social medicine 23 edition. *Measles and MMR should not be administered on those on treatment with high dose steroids, alkylating agents or anti metabolites or under immunosuppressive therapeutic radiation.
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Ans:C.)Antecubital Fossa. Atopic dermatitis It is a chronic, pruritic inflammatory skin disease (see image below) of unknown origin that usually stas in early infancy, but also affects a substantial number of adults. AD is commonly associated with elevated levels of immunoglobulin E (IgE). That it is the first disease to present in a series of allergic diseases--including food allergy, asthma, and allergic rhinitis, in order--has given rise to the "atopic march" theory. The earliest lesions affect the creases (antecubital and popliteal fossae), with erythema and exudation. Over the following few weeks, lesions usually localize to the cheeks, the forehead and scalp, and the extensors of the lower legs; however, they may occur in any location on the body, usually sparing the diaper area and the nose. Lesions are ill-defined, erythematous, scaly, and crusted (eczematous) patches and plaques.
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Harrison's principles of internal medicine * In case of lead ( ninpharmaceutucal toxins) motor involvement and CNS involvement is greater Ref Harrison20th edition pg 2345
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Ans. Hallucinations
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Ans. is 'd' i.e., England First country to introduce compulsory sickness insurance - Germany.First country to socialize medicine completely - Russia.First country to sta accupuncture - ChinaFirst country to sta family planning programme - India.First country to sta concept of health care & public health - England.First country to sta Blindness control programme - India.First country to sta Pasteurization - France.First country to develop bath, sewers and aqueducts for sanitation - Rome.
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Ans. is 'a' i.e., 1 day before and 4 days after appearance of rash Period of communicability: Chicken pox: 1 - 2 days before to 4 - 5 days after appearance of rash Measles: 4 days before to 5 days after appearance of rash Rubella: 7 days before symptoms to 7 days after appearance of rash Mumps: 4 - 6 days before symptoms to 7 days thereafter Influenza: 1 - 2 days before to 1 - 2 days after onset of symptoms Diphtheria: 14 - 28 days from disease onset Peussis: 7 days after exposure to 3 weeks after paroxysmal stage Poliomyelitis: 7 - 10 days before and after onset of symptoms Hepatitis A: 2 weeks before to 1 week after onset of jaundice Hepatitis B: Till disappearance of HBs Ag & appearance of anti-HBs Meningococcal: Until absent from nasal and throat discharge Tuberculosis: As long as not treated
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Some Complications of Alcohol Dependence Medical Complications Central Nervous System: i. Peripheral neuropathy ii. Delirium tremens iii. Rum fits (Alcohol withdrawal seizures) iv. Alcoholic hallucinosis v. Alcoholic jealousy vi. Wernicke-Korsakoff psychosis vii. Marchiaa-Bignami disease viii. Alcoholic dementia ix. Suicide x. Cerebellar degeneration xi. Central pontine myelinosis xii. Head injury and fractures. Ref: A Sho Textbook of Psychiatry, Niraj Ahuja, 7th Edition, pg. no. 39
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Leukemic lymphoblasts react with periodic acid schiff (PAS) stain gives reddish-purple clumps, sometimes more rectangular in character and referred to as "block" positivity (as opposed to the fine granular staining that can be seen in some myeloblasts and other cells). Ref: Lichtman M.A., Shafer J.A., Felgar R.E., Wang N. (2007). G. Lymphocytic Leukemias. In M.A. Lichtman, J.A. Shafer, R.E. Felgar, N. Wang (Eds), Lichtman's Atlas of Hematology.
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MRI is contraindicated in Cardiac pacemakers Aneurysmal metallic clips Metallic foreign body Cochlear implant Claustrophobia(Relative contraindication)
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Ans. is `d' i.e., Field trialAnalytical epidemiology (Analytical study) o Analytical studies are the second major type of epidemiological studies (after descriptive studies).o It contrast to descriptive studies that look at entire population, in analytic studies, the subject of interest is the individual within the population (except in ecological study).o The object is not to formulate, but to test hypothesis.o There are four major types of analytical observational studies -i) Case control study Longitudinal studiesii) Coho studyiii) Cross sectional studyiv) Ecological studyo Simplest form of observational Study --> Cross-sectional Studyo Most preferable observational/analytic Study design --> Coho Studyo Least preferable observational/analytic study design ----> Ecological Study.
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(A) Ganglion cell layer # Retina:> Layer of rods & cones: These are the end organs of vision & are also known as photoreceptors> Outer nuclear layer: It consists of nuclei of the rods and cones.> Outer plexiform layer: It consists of connections of rod spherules and cone pedicles with the dendrites of bipolar cells and horizontal cells.> Inner nuclear layer: It mainly consists of cell bodies of bipolar cells.* It also contains cell bodies of horizontal & muller's cells & capillaries of central artery of retina* The bipolar cells constitute the 1 st order neurons> Ganglion cell layer. It mainly contains the cell bodies of ganglion cells (the second order neurons of visual pathway).
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Roger's anomaly is another name for ventricular septal defeat.
Most common type is perimembranous type.
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Ans. is 'b' i.e., CSSM plus family planning
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The first documented and reported case of child abuse occurred in 1874. A child named Mary Ellen was discovered chained to her bedpost. She was beaten regularly and was found to be severely malnourished. A New York City Church group reported the situation to the police.
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Answer is A (Chorea is aggrevated during pregnancy) Sydenham's chorea may be aggravated by pregnancy. 'Patient's with sydenham's chorea may have chorea during pregnancy (chorea gravidarum) and are at higher risk of chorea induced by phenytoin or oral contraceptives' - The 5- Minute Neurology consult (2003) /399 Sydenhom's chorea usually occurs in isolation and is not associated with ahritis usually. Subcutaneous nodules are typically non tender. Rheumatic fever is associated with Erythema marginatum and not Erythema multiforme Featues of Sydenham's chorea in Rheumatic Fever (10-15% of patients) It usually occurs after a prolonged latent period after group A streptococcus It usually occurs in the absence of other manifestation (usually not associated with ahritis or carditis) It usually occurs in females Presents as rapid, jerkey, involuntary movements (choreiform movements) affecting predominantly the Head /Face and Upper limbs May be generalized or restricted to one side / asymmetrical Typical signs include Milk maid Grip Spooning of extended hands Daing of the protruded tongue Pronator signs Typically associated with excessive emotional lability and personality changes It is a self limiting condition and eventually resolves completely, usually within 6 weeks. Recurrence of chorea may be seen late after complete resolution Factors inducing Recurrence Pregnancy (Chorea gravidorum) Re infection with streptocossus / non specific infections Use of oral contraceptives
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"All types of malignant testicular tumors are more common in incompletely descended testes even if they have been brought down surgically. However it does improve the prospect of early diagnosis." - Bailey
Undescended testis
In undescended testis - the testes is arrested in some part of its path to the scrotum.
In Ectopic testis - the testis is abnormally placed outside its path.
Retractile testis - in infancy 80% of in apparent testis are retractile testis and require no t/t.
Approx 70-77% of cryptorchid testes will spontaneously descend, usually by 3 months of age.
More common in preterm, small for gestational age, LBW & twin neonates.
More common on t. Side*
Secondary sexual characteristics are normal
Complications of incomplete descent
Torsion of testis
Epididymo-orchitis
An associated indirect inguinal hernia is frequent
Atrophy
Pain - A testis situated in the inguinal canal is often liable to trauma and give rise to pain in the groin
Sterility - If the condition is bilateral
Malignancy - risk is 40 times more than a normally placed testis.
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Enterotoxigenic E.coli: Diarrhea caused by ETEC is of two epidemiological types Diarrhea caused by ETEC is endemic in developing countries in the tropics. Common in all age groups. Traveler's diarrhea: Adheres to the intestinal mucosa which is mediated by colonization factor antigens. Produces enterotoxin which may be heat liable or heat stable. Reference: Textbook of Microbiology; Anathanarayan and paniker's; 10th edition; Page no: 285
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Retrosternal Burning pain Epigastric pain Regurgitation TRIAD - GERD Dx- 24 hrs pH monitoring DEMEESTER'S Score (< 14.7 Normal) GERD > 14.7 Sx Mx - Life expectancy > 10 years |Laparoscopic Nissen's fundoplication (Gold standard treatment of GERD) other t/t options- Lifestyle modifications: Cessation of smoking Decrease caffeine intake Avoid large meals just before lying down Drugs for symptomatic improvement - Double dose of proton pump inhibitor
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Refer Harrison 17th/1243 Voricanazole is drug of choice for treatment of Aspergillosis. It can also be used for Candida species Mucormycosis is treated by Amphotercin B.Posaconazole can also be used
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Palatoglossus muscle is supplied by: superior laryngeal nerve vagal accessory complex
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it is ia new or nect generation aminoglycoside i.e neo glycoside, bactericidal in nature ,inhibiting the protein syunthesis, acting on both gram negetive and positive bacteria.
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Ans. D: Axial eyeball length The condition in which incident parallel rays of light do not come to focus upon the light-sensitive layer of the retina may be due to: Abnormal length of the globe-Most impoant Abnormal curvature of the refractive surfaces of the cornea and the lens Abnnormal refractive indices of the media-aqueous or vitreous. Abnormal position of the lens
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Ans. is 'd' i.e., 175 Cal/Kg Also know o On day one, diet should be staed with 80-100 Cal/lcg/d (not more than 100), which can be increased to 150 Cal/Kg/d in a week's time. Protein requirements 1. In severe PEM --> 4-5 g/kd/day. 2. In moderate PEM ---> 2-3 g/kg/day. o On day one, 0.7 g/kg of protein perday should be staed which can be increased to 2-3 g/kg/day in a week's time.
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HDL Risk factors for atherosclerosis and cardiovascular complications (Braunwald) Abnormalities in plasma lipoproteins and derangement in lipid metabolism rank as the most firmly established risk factors for atherosclerosis. Adusted relative risk for future cardiovascular events for selected lipid fractions and lipid ratios in decreasing order are given in the following table. Adjusted relative risk of future cardiovascular events for selected lipoproteins.
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Ans. is 'a' i.e., Herpes keratitisAntiviral DrugIts UseAcyclovirHerpes Simplex Virus Varicella Zoster VimsGanciclovirCMV and HS VFoscamet (i.v.)CMVOseltamivir (oral)Influenza A & influenza BRibavirinChronic HCV (with IFN-?)LamivudineHIV. Chronic HBVEntecavirHBV resistant to lamivudine
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The lesions in Linear IgA disease with a bimodal age distribution ie 60 yrs comprise of uicated plaques and papules, and annular, polycyclic lesions often with blistering around the edge, the string of pearls sign/cluster of jewels sign.
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Proline can only be stably accommodated within the first turn of an α helix. When present elsewhere, proline disrupts the conformation of the helix, producing a bend.
Harper, Ed 30, Pg 38
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KRI paste contains iodoform and camphor.
It resorbs rapidly and has no undesirable effects on succedaneous teeth, contains bactericidal action
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The variables most consistently found to predict 6-week moality are: Child-Pugh class C MELD score > 18 Failure to control bleeding or early re-bleeding Ref:Journal of Hepatology 2010
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Copper is excreted in the bile into GI tract from which it is not reabsorbed. So normally urine contains only traces of copper. Since copper homeostasis is maintained almost exclusively by biliary excretion, any disease which hampers its biliary excretion will lead to accumulation of Cu in the liver (Ex: cholestasis, hepatitis and cirrhosis)In Wilson disease, a genetic condition in which a mutation in the gene for a copper-binding P-type ATPase (ATP7B protein) blocks the excretion of excesscopper in the bile. As a consequence, copper accumulates in the liver, brain, kidney, and red blood cells.So in these conditions, where copper is not excreted from bile, its concentrations increase in blood and excretion through urine increases, thus showing up in urine.Ref: Harper&;s Biochemistry; 30th edition; pg: 676
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Ans: B (Amoxapine) ]Amoxapine is tricyclic antdepressant- KDT 7th/455ATYPICAL ANTIPSYCHOTIC KDT7th/436ClozapineAripiprazoleRisperidone.OlanzapineQuetiapineZiprasidoneAmisulpirideZotepineAsenapine-Katzung 13th/494 73Paliperidone-Katzung 13th/494Sertindole- Katzung 13th/ 494
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Confirmatory test for Down's syndrome: 1. First trimester- Chorionic villous sampling(10-13th week) 2. Second trimester - Amniocentesis(16-18th week)
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Latent Period
After the prodromal reaction comes a latent period, during which the exposed person shows no signs or symptoms of radiation sickness. The extent of the latent period is also dose related, lasting hours or days after supralethal exposures (approximately >5 Gy) to a few weeks after exposures of about 2 Gy.
Oral radiology ; White and Pharaoh 7th edition page no 24
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Placenta succenturiata is a condition in which one or more small lobes of placenta are placed at varying distances from the main placental margin. If it is retained it leads to ...... PPH Sub involution Uterine sepsis Polyp formation Ref: Datta Obs 9e pg 205.
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Anterior horn of lateral ventricle is closed anteriorly by the genu and rostrum of corpus callosum.Lateral ventricleTwo lateral ventricles are the cavities of cerebral hemisphere (one in each hemisphere). Each lateral ventricle communicates with third ventricle through interventricular foramen of Monro.It is divisile into four pas :?1) Central pa (body) : It is located in the medial pas of frontal and parietal lobes. It extends from interventricular foramen (of Monro) in front to splenium of corpus callosum behind. It has choroid plexus. It has :- o Roof : Formed by corpus callosum.Floor : Formed form lateral to medial by caudate nucleus (body), stria terminalis, thalamostriate vein, and lateral pa of upper surface of thalamus.Medial wall (paition between two lateral ventricles) : By septum pellucidum and body of fornix.2) Anterior horn : It lies in front of interventricular foramen of Monro extending into the frontal lobe. It has no choroid plexus. Its bondries are :-Anterior : Posterior surface of genu and rostrum of corpus callosum.Roof : Anterior pa of trunk of corpus callosum.Floor : Head of caudate nucleus and upper surface of rostrum of corpus callosum.Medial (paition) : Septum pellucidum and column of fornix.3) Posterior horn : It lies behind splenium of corpus callosum and extends into occipital lobe. It may be variable in size (may be absent). It has no choroid plexus. Its boundries are :-Floor and medial wall : Bulb of posterior horn raised by forceps major and calcar avis, an elevation raised by calcarine sulcus (anterior pa).Roof and lateral wall : Tapetum4) Inferior horn : It is the largest horn and extends into temporal lobe. It has choroid plexus. Its boundries areRoof and lateral wall : Tapetum, tail of caudate nucleus, stria terminalis and amygdaloid body.Floor : Collateral eminence (elevation by collateral sulcus) and hippocampus medially.
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There is enough elasticity in the structures transmitting force (crossbridges, thick and thin filaments, Z-disks, tendons) that the 10 nm shoening / half sarcomere produced by one cycle will not produce much force. Many cycles are needed to fully stretch these elastic elements. Ca++ must remain high as a result of a train of action potentials in a tetanus for some time to allow the full force to be developed. A is not correct because sufficient Ca++ is released after the transit of one action potential to saturate essentially all of the troponin binding sites and enable all the crossbridges to attach and cycle. Other factor(s) must explain the low twitch force. B is not correct because Ca++ reuptake is a very rapid process. Neveheless, the very high affinity of troponin for Ca++ ensures that it is saturated before the myoplasmic Ca++ falls significantly.
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Ans. (A) Paclitaxel(Ref: Katzung 13th/e p921)Paclitaxel is a taxane that act on mitotic spindle. Drugs acting on mitotic spindle act on M phase of cell cycle.Phase of cell cycleDrugs actingG1EtoposideSAntimetabolitesG2BleomycinEtoposideIrinoctecanTopotecanMVinca alkaloidsTaxanes
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Ans. (b) Recurrent chalazion.
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The two most common presentations of IgA nephropathy are recurrent episodes of macroscopic hematuria during or immediately following an upper respiratory infection often accompanied by proteinuria or persistent asymptomatic microscopic hematuria. So the most likely diagnosis in this patient is IgA nephropathy. IgA nephropathy is an immune complex-mediated glomerulonephritis defined by the presence of diffuse mesangial IgA deposits often associated with mesangial hypercellularity. A renal biopsy is necessary to confirm the diagnosis. There is no optimal treatment. Angiotensin-conveing enzyme (ACE) inhibitors are given in patients with proteinuria or declining renal function. Poststreptococcal glomerulonephritis due to impetigo develops 2-6 weeks after skin infection and 1-3 weeks after streptococcal pharyngitis. This rules out Poststreptococcal glomerulonephritis from the diagnosis in this case. Minimal change disease and Membranous Glomerulonephritis does not produce gross hematuria but instead microscopic hematuria. Ref: Harrison's Internal Medicine, 18th Edition, Pages 2342-2343, 2340, 2345, 2347
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Ans. is 'd' i.e., SSPE o Subacute sclerosing panencephalitis (SSPE) is a rare complication of measles, which develops many years after the initial infection - PSM Park 19th/e p. 128o The most common complications are: measles- associated diarrhea, pneumonia and otitis media -PSM Park 19th/e-128Complications of MeaslesRespiratory tractCNSGastrointestinalOthers (rare)o Laiyngitiso Croupo Bronchitiso Otitis media (M.C.)o Pneumoniao Encephalitiso Transverse myelitiso SSPEo Gastroenteritiso Hepatitis]o Appendicitiso Ileocolitiso Mesentric adenitiso Myocarditiso Glomerulonephritiso Thrombocytopenic purpurao Exacerbation of preexisting T.B.
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Ans. is 'c' i.e., Alteration in gene expression Epigenetics is a heritable change in the level of gene expression, not caused by changes in DNA sequence. It includes changes like Histone modification or DNA methylation
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The break uptime test is performed to evaluate the function of Lacrimal gland.
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Silver sulphadiazine cream(1%) This Broad spectrum prophylaxis against bacterial colonization Paicularly effective against Pseudomonas & MRSA
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DRUGS USED IN CHRONIC GOUT Group Mechanism Drugs Uric acid synthesis inhibitors Xanthine oxidase inhibitors Allopurinol, Febuxostat Uricosuric agents URAT-1 transpoer inhibitors Probenecid, Sulfinpyrazone, Benzbromarone, Lesinurad Recombinant uricase Cause oxidation of urate to allantoin Rasburicase, Pegloticase
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.NAD+ (Niacin)Pyridoxal phosphate (Pyridoxine)Coenzyme A (pantothenate )Methionine reacts with ATP forming S-adenosylmethionine, "active methionine"Harper 30th edition pg: 308
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Eye at bih Anteroposterior diameter of eyeball is about 16.5 mm Corneal diameter is about 10 mm Anterior chamber is shallow and angle is narrow Pupil is small and doesnot dilate fully. Lens is spherical at bih Retina is fully differentiated at bih. Macula differentiates 4-6 months after bih Myelination of optic nerve fibres has reached the lamina cribrosa Refractive status. Newborn is usually hypermetropic by +2 to +3 D Orbit is more divergent(50o) as compared to adult (45o) Lacrimal gland is still underdeveloped and tears are not secreted. Reference: A.K.Khurana; 6th edition; Page no:13
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Opioid poisoning: Pin point pupils.
Opioid withdrawl: dilated pupils.
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In LeFort I fracture, there is hemorrhage in to maxillary sinuses. When antral cavities become full blood starts leaking through the nose. The nasal passages may get blocked with this clotted blood.
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Takayasu arteritis is the choosen answer as it is associated with involvement of superior mesenteric artery. So, it may be associated with abdominal angiitis.
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Paraduodenal recess has the inferior mesentric vein in its right free margin. The fouh pa of the duodenum and the duodenojejunal junction have several folds of peritoneum that give rise to many named recesses. They are probably formed during development due to minor aberrations of duodenal rotation and fixation. The duodena recess include: Superior duodenal recess lies directly to the fouh pa of the duodenum, adjacent to L2 veebrae , and behind a cresentric superior duodenal fold. Inferior duodenal recess lies to the left of the fouh pa of the duodenum, adjacent to L3 veebrae, behind a triangular inferior duodenal fold. Paraduodenal recess lies a little to the left and slightly behind the fouth pa of the duodenum, behind a falciparum fold of peritneum. Its right free edge contains the inferior mesentric vein and ascending branch of the left colic aery. Retroduodenal recess is the largest among duodenal recesses. It lies behind the third and fouh pas of the duodenum in front of the abdominal aoa. It has a wide orifice flanked by the duodenalparietal folds of peritoneum. Mesentericoparietal recess lies just below the third pa of the duodenum and forms a pocket in the upper pa of the mesentry towards the right. It has a large, left facing orifice behind a fold of mesentry raised by the superior mesentric aery. Duodenojejunal recess lies to left of the abdominal aoa, between the duodenojejunal junction and the root of the transverse mesocolon. Ref: Gray's Anatomy 41st edition Pgno: 1108
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Hemophilia C(Rosenthal syndrome) It is due to deficiency of factor XI Ref: http://en.wikipedia.org/wiki/Hemophilia_C
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This patient probably has an inferior wall myocardial infarction complicated by right ventricular involvement. The Cardiac output is probably depressed because of low left hea filling pressure secondary to right ventricular infarction. The initial treatment should be to administer fluids intravenously.
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Ans. C. Brown adipose tissueBrown adipose tissue contains thermogenin, which is a physiological uncoupler of oxidative phosphorylation. This process is called Nonshivering Thermogenesis.
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Hyaluronic Acid A sulfate-free mucopolysaccharide. It was first isolated from the vitreous humor of the eye. Later it was found to be present in synol fluid, skin, umbilical cord, haemolytic streptococci and in the rheumatic nodule. It occurs both free and salt-like combination with proteins and forms so-called ground substance of mesenchyme, an integral pa of the gel-like ground substance of connective and other tissues. Composition: It is composed of repeating units of N-acetyl glucosamine and D-Glucuronic acid. On hydrolysis, it yields equimolecular quantities of D-Glucosamine, D-Glucoronic acid and acetic acid (Fig. 3.20). Functions: (See below under proteoglycans) Hyaluronidase: An enzyme present in ceain tissues, notably testicular tissue and spleen, as well as in several types of pneumococci and haemolytic streptococci. The enzyme catalyzes the depolymerization of hyaluronic acid and by reducing its viscosity facilitates diffusion of materials into tissue spaces. Hence the enzyme, sometimes, is designated as spreading factor.Ref: Textbook of medical biochemistry, MN Chatterji, 8th edition, page no: 34
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When blood glucose enters the erythrocytes, it glycates the e-amino group of lysyl residues and the amino terminals of haemoglobin.The fraction of haemoglobin glycated, normally about 5%, is propoionate to blood glucose concentration.Since the half-life of an erythrocyte is typically 60 days, the level of glycated haemoglobin (HbA1c) reflects the mean blood glucose concentration over the preceding 6 to 8 weeks. Measurement of HbA1c, therefore, provides valuable information for management of diabetes mellitus.Reference: Harper biochemistry, 30th edition, page no 58
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In reidel thyroiditis trucut biopsy is taken.
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Ans. C: Leishmania tropica Oriental sore is a skin disease, occurring in tropical and subtropical Africa and Asia, caused by the parasitic protozoan Leishmania tropica. It is a specific granuloma of the skin, endemic within ceain limited areas in warm countries; characterized primarily by a papule, gradually enlarging by peripheral and subjacent infiltration,with scaling or crusting, and which usually, sometimes with an inter-vening furunculoid stage, slowly breaks down and develops into an indolent ulcer. The disease takes the form of a slow-healing open sore or ulcer, which sometimes becomes secondarily infected with bacteria. Leishmania donovani causes kala-azar. Leishmania braziliensis causes muco-cutaneous leishmaniasis
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Ans. C. Simple globular proteinsa. Proteins on the basis of solubility and physical properties divided into three classes:b. Simple proteins which on complete hydrolysis yield only amino acids. Ex. Albumins, Histones, Globulins, prolamines, Scleroproteins.c. Conjugate proteins which in addition to amino acids contain a non-protein part or prosthetic group. Ex. Nucleoproteins, Mucoprotein, Glycoproteins, Lipoproteins, Chromoprotein, Phosphoproteins.d. Derived proteins are the proteins formed from native protein by the action of heat, physical forces or chemical factors. Ex. Peptones, elastin, myosan.
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The main player in the catalytic mechanism in the serine proteases is the catalytic triad. The triad is located in the active site of the enzyme, where catalysis occurs, and is preserved in all superfamilies of serine protease enzymes. These three key amino acids each play an essential role in the cleaving ability of the proteases. While the amino acid members of the triad are located far from one another on the sequence of the protein, due to folding, they will be very close to one another in the hea of the enzyme. The paicular geometry of the triad members are highly characteristic to their specific function: it was shown that the position of just four points of the triad characterize the function of the containing enzyme. Each amino acid in the triad performs a specific task in this process: The serine has an -OH group that is able to act as a nucleophile, attacking the carbonyl carbon of the scissile peptide bond of the substrate. A pair of electrons on the histidine nitrogen has the ability to accept the hydrogen from the serine -OH group, thus coordinating the attack of the peptide bond. The carboxyl group on the aspaic acid in turn hydrogen bonds with the histidine, making the nitrogen atom mentioned above much more electronegative. The whole reaction can be summarized as follows: The polypeptide substrate binds to the surface of the serine protease enzyme such that the scissile bond is inseed into the active site of the enzyme, with the carbonyl carbon of this bond positioned near the nucleophilic serine. The serine -OH attacks the carbonyl carbon, and the nitrogen of the histidine accepts the hydrogen from the -OH of the and a pair of electrons from the double bond of the carbonyl oxygen moves to the oxygen. As a result, a tetrahedral intermediate is generated. The bond joining the nitrogen and the carbon in the peptide bond is now broken. The covalent electrons creating this bond move to attack the hydrogen of the histidine, breaking the connection. The electrons that previously moved from the carbonyl oxygen double bond move back from the negative oxygen to recreate the bond, generating an acyl-enzyme intermediate. Now, water comes in to the reaction. Water replaces the N-terminus of the cleaved peptide, and attacks the carbonyl carbon. Once again, the electrons from the double bond move to the oxygen making it negative, as the bond between the oxygen of the water and the carbon is formed. This is coordinated by the nitrogen of the histidine, which accepts a proton from the water. Overall, this generates another tetrahedral intermediate. In a final reaction, the bond formed in the first step between the serine and the carbonyl carbon moves to attack the hydrogen that the histidine just acquired. The now electron-deficient carbonyl carbon re-forms the double bond with the oxygen. As a result, the C-terminus of the peptide is now ejected.
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Ankle is a close-fitting hinge-like joint of which the two pas interlock like a moise (the box formed by the distal ends of the tibia and fibula) and tenon (the upward projecting talus). The moise bones are held together as a syndesmosis by the distal (inferior) tibiofibular and interosseous ligaments, and the talus is prevented from slipping out of the moise by the medial and lateral collateral ligaments and joint capsule. The peroneal tendons provide additional stability. Reference - Apley's system of ohopaedics- 9th edn- pg no 907.
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Ans: A. Iron deficiency anemiaReference: Thappa DM. editor. Essentials in Dermatology, 2nd edn. New Delhi: JaypeeExplanation: (See the following table)Nail abnormalityDescriptionCausesKoilonychiaReverse curvature in the longtitudinal and transverse axisIron deficiency anemiaMacronychia/McronychiaToo small or large nails--OnycholysisDistal or lateral separation of the nail from nail bedPsoriasis, OnychomycosisPterygiumCentral fibrotic tongue like band from proximal nail fold joins the nail bed dividing the nail proximal!}1 into twoLichen planusSubungual hyperkeratosisExcessive collection of squamous debris under the free edge of nailPsoriasis OnychomycosisOnychogryphosisNail get thickened and grows upwards in a spiral mannerChronic traumaPachynychia congenitaHypertrophy of nails associated with nail bed and hyponychial hyperkeratosis--Beau's linesTransverse grooves on nailsTemporary cessation of nail formationChemotherapyHypocalcemiaNail infectionCoronary occlusionMalnutritionTerry's nailNail N white proximally hut normal distallyCongestive cardiac failureCirrhosisDiabetes mellitusPittingPunctate erosions on nail surfacePsoriasisAlopecia areataRed LunulaeNails show erythema of lunulaPsoriasis (Dotted red lunula) Congestive cardiac failure CirrhosisSLESplinter hemorrhagesLongiitudinal hemorrhages in nail bedPsoriasisDermatitisFungal infectionsInfective endocarditis SLEMycosis fungoidesRheumatoid arthritisMees linesWhitening or discoloration of the nail in bands or "stria" that run parallel the lunula (nail base)CirrhosisChemotherapyHeavy metal poisoning(Arsenic, Thallium)TraumaMuehrcke's nailsWhite lines (leukonychia) that extend all the way across the nail and he parallel to the lunula {half moon)Non-specificAssc with decreased protein synthesisHypoalbuminemiaNephrotic syndrome
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Infections can spread to cavernous sinus by angular vein and deep facial vein draining dangerous area of face. Fig:- Dangerous area of face
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Mastoid process is a Traction epiphysis.Traction epiphysis is produced due to the pull of the muscles and therefore provide attachment to the muscle. for e.g., sternocleidomastoid muscle puts a traction upon the mastoid process.Note: The mastoid process does not begin to develop until the end of the second year. Before the mastoid process develops, the facial nerve is a subcutaneous structure and is in danger of being damaged by an incision behind the ear, if it extends too far down. Types of epiphysis: Pressure epiphysis Traction epiphysis Atavistic epiphysis Aberrant epiphysis -Aicular ends(takes pa in transmission of weight) Example- Head of femur - Nonaicular(does not take pa in transmission of weight) *Provides attachment to one or more tendons which exe traction on the epiphysis. Example- Tubercles of humerus, mastoid process. - Phylogenetically an independent bone, which in humans is fused to another bone Example- coracoid process of scapula Is not always present Example- Epiphysis of head of first metacarpal
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Ans. is 'a' i.e., Tyrosine kinase Crizotinib* It is a small molecule multitargeted tyrosine kinase receptor inhibitor targeting ALK, MET, ROS1 kinases.* By inhibiting ALK tyrosine kinase activity, crizotinib inhibits cell proliferation, induces G1 - S phase cell cycle arrest and apoptosis.* It is approved for the first line in management of metastatic non-small cell lung cancer with an ALK mutation.* The most common adverse effects associated with crizotinib are vision disorder, diarrhea and edema.* It is also associated with QT prolongation and bradycardia* Tumors invariably acquire resistance after one year of treatment. Mechanism of resistance include mutations in ATP binding pocket of the tyrosine kinase domain of ALK.
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Ans. is a, i.e. InterstitialRef: Shaw 15th/ed p352* Most common variety of fibroid is intramural/interstitial (75%) followed by submucous (15%) and subserous (10%).* To start with all fibroids are intramural/interstitial.Q
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* Initial Symptoms and percent of cases Sensory loss -37% Optic neuritis- 36% Weakness -35% Ataxia-11%. Optic nerve Pain and temporary vision loss in one eye are common symptoms of optic neuritis. Optic neuritis is linked to multiple sclerosis (MS), a disease that causes inflammation and damage to nerves in your brain and spinal cord Ref Davidson edition23rd pg1110
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Ans. is 'b' i.e., Cefoperazone o Cefoperazone is primarily exreted in bile in contrast to other cephalosporins that are usually excreted by the kidney --> safe in renal failure. o Cephalosporins that can be used in presence of renal failure :- i) Cefoperozone, ii) Ceftriaxone, iii) Cefoperamide
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The aerial supply of the middle ureter is derived from the common iliac and gonadal aeries. Finally, the distal ureter is supplied by branches of the common iliac and internal iliac branches, paicularly uterine and superior vesical aeries.The venous drainage is paired with the aeries. ref - BDC 6e vol2 pg318
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Ans. (a) Fungus Ref Ananthanaravan' 7/e; p 603 Rhinosporiduim seeberi Lower aquatic fungi forming spores Natural habitat is reservoir water and perhaps soil contaminated with that water. Once infected organism produce a polypoidal mass lesion in the affected area, commonest site being nose, nasopharynx, tonsil, eye. Diagnosis: Can not be cultivated in aificial media. Histologically the lesion is composed of large number of fungal spores embeded in stroma of connective tissue and capillaries. Treatment: Excison of the polyp is the treatment of choice.
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A healthy liver conves vitamin D (cholecalciferol) to form 25-hydroxycholecalciferol, but a diseased liver has a reduced capacity to do so. The kidney, not the liver, is responsible for the conversion of 25 hydroxycholecalciferol to 1,25-dihydroxycholecalciferol. Vitamin D, not 1,25-hydroxycholecalciferol, is absorbed by the small intestine.
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An elderly patient with fever, chest pain and non-productive (dry cough) are characteristic features of legionnaires disease (pneumonia), caused by Legionella pneumophila. Legionella pneumophila grows on buffered charcoal yeast agar. Hemophilus influenzae grows on blood agar, Moraxella catarrhalis grows on nutrient agar and Burkholderia cepacia needs selective media for its growth. Ref: Textbook of Microbiology, Ananthanarayan and Paniker, 7th Edition, Chapter 45, Page 409.
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Fibromyalgia is a syndrome of known and probably multifactorial cause, which leads to diffuse musculoskeletal pain. Patients often note fatigue, paraesthesia, subjective swelling, and sleep dismrbance. In general, their physical exam is normal. The have tenderness in at least 11 of 18 proscribed tender areas. It is unknown what these areas represent, but their occurrence and reproducibility have been well-documented.
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Response to Co2, PaCO2 is most impoant factor in control of ventilation under normal conditions. PCo2 is most impoant input regulating magnitude of ventilation under resting conditions. Changes in alveolar ventilation have immediate, pronounced effect on aerial Pco2 (unlike Po2). Even slight alterations from normal Pco2 induce significant reflex. Increased Pco2 increases ventilation. Blood Brain Barrier is permeable to Co2, so increased aerial Pco2 increases brain ECF Pco2 and , it stimulates central chemoreceptors which increases ventilation by stimulating respiratory centers. Regulation of respiration: The rhythmic discharges from the brain that produce spontaneous respiration are regulated by alterations in aerial Po2, PCo2, and H+ concentration. There are numerous factors that affect and control ventilation. Chemical control Co2 ( CSF and brain interstitial fluid H+ concentration) o2 ( carotid and aoic bodies) H+ ( carotid and aoic bodies) Nonchemical control Vagal afferents from receptors in the airways and lungs Afferents from the pons, hypothalamus, and limbic system Afferents from proprioceptors Afferents from baroreceptors: aerial, atrial, ventricular, pulmonary Preipheral (Carotid & Aoic) Chemoreceptors: The carotid bodies are located at the bifurcation of common carotid aery. They send afferents in the carotid sinus nerve to the glossopharyngeal nerve (IX) the aoic bodies are located between the arch of aoa and pulmonary aery afferents ascend in the recurrent laryngeal nerves to the vagus (X). Stimulation results from a decrease in carotid and aoic body tissue PO2. Central Chemoreceptors: situated near (beneath) the ventral surface of the medulla, near the origins of the vagi and glossopharyngeal nerves these are anatomically separate from the respiratory centres, and are bathed in brain ECF. This is impermeable to both H+ and HCO3 -, however CO2 diffuses readily and decreases pH of CSF within a few minutes, which subsequently increases ventilation. Ref: A Concise Textbook Of Physiology, By S. And Kutty, K.M., Page 101.
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Ans. a (Cannabis) (Ref-Kaplan & Sadock's Synopsis of Psychiatry, Xth/ Chapter 12.5, Pg 420).MARUUANA/AND/CANNABIS# Marijuana is the most commonly used illegal drug in the United States.# Acute intoxication from marijuana and cannabis compounds is related to both the dose of Tetrahydrocanabinol (THC) and the route of administration.# THC is absorbed more rapidly from marijuana smoking than from orally ingested cannabis compounds.# Acute marijuana intoxication usually consists of a subjective perception of relaxation and mild euphoria resembling mild to moderate alcohol intoxication.# This condition is usually accompanied by some impairment in thinking, concentration, and perceptual and psychomotor function. Higher doses of cannabis may produce behavioral effects analogous to severe alcohol intoxication. THC causes a specific "amotivational syndrome."# Often it can be difficult to recognize the signs of marijuana use because most of the signs take place while the individual is under the influence. Marijuana users may show following signs: Rapid, loud talking and bursts of laughter in early stages of intoxication, Sleepy or stuporous in the later stages, Inflammation in whites of eyes; pupils unlikely to be dilated, Odor similar to burnt rope on clothing, Weight gain or loss., etc# Chronic marijuana use has also been reported to increase the risk of psychotic symptoms in individuals with a past history of schizophrenia.Signs and Symptoms of Intoxication and WithdrawalDrugIntoxicationWithdrawalOpioidsCNS depression, nausea, vomiting, constipation, pupillary constriction, seizures, respiratory depression (life-threatening in overdose). Naloxone/naltrexone will block opioid receptors and reverse effects (beware of antagonist clearing before opioid, particularly with long-acting opioids such as methadone).Anxiety, insomnia, anorexia, diaphoresis, dilated pupils, fever, rhinorrhea, piloerection, nausea, stomach cramps, diarrhea, yawning.Extremely uncomfortable, but rarely lifethreatening.AmphetaminesPsychomotor agitation, impaired judgement, tachycardia, pupillary dilation, hypertension, paranoia, angina, hallucination, sudden death.Treat with haloperidol for severe agitation and symptom-targeted medications.Post-use "crash" with hypersomnolence, depression, malaise, severe craving, suicidality.Phencyclidine hydrochloride (PCP)Belligerence, psychosis, violence, impulsiveness, psychomotor agitation, fever, tachycardia, vertical/ horizontal nystagmus, ataxia, delirium. Give benzodiazepines for severe symptoms; otherwise reassure.Recurrence of intoxication symptoms due to reabsorption in the GI tract; sudden onset of severe, random violence.LSDMarked anxiety or depression, delusions visual hallucinations, flashbacks, pupillary dilation. Give benzodiazepines or traditional antipsychotics for severe symptoms. MarijuanaEuphoria, slowed sense of time, impaired judgement, social withdrawal, appetite, dry moth, conjunctival injection, hallucinations, anxiety, paranoia, amotivational syndrome. BarbituratesLow safety margin, respiratory depression.Anxiety, seizures, delirium, lifethreatening cardiovascular collapse.BenzodiazepinesInteractions with alocohol, amnesia, ataxia, somnolence, mild respiratory depression.Rebound anxiety, seizures, tremor, insomnia, hypertension, tachycardia.
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B i.e. Hydronephrosis
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A fixed split S2 indicates an atrial septal defect (ASD). Spitting at both expiratory and inspiratory phases but does NOT lengthen with inspiration Compared to Wide splitting where there is splitting during expiration and even wider during inspiration, which is seen in conditions with delayed conduction down the right bundle ref - Harrisons internal medicine 20e pg 1671, 1672f
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Lennox-Gastaut syndrome (LGS): High yield facts It typically stas between the ages of 3 to 10 yr It consists of a triad of developmental delay, multiple seizure types and typical EEG changes Patients commonly have multiple seizure types (myoclonic, atypical absence, atonic, astatic, and tonic seizures) that are difficult to control, and most are left with long-term cognitive impairment and intractable seizures despite multiple therapies. EEG findings are 1-2 Hz spike-and-slow waves, polyspike bursts in sleep, and a slow background in wakefulness. Some patients sta with Ohtahara syndrome, develop West syndrome and then progress to LGS
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Ans. is 'b' i.e., Prion o Prions are infectious particle which contains protein onlyo They do not have nucleic acid.
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Indications for surgery in BPH are: * Prostatism *Acute retention of urine *Chronic retention of urine with residual urine > 200ml*Complications like hydroureter, hydronephrosis, stone formation, recurrent infections, bladder changes.*HematuriaReference : page 1045 SRB's manual of surgery 5th edition
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b. Diffuse proliferative(Ref: Nelson's 20/e p 1176-1180, Ghai 8/e p 628)Class I is the Least common & class IV is the most common pattern of lupus nephritis.
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.man is the only impoant reservoir of human hookworm infection.faeces containing the ova of hookworms is the infective material.as long a sthe person harbours the parasite ,the infectivity of the disease continues. ref:park&;s textbook,ed 22,pg no 221
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Parenteral alimentation involves the continuous infusion of a hyperosmolar solution containing carbohydrates (Dextrose), proteins, fat and other necessary nutrients (eg. Vitamins, trace minerals).
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