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Cadaveric spasm, also known as postmoemspasm, instantaneous rigor, cataleptic rigidity, or instantaneous rigidity, is a rare form of muscular stiffening that occurs at the moment of death and persists into the period of rigor mois. In cadeveric spasm, only a pa of muscles are involved and it causes stiffening of that paicular muscles Ref synopsis of forensic laxminarayana 2e ; Krishnan vij Textbook of Forensic medicine and Toxicology 5th edtion ; pg no - 87
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Ans: A (Strychnine poisoning) Ref: The Essentials of Forensic Medicine and Toxicology by KS Narayan Reddy. 29th edition. 2010. Pg:Explanation:Refer 2011 Forensic medicine question explanation
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Ans. is 'b' i.e., Dermatomyositis o Dermatomyositis is a connective-tissue disease related to polymyositis that is characterized by inflammation of the muscles and the skin. o It is a systemic disorder that may also affect the joints, the esophagus, the lungs, and, less commonly, the hea. o On the muscle biopsy, there are two classic microscopic findings of dermatomyositis. They are : mixed B- & T-cell perivascular inflammatory infiltrate and perifascicular muscle fiber atrophy. o It is associated with autoantibodies, especially anti-Jol antibody.
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Increased trabecular meshwork outflow is the mechanism of action of new drug Rhopressa (rho- kinase inhibitors) New Drugs in Glaucoma Anecorvate - Angiostatic steroid. Ethacrynic acid latrunculins - cellular cytoskeletal modulators. Alter TM shape. Olmesean, lomerizine, nivaldipine - improves vascular perfusion. Neurotropic- FGF ,increase ganglion cell life. Memantine : NMDA antagonist. Rho kinase inhibitors increase TM outflow.
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Volkmann's contracture is a flexion deformity of the fingers and sometimes the wrist from an ischemic necrosis of the forearm flexor muscles. Bennett's fracture is a fracture at the base of the metacarpal of the thumb. Scaphoid fracture occurs after a fall on an outstretched hand and involves the scaphoid and lunate bones. Colles' fracture is also called silver fork deformity because the distal fragment of the radius is displaced posteriorly. Boxer's fracture is a fracture of the necks of the second and third (and sometimes the fifth) metacarpals. Smith's fracture is also called a reverse Colles' fracture and is caused when the distal radius is fractured, with the radial fragment angled forward.
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C. jeikeium-causes bacteremia with high moality rates in immunodeficient. C. urealyticum-causes UTI. Both are lipophilic.
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Microphakia, spherophakia (microspherophakia) all are types of abnormal lens.Microphakia - Abnormal smallness of the lens of the eye.Spherophakia (microspherophakia) - in spherophakia the lens is small and spherical (increase the anterior and posterior curvature of the lens). Angle-closure glaucoma occurs when the small round lens has blocked the flow of aqueous through the pupil.Aphakia is an absence of the lens.
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Ans. is d i.e. Menorrhagia I know many of you might be thinking - Inversion of uterus is the correct option. It is correct that. Inversion of uterus occurs in a fundal submucous fibroid polyp when it is being extruded. But chronic inversion of the uterus as such is a rare entity. Most common symptom of fundal fibroid like other fibroids is menstrual irregularitymenorrhagia. The Bottom line is : Most common fibroid causing inversion of uterus is fundal submucous firboid.deg But most common symptom of fundal submucous fibroid is menorrhagia.deg
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The anterior layer of the rectus sheath below the arcuate line is formed by aponeuroses of the external and internal oblique and transverse abdominal muscles, but there is no posterior layer of the rectus sheath below the arcuate line. The anterior layer of the rectus sheath above the umbilicus is formed by aponeuroses of the external and internal oblique abdominal muscles. The deep inguinal ring lies in the transversalis fascia. The lacunar ligament is formed by the external oblique abdominal aponeurosis.
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The second branchial arch forms bony and muscular structures from the ear (proximally) to the hyoid bone (distally), including the muscles of facial expression that are innervated by the facial nerve (cranial nerve (CN) VII). The posterior belly of digastric muscle develops from the mesoderm of second branchial arch hence it is supplied by the facial nerve. The anterior belly develops from the mesoderm of first branchial arch and hence supplied by mandibular nerve.
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Ans. is 'c' i.e., Gastroduodenal aeryGastroduodenal aery gives following branches :-Right gastroepiploic aerySuperior pancreaticoduodenal aery
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Ans. is 'a' i.e., Yolk sac o In early fetal life (upto 10 weeks) erythropoiesis occurs in yolk sac.o By third month of intrauterine life erythropoiesis moves to liver (major) and spleen which are the chief site for erythropoiesis until 5 months of fetal life.o After that erythropoiesis occurs in bone marrow.o In children, blood formation occurs in the marrow cavities of most of the bones. During childhood, there is gradual decrease of erythropoiesis in marrow of long bones and gradual increase in erythropoiesis in marrow of flat bones.o By the age of 20 years, erythropoiesis occurs only in flat bones of axial skeleton (e.g., skull,vertebrae, ribs, sternum and pelvis) and among the long bones, erythropoiesis occurs only in proximal end of femur and humerus.
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Answer is C (Factor V Leiden Mutation) Factor V Leiden mutation is the most common inherited thrombotic disorder Most common genetic cause for thrombophilia Factor V Leiden Most common congenital cause of venous thrombosis Factor V Leiden Most common hereditary blood coagulation disorder Factor V leiden
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Ans. is 'b' i.e., Retinal Vitamin A (Retinol)The retinoids are a family of molecules that are related to retinol (Vitamin A) and are essential for :VisionReproductionGrowthMaintenance of epithelial tissues Structure of vitamin AVitamin A is often used as a collective term for several related biologically active molecules.Vitamin A is essential for vision reproduction, growth and maintenance of epithelial tissues.Vitamin A can exist in several formsRetinol -Retinol is found in animal tissues as a retinyl ester with long chain fatty acids.Retinal (component of the visual pigment rhodopsin)The aldehyde derived from the oxidation of retinol.Retinal and retinol can readily be interconverted.Retinoic acidIt is the acid derived from oxidation of retinal.Retinoic acid cannot be reduced in the body and therefore cannot give rise to either retinal or retinol.b carotenePlant foods contain b carotene, which can be oxidatively cleaved in the intestine to yield two molecules of retinal.Now, the functions associated with each form of vitamin Retinoic acid, derived from oxidation of dietary retinol, mediates most of the actions of the retinoids, except for vision which depends on retinal, the aldehyde derivative of retinol.Note : Retinol acts on the nucleus of the target cells where the vitamin acts in a manner analogous to steroid hormones.
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D i.e. Lying to standing change in posture When a person moves from a supine position to standing position volume of blood pools in the lower extremity because of high compliance of veins & venous return decreases. As a result of decreased venous return the length of ventricular cardiac muscle fibres is decreasedQ and so the cardiac output in accordance with frank-sterling law.
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Advantages of Ether Ether is cardiovascular stable agent. maintains hypoxic and hypercapnic drive good analgesic good muscle relaxation bronchodilator cheap disadvantage slow induction /slow recovery Irritant nature of ether increases salivary and bronchial secretions highly inflammable
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Ans. is 'c' i.e., Interstitial nephritisCauses of eosinophiluriao Acute allergic interstitionl nephritis o Schistosomiasiso Rapidly progressive glomerulonephritis o Chronic pyelonephritiso Acute glomerulonphritis o Graft rejection acute phaseIg A nephropathy, Henoch - Schonlein purpura o Athroembolic renal diseaseProstatitis
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Smack is synthetic opioid Ref : Krishnan vij Textbook of Forensic medicine and Toxicology 5th edtion ; pg no - 492
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Atropine is an anticholinergic drug. Its toxicity causes:
Dry mouth (and not excessive salivation)
Hot skin
Dilated pupil and photophobia
Excitement
Flushing of skin
Hypotension → cardiovascular collapse
Convulsions and coma
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The quadrate lobe is an area of the liver situated on the under the surface of the right lobe, bounded in front by the anterior margin of the liver; behind by the poa hepatis; on the right, by the fossa for the gall-bladder; and on the left, by the fossa for the umbilical vein.
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Drugs used for LA induced seizure :- Benzodiazepines (midazolam), Barbiturates (thiopentone), Propofol.
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Adverse effects ofTCAs l. Anticholinergic - Dry mouth, bad taste, urinary retention, blurred vision, palpitation, constiPation. 2. Sedation, mental confusion, weakness. 3. Increased appetite and veigfit gain. 4. Sweating andfinc tremer. 5. Decreased seizure threshold (clomipramine, maprotiline & bupropion). 6. Postural hypotension > Marimum by amitripSline - Goodman & Gillman 11/e p. 4j3. 7. Cardiac arrythmia; Maximum by amitriptyline and dosulpin. REF : Oxford text book of psychiatry 3rd Ed.
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Ref - Harrison's internal medicine 20e p2517
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Monitoring is the performance and analysis of routine measurements aimed at detecting changes in the environment or health status of population.
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Gustafson's ranking of structural changes in age determination A = Attrition A-0 No Attrition A-1 Attrition lying within enamel A-2 Attrition reaching the dentin A-3 Attrition reaching the pulp P = Periodontosis P-0 No Periodontosis P-1 Periodontosis just begun P-2 Periodontosis along first 1/3rd of root P-3 Periodontosis along 2/3rd of root C = Cementum apposition C-0 Normal C-1 A layer little greater than normal C-2 A great layer C-3 A heavy layer R = Root resorption R-0 No visible restoration R-1 Resorption only on small isolated spots R-2 Greater loss of substance R-3 More cementum and dentin affected T = Root transparency T-0 Transparency not present T-1 Transparency just noticeable T-2 Transparency over apical 1/3rd of root T-3 Transparency over apical 2/3rd of root
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Behcet's syndrome
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Ans. (b) Placenta previaRef.: D.C. Dutta 8th ed. / 290, Williams 22nd ed./822-823* MacAfee and Johnson Regimen is a Conservative Management in Placenta Previa: This consists of complete bed rest, tocolysis, and close observation of patient.* Steroids are generally given to enhance lung maturity.* To undertake this regimen (to wait and watch) all three criteria should be fulfilled:# Mother should be hemodynamically stable# There should be no fetal distress# Pregnancy less than 36 weeks of gestation.* If any of the criteria is not met then the patient should be delivered by LSCS.Also Know* Classification of abruption placentae:/ classification* Zuspan regimen for the treatment of eclampsia using Magnesium sulphate* Other regimens using MgSO4 for treatment of eclampsia are# Pritchard s regimen# Sibai regimen* Most appropriate treatment of eclampsia: MgSO4
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Hoarseness is due to deposition of myxomatous tissue in the vocal cords. Nasal stuffiness is due to predominance of parasympathetic activity. Hypothyroidism also causes Meniere's like syndrome.
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Chin cap was introduced by Oppenheim. It delivers a force of 800 - 1200 (400 - 600 gms/side). The patient is asked to wear the appliance for 12-14 hours/ day.
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The clinical presentation of primary hyperparathyroidism is described on page 769. Parathyroid bone disease is now rare due to earlier diagnosis and treatment. Osteitis fibrosa results from increased bone resorption by osteoclasts with fibrous replacement in the lacunae. This may present as bone pain and tenderness, fracture and deformity. Chondrocalcinosis can occur due to deposition of calcium pyrophosphate crystals within aicular cailage. It typically affects the menisci at the knees and can result in secondary degenerative ahritis or predispose to attacks of acute pseudogout Skeletal X-rays are usually normal in mild primary hyperparathyroidism, but in patients with advanced disease characteristic changes are observed. In the early stages there is demineralisation, with subperiosteal erosions and terminal resorption in the phalanges. A 'pepper-pot' appearance may be seen on lateral X-rays of the skull. Reduced bone mineral density, resulting in either osteopenia or osteoporosis, is now the most common skeletal manifestation of hyperparathyroidism. This is usually not evident radiographically and requires assessment by DEXA (p. 1065). Primary hyperparathyroidism Primary hyperparathyroidism is caused by autonomous secretion of PTH, usually by a single parathyroid adenoma, which can vary in diameter from a few millimetres to several centimetres. It should be distinguished from secondary hyperparathyroidism, in which there is a physiological increase in PTH secretion to compensate for prolonged hypocalcaemia (such as in vitamin D deficiency, p. 1126), and from teiary hyperparathyroidism, in which continuous stimulation of the parathyroids over a prolonged period of time results in adenoma formation and autonomous PTH secretion (Box 20.39). This is most commonly seen in individuals with advanced chronic kidney disease (p. 483). The prevalence of primary hyperparathyroidism is about 1 in 800 and it is 2-3 times more common in women than men; 90% of patients are over 50 years of age. It also occurs in the familial MEN syndromes (p. 795), in which case hyperplasia or multiple adenomas of all four parathyroid glands are more likely than a solitary adenoma. Clinical and radiological features The clinical presentation of primary hyperparathyroidism is described on page 769. Parathyroid bone disease is now rare due to earlier diagnosis and treatment. Osteitis fibrosa results from increased bone resorption by osteoclasts with fibrous replacement in the lacunae. This may present as bone pain and tenderness, fracture and deformity. Chondrocalcinosis can occur due to deposition of calcium pyrophosphate crystals within aicular cailage. It typically affects the menisci at the knees and can result in secondary degenerative ahritis or predispose to attacks of acute pseudogout In nephrocalcinosis, scattered opacities may be visible within the renal outline. There may be soft tissue calcif ication in aerial walls and hands and in the cornea. DAVIDSONS PRINCIPLES AND PRACTICE OF MEDICINE 22ND EDITION PAGE NO-769
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Serial Interval - Interval between primary case and secondary case. Incubation Period- Entry of organism till first sign / Symptom. Generation time - Interval between entry of organism till maximum infectivity of that person or case.
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It is important to know that, confabulation is also known as false memory, but not false memory syndrome. In false memory syndrome, a person erroneously believe that they sustained an emotional or physical (e.g. sexual) trauma in early life. On the other hand, in confabulation person unintentionally fills the gap of memory with untrue material.
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C i.e. Renal aery stenosis Renal retinopathy describes the retinal changes seen in chronic renal failure. These may mimic a hypeensive retinopathy of grade III or IV but the tendency to exudates formation is marked paicularly at the macula.Q Severe hypeension in eclampsia may precipitate a florid retinopathy of grade IV often with exudative retinal detachment. This detachment clears rapidly with the termination of pregnancy when the hypeension is under control.
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GFR = K * EF ....... EF means effective pressure which depends on all pressures mentioned above. Ref: guyton and hall textbook of medical physiology 12 edition:464,465,466
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Synergistic & Antagonistic Muscles (Sherrington's Law) Synergistic muscles are those that have the same field of action. Thus, for veical gaze, the superior rectus and inferior oblique muscles are synergists in moving the eye upward. Muscles synergistic for one function may be antagonistic for another. For example, the superior rectus and inferior oblique muscles are antagonists for torsion, the superior rectus causing intorsion and the inferior oblique extorsion. The extraocular muscles, like skeletal muscles, show reciprocal innervation of antagonistic muscles (Sherrington's law). Thus, in dextroversion (right gaze), the right medial and left lateral rectus muscles are inhibited while the right lateral and left medial rectus muscles are stimulated. What is reciprocal innervation? When a stretch reflex occurs, the muscles that antagonize the action of the muscle involved (antagonists) relax. This phenomenon is said to be due to reciprocal innervation. Impulses in the Ia fibers from the muscle spindles of the protagonist muscle cause postsynaptic inhibition of the motor neurons to the antagonists. The pathway mediating this effect is bisynaptic. A collateral from each Ia fiber passes in the spinal cord to an inhibitory interneuron that synapses on a motor neuron supplying the antagonist muscles. Ref: Motley W., Asbury T. (2011). Chapter 12. Strabismus. In P. Riordan-Eva, E.T. Cunningham, Jr. (Eds), Vaughan & Asbury's General Ophthalmology, 18e.
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This question is a tricky one. The best method does not mean the most accurate method.
Best diagnostic test means the test which has high accuracy and less disadvantages.
Though invasive pulmonary angiography is the most accurate method for diagnosis of PE, it is an invasive procedure.
On the other hand, CT chest with contrast is almost as accurate as invasive pulmonary angiography, for the diagnosis of PE; and it is non-invasive.
Investigation of choice for PE → Chest CT with contrast (especially MDCTA)
Investigation of 2nd choice → Lung scan (V/Q scan)
Best investigation for PE → Chest CT with contrast (MDCTA)
Most accurate investigation for PE → Invasive pulmonary angiography
Gold - standard test for PE → Invasive pulmonary angiography
Screening test for PE → D-dimer assay
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Ref - Davidsons 23e p1025
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clinical criteria to diagnose neurofibromatosis include 6 or more cafeaelait macules, 2 or more neurofibromas, Freckling in axillary and inguinal regions, Optic gliomas , 2 or more Lisch nodules, A distinctive osseous lesion, A first degree relative with NF1. Page no 322 Reference IADVL's concise textbook of dermatology
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Histones are proteins containing unusually higher concentration of basic aminoacids. It functions in the packaging of DNA in the chromosomes. Ref: Vasudevan, Biochemistry, 3rd Edition, Page 345
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The spleen is the most commonly injured abdominal organSabiston 20e pg: 456
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Ans. is 'c' i.e., Vaccination given at 6 months Epidemic of measles occur if propoion of susceptible children is > 40%. If measles is introduced in a virgin community, it infects > 90% of children. Measles vaccine is given at the age of a months, but age can be lowered to 6 months in epidemics. Measles shows a cyclic trend with epidemic every 2-3 years.
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Helicobacter pylori was first recognized as a possible cause of gastritis and peptic ulcer by Marshall and Warren in 1984. This organism is readily isolated from gastric biopsies but not from stomach contents. It is similar to Campylobacter species and grows on chocolate agar at 37degC in the same microaerophilic environment suitable for C. jejuni (Campy-Pak or anaerobic jar without the catalyst). H. pylori, however, grows more slowly than C. jejuni, requiring 5 to 7 days incubation. C. jejuni grows optimally at 42degC, not 37degC, as does H. pylori.
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Functions of posterior cruciate ligament:Stabilises kneePrevents posterior dislocation of the tibia on femurLimits hyper extension of knee only if the anterior cruciate is rupturedFunction of ACL: Prevents anterior dislocation of the tibia on femur Ref: BDC, 4th Volume, 2/145
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Enterococcus Enterococci cause a wide variety of infections ranging from less serious--for example, urinary tract infections--to very serious, such as septicemia. A gram-positive coccus resistant to penicillin must be assumed to be entero coccus until other, more definitive biochemical testing places the isolate in one of the more esoteric groups of gram-positive cocci. Once isolated, there are a variety of tests to speciate enterococci. However, penicillinresistant, non_ vancomycin-resistant, gram-positive cocci are most likely E. faecium. There are a variety of mechanisms for vancomycin resistance in E. faecium and they have been termed Van A, B, or C. These isolates have become one of the most feared nosocomial pathogens in the hospital environment. Unfounately, no approved antibiotics can success fully treat vancomycin-resistant enterococci (VRE)--only some experimental antibiotics such as Synercid.
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pancreas is retroperitoneal. So if it is injured there will be concomitant injury of other viscera.A rise in serum amylase occurs in most cases.Operation is indicated if there is disruption of the main pancreatic duct.Penetrating trauma to upper abdomen or the back carries a higher risk Bailey & Love ,26th edition,1125 .
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Hepatitis C infection is usually identified in asymptomatic individuals screened because they have risk factors for infection, such as previous injecting drug use , or have incidentally been found to have abnormal liver blood tests. Although most people remain asymptomatic until progression to cirrhosis occurs, fatigue can complicate chronic infection and is unrelated to the degree of liver damage. Hepatitis C is the most common cause of what used to be known as 'non-A, non-B hepatitis'. If hepatitis C infection is left untreated, progression from chronic hepatitis to cirrhosis occurs over 20-40 years. Risk factors for progression include male gender, immunosuppression (such as co-infection with HIV), prothrombotic states and heavy alcohol misuse. Not everyone with hepatitis C infection will necessarily develop cirrhosis but approximately 20% do so within 20 years. Once cirrhosis has developed, the 5- and 10-year survival rates are 95% and 81%, respectively. One-quaer of people with cirrhosis will develop complications within 10 years and, once complications such as ascites develop, the 5-year survival is around 50%. Once cirrhosis is present, 2-5% per year will develop primary hepatocellular carcinoma. Ref Davidson edition23rd pg877
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C i.e. Cyanide
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Ans. is'b' i.e., Nicotinic acid Nicotinic acid (Niacin) There are three main type of lipases related to metabolism of lipoproteins ? Lipoprotein lipase- Present in blood vessels and causes hydrolysis of tryglyceride content of VLDL and chylomicrones. Hepatic lipase - Conves IDL to LDL by hydrolysing the triglyceride content of IDL. Hormone sensitive lipase - Present intracellularly in peripheral tissue and causes intracellular lipolysis by hydrolysing triglycerides. Niacin (Nicotinic acid) inhibits intracellular lipolysis by inhibiting hormone sensitive lipase- intracellular FFA to liver- triglyceride synthesis. Niacin also increases the activity of lipoprotein lipase- T hydrolysis of VLDL triglyceride. Nicotinic acid also reduces the production of VLDL in liver by inhibiting TG-synthesis - indirectly the VLDL degradation products IDL and LDL are also reduced. Nicotinic acid is the most effective drug to raise HDL-CH. Increased HDL is due to interference of direct pathway of HDL cholesterol to liver which involves apo-A,- Niacin decreases apo-A, mediated hepatic clearance. Nicotinic acid is used in type I, III, IV & V hyperlipoproteinemias.
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C i.e.Trauma
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Pregnancy is not a contraindication or precaution for Hepatitis B vaccine. Principle: Live-virus vaccines are contraindicated during pregnancy because of the possibility that vaccine virus replication will cause congenital infection or have other adverse effects on the foetus. Must Know - Zoster vaccine is contraindicated in pregnancy. It is a live attenuated vaccine. It is also contraindicated in gelatine or neomycin hypersensitivity, in age Varicella vaccine is contraindicated in pregnancy. It is a live attenuated vaccine. It is also contraindicated in gelatine or neomycin hypersensitivity and known severe immunodeficiency. Note - Influenza live attenuated vaccine is contraindicated in a range of conditions: pregnancy, hypersensitivity to eggs, age > 50, Immunosupression (including HIV), severe immunodeficiency and close contacts of immuno-deficient patients. It is also contraindicated in chronic medical conditions, such as diabetes mellitus, chronic pulmonary disease (including asthma), chronic cardiovascular disease (except hypeension), renal, hepatic, neurologic/neuromuscular, hematologic, or metabolic disorders. Ref: Schuchat A., Jackson L.A. (2012). Chapter 122. Immunization Principles and Vaccine Use. In D.L. Longo, A.S. Fauci, D.L. Kasper, S.L. Hauser, J.L. Jameson, J. Loscalzo (Eds), Harrison's Principles of Internal Medicine, 18e.
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Ans. is 'd' i.e., Penis
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Selenocysteine is the 21st amino acid.its biosynthesis is by replacing oxygen from serine by selenium.cysteine is formed from serine (reversible). hence selenocysteine is formed from cysteineRef: DM Vasudevan - Textbook of Biochemistry, 7th edition, page no: 215
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Ans. (d) Vitamin A deficiency style="font-size: 1.04761904761905em; font-family: Times New Roman, Times, serif">Ref: * Major etiological factor: HPV-16 and Tobacco exposure.* 75% of head and neck cancers are caused by tobacco and alcohol use.* HPV type 16: risk factor for oropharyngeal cancers that involve the tonsils or the base of the tongue.* Paan (betel quid): most common risk factors among south Asian.* EBV is a risk factor for nasopharyngeal and salivary glands cancer.* Preserved or salted foods: Salted foods during childhood are a risk factor for nasopharyngeal cancer.* Vitamin D deficiency is a risk factor for head and neck squamous cell carcinoma (HNSCC).
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Flaer (Flourescein - Labelled proaerolysin) is sensitive test for PNH.
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11b hydroxylase is not required for estradiol synthesis. Ref: Guyton and Hall 13th edition Pgno: 967
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Ans. is 'a' i.e., CD1A CD1A is a T cell surface antigen impoant in dendritic cell presentation of glycolipids and lipopeptide antigens. It is used to diagnose Langerhans cell histiocytosis. The presence of Birbeck granules in the cytoplasm of tumor cells is characteristic of Langerhans cell histiocytosis. As Birbeck granules are not seen in all tumor cells by election microscopy the detection of S-100 and CD1a expression by immunohistochemical techniques aids in the diagnosis. Other immunohistochemical markers of Langerhans cell histiocytosis are HLA-DR, Langerin (CD 207), and CD 68.
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Regulation of beta-catenin preventsgenes that stimulate cell division from being turned on too often and prevents cell overgrowth. The humanAPC gene is located on the long (q) arm of chromosome 5 in band q22.2 (5q22.2). The APC gene has been shown to contain an internal ribosome entry site. Refer robbins
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Marxist theory
Is concerned with the relationship between health and illness and capitalist social organization
– Cause of disease is putting profit ahead of health
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GIANT CELL TUMOR (OSTEOCLASTOMA) It is an aggressive but benign tumor of bone. It is uncommon before age 20 or after 50; 65% of our patients were between ages 20 and 40 years. Giant cell tumors are epiphyseal in origin and they arises after epiphyseal closure. When the lesion is first seen, it is already of good size. Occasionally, it may present as a small lesion
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Ans. is 'a' i.e. Tumour Necrosis For histological grading of breast carcinoma three individual factors are assessed.Nuclear pleomorphism Tubule formation Mitotic countThe most commonly used histological grading system is Nottingham histologic score (also k/a Scarff-Bloom- Richardson)
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Release of cholecystokinin is stimulated by the presence of peptides, amino acids, or fatty acids in the small intestine. Cholecystokinin acts on the pancreas to stimulate secretion of pancreatic enzymes that aid in the digestion of these compounds. Gastrin secretion is stimulated by the presence of peptides or amino acids in the lumen of the stomach, and produces an increase in gastric H+ secretion. Motilin is a hormone that regulates the migrating myoelectric complex, a series of contractions that occur during fasting, clearing the stomach and small intestine of any residual food. Secretin secretion is stimulated by the presence of H+ and fatty acids in the duodenum, and causes an increase in pancreatic and biliary HCO3; release and a decrease in gastric H+ release. Ref: Barrett K.E., Barman S.M., Boitano S., Brooks H.L. (2012). Chapter 25. Overview of Gastrointestinal Function & Regulation. In K.E. Barrett, S.M. Barman, S. Boitano, H.L. Brooks (Eds), Ganong's Review of Medical Physiology, 24e.
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Acetyl CoA is the combination of acetate or acetic acid (2 carbon unit) with Co-enzyme A. Acyl CoA means acyl group (any fatty acid, C4 to C26 in length) combined with Coenzyme A.Ref: MN Chatterjea Textbook of Medical Biochemistry, 6th edition, page no: 131
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Ans. is 'c' i.e., Developmental dysplasia of the hip o Two commonly used clinical test for DDH/CDH are:-i) Barlow's testii) Ortolani's testo Barlow's test# Part 1 - Click sound (clunck) of dislocation on adduction.# Part 2 - Click sound (clunck) of reduction on abductiono Ortolanis test# Click sound (clunk) of reduction on abduction.Note:o If both Barlow's test and ortolani's test are given as options in the same question, go ahead with ortolani's test as some clinicians do not consider part 2 as Barlow's test.
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X-rayshows massively distended transverse colon,ahaustral left colon -History of fever & diarrhea Toxic megacolon: - Life threatening - Occurs in patients of UC and CD . - Diameter > 6 cm - Medical management- Stabilization| Fluids + I/V anti-biotics - TOC - TAC with Ileostomy PMC - No colonic distension, fever & diarrhea Adenocarcinoma colon - No massive distention, fever & diarrhea Pneumatosis intestinalis - Collection of air in the wall of intestine.
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Ans. is 'a' i.e., Dantrolene sodium o I. V dantroline is the DOC, it acts by preventing the release of calcium from sarcoplasmic reticulum. o Others are for suppoive treatment --> oxygen, cooling, and insulin & dextrose are given for hyperkalemia due to potassium release from contracted muscle.
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In lobular carcinoma because: High chance to predispose to invasive carcinoma. 35% of lobular carcinoma in situ may devolop invasive lobular carcinoma either in the same or contralateral breast, 65% may devolop invasive ductal carcinoma. It is multifocal, bilateral(50%). So biopsy from opposite breast should be taken. Reference: SRB's Manual of Surgery, 6th Edition, page no = 526.
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Ans. is 'a' i.e., Onchocerca Onchocerciasis (River blindness or Robles disease)o It is caused by Oncocerca volvulus.o Infection in human begins with deposition of infective larvae on skin by the bite of an infected blackfly.o The manifestations are -1) Oiicocercomata: These are subcutaneous itchy nodules over coccyx, sacrum, iliac crest and trachanter of femur. Nodules are firm and nontender.2) Skin: Pruritis & Rash are most frequent manifestation of onchocerciasis.3) Ocular Tissue: Visual impairment is the most serious complication of onchocerciasis.4) Lymph nodes: Mild to moderate lymphadenopathy is seen in inguinal & femoral areaso Definitive diagnosis depends on the detection of an adult worm in an excised nodule or more commonly of microfilariae in skin scrappings.
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Esophageal varices due to portal hypertension usually bleed without warning or preceding pain. Patients frequently have stigmata of cirrhosis (jaundice and spider angiomata) and portal hypertension (ascites and edema). Blood loss in both Mallory-Weiss tears and esophageal varices can be massive. Hereditary hemorrhagic telangiectasia or Osler-Weber-Rendu syndrome is a cause of nosebleeds, mild GI bleeding, and cutaneous or mucosal telangiectasias. Associated arteriovenous malformations can appear in the brain, lungs, liver, and intestine.
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Ans. is 'd' i.e., Hallucinations Eugen Bleuler renamed dementia precox as Schizophrenia. He recognized that schizophrenia is a group of disorders rather than a distinct entity. Therefore, he used the term, a group of schizophrenias. Bleuler described the characteristic symptoms (fundamental symptoms) for schizophrenia which are also known as 4 'A's of Bleuler :? Ambivalence (coexistence of two opposite feelings and attitude towards the same thing in the same person at the same time). Autism (Preoccupation with fantasies, delusions and hallucinations to the exclusion of reality). Affect disturbances (e.g., inappropriate affect) Association disturbances (e.g., Loosening of association, thought disorder). He also described accessary syptoms of schizophrenia : - delusions, hallucinations, and negativism.
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NEUTROPHILS AND EOSINOPHILS EMPLOY NETS TO ENTRAP PARASITESIn addition to ingesting small microorganisms such as bacteria by phagocytosis, neutrophils and eosinophils can assist in the elimination of larger invaders by trapping them within webs called neutrophil extracellular traps or NETsRef: Harper&;s Biochemistry; 30th edition; Chapter 54 White Blood Cells
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NERIUM ODORUM / WHITE OLEANDER contains-oleadrin and nerin resembles digitalis like action REF;THE SYNOPSIS OF FORENSIC MEDICINE:KS NARAYANA REDDY;28th EDITION;PAGE NO355
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Ans. is 'd' i.e., Type IV Collegen type Tissue distributionI-Ubiquitous in hard & soft tissuesII&1X-Cartilage, intervertebral disc, vitreousIII-Hollow organs & soft tissuesIV-Basement membraneV-Blood vesselsVI-Ubiquitous in microfibrilsVII-Dermoepidemal j unctionIX-Cartilage & Vitro us
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Ans. is 'b' i.e., Anesthesia is injected in subarachnoid space * In spinal anesthesia LA is injected into subarachnoid space (space between pia matter and arachnoid matter).* Structure pierced during SA (from outside in) - Skin - subcutaneous tissue - Supraspinous & intraspinous ligament - Ligamentum falvum - Durameter - Arachnoid matter.* Site of spinal anesthesia is L2-3 or L3-4 intervertebral space in adult (In adult spinal cord ends at lower border of Llvertebrae). In children it is L4-5 intervertebral space (spinal cord ends at lower border L3 vertebrae in children).* Spinal anesthesia leads to creation of a zone of differential blockade, i.e., motor fibres are blocked two levels lower and autonomic fibers are blocked two levels higher than the sensory blockade due to different sensitivity of different fibers.* High spinal (Total spinal) anesthesia: - It occurs when the effect of spinal anesthesia ascends to higher (cervical) levels. It can also occur following attempted epidural/caudal anesthesia if there is inadvertent intrathecal injection. It causes severe hypotension, bradycardia and respiratory insufficiency with loss of consciousness.About other options* Hypotension is the most common complication of spinal anesthesia.* The onset of analgesia is approximately 15-30 minutes in an epidural, while it is approximately 5 minutes in spinal anesthesia.
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NDRI * IMPOANCE Anti-depressant which does not deal with serotonin neurotransmission Also called as Zyban * MECHANISM Prevents reuptake of nor adrenaline and dopamine * DRUGS Bupropion * USE ADHD SMOKING CESSATION HYPOACTIVE SEXUAL DESIRE DISORDER * SIDE EFFECTS seizures ref, kaplon and sadock, synopsis of psychiatry, 11 th edition, pg no. 955
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Ans. is 'a' i.e.. Avascular necrosis of femur headClinical features of AVNo In the earlier stages of AVN, the patient is asymptomatic, and by the time patient presents, the lesion is well advanced.o Common histories patient gives (Any of the following) : -i ) Dislocation of HipAlcoholismSteroid intake for any disorderNephrotic syndromeo Pain is a common complaint. Pain is felt in the grain and may radiate to knee,o Decreased range of motion especially internal rotation followed by abduction.o Sectoral sign or Differential rotation : - Internal rotation is possible in extended position of hip, but as seen as the hip is flexed to 90deg no internal rotation is possible. This is the characteristic sign of AVN.o Limp with antalgic gaito Trendelenberg's test positive.
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Large amounts of growth hormone, leads to gigantism in children and to acromegaly in adults. Before pubey, the individual may grow to an extraordinary height. When the epiphyses are closed, linear growth is no longer possible. In this case, an overabundance of growth hormone produces the pattern of bone and soft tissue deformities known in humans as acromegaly. The sizes of most of the viscera are increased. The protein content of the body is increased, and the fat content is decreased. At least some forms of growth hormone are diabetogenic because they increase hepatic glucose output and exe an anti-insulin effect (insulin resistance) in muscle. Growth hormone is also ketogenic and increases circulating FFA levels. The ability of growth hormone to promote fat utilization, together with its protein anabolic effect, causes an increase in lean body mass (NOT OBESITY).
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Pott's puffy tumour is a complication of pyogenic infection of frontal sinus. Pus collects under the periosteum on the anterior surface of the frontal sinus with associated oedema of skin and subcutaneous tissues.
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Answer- A. Mitral stenosisLarge volume hemoprysis, referred to as massive hemoptysis , is variably defined as hemoptysis of greater than 200-600 cc in 24 h. Massive hemoptysis should be considered a medicai emersency.Hemoptysis does not occur from hea failure itself. Most commonly it is due to mitral valve diseases like or mitral mitral stenosis regurgitation.
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Ans. is 'd' i.e., Peripheral decarboxylase Hypolipidemic drugsHMG-CoA reductase iuhibitors (statins) - Lovastatin, Simvastatin, Pravastatin, Atorvastatin, Rosuvastatin.Bile acid sequestrants (Resins) - cholestyramine, colestipol.Activate lipoprotein lipase (fibric acid derivatives) - clofibrate, gemfibrozil, bezafibrate, fenofibrate.Inhibit lipolysis and triglyceride synthesis - Nicotinic acid.5.Other - Probucol, Gugulipid, Ezetimibe, Avasimibe, Torcetrapib.o Ezetimibe inhibits intestinal cholesterole absorption.o Avasimibe inhibits enzyme acyl Coenzyme A : cholesterol acyl transferase-1 (ACAT-1) which causes esterification of cholesterol.o Torcetrapib inhibits cholesterol ester triglyceride transport protein - | HDL cholesterol.
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Ans: B i.e. 10 days The earliest sign to appear on the X-ray is a periosteal new bone deposition (periosteal reaction) at the metaphysis. It takes about 7-10 days to appear Osteomyelitis Earliest site of involvement: Metaphysis Diagnosis of acute OM: Blood culture (positive in 65% cases) Periosteal reaction seen in acute OM appears after: 10 days MC organism in acute OM: Staph. aureus Brodies abscess: - Equilibrium between host & organism; - Abscess cavity remains without fuher enlargement
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Giant cell arteritis (Temporal arteritis)
It is the most common form of systemic vasculitis in adults, is an acute and chronic, often granulomatous, inflammation of arteries of large to small size.
It affects principally the arteries in the head-especially the temporal arteries—but also the vertebral and ophthalmic arteries and the aorta, where it may cause a thoracic aortic aneurysm
Giant cell arteritis or temporal arteritis
It is the most common form of systemic vasculitis in adults.
It is an acute and chronic; often granulomatous inflammation of arteries of large to small size,
Giant cell arteritis affects principally the arteries in the head, especially the temporal arteries which is the extracranial branch of the carotid artery,
Vertebral and ophthalmic arteries may also be involved.
A segment of the affected artery develops nodular thickening with narrowing of the lumen.
There is granulomatous inflammation in the vessel wall with a foreign body and Langhans type multinucleated giant cells and fragmentation of internal elastic lamina.
Presentation of Giant cell arteritis
o Constitutional symptoms
Most common nonspecific symptoms
Include malaise, fatigue, anorexia and weight loss.
These symptoms are due to the generalized involvement of the body and are not related to any organ involvement,
o A headache
It is the most common vasculitis related symptom.
Most commonly over temporal region.
o Jaw claudication
It is the most specific symptom of GCA.
It is manifested as pain in masseter when eating food that requires vigorous chewing because oxygen demand of the masseter exceeds the supply provided by narrowed and inflamed arteries.
o Visual symptoms
Diplopia and visual loss.
Ophthalmic artery involvement can lead to sudden blindness which is the most feared complication of GCA.
o Polymyalgia rheumatica
Aching and stiffness of the shoulder, neck and lip girdle area,
o Arthritis
o Raised ESR
o Normocytic-Normochromic anaemia
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Ans. is 'd' i.e., Folic acid Assessment of folate deficiencyo Following tests are used for assessment of folate deficiency.Blood levelNormal level in scrum is about 2-20 nanogram/mJ and about 200 micorgram.'ml of packed cells.Histidine load test or FIGLU excretion test :- Histidine is normally metabolized to formimino glutamic acid (FIGLU) from wrhich formimino group is removed by THF. Therefore in folate deficiency, FIGLU excretion is increased in urine.AICAR excretion In purine nucleotide synthesis the 2nd last step is the addition of C2 with the help of N10-formyl THF. This step is blocked in folate deficiency and the precursor, i.e., amino imidazole carboxamide ribosyl-5-phosphate (AICAR) accumulates and is excreted in urine.Peripheral blood picture Macrocytosis, tear drop cells, hvpersegmented neutrophils, anisopoikilocvtosis.
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Ref Harrison 19 th ed pg 820 Infection most commonly involves hea valves but may also occur on the low-pressure side of a ventricular septal defect, on mural endocardium damaged by aberrant jets of blood or foreign bodies, or on intracardiac devices themselves. The analogous process involving aeriovenous shunts, aerio-aerial shunts (patent ductus aeriosus), or a coarctation of the aoa is called infective endaeritis.
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Ans. is 'c' i.e., Hypertension Adverse effect of phenytoin|||At therapeutic levelAt high plasma level (dose related)(a) Hypertrophy of gum -commonest in 20%(a) Cerebellar and vestibular manifestation(b) Hirsutism, coarsening of facial features* Ataxia(c) Hypocalcemia* Vertigo(d) Hypersensitivity reactions, these include -* Diplopia* Rashes* Nystagmus* DLE(b) Epigastric pain, vomiting, nausea* Lymphadenopathy(c) I.V. Injection causes local vascular injury* Neutropenia(e) Hyperglycemia- it inhibits release of insulin(d) Fall in B.P. and cardiac arrythmias(f) Hydantoin syndrome- (fetal)(e) Drowsiness & mental confusions(g) Megaloblastic anemia
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Ingestion of mercurous chloridein teething powder has led to acrodynia (Pink disease/Swift disease) in infants. This condition presents as feverwith a pink-coloured rash, irritability, photophobia, painfuland swollen extremities and hypersecretion of sweat glands.It is believed to be a hypersensitivity response to the mercurouschloride.Krishan Vij textbook of forensic medicine and toxicology 5e pg: 473
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Ans. is 'b' i.e., Inhibin o Following are the tests in the identification of Down's syndrome fetus in pregnant women: # Triple test including MS AFP, UE3, total hCG # Quadruple test including MSAFP UE3, total hCG & Inhibin A
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Beta-blockers when given in MI, prevent arrhythmias and also reinfarction.Hence they. increase the morbidity and decrease the moality . patient when discharged is put on beta blockers. REF: KD Tripathi 8th ed.
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Ans. is 'c' i.e.. Closure of aoic valve Aoic pressure curve With the onset of rapid ejection phase of the ventricular systole, the aoic pressure rises steeply to reach a maximum of about 120 mm Hg. The ejection of blood into the aoa causes a stretch on the aoic walls and makes the blood in the entire aerial system to move at a faster rate. This sets up a pressure wave that travel along the aeries. The pressure wave expands the aerial wall as it travels, and expansion is palpable as the pulse. In the later pa of ventricular systole, the aoic pressure declines and continues to decline throughout the diastole, to reach a minimum of about 80 mm Hg during the isometric contraction of the next cardiac cycle. The elastic recoil of the aoa and the resistance of aerioles help to maintain relatively high aoic pressure during diastole. A notch (incisura or dicrotic notch) is rocorded in the early pa of down strok of the aoic pressure curve. It corresponds to the closure of aoic valve. It is produced by the sudden backward flow of aoic blood followed by the immediate cessation of backtlow due to closure of the aoic valves.
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Ans. Mercury
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Ans. is 'c' i.e., Junction of anterior cerebral aery and anterior communicating aeryBerry aneurysm The fuher away the aneurysm from the anterior circulation or from the circle of willis , the less common will be its rate of occurance.Berry aneurysm or Saccualr aneurysm or Congenital aneurysm is the most frequent type of intracranial aneurysm. Most aneurysms occur in the anterior circulation and are found near the branchs points.Most common site is junction between anterior cerebral aery and anterior communication aery (40%). Next most common site is internal carotid aery and posterior communicating aery (20%)Less frequent sites include :?Top of basilar aeryJunction of basilar aery and the superior cerebllar aery or anterior inferior cerebellar aery. Junction of veebral aery and posterior inferior cerebellar aery.
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A patient who has suffered blunt head trauma requiring repeated surgeries for intracranial bleeding will likely be monitored with an intracranial pressure device. Other indications for intracranial pressure monitoring include subarachnoid hemorrhage, hydrocephalus, postcraniotomy status, and Reye syndrome. Measurement of intracranial pressure (ICP) allows the physician to determine and optimize the cerebral perfusion pressure (which is the difference between the mean aerial pressure and the ICP) Miller&;s anaesthesia 9th edition p654
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Trachea bifurcates at the lower border of fouh thoracic veebrae. <img src=" /> BA CHAURASIA'S HUMAN ANATOMY VOLUME 1. 6TH EDITION.page no-280
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Ulnar nerve injury will cause paralysis of all interossei, medial two lumbricals, hypothenar muscles, adductor pollicis, FCU and medial two slips of FDP.
There is ulnar claw hand (not total claw hand)
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New York Heart Association (NYHA) Classification
Importance: Scale used for quantification of degree of functional limitation imposed by Congestive health failure (CHF)
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Ans. is 'b' SLE (Ref. Harrison, 17/e p 2108, 2138, 2139 & 16/e, p 1991, 2021 (15/e, p 1949)).
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Patient in the question suffering from headache since 8 years believes that he has brain tumor despite of all the investigations being normal. His symptoms are suggestive of hypochondriasis. Essential feature of hypochondriasis, is a belief of serious medical illness that persists despite reassurance and appropriate medical evaluation. These patients have a history of poor relationships with physicians because of the feeling that they have been evaluated and treated inappropriately or in adequately. This disorder is disabling in intensity and is persistent, with waxing and waning symptomatology. Although somatization and somatoform disorders are similar, the major difference is that in somatization patient is not concerned about any paicular diagnosis e.g. cancer. They however are worried about symptoms e.g. aches and pains. Ref: Harrison's Principles of Internal Medicine, 18th Edition, Chapter 391
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Meningococcal conjugate vaccine mcv 4 have new largely replaced meningococcal polysaccharide vaccine Mps in prevention of meningococcal dis CDC recommends that all adolescents should recieve meninegiococcal conjugate vaccine MCV 4 IM =1stdose at 12 12 years and booster at 16 years ref : ananthanaryana
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Ans. is 'c' i.e., 6 years Eye in postnatal period Fixation stas developing by 4-6 weeks. Critical period for development of fixation reflex is 2-4 months. Development of fixation is completed by 6 months. So there are three points to remember : ? Fixation stas developing - 4-6 weeks (1-11/2 months). Critical period for development - 2-4 months. Binocular vision and eye coordination are established - 3 months Fixation development is completed --> 6 months. Macula is fully developed by 4-6 months. Fusional reflex, stereopsis and accomodationis well developed by 4-6 months. Cornea attains normal adult diameter by 2 years of age. Lens grows throughout life. Full visual acuity (6/6) or (20/20) is attained by 6 years of life.
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PUBERPHONIA (MUTATIONAL FALSETTO VOICE) Normally, childhood voice has a higher pitch. When the larynx matures at pubey, vocal cords lengthen and the voice changes to one of lower pitch. This is a feature exclusive to males. Failure of this change leads to persistence of childhood high-pitched voice and is called puberphonia. It is seen in boys who are emotionally immature, feel insecure and show excessive fixation to their mother. Psychologically, they shun to assume male responsibilities though their physical and sexual development is normal. Treatment is training the body to produce low-pitched voice. Pressing the thyroid prominence in a backward and downward direction relaxes the overstretched cords and low tone voice can be produced (Gutzmann's pressure test). The patient pressing on his larynx learns to produce low tone voice and then trains himself to produce syllables, words and numbers. Prognosis is good. Ref:- Dhingra; pg num:-314
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Greenish discharge
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