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C & A Harper, 26th ed, p. 244 & 25,h ed, p. 319
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Factors which | breast milk production: the thought, sight or sound of baby Factors which | breast milk production: Use of dummies, pacifiers Feeding bottles, formula feeding Sore or cracked nipples Lack of night feeding & inadequate emptying of breast.
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(C) Type-III # They are classified into 3 types:> Le Fort I (transverse) fracture runs above and parallel to the palate. It crosses lower part of nasal septum, maxillary antra and the pterygoid plates.> Le Fort II (pyramidal) fracture passes through the root of nose, lacrimal bone, floor of orbit, upper part of maxillary sinus and pterygoid plates. This fracture has some features common with the zygomatic fractures.> Le Fort III (craniofacial dysjunction). There is complete separation of facial bones from the cranial bones. The fracture line passes through root of nose, ethmofrontal junction, superior orbital fissure, lateral wall of orbit, frontozygomatic and temporozygomatic sutures and the upper part of pterygoid plates.
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Ans. is 'b' i.e., Actin
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A i.e. Pyricatachol
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This baby has presented with the typical picture of pyloric stenosis. Projectile nonbilious vomiting is seen in viually all patients. Patients also often develop a hypokalemic, hypochloremic metabolic alkalosis from the persistent vomiting. On exam, the upper abdomen may be distended after feeding and prominent peristaltic waves from left to right may be seen. The classic physical exam finding of an "olive-shaped" mass in the epigastric area is not always felt. An ultrasound is the least invasive, safest diagnostic test. The typical appearance on ultrasound is a hypoechoic ring with a hyperdense center. The pyloric muscle thickness measures greater than 4mm. Since this patient has the symptoms of pyloric stenosis, it is inappropriate to do nothing (choice A). A plain film of the abdomen (choice B) will most likely appear normal unless there is a complete obstruction of the pyloric outlet. Again, this study would expose the baby to unnecessary radiation. And, in this case, it would not help you to establish the diagnosis. A barium enema (choice D) will not help to make the diagnosis in this patient. The fact that the vomitus is nonbilious puts the point of obstruction prior to the entrance of the sphincter of Oddi. A study performed from below will not help to see what is happening so high in the intestinal tract. If you suspected intussusception (paroxysmal abdominal pain, vomiting, diarrhea, heme-positive stool, and sausage-shaped mass in upper mid abdomen on palpation), then a barium enema (or air enema) would be both diagnostic and therapeutic.
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For calculating the minimum amount of fluid per day, a formula based on body weight is recommended: 1500 ml is the minimum water intake with 15ml fluid per kg to be added for the actual weight minus 20kg. Reference: GHAI Essential pediatrics, 8th edition
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Answer is D (G-6PD Deficiency) Glucose - 6 - PD Deficiency is not associated with Pancytopenia and a cellular marrow Myelodysplasias, PNH and Megaloblastic anemia (Vit B12,Folate deficiency) may present with Pancytopenia and a cellular marrow.
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Ans: b (Release of calcium) Ref Khurana text book of physiologyIf activated factor XIII is given the option you can go for that. Otherwise only correct answer is calcium. Thrombosthenin is involved in clot retraction.Platelet-associated factor XIII provides a means by which to promote clot stabilization and platelet interaction with proteins of the coagulation and fibrinolytic pathways.Fibrin stabilising factor (factor XIII) which is normally present in the plasma and also released from activated platelets is activated by thrombin to form XIIla but the XIIIa in the prescence of Ca2+ causes formation of covalent crosslinkages between fibrin threads, thus adding tremendous strength to the fibrin meshwork. The fibrin meshwork traps the remaining components of plasma and blood cells to form a solid mass called clotThrombomodulin is a thrombin binding protein produced by all endothelial cells except those in cerebral microcirculation.lt converts thrombin into protein C activator (AIPGME2007)Thrombasthenin is a contractile protein present in platelet involved in clot retraction and not in stabilizationActivated factor XIII will bind to the surface of activated platelets. These platelets then participate in cell-cell or cell-clot interactions, thereby increasing the local concentration of factor XIIIa.The platelet-associated factor Xllla may increase the amount of crosslinking in a fibrin clot, thereby contributing to the aging of the clot and the reduction in the degree of platelet binding. Clot resistance to fibrinolysis is enhanced by platelet factor XEIIa-mediated crosslinking of alpha 2-antiplasmin to fibrin. The binding of factor XIIIa to the platelet surface requires the activation of the platelet fibrinogen receptor, glycoprotein Ilb-IIIa.Thus, platelet-associated factor Xllla may be used as a marker of in vivo platelet activation. Since half of the factor XIII present in blood is provided by the platelets, it is not surprising that this form of factor XIII plays an important role in hemostasis.
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Ans. C. AnthropoidBy tradition, pelvis are classified as belonging to one of four major groups. The gynecoid pelvis is the classic female pelvis with a posterior sagittal diameter of the inlet only slightly shorter than the anterior sagittal diameter. In the android pelvis, the posterior sagittal diameter at the inlet is much shorter than the anterior sagittal diameter, limiting the use of the posterior space by the fetal head. In the anthropoid pelvis, the anteroposterior (AP) diameter of the inlet is greater than the transverse diameter, resulting in an oval with large sacrosciatic notches and convergent side walls. Ischial spines are likely to be prominent. The platypelloid pelvis is flattened with a short AP and wide transverse diameter. Wide sacrosciatic notches are common. The pelves of most women do not fall into a pure type and are blends of one or more of the above types.
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Ans. is 'd' i.e., 6-8 days o Oral anticoagulants are stopped 6-8 days prior to surgery because their duration of action is about 4-6 days. o Therefore if the drug is stopped its action may remain for the next 6 days. o So it is safer to stop them 6-8 days before surgery.
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Stone in distal ureter: Calculi in the lower ureter often cause pain that radiates to the groin or testicle in males and the labia majora in females. Stone in renal calyx: The pain is a deep, dull ache in the flank or back that can vary in intensity from severe to mild. The pain may be exacerbated after consumption of large amounts of fluid. Stone in renal pelvis: Stones in the renal pelvis >1 cm in diameter commonly obstruct the ureteropelvic junction, generally causing severe pain in the costoveebral angle, just lateral to the sacrospinalis muscle and just below the 12th rib. It often radiates to the flank and also anteriorly to the upper ipsilateral abdominal quadrant. Stone in upper and mid-ureter: Stones or other objects in the upper or midureter often cause severe, sharp back (costoveebral angle) or flank pain. Ref: Stoller M.L. (2008). Chapter 16. Urinary Stone Disease. In E.A. Tanagho, J.W. McAninch (Eds), Smith's General Urology, 17e.
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Henoch-Schonlein purpura, the most common systemic vasculitis in children. Typical features are palpable purpura, abdominal pain, ahritis, and hematuria. Direct immunofluorescence of the skin lesions demonstrates immunoglobulin deposition in and about affected blood vessels. All immunoglobulin classes may be present, but IgA is always present. Many times, it is the only immunoglobulin detected. Ref: Cutaneous Medicine: Cutaneous Manifestations of Systemic Disease By John A. Flynn (MD.), Thomas T. Provost, John A Flynn, 2001, Page 180 ; Harrison's 17th ed chapter 319
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In metabolic alkalosis, there may be a loss of fixed acids or excess of base. It is associated with hypokalemia because of renal conservation of H+ ions and urinary potassium loss. Loss of hydrochloric acid as seen in vomiting in patients with pyloric obstruction results in hypochloremic, hypokalemic, metabolic alkalosis.
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For parotid tumors that arise in lateral lobe superficial parotidectomy with preservation of CN VII is indicated. If the tumor extends in to deep lobe of parotid, a total parotidectomy with nerve preservation is performed.
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Temporary Social Groups: Crowd Group of people come together temporarily, for a sho period, motivated by a common interest or curiosity (e.g., to witness a football match) Lacks internal organization & leadership; When interest is over, crowd disperses. Mob It is crowd with a leader, who forces members into action & is more emotional than crowd. There may be symbol like flag/slogan. It is unstable,without internal organization; When purpose is achieved, group disperses Herd Crowd with a leader whose orders are followed without questions by group members. Eg: tourist group under a guide. Permanent Spatial Groups Band Village Towns & cities State
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Visual cycle In the retina of living animals, under constant light stimulation, a steady state must exist under which the rate at which the photochemicals are bleached is equal to the rate at which they are regenerated. This equilibrium between the photodecomposition and regeneration of visual pigments is referred to as visual cycle. Reference :- A K KHURANA; pg num:-14,15
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Ans. (c) Bimastoid
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In EDS types I and II, the classic variety, causative mutations may involve the COL5A1, COL5A2, and tenascin-X genes. Type IV is characterized by a decreased amount of type III collagen. Types V and VI are characterized by deficiencies in hydroxylase and lysyl oxidase, an important posttranslational modifying enzyme in collagen biosynthesis. Type VII has an amino-terminal procollagen peptidase deficiency. Type IX has abnormal copper metabolism. Type X has nonfunctioning plasma fibronectin.
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The unique feature of atracurium is inactivation in plasma by spontaneous nonenzymatic degradation (Hofmann elimination) in addition to that by Alkaline ester hydrolysis.
Consequently, its duration of action is not altered in patients with hepatic/renal insufficiency or hemodynamic compromise → It is the preferred muscle relaxant for such patients as well as for neonates and elderly.
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Ans. (A). PutrefactionHoney comb appearance or foamy liver is seen in putrefaction due to the presence of gas bubbles within the parenchyma.
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Skeletal fluorosis is a bone disease caused by excessive accumulation of fluoride in the bones. In advanced cases, skeletal fluorosis causes painful damage to bones and joints. Symptoms are mainly promoted in the bone structure. Due to a high fluoride concentration in the body, the bone is hardened and thus less elastic, resulting in an increased frequency of fractures. Other symptoms include thickening of the bone structure and accumulation of bone tissue, which both contribute to impaired joint mobility. Ligaments and cailage can become ossified.Most patients suffering from skeletal fluorosis show side effects from the high fluoride dose such as ruptures of the stomach lining and nausea. Fluoride can also damage the parathyroid glands, leading to hyperparathyroidism, the uncontrolled secretion of parathyroid hormones. These hormones regulate calcium concentration in the body. An elevated parathyroid hormone concentration results in a depletion of calcium in bone structures and thus a higher calcium concentration in the blood. As a result, bone flexibility decreases making the bone more susceptible to fractures As of now, there are no established treatments for skeletal fluorosis patients.However, it is reversible in some cases, depending on the progression of the disease. If fluorine intake is stopped, the amount in bone will decrease and be excreted urine. However, it is a very slow process to eliminate the fluorine from the body completely. Minimal results are seen in patients. Treatment of side effects is also very difficult. For example, a patient with a bone fracture cannot be treated according to standard procedures, because the bone is very brittle. In this case, recovery will take a very long time and a pristine healing cannot be guaranteed. However, fuher fluorosis can be prevented by drinking defluoridated water. It is recently suggested that drinking of defluoridated water from the ''calcium amended-hydroxyapatite'' defluoridation method may help in the fluorosis reversal.Defluoridated water from this suggested method provides calcium-enriched alkaline drinking water as generally fluoride contaminated water has a low amount of calcium mineral and drinking alkaline water helps in eliminating the toxic fluoride from the body Ref Davidson 23rd edition pg 716
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Simultaneous beating of both ears with the palms of the hands is known as TELEFONO. This may lead to rupture of the tympanic membrane causing pain, bleeding and hearing loss. It is difficult to detect this. The external ear may also get torn during pulling of the ears.
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Raynaud's disease is not associated with anti nuclear antibodies (ANA's). ANA's are seen in sjogren's syndrome, rheumatoid ahritis, autoimmune hepatitis, scleroderma, polymyositis & dermatomyositis. Ref: CMDT 2006 Edition, Page 464-465; Harrison's Principles of Internal Medicine, 16th Edition, Page 1489.
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Ans. A Ulnar nerveRef: Gray's Basic Anatomy E-book, P 399Carpal Tunnel Anatomy* Posterior border# Carpal bones* Anterior border# Transverse carpal ligament* Boundaries# Proximally--pisiform and tubercle of navicular# Distally--hook of hamate and tubercle of trapezium* Contents# Flexor digitorum superficialis# Flexor digitorum profundus# Flexor pollicis longus# Median nerve
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A i.e. CarotenoidsProtooncogenes are normal cell genes that paicipate in cellular functions related to growth and proliferationQ. Proteins encoded by protooncogenes may function as growth factor, ligands and receptors, signal transducers, transcription factors and cell cycle regulatorsQ.Protooncogenes on activation become oncogenes that induce cancerQ. The process of activation include gene amplification, point mutation, inseion mutation, retroviral transduction (integration), chromosomal translocation and protein- protein interaction.Onchoproteins encoded by oncogenes have similar functions as their normal counterpas but they are constitutively expressed and endow the cell with self sufficiency in growth. Carotinoids are anticarcinogensQ.
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According to Mahler's theory, the period of childhood is divided into three stages.
Normal autistic phase (0 - 1 year)
Normal symbiotic phase (4 wks to 4 yrs)
Separation individualization phase (5 to 36 months)
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Histopathological Feature of "orphan annie eyed nuclei" is characteristic of papillary carcinoma of thyroid.
Management of papillary carcinoma :
Hemithyroidectomy : In size < 2cm.
Age < 40 years.
No lymphovascular invasion FT.
No capsular invasion FT.
In all other conditions total thyroidectomy is done.
If level VI lymph nodes are involved : Central lymph node dissection along with Total thyroidectomy.
If other lymph nodes are involved : Modified radical neck dissection is done along with total thyroidectomy.
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Nutrients in growth media must contain all the elements necessary for the biosynthesis of pathogenic microorganisms. This rule is especially true of media that are intended to have a selective (select for a specific group of bacteria) or differential (differentiate between a pathogenic and a normal or usual strain of a group) purpose. Bacteria and plants use photosynthetic energy to reduce carbon dioxide expending water. The organisms that can use CO2 as a sole source of carbon are termed autotrophs. Chemolithotrophs are organisms that use an inorganic substrate, such as hydrogen or thiosulfate, as a reductant and CO2 a carbon source. Heterotrophs require organic carbon for growth. Many organisms possess the ability to assimilate nitrate (NO.3) and nitrite (NO2) reductively by conveing these forms to ammonia (NH3). Dissimilation pathways are taken by microorganisms that use these ions as terminal electron acceptors in respiration. This process is known as denitrification, with the final product being nitrogen gas (N2). Fermentation is characterized by substrate phosphorylation, in which products such as glucose are involved for energy production. Autotrophs should not be confused with auxotrophs. Auxotrophs are strains that require a nutrient that is not required by the parental or prototype strain. They are usually derived from mutants with defective synthetic capabilities. Ref: Ananthanarayana textbook of microbiology 9th edition pgno: 45
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b. Renal agenesis(Ref: Nelson 20/e 2513)Components of oligohydramnios complex (Potter syndrome), including low-set ears, micrognathia, flattened nose, limb positioning defects, intrauterine growth restriction & death may result from pulmonary hypoplasia.Bilateral renal agenesis is incompatible with extrauterine life & produces the Potter syndrome.
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Disorders of smell
Anosmia : Total loss of sense of smell
Hyposmia : Partial loss of sense of smell
Parosmia : Perversion of smell (seen in recovery phase of post influenzal anosmia; intracranial tumors).
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The strength attained by amalgam within 8 hours is 70%.
Reference: Phillip’s Science of Dental Materials, Pg-353
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HRCT is best to detect and evaluate suspected cases of bronchiectasis, emphysema, diffuse lung diseases and ILDs.
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Ans. D. Sugar alcohols(Ref: Harper 31/e page 191)In Diabetes mellitus, in the lens by polyol pathway Glucose converted to Sorbitol by the enzyme Aldose reductaseIn galactosemia, Dulcitol or Galactictol is responsible for cataract.Sorbitol, Dulcitol are sugar alcohols.
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Ans. is 'd' i.e., All of the aboveo The traits used to differentiate male and female bones are - 1) In pelvis:- Preauricular sulcus, subpubic angle, pelvic brim (inlet), ischiopubic index, sciatic notch index.2) Skull:- Orbits, supraorbital ridges, external auditory meatus, occipital area, mastoid process, palate, overall general appearance, architecture.3) Mandible:- Chin (symphysis mentis), the angle of body and ramus.
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Roughening by air abrasion by itself is not a substitute for acid-etching techniques. Roughening improves bonding. Acid etching alone or after roughening, however, always produces a better bond than air abrasion alone.
Contemporary air abrasion equipment is helpful for stain removal, debriding pits and fissures before sealing and micromechanical roughening of surfaces to be bonded.
Ref: Sturdevant's art and science of operative dentistry. 4th edition page 328
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Ans. is 'c' i.e., Safflower oil [Ref: Park 23rd/ep.6II\o Richest source of polyunsaturated fatty acid - Safflower oil.o Richest source of monounsaturatedfatty acid - Palm olein oilo Richest source of saturated fatty acid - Coconut oil.
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In the question, patient is presenting with history of 2 midtrimester abortions and gestational age is 32 weeks with labor pains and dilatation of cervix 2 cm
The membranes are not ruptured, hence management includes:
Betamethasone: To accelerate lung maturation of the fetus.
Tocolysis: Tocolytics are not given with the aim to arrest preterm labor for a long time, but to prolong the labor for 48 hours.
This servers the following purposes:
The corticosteroids get time to act.
Allows time for transport of the woman to better obstetrical centre.
Beta-adrenergic agonists, calcium-channel blockers, or indomethacin are the recommended tocolytic agents for such short-term use–up to 48 hours. American college of obstetrics and gynecology recommends that women with preterm contractions without cervical change, especially those with cervical dilation of less than 2 cm, generally should not be treated with tocolytics.
In general, if tocolytics are given, they should be administered concomitantly with corticosteroids. The gestational age range for their use in debatable. However, because corticosteroids are not generally used after 33 weeks and because the perinatal outcomes in preterm neonates are generally good after this time, most practitioners do not recommend use of tocolytics at or after 33 weeks. In this patient G: Age is 32 weeks and cervix is 2 cm dilated so the use of tocolytics is justified
Rescue cerclage (Williams 24/e, p 857): There is support for the concept that cervical incompetence and preterm labor lie on a spectrum leading to preterm delivery. If cervical incompetence is recognized with threatened preterm labor, then emergency cerclage can be attempted.
Cervical cerclage is done in 3 conditions:
Cervical incompetence
Prophylactically in women identified on USG to have short cervix <15 mm
Rescue cerclage–as discussed above.
Antibiotics: Do not have a role in preterm pregnancy with intact membranes. In a study (ORACLE 11 trial) antimicrobials were given to patients with preterm labor but without membrane rupture, the results were disappointing. In his review, Goldenberg (2002) also concluded that antimicrobial treatment of women with preterm labor for the sole purpose of preventing delivery is generally not recommended. In a follow-up of the ORACLE II trial, Kenyon and associates (2008 b) reported that fetal exposure to antimicrobials in this clinical setting was associated with an increased cerebral palsy rate at age 7 years compared with that of children without fetal exposure.
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Ans. is 'a' i.e., Rat tail appearance Rat tail appearance of esophagusEsophageal carcinomaMegaesophagus (sigmoid esophagus)"Bird beak" appearance Hurst phenomenon Achalasia cardiaYo-Yo motion of barium"Corkscrew" appearance (esophageal curling)Rosary-bead'sheikh kebab configurationChain of bead appearance Diffuse esophageal spasm
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The cause of malignant hypehermia is unknown, but it is associated with inhalational anesthetic agents and succinylcholine. It may develop in an otherwise healthy person who has tolerated previous surgery without incident. It should be suspected in the presence of a history of unexplained fever, muscle or connective tissue disorder, or a positive family history (evidence suggests an autosomal dominant inheritance pattern). In addition to fever during anesthesia, the syndrome includes tachycardia, increased O2 consumption, increased CO2 production, increased serum K+ , myoglobinuria, and acidosis. Rigidity rather than relaxation following succinylcholine injection may be the first clue to its presence. Treatment of malignant hypehermia should include prompt conclusion of the operative procedure and cessation of anesthesia, hyperventilation with 100% O2 , and administration of intravenous dantrolene. The urine should be alkalinized to protect the kidneys from myoglobin precipitation. If reoperation is necessary, the physician should premedicate heavily, alkalinize the urine, and avoid depolarizing agents such as succinylcholine. Pretreatment for 24 hours with dantrolene is helpful; it is thought to act directly on muscle fiber to attenuate calcium release.
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Deficiency Disease Group Acid maltase Pompe's disease Glycogen storage disease Acid lipase Wolman disease Lysosomal storage disease Wolman disease Not a sphingolipidosis. Cholesterol ester storage disease Lysosomal acid lipase deficiency Triglyceride | C/F Vomiting Watery green diarrhea Hepatosplenomegaly Calcification of adrenals (characteristic feature) Rx- Enzyme replacement therapy Gaucher's disease It is the most common lysosomal storage disorder. It is characterized by the following clinical features: Painless hepatomegaly and splenomegaly Liver cirrhosis Hypersplenism and pancytopenia Bleeding tendencies Bone pain Osteoporosis, pathological fractures Developmental delay, hypeonia, strabismus, supranuclear gaze palsy. Treatment : Enzyme replacement therapy is available in the form of Human recombinant acid b-glucosidase(Imiglucerase) Velaglucerase alfa Taliglucerase alfa Note:Neurological involvement is not seen in type I Gaucher's disease.
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Ans. is 'c' i.e., Localized anaphylaxis
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Red cell volume is the volume occupied by all the circulating red cells in the body. It can be measured by sustracting the plasma volume from total body water. It can also be measured by injecting tagged red blood cells and measuring the fraction of red cells that is tagged.51 Cr radio isotope of chromium is commonly used. Isotopes of iron(59Fe) and phosphate (32P)and antigenic tagging is also used. Ref: Ganong's Reveiw of Medical Physiology, 21st Editon, Page 3
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Tuberculous infection of bone (osteomyelitis) is a form of secondary osteomyelitis caused by hematogenous dissemination from a primary infected visceral focus. The primary focus may be active or quiescent, apparent or latent, either in the lungs, lymph glands or other viscera.
Periosteal reaction is minimal and abscess does not show characteristic signs of inflammation. Sequestra are also very uncommon.
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Fresh water drowning is associated with both hyperkalemia and corresponding hyponatremia.
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Indications of splenectomy in ITP: Failure of medical therapy Prolonged use of steroids with undesirable effects Most cases of first relapse Splenectomy provides a permanent response without subsequent need for steroids in 75-85% of patients. Laparoscopic splenectomy has become the gold standard for ITP patients. Responses usually occur within the first postoperative week.
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Ans. is b, i.e. VVF repairRef: Shaw 14th/ed, p168SurgeryDone in1. Kelly stitch/Boney's Test/Marshall Marchetti Krantz SurgeryStress Urinary Incontinence2. Chassar Moir Technique/ Latzko technique/ layer techniqueVVF Repair3. Boari Flap TechniqueUretrovaginal Fistula repair4. Purandare Sling/ Fothergill's Repair/ Manchester Repair/Ward Mayo Hysterectomy/ Lefort's ColpocleisisProlapse Uterus5. Strassman Unification SurgeryBicornuate/Didelphic uterus (Indication for operation, if bicornuate or didelphic uterus lead to >3 Abortion)6. Hysteroscopic Septal Resection (M/c done), Jones/Thompkins/ Williams metroplastySeptate Uterus7. McIndoe VaginoplastyMRKH Syndrome/Vaginal agenesis (Best time to perform this surgery is just before/just after marriage)8. Me Donald/Shirodkar CerclageIncompetent Internal os9. Baldy Webster operation, Modified Gilliams operation, Laparoscopic ventrosuspensionRetroversion of the uterus10. Haultains Operation(via abdominal route Spinellis operation (via vaginal route)Inversion of uterus
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Currarino triadorASP triad: - Anorectal malformation or congenital anorectal stenosis - Sacrococcygeal osseous defect (always present) - Classically, hemisacrum with intact first sacral veebra ("sickle-shaped sacrum") - Mild (hypoplasia) to severe (agenesis) of sacrum and coccyx - Presacral mass (various types) - Anterior sacral meningocele - Tumor, e.g. mature teratoma - Dermoid/epidermoid cyst
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Infection with Isospora belli is known to cause diarrhea and its is diagnosed by the presence of large oocysts in stool detected by modified acid-fast staining. This infection is acquired by the consumption of oocysts. Patients usually presents with fever, abdominal pain, and watery nonbloody diarrhea. In AIDS patients or immunocompromised patients it causes profuse watery diarrhea. Trimethoprim-sulfamethoxazole is effective in the treatment of this condition. Ref: Weller P.F. (2012). Chapter 215. Protozoal Intestinal Infections and Trichomoniasis. 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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C i.e. Latent squint Hetrophoria or latent strabismus is a condition in which there is a tendency to misalignment of the visual axis, which is corrected by the fusional capacity. Often latent squints give no trouble until the demand of near vision increase the strain. No symptoms arise, perhaps, until after reading or writing for an hour or two when the letter seems to run together'. There diplopia, which is often not appreciated as actual double vision, causes blurring of the print. With effo, blurring is overcome, but eventually this becomes impossible, headache supervenes & the work has to be abandoned. Anisometropia presents with - imperfect binocular vision, amblyopia, squint & diplopia (Basak p-68).
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Ans: A (Glaucoma) Prostaglandin Analogue areBimatoprostQLatanoprostTravoprostUnoprostoneQAdvantages of PG Analogue;Once daily dosingLow incidence of systemic side effects :It includes irreversible brown pigmentation of the iris & eyelashes, drying of the eyes & conjunctivitis1'(Katzung Wth/307)Potent intraocular pressure lowering effects"Misoprost (PGE1) is used in NSAIDS associated gastrointestinal injury1-'KDT6th/634 _
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The symptoms and membrane over the tonsil are suggestive of infection with Corynebacterium diphtheriae. For the earliest diagnosis, the nasal swab should be cultured in Loeffler's serum slope. Loeffler's serum slope: diphtheria bacilli grow on this media very rapidly and colonies can be seen in 6-8 hours, long before other bacteria grow. Colonies are small, circular white opaque discs but enlarge on continued incubation and may acquire a distinctly yellow tint. Reference: Textbook of Microbiology; Anathanarayan and panicker's; 10th edition; Page no: 242
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harshmohan textbook of pathology 7th edition. *type 3 reaction result from deposition of antigen antibody complexes in tissues which is followed by activation of complement system and inflammatory reaction resulting in cell injury. *type 1 -anaphylactic reaction. *type 2-antibody mediated reaction. *type 4-delayed hypersensitivity reaction.
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Ans. is 'd' i.e., Posterior cord Supraclavicular branches of brachial plexuso Branches of brachial plexus which are above the clavicle are called supraclavicular branches,o These arise from roots and trunks.Supraclavicular branches of brachial plexusFrom roots1. Nerves to scaleni and longus colli2. Branch to phrenic nerve3. Dorsal scapular nerve4. Long thoracic nerveC5,6,7,8C5C5C5,6(7)From trunks1. Nerve to subclavius2. Suprascapular nerveC5,6C5,6Infraclavicular branches of brachial plexuso Branches of brachial plexus which are below the clavicle are called infraclavicular branches,o These arise from cords.Infra clavicular branches of brachial plexusLateral cordLateral pectoralC5.6,7MusculocutaneousC5,6,7Lateral root of medianC(5), 6,7Medial cordMedial pectoralC8,T1Medial cutaneous of forearmC8.T1Medial cutaneous of armC8,T1Medial root of medianC8.T1UlnarC(7), 8,T1Posterior cordUpper subscaputarC5t6Lowrer subscapularC5.6Thoracodorsal (Nerve to latissimus dorsi, middle subscapular nerve)C6,7,8AxillaryC5,6RadialC5,6,7,8, (Tl)
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ADULT INCLUSION CONJUNCTIVITIS Etiology : Inclusion conjunctivitis is caused by serotypes D to K of Chlamydia trachomatis. The primary source of infection is urethritis in males and cervicitis in females. The transmission of infection may occur to eyes either through contaminated fingers or more commonly through contaminated water of swimming pools (hence the name swimming pool conjunctivitis). Reference :- A K KHURANA;6th edition , page:- 68
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Classic distal A/ Type 1 A- Hyperkalemia is not seen Hyperkalemia is seen in type IV A
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Ans. is 'd' i.e., RetrocaecalVermiform Appendix It is a narrow worm-like tubular diveiculum which arises from the postero-medial wall of the caecum about 2 cm below ileocaecal function and is suspended by a peritoneal fold known as mesoappendix or appendicular mesentery.Length of appendix is 2-20 cm (average 9 cm).The appendix lies in the right iliac fossa.Base of the appendix is fixed, but the tip can point in any direction, according to which positions of appendix are classified :-Retrocaecal (12 0' clock) positon : It is the commonest position (in 65% of individuals).Pelvic (4 0' clock) position : It is second commonest position (in 30% of individuals).Paracolic (11 0' clock) position : In 20% of subjects.Midinguinal (6 0' clock) position : In 2% of subjects.Pre and post-ileal (3 0' clock) position : In 1% and 0.4% subjects, respectively.Promontoric (3 0' clock) position : In < 1% of subjects.Appendix develops from midgut and therefore is supplied by superior mesenteric aery through appendicularbranch of ileocolic aery.
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When Lichen planus affects the nails, it causes scarring of the nail bed with early nail ridging and splitting later leading to pterygium formation. Pterygium of nail is scarring from the base of the nail outward in a V formation, which leads to loss of nail. Nail changes in psoriasis includes presence of irregular pits, oil spots, separation of nail plate from its bed, thickening and crumbling of nail plate. People with alopecia areata people have regular nail pits that form a pattern. Ref: Harrison's Principles of Internal Medicine, 18th Edition, Chapter 52; The Merck Manual Home Health Handbook By Merck; The Landscape Makeover Book By Sara Jane Von Trapp, Page 122.
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HUS is a disease characterised by
Hemolytic Anemia (Microangiopathic hemolytic Anemia)
Uremia
Low platelet count
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Point A → 8000 rad (8000 cGy)
Point B → 5000 rad (5000 cGy)
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(C) (Calcium) (4.8 Ganong 24th edition, 18 A.K. Jain 5th)Exocytosis is the Ca^ dependant process.Exocytosis: here-substances secreted by the cell are trapped within vesicles or granules which fuse with the cell membrane and release their contents to the ECF. This leaves the contents of the vesicles or granules outside the cell and cell membrane intact.It requires Ca++ and energy. Hormones, digestive enzymes and synaptic transmitters are examples of substances transported out of the cell by this process.Endocytosis: includes phagocytosis, pinocytosis, clathrin mediated endocytosis, caveolate-dependant uptakeand nonclathrin/noncaveolae endocytosis.
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The patient is suffering from infective endocarditis. With a background of rheumatic fever, the likely risk factor for IE in this case is rheumatic hea disease (RHD). Some of the clinical features of infective endocarditis related to microthromboemboli include erythematous or hemorrhagic nontender lesions on the palms or soles (Janeway lesions), subcutaneous nodules in the pulp of the digits (Osler nodes), and retinal hemorrhages in the eyes (Roth spots). Subendocardial lesions in RHD, exacerbated by regurgitant jets, can induce irregular thickenings called MacCallum plaques, usually in the left atrium. Aschoff bodies are rarely seen in surgical specimens or autopsy tissue from patients with chronic RHD, because of the long intervals between the initial insult and the development of the chronic deformity. Aschoff bodies and Anitschkow cells are seen in acute rheumatic fever.
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Ans. a. Heller's cardiomyotomy (Ref: Sabiston 19/e p1025-1028; Schwartz 9/e p850-851, 857-860: Bailey 26/e p1014- 1017, 25/e p1036-1038; Shackelford 7/e p349-352, 354-361)The features of dysphagia, intermittent chest pain and dilation of esophagus with narrowing of its distal end on radiology in a young female suggest a diagnosis of achalasia. Treatment of choice for achalasia cardia is Heller's cardiomyotomy.Achalasia CardiaAchalasia means "failure to relaxQ," (sphincter remains in a constant state of tone with periods of relaxation)Both the muscle of the esophagus and LES are affectedQ.Prevailing theory: Destruction of the nerves to LES is primary pathology and degeneration of neuromuscular function of the body of esophagus is secondaryQ.Premalignant condition leading to squamous cell carcinomaTriple A-syndrome or Allgroves diseaseQ: Achalasia, Alacrima and ACTH-resistant Adrenal insufficiency.Pathogenesis:Progressive inflammation and selective loss of the inhibitory myenteric neurons in Auerbach'splexus of the esophagus that normally secrete VIP and nitric oxideQ.This results in failure of relaxation of the LES and aperistalsis of the esophageal body with subsequent functional obstruction at the level of the GE junction and gradual dilatation of the esophagusQ.Clinical Features:The classic triad of symptoms consists of dysphagia, regurgitation, and weight loss.Heartburn, postprandial choking, and nocturnal coughing are seen commonly.Men and women are equally affected, with no ethnic predisposition to the diseaseQ.Regurgitation of undigested, foul-smelling foods is common, and with progressive disease, aspiration can become life-threateningQ.Pneumonia, lung abscess, and bronchiectasis often result from long-standing achalasia.Dysphagia progresses slowly over yearsQ.Diagnosis:Barium swallow:Dilated esophagus with a distal narrowing"Bird's beak" ,"Pencil-tip" or "Rat's tail" appearanceQSphincter spasm and delayed emptying through the LESA lack of peristaltic waves in the body and failure of LES relaxationLack of a gastric air bubbleQ on the upright portion is a result of the tight LES not allowing air to pass easily into the stomach.Massive esophageal dilation, tortuosity, and a sigmoidal esophagus (megaesophagus) in advanced stageQMecholyl test is positive in AchalasiaQCCK test is positive in AchalasiaQManometry is gold standard test for diagnosis.Absence of body peristalsis and poor LES relaxation is mandatoryQ for diagnosis.Manometry Findings of Typical AchalasiaAbnormalities of LESAbnormalities of esophageal body* Incomplete or absent LES relaxationQ* Elevated LES pressureQ* Elevated intraesophageal pressureQ (pressurization of the esophagus) from incomplete air evacuation* Simultaneous mirrored contractions with no evidence of progressive peristalsisQ* Low-amplitude waveformsQ indicating a lack of muscular toneTreatment:Early stage: Sublingual nitroglycerin, nitrates, or calcium channel blockersQ may offer hours of relief of chest pressure before or after a meal.Bougie dilationQ up to 54 French may offer several months of relief but requires repeated dilations to be sustainable.Botulinum toxin:Injection of botulinum toxin (Botox) directly into the LES blocks acetylcholine release, preventing smooth muscle contraction, and effectively relaxes the LESQ.With repeated treatments, Botox may offer symptomatic relief for yearsSymptoms recur more than 50% of the time within 6 monthsQ.Laparoscopic Heller myotomy is now the operation of choiceQ.Extent of Heller's myotomy: 2 cm above GE junction to 1 cm belowQ, over stomach.Partial antireflux procedure (Toupet or Dor fundoplication)Q will restore a barrier to reflux and decrease postoperative symptoms.Esophagectomy is considered megaesophagus, sigmoid esophagus, failure of more than one myotomy, or an undilatable reflux strictureQ.
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Ans. is 'b' i.e., Inhibition of ATP synthesis only not ETC As the name suggests, these componds block the coupeling of oxidation with phosphorylation. These compounds allow the transfer of reducing equivalents in respiratory chain but prevent the phosphorylation of ADP to ATP by uncoupling the linkage between ETC and phosphorylation. Thus the energy instead of being trapped by phosphorylation is dissipated as heat. Uncouplers may be :? i) Natural :- Thermogenin, thyroxine ii) Synthetic :- 2, 4-dinitrophenol (2, 4-DNP), 2, 4-dinitrocresol (2, 4-DNC), and CCCP (chlorocarbonylcyanidephenyl hydrazone).
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The foramen ovale functionally closes almost immediately after bih as pressure in the right atrium decreases and pressure in the left atrium increases, thereby pushing the septum primum against the septum secundum. Anatomical fusion occurs much later in life; more than 25% of the population has probe patency of the foramen ovale, in which anatomical fusion does not occur.
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Posterior circulation TIA is suggested by the transient episodes. The basilar artery is formed by the two vertebral arteries and supplies the pons, the midbrain, and the cerebellum. With vertebrobasilar TIAs, tinnitus, vertigo, diplopia, ataxia, hemiparesis, and bilateral visual impairment are common findings.
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There should be at least 1-1.5 mm width of bone required labial and lingual to the implant (Different according to text books). As in question minimum thickness is asked more favorable answer will be 6mm only.
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The main pathological changes in Keratoconus are thinning and ectasia of the lens which occur as a result of defective synthesis of mucopolysaccharide and collagen tissue. REF : AK KHURANA 7TH ed.
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Ans. is 'b' i.e., Blastocyst * The morula after spending about 3 days in the tube enters the uterine cavity via the narrow ostium (1 mm) on the fourth day in the 16-64 cell stage. Blastocyst formation is on the 5th day.* Implantation occurs in the endometrium on the anterior or posterior wall of the body near the fundus on the sixth day following fertilization (corresponding to the 20th day of the menstrual cycle).* The deeper penetration of the human blastocyst is called interstitial implantation, which happens by approximately the 13th day after fertilization.
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The presence of painless indurated ulcer and a non-tender lymph node is suggestive of primary syphilis.
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β-thalassemia trait and α-thalassemia trait are typically asymptomatic.
The anatomic changes in β-thalassemia major are similar in kind to those seen in other hemolytic anemias but are profound in degree. Ineffective erythropoiesis and hemolysis result in a striking hyperplasia of erythroid progenitors, with a shift towards early forms. The expanded erythropoietic marrow may completely fill the intramedullary space of the skeleton, invade the bony cortex, impair bone growth, and produce skeletal deformities. Extramedullary hematopoiesis and hyperplasia of mononuclear phagocytes result in prominent splenomegaly, hepatomegaly, and lymphadenopathy. The ineffective erythropoietic precursors consume nutrients and produce growth retardation and a degree of cachexia reminiscent of that seen in cancer patients. Unless steps are taken to prevent iron overload, during the span of years, severe hemosiderosis develops.
Robin’s Textbook of pathology 10th ed Page 442
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Ans: C (Ability to read and write) Ref: Textbook of Preventive and Social Medicine, K Park. 22nd edition. page no 44 7Explanation:Census is conducted once in 10 years in India.Literacy rate is assessed those above 7 years ageIn census it was first used in 1991 censusA person who can read and write with understanding in any language is considered as literateA person who can merely read but cannot write is not considered literate
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Ans. is `b' i.e., 0.8-1.5 ng/ml o Therapeutic concentration of digitoxin is 15-30 ng/ml and of digoxin is 0.5-1.4 ng/ml
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Ans. (b) 5 monthsRef O.P Ghai 8th ed/4Birth weight doubles at 5 months, triples in an year and is four times at 2 years and becomes 5 times at 3 years.Note: Newborns lose 10% of body weight in first ten days due to loss of extracellular water, after which they gain 25-30gms per day for first 3 months of life.
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Harshmohan textbook of pathology 7th edition. even though basal cell carcinoma is a malignant one, it spread to the surrounding tissues , (locally aggressive cutaneous tumour) and that rarely metastasis. .
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Causes of secondary Osteosarcoma Paget disease. Radiation Fibrous dysplasia Enchondromatosis Multiple osteochindroma Bone infraction Chronic osteomyelitis Refer Maheshwari 9th/e p 239
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140 cm
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Positive trendelenburg's sign is seen in superior gluteal nerve (Gluteus mediusminimus) injury and not in Inferior gluteal nerve injury (Gluteus maximus). The gluteus maximus is the most powerful hip extensor and is crucial for movements requiring large forces. It functions primarily between the flexed and the standing positions, as when rising from the sitting position, straightening from the bending position, walking uphill and upstairs, running and jumping.
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Acute diveniculitis severe enough to warrant hospitalization requires intravenous fluid replacement and broad-spectrum antibiotic therapy. Morphine is a poor choice for analgesic because it increases intracolonic pressure and may aggravate the diveniculitis. Meperidine is a better choice because it decreases intraluminal pressure. Unless there is small bowel obstruction from a loop of intestine adherent to the inflammatory mass, a nasogastric tube is necessary. The patient should respond promptly to appropriate management. Emergency operation is not necessary. Once the process has subsided, colonoscopic examination or barium enema can be done electively.
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Pregnancy
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ref : bailey and love 27th ed
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Refer : Anatomy and Physiology of Eye – AK Khurana pg 59
Concentration of components in plasma and aqueous humour
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D i.e. Cyclopropane
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Ans is 'd' i.e., Methylene blue test `Methylene blue Reduction test' is an indirect test Jar detection of microorganism in milk. It is carried out on milk prior to the process of pasterurization and is not used to check the efficiency of pasteruization.
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Cerebellar glomeruli are seen in the granular layer of cerebellar coex. It is a synaptic complex involving four types of neurites: Mossy fibre terminalDendrites of granule cell Dendrites of golgi cells Golgi cell axon terminal Each glomeruli is surrounded by a capsule of neuroglial cells and appears ovoid or spherical. (Ref: Vishram Singh textbook of clinical neuroanatomy, second edition pg 116, fig 10.6)
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Ans. is 'c' Loffler's Serum slope Fever, cervical lymphadenopathy and grey membrane on the tonsil extending to the anterior pillar confirms the diagnosis of diptheria injection.Harrison states that- "If pseudomembrane formation occurs beyond the tonsils and with it cervical lymphadenopathy is also present then the case is categorised as severe case of diptheria"We also know that diphtherial infection can cause severe complication such asRespiratory obstructionMyocarditis*Polyneuritis*The risk of each of these complications is proportional to the severity of the diseaseSo in a severe disease rapid diagnosis is must which can be achieved byLoeffler's Serum Slope It may show growth in 4 to 8 hrs.Tellurite Blood agar Corynebacterium diptheria is also grown on tellurite blood agar but they take longer time (at least 2 days) to grow on these mediaNOTE For culture of corynebacterium diptheria the swabs are also inoculated on plates of ordinary blood agar just for differentiating staph and streptococcal pharyngitis which stimulates diptheria.TreatmentAntibiotic (Erythromycin or Procaine penicillin)
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Differentiating features of psychogenic or non epileptic seizures or pseudoseizures: Completely asynchronous thrashing of the limbs and repeated side-to-side movements of the head Striking out at a person who is trying to restrain the patient Hand-biting, kicking, trembling, and quivering Pelvic thrusting and opisthotonic arching postures Screaming or talking during the ictus Eyes are kept quietly or forcefully closed Tend to occur in the presence of observers, to be precipitated by emotional factors, and to be prolonged for many minutes or hours; with few exceptions, tongue-biting, incontinence, huful falls, or postictal confusion are lacking Serum creatine kinase levels are normal after hysterical convulsions Ref: Samuels M.A. (2009). Chapter 16. Epilepsy and Other Seizure Disorders. In M.A. Samuels (Ed), Adams and Victor's Principles of Neurology, 9e.
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The membranous labyrinth of the internal ear is derived from the otic vesicle The surface ectoderm on either side of the hindbraint thickens to form otic placodes. The otic placodes invaginate to form otic vesicles. The otic vesicles fuher divides into 2 components that develop into structures of the membranous labyrinth: The ventral component forms the saccule and cochlear duct The dorsal component forms the utricle, semicircular canals, endolymphatic duct. Ref: Inderbir Singh Human Embryology 11 e pg 328.
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Supression of hypothalamo pituitary axis occur depending on the dose and duration of therapy. It occurs when hydrocoisone (>20-25mg/day) or equivalent is given for more than 2-3weeks. Prednisolone is 5 times more potent than hydrocoisone and therefore 5 mg prednisone is equivalent to 25 mg Hydrocoisone. Thus, suppression of HPA should be expected in any patient who has received > 5mg prednisolone/day for more than 2- 3 weeks. With the administration of steroids adrenal coex atrophies, and stoppage of exogenous steroid can precipitate a withdrawal syndrome. Withdrawal syndrome is characterized by fever, malaise, weakness, pain in muscles and joints, and reactivation of the disease. When subjected to stress these patients undergo acute adrenal insufficiency. Ref: Essentials of Medical Pharmacology, 5th Edition, Page 265; Pharmaceutical Innovation: Revolutionizing Human Health By Ralph Landau, Page 245; Asthma Care in the Community By Jill Waldro, Page 58
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Persistent deviation of the neck (Torticollis) after one day of taking haloperidol is a feature of acute muscular dystonia (acute drug dystonia).
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Ans. A. Lateral SpinothalamicThe spinothalamic tract is a sensory pathway from the skin to the thalamus. From the ventral posterolateral nucleus in the thalamus, sensory information is relayed upward to the somatosensory cortex of the postcentral gyrus.The spinothalamic tract consists of two adjacent pathways: anterior and lateral. The anterior spinothalamic tract carries information about crude touch. The lateral spinothalamic tract conveys pain and temperature.The pathway crosses over (decussates) at the level of the spinal cord, rather than in the brainstem like the dorsal column- medial lemniscus pathway and lateral corticospinal tract.
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Chromophilic renal cell carcinoma is a distinct type of human renal cancer, only recently recognized and defined by its characteristic histomorphological aspect and cytogenetic aberrations. Immunohistochemistry revealed coexpression of vimentin and cytokeratins in all cell lines the cytokeratin polypeptide patterns, however, varying between the different cell lines. Chromphi-1 tumour cells produced slowly growing tumors in nude mice using the subrenal capsule assay. In all cell lines, the cytogenetic analysis revealed numerical chromosomal aberrations known to be characteristic for chromophilic RCCs, i.e. loss of the Y chromosome, tri- or tetrasomy of chromosomes 7 and 17 as well as various combinations of additional structural and numerical chromosomal aberrations. Ref: Wikipedia
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Dorsum of the tongue is specialized mucosa
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Staphylococcal scalded skin syndrome/ Pemphigus neonatorum/Ritter's disease/Localized bullous impetigo Induced by epidermolytic exotoxins(exfoliatin)A and B, which are released by S. aureus -detachment within the epidermal layer, by breaking down the desmosomes. One of the exotoxins is encoded on the bacterial chromosome, while the other is encoded on a plasmid. Septic shock Result of a systemic response to infection or multiple infectious causes. Sepsis may be present, but septic shock may occur without it.
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(Dobutamine): (124-KDT 7th edition)DOBUTAMINE - ("Cardiac stimulant") A derivative of dopamine, but not a D1 or D2 receptor agonist, though it acts on both alpha and beta adrenergic receptorsIt is used as an inotropic agent in pump failure accompanying MI, cardiac surgery, and for short term management of severe CHF. It is less arrhythmogenic adrenalineCatecholamines -1. Noradrenaline 2. Adrenaline 3. Dopamine
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In an upright posture, the soleus is responsible for pumping venous blood back into the hea from the periphery and is often called the skeletal-muscle pump, peripheral hea or the sural (tricipital) pump. Soleus muscles have a higher propoion of slow muscle fibers than many other musclesReference: Chaurasia Volume II; 7th edition; Page no: 116
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ANSWER: (A) VisionREF: Guyton 12th Ed. Pg 624PRIMARY VISUAL CORTEX is also called visual area I or striate cortex because of the highly striated appearance.The primary visual (VI) cortex is mostly located on the medial aspect of the occipital lobe, and is coextensive with the subcortical nerve fibre stria of Gennari in layer IV, hence its alternative name, the striate cortex.It occupies the upper and lower lips and depths of the posterior part of the calcarine sulcus and extends into the cuneus and lingual gyrus. Posteriorly it is limited by the lunate sulcus, and by polar sulci above and below this sulcus. It extends to the occipital pole.The primary visual cortex receives afferent fibres from the lateral geniculate nucleus via the optic radiation. The latter curves posteriorly and spreads through the white matter of the occipital lobe. Its fibres terminate in strict point-to-point fashion in the striate areaThe primary visual cortex is divided into six functionally distinct layers, labeled 1 through 6. Layer 4, which receives most visual input from the lateral geniculate nucleus (LGN), is further divided into 4 layers, labelled 4A, 4B, 4Ca, and 4Cb. Sublamina 4Ca receives most magnocellular input from the LGN; while layer 4Cb receives input from parvocellular pathways .The striate cortex is granular.Layer IV, bearing the stria of Gennari, is commonly divided into three sublayers. Passing from superficial to deep, these are IVA, 1VB (which contains the stria), and JVC. The densely cellular I VC is further subdivided into a superficial I VCa and a deep IVCb. Layer IVB contains only sparse, mainly non-pyramidal, neurones. The input to area 17 from the lateral geniculate nucleus terminates predominantly in layers IVA and IVC.
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Ans. (a) Nodular SclerosisRef: Robbin's pathology 9th ed. /606-607; Harrison 18th ed. Chapter 110Hodgkin's DiseaseNodular lymphocytePredominant Hodgkin's diseaseClassical Hodgkin's diseaseNodular sclerosis Hodgkin's diseaseLymphocyte-rich classic Hodgkin's diseaseMixed-cellularity Hodgkin's diseaseLymphocyte-depletion Hodgkin's disease
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Ans. is 'd' i.e., Productive cough Amiodarone is a class III antiarrhythmic drug and thus blocks potassium channel. It acts by increasing the action potential duration and effective refractory period.In spite of its present classification as class 3 drug, amiodarone also significantly blocks inactivated sodium channels. It also has weak adrenergic and calcium channel blocking actions.Consequence of these actions include slowing of the heart rate and AV node conduction.Amiodarone is the most powerful antiarrhythmic drug available for the treatment and prevention of both atrial and ventricular arrhythmias.Adverse effect:-Even short term use of Amiodarone causes serious toxicity.Amiodarone accumulates in many tissues which includes heart, lung, liver and skin.Pulmonary toxicityIt is the most important adverse effect.It is dose related. Fatal pulmonary fibrosis may be observed even in low doses.Patient usually presents with cough, chest pain and shortness of breath. Symptoms usually start with dry cough and dyspnoea. Remember, that patients on amiodarone often have dyspnoea attributable to other problems such as heart failure, so amiodarone lung toxicity is difficult to diagnose.Liver toxicityAbnormal liver function and hepatitis develops during amiodarone therapy. (I have not got any documented evidence of liver cirrhosis).Skin depositsSkin deposits results in photodermatitis and gray blue skin discoloration in sun exposed areas e.g. the malar region.Corneal micro depositsCorneal micro deposits are seen in virtually all patients treated with Amiodarone after few weeks of treatment.Sometimes optic neuritis may develop and progress to blindness.Effect of Amiodarone on ThyroidAmiodarone is a potential source of large amount of inorganic iodine and it also blocks the peripheral conversion of thyroxine (T4) to triiodothyronine (T3).Thus Amiodarone may result in hypothyroidism or hyperthyroidism.Thyroid function should be evaluated prior to initiation of treatment and monitored periodically.Cardiac toxicityAmiodarone may produce symptomatic bradycardia and heart block in patients with preexisting sinus or A-V node disease.
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The above procedure shown in image is - Embalming Ethanol is a preservative is not the usual content of Embalming solution.- Instead Methanol is used (cheaper) and more toxic to bacteria than ethanol. MC used - formaldehyde - dehydrates , hardens the tissue- Formalin - 60%- Methanol - 25%- Liquefied phenol - 10%- Sodium lauryl sulphate- 1%- Mercuric chloride - 1%- Eucalyptus oil- 1% Lets Revise :-
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