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In constrictive pericarditis, ECG does not show ST elevation, it frequently shows low voltage QRS complexes and diffuse flattening or inversion of the T waves. 1/3rd of the patients shows changes consistent with atrial fibrillation. Constrictive pericarditis: Is inflammation of pericardium which leads to the formation of a thickened, fibrotic, adherent pericardium that restricts diastolic filling and produces chronically elevated venous pressures. Clinical features: Patients presents with progressive dyspnea, fatigue, and weakness. On examination: JVP is elevated with a rapid y descent. Kussmaul sign and pulsus paradoxus is present. Apex of hea retract with systole and a pericardial knock may be heard in early diastole. Chest radiograph may show cardiomegaly and pericardial calcification. Echocardiography shows thickened pericardium and septal bounce reflecting the rapid early filling. Reference: 1. Current Medical Diagnosis and Treatment, 2012, Chapter 10 2. Harrison's Internal Medicine, 18th Edition, Chapter 239
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A. i.e. Maxillary aeryMiddle meningeal aery, commonest source of extradural haemorrhage is branch of Ist pa of maxillary aery(terminal branch of external carotid aery)
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C i.e. Flowering tops
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ANTI-IgE ANTIBODY Omalizumab It is a humanized monoclonal antibody against IgE. Administered s.c., Mech of action:- It neutralizes free IgE in circulation without activating mast cells and other inflammatory cells. On antigen challenge, little IgE is available bound to the mast cell surface receptors (FceR1) to trigger mediator release and cause bronchoconstriction. In severe extrinsic asthma, omalizumab has been found to reduce exacerbations and steroid requirement. No benefit has been noted in nonallergic asthma. Ref:- kd tripathi; pg num:-231
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Information in this question are :-
Recurrent bilateral conjunctivitis
In hot weather
Burning, itching & lacrimation
Polygonal raised area on palpebral conjunctiva
Diagnosis is vernal keratoconjunctivitis.
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<p>The tumors causing inappropriate rise in erythropoietin are renal cell caarcinoma,hepatocellular carcinoma ,cerebellar hemangioblastoma.</p><p>Reference :Harsh mohan textbook of pathology sixth edition pg no 359.</p>
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Cannabis / marijuana:Most commonly abused substance in India Opium: Derived from Papaver somniferum; poison of choice for suicide Heroin / brown sugar: Synthetic derivative of opium Datura: Roadside poison or railway poison Cocaine: Obtained from dried leaves of Erythroxylum coca
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Ans. is 'd' i.e., Progression to kyphosis deformity is least with lumbar lesions Tuberculosis in children Extra-pulmonary tuberculosis accounts for 5 - 10% of total cases of tuberculosis in children o About 1/3 of children with tuberculosis have extrapulmonary tuberculosis The most common mode of presentation in a child less than 2 years is development of a gibbusof the dorsal area. o Under the age of four, backache in children should be regarded as pathological unless and until proved otherwise. o MRI cannot differentiate between pyogenic or tuberculous infection. Veebral tuberculosis is the most common form of skeletal tuberculosis in children, accounting for 50% of all cases in repoed series. Approximate distribution in the skeleton are spine (50%), hip (20%), knee (10%), ankle and foot (5%), hand and wrist (3%), elbow (2%), shoulder (1 %), bursal sheaths and other bones (8%) The thoracic spine is most commonly affected; the radiological features include bone marrow oedema and enhancement, posterior element involvement, canal stenosis, and spinal cord or nerve root compression. Inter-veebral disc enhancement, veebral collapse and kyphosis deformity are paicularly suggestive of tuberculosis. Those with dorsal lesions have maximal deformity at the time of presentation, paly due to the additive effect of the normal thoracic kyphosis. However, the rib cage offers protection against additional collapse. Patients with dorsolumbar lesions have the worst prognosis as they tend to collapse more during the active phase of the disease and even more during the growth period. Those with lumbar lesions have the best prognosis with the least deformity at presentation, a lesser increase during the active phase, and also a tendency for substantial decrease during the growth period.
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Fixed drug eruptions Fixed drug eruptions Fixed drug eruptions are a unique form of drug allergy that produces red plaques or blisters that recur at the same cutaneous or mucosal site each time the drug is ingested. Clinical manifestations:? "The lesions appear at the same cutaneous or mucosal site each time the drug is ingested". - Single or multiple, round sharply demarcated, dusky red plaques appear soon after drug exposure and reappear in exactly the same location each time the drug is taken. Most common site for fixed drug eruptions is male genitalia0 - Lesions can occur on any pa of the skin, mucous membranes lips, hands, genitalia (especially male genitalia) and occasionally oral mucosa are oured sites. Reactivation and refractory phase - The length of the time from the reexposure to a drug and the onset of symptoms is 30 'ninnies to 8 hours following each exacerbations. Some patients demonstrate a refractory period (weeks to several months) during which the offending drug does not activate the lesions. Cross sensitivity - Ingestion of drugs with similar chemical nature may precipitate exacerbations. - This phenomenon has been repoed with tetracycline and sulfonamides. Diagnosis - Taking a careful history is impoant because patients often do not relate their complaints to the use of a drug. - Provoking the lesion with the suspected drug confirms the diagnosis. Treatment - Topical steroids are useful. Drugs associated with fixed drug eruptions :- - Tetracycline - Phenolphthalein - Sulphonamides - Barbiturates - Quinine
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Telomers and TelomeraseTelomers are sho repeated sequences of DNA present at the end of eukaryotic chromosomes.In normal cells, telomeres get shoened in each replicated cycle. After the telomers get shoened by a critical length, cell stops dividing and enters into Go phase (senscence).However, germ cells, cancer cells and stem cells have an enzyme telomerase (telomerase activity) which prevents telomer shoening.Thus telomers are not shoened in these cells, and therefore these cells have ability to self replicate extensively.Telomerase is a reverse transcriptase (RNA dependent DNA polymerase) and is responsible for telomer synthesis and maintaining the length of telomers (replication of end of chromosome).Thus, telomerase provide longetivity to the cells which contain this enzyme.Telomerase is absent from most of the somatic cells and hence they suffer progressive loss of telomers and they exit the cell cycle.
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Orbitalis muscle The muscle of Muller, or orbitalis muscle, is a thin layer of smooth muscle that bridges the inferior orbital fissure. It is supplied by sympathetic nerves."Its functions are unceain, but its contraction may possibly produce a slight .forward protrusion of the eyeball."- Gray's AnatomyIts palsy may thus lead to enophthalmos (recession of the eyeball within the orbit)The superior and inferior tarsal muscles are small muscle laminae inseed into the upper and lower eyelids. Both are supplied by sympathetic nerves. The contraction of superior tarsal muscle elevates the eyelid acting as a supplement to the action of levator palpebrae superioris muscle. Mild ptosis seen in Homer's syndrome is the result of interruption of the sympathetic supply to the superior tarsal muscle. Contraction of inferior tarsal muscle during downward gaze pulls the lower lid downwards.Action of Levator palpebrae superioris muscle is elevation of the upper eyelid.
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Cortisol levels in blood are normally elevated at 8.00 AM and decrease to less than 50% by midnight.
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-Exterior pollicis brevis & abductor pollicis longus tendons. - form the anterolateral border of anatomical Snuff box. -It occurs d/o repeated overuse of thumb/ wrist paicularly like thumb abduction. -Finkelstien test : Sudden ulnar detion is painful. -Anatomical snuff box Triangular depression on lateral side of wrist seen best when thumb is extended. Boundaries :- -Anterolateral - Abductor policies longus tendon Exterior pollicis brevis tendon -Posteromedial - Exterior pollicis longus tendon -Floor - Scaphoid & trapezium Contents - Radial aery, radial nerve, cephalic vein
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Ans. is 'c' i.e., Ice lined refirgerator o At the PHC level, all vaccines are kept in the small ILR (Ice-lined regrigerators)for a period of 1 month at temperature of +2degC to + 8degC. o At the PHC small DF (deep freezer) is also used, but small ILR is the main storage equipment.
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Ans. A i.e. Fracture scaphoid Scaphoid Only carpal bone to undergo fracture as well as AVN: Scaphoid Fragment undergoing necrosis in fracture scaphoid: Proximal MC site of fracture scaphoid: Waist
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Ans is 'b' i.e. Hyperacute rejectiono Hyperacute rejection is caused by ABO incompatibility and preformed cytotoxic antibodies against donor HLA antigens. Therefore immunosuppressant is not helpful.
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The ventral lateral nucleus of the thalamus is primarily involved with motor function and does not contribute to descending pathways that influence pain transmission. Neurons in the periaqueductal gray project to the nucleus raphe magnus, the cells of which give rise to raphespinal fibers. These axons utilize serotonin as a neurotransmitter, which they release at their terminals on enkephalinergic interneurons in the substantia gelatinosa of the dorsal horn. The latter neurons then form synapses directly wtih the terminals of incoming primary afferent pain fibers from the dorsal roots.
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Ans: a (Cocaine) Ref: Reddy, 27th ed, p. 535Hallucination of worms crawling over the body occurs in cocaine poisoning - Magnan symptoms.Tactile hallucination -Delerium tremens.Amphetamine poisoning.Chronic cocaine poisoning.Atropine overdose.Lilliputian hallucination -Acute cocaine poisoning.Delirium tremens.
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Ans. a (Idiopathic retroperitoneal fibrosis) (Ref. Bailey and Love 24th ed., 64.4)IDIOPATHIC RETROPERITONEAL FIBROSIS (Ormand's disease)# a rare condition in which one or both ureters become bound up in a progressive fibrosis of the retroperitoneal tissues.# The cause is unknown although some cases may be drug related.# A similar clinical picture occurs in patients with leaking aortic aneurysm and infiltrating retroperitoneal malignancy.# The patient complains of backache which is unremitting for several months, n ESR is markedly raised.# The onset of anuria and renal failure prompts investigation of the renal tract which reveals hydronephrosis.# The excretion urogram typically shows displacement of the obstructed ureters towards the midline.# The appearances on CT are diagnostic.# Treatment- It may be possible to insert ureteric stents as a temporary measure while renal function recovers.- If not, percutaneous nephrostomies will allow the obstructed kidneys to drain.- Some patients need renal replacement by dialysis.- Some advocate that these patients should be treated conservatively with high-dose steroids.- Surgical treatment involves careful dissection of the ureters from their entrapment (ureterolysis).- Wrapping omentum around the freed ureters make recurrent obstruction less likely.Educational Points:RUPTURE OF THE URETER# Injury during pelvic surgery is far more common.# Occurs most often during vaginal or abdominal hysterectomy.# Preliminary catheterisation of the ureters prevents such accidents.# Repair of the injured ureter- If there is no loss of length and the cut ends of the ureter can be brought together without tension, they should be joined by a spatulated anastomosis over a double pigtail catheter.- If the division is very low down, the bladder wall may be hitched up so that the ureter can be reimplanted into it. Extra length may be obtained by mobilising the kidney.- Boari's operation. A flap of bladder wall is fashioned into a tube to replace the lower ureter.- The ureter may be implanted end to side into the contralateral ureter. The disadvantage of a transureteroureterostomy is that it risks converting a unilateral injury into a bilateral one.- Occasionally, when conservation of all renal tissue is vital, replacement of the damaged ureter by a segment of ileum is necessary.- Nephrectomy may be the best course when the patient's outlook is poor and the other kidney is normal.
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ANSWER: (B) HyponatremiaREF: Harrison's 17th ed chapter 46"Diarrhea leads to ECF contraction and Hyponatremia which may lead to seizures"
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Ans. is 'c' i.e., Sporotrichosiso Fusiform cigar bodies are seen in sporotrichosis.o The organism (sporothrix schenckii) are usually described as tiny, cigar-shaped bodies, 3-5 microns in length, which bear from one to three small oval buds at either or both pales,o Occasionally a larger asteroid body may be seen.
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Conditions also. with peptic ulcer have already been described. Plummer Vinson Paterson Kelly syndrome consists of :- Iron deficiency anemia Dysphasia atrophic oral mucosa, glossitis brittle spoon-shaped fingernails. Typically pts are Woman over 40 yrs of age. Its a Pre-malignant condition* for both oral cavity & esophagus. Ref : S Das textbook, 3/e, p818
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Ans. is 'a' i.e., Zinc dificiency
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The difference in structure of cysteine and cystine. Two molecules of cysteine are joined together by S--S bond to form one molecule of cystine.Ref: M.N. Chatterjea - Textbook of Biochemistry, 8th edition, page no: 504
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Ans. is 'a' i.e., Sho stretches of DNA; 'b' i.e., Recognised by specific restriction endonuclease; c i.e., Complementary strands Palindromic DNA o A DNA sequence consists of two complementry strand coiled in a double helicle structure. o A sequence of duplex DNA that is same when two strands are read in opposite direction is called Palindrome 5'-GGCC-3' 3'-CCGG-5' Figure 1 - Palindrome o These palindrome serves as the target for most restriction endonuclease. Also know Inveed repeats o In these cases, two different segments of the double helix read in the same but in opposite direction. 5' - AGAACA nnnnnnnnn TGTTCT - 3' 3' - TCTTGT nnnnnnnnn ACAAGA - 5' Figure 2 - Inveed repeats Now you must be thinking that what is the difference between palindrome and inveed repeats ? o In palindrome the sequence is same in the complementry region of two strands, ie. the strands of DNA have same sequence in opposite direction on the same segment (see fig 1) of DNA. o In inveed repeats it occurs on two different segments of DNA, i.e. it is not complementry. The intervening strands of DNA do not have same sequence in opposite direction (see fig 2).
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Option d : Heparin contains iduronic acid Glucuronic acid is the hexuronic acid present in most of the glycosaminoglycans. Iduronic acid is a component of Heparin Dermatan sulfate Heparin and Heparan sulfate both contain N-sulfo glucosamine sugar instead of N-acetyl glucosamine as sugar component. NOTE: Dermatan sulfate is made up of N-acetyl galactosamine + iduronic/glucuronic acid
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Most common paraneoplastic syndrome associated with small cell lung cancer => SIADH > Cushing syndrome.
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"Apple jelly nodules" : - Characterized by yellow-brown nodules with tiny darker granules. On probing, the nodules are soft jelly-like seen in cutaneous TB infection Lupus vulgaris.
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C i.e. Required for transpo of glucose, aminoacid, K+ & Na+
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ANSWER: (A) Prolactin is increased during nightREF: OP Ghai 7th ed p. 122Breast feeding is important during night because the maximum concentration of prolactin is produced during night; hence it helps to increase quantity of breast milk production.
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Ans. is 'a' i.e., Deafness o Niacin deficiency results in 'Pellagra'Pellagra is identified by the presence of three 'D's --> Diarrhea, Dementia, Dermatitis
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Non-disjunction: failure of chromosomes to separate normally during cell division. It may occur in meiosis or mitosis. It may result in Aneuploidy. If non-disjunction occurs in one of the first few mitotic divisions, 2 or more cell lines can be observed in the same individual- 'Mosaicism'
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Ans. B i.e. Acetaminophen Acetylcysteine It is a derivative of cysteine; an acetyl group is attached to the nitrogen atom. This compound is sold as a dietary supplement commonly claiming antioxidant and liver protecting effects. It is used as a cough medicine because it breaks disulfide bonds in mucus and liquefies it, making it easier to cough up. It is also this action of breaking disulfide bonds that makes it useful in thinning the abnormally thick mucus in cystic and pulmonary fibrosis patients.
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N-linked glycosylation begins in the endoplasmic reticulum. A core oligosaccharide is synthesized attached to a molecule of the lipid dolichol. The oligosaccharide is transferred from dolichol to an asparagine residue of the polypeptide chain. The oligosaccharide is first trimmed and then modified by the addition of monosaccharide units as the protein molecule is processed through the endoplasmic reticulum and the Golgi apparatus. Ref : Biochemistry by U. Satyanarayana 3rd edition Pgno : 562
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B i.e. After surgery for cataract or glaucoma Ciliary Block Glaucoma/ Malignant Glaucoma Also known as direct lens block glaucoma, aqueous misdirection syndrome, ciliovitreolenticular block Q. It classically occurs in patients with primary narrow angle glaucoma operated for peripheral iridectomy or filtration (e.g. trabeculectomy) surgery Q and after cataract surgery. Q
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Answer is B (Libman sach's Endocarditis) Flat vegetation in pockets of valves are charachteristic of Libman sach's endocarditis
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Norwegian or crusted scabies Seen in immunocompromised patients (with lymphoreticular or other malignancies, HIV infection, and those on immunosuppressives) and those who are mentally challenged. Clinical presentation:- Thick, scaling, crusted plaques that are found most commonly on the hands, feet, and scalp but may be generalized in distribution Lesions contain thousands of mites. May cause epidemics of ordinary scabies in contacts because of high load of mites. Ref:- Dermatology review by Asra Ali; pg num:- 290
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-The anterior interosseous nerve and vessels lie in close relation to the anterior surface of the interosseous membrane of forearm stretching between the interosseous borders of radius and ulna.At the upper margin of the pronator quaadratus, the anterior interosseous vessels pass through the interosseous membrane to enter the posterior compament of forearm. -The lower pa of the posterior surface of interosseous membrane is closely related to the anterior interosseous aery and posterior interosseous nerve.The posterior interosseous vessels enter the posterio compament through the gap between oblique cord and upper margin of the interosseous membrane. -reference; clinical anatomy for students ,problem solving appproach,neeat v kulkarni, page no.79
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A i.e. Lens dislocation
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Caveolins are proteins that interact with cholesterol and polymerize to form the caveolae (flask-shaped membrane depressions). These are prominent in endothelial cells, where they help in the uptake of nutrients from the blood. These are involved in cholesterol regulation and transcytosis. Transcytosis across capillary endothelium
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Subscapularis is one of the rotator cuff muscle in the shoulder. Lift off test is used to identify the patentcy of the subcapsularis muscle and to detect an isolated rupture of subscapularis tendon. Lift off test is also known as "Gerber's test". Ref: Examination of the Shoulder: The Complete Guide, Newyork, Page 231; Campbell's Ohopaedics, 11th Edition, Page 2607.
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CAMs bind to laminins, a family of large cross-shaped molecules with multiple receptor domains in the extracellular matrix. Laminin is a high molecular weight ECM protein. Many CAMs pass through the cell membrane and are anchored to the cytoskeleton inside the cell. Some bind to like molecules on other cells (homophilic binding), whereas others bind to nonself molecules (heterophilic binding). Actin is connected to the sarcolemma, from where integrin connects it to laminin in ECM.
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Best diseaseAutosomal dominant inheritance due to mutation of bestrophin gene on 11q13 chromosomeLipofuscin accumulation throughout the RPELarge yellow yolk like ( vitelliform ) lesion - EGG YOLK APPEARANCEBest investigation for diagnosis of Best disease is made on the basis of abnormal electrooculogram findings - a severe loss of light response of the standing potential occursArden ratio - less than 1.5 & frequently near 1.1Electro-retinography - reduced C waveBEST disease - relatively normal electroretinographic results with abnormal electro oculographic findings(Refer: AH Khurana, Comprehensive Textbook of Ophthalmology,5thedition, pg no: 520-521)
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C i.e. 7.5% solution gives 2n molsConcentration of bicarbonate- Intracellular : 10 mmoVLQ- Extracellular : 27 mmol/LQIn kidney bicarbonate is produced by carbonic anhydraseQ.
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The obturator nerve innervates the adductor muscles, including the gracilis, pectineus, and obturator externus. The tibial nerve supplies the calf muscles and intrinsic muscles in the plantar portion of the foot. The inferior gluteal nerve innervates the gluteus maximus; the superior gluteal nerve supplies the gluteus medius and minimus and tensor fasciae latae. The femoral nerve provides motor supply to the quadriceps femoris, sartorius, and, in some cases, the pectineus.
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Most common cause of hyponatremia in children - Syndrome of inappropriate ADH.
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Ans. is 'b' i.e., 10-20 words
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Wernicke's aphasia is caused by a lesion in the posterior superior temporal gyrus of the dominant hemisphere. It is characterized by impaired language comprehension, inability to repeat, and fluent speech output with paraphasic errors. The only associated neurologic sign may be a right superior quadrantanopia second~ to the proximity of the inferior optic radiation to Wernicke's area in the left temporal lobe.
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Ans. (b) Three monthly injections of RanibizumabOption a - LP is done for extrafoveal lesions, rarely done now a days.Option b - Anti-VEGF drugs are the mainstay of treatment for Wet ARMD as has been seen in many trials such as MARINA, ANCHOR, Pronto trial etcOption c - PDT can be done, but used only ifPurely occult CNVPredominantly classical CNV, subfoveal, not larger than 5400 microns and a visual acuity of 6/60 or better.Option d - Wet ARMD needs to be treated. Observation may be done in cases of Dry ARMD.
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CYP 2C19 is the principal enzyme that metabolizes omeprazole to an inactive metabolite. The efficacy of drug-influenced by the CYP 2C19 genotype.
Reduced CYP2C19 enzyme activity (poor metabolizers) may lead to higher exposure to the drug and improve outcome at standard doses.
In contrast, increased CYP2C19 activity (ultrarapid metabolizers) may have an insufficient response to treatment as the drug is inactivated faster.
Omeprazole is highly plasma protein bound drug,
It has oral bioavailability around 50%
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Humans are infected when the leptospires in water contaminated by the urine of carrier animals (rats, dogs, cattle, and pigs), enters the body through cuts or abrasions on the skin / through intact mucosa of mouth, nose or conjunctiva. The incubation period is 2-20 days. Ref: Current Medical Diagnosis and Treatment 2012, Chapter 34 ; Textbook of Microbiology By Ananthanarayan and Panicker, 8th Edition, Pages 381-383
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Campylobacter botulinum growing in food produces a potent neurotoxin that causes diplopia, dysphagia, respiratory paralysis, and speech difficulties when ingested by humans. The toxin is thought to act by blocking the action of acetylcholine at neuromuscular junctions. Botulism is associated with high mortality; fortunately, C. botulinum infection in humans is rare. Activation of cyclic AMP is important in cholera disease, not botulism. Clostridia are gram-positive and have no endotoxin. Ingestion of the botulism toxin initiates the disease. The actual organism may or may not be alive when ingested. An enterotoxin, by definition, would affect the intestinal tract.
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Ticks are the vectors of Q fever, relapsing fever, KFD, Tularemia Mosquito are the vectors of malaria, filaria, Japanese encephalitis, dengue, chikungunya Flies are the vectors of typhoid, diarrhoea,dysentery, cholera, gastroenteritis, anthrax, yaws. Park's Textbook of Preventive and Social Medicine, 25th Edition, Pg 833,834
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Ref: Parson's 21st edition Diseases of the Eye page no:358Kanski: Clinical Ophthalmology; 7th edition, pg no 864Explanation:Chloroquine is a melanotropic drugIt is excreted very slowly from the body & get accumulated in melanin containing structures like RPE & choroidHydroxychloroquine - Less toxicMaximum dosage - Chloroquine - 6mg/kg/dayHydroxychloroquine - 4.5mg/kg/dayOther ocular side effects:vortex keratopathy - reversibleAnterior capsular cataract,Optic neuropathyOther causes of Bull's Eye MaeulopathyCone dystrophyCone rod dystrophyInverse retinitis pigmentosaStargardt 's disease
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Streptococcus
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The spread of carcinoma of buccal mucosa
Buccal carcinoma spread locally and to regional lymph nodes.
1) Local spread: - From its site of origin, the lesion may spread deeply involving submucosa → muscle → Subcutaneous fat → skin. Involvement of buccinator muscle or anterior masseter causes trismus.
2) Lymphatic spread: - Nodal involvement occurs in about 50% of cases. Submandibular and later the upper jugular nodes may get involved. Upper jugular nodes may also be involved, directly skipping the submandibular group.
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There is polyuria (not oliguria)
Hypervitaminosis
The sign and symptoms of vitamin D intoxications are secondry to hypercalcemia which is caused by -
Excessive bone resorption (major cause) Vit D causes bone resorption.
Increased calcium absorption
Manifestations are -
GIT --> Nausea, vomiting, anorexia, poor feeding, constipation, abdominal pain and pancreatitis.
CVS --> Hypertension, arrhythmias and decreased QT interval.
CNS ---> Lethargy, hypotonia, confusion, psychosis, disorientation, depression, hallucinations & coma.
Kidney --> Polyuria, hypernatremia, dehydration, nephrolithiasis and nephrocalcinosis.
Metastatic calcification.
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Ans: c (Prostate) Ref: Robbins, 7th ed, p. 1352; Harsh mohan, p. 26# Corpora amylaceae are basophilic, PAS positive, concentrically laminated structures# They represent degenerative changes and they occur in increasing number with advancing age# Consists of GAGS , heat shock proteins and ubiquitin# They are located in astrocytic end processes, prostate, brain and spinal cord in elderly and in old infarcts of lung.Other important structures: Hirano bodies -Alzhiemer diseaseMichaeli gutmann bodies - malakoplakiaLafora bodies - myoclonic epilepsyVerocay bodies - neurilemmomaRed fibres - apoptosisVirchow- hassall body- thymusPsammoma bodies- Papillary ca thyroid meningiomaCitron bodies - Cl. Septicum infectionDurk granuloma - brain in malaria
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(A) needs urgent hospital referral or admission (classifies as and colour coded pink) (C) can be managed at home (classified as and colour coded green) (D) needs specific medical Rx or advice (classified as and colour coded yellow)
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Step 9 of Glycolysis i. Phosphoenolpyruvate (PEP) is dephosphorylated to pyruvate, by pyruvate kinase. First PEP is made into a transient intermediary of enol pyruvate; which is spontaneously isomerized into keto pyruvate, the stable form of pyruvate. ii. One mole of ATP is generated during this reaction. This is again an example of substrate-level phosphorylation (Fig. 9.13). iii. The pyruvate kinase is a key glycolytic enzyme. This step is irreversible. reversal, however, can be brought about in the body with the help of two enzymes (pyruvate kinase and phosphoenolpyruvate carboxykinase) and hydrolysis of 2 ATP molecules. starvation activation of pyruvate kinase brought to glycolysis.Ref: DM Vasudevan, 7th edition, page no: 109
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In hemophilia there will be abnormal aPTT and normal PT. Symptoms People with hemophilia A often, bleed longer than other people. Bleeds can occur internally, into joints and muscles, or externally, from minor cuts, dental procedures or trauma. How frequently a person bleeds and the severity of those bleeds depends on how much FVIII is in the plasma, the straw-colored fluid poion of blood. Normal plasma levels of FVIII range from 50% to 150%. Levels below 50%, or half of what is needed to form a clot, determine a person's symptoms. Mild hemophilia A- 6% up to 49% of FVIII in the blood. People with mild hemophilia Agenerally experience bleeding only after serious injury, trauma or surgery. In many cases, mild hemophilia is not diagnosed until an injury, surgery or tooth extraction results in prolonged bleeding. The first episode may not occur until adulthood. Women with mild hemophilia often experience menorrhagia, heavy menstrual periods, and can hemorrhage after childbih. Moderate hemophilia A. 1% up to 5% of FVIII in the blood. People with moderate hemophilia A tend to have bleeding episodes after injuries. Bleeds that occur without obvious cause are called spontaneous bleeding episodes. Severe hemophilia A. <1% of FVIII in the blood. People with severe hemophilia A experience bleeding following an injury and may have frequent spontaneous bleeding episodes, often into their joints and muscles. Reference: GHAI Essential pediatrics, 8th edition
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Ans. is 'c' i.e, NOo Substances which cause vasodilatation, can cause fall in BP.o Substances which cause vasoconstriction, can cause rise in BP.Vasodilators (cause decrease in BP)Vasoconstrictors (casue increase in BP)o Kinins (Bradykinin)o PGEL,o PGI, (Prostacyclin)o VTPo ANPo Nitric oxide (NO)o Adrenaline & Noradrenalineo ADM (Vasopressin)o Angiotensin IIo Endothelinso PGF2o Thromhoxane-A,
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Ans. is 'c' i.e., Infection of submandibular space o Caldwell-Luc operation is a process of opening the maxillary antrum through canine fossa by sublabial approach and dealing with the pathology inside the antrum.o In this surgery, antrum is reached through a incision in gingivolabial sulcus (from lateral incisor to 2nd molar) and then opening of antrum in this area.o During the surgery a noso-antral window is made through the inferior meatus so that after the surgery, packing of sinus can be removed through this window.
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Ans. is 'b' Zenker's diverticulum Symptoms of Zenker's diverticulumPresenting symptoms include dysphagia associated with the spontaneous regurgitation of undigested, bland material, after interrupting eating or drinking.The dysphagia is occasional when the diverticula gets filled with food. Dysphagia is relieved when the diver- ticulum empties.Other symptoms areHalitosis (foul mouth odour) gurgling noise after eating swelling in the neck aspiration of contents leading to recurrent pneumonia, lung abscessDiagnosis is confirmed by barium swallowIn Achalasia & Ca esophagus, the dysphagia is progressive and not occasional, though regurgitation may be seen in achalasia.Diabetic gastroparesis is a rare disorder leading to motor abnormality of the esophagus.
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Ans. is 'b' i.e. high inguinal orchidectomy & radiotherapy Testicular Cancer - is mainly of two types - Germ cell tumors (GCT) 95% - Non germinal neoplasms -- 5% (includes leydig cells, seoli cells, gonadoblastoma) Germ cell tumors are of 2 types Seminomas (More common, better prognosis) Nonseminomas i.e. - Embryonal Ca Teratoma Choriocarcinoma Yalk sac (Endodermal sinus) Carcinoma Germ Cell Tumor Staging and Treatment Treatment Stage Extent of Disease Seminoma Nonseminoma IA Testis only, no vascular/ lymphatic invasion (TI) Radiation therapy RPLND or observation IB Testis only, with vascular/ lymphatic invasion (T2), or extension through tunica albuginea (T2), or involvement of spermatic cord (T3) or scrotum (T4) Radiation therapy RPLND HA Nodes <2 cm Radiation therapy RPLND or chemotherapy often followed by RPLND BE Nodes 2-5 cm Radiation therapy RPLND +/- adjuvant chemotherapy or chemotherapy followed by RPLND IIC Nodes >5 cm Chemotherapy Chemotherapy, often followed by RPLND III Distant metastases Chemotherapy Chemotherapy, often followed by surgery (biopsy or resection) RPLND : retroperitoneal lymph node dissection Extra gonadal Germ cell tumors --> Infrequently GCTs arise from an extra gonadal site. They have poor prognosis. They are treated by chemotherapy.
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Magistrate inquest done in cases of Death in prisons Death of a person in police custody or while under police interrogation Man missing in police custody Death due to police firing Death of a mentally ill prisoner in psychatric hospital Death of a woman within 7 years of marriage Exhumation Rape of a woman I police custody In any case, Magistrate can conduct an inquest in addition to police inquest (CrPC 176) Ref: FORENSIC MEDICINE AND TOXICOLOGY Dr PC IGNATIUS THIRD EDITION PAGE 7
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The sucrose gap technique is used to create a conduction block in nerve or muscle fibers. A high concentration of sucrose is applied to the extracellular space, which prevents the correct opening and closing of sodium and potassium channels, increasing resistance between two groups of cells. It was originally developed by Robe Stampfli for recording action potentials in nerve fibers, and is paicularly useful for measuring irreversible or highly variable pharmacological modifications of channel propeies since untreated regions of membrane can be pulled into the node between the sucrose regions Ref: guyton and hall textbook of medical physiology 12 edition page number:475,476,477
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The proteins of maize are deficient in tryptophan and lysine; while some strains contain an excess of leucine. Excess of leucine or deficiency of tryptophan causes decreased synthesis of niacin in the body. This explains the pellagragenic action of maize.
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.FAMILIAL ADENOMATOUS POLYP (FAP) * It is inherited as an autosomal dominant neoplastic condition (chromosome no. 5q21). * It presents in younger age group--15-20 years. * Incidence is equal in both sex, involving commonly the large intestine but can also occur in stomach, duodenum and small intestine. * It is familial with a high potential for malignant transformation. If there is no adenoma at the age of 30 years, then it is not FAP of colon. * It can be associated with duodenal or ampullary carcinomas , Gardner's syndrome (Desmoid tumour in the abdomen, osteomas (75%) and epidermoid cysts) and also Turcot"s syndrome (FAP + brain tumour(medulloblastoma or gliomas)) or sarcoma of bone. * Usually multiple (over 100). * Presents with lower abdominal pain, loose stools with blood and mucus, weight loss. ref:SRB's manual of surgery,ed 5,pg no 899
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Many clinical studies revealed that average dose consumption of 20-35 mg/kg body weight / day during tooth formation results in -discoloration. Doses > 35 mg/kg/ day results in both discoloration and hypoplasia of enamel.
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Ans. is 'a' i.e., 5 Mode is the most frequently occuring value in the distribution. However sometimes, there are two (instead of one) most frequently occuring values in the distribution. This is known as bimodal distribution. For bimodal distribution:- Mode = 3 median -- 2 mean In the question median is 3 and mean is 2. Thus, Mode = 3 (3) -- 2 (2) = 5.
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"The most common site for a blowout fracture to occur is the posteromedial aspect of the orbital floor, medial to the infraorbital neurovascular bundle where the maxillary bone is very thin." - The Internet Journal of Otorhinolaryngology Blow out fracture: The usual mechanism is a blow to the eye, with the forces being transmitted by the soft tissues of the orbit downward to the thin floor of the orbit. The floor is usually the path of least resistance, and fractures downward into the maxillary sinus. Clinical features: Enophthalmos Recession of the eyeball within the orbit Diplopia: Double vision Especially on upward gaze Due to inferior rectus entrapment Forced Duction test is positive confirming the presence of muscle restriction Hypesthesia: Reduced sense of touch or sensation Due to injury of infraorbital nerve Usually have numbness of the gingiva and of the skin of the midface Investigation: Radiograph (Waters view) may see a soft tissue mass on the superior margin of the maxillary sinus, representing the herniated periorbital tissues into the sinus. Hanging drop or tear drop sign: hanging opacity of superior maxillary antrum. Computed tomography is the gold standard. Coronals provide best view. Extraocular muscle rounding and herniation of fat into maxillary sinus can be clearly viewed. Management: Medical management for asymptomatic patients-IV antibiotics and sho course of oral steriods. Surgical management for symptomatic patients. Ref: Parson's Disease of the eye, 20th Edition, Page 468; Comprehensive opthalmology, By A.K Khurana, 4th Edition, Page 397
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Ans. B: 2nd order neuron In the case of the optic nerve and tracts there are three separate neurons linked together, extending from the retina to the occipital coex. The sensory end-organ consists of the rods and cones. The first neuron begins in the outer plexiform or granular layer, and ends in the inner plexiform or granular layer. The cell-body governing the nutrition of this fiber is the bipolar cell, which cells forms the inner nuclear layer. This neuron, although extremely sho is the true optic nerve in the physiological sense, and corresponds to the long fiber which runs from the sole of the foot up into the spinal cord. The second neuron in the retina begins in the inner nuclear layer and runs from here up to the primary optic ganglia, i.e., chiefly the external geniculate body. This is the anatomical optic nerve. The cell governing the nutrition of this fiber is the ganglion cell.
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Of all the membranes inner mitochondrial membrane is rich in protein content
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A reaction between Cu3 Sn (ε phase) and γ2 occurs and yields Cu6Sn5 (η phase). Because of the low copper content, a majority of γ2 remains. The addition of more than 6% of copper by weight can reduce or eliminate the γ2 phase by the formation of Cu-Sn phase.
Reference: PHILLIPS’ SCIENCE OF DENTAL MATERIALS, 12th ed page no 344
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i.e. (Carcinoma descending colon): (1181-Love & Bailly 25th)* Barium enema showing a carcinoma of the sigmoid colon. It may have a 'apple core' appearance i.e. a short irregular stenosis with sharp shoulders at each end.* Carcinoma of the left colon appears as a fixed filling defect with an annular "apple core" configuration lesion of the right colon may appears as - constriction or an intraluminal mass (663 - CSDT13th)CEA levels are high in 70% of patients with cancer of large intestine but less than half of patients with localize disease are CEA positive. CEA does not therefore serve as a useful screening procedure, nor is it an accurate diagnostic test for colorectal cancer in a curable stage. CEA is helpfid in detecting recurrence after curative surgical resection; if high CEA levels return to normal after operation and then rise progressively during the follow up period, recurrence of cancer is likely (663-CSDT 13th)* Apple jelly nodules are seen in Lupus vulgaris*** Claw appearance on barium enema - Intussusception* Napkin - Ring sign - carcinoma colonRisk Factors for the Development of Colorectal cancer* Diet: Animal fat, High caloric diet, High saturated fat consumption* Hereditary syndromes (Autosomal dominant inheritance* Polyposis coli* Nonpolyposis syndrome (Lynch syndrome)* Inflammatory bowel syndrome (UC & CD)* Streptococcus bovis bacteremia* Uretero sigmoidostomy* DM and obesity* Tobacco use* Sedentary life style* High red meat consumption* High content of refined carbohydrate* There is narrowing of terminal ileum due to irritability This along with shortened rigid caecum is called as "Sterilin sign" seen in Crohn's disease and Ileocaecal TuberculosisCROHN'S DISEASE or REGIONAL ENTERITISULCERATIVE COLITIS* Terminal ileum is the Most common site*** Granularity & asymmetrical involvement with skip lesion* Ulcer - Apthous ulcer and fissure ulcer* Cobblestone pattern** (Serpiginous transverse ulcer seperated by areas of edema)* Rigidity of mesenteric border and pseudosacculation of anti mesenteric border (Omega sign)* Wide gapping of bowel loops due to thickening of bowel wall* Stricture : long segment (String sign of cantor)*** Collar button ulcer* Double Tracking (longitudinal submucosal ulceration over several centimeter)* Symmetrical involvement of colon* Rectum involvement in 95% of cases*** Thumbprinting** due to mucosal oedema* Blunting of haustral fold (Pipestem appearance)*** Inflammatory polyp*** Back wash ileitis. In UG when whole colon involved, the inflammation extends 1-2 cm into terminal ileum in 10-20% cases called Backwash ilitis* Gaseless abdomen in X-ray***
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Haptens are low molecular weight molecules.
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child&;s criteria odf liver chirrosis 0.9 to 1.3 mg/dL for adult males. 0.6 to 1.1 mg/dL for adult females. 0.5 to 1.0 mg/dL for children ages 3 to 18 years. 0.3 to 0.7 mg/dL for children under age 3. Low values Pregnancy can also cause low blood creatinine levels. Low creatinine clearance levels can mean you have chronic kidney disease or serious kidney damage. Kidney damage can be from conditions such as a life-threatening infection, shock, cancer, low blood flow to the kidneys, or urinary tract blockage. Ref Davidson edition23rd pg 908
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CMV retinitis is the most frequent and serious ocular oppounistic infection and is the leading cause of blindness in AIDS patients. In early stages retinitis may be asymptomatic, but later causes changes in visual acuity, visual field cuts, photophobia, scotoma, and eye redness or eye pain. Indirect ophthalmoscopy shows fluffy white perivascular lesions with areas of hemorrhage within them. Treatment includes intraocular ganciclovir implants, in conjunction with oral ganciclovir. Alternative first-line therapy is ganciclovir without implants for 14 to 21 days. Ref: Harrison's Internal Medicine, 18th Edition, Chapter 214 ; Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 7th Edition, Chapter 149
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Ans. is a i.e. Breast cancer
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Ans is 'a' ie Thymoma RememberMost common mediastinal mass-Neurogenic tumorsMost common Ant. mediastinal mass-ThymomaMost common Middle mediastinal mass-Bronchogenic & pleuropericardial cystsMost common Posterior mediastinal mass-Neurogenic tumorMost common malignant mass of mediastinum-LymphomasMost common mediastinal mass in children-Neurogenic tumor
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Dystrophic Epidermolysis Bullosa (DEB): It is a spectrum of dermolytic diseases where blistering occurs below the basal lamina; healing is therefore usually accompanied by scarring and milia formation--hence, the name dystrophic. There are four principal subtypes, and all are due to mutations in anchoring fibril type VII collagen. Anchoring fibrils are therefore only rudimentary or absent. Of the four main types of DEB, dominant DEB or Cockayne-Touraine disease and recessive DEB (RDEB) are impoant. There is as yet no causal therapy for EB, but gene therapy is being investigated. Ref: Suurmond D. (2009). Section 6. Bullous Diseases. In D. Suurmond (Ed), Fitzpatrick's Color Atlas & Synopsis of Clinical Dermatology, 6e.
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Dense-deposit disease (formerly called Type II MPGN) Excessive activation of the alternative complement pathway. Electron M/E - Permeation of the lamina densa of the GBM by a ribbon-like, homogeneous, extremely electron-dense material of unknown composition. By immunofluorescence, C3 is present in irregular granular or linear foci in the basement membranes on either side but not within the dense deposits. C3 is also present in the mesangium in characteristic circular aggregates (mesangial rings). IgG is usually absent, as are components of the classical pathway of complement activation (such as C1q and C4).
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Celiac plexus is formed by the greater and lesser splanchnic nerves of both sides, and fibers from the anterior and posterior vagal trunks. Contribute to renal plexus ref - sciencedirect.com
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Ans. is 'd' i.e., Trnasperency of the tooth Age from teeth after 20 years Teeth eruption is useful for age estimation upto about 18 years, beyond which it is just a guess work. The methods used are :? A) Gustafson's method : Useful only in persons older than 21 years of age, depending on the physiological changes in each of the dental tissues. Attrition - due to wear and tear from mastication, upper surface of teeth destroyed gradually, first involving the enamel - dentine - pulp (depending on the functional use of teeth and hardness of enamel). Paradentosis - recession of gums and periodontal tissue surrounding the teeth, exposing the neck and adjacent pa of root - teeth fall off (poor hygiene increases paradentosis). Secondary dentine formation - develop within the pulp cavity and decrease size of the cavity, sta from base - apex, obliterate the cavity, increase with age, caries and paradentosis. Cementum apposition - near the end of root, increase cementum, increase thickness, deposited throughout life, and form incremental lines (devised by Boyde). Root resorption - because of cementum and dentine, absorption of root sta at apex and extend upward (may be pathological). Transparency of the root - seen after 30 years of age, canal in the dentine at first widen, increase with age because of deposition of minerals. They become invisible and dentine becomes transparent (Most reliable of all the criteria). B) Mile's method : Age can be known by changes of root transparency. Q Boyde' method : On enamel of the tooth, there is a line at bih (neonatal line). With increase in age, more lines are added, study of which helps in age determination. D) Stack's method : Age of infant can be known from height and weight of erupting teeth.
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park's textbook of preventive and social medicine 23rd edition *synthetic pyrethroids devoloped so far are tetramethrin,resethrin,prothrin and propahin *they are now being devoloped to replace natural pyrethrins some are found to be as much as 10ttimes as effective as naturally occuring pyrethrins .
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Shigellosis results in bloody dysentery because Shigella is highly virulent, resistant to gastric acid, and can invade and destroy the colonic mucosa. There is typically a mononuclear infiltrate extending to the lamina propria, with a neutrophilic exudate overlying the ulcerated areas. Stricture formation may follow intestinal tuberculosis. Intranuclear inclusions in enterocytes point to infection with DNA viruses, such as herpesviruses like cytomegalovirus. Granulomatous inflammation may be seen with granulomatous colitis (Crohn disease) and intestinal tuberculosis (rare). An increase in mononuclear inflammatory cells may be seen with milder forms of enterocolitis caused by viruses, Giardia, and Salmonella spp.
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Robbins basic pathology 9th edition page no 187 TGF b can function to prevent or promote tumor growth, depending on the state of other genes in the cell.
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DPT vaccine should not be frozen. They should be stored in a refrigerator between 2 to 8 deg. The vaccine should be used before expiry indicated on the l (refer pgno:162 park 23 rd edition)
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Cumulative risk of cancer increases with duration of ulcerative colitis, reaching 25% at 25 years, 35% at 30 years, 45% at 35 years and 65% at 40 years The risk of malignancy in Crohn's pancolitis is similar to UC pancolitis, i.e. 2% after 10 years, 8% after 20 years and 18% after 30 years approximately.
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Barr body is formed due to random inactivation or condensation of one of the 2 female chromosomes in all the somatic cells of female mammals. Buccal smears are known to be potential source of Barr bodies. Acriflavin schiff stain was used in staining these Barr bodies. Ref: NCBI.org
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The metabolism of malarial parasite is dependent on the digestion of erythrocyte haemoglobin which is conveed into malarial pigment.This pigment may be yellowish brown or dark brown in colour(refer pgno:56 baveja 3 rd edition)
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Idiot : 0 - 25.
Imbecile : 26 - 50.
Moron : 51 - 70.
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Clinical picture s/o P.embolism Next step should be CT Pulmo angiography - not there in option thus V/Q scan next best.
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Treatment of myopia 1. Optical treatment of myopia 2. Surgical treatment of myopia Radial keratotomy (RK) Photorefractive keratectomy (PRK) Laser in-situ keratomileusis (LASIK) Extraction of clear crystalline lens Phakic intraocular lens Intercorneal ring (ICR) implantation Ohokeratology 3. General measures-include balanced diet rich in vitamins and proteins and early management of associated debilitating disease. 4. Low vision aids (LVA) 5. Prophylaxis (genetic counselling). Reference : A K KHURANA OPHTALMOLOGY,Edition4, page-35,36,47,48
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C i.e. Craniopharyngioma - Most common cause of intra cranial calcification = Pineal body calcificationQ - Most common calcifying brain tumor in child = CraniopharyngiomaQ > Oligodendroglioma - Craniopharyngioma causes characteristic suprasellar calcification with cystic appearanceQ - Craniopharyngioma arises from remnants of rathke's pouchQ (mesodermal structure from which anterior pituitary gland is derived) near pituitary stalk. It presents as suprasellar cystic lesion with a tendency for calcification (80%). It is the most common suprasellar tumor in childrenQ. -Medulloblastoma mostly arises from cerebellar vermis & Medulloblastoma of posterior fossa are the M. C. malignant brain tumor of childrenQ. Pilocytic (spindle shaped) low grade Astrocytoma is the most common brain tumorQ, most common posterior fossa tumor of childrenQ.
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All three of the nerves listed innervate muscles that supply the thumb. Extension is provided by the extensors pollicis longus and brevis, which are innervated by the radial nerve. Ref: Maheshwari 6e pg 63,65.
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