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Microscopically there were collections of "lipidic" cells embedded in the myxoid matrix, typical of cardiac myxoma.</p > Ref:mayo clinic A myxoma is a rare benign tumor of the hea. Myxomas are the most common primary cardiac tumor in adults, and are most commonly found within the left atrium.Myxomas may also develop in the other hea chambers. The tumor is derived from multipotent mesenchymal cells
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Ans. c (100). (Ref. Harrison's internal medicine 16th ed. 528)FAMILIAL POLYPOSIS COLI (FAP)# It is characterized by appearance of thousands of adenomatous polyps throughout the large bowel.# By definition, in FAP at least more than 100 colonic adenomas must be present.# Colonic polyps are rarely present before puberty but are evident in affected individuals by 25 years of age.# If polyposis coli is not treated surgically, colorectal cancer will develop in almost all patients before age 40.# Once multiple polyps that constitute 'Polyposis' are detected patients should undergo total colectomy.Polyposis syndromsPeutz-Jeghers syndrome# Autosomal dominant; involves entire gastrointestinal tract; melanin pigmentation of the buccal mucosa# Polyps-hamartomas; not premalignantTurcot syndromeColonic polyps associated with brain tumorsFamilial multiple polyposis# Autosomal dominant, appearance of polyps during adolescence - Start in rectosigmoid area and spread to cover entire colon - Virtually ail patients develop cancers; prophylactic total colectomy remommendedGardner syndrome# Colonic polyps associated with desmoid tumors# Risk of colon cancer nearly 100%
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Hyperosmolar hyperglycemic syndrome (HHS) is a clinical condition that arises from a complication of diabetes mellitus. This problem is most commonly seen in type 2 diabetes. Won Frerichs and Dreschfeld first described the disorder around 1880. They described diabetic patients with profound hyperglycemia and glycosuria without the classic Kussmaul breathing or acetone in the urine seen in diabetic ketoacidosis. This clinical condition was formerly called non-ketotic hyperglycemic coma; hyperosmolar hyperglycemic non-ketotic syndrome, and hyperosmolar non-ketotic coma (HONK). Ref - pubmed.com
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*Multiple myeloma is plasma cells disorder. These plasma cells may have intracytoplasmic inclusion called as Russel bodies and intranuclear inclusions called as Dutcher bodies.
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Ans is 'b' ie Haman's procedure As already explained above, a variety of operations can be done in the obstructing lesion of left colon depending on a variety of factors, but Haman's procedure is the most commonly preferred operation.
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Answer- A. Hirschsprung's diseaseSurgery in Hirschsprung's discase aims to remove the aganglionic segment and'pull-through'ganglionic bowel to the anus (e.9. Swenson, Duhamel, Soave and transanal procedures) and can be done in a single stage or in several stages after first establishing a proximal stoma in normally innervated bowel.
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When HR is <60/min even after 30sec of effective Positive Pressure Ventilation and chest compressions, adrenaline is given i.v through umbilical vein at a dose of 0.1 - 0.3 ml/kg in 1:10,000 concentration. Reference : page 132 Ghai Essential Pediatrics 8th edition
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Ans. a. Talonavicular-Calcaneocuboid (Ref: www.vasylimedical.com/pdf/VasyliMedical%20Pronation.pdf)When pronation of the foot occurs, axes of Talonavicular- Calcaneocuboid joints move in parallel direction.'An explanation of the concept of 'unlocking' the foot has been described by Root, Orien and Weed, although the exact mechanism is still unknown. The mid-tarsal joint comprises the talo-navicular joint (longitudinal axis) and the calcaneo-cuboid joint (oblique axis). When the subtalar joint is in neutral these two axis are relatively divergent. However, as the subtalar joint pronates, these two axis become parallel.'-www.vasylimedical.com/pdf/ VasvliMedicai%20Pronation.pdf
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Type IV cailage is present in basement membranes Type Distribution I Non Cailaginous connective tissues, including bone, tendon, skin II Cailage, vitreous humor III Extensible connective tissues, including skin, lung, vascular system IV Basement membranes V Minor component in tissues containing collagen I VI Muscle and most connective tissues VII Dermal-epidermal junction VIII Endothelium and other tissues IX Tissues containing collagen II X Hyperophic cailage XI Tissues containing collagen II XII Tissues containing collagen I XIII Many tissues, including neuromuscular junctions and skin XIV Tissues containing collagen I XV Associated with collagens close to basement membranes in many tissues including in eye, muscle, microvessels XVI Many tissues XVII Epithelia, skin hemidesmosomes XVIII Associated with collagens close to basement membranes, close structural homolog of XV XIX Rare, basement membranes, rhabdomyosarcoma cells XX Many tissues, paicularly corneal epithelium XXI Many tissues XXII Tissue junctions, including cailage-synol fluid, hair follicle-dermis XXIII Limited in tissues, mainly transmembrane and shed forms XXIV Developing cornea and bone XXV Brain XXVI Testis, ovary XXVII Embryonic cailage and other developing tissues, cailage in adults XXVIII Basement membrane around Schwann cells Reference: Harper; 30th edition; Page no: 628 Table no: 50-1
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Rousing's sign is corroborative of acute appendicitis. The other signs are corroborative of appendicitis. Hyperesthesia is a useful sign provided that it is performed objectively. The area of hyperesthesia is a triangular area (base placed upward) in the right lower abdomen.
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Ans. (c) Small cell lung CARef: Robbiris 9th ed./ 717* Azzopardi effect is basophilic staining of vascular walls due to encrustation by DNA from necrotic tumor cells.* It is seen in small cell lung carcinoma
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Craniofacial osteomas are benign tumors often originating in the paranasal sinuses The frontal sinus is the most frequent location followed by the ethmoid, maxillary and sphenoid sinus, respectively Age of presentation = second to fifth decade with a male-femate ratio - 3:1. Presentation: Generally they are an incidental finding on radiography It may produce symptoms like ? Visual impairment Intracranial neurological complications like meningitis or pneumocephalus with seizure. Management Removal by endoscopic sinus surgery.
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Autograft or autologous graft means skin grafts from one site of body to another. They are the best skin grafts.
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There is deep dermal tenderness on application of pressure in secondary syphilis. This is known as an Ollendorff sign or Buschke ollendroff sign.
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In the space there is no gravity. In order to compare the blood pressure taken preflight and the one in the space, BP should be taken in a position where gravity is nullified. In lying position the gravitational force is nullified, so preflight BP measurement should be done in the lying down position. In supine position, legs are at the same level as the hea so that the gravitational forces that come into play in the upright position are diminished. When a person is lying on his back, the tricuspid valve is located at almost exactly 60% of the chest thickness in front of the back. This the zero pressure reference level. Ref: High-Yield Physiology, Pa 845, Volume 2008 By Ronald W. Dudek, Page 51; Essentials Of Medical Physiology By Khurana, Page 185.
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Out of the given 4 types of hemolytic anemias only alpha thalassemia is able to give rise to such severe presentation at birth. In all other conditions the newborn is either normal or has mild jaundice.
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Carbon dioxide is the most widely used peritoneal distention medium, because it is non-flammable, colourless and has a higher blood solubility than air & the rapid absorption of CO2 in blood reduces the incidence of gas emboli.
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Option C: Squamous changes to Columnar
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Ans. C: 24 mm The eye of the newborn is hypermetropic and the average axial length is about 18mm.At the age of 3 years it is 23 mm and from age 3-14 years it increases by 1 mm. In the emmetropic eye, the axial length (from the posterior corneal surface to the retina) varies from 22 to 26 millimeters. In the emmetropic eye (which has no refractive error), the range of corneal refracting power is between 39 and 48 diopters, while the range of lenticular refracting power is between 15 and 24 diopters.
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Vegetation in SLE Vegetation in NBTE Small, sterile, firm Both surface of valve Lower surface> upper surface Libman sack endocarditis Marantic endocarditis Along the line of closure Non invasive Don't elicit inflammatory reaction Small, Sterile Friable: Embolism Seen in - Ca Pancreases- AML M3 Vegetation of IE Vegetation Of RHD Large, multiple Friable High risk of embolism Vegetation at periphery Deposition of bacteria in multiple Organ like kidney and Brain. Small, sterile Along line of closure Firm - less chance of embolism
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Dentate nucleus is associated with Cerebrocerebellum which correspond to lateral zone of cerebellum Ref: Ganong , 25th edition/ page 248
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RNA dependent DNA polymerase
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Ref Harrison 19 th ed pg 1569 Amyloidosis is the major cause of restrictive cardiomyopathy . Several proteins can self-assemble to form the beta-sheets of amyloid proteins, which deposit with differ- ent consequences depending on the type of protein.
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Ans is 'c' i.e. Rodent EdgesUlcerSloppingVenous, TraumaticUnderminedTB, DecubitusPunched outGummatus, Deep trophicRolled upRodent (BCC)Everted (rolled out)see
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Lymphatics from the glans drain into the deep inguinal nodes also called gland of Cloquet. Lymphatics from the rest of the penis drain into the superficial inguinal lymph nodes.Ref: Vishram Singh; Volume II; 2nd edition; Page no: 464
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Glands of Wolfring and Krause are accessory lacrimal glands. They resemble lacrimal gland in structure and function and is located in the conjunctival stroma. Most of the glands of Wolfring lies at the superior margin of the upper tarsus, and most of the glands of Krause lies in the upper fornix. Glands of Zeiss are sebaceous glands associated with the cilia. Glands of Moll are modified sweat glands arranged in a single row numbering 20-30 in each lid. Meibomian glands or tarsal glands are modified sweat glands arranged in a single row numbering 20-30 in each lid. Ref: Riordan-Eva P. (2011). Chapter 1. Anatomy & Embryology of the Eye. In P. Riordan-Eva, E.T. Cunningham, Jr. (Eds), Vaughan & Asbury's General Ophthalmology, 18e.
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Example of larvivorous fish (those that feed on immature stages of mosquitoes) are Gambusia, Poecilia, Aplochelius Ref : Park 23rd edition Pgno : 773
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Ans. is `a' i.e., Hodgkin's lymphomao Hodgkin's lymphoma encampasses a distinctive group of neoplasms that arise almost invariably in a single lymph node or chain of lymph nodes and spread characteristically in a stepwise fashion to the anatomically contiguous nodes.o Therefore staging of Hodgkin's lymphoma not only determines prognosis, but also guides therapy.o With correct treatment protocols, tumor stage rather than histologic type is the most impoant prognostic variable. o Staging of Hodgkin's lymphoma :Stage I --> Involvement of single lymph node or single extralymphoid siteStage II Involvement of 2 or more lymph node on the same side of diaphragmStage III Involvement of both sides of diaphragm which may also be accompanied by localized involvement of single extralymphoid site or spleenStage IV --> Diffuse or disseminated involvement of one or more extra lymphoid organs or tissue with or without associated lymph node involvemento Each of these stages is divided into A & B category .A category Without symptomsB category With symptoms such as unexplained weight loss, unexplained fever & night sweats
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Ans. is 'b' i.e., Trichomoniasis o Patients infected with Trichomonas vaginalis complain of a typical discharge, which is thin, profuse, frothy, irritating, creamy or slight green in colour.o Slight green colour of the discharge is often not complained by the patient but spotted by the physiciano The answer cannot be PPROM because the USG scan done following her complains shows liquor amnii to be adequate, whereas leaking per vaginum for 18 - 24 hours will cause reduction in the quantity of liquor around the fetus.Trichomoniasis:# Sexually transmitted disease.# Associated with other STDs, particularly gonorrhea.# NOT associated with infertility# Subepithelial haemorrhages produced give the appearance of strawberry spots on the vaginal vault and cervix, hence giving it the appearance of strawberry vagina and cervix, known as colpitis macularis.# In males it infects the urethra and prostate.# Diagnosis is confirmed by Microscopic examination of wet mount of discharge specimen which shows motile trichomonas.# Culture is Gold standard but is impractical as it requires special culture medium known as Diamond medium.# Treatment: Metronidazole or Tinidazole or Secnidazole.# Alternate drugs : Polyoxyethylene suppository.
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The angiotensin-converting enzyme normally helps in conversion of angiotensin I to angiotensin II, which acts as a vasoconstrictor in case of hypovolemia.
In addition to that, ACE also helps in the breakdown of bradykinin.
When ACE inhibitors (captopril) are given, it inhibits ACE and in addition inhibits the breakdown of bradykinin also, which leads to accumulation of bradykinin level in the body.
This increased level of bradykinin presents with a Dry cough, rashes, urticaria and angioedema.
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Volume of the orbit is 30ml Orbit" can refer to the bony socket, or it can also be used to imply the contents. In the adult human, the volume of the orbit is 30 millilitres (1.06 imp fl oz; 1.01 US fl oz), of which the eye occupies 6.5 ml (0.23 imp fl oz; 0.22 US fl oz). Ratio of volume of orbit to eyeball is 4.5:1 Reference: Aravind FAQS in Ophthalmology; First Edition; Page no: 577
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. Inflammation
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Ans. is 'b' i.e., Hepatitis Bo Important facts regarding different types of vaccine during pregnancy are:-1) Live vaccines: As a rule of thumb all live vaccines are contraindicated during pregnancy. Important ones are measles, mumps, rubella, varicella, BCG, OPV, and yellow fever.2) Inactivated (killed) viral vaccines: These are not contraindicated during pregnancy and vaccines given are influenza and hepatitis A & B. In case of rabies vaccination, information is very limited.3) Inactivated bacterial vaccines: These are not contraindicated in pregnancy. Vaccination against pneumococcus, meningococcus or typhoid show no confirmed side effects.4) Toxoids : These are safe during pregnancy, e.g. tetanus toxoid.5) Immunoglobulins : These are used for post-exposure prophylaxis, e.g. rabies, tetanus, hepatitis A & B, and varicella.
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Indications for Blood Transfusion To correct anemia due to blood loss and to combat postpaum hemorrhage Patient with severe anemia seen in later months of pregnancy (beyond 36 weeks) Refractory anemia: Anemia not responding to either oral or parenteral therapy in spite of correct treatment Associated infection Reference: Textbook of Obsteics; Sheila balakrishnan; 2nd edition; Page no: 288
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Ans: b (M. ulcerans) Ref: Ananthanarayan, 7th ed, p. 367M.ulcerans is the only toxin producing mycobacterium, causing buruli ulcer
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Ans. is 'b' i.e., Thelarche In girls, the first visible sign of pubey is the appearance of breast buds (Thelarche), between 8-12 years of age. In boys the first visible sign of pubey is testicular enlargement, beginning as early as 91/2 yr.
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Febuxostat is a non purine inhibitor of xanthine oxidase which is required for oxidation of hypoxanthine and xanthine to uric acid. It is usually used in gout especially in patients who are intolerant to allopurinol. Other drugs used in the treatment of hyperuricemia: Uricosuric drugs Probenecid Sulfinpyrazone Uric acid synthesis inhibitor Allopurinol Ref: The Rheumatology Handbook By Margaret Callan, page 422.
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ANSWER: (B) Paramesonephric ductREF: Langman s medical embryology 9th ed p. 340-341Repeat Anatomy December 2011See APPENDIX-5 for "ADULT DERIVATIVES AND VESTIGIAL REMAINS OF EMBRYONIC UROGENITAL STRUCTURES" APPENDIX - 5Adult Derivatives and Vestigial Remains of Embryonic Urogenital StructuresEmbryonic StructureMaleFemaleGonadal RidgeCortexMedullaTestisSeminiferous tubules Rete testisOvaryOvarian folliclesMedullaRete ovariiGubernaculumGubernaculum testisOvarian ligamentRound ligament of uterusMesonephric tubulesDuctus efferentesParadidymisEpoophoronParoophoronMesonephric ductAppendix of epididymisDuctus epididymidisDuctus deferensUreter, pelvis, calices, and collecting tubulesEjaculatory duct and seminal vesicleAppendix vesiculosa Duct of epoophoron Duct of GartnerUreter, pelvis, calices, and collecting tubulesParamesonephric duct (Mullerian duct)Appendix of testisHydatid (of Morgagni)Uterine tubeUterusUpper VaginaUrogenital sinusUrinary bladderUrethra (except glandular portion)Prostatic utricleProstate glandBulboureth rod glandsUrinary bladder UrethraLower Vagina (from sinovaginal bulb)Urethral and paraurethral glandsGreater vestibular glandsVestibule of vaginaMullerian tubercleSeminal colliculusHymenGenital tuberclePenisGians penisCorpora cavernosa penisCorpus spongiosumClitorisGians clitoridisCorpora cavernosa clitoridisBulb of the vestibuleUrogenital foldsVentral aspect of penisLabia minoraLabioscrotal swellingsScrotumLabia majora
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Ans. is 'd' i.e., Hypertonia Features of neonatal hypothyroidismo Neonate is normal at birth due to presence of maternal thyroid hormones.o First clinical sign is prolongation of physiological jaundice due to delayed maturation of glucuronide conjugation.Other features are:-o Open posterior fontanel and wide sutureso Large tongue - Can cause respiratory difficultieso Rough dry skin which is cool & mottledo Hypotonia, large abdomen, flaccid muscleso Sleepy, little cry, poor feed & chocking spells during feeding.o Short neck with thick supraclavicular pad of fat may be present.o Marked physical & mental retardation, delayed social smile.o Short stature, normal head size with short extremities.o Short stature is disproportionate (upper segment > lowersegment).o Delayed relaxation of deep tendon reflexes.o Edematous, characteristic facieso Constipationo Pallor, hypothermiao Delayed pubertyo Refractory anaemia commono Slow pulse, cardiomegaly & Heart murmur.o Delayed dentition.o Open mouth with protuberant tongueo Delayed bone growth (Bone age < chronological age).
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Ref-KDT 6/e p758 Newer liposomal preparations of amphotericin B have the following features: Less chances of nephrotoxicity and infusion related reactions Lesser uptake in the tissues like kidney More expensive Similar in efficacy and antifungal spectrum as conventional preparations
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Amyloidosis is the extracellular deposition of insoluble protein fibrils.
AL- Primary systemic amyloidosis
AA- Secondary amyloidosis
AF- Familial
Aβ2M- In ESRD
Diagnosed by abdominal fat pad aspiration showing apple green birefringence by polarized light microscopy with Congo red stain
High ESR, High ALP
Serum Immunofixation electrophoresis (SIFE), UIFE-sensitive to detect light chains (Lamda more common)
Kidneys- most common involved. Nephrotic range proteinuria, azotemia seen Heart- second common organ; restrictive cardiomyopathy, low voltage complexes in ECG, sparkly appearance on ECHO heart
Peripheral sensory neuropathy, carpal tunnel syndrome
Large tongue, raccoon-eye sign-Factor X deficiency^ bleeding)
Treatment- AL- Melphalan. dexamethasone, lenalidomide & bortezomib;
HDM/SCT- Autologous stem cell transplantation after high-dose melphalan
High BNP. pro-BNP, troponin T & I in cardiac involvement, used for prognosis too.
AA Amyloidosis: secondary to chronic infections - tuberculosis, SABE or inflammatory conditions like RA, IBD, Castleman's disease
Treat the primary disease, TNF & IL -1 antagonist.
The new drug - Eprodisate for renal AA
AF Amyloidosis: AD, mutant TTR (transthyretin/prealbumin)
° Peripheral & autonomic neuropathy
° Cardiac conduction defects
• Aβ2M/ Amyloidosis: associated with ESRD. on hemodialysis
Carpal tunnel syndrome, joint effusions, cystic bone lesions
Decreases with stopping dialysis
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A concept that may be used to reduce shrinkage stress is the use of “soft-start” polymerization. This approach utilizes a number of procedures to prolong the gel phase of the setting reaction of the composite resin material. The theory is that the longer the setting composite can maintain a gel or flowable condition, the better it can distribute the stresses resulting from shrinking. Procedures to do this include the use of ramped lights, pulse curing, or simply holding the curing light some distance from the material for the initial exposure.
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Dupuytren's contracture (contracture of palmar aponeurosis)a. It is characterized by flexion deformity of one or more fingers due to the thickening and shoening of the palmerb. aponeurosis.c. Etiology:i. Unknownii. Hereditary predispositioniii. Cirrhosis of liveriv. Epileptic patients on phenytoind. The fingers are drawn in flexion at MCP and PIP joints.e. The ring finger is most commonly affected.f. The contracture is usually limited to the medial three fingers.g. Peyronie's disease and planter fascia thickening are also known associations.h. An elderly with mild contracture does not need any Rx.i. If the deformity is severe and hampers routine activity, subtotal excision of palmar aponeurosis may be required.j. Evidence also points to heredity as a predisposing factor in Dupuytren&;s disease. The lesion seems to occur earlier and more frequently in some families, and James suggested an autosomal dominant pattern. Vascular insufficiency and cigarette smoking have been linked to Dupuytren disease as possible causative factors .
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Ans. is 'c' i.e., Right renal vein shorter than left renal vein Renal vasculatureo Each kidney is supplied by renal artery {branch of abdominal aorta) and is drained by renal vein to IVC.o Renal artery Right renal artery is longer and passes behind JVC. Renal artery divides into : -Posterior division Supplies posterior segment.Anterior division Divides further into 4 branches to supply apical, upper anterior middle anterior and lower segments.o Renal vein Left renal vein is longer and passes in front of abdominal aorta, behind the origin of superior mesenteric artery. Therefore, it may be compressed in the narrow angle between the two arteries. Left renal vein also receives left inferior phrenic vein, left gonadal vein and left suprarenal (adrenal) vein. Each renal vein begins beneath the true capsule as stellate vein.
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The single most impoant prognostic factor is lymph node status:5-year survival without groin node metastases is greater than 90%; with groin node metastases, 5-year survival is 50%. Inguino-femoral lymph nodes are involved in stage iii whereas pelvic and other lymph nodes are involved in stage iv A and hence pelvic lymph nodes will have poorer prognosis
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Acrodermatitis enteropathica is an autosomal recessive disorder postulated to occur as a result of mutations in the SLC39A4 gene located on band 8q24.3. The SLC39A4 gene encodes a transmembrane protein that is pa of the zinc/iron-regulated transpoer-like protein (ZIP) family required for zinc uptake. This protein is highly expressed in the enterocytes in the duodenum and jejunum; therefore, affected individuals have a decreased ability to absorb zinc from dietary sources. Absence of a binding ligand needed to transpo zinc may fuher contribute to zinc malabsorption. Ref: Medscape
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Answer is A (Suprapubic aspiration) Urine obtained from suprapubic aspiration is least likely to be contaminated- Suprapubic aspiration avoids potential contamination but is rarely used because of its invasiveness It may be indicated in children2 (and selected other patients) Desirable propeies of a voided sample It is best to collect a clean voided mid stream urine sample (First 15-30 ml are discarded and the next 50- 100 ml are collected) The midstream clean catch method reduces the likelihood of contamination with meatal or urethral secretions Freshly voided specimen should be tested (Within one hour of voiding) Urine specimen should not be collected immediately after the patient has eaten (Should be obtained a few hours after the patient has eaten) First voided morning specimen should be obtained for qualitative protein testing (Patients with possible ohostatic proteinuria) and for specific gravity testing.
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Ans. is 'd' i.e., >100 Familial adenomatous polyposis* This autosomal dominantly inherited condition is characterized by the development of multiple rectal and colonic adenomas around puberty.* It is due to mutation of the adenomatous polyposis coli (APC) gene, allowing genetic testing in the 75 percent of families in which a mutation can be identified.* A colonoscopy and biopsy will confirm the diagnosis.* FAP is defined clinically by the presence of more than 100 colorectal adenomas.* As this condition is premalignant, a total colectomy must be performed; often, the rectum can be preserved, but regular flexible endoscopy and removal of polyps before they develop carcinoma are required.* The operation of restorative proctocolectomy with ileal pouch- anal anastomosis is an alternative if proctectomy is required: the rectum is replaced by a 'pouch* of folded ileum.* A pan-proctocolectomy with permanent ileostomy is necessary in some instances, especially when patient follow up may be impractical.
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Massive hemoptysis is generally defined as expectoration of over 600 mL of blood within a 24hour period. It is a medical emergency associated with a moality rate of 30 to 50%. Ref: Harrison; 20th edition pg 233
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A i.e. DNAHereditary information is preserved in DNA. Thus all genetic diseases are due to change in DNAQ.
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McMohan and Pugh
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* All the symptoms of hypoglycemia are blocked by beta blockers except sweating as it has cholinergic innervation * Beta blockers (non selective) are contraindicated in : ABSOLUTE C/I Pheochromocytoma Decompensated hea failure symptomatic bradycardia AV block Asthma RELATIVE C/I Peripheral vascular disease
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b. Pronator quadratus is attached to the radius and ulna and lies against the anterior surfaces of these bones. Explanationsa. The median nerve is found on the deep surface of flexor digitorum superficialis muscle, to which it is usually bound with fascia. c. The Ulnar nerve lies under flexor carpi ulnaris with the ulnar aery on its lateral side. d. The anterior interosseous nerve is the branch of the median nerve which supplies the deep flexor muscles: the lateral two tendons of flexor digitorum profundus, pronator quadratus and flexor pollicis longus.
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The aim of active immunisation with tetanus toxoid is to vaccinate the entire community and ensure a protective level of antitoxin approximately 0.01 IU/ml serum throughout life Reference; Park&;s Textbook of preventive and social medicine, 24th edition.Pg no. 330
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- Given patient has increased coisol & ACTH levels with cushingoid signs & symptoms. - This could result from either functional ACTH-secreting tumor in pituitary (Cushing's disease) or an ectopic tumor (such as a small cell carcinoma of lung, choice B). - To distinguish b/w these two,high doses of potent synthetic glucocoicoid(dexamethasone) is administered High-dose dexamethasone suppresses ACTH secretion at least by 50% in Cushing's disease Whereas secretion from ectopic tumor is not suppressed by dexamethasone. - As 75% suppression of coisol levels is seen in this pt, diagnosis is cushing's disease. OTHER OPTIONS: Addison's disease (choice A) is primary adrenal insufficiency, with increased plasma ACTH (producing hyperpigmentation) & decreased plasma coisol, aldosterone levels compared to normal. Conn's syndrome (choice C) results from hypersecretion of aldosterone by adrenal coex resulting in decreased ACTH production.
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human mitochondrial DNA is a double-stranded circular molecule containing approximately 16,500 base pairs.(REF: GANONG'S REVIEW OF MEDICAL PHYSIOLOGY 23rd EDITION page no.34.)
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A barbiturate is a drug that acts as a central nervous system depressant, and can therefore produce a wide range of effects, from mild sedation to death . The kinetics of barbiturate elimination are mixed: first order at low concentrations and zero order at high ones Ref-6/e p31
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PYRIFORM FOSSA:
It is a deep recess broad above and narrow below in the anterior part of lateral wall of the laryngopharynx, on each side of the laryngeal inlet.
These recesses are produced due to bulging of larynx into laryngopharynx.
Boundaries:
Medial: Aryepiglottic fold and quadrangular membrane of larynx.
Lateral: Mucous membrane covering the medial surface of the lamina of thyroid cartilage and thyrohyoid membrane.
The internal laryngeal nerve and superior laryngeal vessels pierce the thyrohyoid membrane and traverse underneath the mucous membrane of the floor of the fossa to reach the medial wall.
Above: Piriform fossa is separated from epiglottic vallecula by lateral glossoepiglottic fold.
Key Concept:
Internal laryngeal nerve is the nerve related to pyriform fossa.
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Chlorthiazide is a thiazide diuretic which can lead to hyper uricema, as Thiazide diuretics competitively inhibit excretion of uric acid.
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Characteristics includelarge, soft, friable, easily detached vegetations consisting of fibrin and intermeshed inflammatory cells and bacteria. Complications may includeulceration, often with perforation, of the valve cusps or rupture of one of the chordae tendineae. 2. Classification Acute endocarditis is caused by pathogens, such as Staphylococcus aureus (50% of cases). This type of endocarditis is often secondary to infection occurring elsewhere in the body. Subacute (bacterial) endocarditis is caused by less virulent organisms, such as Streptococcus viridans (more than 50% of cases). This type of endocarditis tends to occur in patients with congenital hea disease or preexisting valvular hea disease, often of rheumatic origin. 3. Clinical features a. Valvular involvement The mitral valve is most frequently involved. The mitral valve along with the aoic valve is involved in about 40% of cases. The tricuspid valve is involved in more than 50% of cases of endocarditis of intravenous drug users, in whom endocarditis is most often caused by staphylococcal infection. b. Complications Distal embolization occurs when vegetations fragment. Embolization can occur almost anywhere in the body and can result in septic infarcts in the brain or in other organs. The renal glomeruli may be the site of focal glomerulonephritis (focal necrotizing glomerulitis) caused by immune complex disease or by septic emboli.
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Ans. is 'c' i.e., Highly selective vagotomy It is least seen with highly selective vagotomy because the motility of the stomach is least affected in highly selective vagotomy and is most common with gastrectomy.
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Ans. Avulsion
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Ref: KV Krishna Das - Clinical Medicine 4th Edition pg no:175-176 Right sided hea failure is accompanied by systemic venous congestion and peripheral edema, whereas left sided hea failure is accompanied by pulmonary venous congestion and pulmonary edema. Dependent edema, paicularly prominent towards evening is a characteristic symptom of congestive cardiac failure. The sequence of events is: rise in jugular venous pressure, enlargement and tenderness of the liver, and dependent edema. As the condition progresses, symmetric dependent edema sets in. This is preceded by weight gain of 3 to 4 kg due to water retention. Though the edema is predominantly over the dependent pas, with worsening of the condition, the edema may extend to the thighs, abdominal wall and face, paicularly in children. Ascites may also develop. Similar distribution of edema can occur in cirrhosis of liver, but in cirrhosis, ascites is more prominent than peripheral edema. In chronic right sided hea disease such as tricuspid incompetence, constrictive pericarditis and right ventricular endomyocardialfibrosis, chronic venous congestion of the liver leads to cardiac cirrhosis. In these conditions ascites tends to be more prominent than peripheral edema
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Osmotic pressure is determined by the number of molecules dissolved in a fluid rather than by the mass of these molecules. Therefore, when corrected for number of molecules rather than mass, the following chart gives both the relative mass concentrations (g/dl) of the different types of proteins in normal plasma and their respective contributions to the total plasma colloid osmotic pressure (Πp).
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* IV KCl - Never given as bolus as it can cause Diastolic arrest. * Always given diluted and advised to give diluted in saline.
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Ans. is 'd' i.e., Pentothenic acid VitaminActive form (coenzymes)Reaction typeB1 (Thiamin)Thiamine pyrophosphate (TPP)Oxidative decarboxylation, TransketolationB2 (Riboflavin)FMN, FADOxidation / Reduction (Redox reaction)B3 (Niacin)NAD+, NADP+Oxidation / Reduction (Redox reaction)B6 (Pyridoxin)Pyridoxal phosphate (PLP)Transamination, deamination, decarboxylation, condensation, trans-sulfurationB12 (cobolamin)Methylcobalamin. deoxyadenosy Icoba lam inIsomerization of meihylmelonyl-CoA to succinyl-CoA, synthesis of methionine from homocysteineFolic acidTetrahydrofolate (THF)One carbon group transferBiotinBiocytinCarboxylationPantothenic acidPentothenate in Co A and ACPAcyl group transferVitamin KVitamin KCarboxylation of glutamic acid residue
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Carbamoyl phosphate synthase 1 conve CO2 + NH4 to Carvomyl phosphate Ref-Harpers illustrated biochemistry 30/e p680
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In contrast in Adrenal insufficiency weight loss occurs Ref - Davidson's medicine 23e p672 , ( Harrison 17 pg 2263)
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Under resting conditions, the concentrations of sodium and chloride ions in the saliva are only about 15 mEq/L each, about one-seventh to one-tenth their concentrations in plasma. Conversely, the concentration of potassium ions is about 30 mEq/L, seven times as great as in plasma, and the concentration of bicarbonate ions is 50 to 70 mEq/L, about two to three times that of plasma.
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Cerebellar astrocytomas donot show any clear gender predilection and are equally common in both males and females. Cerebellar Astrocytomas MC astrocytomas in childhood are low grade astrocytomas Juvenile pilocytic Astrocytoma (JPA) is MC astrocytoma in children Cerebellar Astrocytoma (JPA) donot show any clear gender predilection Cerebellar astrocytoma (JPA) most commonly develop during first two decades of life Cerebellar astrocytoma surgical resection the overall survival for JPA approaches 80-100% Ref: Nelsons 20th edition Pgno: 2455
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Leprosy: Oldest disease known. Caused by Mycobacterium leprae. Mode of transmission: Air droplets, skin contact, transplacental, breast feeding, insect bite, tattoo, corneal/organ transplantation. Mycobacterium leprae has no aificial culture media. Leprae bacilli are cultured by: Foot pad of mice. 9-banded armadillo. Other options: Bordet gengou medium: Bordetella Peussis. LJ medium: Mycobacterium Tuberculosis. Loeffler's serum slope: Corynebacterium Diphtheria.
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Ans. is 'b' i.e., Increased breath sounds Physical examination findings of Common pulmonary conditions Pleural effusionPneumoniaEndobronchial tumorPneumothoraxTracheal positionChest wall movementFremitusPercussionBreath soundsCracklesWheezeShifted or midtineReduced or normalDecreasedDullDecreasedNoneNoneMidlineReduced or normalIncreasedDullIncreasedNoneNoneShifted or midi ineReduced or normalNormal or decreased Normal or DullNormal or DecreasedNonePossibleShifted or midlineReducedNoneHyperresonantDecreased/absentNoneNoneEgophonyBand above effusion (skodiac)PresentNoneNoneTracheal positionDeviated Away fromo Pneumo thoraxo EffusionDeviated towardso Collapseo ConsolidationTactile vocal fremituso Tactile vocal fremitus is vibration felt on the patients chest during low frequency vocalisation,o Commonly the patient is asked to repeat a phrase while the examiner feels for vibtations by placing a hand over the patient chest or back.o Tactile fremitus is normally more intense in the right second intercostal space as well as in the interscapular region as these:Tactile fremituso In creased-Consolidationo Decreased or absent-Pleural effusion or Pneumothorax o Reason for increased fremitus in a consolidated lung is the fact that the sound waves are transmitted with less decay in solid or fluid medium (consolidation) than in a gaseous medium (consolidation) than in a gaseous medium (aerated lung). Conversely the reason for decreased fremitus in a pleural effusion or pneumothorax (or any pathology separating the lung tissue itself from the body wall) is that this increased space diminishes or prevents entirely sound transmissiono Egophony is a change in timbre (EO to A) but not pitch or volume.o It is due to decrease in the amplitude and an increase in the frequency of the second formant produced by solid (including compressed lung) interposed between the resonator and the stethoscope head,o The sound of a spoken "E " change to "A " over an area of consolidation. The spoken "E " is beared as "A " when listening over the consolidation because the frequencies of the vibrations are altered by the consolidation. Egophony or "E" to ".A " changes may also occur in small band like area just above a pleural effusion because of compression of lung tissue that occurs just above the effusion.
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D. i.e. Temerature
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ECG changes- flattened T wave, a depressed ST segment & appearance of a U wave- seen in Hypokalemia
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FMA and its relationship with IMPA:
Tweed observed that patients whose FMA was more than 30 degrees demonstrate nature’s way of compensating for inclination of the mandibular incisors to the mandibular plane. The IMPA was found to be as little as 77 degrees and the FMIA to be around 65 degrees. The occlusal plane converges towards the mandibular plane as a result of the excessive height of the mandibular incisors compared with molar height.
Ref: Orthodontics: Diagnosis and Management of Malocclusion and Dentofacial Deformities, 3e, Om P. Kharbanda pdf no 1001
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In most patients laryngomalacia is a self-limiting condition.
Treatment of laryngomalacia is reassurance to the parents and early antibiotic therapy for upper respiratory tract infections.
Tracheostomy is required only in severe respiratory obstruction.
Surgical intervention (supraglottoplasty i.e. reduction of redundant laryngeal mucosa) is indicated for 10% of patients. Main indications for surgery are:
Severe stridor
Apnea
Failure to thrive
Pulmonary hypertension
Cor pulmonale.
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Usage of GnRH agonists : Pulsatile GnRH agonist Non pulsatile (continuous) GnRH agonist Delayed pubey Ovulation induction Kallmann's syndrome Male infeility Endometriosis Hirsutism Uterine fibroids Central precocious pubey Prostate cancer Breast and ovarian cancer Note : Non-pulsatile administration of GnRH agonist is not useful in male infeility.
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Ans. is 'a' i.e., AEC inhibitors o ACE inhibitors are now drug of choice for initial management of hea failure.o Loop diuretics (furosemide) are the DOC for acute hea faiure.o Though the ACE inhibitors are the DOC for chronic HE, diuretics are given to almost all the patient initially to relieve congestive symptoms.
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B i.e. Atracurium besylate
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Ans. D. Phencyclidine (PCP)Abused drug - Synonym/manifestation* Methylenedioxymethamphetamine. MDMA: Rave drug/Ecstasy.* LYSERGIC ACID DIETHYLAMIDE (LSD): "bad trip"* Methamphetamine: Also called "meth," "speed," "crank," "chalk," "ice," "glass," or "crystal."* Phencyclidine (PCP): "Angel dust"* MARIJUANA (CANNABIS): Delta-9-tetrahydrocannabinol (THC); "Hash oil"
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Pseudo-koebner's phenomenon is seen in plane wart, molluscum contagiosum and eczematous lesions.
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Primary supports of Uterus
- Muscular support
Pelvic diaphragm (Levator ani), urogenital diaphragm, perineal body.
- Mechanical support
Uterine axis, pubocervical ligament, Mackenrodt ligament, uterosacral ligament, round ligament of the uterus.
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Ans. is 'd' i.e., Humidity Instruments MeasureSling psychrometer} Assmann psychrometerHumidityDry & wet bulb hygrometer Kata thermameter-Cooling power and air velocityGlobe thermameter-Radiant tempratureAnemometer-Air velocityWind vane-Wind (air) directionSound level meter-Intensity of soundBond frequency analyzer-Characteristic (pitch) of sound
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Ans. C. Oral contraceptivea. The given USG suggests molar pregnancy as it is showing snowstorm appearance.b. IUCD/POP can cause irregular bleeding/spotting.c. Barrier methods have high failure rates.d. OCP are ideal for post molar contraception.
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Band of baillarger is horizontally running myelinated nerve fibers present in cerebral cortex, due to which visual cortex is referred to as striate cortex. Outer band is present in inner granular layer (layer no-4), and inner band is present in inner pyramidal layer (layer no-5)
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CoA biosynthesis requires cysteine, pantothenate (vitamin B5), and adenosine triphosphate (ATP).it is naturally synthesized from pantothenate (vitamin B5), which is found in food such as meat, vegetables, cereal grains, legumes, eggs, and milk.Pantothenate (vitamin B5) is phosphorylated to 4'-phosphopantothenate by the enzyme pantothenate kinase (PanK; CoaA; CoaX). This is the committed step in CoA biosynthesis and requires ATP.A cysteine is added to 4'-phosphopantothenate by the enzyme phosphopantothenoylcysteine synthetase (PPCS; CoaB) to form 4'-phospho-N-pantothenoylcysteine (PPC). This step is coupled with ATP hydrolysis.PPC is decarboxylated to 4'-phosphopantetheine by phosphopantothenoylcysteine decarboxylase (PPC-DC; CoaC)4'-phosphopantetheine is adenylylated (or more properly, AMPylated) to form dephospho-CoA by the enzyme phosphopantetheine adenylyl transferase (PPAT; CoaD)Finally, dephospho-CoA is phosphorylated to coenzyme A by the enzyme dephosphocoenzyme A kinase (DPCK; CoaE). This final step requires ATP.
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Fever on post-operative day 3 after laparoscopic splenectomy suggests left lower lobe consolidation. Left lower lobe atelectasis Most common complication after Open Surgery; Pleural effusion and pneumonia also can occur. Hemorrhage can occur intra-operatively or postoperatively, presenting as subphrenic hematoma. Transfusions have become less common since the advent of Laparoscopic Surgery, although the indication for operation influences the likelihood of transfusion as well. Subphrenic abscess and wound infection are among the perioperative infectious complications.
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It is a dominantly inherited dystrophy of endothelium and Descemet's membrane. It is characterised by lesions with variable appearance, such as vesicles, curvilinear lines or geographical opacities at the level of Descemet's membrane. The condition is very slowly progressive and thus usually asymptomatic. Corneal oedema sometimes may occur, requiring keratoplasty. Rarely it may be complicated by secondary glaucoma.Reference:Comprehensive ophthalmology,AK Khurana,4th edition,page no.119
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Faecal occult blood testing of people aged 60-69 years, followed by colonoscopy in those who test positive. A guaiac-based test is used, which detects peroxidase-like activity of faecal haematin. Studies have suggested a 15-20% reduction in colorectal cancer-specific moality in the screened population. Flexible sigmoidoscopy can also be used as the initial screening tool, with a similar reduction in colorectal cancer-specific moality.In FAP rectosigmoidoscopy is staed at 10- 12 years. In HNPCC colonoscopy is staed at 20-25 years.Ref: Bailey and love, page: 1262
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Unlike the low solubility products of purine catabolism, catabolism of the pyrimidines forms highly water-soluble products-- CO2, NH3, b-alanine, and b-aminoisobutyrate (Figure 33-12). Humans transaminate b-aminoisobutyrate to methylmalonate semialdehyde, which then forms succinyl-CoA (see Figure 19-2). Excretion of b-aminoisobutyrate increases in leukemia and severe x-ray radiation exposure due to increased destruction of DNA. However, many persons of Chinese or Japanese ancestry routinely excrete b-aminoisobutyrate.Ref: Harpers Illustrated Biochemistry, 30th edition, page no: 355
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Autoclave: Recommended condition- 121–124°C temperature for 15 min at 1.1 bar pressure
Alternate: 134–138°C temperature for 3 min at 2.2 bar pressure
Hot air oven: 160°C temperature for 120 min or 180°C temperature for 30 min
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cAMP undergoes rapid hydrolysis catalysed by the enzyme phosphodiesterase, to 5'AMP which is inactive. Caffeine and theophylline can inhibit phosphodiesterase and increase the intracellular levels of cAMP.
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Ringer lactate is preferred agent for resuscitation for the initial 24 hours Nasogastric intubation is done to decrease the risk of emesis and possible aspiration (as paralytic ileus develops in the patients of burn) Dextran is a colloid and can be used after 24 hours however, albumin is the preferred and most widely used colloid Ref: Sabiston 20th edition Pgno :514
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Ans. is 'b' i.e., Women in reproductive age group in a given year
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Linezolid is Oxazolidinone. MOA: It inhibits protein synthesis by preventing formation of the ribosome complex that initiates protein synthesis by binding to 23S ribosomal RNA of the 50S subunit. It is active against Gram positive organisms including Staphylococci, Streptococci, Enterococci, Gram positive Anaerobic cocci and Gram positive bacilli such as Corynebacteria, Nocardia sp. and L.monocytogenes. It is primarily a Bacteriostatic agent but is Bactericidal against Streptococci. It is also active against Mycobacterium Tuberculosis. Thrombocytopenia is the most common complication seen with its chronic use , also Optic and Peripheral Neuropathy and Lactic acidosis can occur (due to inhibition of mitochondrial protein synthesis). Anemia and Neutropenia can also occur .
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Ovarian cycles consists of the following : recruitment and growth of the follicles, ovulation, corpus luteum formation and finally regression of corpus luteum. Along with changes in the ovary there are simultaneous changes in the uterus - the menstrual cycle. Endometrial sampling revealing proliferative or secretory endometrium will tell whether ovulation has occured or not. Similarly the hormones FSH, LH, estradiol and progesterone will also correlate with the phase of ovarian cycles. Vaginal cytology and calculating the maturation index will tell us the phase of the ovarian and menstrual cycle. Estrous cycle does not occur in humans.
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Ref-Katzung 11/e p952 Anthracyclines (daunorubicin, doxorubicin, epirubicin and idarubicin)can cause severe cardiotoxicity manifesting as dialted Cardiomyopathy and arrhythmias. The anthracycline chemotherapeutic agents (doxorubicin, daunorubicin, epirubicin and idarubicin) form free radicals in the myocardium. Their most severe side effect is a cumulative doserelated dilated cardiomyopathy. It presents with symptoms of left and right ventricular CHF.
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Ans. is `d' i.e., All
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Ans. Consists of lymphocytes, plasma cells, epitheloid and giant cells
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