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A high incidence of colorectal cancer is seen in economically prosperous, upper socioeconomic class. This observation led to attention on environmental factors, particularly diet in the etiology of colon cancer.
Dietary factors associated with colon cancers are:
Animal fat
diet high in animal fats such as found in red meat (beef pork, lamb) and processed meat (Sausages, hams & bacan etc.) increases the risk of colon cancer.
A diet high in saturated or polyunsaturated fats increases risk of colorectal cancer, while a diet high in oleic acid (olive oil, coconut oil, fish oil) does not increase risk.
consumption of fish (including fresh, canned, salted and smoked fish decrease the risk of colon cancer. This is because of the anti-cancer activity of omega-3 fatty acids found in fishes.
note that consumption of chicken has no effect on colon cancer.
Fibres
though Harrison writes that dietary fibres play no role in colon cancer, all other books i.e. Schwartz, CSDT & Maingot's are of the view that a high fibre diet has protective effect and a low fibre diet increases the risk.
Alcohol - is also a risk factor
Ingestion of calcium, selenium, vitamin A, C & E, carotenoids, and plant phenols decrease the risk of colon cancer.
Insulin resistance
a high calorie diet coupled with physical inactivity leads to excess weight gain and insulin resistance which further causes increased levels of insulin and insulin-like growth factors type I (IGF-I). This growth factor appears to stimulate proliferation of intestinal mucosa
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Ans. Centre of the lens
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Epispadias is present, not the hypospadias in Ectopia vesicae. Umbilical hernia, Visible ureterovesical efflux and Waddling gate are seen in Ectopia vesicae. Clinical Features Posterior wall of the bladder protrudes through the defect with mucosal edges fused with skin and urine spus onto the abdominal wall from the ureteral orifices. Rectus muscles which are Inseed on the public rami are also widely separated An umbilical hernia though usually small Is present along with extrophlc bladder. In males, complete epispadias with a wide & shallow scrotum. Undescended testis & Inguinal hernias are common. Females also have epispadias with bifid clitoris and wide separation of the labia. Anus is dislocated anteriorly in both sexes and there may be rectal prolapse. Ectopia vesicae increases the risk of Adenocarcinoma of bladder.
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Platelet aggregation is often a determining factor in heart attacks. Thromboxane A2 , produced by platelets, promotes platelet aggregation when clotting is required, and inhibition of thromboxane A2 synthesis by aspirin reduces the potential for inappropriate clot formation, and further heart attacks. Thromboxane A2 is produced from arachidonic acid by the action of COX, the enzyme covalently modified and irreversibly inhibited by aspirin. Leukotrienes are also synthesized from arachidonic acid, but utilize lipoxygenase in their synthesis, which is not inhibited by aspirin. Cholesterol, triglyceride, and cytokine synthesis do not require COX activity.
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The net protein utilization, or NPU, is the ratio of amino acid conveed to proteins to the ratio of amino acids supplied. It may be affected by the salvage of essential amino acids within the body, but is profoundly affected by the level of limiting amino acids within a foodstuff.This value can be determined by determining dietary protein intake and then measuring nitrogen excretion. One formula for NPU is:NPU = ((0.16 x (24 hour protein intake in grams)) - ((24 hour urinary urea nitrogen) + 2) - (0.1 x (ideal body weight in kilograms))) / (0.16 x (24 hour protein intake in grams))As a value, NPU can range from 1 to 0, with a value of 1 indicating 100% utilization of dietary nitrogen as protein and a value of 0 an indication that none of the nitrogen supplied was conveed to protein.
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Torsion is most commonly seen in adult age group
On elevation of testis pain increases.
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Ganglion cells
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Purposeless involuntary facial and limb movements, constant chewing and puffing of checks suggest the diagnosis of tardive dyskinesia (an extrapyramidal side effect of antipsychotics).
Clozapine does not produce extrapyramidal side effects.
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Answer is B (Testicular Atrophy) Testicular Atrophy is not documented as a feature of Wilson's disease. Hemolytic Anemia, Chorea and Chronic active hepatitis are documented manifestations of Wilson's disease. Hemolytic Anemia is a feature of Wilson disease Hemolytic Anemia may occur in severe hepatic failure because large amounts of copper derived from Hepatocellular damage are released into the blood stream. . The association of hemolvsis and liver disease makes Wilson's a likely diagnosis '- Harrison Chorea is a feature of Wilson's disease Chorea is an established Neurological manifestation of wilson's disease Chronic Active hepatitis is a feature of Wilson's disease Wilson's disease may present as fatty change, acute hepatitis, chronic active hepatitis, cirrhosis or massive hepatic necrosis.
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Ans. is 'a' ie Insulinoma Whipple's triad includesSign and symptoms of hypoglycemiaSerum levels of less than 40 mg/ dl of glucose during the attackby prompt relief of symptoms after glucose administration.Whipple's triad is seen in - InsulinomaInsulinomasare endocrine tumors of the pancreas thought to be derived from b cells that secrets insulin.Insulinomas are generally small* (>90% are <2 cm in diameter), usually solitary tumor.Only 5 to 15% are malignant.they are distributed equally in head, body & tail of pancreas*
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Ans. Extra-amniotic ethacrydine lactate
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Ans is 'a' i.e., Left Anterior descending artery o The most common site of myocardial infarction us anterior wall of left ventricle and the most common artery involved is anterior wall of left ventricle located near apex.Myocardial infarctionCommonUncommonRareo Left anterior descendingo Left main coronary artery.o Penetratingartery (40%-5O%)Secondary branchesInframyocardial branchesIt is branch of left coronary# Diagnol branches of LAD.of coronary arteries,artery and affects.# Marginal branches # Anterior wall of i.v. near apex. # Anterior portion of ventricular system. o Right coronary Artery (30-40%) # Inferior posterior wall of i.v. # Posterior portion of ventricular septum. # Infetrior/posterior right ventricular free wall. o Left circumflex (15-20%) # Lateral wall of left ventricle except the apex.
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Ans. is 'a' i.e., Covalent bond Defective protein is first covalently attached to ubiquitin.Covalent bond is formed between glycine (a-carboxyl group) of ubiquitin and lysine (amino group) of target protein.Ubiquitinated protein is then degraded in proteosomes by ATP dependent (energy dependent) mechanism. Proteins are degraded by proteolytic enzymes which is energy independent (non-energy dependent).
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Ans. is 'd' i.e., Health care workers In health care workers there is small but definite risk
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Ans. (b) Ductus venosusRef: D.C. Dutta 8th ed. / 36; William's Obstetrics 23rded, Ch: 4* Ductus venosus carries oxygenated blood from placenta and drains into IVC.* Ductus arteriosus is a connection between aorta and pulmonary arteries, thereby bypassing lung. Persistence of ductus arteriosus leads to a congenital heart condition called Patent Ductus Arteriosus.* Foramen ovale is connection between right atrium and left atrium.* Umbilical artery carries deoxygenated blood from fetus to mother.Also KnowImportant vessles and their remnantsDUCTUSVENOSUSLigamentum VenosumDUCTUS ARTERIOSUSLigamentum arteriousmUmbilical ArteriesMedial umbilical arteryLeft umbilical veinLigamentum Teres of Liver
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Ans. d. (Hepatitis E) (Ref. Ananthanarayan-6th ed., 519)# A unique feature of Hepatitis E virus is the clinical severity and high case fatality rate of 2(M0% in pregnant women, especially in the last trimester of pregnancy.eHEPATITIS E# A distinct type of waterborne "non-A, non-B" hepatitis has been identified in India, Asia, Africa, and Central America (previously labelled epidemic or enterically transmitted non-A, non-B hepatitis), classified as hepatitis E virus (HEV).# Hepatitis E is enterically transmitted non-A non-B Hepatitis.# Hepatitis E is a 32- to 34-nm, nonenveloped, HAV-like virus with a 7600-nucleotide, single-stranded RNA genome.# The infection caused by hepatitis E is essentially water-borne disease- Water or Food supplies, contaminated with feces in which the virus is excreted, have been implicated in all major outbreak. Hepatitis AHepatitis BHepatitis CHepatitis DHepatitis ENucleic acidRNA (picornavirus)DNA (Hepadna)RNA (Flavivirus)RNARNA (Calcivirus)Characteristics# 50% seroposi- tivity in people >50# Worldwide carrier rate 300 million# 1,50,000 new cases/year in U.S.# Replication defectiveFulminant hepatits 0.3-3%; 20% in pregnant women# Clinical disease: mild or asympto- matic; rare after childhood# 300,000 new infections/year in U.S.# Most important cause of transfusion related hepatitis# Dependent on HBV coinfection for multiplicationTransmission:# Fecal-oral raw shellfish (concen- trate virus)# Parental, close personal contact# Transfusion# Parenteral, close personal contactParenteral, close personal contactWaterborneYoung adults # Not shed in semen, aliva, urine# Shed in stool 2 weeks before onset of jaundice and 1 week after# Dialysis# Needle-sticks# IV-drug use# Male homosexual activity# Route of transmission undetermined in 40-50% of cases Incubation2-6 weeks4-6 weeks2-26 weeks4-7 weeks in superinfection2-8 weeksCarrier stateNone1% blood donors1%1-10% in drug addictsUnknownProgression to chronic hepatitisNone5-10% acute infections>50%<5% in coinfection* 80% superinfectionNoneIncreased risk of Hepatocellular CaNoYesYesYes, same as for BUnknown although not likelyViral antigen # HBsAg indicates current infection# HBsAg indicates infectiviity Also Know:* Most common cause of sporadic cases in adults is - Hepatitis E.* Most common cause of sporadic cases in children is - Hepatitis A.* Most common virus associated with transfusion-associated hepatitis is HCV.
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Ref-KDT 7/e p108 Pyridostigmine acts for 3 to 6 hours as compared to 0.5 to 2 hourshours dur of action of neostigmine. It is less impoant than neostigmine Rest of the propeies are similar to neostigmine
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Ans. b. Point mutation (Ref: Ghai 7/e p310-312; Harper's 27/e p368-371)An afroamerican kid of 6 years of age presented with abdominal pain, chronic hemolysis and abnormal RBC shape on peripheral smear. This patient is suffering from sickle cell anemia. Most likely disorder responsible for this condition point mutation.'Sickle cell anemia is an autosomal recessive disease that results from the substitution of valine from glutamic acid at position 6 of the beta-globin gene (Point mutation).'- Ghai 7/e p310Point mutations within coding sequences:A point mutation may alter the code in a triplet of bases and lead to the replacement of one amino acid by another in the gene product.An excellent example of this type is the sickle mutation affecting the b-globin chain of hemoglobinQ. Here the nucleotide triplet CTC for GAG in mRNA), which encodes glutamic acid, is changed to CAC (or GUG in mRNA), which encodes valine. This single amino acid substitution alters the physicochemical properties of hemoglobin, giving rise to sickle cell anemia.Sickle Cell DiseaseSickle cell disease is a common hereditary hemoglobinopathy that occurs primarily in individuals of African descentQ.Caused by a point mutation in the sixth codon of b-globin that leads to the replacement of a glutamate residue with a valine residueQ.In certain populations in Africa the prevalence of heterozygosity is as high as 30%. This high frequency probably stems from protection afforded by HbS against falciparum malariaQ.Pathogenesis:HbS molecules undergo polymerization when deoxygenated.Initially the red cell cytosol converts from a freely flowing liquid to a viscous gel as HbS aggregates form.With continued deoxygenation aggregated HbS molecules assemble into long needle-like fibers within red cells, producing a distorted sickle or holly-leaf shapeQ.Presence of HbS underlies the major pathologic manifestationsChronic hemolysisQMicrovascular occlusionsQTissue damageQMorphology:Peripheral blood demonstrates variable numbers of irreversibly sickled cells, reticulocytosis, and target cells, Howell-Jolly bodiesQ (small nuclear remnants).The bone marrow is hyperplastic as a result of a compensatory erythroid hyperplasiaQ.Expansion of the marrow leads to bone resorption and secondary new bone formation, resulting in prominent cheekbones and changes in the skull that resemble a crew-cut in X-raysQ.Increased breakdown of hemoglobin can cause pigment gallstones and hyperbilirubinemiaQ.Splenic infarction, fibrosis, and progressive shrinkage (autosplenectomy)Q.
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Immediately following mid - trimester aboion
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Ans. is 'a' Inj. Vitamin B1 .This chronic alcoholic patient is in altered sensorium due to Wernicke's encephalopathy.TreatmentWernicke's disease is a medical emergency and requires immediate administration of thiamine (i.v. or i.m.).Note: That glucose infusion may precipitate Wernicke's disease in a previously unaffected patient or cause a rapid worsening of an early form of the disease.For this reason thiamine should be administered to all alcoholic patients requiring parenteral glucose.
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A left tracheal deviation with an enlarged thyroid gland will most likely compress the left brachiocephalic vein. The other answer choices lie too far laterally to be affected by the tracheal deviation.
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Phase 2 (plateau), calcium channels open and fast potassium channels close.
A brief initial repolarization occurs and the action potential then plateaus as a result of:
(1) Increased calcium ion permeability.
(2) Decreased potassium ion permeability. The voltage-gated calcium ion channels open slowly during phases 1 and 0, and calcium enters the cell. Potassium channels then close, and the combination of decreased potassium ion efflux and increased calcium ion influx causes the action potential to plateau.
Key Concept:
Ca++and K+ channels remain open during plateau phase (phase 2) of AP. But Ca2+ initiates the plateau phase, as K+ channels are already open from phase 1. This Ca++ channel in phase 2 is also known as calcium-sodium channel.
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Gomez classification is based on weight retardation. In this system, the normal reference child is in the 50th centile of the Boston standard. It has a prognostic value for hospitalized children.REF.PARK'S TEXTBOOK OF PREVENTIVE AND SOCIAL MEDICINE.Editon-21.Page no-591
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Ans. C i.e. Timolol maleate Contraindications of Timolol maleate Bronchial asthma; A history of bronchial asthma; Severe chronic obstructive pulmonary disease Sinus bradycardia; Second or third degree atrioventricular block; Ove cardiac failure Cardiogenic shock; Hypersensitivity to any component of this product.
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Note :
Hyoglossal nerve passes lateral to internal and external carotic arteries.
Superior larngeal nerve passes medial to both arteries.
Glossopharyngeal and pharyneal branch of vagus pass between them.
The vagus lies most medial in the foramen.
Glossopharyngeal nerve and inferior petrosal sinus exit from the anterior compartment of the foramen.
Vagus and accessory nerves exit from the middle compartment.
The sigmoid sinus exits from the posterior compartment is soon joined by the inferior petrosal sinus becomes the internal jugular vein.
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About 95% of patients will develop musculoskeletal symptoms during the course of SLE. Arthralgias and myalgias predominate, but arthritis, hand deformities, myopathy, and avascular necrosis of bone also occur. About 85% of patients will have hematologic disease and 80% will have skin manifestations.
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Ans. A. Anencephaly Ref: DC Dutta's obstetric p408ExplanationIn the first half of pregnancy, the diagnosis of anencephaly is made by elevated alpha-fetoprotein in amniotic fluid and confirmed by sonography.Question not recalled properly: Imerslund-Grasbeck syndrome, its cause was asked.ExplanationCaused by low levels of vitamin B12 (also known as cobalamin).The characteristic features are# Megaloblastic anemia.# Proteinuria (-50% cases)# Normal kidney function.Typically begins in infancy or early childhood.Symptoms include:# An inability to grow and gain weight at the expected rate (failure to thrive),# Pale skin (pallor),# Excessive tiredness (fatigue), and# Recurring gastrointestinal or respiratory infections.# Other features include mild neurological problems, such as weak muscle tone (hypotonia), numbness or tingling in the hands or feet, movement problems, delayed development, or confusion.Mutations in the AMN or CUBN gene. The AMN gene provides instructions for making a protein called amnionless, and the CUBN gene provides instructions for making a protein called cubilin which are in turn responsible for uptake of Vit bl2 in body.Management is symptomatic.
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Hypertrophy:-
→ Increase in size and functions of cells.
→ Results due to increase in growth factor or trophic stimuli.
→ Includes puberty, lactating breasts and skeletal muscle fibers (in bodybuilders).
Hyperplasia:-
→ Increase in number of cells (in tissue) organ.
→ Results due to increase in growth factors, increased expression of growth-promoting genes and increased DNA synthesis.
→ It persists as long as stimulus is present.
Eg:- Breast development at puberty, endometrial hyperplasia, benign hyperplasia of prostate, hypertrophy of liver cells after partial hepatectomy.
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Cerebrohepatorenal syndrome or Zellweger's syndrome is characterised by abnormalities in the synthesis of bile acids and a marked reduction of plasmalogens. Long-chain fatty acids are accumulated in Zellweger's syndrome. It is a rare inherited absence of peroxisomes. It is due to mutations in genes encoding proteins called peroxins, involved in peroxisome biogenesis. Such individuals accumulate C26-C38 polyenoic acids in brain tissues and also exhibit a generalised loss of peroxisomal functions. It causes severe neurological symptoms and most patients die in first year of life. Treatment is often suppoive and symptom-based. Reference: Harper's Illustrated Biochemistry 31st edition Page nos 215
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Langerhans cells are dendritic cells (antigen-presenting immune cells) of the skin and mucosa, and contain large organelles called Birbeck granules. They are present in all layers of the epidermis except the stratum corneum, which protects against infections, and are most prominent in the stratum spinosum. Reff: Ananthanarayanan & Panikers textbook of microbiology 9th edition pg: 138
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Lymphatic spread of Cervical Cancer includes: Pelvic nodes Parametrial Obturator Internal iliac External iliac Common iliac Sacral Para aoic nodes Reference : Textbook of Gynaecology; Sheila balakrishnan; 2nd edition; Pg no: 258
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Intravesical chemotherapeutic agents are
Mitomycin C
BCG ( best)
Thiopeta
Epirubicin
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In Clean sharp guillotine amputations, Minimal local crush amputations, Avulsion amputation with minimal proximal distal vascular injury have the best outlook regarding survival and return of function after replantation. Crushed and avulsed vessels require debridement and the use of interpositional vein grafts and the outlook is less ceain.
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Cerebroside is a Glyolipid. It doesn't contain phosphate group.
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Most common finding of congenital Rubella is IUGR. Other manifestations are cataract, PDA, Pulmonary stenosis, sensorineural hearing loss meningoencephalitis, pneumonia, hepatitis, bone lucencies, thrombocytopenic purpura, anemia. Late sequelae include motor and mental retardation. Ref: Kliegman, Behrman, Jenson, Stanton, (2007), Chapter 244, "Rubella", In the book, "Nelson's Textbook of Pediatrics", Volume 1, 18th Edition, New Delhi, Page 1340
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B i.e. Congenital lobar emphysema Hyperansradiant (Radiolucent) lung on CXR is seen in EmphysemaQ - Pulmonary embolism - Pneumothorax - Polland's syndrome - Patient rotation - Macleod syndrome
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Ans. (a) H. influenzae stains known to produce Beta lactamase Approximately 20-35% of nontypable strains of hemophilus produce 13-lactamase. In addition to 0-lactamase alteration of penicillin binding proteins is a second mechanism of ampicillin resistance has been detected in isolates of H. influenzae.
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Pattern of calcification in breast diseases Carcinoma- Microcalcification, punctate, branching Fibroadenoma-Popcorn( coarse, granular, crushed Stone) Fibrocystic disease - powdery Fat necrosis - Curvilinear Ref: Robbins 9th edition Pg no :1069
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Ans. is 'b' i.e., Fixed frame analysis Endothelial cell density in specular microscopy is counted by fixed frame analysis and variable frame analysis. Cell density (ceIlsimrn2 ) = Cell count in frame
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Ans. Dianosil
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Ans. is 'd' i.e., All of the above Clinical features of deliriumo Delirium has an acute onset and rapid progress. The clinical features of delirium are : -Abnormalities of consciousness : - The most conspicuous feature is a clouding of consciousness which ranges from mild dulling to deep coma.Cognitive impairment: - Confusion or disorientation particularly to time and next to place and occasionally to person. Poor concentration, inattention, altered sensorium and disturbances of memory are seen. There is impairment of immediate and recent memory, remote memory is normal.Perceptual anomalies : - Delirium is the most common cause of illusion. Hallucination, particularly visual are common.Emotional disturbances : - Most commonly it is fear, followed by anxiety. Less commonly euphoria, apathy or depression may occur. Mood constantly fluctuates, i.e., labile mood.Language disturbances : - Mutism as well as rambling and incoherent speech.Psychomotor disturbances : - Hypo or hyperactivity, agitation.Disorder of sleep: - Sleep wake rhythm is usually altered. Sleep is fragmented and disturbed by nightmares. Diurnal variation with sedation in the day time and restlessness at night (Sun downing) is common.Autonomic disturbances : - Tachycardia, sweating, tremers.Neurological signs : - Tremor, seizure, choreiform movements.Electroencephalography (EEG) : - The most typical finding is diffuse (generalized) slowing. Low voltage fast activity is seen if the delirium is due to withdrawal of sedative drugs or alcohol.o All symptoms fluctuate in severity and rapidly with apparently normal periods (lucid intervals) in between.
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Deoxygenated blood from the transverse sinus drains to the sigmoid sinus, which empties into the internal jugular veins. The transverse sinuses receive blood from the confluence of sinuses, which is located in the posterior cranium.
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Refer Katzung 11/e p 594 Ximelagatran was the first viral direct thrombin inhibitor approved, however it was later withdrawn because of hepatotoxicity. Recently a new direct thrombin inhibitor Dabigatrin had been approved for the prophylaxis of stroke and systemic embolism in nonvalvular atrial fibrillation
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Ans. Both of the above
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The best specimen used for toxicological analysis in embalmed body is SKELETAL MUSCLE FROM BUTTOCK In embalmed body its very difficult to detect volatile poisons.
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Answer is C (Chromosome-3) Presence ofpainless haematuria with balottable muss in right flank in this foy years old male suggests diagnosis of renal cell carcinoma. The most common histological variant 'clear cell carcinome' is associated with a defect in chromosome 3.
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The daily requirement of iodine for adults is placed at 150micrograms. The recommendation of WHO of 250mg per day for iodine during pregnancy have also been adopted. This amount is normally supplied by well-balanced diet and drinking water except in regions where food and water is deficient in iodineRef: Park; 23rd ed; Pg 624
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Internal urethral orifice lies at the apex (not the lateral angle of base) of urinary bladder. Note: It's the ureters that open at lateral angles. Embryologically, the trigone of the bladder is derived from the caudal end of mesonephric ducts, which is of mesodermal origin (the rest of the bladder is derived from the endodermal urogenital sinus). Urinary bladder is lined by transitional epithelium (including trigone).
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C i.e. Osteopetrosis In osteopetrosis, there is reduced osteoclastic bone resorption resulting in diffuse symmetrical skeleton sclerosis. Also k/a marble bone disease d/t its stone like quality of bones; however the bones are abnormally brittle & fracture like a piece of chalk. It can present radiologically as? Sclerosis of all bones more prominent at base of skullQ. Sclerosis of veebral end plate 1/t characteristic sandwitch or broad stripped (rugby jersey spine) Q Bone in bone appearanceQ d/t sclerotic foci within the bone.
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ZIDOVUDINE: Is a NI (NUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITOR) against HIV-1, HIV-2 and HTLVs I and II. It causes Competitive inhibition but no impact on cells already infected with HIV . It causes Bone Marrow Suppression, Lipodystrophy, Erythrocytic Macrocytosis, Skeletal muscle myopathy, Hepatic toxicity and on chronic use can cause Nail hyperpigmentation
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Careful physical examination can be very useful in diagnosing many common pulmonary disorders. Atelectasis and large pleural effusions both can present with decreased fremitus, dullness or flatness to percussion, and absent breath sounds. In atelectasis, tracheal shift, if present, is toward the affected side, and the opposite for a large pleural effusion. Asthma's most typical manifestations are prolonged expiration and diffuse wheezing. However, impaired expansion, decreased fremitus, hyperresonance, and low diaphragms can also be found. A complete pneumothorax results in absent fremitus, hyperresonance or tympany, and absent breath sounds. Lobar pneumonia is characterized by consolidation with increased fremitus, dullness, and auscultatory findings of bronchial breathing, bronchophony, pectoriloquy, and crackles.
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Fast EPSP in autonomic ganglia are generated by Acetylcholine on nicotinic cholinergic receptors.
Slow EPSP in autonomic ganglia are generated by Acetylcholine on M1 muscarinic receptors.
Slow IPSP in autonomic ganglia are generated by Catecholamines (Dopamine, noradrenaline) on dopaminergic, α- adrenergic and M2 muscarinic receptors.
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In uterus didelphys there is complete lack of fusion of Mullerian ducts with a double uterus, double cervix, and a double vagina. Ref: Shaw's Textbook of Gynaecology, 12th Edition, Page 62 ; Textbook of Gynecology By D C Dutta, 4th Edition, Page 42
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A. i.e. Catatonic schizophrenia
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Ans. is 'b' i.e., Chest indrawing The only sign for severe pneumonia is chest indrawing
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Ans. c (Taenia solium). (Ref. Harrison, Medicine, 17th ed., chapter 213)ADULT TAPEWORM INFECTION (Taenia Solium)# The pork tapeworm T. solium can cause two distinct forms of infection in humans:- adult tapeworms in the intestine or- larval forms in the tissues (cysticercosis).# Humans are the only definitive hosts for T. solium;# Pigs are the usual intermediate hosts.# Infection that cause human cysticercosis is by ingestion of Taenia solium eggs. (JK'09)# The adult tapeworm generally resides in the upper jejunum.# Autoinfection can occur# 'Cigar shaped' calcification or 'rice-grain' calcification.Diagnostic Criteria for Human Cysticercosis1.Absolute criteriaa. Demonstration of cysticerci by histologic or microscopic examination of biopsy materialb. Visualization of the parasite in the eye by funduscopyc. Neuroradiologic demonstration of cystic lesions containing a characteristic scolex.2.Major criteriaa. Neuroradiologic lesions suggestive of neurocysticercosisb. Demonstration of antibodies to cysticerci in serum by enzyme-linked immunoelectrotransfer blotc. Resolution of intracranial cystic lesions spontaneously or after therapy with albendazole or praziquantel alnno3.Minor criteriaa. Lesions compatible with neurocysticercosis detected by neuroimaging studiesb. Clinical manifestations suggestive of neurocysticercosisc. Demonstration of antibodies to cysticerci or cysticercal antigen in cerebrospinal fluid by ELISAd. Evidence of cysticercosis outside the central nervous system (e.g., cigar-shaped soft tissue calcifications)4.Epidemiologic criteriaa. Residence in a cysticercosis-endemic areab. Frequent travel to a cysticercosis-endemic areac. Household contact with an individual infected with Taenia solium# Diagnosis is confirmed by either one absolute criterion or a combination of two major criteria, one minor criterion, and one epidemiologic criterion. A probable diagnosis is supported by the fulfillment of (1) one major criterion plus two minor criteria; (2) one major criterion plus one minor criterion and one epidemiologic criterion; or (3) three minor criteria plus one epidemiologic criterion,# Rx:- Intestinal T. solium infection is treated with a single dose of praziquantel (10 mg/kg).- Praziquantel occasionally evokes an inflammatory response in the CNS if concomitant cryptic cysticercosis is present.- Niclosamide (2 g) is also effective.
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Ans. is 'b' i.e. pulmonary valve is commonly involved Infective endocarditis in I.V. drug abusers usually involves the right side of the heart.Tricuspid valve is most commonly involved.Pulmonary valve is involved in fewer cases only.Most common organism causing endocarditis in I.V. drug abusers is =>staphylococcus aureus.Other common organisms are :CandidaEnterococcus fetalisPseudomonasSerratia marcescens
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The incidental adrenal mass is seen in as many as 1.3% of abdominal CT scans performed for other reasons. Adrenocoical adenomas are most common, followed by adrenocoical carcinoma, metastases from other primary cancers, and pheochromocytoma. Biochemical evaluation must weigh the prevalence of adrenal neoplasms against the consequences of a missed life-threatening diagnosis, as in pheochromocytoma. All adrenal masses should be evaluated for pheochromocytoma with measurement of 24-hour urine catecholamines and their metabolites. Aldosterone and coisol measurement are indicated if clinical features suggest aldosteronism or Cushing's syndrome. Fine-needle aspiration of adrenal masses is indicated for clearly cystic lesions or if metastasis is suspected based on the presence of another known primary. Fine-needle aspiration is not routinely indicated in the evaluation of adrenal lesions and is contraindicated until pheochromocytoma is definitively excluded. Adrenal lesions should be resected if they are functional, are larger than 6 cm., or have enlarged during follow-up.
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Ptosis and ophthalmoplegia occur in cavernous sinus thrombosis due to involvement of III and IV and V cranial nerves. Retinal vessels are also engorged but pupils are fixed and dilated,due to involvement of III nerve and sympathetic plexus. Ref Dhingra 5/e,p 214.
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Ans. is 'b' i.e., Ethmoid and maxillary Maxillary sinus - 4 Develop at bih; completely develop at 9 years Ethmoidal sinus - Develop at bih; completely develop at late pubey Frontal sinus - Develop at 2 year; completely develop at late adolescence Spenoid sinus - Develop at 3-5 years; completely develop at 12-15 years
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It is a subsequently introduced congener of mebendazole: retains the broad-spectrum activity and excellent tolerability of its predecessor, and has the advantage of single dose administration in many cases. One dose treatment has produced cure rates in ascariasis, hookworm (both species) and enterobiasis which are comparable to 3 day treatmentwithmebendazole. ESSENTIALS OF PHARMACOLOGY page no. 850
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Ans. is 'a' i.e., p-24 antigen * P-24 antigen is the earliest virus marker to appear in blood and is the one tested for.* It may be detectable in blood after about 2 weeks.Laboratory diagnosis of HIV infection* Laboratory diagnosis is made by:A) Antibody detection# It is the most common method used for diagnosis of HIV infection.# ELISA is the most sensitive test and therefore is the serening test of choice.# Western blot is the most specific (Confirmatory) test and therefore is the 4gold standard* for diagnosis,# Antibodies test usually become positive 22 days after the infection.B) Detection of HIV nucleic acid or antigen# p24 antigen detection by ELISA can be done 16 days after infection (earlier than antibody detection).# Nucleic acid detection tests are the earliest to become positive (12 days after infection). Most commonly used test is reverse transcriptase PCR, (RT-PCR). Other methods used are DNA-PCR, RNA-PCR, RNA- bDNA (branched DNA), and RNA-NASBA (nuclei acid sequenced based assay).C) Virus isolation# Co-cultivation of the patient's lymphocyte with uninfected lymphocytes in the presence of IL-2# Not suitable as a routine diagnostic procedure.In infected individual HIV can be isolated from :* Blood* Semen* Saliva* Urine* Lymphocytes* Cervical secretions* Tears* Breast milk
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Answer is B (Goodpasture's Syndrome) Goodpasture's Syndrome is an autoimmune disease characterized by formation of Anti-Glomerular Basement Membrane Antibodies (Anti-GBM Antibodies) that attack both, Pulmonary Capillaries (Hemoptysis) and the Glomerulus (Hematuria) The association of Hemoptysis and Hematuria along with anti-basement membrane antibodies suggests a diagnosis of Goodpasture's Syndrome
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Ref:- Sima Jain; pg num:- 25
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Most common cause of superficial thrombophlebitis is an intravenous catheter. Ref: Hurst's The Hea By Valentin Fuster, Richard A. Walsh, Robe A. Harrington, 13th Edition, Chapter 109; Doctor C's Medical Guide By Joseph Ciabattoni, Page 102; Primary Care Medicine: Office Evaluation and Management of The Adult Patient By Allan H. Goroll, 6th Edition, Page 317; Sclerotherapy By Robe A. Weiss, Page 251
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Ans. is 'a' i.e., ProcaineShort durationLow potencyIntermediate duration (30-90 min)Intermediate potencyLong duration (> 120 min)High potencyo Chlorprocaine (shortest acting)o Procaineo Lignocaineo Mepivacaineo Prilocaineo Cocaineo Bupivacaineo Tetracaineo Etodicaineo Ropivacaineo Dibucaine (longest acting)
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Answer is C (Absent in MS): Third hea sound (S3) is commonly seen in association with ventricular dysfunction. Ventricular function is usually. normal with MS and hence S3 is usually not a feature of MS. Physiological S3 may be heard in athletes, while constrictive Pericarditis and ischaemic hea disease (MI) are established causes of pathological S3.
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Ans. c. Dientamoeba
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Ans. (a) Coarctation of aortaRef: Harrison 19th ed. /1525* By far the most common cause of rib notching. It Usually involves the posterior 4th - 8th Ribs.* Collateral flow bypassing the aortic constriction to reach the abdomen and lower extremities comes almost entirely from the two subclavian arteries via the thyrocervical, costocervical, and internal mammary arteries and their subdivisions to the posterior intercostals and then into the descending aorta. The large volume of blood traversing this route causes dilatation, tortuosity, and increased pulsation of the intercostal arteries, which result in gradual erosion of the adjacent bones
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Myocardial infarction (MI), also commonly referred to as "hea attack," is necrosis of hea muscle resulting from ischemia. Acute occlusion of the proximal left anterior descending (LAD) aery is the cause of 40% to 50% of all MIs and typically results in infarction of the anterior wall of the left ventricle, the anterior two thirds of the ventricular septum, and most of the hea apex; more distal occlusion of the same vessel may affect only the apex. Similarly, acute occlusion of the proximal left circumflex (LCX) aery (seen in 15% to 20% of MIs) will cause necrosis of the lateral left ventricle, and proximal right coronary aery (RCA) occlusion (30% to 40% of MIs) affects much of the right ventricle. (Robbins Basic Pathology,9th edition,pg no.393)
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Local Potential
Proportional to stimulus strength
Does not follow all or none law
It is not propagated
Exhibits summation
Can be depolarising / hyperpolarising
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Gas gangrene is rapidly spreading, edematous myonecrosis occurring characteristically in association with a severe wound of extensive muscle mass contaminated by pathogenic clostridia. Most frequently encountered is clostridium perfringes. Also caused by clostridium novyi, Clostridium septicum and clostridium histolyticum. Reference: Textbook of Microbiology; Anathanarayan and paniker's; 10th edition; Page no: 261
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<p> The risk of recurrence of hydatidiform mole on future pregnancy is about 1-4%. Reference:DC Dutta&;s Textbook of obstetrics,8th edition,page no:226 <\p>
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Ans. is 6a' i.e., Causes only localized infectiono Streptococcal diseases can be braodly classified into three groups1) Suppurative infections# These are otitis media, sore throat, mastoiditis, pneumonia, abscesses, erysipelas, impetigo (non-bullous impetigo or impetigo contagiosum), cellulitis, necrotizing fascitis, puerperal sepsis and bacteremia.o Sore throat is the most common streptococcal disease.# The M protein types of a S. pyogenes most commonly associated with skin infection (impetigo) are different from those causing resporatory infection (Pharyngitis).2) Toxin mediated# These are scarlet fever and toxic shock syndrome.# Scarlet fever is caused by erythrogenic toxin.# Toxic shock syndrome (TST) is due to pyrogenic exotoxin A (erythrogenic toxin) produced by strains M type-1 and -3 of strep, pyogenes. These strains are also called as 'Flesh eating bacteria.'3) Non-suppurative complications (immune mediated)# These are rheumatic fever and glomerulonephritis.# Rheumatic fever follows streptococcal throat infection (hut not skin infection), whereas glomerulonephritis can occur after throat or skin infections.# These non-supporative complications are due to antigenic cross-reactivity of streptococcal antigenic component with human tissues. This antigen cross reactivity is resoponsible for the production of cross reacting antibodies, i.e. antibodies are formed against streptococcal antigens but they damage host tissue antigens because of similarity between streptococcal antigens and human tissue antigens - antigenic cross reactivity.
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Ans. d (BOAA). (Ref. Park, Textbook of PSM, 17th ed., 441)LATHYRISM# Neurolathyrism is crippling disease of nervous system characterised by gradually developing spastic paralysis of lower limbs, occuring in adults consuming the pulse, Lathyrus sativus ("khesari dhal").# The toxin present in lathyrus is beta oxaly amino alanine (BOAA).# The disease affects mainly young men in the age group of 15--45 years# Stages: - Latent stage, No-stick stage, One-stick stage, Two-stick stage and Crawler stage.# Interventions - Vitamin C prophylaxis- Banning the crop- Removal of toxin (b\ Steeping method and Parboiling).- Education- Genetic approach- Socio-economic changes.
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Sturge-Weber syndrome
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Resection of retro sternal goitre can almost always be carried out from the neck, but median sternotomy is rarely necessary Characteristics that might predict an inability to mobilize a thoracic goiter into a cervical incision include a reoperative field, an invasive substernal thyroid malignancy, goiters that extend below the inferior margin of the aoic arch, goiters that reach the carina, goiters that extend into the posterior mediastinum, and true ectopic mediastinal thyroid tissue. Source : Sabiston 20th edition Pg : 918
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Cerebral achromatopsia is an aquired loss of colour vision which occur due to damage in visual coical area V4. It is usually caused by occlusion of occipitotemporal branch of posterior cerebral aery.
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MC - Type 1 Diabetes | DOC - Insulin Mixed split regime Basal bolus regime - Screening for Nephropathy should begin: In Pre-pubeal age - 5 years after onset Pubeal age - 2 years after onset
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Tryptophan is conveed to Seratonin, which is then acetylated and fuher methylated to form Metatonin.Ref: DM Vasudevan - Textbook of Biochemistry, 7th edition, page no: 240, Fig no 18.10.
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The material containing Clostridium tetani is inoculated on one half of the blood agar plate. An extremely fine, transparent film of growth is the delicately filamentous advancing edge Clostridium tetani produce swarming growth which is detected in the opposite half of plate after 1-2 days of anaerobic incubation. Reference: Textbook of Microbiology; Anathanarayan and paniker's; 10th edition; Page no: 266
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Ans. B. Ultrasonography. (Harrison's Medicine, 18th/Ch. 311)The plain abdominal film may detect gallstones containing sufficient calcium to be radiopaque (10-15% of cholesterol and 50% of pigment stones). Plain radiography may also be of use in the diagnosis of emphysematous cholecystitis, porcelainUltrasonography of the gallbladder is very accurate in the identification of cholelithiasis and has replaced oral cholecystography. Stones as small as 1.5 mm in diameter may be confidently identified provided that firm criteria are used .Role of Ultrasound in Biliary System:# Ultrasound is most important modality in evaluating GB pathologies. It is investigation of choice for diagnosis of:- Gall stones (Procedure of choice for detection of stones)- GB polyp- Mucocele- Empyema of GB- Acute cholecystitis (initial/screening)- Adenomyomatosis of GB ("Comet- tail" artefacts)- Cholesterosis (Strawberry GB)- Early Carcinoma GB.# CT may be better than US in following GB pathologies:- Porcelain GB- Emphysematous cholecystitis# Advanced GB cancer# Cholecystoenteric fistula (Gallstone ileus)- WES Sign- Wall-Echo-Shadow: When a gallbladder is contracted around a gallstone, sometimes the only visualization of this is a shadow coming out of the liver. This is due to the stone's reflection that obscures the rest of the gallbladder. The three layers of the gallbladder wall of the anterior gallbladder are generally seen, followed by the echogenic stone which is followed by the shadow caused by the stone.- Imaging in acute cholecystitis:# Ultrasound (US) is the initial imaging study for the diagnosis of acute cholecystitis because it is performed relatively quickly and does not expose the patient to ionizing radiation. Ultrasound is much more accurate than plain film radiographs or CT (sensitivity is 88 % and specificity is 80 % of US). Furthermore, the modality is faster and more generally more readily available than cholescintigraphy or MRI.# US is not the most accurate imaging modality for the diagnosis of acute cholecystitis. Cholescintigraphy, usually in the form of the HIDA scan, is 97 % sensitive and 90 % specific (hence the investigation of choice). Radiopharmaceuticals such as 99mTc-labeled N-substituted iminodiacetic acids (HIDA, DIDA, DISIDA, etc.) are rapidly extracted from the blood and are excreted into the biliary tree in high concentration even in the presence of mild to moderate serum bilirubin elevations. Failure to image the gallbladder in the presence of biliary ductal visualization may indicate cystic duct obstruction, acute or chronic cholecystitis, or surgical absence of the organ. Such scans have some application in the diagnosis of acute cholecystitis.
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Stroke volume is the volume ejected from the ventricle and is represented on the pressure-volume loop as phase 2 - 3; End-diastolic volume is about 140 mL and end-systolic volume is about 65 mL; The difference, or stroke volume, is 75 mL. Cardiac output is calculated as stroke volume x hea rate or 75 mL x 70 beats /min = 5250 mL/min or 5.25 L/min
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CHOLERA ENTEROTOXIN Light (L) toxin : Binds with ganglioside in epithelial cell membrane Heavy(H) toxin : Activates Adenyl cyclase in Epithelial cell wall which increase camp, leading to outpouring of isotonic fluid in lumen of intestine Ref: Park 25th edition Pgno : 253
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Ans: a (Alzheimer's disease) Ref: Ganong, 22nd ed, p. 215Alzheimer's disease is not caused by over expression of a trinucleotide repeat. The rest 3 options are examples of trinucleotide repeat diseases where as Alzheimer's is primarly a degenerative disease (Basal ganglia) resulting in movement disorder.Some examples of trinucleotide repeat diseases:-Huntington's disease -- CAGSpinocerebellar ataxia --CAG(Type 1, 2, 3, 63)Fragile X syndrome -- CGGMyotonic dystrophy -- CTGFrederich's ataxia -- GAA
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Tuberous sclerosis, an autosomal dominant condition, can result in severe mental retardation and seizures. Infantile spasms, a hypsarrhythmic EEG pattern, hypopigmented lesions (ash-leaf spots), cardiac tumors, sebaceous adenomas, a shagreen patch (a roughened, raised lesion over the sacrum), and calcifications on the CT scan are all features of this condition. No specific treatment is available.
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Ans. B: Rupture of berry aneurysm Eighty-five percent of SAH are caused by saccular or 'berry' aneurysms arising from the bifurcation of cerebral aeries, paicularly in the region of Circle of Willis SAH: Most aneurysm presents as sudden SAH Occipital and posterior cervical pain may signal a posterior inferior cerebellar aery or anterior inferior cerebellar aery aneurysm (rare) A classic presentation of SAH is the explosive onset of sever headache (thunder clap type headache), or a sudden transient loss of consciousness followed by severe headache Nuchal rigidity and vomiting may be present (simulating meningitis) Rebleed and vasospasm are responsible for clinical deterioration in a week following CT scan is a sensitive indicator and usually allows for prompt diagnosis
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Complications of chronic osteomyelitis
Following complications can occur : -
Acute exacerbation Growth abnormalities due to damage to adjacent growth plate: - Shortening, Deformities.
Pathological fracture
Joint stiffness
Sinus tract malignancy (very rare): - Squamous cell carcinoma
Amyloidosis
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Pollex means Thumb, which means strong in latin. There are four sho muscles of thumb (pollex), they are abductor pollicis brevis, opponens pollicis, flexor pollicis brevis and adductor pollicis. The first three of these muscles form the thenar eminence. All these muscles are supplied by median nerve except for adductor pollicis which is innervated by ulnar nerve.Ref: Snell's, Clinical Anatomy, 7th edition, Page 542, 543.
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OBER&;S TEST:Used in physical examination to identify tightness of iliotibial band. During the test ,the patient lies on his side with the unaffected leg on the bottom with their shoulder and pelvis in line. The knee may extended or flexed to 90 or 30 degrees.The hip is maintained in slight extension.The test leg is abducted,then allowed to lower toward the table with the pelvis stabilized NORMAL: able to abduct parallel to the examining surface Inability to adduct to parallel indicates tightness of iliotibial band REF : MAHESWARI 9TH ED
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Ans. is 'a' i.e., P gene
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The incidence of trisomy 13 is about 1:12,000 live bihs, and 60% of affected individuals are female. Most infants with trisomy 13 have congenital anomalies that are incompatible with survival. Surviving children demonstrate failure to thrive, cognitive disabilities, apneic spells, seizures, and deafness. The symptoms and signs include characteristic features, often a normal bih weight, CNS malformations, eye malformations, cleft lip and palate, polydactyly or syndactyly, and congenital hea disease. The incidence of trisomy 18 syndrome is about 1:4000 live bihs, and the ratio of affected males to females is approximately 1:3. Trisomy 18 is characterized by prenatal and postnatal growth retardation that is often severe, and hypeonicity. Complications are related to associated bih defects. Death is often caused by hea failure or pneumonia and usually occurs in infancy or early childhood, although a small percentage of patients reach adulthood. Characteristic features of Trisomy 21 include upslanting palpebral fissures, epicanthal folds, midface hypoplasia, and small, dysplastic pinnae. Characteristic features of Turner syndrome (Monosomy X) include webbed neck, triangular facies, sho stature, wide-set nipples, amenorrhea, and absence of secondary sex characteristics. Ref: Tsaic A.C., Manchester D.K., Elias E.R. (2012). Chapter 37. Genetics & Dysmorphology. In W.W. Hay, Jr., M.J. Levin, R.R. Deterding, J.J. Ross, J.M. Sondheimer (Eds), CURRENT Diagnosis & Treatment: Pediatrics, 21e.
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D i.e. Linoleic Acid
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Multiple somatic symptoms (Pain, GI symptom, sexual symptom) suggest the diagnosis of somatization disorder.
This question can be solved in a very simple way. The patient is presenting with somatic symptoms. The psychiatric diseases with somatic symptoms are somatoform disorders, factitious disorder, and malingering. Amongst the given options only somatization disorder (a somatoform disorder) presents with somatic symptoms.
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"A wide-mouthed, thin walled unattached diverticulum in an adult patient can probably quite safely be left alone." - Maingot's
Treatment
Any symptomatic Meckel's diverticula is resected (Diverticulectomy)
There are two techniques for excision of the diverticulum
simple excision
resection with the segment of ileum containing the diverticulum and then reanastomosis.
Resection of ileum with reanastomosis is reserved for
patients with peptic ulceration in the ileal mucosa
a gangrenous diverticulitis affecting the base of the diverticulum
if the base of the diverticulum is inflamed or perforated
in rare cases of malignant disease situated in Meckel's diverticulum.
Management of asymptomatic Meckel's diverticula found incidentally on laprotomy
Management is controversial and different books write differently.
According to Maingot's
a wide-mouthed, thin walled Meckel's diverticulum without any attached band can be left. prophylactic diverticulectomy is done
if the diverticula has a narrow base
if there is any palpable thickening or adhesions suggestive of ectopic tissue.
if there is any attachment either by bands to the umbilicus or by a mesodiverticular vascular strand.
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-Lymphadenopathy and hepatosplenomegaly are very rare in aplastic anemia. Features of Aplastic anemia: Physical examination -Pallor &/ signs of congestive hea failure Ecchymoses, Petechiae, gum bleeding & epistaxis d/t thrombocytopenia Fever, pneumonia & sepsis d/t neutropenia etc
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- the characteristic of waste suitable for incineration are ; a low heating volume a moisture content below 30% content of Non-combustible content of combustible matter is above 60 Reference : Park's textbook of preventive and social medicine, 23rd edition, pg no:791 <\p>
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A synol sarcoma (also known as: malignant synovioma is a rare form of cancer which occurs primarily in the extremities of the arms or legs, often in close proximity to joint capsules and tendon sheaths. As one of the soft tissue sarcomas, it is one of the rarest forms of soft tissue cancer. The name "synol sarcoma" was coined early in the 20th century, as some researchers thought that the microscopic similarity of some tumors to synovium, and its propensity to arise adjacent to joints, indicated a synol origin; however, the actual cells from which the tumor develops are unknown and not necessarily synol. Primary synol sarcomas are most common in the soft tissue near the large joints of the arm and leg but have been documented in most human tissues and organs, including the brain, prostate, and hea. Synol sarcoma occurs most commonly in the young, representing about 8% of all soft tissue sarcomas but about 15-20% of cases occur in adolescents and young adults. The peak of incidence is in the third decade of life, with males being affected more often than females (ratio around 1.2:1).
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Ans. is 'None'
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There is increased respiratory rate.the child must be intubated and venilated to provide suppo . Reference: GHAI Essential pediatrics, 8th edition
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