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"Onodi cell" is the posterior most posterior ethmoid cell extending lateral to the sphenoid sinus. While removing disease from the Onodi cells there are chances of injury to optic nerve and internal carotid which lie in the vicinity. The posterior ethmoidal cells in the floor of orbit are known as "Haller cells".
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Spectrin causes membrane loss leading to spherical shape of rbc
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Hepatotoxicity due to rifampin alone is uncommon and often consists of isolated hyperbilirubinemia. Ref: Harrisons Principles of Internal Medicine, 18th Edition, Page 1375
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Most common pathogen is gram - negative bacteria (E.coli, klebsiella pneumoniae)
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Negri bodies "Negri bodies are pathognomonic for Rabies". - Negri bodies are eosinophilic cytoplasmic inclusion bodies in brain neurons and are composed of randomly oriented rabies virus, nucleocapsids embedded in an amorphous substance or matrix. These inclusions are seen in:? - Purkinje cells of cerebellum - Pyramidal cells of hippocampus Also know:- In Measles Both nuclear and intracytoplasmic bodies can be seen.
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Ans. D. Promoter regionThe binding of enzyme RNA polymerase to DNA is prerequisite for the beginning of transcription. The specific region on DNA where the enzyme binds is known as promoter region.
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Bipolar disorder - Bipolar disorder is characterized by marked mood swings between mania (mood elevation) and bipolar depression that cause significant personal distress or social dysfunction Bipolar I - mania + depression Bipolar II - depression + hypomania Mania: Decrease need for sleep Over talkativeness Abnormally increase activity levels Distractibility Increase self-esteem or grandiosity Flight of ideas Excessive involvement in pleasurable activities that have a high potential for painful consequences Duration - 7 days Hypomania - Less severe symptoms than mania Duration - 4 days Treatment:- Acute mania - mood stabilizer + antipsychotic >only antipsychotic In pregnancy antipsychotic is preferred because most of mood stabilizer are teratogenic Mood stabilizer - lithium (D/O/C for acute mania, causes ebstein's anomaly), valproate (most teratogenic), carbamazepine
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Men have higher reference intervals than women in tests related to iron and hemoglobin (Hb) concentration in blood. The normal reference interval for Hb concentration in women is lower (12.0-16.0 gm/dL) than that for men (13.5-17.5 gm/dL) due to lower serum testosterone levels (testosterone is higher in men and stimulates erythropoiesis) and blood loss during menses. Fuhermore, women normally have about 400 mg of iron (as ferritin) in their bone marrow iron stores versus an average of 1000 mg of iron for men. In the absence of inflammation, the small circulating fraction of ferritin correlates well with ferritin stores in the bone marrow. Hence, men have different reference intervals for serum ferritin than do women (15-200 ng/mL in men versus 12-150 ng/mL in women). The mean corpuscular volume, serum alkaline phosphatase, serum glucose, and serum sodium are similar in both sexes. Ref: Beutler E. (2010). Chapter 42. Disorders of Iron Metabolism. In J.T. Prchal, K. Kaushansky, M.A. Lichtman, T.J. Kipps, U. Seligsohn (Eds), Williams Hematology, 8e.
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Ans. is 'c' i.e., 18 months
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Ligation of one or both internal iliac aeries is done to contro hemorrhage from pelvic vessels. it is technically difficult and is onlt successfull in half of the time. The impoance mechanism of iliac aery ligation is a 85% reduction in pulse pressure in the aeries distal to ligation.This conves an aerial pressure system into one with pressures approaching those in the venous circulation. this creates vessels more amenable to hemostasis pressure and clot formation. Reference: Wlliams text book of Obstetrics, 24th edition page no 820
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Bromocriptine and pergolide are ergot derivatives and dopamine agonists These are known to cause vasoconstriction and thus gangrene S/E of Pergolide : Valvular hea disease Pramipexole and ropinirole are also dopamine agonists but these are non-ergot derivatives. These do not cause gangrene and are longer acting. S/E of Ropinirole : Nausea, dizziness, hallucinations,postural hypotension.
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Nysten's rule: It is a sequential development of rigor mois in the body after death. Sequence of appearance: Eyelids, Neck & lower jaw, then Face, Chest Muscles, Upper Limb, Abdomen, Lower limb and lastly Fingers and Toes. Rigor disappears in the same sequence cadaveric rigidity first appears in involuntary muscles; the myocardium becomes rigid in an hour. cadaveric rigidity first seen in myocardium than eye lid but first external site of cadaveric rigidity is eyelid.
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In hemochromatosis iron deposits are seen in pituitary gland, skin , pancreas and heart.
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bronchial artery supplies bronchial tree till respiratory bronchiole.
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Ans. is 'd' i.e. Modifed radical mastectomy followed by hormone therapy
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(Parotid gland) (546-HM) (584-Basic pathology 8th)Pleomorphic adenoma (Mixed salivary tumour) is the commonest tumour in the parotid gland and occurs less often in other major and minor salivary gland, common in females.
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Slow sand filters are for effective in removal of bacteria. Slow sand filters remove about 99.9- 99.99%.Rapid sand filters remove 98-99% bacterias. Slow sand filters occupy less area,operation is less skilled. Parks textbook of preventive and social medicine.K Park. Edition 23.Pg no: 714.
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Somatomedins are polypeptide growth factors secreted by the liver and other tissues. The first of these factors isolated was called sulfation factor because it stimulated the incorporation of sulfate into cailage. However, it also stimulated collagen formation, and its name was changed to somatomedin. It then became clear that there are a variety of different somatomedins and that they are members of an increasingly large family of growth factors that affect many different tissues and organs. The principal (and in humans probably the only) circulating somatomedins are insulin-like growth factor I (IGF-I, somatomedin C) and IGF-II. Ref: Barrett K.E., Barman S.M., Boitano S., Brooks H.L. (2012). Chapter 18. The Pituitary Gland. In K.E. Barrett, S.M. Barman, S. Boitano, H.L. Brooks (Eds),Ganong's Review of Medical Physiology, 24e.
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Ans. is `d' i.e., Activation of macrophagesAlso see above explanation.Growth factors and cytokines involved in regeneration and wound healingGrowth factor Epidermal growth aTransforming growth factor aHeparin-binding EGFHepatocyte growth factor/scatter factorVascular endothelial cell growth factor (isoforms A,B,C,D)Platelet-derived growth factor (isoforms A,B,C,D)Fibroblast growth factor 1 (acidic), 2 (basic), and familyTransforming growth factor 13 (isoforms 1,2, 3); other members of the family are BMPs and activinFunctionsMitogenic keratinocytes and fibroblasts; stimulates keratinocyte migration and granulation tissue formationSimilar to EGF; stimulates replication of hepatocytes and most epithelial cellsKeratinocyte replicationEnhances proliferation of hepatocytes, epithelial cells, and endothelial cells; increases cell motility, keratinocyte replicationIncreases vascular permeability; mitogenic for endothelial cells; angiogenesisChemotactic for PMNs, macrophages, fibroblasts, and smooth muscle cells; activates PMNs, macrophages and fibroblasts; mitogenic for fibroblasts, endothelial cells, and smooth muscle cells; stimulates production of MMPs, fibronectin, and HA; stimulates angiogenesis and wound contractionChemotactic for fibroblasts; mitogenic for fibroblasts and keratinocytes; stimulates keratinocyte migration, angiogenesis, wound contraction and matrix depositionChemotactic for PMNs, macrophages, lymphocytes fibroblasts and smooth muscle cells; stimulates TIMP synthesis, angiogenesis and fibroplasia; inhibits production of MMPs and keratinocyte proliferationKeratinocyte growth Ka Fibroblasts Stimulates keratinocyte migration, proliferationfactor (also called and differentiationFGF-7)Tumor necrosis factor TNF Macrophages mast cells, Activates macrophages; regulates otherT lymphocytes cytokines, multiple functions
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Ans. is 'b' i.e., Thalassemiao Defective splicing (defect in snurps) is the most common mutation causing thalassemia,o Molecular defect in pathogens is of thalassemia:-b-Thalassemiao Most common type of genetic abnormality in b-thalassemia is point mutation i.e., nonsense.o Some may also occur due to deletion or insertion i.e., frame shift mutations,o Defect may occur at different steps of b-chain synthesis:i) Splicing mutationso Mutations leading to aberrant splicing are the most common cause of b-thalassemia.ii) Chain terminator mutationso This cause premature termination of mRNA translation.iii) Promoter region mutationso This results in transcription defect.a-Thalassemiao The most common cause of reduced a-chain synthesis is deletion of a-globin genes,o Rarely nonsense mutation may also cause a-thalassemia.
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Quinsy is also called peritonsillar abscess. It is collection of pus in peritonsillar space which lies between capsule of tonsil and superior constrictor muscle.Parapharyngeal space (also called pharyngomaxillary or lateral pharyngeal space) lies lateral to pharynx and extends from the base of skull above to the greater cornua of hyoid bone below. Infection of this space causes parapharyngeal abscess.Retropharyngeal space lies between buccopharyngeal fascia covering the constrictor muscles of pharynx and prevertebral fascia covering prevertebral muscle. Retropharyngeal space extends from skull base to bifurcation of trachea. Infection of this space causes acute or chronic retropharyngeal abscess due to tuberculous lymph nodes which lie in this space.Infection of prevertebral space which lies between vertebral bodies and prevertebral fascia causes prevertebral abscess (also called, though improperly, the chronic retropharyngeal abscess). This space extends from skull base to coccyx.Abscess within the tonsil is formed due to infection of its crypts and forms an intratonsillar abscess.Various head and neck spaces where abscesses can form.
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Roseola infantum*A history of 3 days of high-grade fever in an otherwise nontoxic 10-month-old child with a blanchable maculopapular rash on trunk -Roseola.*Mean duration- 6days - so sixth disease/Exanthem subitum.*Nagayama spots-ulcers at the uvulopalatoglossal junction.*DD - Measles, Rubella, Drug allergy.*M/C complication-convulsions / recurrent seizures/temporal lobe epilepsy.*Rx suppoive*Severe cases-Ganciclovir/ Foscarnet.(Refer: Nelson's Textbook of Paediatrics, 19thedition, pg no:1117)
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Drug-Induced Hemolysis
Certain drugs (such as penicillin, quinidine, phenacetin, etc.) may induce hemolysis of red blood cells. They attach to the surface of red blood cells and induce the formation of IgG antibodies.
These autoantibodies then react with red blood cell surface, causing hemolysis. This is Type II hypersensitivity reaction.
Parija SC. Textbook of Microbiology & Immunology. Elsevier Health Sciences; 2014. Page: 316-17
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Stimulation of 5-HT1B/1D receptors can stop an acute migraine attack. Ergotamine and dihydroergotamine are nonselective receptor agonists, whereas the triptans are selective 5-HT1B/1D receptor agonists. A variety of triptans--sumatriptan, almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, and zolmitriptan--are available for the treatment of migraine. Rizatriptan and eletriptan are, on a population basis, the most efficacious of the triptans currently available. Sumatriptan and zolmitriptan have similar rates of efficacy as well as time to onset, with an advantage of having multiple formulations, whereas almotriptan has a similar rate of efficacy to sumatriptan and is better tolerated, and frovatriptan and naratriptan are somewhat slower in onset and are also well tolerated Ref Harrison 20th edition page 3100
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Ans. B i.e. Edrophonium test Myasthenia gravis Decreased myoneural junction transmission Features: Dysahria, Dysphagia, Proximal muscle weakness, Sensory modalities and deep tendon reflexes are NORMAL MC used cholinergic drugs: Pyridostigmine/neostigmine Surgical procedure (should be done in all cases): Thymectomy
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Lipoxins are also generated from AA by the lipoxygenase pathway, but unlike prostaglandins and leukotrienes, the lipoxins are inhibitors of inflammation. Ref: Robbins 8th edition Chapter 2.
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Oblique view of the wrist is required for scaphoid fracture * Most common fractured bone in the wrist * Peanut shaped bone that spans both row of carpal bones * Does not require excessive force and often not extremely painful so can be delayed presentation * Pain over the anatomic snuff box * Pain is not usually severe * Often present late Scaphoid Fracture Treatment * Cast 6-12 weeks * Sho arm vs. long arm * Follow patient every 2 weeks with x-ray * CT and clinical evaluation to determine healing * Consider screwing early Ref: Maheshwari and Mhaskar 9th ed pg 367.
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Measles-mumps-rubella (MMR) vaccine and its component vaccines should not be administered to women known to be pregnant. Because a risk to be fetus from administration of these live virus vaccines cannot be excluded for theoretical reasons, women should be counseled to avoid becoming pregnant for 28 days after vaccination with MMR vaccine or its component vaccines or varicella vaccine. Ref: Park 24th edition
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In PDA CHF may devolop within 6 -10 week of life. Large PDA will lead to pulmonary hypeension and reversal of shunt lead to eisenmenger syndrome and differential cyanosis Ref : Ghai essential of pediatrics, eighth edition, P.no:418 Harrison principals of internal medicine,19th edition,p.no:1523 Davidson&;s principles and practice of medicine,21st edition,p.no:629
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Causes :
Chronic renal failure.
Administration of furosomide.
Hypercalcemia.
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Ans. is 'a' i.e., 1977 * It is the only infectious disease which has been eradicated globally. The world's last case occured in Somalia on 26 October 1977. The WHO declared on 8 may 1980 that smallpox had been eradicated.* In April 1977, India was declared smallpox free. The last idiginous case in India occured on 17 may 1975 in Bihar and India's last known case of smallpox was an importation from Bangladesh, which occured on 24 May 1975.
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Ans. C. Pulled up cecumA barium follows=through examination shows absent filling of the lower ileum, caecum and the ascending colon as a result of narrowing of the ulcerated segment.
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Somatostatin and /or its analog octreotide are the agents of choice for medical management of variceal bleed. Drugs used in Poal hypeension Drugs decreasing poal blood flow Drugs decreasing intrahepatic resistance Non-selective beta blockers Vasopressin and Terlipressin Somatostatin and Octreotide Nitrates Alpha-blockers Angiotensin receptor blockers
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B i.e. Orotracheal intubation - ABCDE of trauma care includes Airway maintenance and cervical spine protection, Breathing and ventilation, Circulation with haemorrhage control, Disability and neurological assessment and Exposure (undress) to assess for other injures. So option C is excluded. And decreased 02 saturation (80%) with oxygen (most probably through mask or nasal tube) indicate that patient needs tracheal intubation. The tube in trachea can be put nose (nasotracheal), oral cavity (orotracheal) or trachea itself (tracheostomy). - Ideally tracheostomy should be performed under GA. And technically tracheostomy with an awake local anesthetic in a patient with severe airway compromise is difficult because the ideal positioning with an extended head and supine is often not tolerated by patient, and the procedure is to be undeaken in a semi upright sitting position. Because tracheostomy is a relatively time taking procedure in comparison to intubation, it does not have much role in emergency airway managementQ. Tracheostomy is usually done when immediate 02 requirements are taken care of by rapid intubation and prolonged intubation is plannedQ (>1 to 2-3 weeks). However, if intubation is impossible, cricothyroidotomy is an emergency procedure. So option D is excluded. Orotracheal intubation using rapid sequence induction is the technique of choice for resuscitationQ. And nasotracheal intubation is preferred in awake patients. But it is impoant to understand that in case of maxillary fracture, awake intubation is not possible. Nasotrached intubation is contraindica in severe mid facial injuryQ. So for maxillary fracture, orotracheal intubation is method of choice for immediate management of hypoxia.
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GLUT-3 = GLUCOSE UPTAKE DURING FASTING BRAIN KIDNEY PLACENTA REF : LIPINCOTT 9TH ED
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Ans. is 'a' i.e., Clofazamine Clofazimineo Clofazimine is a leprostatic drug.o It acts by interfering the template function of DNA.o Adverse effects of clofazimine1. Skin -Reddish-black discolouration of skin, dryness of skin and itching. Discolouration of hair and body secretions, acneform eruptions and phototoxicity, conjuctival pigmentation.2. GIT -Enteritis with loose stools, nausea, abdominal pain, anorexia and weight loss.Remember - Clofazimine has antiinflammatory property can be used in lepra reaction.
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This is a case of Von-Willebrand factor disease. The image shows an ecchymotic patch. Von Willebrand disease (vWD) is a common, inherited, genetically and clinically heterogeneous hemorrhagic disorder caused by a deficiency or dysfunction of the protein termed von Willebrand factor (vWF). Consequently, defective vWF interaction between platelets and the vessel wall impairs primary hemostasis. The main treatment options for patients with vWD are desmopressin (DDAVP), recombinant vWF, and vWF/factor VIII (vWF/FVIII) concentrates. Bernard-soulier syndrome is ruled out as platelet size and count are normal. Hemophilia A is ruled out because there is reduced ristocetin cofactor activity.
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Ans. is 'a' i.e.,Injection benzathine pencillin 2.4 million units IM single dose
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Secondary bacterial peritonitis- Aka acute suppurative bacterial peritonitis- Caused by visceral perforation- Poly microbial infection* E. coli (aerobe)* Bacteroides fragilis (anaerobe) Treatment- Exploratory laparotomy + peritoneal lavage + repair of perforation / stoma formation
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Auto phagosomes are lysosome derived phagocytic vacuoles filled with fragments of old or damaged organelles.
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Ref: Davidson 21st edition, pg 771Explanation:Cushing's syndrome refers to clinical features due to chronic exposure to excess of glucocorticoids of any etiology.Its of 2 types:ACTH- dependent Cushing's: Pituitary adenoma secreting ACTH (Cushing's disease), ectopic ACTH syndrome (Lung carcinoid, small cell ca lung, medullary ca thyroid, pheochromocytoma).ACTH- independent Cushing's: Iatrogenic (chronic glucocorticoid therapy), adrenal adenoma, adrenal carcinoma* Cushing's disease is due to a pituitary adenoma secreting ACTH.Pituitary microadenoma in 90%Cushing's syndrome is caused by excess activation of the GR (Glucocorticoid receptor)Anterior Pituitary--| |ACTH |(-)|Adrenal cortex | |Cortisol | |GR--Pseudo-Cushing's: Cortisol excess as a part of other illnessSeen in alcohol excess, chronic depression & primary obesityCarney's complex: cardiac myxomas, hyperlentiginosis, Sertoli cell tumor & PPAND (Primary Pigmented Nodular Adrenal Disease)McCune- Albright syndrome- Polyostotic fibrous dysplasia, precocious puberty & cafe- au-Iait spotsScreening tests: 24hr urinary free cortisol. Overnight dexamethasone test.--> Low dose dex testTreatment: Surgery for adrenal tumorsCushing's disease-removal of pituitary tumor via transsphenoidal approach; bilateral adrenalectomy for recurrenceOral agents for Cushings syndrome- metyrapone, ketoconazole, mitotaneIV etomidate in severe cases.
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Endo cpm and MTA plugs are aqueous solvent based MTA.
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C i.e. Chancre
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Mayer Rokitansky Kuster Hauser syndrome ; Mullerian Agenesis (karyotype;46XX) (Phenotype female) Vagina,Uterus,Fallopian tubes absent. Typically ovaries are normal Secondary sexual characters are well developed May be associated with urologic anomalies and Skeletal malformations Management; 1.Frank dilatation 2.Vaginoplasty (Mc Indoe operation or Williams vaginoplasty) Ref: Clinical Gynecologic Endocrinology and Infeility; Eigth Edition, Chapter 9
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Ans. is 'a' i.e., Otosclerosiso See the above explanation.Gelle's testo It is a bone conduction test and examines the effect of increased air pressure in ear canal on hearing.o Increased air pressure in the ear canal (by Siegle's speculum) pushes the tympanic membrane and ossicles inwards which raises the intralabyrinthine pressure and causes immobility of basilar membrane and decreased hearing,o However, if ear ossicles are already fixed or disconnected, the pressure cannot be transferred to the inner ear - No change in hearing in this situation.o The base of the vibrating tuning fork is placed on the mastoid process and air pressure in ear canal increased (by Siegle's speculum).o Interpretation is : -Positive Gelle's (decreased hearing on increased pressure) -Normal or sensorineural hearing loss.Negative Gelle's (No effect of pressure change in hearing)- Disconnected or fixed ossicular chain.
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.Necrotising enterocolitis is an acquired inflammatory disease commonly seen in infants and newborn but occasionally can occur in children and adults. It ismore commonly seen in premature babies. It is more common in formula fed babies than breast bed babies. Reduced gut flora make virulent pathogens to act and cause sepsis. * Common site is terminal ileum, caecum and ascending colon. Often it can involve entire small bowel. * Gas in the bowel wall and often in poal vein is typical. ref:SRB&;s manual of surgery ,ed 3,pg no 810
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Ans. is 'b' i.e., Petrositis Petrositiso Infection of mastoid and middle ear may be complicated by the spread of infection within the temporal bone into petrous apex.o Petrositis is an extension of infection from middle ear and mastoid to the petrous part of the temporal bone, o Gradenigo's syndrome is the classical presentation and consists of a triad of: -External rectus palsy (Vlth nerve/abducent nerve palsy) causing diplopia.Deep seated orbital or retroorbital pain (Vth nerve involvement).Persistent ear discharge due to ipsilateral acute or chronic otitis media.o Associated symptoms of otitis media are also present e.g., conductive deafness.o Other symptoms are fever, headache, vomiting, and sometimes neck rigidity.o Some patient may get facial paralysis and recurrent vertigo due to involvement of facial and statoacoustic nerves.
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Principles of chlorination:
The "chlorine demand" of the water should be estimated. The chlorine demand of the water is the difference between the amount of chlorine added to the water and the amount of residual chlorine remaining at the end of a specific period of contact at a given temperature and pH of the water.
The minimum recommended concentration of free chlorine is 0.5 mg/liter for one hour. The free residual chlorine provides a margin of safety against subsequent microbial contamination which may occur during storage and distribution.
Essentials of preventive and community dentistry
Soben Peter
5th edition
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Congestive cyanotic hea disease is a causefor bilateral clubbing Ref Harrison 19th edition pg 250
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Ans. a (Epitheloid cell). (Ref. Robbins, Pathologic Basis of Disease, 6th/pg.204)Characteristic features of granulomatous reaction/inflammationa) Epithelioid cells (modified macrophages)b) Giant cells (Langhans, foreign body)c) Necrosis (caseation)d) Fibrosis
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Suckling
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Ans. is 'b' i.e., Vancomycin o Vancomycin causes renal toxicity which is dose related therefore significant dose reduction is needed in renal failure. o Rest of the drugs asked in the question are metabolised mainly in liver therefore no adjustment needed in renal failure.
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REF : KD TRIPATHI 8TH ED
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Ans. (b) Para aorticRef Harrison 19th ed. / 589Points to Remember about testicular tumor* In metastatic disease-retroperitoneal LN is Most commonly involved* Metastasis- Lymphatic >> Blood (m/c lung)* Exception is Choriocarcinoma where blood metastasis (m/c lung)>> lymphatic metastasis.* Most common testicular tumor- in general - seminoma# Prepubertal adults- teratoma# Infant and children- yolk sac tumor* Most common presentation- nodule or painless swelling of one gonad* Most common bilateral testicular tumor- Malignant lymphoma* Most common bilateral primary testicular tumor- Seminoma* FNAC contraindicated* Intial IOC- USG(hypo echoic area within tunica albuginea is suspicious)* HPE diagnosis by-radical orchiectomy (inguinal approach)* Scrotal orchiectomy- contraindicated* Chavesseac maneuver- soft clamp applied to cord- biopsy from suspicious area- sent for frozen section- if+ ligate cord, do orchiectomy- final HPE
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Hypokalemia with neuromuscular irritability, hypertension, and low plasma renin suggests hyperaldosteronism. The most common cause for primary hyperaldosteronism is idiopathic adrenal cortical nodular hyperplasia. An insulinoma arising in the pancreas could account for episodic weakness, but the glucose level would be low. About 10% of pheochromocytomas are extra-adrenal, including para-aortic, and could account for hypertension from catecholamine excess, but there would not be hypokalemia. Thyroid enlargement could be Graves' disease, though it is usually diffuse, and could account for weakness and hypertension, but with wider pulse pressure, and without hypokalemia. A malignancy in the chest is more likely to be the cause of a paraneoplastic syndrome, but that is unlikely to be hypokalemia.
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The above pigments account for the greenish colonies seen with psuedomonas. Ref: Text Book of Microbilogy By Ananthanarayan, 6th Edition, Page 294 ; Harrison's Principles of Internal Medicine, 14th Edition, Page 944
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Ans. is 'b' i.e., 90 degrees PELVISTraitMaleFemale1) Bony frameworkMassive, rougher, marked muscle sites. Stands higher and more erect.Less massive, slender, smoother.Less muscle marking.2) GeneralDeep funnel.Flat bowl.3) IliumLess vertical; curve of iliac crest reaches higher level and is more prominent.More vertical; distance between iliac crests is less; iliac fossae shallow; curves of crest well marked.4) Preauricular sulcus (attachment of anterior sacroiliac ligament)Not frequent; narrow, shallow.More frequent, broad and deep5) AcetabulumLarge, 52 mm. in diameter; directed laterallySmall, 46 mm. in diameter; directed anterolaterally.6) Obturator foramenLarge, often oval with base upwardsSmall, triangular with apex forwards.7) Greater sciatic notchSmaller, narrower, deeper.Larger, wider, shallower.8) Illeo-pectineal lineWell marked and rough.Rounded and smooth.9) Ischial tuberosityInvertedEverted; more widely separated10) Body of pubisNarrow, tirangular, thick; short is chial ramus.Broad, square; ischial ramus is lengthened and narrowed; pits on posterior surface if borne children.11) Ramus of pubisIt is like continuation of body of pubis.Has a constricted or narrowed appearance and is short and thick.12) Ischiopubic ramiMore everted, thicker and rougher.Less everted, thinner and smoother.13) SymphysisHigher, bigger and narrow in width.Margins of pubic arch everted.Lower, wider and rounded, margins of pubic arch not everted; distance between two pubic tubercles greater. The dorsal border is irregular and shows depressions or pits (scars of parturition).14) Subpubic angleV-shaped, sharp angle 70deg to 75deg.U-shaped, rounded, broader angle 90deg to 100deg15) Pelvic brim or inletHeart-shapedCircular or elliptical; more spacious; diameters longer.16) Pelvic cavityConical and funnel-shapedBroad and round17) Pelvic outletSmallerLarger18) Sacroiliac articulationLarge, extends to 2 1/2 to 3 vertebrae.Small, oblique, extends to 2 to 2 1/2 vertebrae.19) Sacroliliac joint surfaceLarge and less sharply angulated.L-shaped and elevated anteriorly.20) SacrumLonger, nanrower, with more evenly distributed curvature; promontory well marked. Body of first sacral vertebra larger.Shorter, wider; upper half almost straight, curve forward in lower half; promontory less marked.Body of first sacral vertebra small.21) CoccyxLess movableMore movable22) Ischiopubic index73 to 9491 to 115 Public length in mm.------------------Ischial length in mm.x 100 23) Sciatic notch index4 to 55 to 6 Width of notch index------------------Depth of sciatic notchx 100 24) Pubic ramus ratio1:12 : 1 or greater
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Therapeutic level of lithium used in acute mania is 0.8-1.2 meq/L NOTE: Safe range: 0.6 and 1.5 mEq/L. Acutely manic or hypomanic patients: 1.0-1.5 mEq/L Long-term prophylaxis: 0.6-1.0 mEq/L
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Ans. B. Punch biopsyPunch biopsy is required in all cases in which there is visible area of redness, an iodine negative area or an area of colposcopic abnormality.A cone biopsy and curettage should be done when cytologic examination reveals moderate or severe dysplasia, carcinoma in situ, or perhaps invasive carcinoma.
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In thalassemia hair pin cells , target cell are found.
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The constellation of calcinosis cutis, Raynaud's phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia, was historically termed the CREST syndrome . Anti-centromere antibodies (ACAs; often styled solid, anticentromere) are autoantibodies specific to centromere and kinetochore function. They occur in some autoimmune diseases, frequently in limited systemic scleroderma (formerly called CREST syndrome), and occasionally in the diffuse form of scleroderma. Ref - HArrisons 20e p2546
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Pt has depression and psychotic symptoms, so treatment is antidepressant along with antipsychotic drugs
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Migratory motor complex resumes 90 - 120 mins after the meal and occurs at interval of 90 mins till next meal.
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B i.e. Rosacea
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Bacteria Present at Most effective drug Rapidly multiplying Wall of tubercular cavity Isoniazid Intermittently dividing (Spuers) In casseous necrosis Rifampicin Slow multiplying Inside the macrophages Pyrazinamide
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The earliest manifestation of leprosy is the involvement of the cutaneous nerve, resulting in a loss of thermal sensation as the initial deficit and then evolving to involve other modalities like pain and touch. Sensory modalities subserved by larger fibers are lost in more advanced stages of the disease. Ref Harrison20th edition pg 1335
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Symptoms of nasal obstruction, mouth breathing and hearing impairment are due to adenoids, and adenoidectomy would be required. Since the child also suffers from hearing impairment (due to otitis media with effusion), a myringotomy with grommet insertion will be required. Simply doing myringotomy (optimised) will lead to recurrence unless cause (adenoids) is removed.
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D i.e. Increased triglyceride & cholesterol level in serum
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72 hours
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C i.e. Papaverine Papaverine is an opioid alkaloid with almost no central effectsQ (i.e. analgesia, sedation, euphoria, anxiolytic, addictive, respiratory depression). It does not suppress intestinal peristalsis, and relieves spasm in aeries. It is used to treat visceral (GI tract, bile duct, ureter) spasm, vasopasm of coronary & cerebral vessels and erectile dysfunction. It can also be used as smooth muscle relaxant in microsurgery, & cryopreservation of blood vessels and as a topical growth factor.
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A i.e. Absorbed in upper small intestineThe body of young adult contains - 1100gm (27.5mol) of Ca; 90% of it is in skeleton. The plasma calcium, is normally about 10gm/dL (5meq/ L, 2.5 mmol / L)Q, of which 50% is ionized. The remainder is bound ionically to negative charged proteins (predominantly albumin & immunoglobins) or loosly complexed with phosphate, citrate, sulphate. It is the free ionizedcalcium, that is a vital second messengerQ and necessary for blood coagulation, nerve conduction and muscle contractionQ.The level of plasma calcium at which fatal tetany occurs is still above the level at which clotting defect would occur.Since the extent of calcium binding by plasma protein is propoionate to the plasma protein level, it is impoant to know the plasma protein level when evaluating the total plasma calcium. An algorithm to correct for protein changes adjusts the totalserum calcium (in mg / dL) upward by 0.8 times the defecit in serum albumin (in gm/dl) or by 0.5 times the defect in serum immunoglobin (in g/dl). So corrected calcium concentration= Total calcium level (mg/dL) + 0.8 mg/dL (0.2MM) for every decrement in serum albumin of 1.0 gm/dL (below the reference value of 4.1 gm/dL of albumin).= Total calcium level (mg/dL) + 0.5 mg/dL for every decrement in serum immunoglobulin of 1gm/dL.PH affects the calcium level, for example tetany appear at much higher total Ca++ levels, if patient hyperventilates, increasing plasma pH. Plasma proteins are more ionized when the pH is high, providing more protein anion to bind with calcium thus reducing effective amount of ionized calcium. In same way acidosis increases ionized Ca++ levelsQ.Intestinal absorption of calcium involves both active (transcellular) and passive (pa racellular) mechanism. Passive absorption is nonsaturable & approximates 5% of intake, whereas active mechanism controlled by 1, 25, (OH)2 D, normally ranges from 20- 70%. Active absorption occurs mainly in proximal small bowel (duodenum & proximal jejunum)Q. Optical rates of Ca** absorption requires gastric acidQ. This is especially true for weakly dissociable calcium supplements as Ca CO3.Calcium interchange between plasma and rapidly exchangeable reservoir of bone is 500mmol per day. Whereas between plasma and stable pool of bone is only 7.5mmol/day. 98-99% of filtered calcium is reabsorbed - 60% of which occurs in PCT and remainder in ascending loop of Henle and distal tubule.Total diffusible calcium1.34- Ionized (Ca++)1.18- Complexed to HCO 3, citrate etc0.16Total nondiffusible (protein bound) calcium1.16- Bound to albumin0.92- Bound to globulin0.24Total plasma calcium2.50
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Eculizumab is a humanized IgG monoclonal antibody that binds the C5 complement component, inhibiting its cleavage into C5a and C5b thereby inhibiting the terminal pore-forming lytic activity of complement. Eculizumab is approved for patients with paroxysmal nocturnal hemoglobinuria (PNH) and dramatically reduces the need for red blood cell transfusions. Ref: Katzung 11th edition Chapter 61.
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Differential cyanosis
When one extremity is pink and the other extremity is cyanotic, it is referred to as differential cyanosis.
Causes of differential cyanosis
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Ans. is 'd' i.e., 4 Now, at least 4 antenatal visits, during pregnancy, are recommended.
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Aqueous penicillin can cross BBB and hence it is the drug of choice in patients of neurosyphilis.
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B i.e. Catatonic schizophrenia
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Robbins and Cotran pathologic basis of disease South Asia edition. *alpory's syndrome is an d linked dominant disorder having mutation in alpha 5 chain of type 4 collagen located on x chromosome. *phenylketonuria -is an autosomal recessive disorder . *myotonic dystrophy - autosomal dominant. *spinal cord atrophy-autosomal recessive.
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Diethyl toluimide /deetis an all purpose repellant.
They are used for application on skin, and their chief advantage is short duration of protection.Repellant are contact poisons.
They are used as peraonal protective measure against mosquito bite.
Other neasure are using mosquito nets and screening.
Parks textbook of preventive and social medicine.K Park
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These are physiological opacities and represent the residues of primitive hyaloid vasculature.
Patient perceives them as fine dots and filaments, which often drift in and out of the visual field, against a bright background (e.g., clear blue sky).
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Ans. c. There would be no differenceAccording to NAB (National Association for Blind), India Legal blindness is defined as visual acuity of not greater than 20/200 in the better eye with best correction or a visual field of less than 20 degrees.What does 20/200 means?A person with normal visual acuity can see an object clearly, at 200 feet; a legally blind person must be 20 feet or closer to see the same object.Note: 20/200 feet is same as 6/60 metersAccording to NPCB, the criteria for blindness (Economic Blindness) is visual acuity of <6/60 in the better eye with best possible correction.Thus, since both the criteria are same, the prevalence will remain same.
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C.tetani produces two distinct toxins- a hemolysin(tetanolysin), and neurotoxin(tetanospasmin). Tetanospasmin: This is the toxin responsible for tetanus. This toxin acts pre-synaptically. The abolition of spinal inhibition causes an uncontrolled spread of impulses initiated anywhere in the central nervous system. This results in muscle rigidity and spasms. Tetanolysin: it is not relevant in the pathogenesis of tetanus. Ref: Textbook of microbiology; Ananthanarayan and paniker's; 10th Edition; Pg: 265
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Ans. is 'a' i.e., Maxillary carcinoma
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Diabetes insipidus is condition characterised by excessive thirst excretion of large amounts of severely diluted urine Those with diabetes insipidus continue to uinate large amount of urine in spite of water deprivation.Ref: DM Vasudevan, 7th edition, page no: 373
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Seminoma is a malignant testicular neoplasm. All the other options are benign tumours.
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B i.e. The commonest position for the head of the humerus to move into is the subspinous
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The first trick to this question is to determine where the lesion is. The corneal reflex is tested by touching a cotton wisp to the eye. A normal response would be blinking of the ipsilateral eye as well as the contralateral eye (consensual reflex). The afferent limb of the corneal reflex is contained within the ophthalmic division of the ipsilateral ophthalmic nerve (V1), the efferent limb is by both (right and left) facial nerves (VII). This woman had a normal corneal reflex in her right eye, indicating a normal right V1 and right VII. However, she lacked a consensual reflex, indicating an abnormal left VIIth nerve. The next trick to this question is to determine what other signs a lesion in the left VIIth nerve could produce. A lesion in the left VIIth would also produce hyperacusis (increased sensitivity to sound) in the left ear because of paralysis of the stapedius muscle, which ordinarily dampens sound transmission through the middle ear. The absence of a pupillary light reflex of the left eye could be caused either by a lesion of the left optic nerve (CN II; afferent limb) or by a lesion of the left oculomotor nerve (CN III; efferent limb). The inability to abduct the right eye could be caused by a lesion of the right abducens nerve (CN VI), which innervates the lateral rectus muscle. Loss of pain and temperature of the left face could be caused by a lesion of the spinal nucleus of V. This nucleus is located in the medulla, and receives pain and temperature information from the face the trigeminal nerve (CN V). Ref: Rosenga A.J., Novakovic R.L., Frank J.I. (2005). Chapter 67. Coma, Persistent Vegetative State, and Brain Death. In J.B. Hall, G.A. Schmidt, L.D. Wood (Eds),Principles of Critical Care, 3e.
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Ans. is 'a' i.e., Cervical spine o In decreasing frequency, the metacarpophalangeal (MCP), wrist, proximal interphalangeal (PIP), knee, metatarsophalangeal (MTP), shoulder, ankle, cervical spine, hip, elbow and temporomandibular joints are most commonly affected.
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Boudaries of ischiorectal fossa
Anterior - Perineal membrane
Posterior - Gluteus maximus
Lateral - Obturator internus
Medial - External anal sphincter and levator ani
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Clopidogrel inhibits ADP receptors whereas Abciximab, Tirofiban and Eptifibatide are GP IIb/IIIa antagonists.
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Ans. Damage to sympathetic nerve supply
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Sentinel lymph node is the first axillary lymph node draining the breast. SLNB is done in all cases of early breast cancers ,T1 and T2 without clinically palpable nodes. It is not done in clinically palpable axillary nodes as tgere is already distoion of lymphatic flow due to tumour. SRB's Manual of Surgery.Edition -5. Pg no:543
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preservatives used in university of visconsin solution during organ transplantation a- lactobionate = minimize cel swelling and reperfusion b- glutathionate =antioxidant free c- allopurinol- radical scavenger d- adenosine - precursor of energy metabolism e- raffinose & hydroxy ethy starch - prevention of the extra cellular space expansion ref : bailey and love 27th ed
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Preterm infants, especially those under 28 weeks gestation are highly prone for apnea due to the poor development of mechanisms of respiratory control and have apnea of prematurity. Apnea soon after bih can occur due to bih asphyxia, maternal drug use, infections, metabolic causes and congenital anomalies. Reference: GHAI Essential pediatrics, 8th edition
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Ans. is 'c' i.e., Antigen-antibody complex mediated o The principal morphological manifestation of immune (antigen-antibody) complex injury is necrotizing vasculitis with necrosis of vessel wall and intense neutrophilic infiltration. o The necrotic tissue and deposits of immune complexes, complement and plasma proteins produce a smudgy eosinophilic deposition that obscures the underlying cellular detail, an appearance termed fibrinoid necrosis.
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b. Coarctation of aorta(Ref: Nelson's 20/e p 2205, Ghai 8/e p 413-433)Feeble femoral pulsations compared to strong brachial pulsations suggests of coarctation of aorta.
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Liquefaction temperature → 70-100o C
Gelation temperature → 37-45o C, just above oral cavity temperature.
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A i.e. Pilocarpine In inflamatory glaucoma (glaucoma with uveitis) pilocarpine (miotic) & prostaglandin analogue e.g. latanoprost are contraindicated Q because - Pilocarpine 1/t development of posterior synechiae Prostaglandin analogue enhance breakdown of aqueous barrier and exacerbate cystoid macular edema.
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Conduct disorder - Persistent pattern of antisocial behavior in which the individual repeatedly breaks social rules and carries out aggressive acts.in conduct disorder they do it deliberately usually characterized by aggression and violation of the rights of others boys with conduct disorder show physical & relationship aggression but in girls relationship aggression is more predominant than physical aggression children with conduct disorder usually have behaviors characterized by aggression to persons or animals, destruction of propey, deceitfulness or theft, and multiple violations of rules, such as truancy from school child with conduct disorder is prone to develop personality disorder and substance abuse
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Ans. (a) Remove the foreign bodyRef: Kanski's Clinical Ophthalmology 8th Ed; Page No- 879* CT scan is the investigation of choice for metallic Foreign Body (FB).* MRI is Contraindicated for metallic (Iron) FB.* Magnetic removal of magnetized FB.* Forceps removal +- pars plana vitrectomy for non-magnetic FB.* In penetrating trauma, patching should be done as the first line treatment.* SEIDEL Test: Used to locate the entry wound in penetrating by use fluorescein dye.
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Ans. is 'd' i.e., Nitrofurantoin Nitrofurantoin acts by generation of highly reactive intermediates which damage DNA. It does not inhibit cell wall synthesis. Drugs inhibiting cell wall synthesis - beta-lactarn antibiotics (Penicillin, Cephalosporins, monobactoms, Carbapenems), Cycloserine, bacitracin, vancomycin, fosfomycin. o Cause leakage from cell membrane - Polypeptides (Polymyxins, Colistin, tyrothricin), Polyenes (Amphotericin B, Nystatin, Hamycin), Azoles (Ketoconazole, fluconazole, intraconazole) o Inhibit protein synthesis - Tetracyclines, Chloramphenicol, Erythromycin, Clindamycin, Linezolid. o Cause misreading of m-RNA code and affect permeability- Aminoglycosides. Inhibit DNA gyrase - Nalidixic acid and fluoroquinolones. Interfere with DNA function - Rifampin, metronidazole. Interfere with DNA synthesis - Acyclovir, zidovudin. o Interfere with intermediary metabolism - Sulfonamide, Sulfones, PAS, trimethoprim, Pyrimethamine, Ethambutol.
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