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Ref: Diseases of Ear, Nose and Throat by Dhingra, 5th edition. Chapter on Cancer LarynxExplanation:TNM STAGING OF CANCER GLOTTIS ( AMERICAN JOINT COMMITTEE ON CANCER,GlottisTl: Tumour confined to vocal cords with normal mobilityConfined to one vocal cord.Extending to both vocal cords.T2: Supraglottic or subglottic extension of tumour with normal cord mobility.T3: Tumour confined to lary nx w ith vocal cord fixation.T4: Massive tumour with thyroid cartilage destruction and/or extension to confines of larynx.Regional Lymph Nodes (N)NX:Regional lymph nodes cannot be assessed (e.g. Previously removed).N0: No regional lymph node metastasis.N1: Metastasis in a single ipsilateral lymph node. 3 cm or less.N2: Metastasis in a single ipsilateral lymph node, more than 3-6 cm.N3: Metastasis in a lymph node more than 6 cm. Distant Metastasis (M)MX: Distant metastasis cannot be assessed.M0: No distant metastasis.M1: Distant metastasis.
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Emerging patterns of social behaviour from 1-5years of age 15months Indicates some desires or needs by pointing Hugs parents 18months Feeds self Seeks help when in trouble May complain when wet or soiled Kisses parent with pucker 24months Handles spoon well Often tells about immediate experiences Helps to undress Listens to stories when shown pictures 30months Helps put things away Pretends in play 36months Plays simple games (in "parallel" with other children) Helps in dressing (unbuttons clothing and puts on shoes) Washes hands 48months Plays with several children, with the beginning of social interaction and role-playing Goes to the toilet alone 60months Dresses and undresses Asks questions about the meaning of words Engages in domestic role-playing Ref: Nelson paediatrics; Table 11-1
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Ans. Sec. 375 IPC
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Ans is 'd' i.e. Esophageal reflux "Reflux esophagitis is the most common type of esophagitis. It occurs in patients with gastroesophageal reflux disease (GERD) secondary to dysfunction of the lower esophageal sphincter. " "Candidal esophagitis is the most common form of infectious esophagitis."-The Washington manual of surgical pathology pi 65
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Child is showing features of scabies, caused by infestation with Sarcoptes scabiei. It is usually acquired by sleeping with or in the bedding of an infested individual or by other close contact. Clinical Findings: Itching is the most common symptom. Lesions consist of generalized excoriations with small pruritic vesicles, pustules, and burrows in the web spaces and on the heels of the palms, wrists, elbows, around the axillae, and on the breasts of women. Nodular lesions may occur on the scrotum or penis and along the posterior axillary line. Diagnosis is confirmed by microscopic demonstration of the organism, ova, or feces in a mounted specimen examined with tap water. Ref: Current Medical Diagnosis and Treatment, 2012, Chapter 6; Harrison's Principles of Internal Medicine, 18th Edition, Chapter 169.
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Ans. is 'b' i.e., Adenomatous polyp
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Ans: D i.e. HypeensionThe nephrotic syndrome, also due to glomerular disease, is characterized by heavy proteinuria (more than 3.5 gm/ day), hypoalbuminemia, sever edema, hyperlipidemia, and lipiduria (lipid in the urine)Nephritic syndrome is due to glomerular disease and is dominated by the acute onset of usually grossly visible hematuria (RBC in urine), mild to moderate proteinuria, and hypeension; it is the classic presentation of the post-streptococcal glomerulonephritis
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The four vitamins, namely vitamin A, D, E, and K are known as fat or lipid soluble. water soluble vitamins thiamine, riboflavin, niacin, pyridoxine, pantothenic acid, biotin, folic acid, Vit B12, ascorbic acid ref DM vasudevan 8th ed page 466
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(Ref: KDT 6/e p750) Mycobacterium avium complex infection is treated with combination of rifabutin, ethambutol and clarithromycin.
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Transverse rectus abdominis myocutaneous flap(TRAM) is used. TRAM flap is based on superior epigastric aery. Ipsilateral or contralateral flap can be used. It gives the bulk needed for reconstruction and so implant is not needed. Donor site morbidity and fat necrosis can occur. LD flap( latissimus dorsi musculocutaneous flap) can also be used. It is based on subscapular aery. Easy to perform unlike TRAM flap. Reference: SRB's Manual of Surgery, 6th Edition page no = 553.
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Ans. is 'b? i.e., Endometrial ea Benefits of OCPs:Contraceptive benefits:Protection against unwanted pregnancy (failure rate 0.1 per 100 women year)Convenient to useNot intercourse relatedReversibilityImproving maternal and child healthcareNon contraceptive benefits:Improvement of menstrual abnormalities:o Regulation of menstrual cycleo Reduction in dysmenorrhoea (40%), menorrhagia (50%), premenstrual tension syndrome (PMS) and mittelschmerz's syndromeo Protection against iron deficiency anemiaProtection against health disorders:o Pelvic inflammatory' diseaseo Endometriosiso Ectopic pregnancyo Fibrous uterus (Progesterone only pills)o Hirsutism and acneo Functional ovarian cystso Benign breast diseaseo Osteopenia and postmenopausal osteoporotic fractureso Autoimmune disorders of thyroido Rheumatoid arthritisPrevention of malignancies:o Endometrial cancer (50%)o Epithelial ovarian tumours (50%)o Colorectal cancer (40%)Also beneficial in - o DUBo Hormonal therapy for hypothalamic amenorrheao Prevention of menstrual porphyria
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Extrahepatic binary atresia
Biliary Atresia is the absence of patent bile duct draning the liver.
The abnormality found most commonly is complete atresia of extrahepatic biliary structures.
Infants with biliary atresia often has an uneventful neonatal course until jaundice is noted at 2-3 weeks of age.
Conjugated hyperbilirubinemia occurs.
Urine is dark in colour
Stools may be normal or clay coloured (acholic).
The liver may be of normal size early, but it becomes enlarged with time.
Liver becomes hard as a consequence of progressive cirrhosis
Splenomegally is usually seen
Laboratory findings
Direct bilirubin levels over 3 mg/dl
Alkaline phosphatase elevated to 500-1000 units/L
Gamma Glutamyl transpeptidase levels > 300 units/L
Imaging studies
Absence or inability to visualize a contracted gall bladder on USG
Serial Scintiscans of right upper abdomen should be obtained after injection of Technitium Tc 99m. labeled iminodiacetate. Compounds (IDA, HIDA, PIPIDA) --> Liver fails to secret these compounds into the duodenum due to biliary obstruction.
Needle biopsy of the liver - If bleeding and clotting tests are normal.
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(Length of one upper limb x 2) +34 is equal to stature. Height of head x 8 is equal to stature Length from veex to pubis x 2 is equal to height Length of foot x 7 is the approximate height Suprasternal notch to pubic symphysis x 3.3 is equal to stature. Ref: FORENSIC MEDICINE AND TOXICOLOGY Dr PC IGNATIUS THIRD EDITION PAGE NO 96
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(Free margin of lesser omentum): Ref: 275-BDC-2, 268-Snell 7thBile-Duct - The bile duct (common bile duct) is about 3 in (8 cm) long in the first part of its course, it lies in the right free margin of the lesser omentum in front of the opening in the lesser sac.Bile duct relationsA. Supraduodenal part In the free margin of lesser omentum1. Anteriorly: Liver2. Posteriorly: Portal vein and epiploic foramen3. To the left: Hepatic arteryB. Retroduodenal part:1. Anteriorly: first part of duodenum2. posteriorly: IVC3. To the left: gastroduodenal arteryC. Infraduodenal part:1. Anteriorly: A groove in the upper and lateral parts of the posterior surface of the head of the pancreas2. Posteriorly: IVCD. Intraduodenal part
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Ans. is 'd' i.e., Macrocytic anaemia "The most common adverse effect of zidovudine is myelosuppression, resulting in macrocytic anemia (1-4%) or neutropenia (2-8%)". So most common side effect of zidovudine is neutropenia (2-8%) followed by macrocytic anemia (1-4%). Other side effects are - nausea, anorexia, headache, insomnia, abdominal pain, myalgia, malaise, fatigue, myopathy, lactic acidosis, hepatomegaly with steatosis, convulsions and encephalopathy.
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Gluteus maximus and Tensor fascia lata has their insertion on Iliotibial tract.
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We do not need any reference to answer this paicular question as the answer is hiddeb in the question only. The question itself says that no active bleeding is seen-so no need to do anything just observe the patient and because his BP is 200/100 Hg which is quite high,give him antihypeensive drugs. Ref.Scott Brown 7/e,Vol 1,p 1065
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Ans. D. Munchausen syndrome by proxy syndromeFactitious disorder imposed on another (FDIA) formerly Munchausen syndrome by proxy (MSP) is a mental illness in which a person acts as if an individual he or she is caring for has a physical or mental illness when the person is not really sick.
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Ans. is 'c' i.e., Tricuspid atresia Classification and diagnosis of congenital hea diseases. o Congenital hea diseases are basically divided into the following groups : ? Structural hea defects In general these defects are known as congenital hea diseases. Functional hea defects e.g., congenital cardiac arrhythmias. Positional hea defects e.g., dextrocardia. Structural hea defects (Congenital hea disease) o These are divided into two main groups. Acyanotic congenital hea diseases Cyanotic congenital hea diseases. o Each group is fuher divided according to : - i) Pulmonary blood flow Increased, normal or decreased (oligemia). Dominated (hyperophied ventricle) ---> Right or left.
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Mastitis in many cases the lactiferous ducts will first become blocked by epithelial debris leading to stasis; this theory is suppoed by the relatively high incidence of mastitis in women with a retracted nipple.Periductal fibrosis is a sequela of periductal mastitis and may result in nipple retraction.Schwaz surgery 15th edition pg: 509
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Balanced force concept uses Flex-R file and is described as "Positioning and pre-loading an instrument through a clockwise rotation and then shaping the canal with a counterclockwise rotation".
Many authors discovered that greater risk of instrument damage was associated with clockwise movement.
For best results, preparation is completed in a step-down approach.
After mechanical shaping of coronal and middle thirds with Gates-Glidden drill, insertion of the instrument is done with a quarter turn clockwise rotation while slight apical pressure is applied.
Cutting is accomplished by making a "Counterclockwise rotation".
The counter-clockwise rotation and apical pressure act together to enlarge and shape the canal to the diameter of the instrument.
The clockwise rotation should not exceed 90° while the counterclockwise motion must be 120° degrees or greater.
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Ans. (C) 7-methylguanosine cap(Ref: Harpers Illustrated Biochemistry 31st Ed; Page No- 396)Eukaryotic mRNA has 7-methylguanosine cap at 5' end and poly-A tails at 3' end. The 7-methylguanosine caps help the ribosome to recognize the site of attachment to the mRNA.Once the ribosome binds the 5' end, they then scan downstream until they encounter an AUG Codon (Start codon)AAUAAA is present at the 3' end, is the polyadenylation sequence (Poly A tail); they help stabilize the mRNA, facilitate its exit from the nucleus and aid in translation. After the mRNA enters the cytosol, the poly-A tails is gradually shortened.tRNA molecule serve as adaptors for the translation of the information in the sequence of nucleotides of the mRNA into specific amino acids.Extra EdgeDifferences between Eukaryotes and Prokaryotes in the Initiation of Protein Synthesis EukaryotesProkaryotesInitiation factorseIFs (12 or more)IFs (3)Ribosomes80S (40S and 60S subunits)70S (30S and 50S subunits)Binding of mRNA to small ribosomal subunitCap at 5'-end of mRNA binds elFs and 40S ribosomal subunit containing methionyl tRNAiMet. mRNA is scanned for AUG start codon within the Kozak consensus sequenceShine-Dalgarno sequence upstream of initiating AUG binds to complementary sequence in 16S rRNAFirst amino acidMethionineFormyl-methionine
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<p>Splenomegaly is seen in CML,polycythemia vera & chronic idiopathic myelofibrosis.Whereas in primary thrombocytosis, splenomegaly is least likely associated ,but hemorrhagic & thrombotic events are common. </p><p>Reference :Harsh mohan textbook of pathology sixth edition pg no 360.</p>
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Activation energy is free energy difference between the substrate & transition state.
Activation energy may be also be defined as the minimum energy required to start a chemical reaction.
Reference-Harper 30th edition pg -75
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Papilloedema causes gradual loss of vision.
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Drug elimination is the sum total of metabolic inactivation and excretion.
Depending upon the ability of the body to eliminate a drug, a certain fraction of the central compartment may be considered, to be totally 'cleared' of that drug in a given period of time to account for elimination over that period.
Reference: Essentials of Medical Pharmacology Eighth Edition KD TRIPATHI page no 38
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Answer is A (Primary Hyperparathyroidism): Serum Calcium with Decreased Serum Phosphate levels are typical of Primary Hyperparathyroidism
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Transverse ligament forms the horizontal part of cruciform ligament.
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Management of appendicular mass Ochsner-Sherren regimen * Conservative treatment with * Nil by mouth * Ryle&;s tube aspiration * Antibiotic therapy * Cephalosporins * Atninoglycoside * Metronidazole * Recording of size of mass daily * Recording of TPR cha 4hourly * Input & output cha ref : bailey and love 27th ed
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Parameters specific in ruling out Malnutrition LOSS OF LEAN BODY MASS MUSCLE WEAKNESS DEVELOPMENTAL OR INTELLECTUAL DELAY INFECTIONS IMMUNE DYSFUNCTION DELAYED WOUND HEALING PROLONGED HOSPITAL STAY REF : OP GHAI 9TH ED
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Answer is A (Coical adenoma): Conn's syndrome by defination refers to primary aldosteronism secondary to an aldosterone producing adrenal adenoma. The most common aldosterone producing adrenal tumor is a unilateral adrenal adenoma. Adrenal carcinoma is a rare cause of primary aldosteronism. Primary Aldosteronism secondary to bilateral coical hyperplasia is not defined as Conn's syndrome. Primary Aldosteronism Associated Adrenal Tumor Adrenal Adenoma (Conn's syndrome) Adrenal carcinoma (Rare cause) According to Harrisons 17th edition the most common cause of Conn's syndrome is an aldosterone producing adrenal adenoma. Most cases are unilateral() with a smallQ adenoma which may occur on either side. Without Associated Adrenal tumor Bilateral Coical Hyperplasia (Idiopathic Hyperoldosteronism)/Nodular hyperplasia) According to Harrisons I7th edition the most common cause for primary Hyperaldosteronism is Bilateral coical Hyperplasia. `These patients constitute 80% of patients with Primary Hyperaldosteronism' (Harrison)
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Time sector scanning of neonates is preferred because of the practical reason the open fontanelle serve as acoustic windows. Best results are obtained with a high-frequency phased array transducer (5-8 MHz) with a small footprint probe. Additional information : Neurosonography stas with gray-scale imaging performed the anterior fontanelle in the coronal and sagittal planes. Generally, six to eight coronal images are obtained, beginning at the anterior frontal lobes and extending to the occipital lobes posterior to the lateral ventricle trigones. The transducer is then rotated 90deg and five sagittal images are obtained, including a midline and two parasagittal views of right and left hemispheres encompassing the peripheral coex . Color Doppler images for aerial and venous structures may be obtained for the screening of vascular structures. Documentation of Doppler imaging of the circle of Willis and the region of vein of Galen is an essential pa of the assessment
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A major cause of spontaneous aboions in the first trimester is chromosomal abnormalities; however, the causes of losses in the second trimester are more likely to be anatomical in origin for which an HSG can be done, endometrial biopsy in luteal phase rules out luteal phase defect A postcoital test is useful for couples who cannot conceive, due to abnormal sperm cervical interaction, but does not address post-conception losses.
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Dextrocardia occurs due to situs invertus.
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Ans. Epithelium
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There are no pain receptors in the brain itself. But he meninges (coverings around the brain), periosteum (coverings on the bones), and the scalp all have pain receptors. Surgery can be done on the brain and technically the brain does not feel that pain Ref: guyton and hall textbook of medical physiology 12 edition page number:685,686,687
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Ans. A. Subnuclear vacuolation. (Ref. Williams9 Gync lst/Fig,15-20; Obstetrics Dutta 7th/pg. 17-18).The endometrial cycle follows the changes in the endometrium during the 'menstrual' cycle. It is divided into phases with characteristic histological changes:# Proliferative phase (pre-ovulatory) - can be though of as building the endometrium at the same time as the follicle is maturing for ovulation (need to grow before it can secrete)# Interval phase# Secretory (post-ovulatory)- can be thought of as preparing for implantation (secretory in order to support implantation)# Menstrual phaseProliferative PhaseThe glands are simple. Mitotic activity is conspicuous. In the endometrium, the proliferative activity occurs even before the complete cessation of menstruation, i.e. a few days into the cycle. The glands at this earlier stage are relatively straight or at most slightly coiled and are found within relatively loose endometrial stroma. There is brisk cell division with prominent mitotic activity in both the glands and the stroma. Under the influence of oestrogen, the stroma is often the thickest at day 10. After this, the rate of glandular growth relative to the stroma results in coiling of the glands as the cycle moves towards ovulation. The nuclei rather than central are pseudostratified, though they tend to be found in the basal half.Interval PhaseThe interval phase occurs over a short period of 24-48 hours. 1-2 days folllowing ovulation, there is peak of luteinizing hormone and increased progesterone, which brings on the secretory changes. The early interval phase is therefore indistinguishable from late proliferative phase without biochemical corrobation. The cut-off is somewhat arbitrary, but there may be a brief overlap of proliferative and secretory phase features, the latter manifest as subnuclear vacuolation.Secretory PhaseThe amount of subnuclear vacuolation is at its maximum in the early secretory phase (days 3-4 post-ovulation or days 17- 18 of the cycle) and are initially seen to line up giving the appearence of a line of vacuoles and a line nuclei. Mitotic activity is minimal as the glands are no longer dividing, but the cells dilate and become more tortuous. As the cycle moves into the mid-secretory phase, the vacuoles begin to be found above the nuclei as they head for the luminal surface.# Early secretory phase change. There are subnuclear vacuoles. The glands are beginning to become convoluted. Mitotic activity is now absent.# In the mid-secretory phase (days 5-11 post-ovulation or days 19-25 of the cycle), the glands remain dilated, but become more irregular with a papillary or saw-tooth appearence. The vacuoles move to a supranuclear position and the contents may be seen within the lumina. The stroma becomes looser and more oedematous, becoming most prominent at days 20-22. Day 21 is regarded as the optimal time for implantation. Decidualisation of the stroma also occurs.# In the late secretory phase (days 26-28), decidualisation extends from the surface to the deeper stroma. Lymphocytes being to appear.Menstrual PhaseIn the absence of conception, hCG is not produced and corpus luteum is unable to sustain itself. Withdrawal of progesterone causes the stroma to crumble, forming balls of deep blue stromal cells (with H&E staining). Secretions are also exhausted at this stage and the glands break off. Red blood cells and neutrophils are mixed between the involuting structures.OVULATIONDefinition: It is a process whereby a secondary oocyte is released form the ovary following the rupture of graafian follicle and becomes available for the conception.Mechanism: A. Changes in the follicle:a. Preovulatory enelargement of the Graafian follicle due to accumulation of follicular fluid and measures 20 mm in diameter.b. The cumulus oophorus separates separates from the rest of granulosa cells and floats freely in the antrum. The inner layer of cells surrounding the oocyte is arranged radially and is termed corona radiata. The stigma develops as a conical projection, which penetrates the outer surface layer of ovary. The cumulus escapes out of the follicle as a slow oozing process, taking about 1-2 minutes along with varying amount of follicular fluid.c. Changes in the oocyte: Prior to ovulation its cytoplasmic volume is increased along with chnages in the number and distribution of mitochondria and in the golgi apparatus. Completion of arrested first meiotic division occurs with extrusion of the fitrst polar body, each containing haploid number of chromosomes.Causes:# LH surge: Sustained peak level of estrogen for 24-36 hrs in the late follicular phase -LH surge occurs form anterior pituitary (persists for 24 hrs) - Ovulation occurs approx 24-36 hrs after LH surge ->LH surge stimulates completion of reducation division of the oocyte -^initiate leutinisation, synthesis of progesterone and pgs. IT IS THE BEST PREDICTOR OF OVULATION.# FSH rise: Preovulatory rise of progesterone facilitates the positive feedback action of estrogen to induce FSH surge a increase in plaminogen activator a plasminogen a plasmin a helps lysis of the walls of follicle. Thus, the combined LH/FSH midcycle surge is responsible for the final tage of maturation, rupture of the follicle, and expulsion of the oocyte.# Stretching factor# Contraction of micromuscles in the theca externa and ovarian stroma due to increased pg synthesis.
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In AV block, HR is 40 bpm and b blockers fuher causes cardiac depression. Therefore they are avoided in this condition. In all other 3 conditions, b blockers are used.
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(Vas deference) (1403-LB) (1377-B &L 25,h)* The testis develops from the genital fold medial to the mesonephros (Wolffian body)* The Wolffian duct becomes the epididymis and vas deferensDevelopment of genitourinary System:Embryonic structureStructure developing in MALEStructure developing in FEMALEGenital tuberclePenis (C. cavernosa)ClitorisUrethral foldsPenile urethra (C. spongiosa)Labia minoraGenital swellingScrotumLabia majoraGubemaculumGubemaculums testisLigament of ovaryRound ligament of uterus Genital glandsTestisOvary (genital ridge)Germinal cordsSeminiferous tubulesPfluger's tubeMesonephric duct (Wolffian duct)Epididymis, Vas deferens and seminal vesicles Ejaculatory ductsAppendix epididymidisDuct of epoophoron Gartner's duct vesicular appendageUreter, renal pelvis etc Trigonal structure**Ureter, renal pelvis, et^ Trigonal structuresMullerian duct (Paramesonephric duct)Appendix testisProstatic utricleUterine tubes, Uterus, Vagina (upper four- fifths)Muller's tubercleVeromontanumSite of hymenSinovaginal bulb from urogenital sinusPart of prostatic utricleLower one-fifth of vaginaJunction of sinovaginal bulb and urogenital sinusDisappears normally (remnants probably from posterior urethral valves)HymenUrogenital sinusVentral and pelvic partUrinary bladder (except the trigone)Supramontanel part of prostatic urethraUrinary bladder (except the trigone) whole urethraPhallic or urethral portionInframontanal part of prostatic urethra Membranous urethraVaginal vestibules
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Ans. A i.e. Neuron Nissl body/Nissl or tigroid substance It is a large granular body found in neurons. These granules are rough endoplasmic reticulum (RER) with rosettes of free ribosomes, and are the site of protein synthesis. It was named after Franz Nissl, a German neurologist who invented the Nissl staining method
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Ans. is 'c' i.e., Paired T-test o Paired T - test : is applied to paired data when each individual gives a pair of observation, such as when observations are made both before and after the play of a factor. e.g. Pulse rate before and after administration of a drug.
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Most cardiac muscle diseases are secondary to some other condition, e.g., coronary atherosclerosis, hypeension, or valvular hea disease. However, there are also cardiac diseases attributable to intrinsic myocardial dysfunction. Such diseases are termed cardiomyopathies (literally, "hea muscle diseases"); these can be primary--that is, principally confined to the myocardium--or secondary presenting as the cardiac manifestation of a systemic disorder. Cardiomyopathies are thus a diverse group that includes inflammatory disorders (e.g., myocarditis), immunologic diseases (e.g., sarcoidosis), systemic metabolic disorders (e.g., hemochromatosis), muscular dystrophies, and genetic disorders of myocardial fibers. In many cases, the cardiomyopathy is of unknown etiology and thus is termed idiopathic; however, a number of previously "idiopathic" cardiomyopathies have been shown to be the consequence of specific genetic abnormalities in cardiac energy metabolism or in structural and contractile proteins. (Robbins Basic Pathology,9th edition,pg no.397)
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C i.e. Varus / valgus stress test in 30deg of flexion Lachmans test , most sensitive for ACL injury is done in 20deg of knee flexion. Tension in ACL is least at 30 - 40deg of knee flexion Main test for MCL (medial collateral ligament) is valgus (abduction) stress in 30deg of knee flexionQ. Because in full extension it is indicative of combined MCL, posterior oblique ligament injury & possible cruciate ligament injury. Varus (Adduction) stress test in 30deg flexion removes the lateral stabilizing effect of illotibial band so that the lateral collateral ligament can exclusively be examined. Mechanism of Injury Valgus force MCL Varus force LCL Backward force PCL Twisting Injury - ACL - Menscus (medial & lateral) - MCL Examination Direction of Force Position of knee Ligament Tested Varus /Valgus Full extension PCL, Posterior capsule LCL MCL Varus Valgus 30deg flexionQ 30deg flexionQ Posterior 90deg flexion PCL Anterior - 30deg flexionQ (lachman's test) - 90deg flexion (anterior drawer) ACL
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(C) Knee joint # Synovial joints (or diarthroses, or diarthroidal joints); are the most common and most moveable type of joints in the body.> As with all other joints in the body, synovial joints achieve movement at the point of contact of the articulating bones.> Structural and functional differences distinguish the synovial joints from the two other types of joints in the body, with the main structural difference being the existence of a cavity between the articulating bones and the occupation of a fluid in that cavity which a ds movement.
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There are 3 blades commonly used by Surgeons: - * 11' size- For Incision and Drainage of Abscess, Aeriotomy * 15' Size- For precise cosmetic incisions * 22' Size- For Long Incisions and Laparotomy Incisions Ref:- Surgery Sixer 3rd Edition; Pg num:- 39
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Ref: Sabiston Textbook of Surgery, 19th edition, Page 1095Explanation:"Desmoid tumours are commonly associated with familial adenomatous polyposis (FAPi in which colonic polyps are the most common feature. "Ref: SabistonDESMOID TUMOURDesmoid tumor, also known as fibromatosis or aggressive fibromatosis.It is an uncommon neoplasm that occurs sporadically or as pail of an inherited syndrome associated with:o Familial adenomatous polyposis (FAP). o Gardner's syndrome, an autosomal dominant syndrome of GI adenomatous polyps or adenocarcinoma, osteomas, and skin and soft tissue tumors.PathophysiologyArise from fibroaponeurotic tissue.Lack metastatic potential.Locally aggressive and invasive, with a high propensity for recurrence.Associated with oral contraceptive use.Estrogen receptors.ClassificationDesmoid tumors are typically classified by location:Extra-abdominal or extremity desmoids (i.e., those tumors occurring in the proximal extremities or limb girdle).Abdominal wall tumors.Intra-abdominal desmoids, which involve the mesentery, pelvis, or bowel wall.Clinical FeaturesMajority of desmoid tumors are sporadic.Typically in young women during pregnancy or within a year of childbirth.Typically present as a slowly growing mass.Usually present with an asymptomatic mass or with symptoms related to mass effect from the tumor.Often a temporal association between the discovery of the tumor and an antecedent history of abdominal trauma or operation.InvestigationsImaging (CT or MRI) is necessary to delineate the extent of tumor involvement fully.No need to perform staging for metastatic disease.Biopsy is required to establish the diagnosis.Core needle biopsy or incisional biopsy will demonstrate a tumor composed of bundles of spindle cells and an abundant fibrous stroma.Immunohistochemistry can help clarify difficult diagnoses.Typically stain positive for b-catenin, actin, and vimentin and stain negative for cytokeratin and S-100.ManagementSurgerySurgery is the treatment of choice.Resection of the tumor with a wide margin of normal tissue is the optimal treatment.Often, the extent of this resection will require abdominal wall reconstruction with local tissue Haps or mesh prostheses.RadiationAbdominal wall desmoids are responsive to radiation therapy, although the treatment effect is slow and may be progressive over several years.Radiotherapy as Primary TreatmentRadiotherapy alone is an acceptable treatment option for patients w ith unresectahle desmoid tumors or minors for which resection will he associated with high morbidity risks or major functional loss.Adjuvant RadiotherapyAd juvanl radial ion therapy is controversial, with most centers reserv ing this modality for patients with positive margins, or close margins.Neoadjuvant RadiotherapyThe use of neoadjuvant radiation therapy is less v ell accepted than adjuvant radiation therapy because of the slow response times, often 1 year or more, with the potential for making subsequent abdominal wall reconstruction more difficult, and few studies demonstrating a clear benefit.Adjuvant Medical TherapyTamoxifen.NSA1DS particularly Indomethacin and Sulindac.Imatinih A tyrosine kinase inhibitor.Chemotherapy- Methotrexate with vinblastine, doxorubicin-based therapy, and ifosfamide- hased regimens.For desmoids with rapid growth, medical oncologists may recommend therapies typically used for sarcomas, such as doxorubicin and dacarbazine.
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Menorrhagia - Increased menstrual flow (>80ml) / increased duration at regular cycles. (>5 days) Treatment 1st line - NSAIDS Tranexamic acid 2nd line - hormones - Progesterone > estrogen Danazol GnRh analogues- stops periods. 3rd line - Surgical management Dilatation and Currettage Endometrial ablation Hysterectomy
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6 month old infant presented with multiple papules & exudative lesions on the face, scalp, trunk and few vesicles on palms and soles for 2 weeks. His mother has H/O itchy lesions. The most likely diagnosis is scabies. infantile scabies is characterised by vesicles erythematous papules,pustules , vesicles over the face , scalp, palms and soles.. family history in mother is suggestive of scabie infection Infantile eczema:-Infantile phase:- AD more acute with predominantly involving face,scalp and extensor surfaces of extremities.Typically there are papules,vesicles,excoriations and exudation. Infantile seborrheic dermatitis lesions are greasy scaly plaques present over the scalp. Crusted lesions over the cheeks, and extensor aspect of upper and lower limbs. Impetigo lesions are presented as bullae or crusted lesions with honey comb crust. iadvl textbook of dermatology page 459
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Polarizing microscopy, X-ray diffraction and infrared spectroscopy are techniques for analysing renal and gall bladder stones.
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This patient should increase both the 7 AM (pre break fast) and pre-dinner doses of crystalline zinc (regular) insulin. The dosage of rapid-acting regular insulin administered before breakfast and dinner can be adjusted on the basis of the pre-lunch and bedtime blood glucose values, because the peak effect of the regular insulin injections will occur at these times. Because both the pre-lunch and the bedtime glucose levels are significantly elevated, both doses of regular insulin should be increased. The dosage of neutral protamine Hagedorn (NPH) insulin can be monitored using the pre-dinner and pre-breakfast blood glucose determinations, because the morning and evening NPH injections will have their peak effect at these times. Because both pre-dinner and pre-breakfast levels are normal, there is no need to adjust NPH dosage. Ref - Harrison's principles of internal medicine 20e pg 2683-84,2684f
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Tuberculosis Preventing exposure to tuberculosis is impoant when there is an infectious case in the household, in clinics and in hospitals.Adequate ventilation, masks and safe coughing procedures reduce the risk of exposure. For HIV-uninfected individuals with latent TB infection (LTBI), the lifetime risk of developing active TB due to reactivation is 8 to 10%. In contrast, this risk is approximately 10% per year for HIV-infected persons (128, 142, 227, 228). Ref Harrison 20th edition pg 879
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"Oblique fracture may need a lag screw, neutralization by tension band system or plate". - Apley's.
Treatment of olecranon fracture :
Treatment of olecranon fracture may be either conservative or surgical.
Conservative treatment :
Conserative treatment includes immobilization in above elbow slab. Indications are :
Undisplaced fractures.
Displaced fracture with displacement less than 2 nun.
Surgical treatmentn :
It is indicated in displaced fracture (> 2mm) and in avulsion fractures due to triceps pull.
Methods of fixation are :
Open reduction and internal fixation by figure of 8 tension band wiring (TB W) : It is the most commonly used method for olecranon fracture. This method is used for avulsion fractures : transverse fractures when the fracture is proximal to coronoid : and sometimes oblique fractures.
Lag screw fixation (interfragmentary screw) : Used in comminuted fracture when the distal fragment is displaced anteriorly and in the oblique fracture.
Plate and screw fixation with grafting : Displaced comminuted fracture where tension band wiring is not possible.
Excision of the proximal fragments.
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Ans. is 'a' i.e., Ach chlinestrase activity derangement Dibucain number : Dibucain (a local anaesthetic) inhibits 80% of normal pseudocholinesterase and 20% of atypical (non-functional) pseudocholinesterase. Therefore normal dibucain number is 70-80%. Dibucain number is used to measure the activity of atypical pseudocholinesterase.
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Ans. B. Increased melanocytesSimple lentigo occurs due to an increase in melanocytes at dermal-epidermal junction.* Simple Lentigo also known as Lentigo simplex is a light- to dark-brown or black macule that does not fade away once it appears.* They usually appear during childhood and increase in number until the age of 40.* It is more common in individuals with red hair and fair skin.Lentigo simplex: Hyperpigmentation is evident in the basal and squamous epidermal cells. There is a slight increase in non-atypical melanocytes between the epidermal basal cells. Magnification 40x(H&E).
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Ans. is 'a' i.e., Local distribution of disease o Inner and outer city variations in disease frequency are well known. o These variations are best studied with the aid of "spot maps" or "shaded maps". o These maps show at a glance areas of high and low frequency, the boundaries and distribution. o For example, if the map shows "clustering" of cases, it may suggest a common source of infection or a common risk factor shared by all the cases. o The classical example of use of spot maps was by John snow for cholera epidemic in 1854.
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Chronic hepatitis B [Ref Robbin 7Th/e p. 8991 Cirrhosis of the liver is a pathological entity which clinically represents the end stage of chronic liver disease. It is characterized by three features. i) Bridging fibrous septa& in the form of delicate bands or broad scars linking poal tracts with one another and poal tracts with terminal hepatic veins. ii) Parenchymal nodulesQ containing proliferating hepatocytes encircled by fibrosis with diameters varying from very small to large. Cirrhosis is defined as micronodular or macronodular depending upon the size of parenchymal nodules Micronodular cirrhosisu - Parenchymal nodules < 3 mm in size Macronodular cirrhosisQ - Parenchymal nodules > 3 mm in size Viral hepatitis commonly causes macronodular cirrhosisdeg. In viral hepatitis the cirrhosis is characterized by irregularly large sized nodules separated by variable but mostly broad scars. This pattern of cirrhosis is historically called posnecrotic cirrhosise. Postnecrotic cirrhosis is not only applied to viral hepatitis but to all forms of cirrhosis in which the liver shows large irregular sized ntacronodules with broad scars regardless of the etiology. Also remember these Alcholic cirrhosis is typically micronodularQ, but can become macronodulare in later stages. Viral cirrhosis is typically macronodularQ. Cirrhosis associated with virus is called postnecrotic cirrhosis. Postnecrotic cirrhosis is also called posthepatitis cirrhosis macronodular cirrhosis and coarsely nodular cirrhosis. Cirrhosis in hemochromatosis is typically micronodularQ (can be macronodular sometimes). Wilson's disease causes macronodularQ cirrhosis. Biliary cirrhosis whether primary or secondary is micronodularQ.
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Mitochondrial membrane ruptures releasing substances like cytochrome c ....which play major role in apoptosis Ref guyton and hall textbook of medical physiology 12/e pg 40
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Ans. is d i.e., Myosin The inner hair cells of organ of coi have 50-200 ciliated structure called stereocilia. The top of each stereocilium is linked to the side of next adjacent higher stereocilium by means of a thin filamentous strucuture called the tip-link. Mechanically gated ion channels are located at these attachment points on the sides of stereocilia. Each stereocilium comprises of several actin filaments encased by a plasma membrane. The opening and closing of the ion channels is accomplished through the binding and unbinding of proteins at terminal ends of the tip links with a group of channel motor proteins (myosin) which move up and down the actin filaments of stereocilia.
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Ref: Grays Anatomy 40th edition pg: 244Explanation:Anatomy of OrbitThe orbits are conical or four-sided pyramidal cavities, which open into the midline of the face and point back into the head.Each consists of a base, an apex and four walls.The base, which opens in the face, has four borders.Borders of Orbital BaseSuperior margin: Frontal boneInferior margin: Maxilla Palatine and ZygomaticMedial margin: Frontal. Lacrimal and EthmoidLateral margin: Zygomatic and SphenoidWalls of the OrbitMedial Wail of the OrbitThis is the thinnest wall of the orbitFormed by four bones1. Frontal process of maxilla2. Lacrimal bone3. Orbital plate of ethmoid4. Body of sphenoidLateral wall of the OrbitThis is the strongest wallFormed by two bones1. Zgomatic bone2. Orbital surface of greater w ing of sphenoid RoofFormed by two bones1. Orbital plate of frontal bone2. Lesser wing of sphenoidFloorIt is formed by three bones1. Orbital surface of the body of the maxilla2. Zygomatic bone3. Orbital surface of Palatine bone
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Ans. is 'a' i.e., Ketamine
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Psychoanalysis : Sigmond Freud
Child psychoanalysis: Anna Freud
Analytical psychology: Carl Jung.
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duct ectasia; it is dialatation of lactiferous duct due to muscular relaxation of ductwall with periductal mastitis greenish discarge from the nipple indurated mass under the areola which is tendor eventually it forms Abscess and fistula associated with smoking treatment is cone excision of involved major ducts - Adair Hadfield operation ref ;(page no;525) 5th edition of SRB&;S Manual of SURGERY
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Omphalocele is a midline abdominal wall defect. The abdominal viscera (commonly liver and bowel) are contained within a sac composed of peritoneum and amnion from which the umbilical cord arises at the apex and center. When the defect is less than 4 cm, it is termed a hernia of the umbilical cord; when greater than 10 cm, it is termed a giant omphalocele. Associated abnormalities occur in 30-70% of infants and include, in descending order of frequency, Chromosomal abnormalities (trisomy 13, 18, 21) Congenital hea disease (tetralogy of Fallot, atrial septal defect) Beckwith-Wiedemann syndrome (large-for-gestational-age baby; hyperinsulinism; visceromegaly of kidneys, adrenal glands, and pancreas; macroglossia; hepatorenal tumors; cloacal extrophy) Pentalogy of Cantrell Prune belly syndrome (absent abdominal wall muscles, genitourinary abnormalities, cryptorchidism) Ref: Albanese C.T., Sylvester K.G. (2010). Chapter 43. Pediatric Surgery. In G.M. Dohey (Ed), CURRENT Diagnosis & Treatment: Surgery, 13e.
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MivacuriumMivacurium is the shoest acting competitive blockersIt does not need reversal -can be used as an alternative to SCh for endotracheal intubationIt is metabolized rapidly by plasma cholinesterases -prolonged paralysis can occur in pseudocholinesterase deficiency Mivacurium is the only nondepolarising (competitive) blocker that is metabolized by plasma cholinesterase (pseudocholinesterase).(Refer: stoelting's pharmacology and physiology in anaesthetic practice, 5th edition, pg no.328)
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Ans. is 'a' i.e. Eisenmenger syndrome This syndrome is secondary pulmonary hypertension that can develop with any cardiac lesion in which pulmonary vascular resistance becomes greater than the systemic vascular resistance and there should also be some right to left shunting. The most common underlying defects are atrial or ventricular septal defects and persistent ductus arteriosus.Patients usually are asymptomatic but eventually pulmonary hypertension becomes severe enough to cause right to left shunting.The prognosis for pregnancy depends upon the severity of pulmonary hypertension.The mortality rate in Eisenmenger's syndrome is 50%. It is the maximum mortality for any cardiovascular disorder in pregnancy. So termination of pregnancy is done in most cases.Maternal tolerance to specific heart conditions;Well toleratedPulmonary stenosisAortic insufficiencyMitral insufficiencyCongenital heart blockWell tolerated if pulmonary hypertension is not presentAtrial septal defectsVentricular septal defectsPatent ductusVariable tolerance depending on the functional capacity of the heartUncomplicated Aortic coarctationAortic stenosisMitral regurgitationAortic regurgitationPoorly tolerated and source of significant problems during pregnancyMitral stenosisPeripartum cardiomyopathyPrimary pulmonary hypertensionEisenmenger's syndromeMarfan's syndrome with dilated aortic rootMetallic valve prosthesisCongenital cyanotic heart diseaseConditions listed in group C if pulmonary hypertension is present.Any class III or IV lesion.
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Ans. (b) Elementary body is metabolically active Reproductive Cycle of Chlamydiae Elementary body (EB) Stable spherical form, metabolically inactive - Extracellular phase Infectious form 200 - 300 nm diameter Rigid trilaminar cell wall Electron dense nucleoid (contains DNA) DNA = RNA Attach to surface of susceptible epithelial cell near base of microvilli by adhesins (e.g. major outer membrane protein); receptors (heparin sulfate like proteoglycans in case of C. trachomatis) | Engulfment of EB into host cell either by endocytosis into clathrin-coated pits or pinocytosis into non-coated pits. Lysosomal fusion is inhibited by unknown mechanism, so EB form of chlamydiae is protected under membrane bound environment. | Reorganisation of EB by spheroplast-like transformation/loss of cross-linking of EB membrane proteins. Reticulate body (Initial body form) - Pleomorphic stage Intracellular form Growing and replicative form 500-1000 nm size No electron dense nucleoid RNA > DNA Within membrane bound vacoule RB divides by binary fission repeatedly to form EB. |Cytoplasmic inclusion bodies form (EB filled vacoule) |This EB liberate from host cell to infect new cells.
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Ans. is 'd' i.e., Oxidoreductase o Alcohol dehydrogenase is a NAD-linked dehydrogenase (oxidoreductase)o It catalyzes the oxidation of ethanol to acetaldehyde.
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The underlying aetiology of PHPT is usually a solitary parathyroid adenoma, however, in a small number of patient (2-4%), there are double adenomas. It may occur in a sporadic fashion or it can be familial (MEN type 1 or type 2A, hyperparathyroidism-jaw tumour syndrome (HPT-JT)Ref: Bailey and Love 27e pg: 826
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Ans. c. ESR is raised because of increased RBC aggregate (Ref: Robbins 9/e p99, 8/e p75)when an inflmmatory process is present, the high proportion of fibrinogen in the blood cuses RBCs to stick to each other. Erythrocyte Sedimentation rateFibrinogen binds to red cells and causes them to from stacks (rouleaux) that sediment more rapidly at unit gravity than do individual cells. This is the basis for measuring the ESR.ESR is simple test for systemic inflammatory response caused by any stimulus.The ESR is a simple non-specific screening test that indirectly measures the presence of inflammation in the body.It reflects the tendency of red blood cells to settle more rapidly in the face of some disease states, usually because of increases in plasma fibrinogen, immunoglobulins, and other acute-phase reaction proteins.Changes in red cell shape or numbers may also affect the ESR.Note that the ESR denotes merely the presence of tissue damage or disease, but not its severityIt may be used to follow the progress of the diseased state, or monitor the effectiveness of treatment.ESRIncreasedDecreased* PregnancyQ* InflammationQ* AnemiaQ* Rheumatoid arthritisQ* CancerQ* Kidney disorders* PolycythemiaQ* Sickle cell anemiaQ* Hereditary spherocytosisQ* Congestive heart failureQ
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Mercury colitis may resemble diptheritic colitis. Ref: Environmental and Chemical Toxins and Psychiatric Illness By James S Brown, Page 162; The Journal of Experimental Medicine
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Cheopis index:- It is average number of X. Cheopis / rat.
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Hyperacute rejection occurs when preformed anti-donor antibodies are present in the circulation of the recipient. Such antibodies may be present in a recipient who has previously rejected kidney transplant, Multiparous women, Prior blood transfusionsHyperacute Rejection occurs within minutes or hours after transplantation.Robbins pathology 9e Pg: 233
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Diagnosis is made by MRCP
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Acantholysis seen in diseases such as pemphigus vulgaris, pemphigus foliaceous,SSSS, Dariers disease. It is absent in bullous pemphigoid, making it useful for differential diagnosis. page no.110.Reference IADVL's concise textbook of dermatology
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A i.e. Azoospermia Prolonged administration of testosterone in males causes azoospermiaQ. Testosterone & Male sterility - The fact that intratesticular levels of testosterone need to be greater than 100 folds higher than circulating levels of hormone to maintain normal rates of spermatogenesis; however, it is the circulating levels of testosterone that provide the negative feedback to pituitary & hypothalamus is an impoant loophole in male reproductive axis. This means that exogenous testosterone (T) administration can raise circulating levels of T. sufficient to inhibit LH but not sufficient to accumulate in testis at required concentration for normal spermatogenesis. However, decreased LH levels will fuher diminish intratesticular production of testosterone by Leydig cells resulting in reduced spermatogenesis. - This is the cause for sterility in cases of prolonged testosterone administration or steroid abuse in menQ. And this loophole is recently being researched as a possible strategy for developing male oral contraceptives.
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B. i.e. Auditory hallucinations giving running commentary
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Tapering of veins on either side of the crossings Gunn sign is seen in grade III hypeensive retinopathy. Grade 1 Generalized aeriolar attenuation Broadening of aeriolar light reflex Concealment of vein at A-V Crossings Grade 2 Severe generalized and focal aeriolar constriction A-V crossing change (Salus sign) Grade 3 Copper wiring of aerioles Venous banking distal to a-v crossing (bonnet's sign) Venous tapering on either side of the crossing (Gunn's sign) Right angle deflection of veins Flame shaped haemorrhages, cotton wool spots, hard exudates Grade 4 All changes of grade 3 Silver wiring of aerioles Disc oedema
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The initial hemorrhage in placenta pre is usually painless and rarely fatal. If the fetus is premature and if hemorrhaging is not severe, vaginal examination of a woman suspected of having placenta pre frequently can be delayed until 37 weeks gestation; this delay in the potentially hazardous examination reduces the risk of prematurity, which is often associated with placenta pre. Vaginal examination, when needed to determine whether a low- lying placenta is covering the internal os of the cervix, should be performed in an operating room fully prepared for an emergency cesarean section. Increasing maternal age and multiparity are associated with a higher incidence of placenta pre. Also Know: Placenta pre is used to describe a placenta that is implanted over or very near the internal cervical os. There are several possibilities: Total placenta pre--the internal os is covered completely by placenta Paial placenta pre--the internal os is paially covered by placenta Marginal placenta pre--the edge of the placenta is at the margin of the internal os Low-lying placenta--the placenta is implanted in the lower uterine segment such that the placental edge does not reach the internal os, but is in close proximity to it Vasa pre--the fetal vessels course through membranes and present at the cervical os. Ref: Cunningham F.G., Leveno K.J., Bloom S.L., Hauth J.C., Rouse D.J., Spong C.Y. (2010). Chapter 35. Obstetrical Hemorrhage. In F.G. Cunningham, K.J. Leveno, S.L. Bloom, J.C. Hauth, D.J. Rouse, C.Y. Spong (Eds), Williams Obstetrics, 23e.
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The combination of proliferating fibroblasts, loose connective tissue, new blood vessels and scattered chronic inflammatory cells, forms a type of tissue that is unique to healing wounds and is called granulation tissue. This term derives from its pink, soft, granular gross appearance, such as that seen beneath the scab of a skin wound.
Robbins Pathology 10th ed page no 90
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Multiple proteins from a single gene may be generated by Alternative splicing Differential RNA processing The genome is same in all the somatic cells. But the transcriptome is different. Around 25,000 proteogenic genes code for more than 2 lakh proteins. Thus, proteome is more diverse than transcriptome. This is due to differential RNA processing/ Alternate RNA splicing/RNA editing/Alternate promoter utilisation/Alternate polyadenylation. -Mutation in the promoter leads to | frequency of transcription - option b is excluded. -RNA interference | half-life of mRNA - option c is excluded. -Alternate polyadenylation produces different proteins, not capping - option d is excluded.
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Ans. 1%
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Reflex resposible for tachycardia during right atrial distension is Bainbridge reflex. Atrial Reflex Control of hea rate: The Bainbridge Reflex The stretch recceptors of the atria that elicit the Bainbridge reflex transmit their afferent signals through the vagus nerve nerves to the medulla of the brain. Then efferent signals are transmitted back through vagal and sympathetic nerves to increase hea rate and strength of hea conntraction. Bezold-Jarisch Reflex: Activation of chemosensitive vagal C fibers in the cardiopulmonary region (eg,, Juxta capillary ragion of alveoli, ventricles, atria, great veins, and pulmonary aery) causes profound bradycardia, hypotension and a brief period of apnea followed by rapid shallow breathing. Cushing Reflex: When ICP is increased, the blood supply to RVLM neurons is compromised. The local hypoxia and hypercapnia causes an increase in discharge from the neurons, producing hypeension, bradycardia and irregular respiration. The resultant rise in systemic aerial pressure tends to restore the blood flow to the medulla. REF: Guyton and Hall 13th edition PGno: 223
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Ananthanarayanan and Paniker's textbook of microbiology 9th edition . IL1 helps in the proliferation and differentiation of T and B lymphocyte. IL2 Promote growth and differentiation of Tand B cells. IL4 promote proliferation B and cytotoxic T lymphocytes. IL12 activates NK cells.
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Many of the adverse changes can be accounted for by endotoxin release. Escherichia coli is the most common organism involved in gram-negative septicemia, followed by Klebsiella, Aerobacter, Proteus, and Pseudomonas. The cardiac index is high, peripheral resistance is decreased, and CVP is low to normal. The most common conditions leading to gram-negative sepsis are those of the urinary tract, followed by respiratory and biliary tract and abdominal visceral infections. Endotoxins are lipopolysaccharide complexes. The lipid A portion is probably responsible for the toxicity.
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Spider naevi- benign vascular lesion, can be solitary or multiple Characterized by a central red aeriole, representing the body of the spider, surrounded by a radial pattern of thin-walled capillaries, resembling legs. On release of central compression fills from center to periphery. Usual site to check for spider naevi - SVC distribution. Associated with: Thyrotoxicosis Estrogen-excess states- pregnancy, OCP Hepatorenal syndrome Liver cirrhosis Alcoholics Viral hepatitis Rheumatoid ahritis
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The synopsis of forensic medicine & toxicology ; Dr k.s narayan reddy ; 28th edition ; pg.no. 122 A shot gun have a muzzle ,barrels,choke bore but not a bullet .
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Fat intake should be 15-30% of total daily intake. Salt intake should be reduced to an average of not more than 5g per day. Saturated fat should Contribute no more than 10% of total energy intake. REF. PARK'S TEXTBOOK OF PREVENTIVE AND SOCIAL MEDICAL 21ST EDITION. PAGE NO - 589
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Ans. is 'b' i.e., It is common with exposure to UV rays Pterygiumo Pterygium is a non-cancerous (non-neoplastic) growth of conjunctiva, characterized by a wing-shaped fold of conjunctiva encroaching upon the cornea from either side within the interpalpebral fissure. Pterygium is always situated in the palpebral aperture.o Pathologically Pterygium is a degenerative and hyperplastic condition of conjunctiva. The subconjunctival tissue undergoes elastotic degeneration and proliferates as vascularized granulation tissue under the epithe Hum, which ultimately encroaches the cornea. The corneal epithelium, Bowman's layer and stroma are destroyed.Etiology & Clinical featureso Pterygium is more common in people with excess outdoor exposure to sunlight (UV rays), dry heat, high wind and abundance of dust. Therefore it is more common in those who work outdoorso Clinically it presents as a triangular fold of conjunctiva encroaching the cornea in the area of palpebral aperture, usually on the nasal side. Other findings are Stocker's line (deposition of iron)o Ptergyium is an asymptomatic condition in the early stages, except for cosmetic intolerance. Visual disturbance or corneal astigmatism may occur. Visual disturbances are due to encroachment of pterygium on pupillary area or corneal astigmatism.Occasionally diplopia may occur due to limitation of ocular movements.Treatmento Asymptomatic pterygium which is not progressive is best left alone. Surgical excision is the only satisfactory treatment and is indicated for:1) Cosmetic reasons,2) Continued progression threatening to encroach onto the pupillary area (once the pterygium has encroached pupillary area, wait till it crosses on the other side),3) Diplopia due to interference in ocular movement.o Simple excision ('bare sclera' technique) is associated with high recurrence rate (upto 80%) that may be more aggressive than the initial lesion. Thus conjunctival autografting is currently most popular approach. Adjunctive treatment with mitomycin C, beta-irradiation, and amniotic membrane patch grafting can also be used for aggres sive lesions.
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Ocular leprosy: The early clinical signs of ocular leprosy are, Lagophthalmos Loss of the lateral poions of the eyebrows and eyelashes (madarosis) Conjunctival hyperemia Superficial keratitis Interstitial keratitis--beginning typically in the superior temporal quadrant of the cornea--often supervening. Granulomatous iritis with lepromas (iris pearls) is common, and a low-grade iritis associated with iris atrophy and a pinpoint pupil may also occur. Hyperophy of the eyebrows with deformities of the lids and trichiasis late in the course of the disease. Exposure keratitis, typically in the inferior and central cornea, can result from facial motor nerve palsy and absence of corneal sensation. Ref: Pringle E., Graham E.M. (2011). Chapter 15. Ocular Disorders Associated with Systemic Diseases. In P. Riordan-Eva, E.T. Cunningham, Jr. (Eds), Vaughan & Asbury's General Ophthalmology, 18e.
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RBC can utilise only glucose even during fasting / starvation
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Ans. is less gestation age (Ref Nelson, 17/e, p 2113, 2114 (16/e, p. 1925); O.P. Ghai, 6/e, p 629 (5/e, p. 504)).There is always the confusion between pre-maturity (less gestation age) and O2 toxicity, as the predisposing factor (Some are also confused with low birth weight).Read these lines from Nelson. They will clear away most of your doubts."Retinopathy of prematurity occurs almost exclusively in pre-term infants."The risk factor's associated with ROP are not fully known, but prematurity and the associated retinal immaturity at birth represents the major factors.Hyperoxia is also a major factor but other problems, such as respiratory distress, apnea, bradycardia, heart disease, infection, hypoxia, hypercarbia, acidosis, anemia and the need for transfusion are thought by some to be contributory factors".Crux is Predisposing factor for ROP -Prematurity (les gestation age)* Precipitating factor -Hyperoxia*
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Ans. is 'a' i.e., Budd Chiari Syndrome * Young female with myeloproliferative disorder - points towards a procoagulant state* Presentation of acute onset abdominal discomfort and ascites mostly points to involvement of hepatic vein - probably thrombosis of hepatic vein due to the procoagulant state ->> so the most probable diagnosis is - Budd Chiari Syndrome.Budd Chiari syndrome* This is a condition principally affecting young females, in which the venous drainage of the liver is occluded by hepatic venous thrombosis or obstruction from a venous web.* Asa result of venous outflow obstruction, the liver becomes acutely congested, with the development of impaired liver function and, subsequently, portal hypertension, ascites and oesophagealvarices.* In an acute thrombosis, the patient may rapidly progress to fulmi- nant liver failure but, in the majority of cases, abdominal discomfort and ascites are the main presenting features.* If chronic, the liver progresses to established cirrhosis.* The cause of the venous thrombosis needs to be established, and an underlying myeloproliferative disorder or pro-coagulant state is commonly found, such as anti-thrombin 3, protein C or protein S deficiency.* The diagnosis is commonly suspected in a patient presenting with ascites, in whom a CT scan shows a large congested liver (early stage) or a small cirrhotic liver in which there is gross enlargement of segment I (the caudate lobe). This feature results from preservation and hypertrophy of the segment with direct venous drainage to the I VC in the face of atrophy of the rest of the liver due to venous obstruction.* IVC compression or occlusion from the segment I hypertrophy is also a common feature, as is thrombosis of the portal vein.* Confirmation of the suspected diagnosis is by hepatic venography via a transjugular approach, which demonstrates occlusion of the hepatic veins and may allow a transjugular biopsy.
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Membranous pa of ventricular system is a small poion of the ventricular and atrioventricular septum located at the base of the hea adjacent to the anteroseptal tricuspid commissure , the right aoic posterior valve commissure and the anterior mitral valve leaflet. Because of the apical displacement of the tricuspid valve compared to mitral valve, a poion of the membranous septum separates the left ventricle from the right atrium. The remaining three regions of the ventricular septum are inlet, outlet and trabecula. They are all muscular and and they radiate out from the membranous septum. Ref: Echocardiography in Pediatric and Adult Congenital Hea Disease edited by Benjamin W. Eidem, page 196.
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First generation drugs like norfloxacin have narrow spectrum. The concentration of norfloxacin reached in urine is bactericidal, thus it can be used for UTI but it is not effective for systemic use.
Second-generation drugs like ciprofloxacin and ofloxacin are effective against gonorrhoea and other gram-negative organisms including pseudomonas. Ciprofloxacin is the drug of choice for prophylaxis and treatment of anthrax and for prophylaxis of meningococcal meningitis.
Ciprofloxacin and levofloxacin are the only fluoroquinolones effective against Pseudomonas.
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Ans. is 'a' i.e., ThalassemiaThalassemia Syndromes :?The thalassemia syndromes are a heterogeneous group of disorders caused by inherited mutations that decrease the synthesis of either the a-globin or (3-globin chains that compose adult hemoglobin, HbA (a2(32), leading to anemia, tissue hypoxia, and red cell hemolysis related to the imbalance in globin chain synthesis.
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Ans. is 'a' i.e., ARDS ARDS Criteria 1. Acute, meaning onset over 1 week or less. 2. Bilateral opacities consistent with pulmonary edema must be present and may be detected on CT or chest radiograph. 3. PF ratio < 300 mmHg with a minimum of 5 cmH20 PEEP (or CPAP). 4. C VP < 18 mmHg. X-Ray showing bilateral infiltrates:
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Ans. (a) InsulinRef: Harper's Biochemistry, 30 ed. pg. 191-192th* Synthesis of glucose from non-carbohydrate source is called Gluconeogenesis.Hormonal Regulation Glucagon, epinephrine, glucocorticoids.| Insulin|* Gluconeogenesis is regulated by 4 key enzymes-# Pyruvate carboxylase# Phosphoenolpyruvate carboxylase# F16 bisphosphatase# G-6-phosphatase
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Ans. (d) T1 and T2 cancer with or without lymph node involvementRef: Sabiston 19th Edition, Pages 1356-1360Transanal excision of cancer rectum* T1N0 or T2N0 lesion <4cm in diameter* <40% circumference of the lumen* <10cm from dentate line* Well to moderately differentiated histology* No evidence of lymphatic or vascular invasion on biopsyOn Endo USG:* T1 and T2 lesions without nodes will be opted for Transanal excision
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openlifescienceai/medmcqa
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D i.e. Fracture long bones only
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openlifescienceai/medmcqa
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