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Rapid rewarming in a warm (98.6 degF to 102.2 degF / 37 degC to 39 degC) water bath is the treatment of choice. Slow rewarming may cause more tissue damage. Frostbite : Treatment * Rapid rewarming in 42degC water (do not thaw in field if refreezing might occur) * Narcotics * Tetanus prophylaxis * Topical antibiotics as for 2nd degree burns * No debridement surgery for at least several months unless wet gangrene / infection occur * If large amounts of tissue involved, watch for rhabdomyolysis / renal failure REF : NARAYANAREDDY
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D i.e. Liver
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Ceftriaxone and cefoperazone are excreted mainly in the bile, therefore do not require dose reduction in any grade of renal failure.
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Ans. is 'b' i.e.,Amylase
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Ipsilateral ophthalmoplegia due to 3rd, 4th ,& 6th cranial nerve involvement ptosis due to 3rd nerve paralysis. Ref .ak khurana 6th edition pg no 413
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Ans: C. CarbapenemsNew Delhi metallo-beta-lactamase f (NDM-f ):An enzyme that makes bacteria resistant to a broad range of beta-lactam antibiotics.These include the antibiotics of the carbapenem family, which are a mainstay for the treatment of antibiotic-resistant bacterial infections.The gene for NDM- I is one member of a large gene family that encodes beta-lactamase enzymes called carbapenemases.Bacteria that produce carbapenemases are often referred to in the news media as "superbugs".Because infections caused by them are difficult to treat.Such bacteria are usually susceptible only to polymyxins and tigecycline.
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Ans. (a.) Antigen presentation(Ref: Robbins 9th/198)Macrophages that have phagocytosed microbes and protein antigens process the antigens and present peptide fragments to T cells. Upon activation, B lymphocytes proliferate and then differentiate into plasma cells that secrete different classes of antibodies with distinct functions
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The phrenic nerve lies on the anterior surface of the anterior scalene muscle. The nerve is held tightly against the surface of the muscle by the deep cervical fascia The roots of the brachial plexus and the subclavian artery pass posterior to the anterior scalene muscle and anterior to the middle scalene muscle.
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Fibroadenomas are benign tumors usually seen in young females.
These are encapsulated and move freely within breast so they are called mouse in the breast.
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The nerve commonly damaged during McBurney's incision is Iliohypogastric Nerve. Damage to this nerve result in the development of right inguinal hernia. Mc Burney's incision/ grid iron incision is commonly done for appendectomy. In this an oblique incision is made in the right iliac fossa about 5cm above and medial to the anterior superior iliac spine at right angle to the spino umbilical line. Ref: Anatomy of Abdomen and Lower Limb By Singh, Page 46.
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Japanese Encephalitis (JE) virus
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Superior thoracic aery is the only branch from the first pa of the axillary aery. The axillary aery is a continuation of the subclan aery and is divided into three pas. Branches from the second pa of the axillary aery are: Lateral thoracic aery Thoracoacromial aery Branches from the third pa of the axillary aery are: Subscapular aery Anterior circumflex humeral aery Posterior circumflex humeral aery
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Breast feeding week is celebrated from August 1-7 Reference: www.worldbreastfeeding.org
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Ans. is. a. Ecthyma gangrenosum
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Ans. is 'b' i.e., Columnar Ventricles of brain and central canal of spinal cord are lined by simple ciliated columnar epithelium. Types of epithelium and their distribution have been explained in details in previous sessions.
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Ans. is 'd' i.e., Overuse of salicylatesOveruse of salicylates (NSAIDs) cause acute gastritis.Gastritis o Gastritis is the inflammation of Gastric mucosa.o It is a histological diagnosis and can be divided into ?A. Acute gastritisIt is acute mucosal injury, usually transient in injury and is associated with neutrophilic infiltration.Impoant causes areHeavy used of NSAIDs (aspirin) 4. Ischemia and schockAlcohol and smoking 5. Severe stress (Trauma, burn, surgery)Uremia 6. Nosogastric intubationB. Chronic gastritisIt is characterized by the presence of chronic mucosal inflammatory changes leading eventually to mucosal atrophy and intestinal metaplasia, usually in the absence of erosions.Impoant causes areH.pylori infection 4. Autoimmune, in association with pernicious anemiaAlcohol and smoking 5. Granulomatous conditions --> Crohn diseaseRadiation 6. Miscellaneous - Amyloidosis, graft - versus - host disease, uremia.
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Note the distribution of S2-S4 nerve. The S2, S3, S4 innervation, if damaged at the level of the spinal cord, is most likely to produce incontinence of bladder or bowel. Pain of the vaginal delivery arises from stimuli from the lower genital tract. These are transmitted primarily through the pudendal nerve, the peripheral branches of which provide sensory innervation to the perineum, anus, vulva, and clitoris. The pudendal nerve passes beneath the sacrospinous ligament just as the ligament attaches to the ischial spine. Sensory nerve fibers of the pudendal nerve are derived from ventral branches of the S2 through S4 nerves.... So labour will be painful but the vaginal stretching and the episiotomy may not be. Movement of the leg is mediated by L2-L4.
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Ans. c. Azoles act on them
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Atracurium is an intermediate acting nondepolarizing neuromuscular blocker which is inactivated in the plasma by spontaneous nonenzymatic degradation (Hoffman's elimination) in addition to that by cholinesterase.
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Gliomas account for 60% of brain tumours, with the aggressive glioblastoma multiforme (WHO grade IV) the most common glioma, followed by meningiomas (20%) and pituitary tumours (10%). Although the lower-grade gliomas (I and II) may be very indolent, with prognosis measured in terms of many years, these may transform to higher-grade disease at any time, with a resultant sharp decline in life expectancy Ref Harrison 20th edition pg2258
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ANSWER: (C) Allergic rhinitisREF: PL Dhingra 4 th edition page 167Causes of Epistaxis:IdiopathicLocal CausesTrauma: Finger nail trauma, injuries of nose, intranasal surgery, fractures of middle third of face and base of skull, hard-blowing of nose, violent sneeze.Infections:Viralrhinitis, nasal diphtheria, acute sinusitis, atrophic rhinitis, rhinitis sicca, tub erculosis, syphilis septal perforation, granulomatous lesion of the nose, e.g. Rhinosporidiosis.Foreign bodies: Rhinolith, Maggots, leechesNeoplasms of nose and paranasal sinuses: Hemangioma, Papilloma, Carcinoma or sarcoma. Atmospheric changes: High altitudes, sudden decompression (Caisson's disease).Deviated nasal septumNasopharyngeal Adenoiditis, Juvenile angiofibroma, Malignant tumorsGeneral CausesCardiovascular: Hypertension, arteriosclerosis, mitral stenosis, pregnancyDisorders of blood and blood vessels: Aplastic anemia, leukemia, thrombocytopenic, vascular purpura, hemophilia, Christmas disease, scurvy, vitamin K deficiency, hereditary hemorrhagic telangiectasia.Liver disease: Hepatic cirrhosis (deficiency of factor II, VII, IX & X)Kidney disease: Chronic nephritisDrugs: Excessive use of salicylates and other analgesics, anticoagulantMediastinal compression: Tumors of mediastinum (raised venous pressure in the nose)Acute general infection: Influenza, measles, chickenpox, whooping cough, rheumatic fever, infectious mononucleosis, typhoid, pneumonia, malaria, dengue fever Vicarious Menstruation
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Fragmented thrombi from DVTs are carried through progressively larger veins and the right side of the hea before slamming into the pulmonary aerial vasculature. Depending on the size of the embolus, it can occlude the main pulmonary aery, straddle the pulmonary aery bifurcation (saddle embolus), or pass out into the smaller, branching aeries (Fig. 4-15). Frequently there are multiple emboli, occurring either sequentially or simultaneously as a shower of smaller emboli from a single large mass; in general, the patient who has had one PE is at high risk for more. Rarely, a venous embolus passes through an interatrial or interventricular defect and gains access to the systemic aerial circulation (paradoxical embolism). A more complete discussion of PEs is presented in Chapter 15; the following is an overview of the major functional one
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Option a: Topoisomerases
Option b: DNA polymerases
Option d: DNA ligase.
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Ans. Sec. 228-A IPC
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Ans. is 'a' i.e., Silencing of paternal chromosome; 'b' i.e., Silencing of maternal chromosome; `c' i.e., Angelman syndroma Prader Willi Syndrome Deletion occurs exclusively on paternal chromosome 15 (deletion of band q 12 in long arm of chromosome 15) Features : Diminished fetal activity Hypotonia Obesity Mental retardation Sho stature Hypogonadotropic hypogonadism
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The most likely disease to be caused by the flea bite in a young boy is PLAGUE caused by YERSINIA PESTIS and smear is stained with WAYSON stain. Albe staining:- staining the volutin granules found in Corynebacterium diphtheriae Zeihl Neelson staining:-for Mycobacterium Mc Fadyean staining:-M'Fadyean Stain(Polychrome Methylene blue) is used for capsule staining of Bacillus anthracis.
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Methemoglobinemia Signs and symptoms Headache, nausea, vomiting, breathlessness, confusion, coma, convulsion, severe metabolic acidosis. Hemolysis may occur in G6PD deficiency. Blood is chocolate brown in color (chocolate cyanosis) Ref: FORENSIC MEDICINE AND Toxicology Dr PC IGNATIUS THIRD EDITION PAGE 430
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The post otic pa of paraxial mesoderm form bilateral solid cord of cells extending along the side of notochord beneath the neural tube. It undergoes segmentation to form series of paired somites. The somites are differentiated into ventro medial (sclerotome)and dorso lateral pa (dermomyotome) The somites appear between 20-30 days of development and by the end of first month, 44 pairs of somites are laid down. Thus, the 4th week of development is known as somite period. Out of 44 pairs of post otic somites: 4 are occipital, 8 cervical, 12 thoracic, 5 lumbar, 5 sacral and 8-12 coccygeal.
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Ans. is 'a' i.e., Aspiration of gastric contentso Mendelson 's syndrome is chemical pneumonitis caused by aspiration of gastric contents during anaesthesia.Classification of aspiration pneumoniao Aspiration pneumonia is characterized by:o The character of the inoculum, pathogenesis of the pulmonary conditions, presentation, and management guidelines. All these features assist in distinguishing clinical syndromes within the category of aspiration pneumonia.o The three syndromes that are most frequently seen clinically and best studied are -# Chemical pneumonitis,# Bacterial infection, and# Airway obstruction.Chemical pneumonitiso The term chemical pneumonitis refers to the aspiration of substances that are toxic to the lower airways, independent of bacterial infection.o The prototype and best studied clinical example is chemical pneumonitis associated with the aspiration of gastric acid first described by Mendelson and sometimes referred to as Mendelson's syndrome.The production of chemical pneumonitiso Require an inoculum that has a pH of < 2-5 and that is relatively large (usually I to 4 mL/kg).o This would translate to an inoculum of at least 25 mL of gastric acid in adult humans. It is probable that smaller volumes produce a more subtle process that either escapes clinical detection or causes a less fulminant form of pneumonitis.o The clinical observation that patients with esophageal or gastric reflux experience frequent bouts of recurrent pneumonitis, often accompanied by pulmonary fibrosis, supports this concept.Clinical featureso The following clinical features should raise the possibility of chemical pneumonitis# Abrupt onset of symptoms with prominent dyspnea# Fever, which is usually low grade# Cyanosis and diffuse crackles on lung auscultation# Severe hypoxemia and infiltrates on chest imaging involving dependent pulmonary segments. The dependent lobes in the upright position are the lower lobes. However, aspiration that occurs while patients are in the recumbent position may result in infection in the superior segments of the lower lobes and the posterior segments of the upper lobes.
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Posterior Triangle
The posterior triangle is a space on the side of the neck situated behind the
sternocleidomastoid muscle.
Boundaries
Anterior: Posterior border of sternocleidomastoid
Posterior :Anterior border of trapezius
Inferior or base: Middle one- third of clavicle
Apex lies on the superior nuchal line where the trapezius And sternocleidomastoid meet
Roof : Investing layer
Floor: Formed by a prevertebral layer of deep cervical fascia covering
the following muscle: a. splenius capitisb. Levator scapulae; c.
Scalenus medius and occasionally scalenus posterior.
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Antigen-antibody reactions are detected by- Precipitation/flocculation tests, agglutination tests, neutralization tests, complement fixation tests (CFT), western blotting (immunoblotting), ELISA, and radioimmunoassay (RIA).
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Comet tail artefact is a special finding in Adenomyomatosis.
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- Central muscle relaxant - Used in malignant hypehermia, neuroleptic malignant syndrome etc- Cause respiratory muscle weakness - breathlessness- Chronic dantrolene use - liver dysfunction, kidney dysfunction- Bradycardia Dantrolene contributes to prolonged non depolarizing neuromuscular blockade, In addition to volatile anesthetics, other drugs, such as aminoglycoside antibiotics, local anesthetics, cardiac antiarrhythmic drugs, dantrolene, magnesium, lithium, and tamoxifen (an anti-estrogenic drug), may enhance the neuromuscular blockade produced by nondepolarizing NMBDs. A few drugs may diminish the effects of a nondepolarizing NMBD, including calcium, coicosteroids, and anticonvulsant (phenytoin) drugs.
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In the question, data has been divided into two groups, i.e. HIV positive/HIV negative → Data should be measured on the nominal scale especially Dichotomous type of nominal scale.
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Ans. is 'a' i.e., 8-21 days of cycle Safe Period (rhythm method)o This is also known as the calendar method first described by Ogino.o The method is based upon the fact that ovulation occurs from 12 to 16 days before the onset of mensturation.o Calculation is as follows:The shortest cycle minus 18 days gives the first day of the fertile periodThe longest cycle minus 10 days gives the last day of fertile period.For example, if a woman's mensturai cycle varies from 26-31 days, the fertile period during which she should not have intercourse would be from the 8th day to 21st day of the mensturai cycle, counting day one as the first day of the mensturai period.
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A i.e. Troponin (+ve)
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The best t/t for such tumor is excision of the growth along with segmental mandibulectomy.
Hemimandibulectomy would not be useful, as the tumor is midline.
Since the bone is involved by the growth, marginal mandibulectomy would not be a good choice.
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Temporal association centers around the question: does the suspected cause precede the observed effect? Ref: 25th edition, Park's Textbook of Preventive and Social Medicine, Page no. 97
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ref : hazarika 4th ed
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Ans. is 'd' i.e., Curve formed by neck of femur and obturator foramenShenton's lineo It is a smooth curve formed by inferior border of neck offemur with superior margin of obturator foramen.Nelaton's line:o With the hip in 90 degree offlexion, a line joining the ASIS and ischial tuberosity passes through the tip of the greater trochanter on that side.o In cases of supratrochanteric shortening the trochanter will be proximal to this line.Shoemaker's line:o With the patient lying supine, the line joining ASIS and tip of the greater trochanter is extended on the side of the abdomen on both sides.o Normally these lines meet in the middle above the umblicus.o In case one of the greater trochanter has migrated proximally the lines will meet in the opposite side of the abdomen and below the umblicus.Chiene's line:o With the patient lying supine, lines are drawn joining the two ASIS and the two greater trochanters.o Normally these make two parallel lines. In case one of the trochanters has moved proximally the lines will converge on that side.Perkin's line:o When the congenital Dislocation of hip is mild in nature, the perkins lines are drawn to detect it.o A horizontal line is drawn through the triradiate cartilage and a vertical line is drawn down from the outer edge of the acetabulum on both sides.o The upper femoral epiphyses normally lies medial to the vertical line and below the horizontal lineo But in congenital dislocation of hip the epiphyses will lie on the outer aspect of the vertical line and above the horizontal line.Brvants triangle:o The patient lies supine.o The tips of the greater trochanter and ASIS on both sides are marked.o A perpendicular is dropped from each ASIS on to the bed. From the tip of the greater trochanter another perpendicular is dropped on to the first one. The tips of the greater trochanter are joined to the ASIS on the respective side. This forms a triangle ABC.o The side BC of the triangle measures supra trochantric shortening of hip.
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For the diagnosis of minor depression 2-4 and for major depression 5 DSM IV symptoms are required for at least for a two week period.
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The clinical picture described is classical of enteric perforation and peritonitis.
In enteric fever ulcers occur in intestine, which may perforate if not treated properly. This complication is seen in third or fourth week of fever. It is a life threatening complication and urgent medical and surgical intervention is required;
GIT haemorrhage is another life threatening complication of enteric fever that occurs in third or fourth week of fever. In acute appendicitis and acute pancreatitis abdominal pain is the main feature rather than fever of 15 days duration. In DU perforation fever is absent.
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Ans. is 'a' i.e., Ketoconazole
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Ans. is 'a' i.e., Preoccupation with fear of a serious illness Hypochondriasis* The primary feature of hypochondriasis is persistent preoccupation with excessive fear of a serious (e.g., cancer) or incurable (e.g., AIDS) disease, which is based on person's own interpretation of physical symptoms or sensation, i.e., misinterpretation of physical symptoms or sensations, for example an occasional change in heart rate will lead a person with hypochondriasis to fear of heart disease.* Therefore, Hypochondriasis is abnormal preoccupation about normal body function i.e., body functioning is normal but patient thinks it as abnormal.* The preoccupation with the presence of a feared illness persists in spite of normal medical assessment and investigations. Patient goes from one doctor to another for a consultation.* People with hypochondriasis are able to acknowledge that their fears are unrealistic (insight is present), but this intellectual realization is not enough to reduce their anxiety.* Two important facts differentiate hypochondriasis from somatization disorder : -i) Patient with hypochondriasis is preoccupied with illness, on the other hand patient with somatization disorder is occupied with symptoms.ii) Hypochondriasis patient is preoccupied with one illness (usually) while patient with somatization disorder has many (at least 8 or more) symptoms.Other options* Preoccupation with multiple symptoms - Somatization disorder* Maintaining sick role - Factitious disorder (Munchausen syndrome)* Intentional production of false or exaggerated physical symptoms - Malingering
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Ans. is 'b' i.e., Ostium secondum
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The term cutaneous vasculitis is defined broadly as inflammation of the blood vessels of the dermis. Due to its heterogeneity, cutaneous vasculitis has been described by a variety of terms including hypersensitivity vasculitis and cutaneous leukocytoclastic angiitis. The typical histopathologic feature of cutaneous vasculitis is the presence of vasculitis of small vessels. Postcapillary venules are the most commonly involved vessels; capillaries and aerioles may be involved less frequently. ( Harrison&;s principle of internal medicine,18th edition,pg no. 2798)
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Hysteroscopy is best for diagnosing lesions within the uterine cavity Also: Abnormal Uterine Bleeding Oligomenorrhea amenorrhea, Recurrent Pregnancy loss Endometrial carcinoma, Un-explained infeility Suspected anomalies Missing IUCDs Diagnosing intra uterine submucous fibroids, Polyps, adhesions Septums etc.
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Carrier pump Na-K-2Cl transpoer. REABSORPTION IN THICK ASCENDING LIMB: Sodium, Potassium & Chloride reabsorption: By "Secondary active transpo" - Through Na2+-K+-2Cl-- carrier transpoer. Transpos one Na2+, one K+, & two Cl-. Active sodium absorption occurs. 30% filtered Na2+ reabsorbed. Ref: Guyton 12th Ed.
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Increased venous capacitance is NOT caused by sympathetic stimulation. Impoant effects of increased sympathetic stimulation: Aeriolar vasoconstriction Increased stroke volume Increased hea rate Venoconstriction and decrease in venous capacitance The increase in mean systemic filling pressure is caused mainly by venous contraction. All these efffects together about an increased aerial pressure. Ref: Guyton and Hall 13th edition Pgno: 260
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Oral alkylating agent Temozolomide is an alkylating agent that can be given orally Refer Goodman Gilman. 12/e p1687
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Mycoplasma infection may begin with a sore throat and the most common presenting symptom is cough. The possibility of M. pneumoniae- when community-acquired pneumonia fails to respond to treatment with a penicillin or a cephalosporin--antibiotics that are ineffective against mycoplasmas. Clinical findings, non-microbiologic laboratory tests, and chest radiography are not useful for differentiating M. pneumoniae pneumonia from other types of community- acquired pneumonia. In addition, since M. pneumoniae lacks a cell wall, it is not visible on gram's stain.
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B i.e. Children
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Gate control theory of pain states that innocuous stimuli, such as rubbing a hu area (massage), can block or reduce painful sensations. Such stimulation inhibits C fibres and A delta fibres and activates the large-diameter (Ab) fibersand their activity leads to release of GABA and other inhibitory neurotransmitters by interneurons within the dorsal horn. Transcutaneous electrical nerve stimulation (TENS) of pain relief is also based on gate control theory of pain. Lamina II or substantia gelatinosa acts as the gate where pain modulation occurs. A: Dorsal or posterior horn B: Lateral horn: From T1 to L2, the lateral horn contains the visceral motor efferent cell bodies of the sympathetic system, and From S2 to S4, it contains the visceral motor efferent cell bodies of the parasympathetic system. These cell bodies are collectively referred to as the intermediolateral nucleus. C: Ventral or anterior horn D: Anterolateral tract (spinothalamic tract)
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Ans. is 'a' i.e., Established pattern of behavior
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Chronic hyperophic candidiasis is a long term infection of candida seen in the middle aged male patients, smokers. There is a membrane formation, But its not a premalignant condition. Premalignant lesion: Oral submucous fibrosis Lichen planus Leukoplakia (MC premalignant lesion seen in smokers & tobacco chewers)
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Ans. A Palmitic acid* Palmitic acid is the most common fatty acid found in animals, plant and microbes.* Excess carbohydrates and proteins are converted to palmitic acid.* Palmitic acid is the first fatty acid synthesized during fatty acid synthesis.* Note: First step in fatty acid synthesis is transfer of acetate units from mitochondrial acetyl CoA to the cytosol.
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In mediastinal tamponade, hypotension, dyspnea, cyanosis, and a decrease in pulse pressure will be evident. During inspiration, the pulse pressure is further impeded to cause obstruction to transmitted ACV waves in the neck; in congestive cardiac failure, the ACV waves recorded in the neck are more prominent. Paresis of the arm is unlikely to occur because the lower part of the brachial plexus (T1) passes along the inner border of the first rib to reach the neck.
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Ans. is 'c' i.e., Both o Myringotomy for grommet insertion (in SOM) - Antero - inferioro Myringotomy in ASOM - Postero - inferiorMyringotomyo Myringotomy is also known as myringocentesis, tympanostomy or tympanotomy. Myringotomy is a surgical procedure in which a small incision is made in the eardrum (tympanic membrane). Myringotomy is done to drain suppurative or nonsuppurative fluid (effusion) of middile ear or to provide aeration in case of nonfunctional eustachian tube.IndicationsAcute suppurative otitis mediaSevere earache with bulging tympanic membraneIncomplete resolution with opaque drum and persistent conductive deafnessComplications of acute otitis media, e.g. facial paralysis, labyrinthitis or meningitis with bulging tympanic membraneSerous otitis mediaAero-otitis media (to drain fluid and ""'unlock" the eustachian tube)Atelectatic ear (grommet is often inserted for long-term aeration)Incision sites for myringotomyo Two common incision sites are usedAnterior-inferior quadrantAlso known as anterior myringotomyUsed in cases of serous otitis media when grommet is to be insertedPostero-inferior q uad rantAlso known as posterior myringotomyUsed in cases of ASOMThis area is preferred because this is the most accessible area, relative less vascular and there are less chances of damage to ossicular chain.
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b. Staph aureus(Ref: Nelson's 20/e p 2088-2093, Ghai 8/e p 379-381)The given chest X-ray finding is suggestive of pneumonia with pneumatoceles, seen in infection due to Staph aureus.
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Ans. is 'c' i.e., Radical cholecystectomy
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Ans. is 'a' i.e., Furosemide Pharmacological management of acute pulmonary edema* Loop diuretics are the drugs of choice for management of acute pulmonary edema. Loop diuretic. The "loop diuretics" furosemide, bumetanide, and torsemide are effective in most forms of pulmonary edema, even in the presence of hypoalbuminemia, hyponatremia, or hypochloremia. Furosemide is the diuretic of choice as it also acts as a venodilator that reduces preload rapidly, before any diuresis. The initial dose of furosemide should be <0.5 mg/kg, but a higher dose (1 mg/kg) is required in patients with renal insufficiency, chronic diuretic use, or hypervolemia or after failure of a lower dose.* Nitrates Nitroglycerin and isosorbide dinitrate act predominantly as venodilators but have coronary vasodilating properties as well. They are rapid in onset and effective when administered by a variety of routes. Sublingual nitroglycerin (0.4 mg x 3 every 5 min) is first-line therapy for acute cardiogenic pulmonary edema. If pulmonary edema persists in the absence of hypotension, sublingual may be followed by IV nitroglycerin, commencing at 5-10 g/min. IV nitroprusside (0.1-5 g/kg per min) is a potent venous and arterial vasodilator. It is useful for patients with pulmonary edema and hypertension but is not recommended in states of reduced coronary artery perfusion.* Morphine Given in 2- to 4-mg IV boluses, morphine is a transient venodilator that reduces preload while relieving dyspnea and anxiety. These effects can diminish stress, catecholamine levels, tachycardia, and ventricular afterload in patients with pulmonary edema and systemic hypertension.* Angiotensin-Converting Enzyme (ACE) Inhibitors ACE inhibitors reduce both afterload and preload and are recommended for hypertensive patients. A low dose of a short-acting agent may be initiated and followed by increasing oral doses. In acute MI with heart failure, ACE inhibitors reduce short- and long-term mortality rates.* Other Preload-Reducing Agents IV recombinant brain natriuretic peptide (nesiritide) is a potent vasodilator with diuretic properties and is effective in the treatment of cardiogenic pulmonary edema. It should be reserved for refractory patients and is not recommended in the setting of ischemia or MI.
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(a) Symptoms are predominantly caused by involvement of subglottis(Ref. Cummings, 6th ed., 3049; Scott Brown, 8th ed., Vol 1; 326)
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The dark zone
This lies adjacent and superficial to the translucent zone. It has been referred to as the ‘positive zone’ because it is usually present. This zone is formed as a result of demineralization and appears dark brown in ground sections examined by transmitted light after imbibition with quinolone.
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C i.e., MRI A known complication of long term steroid uptake and chronic alcoholism is avascular necrosis of hip. MR scanning is the most sensitive and specific means of detecting changes in avascular necrosisQ. Sensitivity & Specificity approach 100%.
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Clinical features Most commonly presents with right upper quadrant pain often mimicking cholecystitis and cholelithiasis Weight loss, jaundice and abdominal pain are less common presenting symptoms Chronic cholecystitis with a recent change in quality or frequency of the painful episodes in 40% patients Malignant biliary obstruction with jaundice, weight loss and RUQ pain Ref: Sabiston 20th edition Pgno : 1512-1514
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CONGENITAL ADRENAL HYPERPLASIA Clinical presentation: Ambiguity of sex detected at bih are due to androgenital syndrome unless proved otherwise. Hirsutism and amenorrhea may be presenting features around pubey in milder form. Diagnosis at bih An enlarged clitoris Presence of penile urethra or hypospadias Hyponatremia,hypokalemia and hypotension Fusion of labia minora Ref: D.C.DUTTA'S TEXTBOOK OF GYNAECOLOGY,6th edition; Pg no:440 other causes include female psuedohermaphroditism,mixed gonadal dysgenesis, male psudeohermaphroditism and rarely true hermaphroditism page 54 ,16th edition shaw's textbook of gynaecology
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Ans. is 'a' i.e. Infusion of calcium gluconate EMERGENCYModalityMechanism of actionOnsetDurationCalcium gluconateAntagonizes cardiac conduction abnormalities0-5 minutes1 hourSodium BicarbonateDistributes K+ into cells(only indicated with acidosis)15-30 minutes1 -2 hoursInsulinDistributes K+into cells15-60 minutes4-6 hoursAlbuterolDistributes K+ into cells15-30 minutes2-4 hoursNONEMERGENCYModalityMechanism of actionDuration of treatmentLoop diuretic| Renal K4 excretion0.5-2 hoursSodium polystyrene sulfonate (kayexalate)Ion-exchange resinbinds K+1 -3 hoursHemodialysisExtracorporeal K+removal48 hoursPeritoneal dialysisPeritoneal K+ removal48 hours
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Ans. is 'a' i.e., Superficial parotidectory o Pleomorphic adenomas arise most commonly in the parotid gland. These form majority (~80-90%) of tumors of the parotid gland.o Pleomorphic adenomas are less common in the submandibular glands & sublingual glands; relatively rare in the minor glands.o Pleomorphic adenomas are benign tumors derived from a mixture of ductal (epithelial) and myoepithelial cells, and therefore show both epithelial and mesenchymal differentiation (hence k/a mixed tumor)o Although benign, it has the potential to turn malignant k/a carcinoma ex pleomorphic adenoma or malignant mixed tumor. The incidence of malignant transformation increases with the duration of the tumoro Signs & symptoms suspicious of malignant transformation# rapid growth# pain# paresthesias# facial weakness# skin invasion and fixation of mastoid tip.Treatment of Pleomorphic adenoma (or any benign lession of Salivary' gland)o in Parotid-superficial protidectomyo in other salivary glands-Excision of the affected gland.The above mentioned books mention the following indications of postop radiotherapy in Pleomorphic adenoma of parotid.Indications for postop radiotherapy in Pleomorphic adenomao Involvement of the deep lobe of the parotido Recurrent lesionso Large (> 5 cm) lesions, which may not allow complete surgical excision with adequate margins.o Microscopically positive margins after surgical resection.o Malignant transformation within a predominantly benign tumor.
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Ans. is 'a' i.e., Right atrium o The heart has following borders and surfaces:-A) Bordersi) Right border:- Formed by right atrium.ii) Left border (obtuse margin):- Formed mainly by left ventricle and partly by left auricle (in its upper most part).iii) Inferior border (acute margin):- Formed mainly by right ventricle and partly by left ventricle near apex.iv) Upper border:- Mainly by left atrium and partly by right atrium where SVC enters.v) Apex:- Formed by left ventricle.B) Surfacesi) Anterior (sternocostal) surface:- Formed mostly by right ventricle (major) and right auricle and partly by left ventricle and left auricle.ii) Inferior (diaphragmatic) surface:- It is formed by left ventricle (left 2/3) and right ventricle (right 1/3). It is traversed by posterior interventricular groove (PIV) containing PIV branch of RCA.iii) Base (posterior surface) :- Formed mainly by left atrium and partly by right atrium. It is separated from T5 to T8 vertebrae by pericardium, oblique pericardial sinus, esophagus and descending thoracic aorta.iv) Right surface:- Mainly by right atrium.v) Left surface :- Mainly by left ventricle and partly by left auricle.o Dont get confused with above question. Most probably this question has been framed by a radiologist. Read following factsi) Right border of heart is formed by (anatomically) - Right atrium.ii) Right border of heart is formed by (on X-ray PA view) - Right atrium (majority), SVC, I VC.o Similiarly-i) Left border of heart is formed by (anatomically) - Left atrium (mainly), left auricle.ii) Left border of heart is formed by (on X-ray PA view) - Aortic knucle, Pulmonary trunk, left auricle, left atrium, left ventricle.
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Ans is a i.e Pancytopenia Venous thrombosis. Recurrent aboions and pulmonary hypeension are all seen in case of antiphospholipid syndrome. Antiphospholipid antibody syndrome leads to thrombocytopenia (in 40-50% cases) and hemolytic anemia in 25% cases but leucopenia is not seen in it. Also in causes of pancytopenia - No where is APS mentioned so. it is the best answer. Diagnostic Clinical Criteria for Antiphospholipid Antibody Syndrome : Thrombosis - Venous - Aerial (small vessels). Adverse pregnancy outcome - 3 or more consecutive miscarriages < 10 weeks. - 1 or more fetal deaths > 10 weeks. - 1 or more preterm bihs due to severe pre-eclampsia or IUGR. Indications for Antiphospholipid antibody testing : 3 or more consecutive first trimester losses Unexplained 2nd or 3rd trimester loss Unexplained IUGR Early onset severe pre-eclampsia Unexplained thrombosis Autoimmune connective tissue disease like SLE False positive serological tests for syphilis
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Answer is D (Right Bundle Branch Block) Brugada Syndrome is typically associated with a Right Bundle Branch Block (RBBB) pattern on EKG. Brugada Syndrome is characterized by syncopal episodes and/or sudden death and a characteristic electrocardiogram (ECG) with a pattern of Right Bundle Branch Block with an ST segment elevation in leads V1 to V3. The diagnosis Brugada syndrome is based on the history of sudden death with the typical electrocardiographic pattern of ST segment elevation in leads V1-V3, with or without right bundle branch block. The presence of RBBB is not essential to the diagnosis of Brugada Syndrome. Patients with Brugada Syndrome may have a structurally normal hea.
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COPD does not produce metabolic acidosis, it causes respiratory acidosis, so there is no question of anion gap acidosis.
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Ans. Hodgkins disease
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Disturbances in morphodifferentiation results in supernumerary roots or cusps, twinning, suppression of parts like cusp or root. Hutchinson's incisor is due to disturbance in morphodifferentiation.
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Ans. is 'a' i.e., Nifedipine
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Papillary carcinoma is the most common of the thyroid neoplasms and is usually associated with an excellent prognosis, particularly in female patients younger than 40 years.
About 70% to 80% of patients in the United States in whom thyroid carcinoma is newly diagnosed have papillary carcinoma.
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Skin scraping and koh mount is used to demonstrate superficial fungal infections caused by dermatophytes and yeasts. after the material obtained from scrapings it is placed on a glass slide containing 10-30% koh and covered by cover slip. fungal elements resist digestion by koh as they contain chitin. dermatophytes appear as translucent nonpigmented spectate mycelia or ahrospores candida appear as budding yeast cells with pseudohyphae pityriasis versicolor appear as sphagetti and meat ball appearance. iadvl textbook of dermatology page 272
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True labour pains: Cervical dilatation Regular and gradual increase in duration and frequency of contractions Bag of water is formed Associated with show Painful uterine contractions. Ref: Datta Obs 9e pg 110.
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A i.e. Wrist
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Ans. is 'b' i.e. Increased capillary density at the distal half of nails Half and Half nail are characterized by a band in the midportion of the nail separating the darker distal portion from the proximal white portion. They are a common occurrence in renal failure and are seen in l/3rd patients of renal failure.Pathophysiology of Half and half nailThey are also called Lindsay's nailTheir pathogenesis is not clearly understood.Two mechanisms have been proposed.increased melanin depositionthe proximal half of the nail appears white because of the edema associated with dilated capillary network According to Oxford text book of clinical nephrology 2nd/e chapter 11.3.11. "The so called "half-and half nail" in typical of uremia the distal portion of each nail bed is red, pink or brown, occupies 20-60 percent of the total nail length, and always sharply demarcated, the proximal portion has dull whitish ground glass appearance.When pressure is applied, the discoloration does not fade completely. This change can affect single nails, or all the nails, or all the nails of the hand or feet or both. Half and half nail often begins before dialysis. It occurs in 15-50% of patients on regular dialysis.The histology of the nail plate itself shows no change and it contains no melanin, the number of capillaries under the nail plate is increased, with remarkable thickening of the capillary walls.The increase in capillary density of the nail bed might account for the band.The disorder in probably partially reversible. In some patients a lightening of the colour and a decrease in the width of the brown are have been seen after months of observation
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d. All(Ref: Nelson's 20/e p 850-857, Ghai 8/e p 169-170)Surfactant deficiency is the primary cause of RDS; Alveolar atelectasis, hyaline membrane formation & interstitial edema are seen in RDS.
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Ans. d (All of the above) (Ref. Bailey and Love 24th ed., 57.10)Complications of colostomies: The following complications are more common after poor technique:# Prolapse;# Retraction;# Necrosis of the distal end;# Stenosis of the orifice;# Colostomy hernia;# Bleeding (from granulomas around margin of colostomy);# Colostomy 'diarrhoea': this is usually an infective enteritis and will respond to oral metronidazole 200 mg TID.STOMASColostomy# A colostomy is an artificial opening made in the large bowel to divert faeces and flatus to the exterior, where it can be collected in an external appliance. Depending on the purpose for which the diversion has been necessary a colostomy may be temporary or permanent.# Temporary colostomy- This is most commonly established to defunction an anastomosis after an anterior resection, to prevent faecal peritonitis developing following traumatic injury to the rectum or colon, and to facilitate the operative treatment of a high fistula in ano. It is now less commonly used for patients with distal obstruction of the sigmoid colon as a result of carcinoma or diverticular disease.# Double-barrelled colostomy- This colostomy was designed so that it could be closed by crushing the intervening 'spur' using an enterotome or a stapling device. It is rarely used now but occasionally the colon is divided so that both ends can be brought separately to the surface ensuring that the distal segment is completely defunctioned.# Permanent colostomy- This is usually formed after excision of the rectum for a carcinoma by the abdominoperineal technique (APR).- It is formed by bringing the distal end (end colostomy) of the divided colon to the surface in the left iliac fossa, where it is sutured in place joining the colonic margin to the surrounding skin.- The point at which the colon is brought to the surface must be carefully selected to allow a colostomy bag to be applied without impinging on the bony prominence of the anterosuperior iliac spine. The best site is usually through the lateral edge of the rectus sheath, 6 cm above and medial to the bony prominence.Loop ileostomy# An ileostomy is used by some surgeons as an alternative to colostomy, particularly for defunctioning a low rectal anastomosis. The creation of a loop ileostomy from a knuckle of terminal ileum has already been described. The advantages of a loop ileostomy over a loop colostomy are the ease with which the bowel can be brought to the surface and the absence of odour. Care is needed, when the ileostomy is closed, that suture line obstruction does not occur.Caecostomy# This is rarely used now. In desperately ill patients with advanced obstruction, a caecostomy may be useful. Caecostomy is only a short-term measure to allow a few days for the condition of the patient to improve. Reoperation should normally follow fairly soon thereafter and a proper surgical procedure carried out.
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Dengue (breakbone fever) is caused by a group B togavirus that is transmitted by mosquitoes. The clinical syndrome usually consists of a mild systemic disease characterized by severe joint and muscle pain, headache, fever, lymphadenopathy, and a maculopapular rash. Hemorrhagic dengue, a more severe syndrome, may be prominent during some epidemics; shock and occasionally death result.
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Nearly every allograft develops some degree of arteriopathy within 10 years, and half of the patients have significant arteriopathy by 5 years following transplantation. Unlike atherosclerosis, the smaller coronary artery branches are preferentially affected, but the result is the same: ischemic damage. The inflammation that may come from rejection is not a risk for amyloid deposition. A transplanted heart does not have a functional pericardial sac, and though there may be some fibrous adhesions following surgery, they are not constrictive. Transplant recipients receiving immunosuppressive therapy have immune dysregulation that increases the risk for both carcinomas and lymphoid malignancies, but these are unlikely to involve the heart. The immunosuppression with antirejection drugs increases the risk for infection with opportunistic agents, but these are not common and they can often be treated.
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Goose skin is seen in drowning. (usually cold water). It is due to contraction of erector pili muscles, attached to hair follicle.
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Henoch Schonlein PurpuraSystemic vasculitis syndrome involving small and medium size vesselsUsually seen in children (in fact it is the most common small vessel vasculitis in children)Vasculitis is caused by immune complex depositionSystemic manifestationSkinJointsAbdominal visceraRenal vasculatureTypical palpable purpuric skin lesionMost common over buttocks and exterior surface of legs and armsAhralgiaColicky abdominal pain associated with nausea, vomiting, diarrhea/constipation Melena or HematemesisProteinuria Microscopic hematuria with RBC cast in urine (Glomerulonephritis) Nephrotic syndromeMost common antibody seen in these immune complexes is IgA (IgA levels are elevated)Platelet count is normal or elevated Serum complements levels are normalPrognosis is excellent and disease is self-limiting. Lasts about six weeks and resolve without sequelae.Treatment involves administration of glucocoicoids(Prednisolone).(Refer: Harrison's Principles of Internal Medicine, 18th edition, pg no: 2797)
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Ans. is 'c' i.e., Antigenicity Adjuvants . Any substance that enhances the immunogenicity of an antigen. . Actions : - May confer immunogenicity on nonantigenic substances. - Increases the concentration and presistence of the circulating antibodies. - Enhances the degree of cellular immunity - Leads to production of adjuvant disease such as allergic disseminated encephalomyelitis. . The most potent adjuvant is Freund's complete adjuvant which is the incomplete adjuvant along with a suspension of killed tubercle bacilli. . Other adjuvants. - Incorporation of protein antigen in the water phase of water in oil emulsion (Freund's incomplete adjuvant) - Aluminium hydroxide and Aluminium phosphate are commonly used with human vaccines. - Gram negative bacilli show an adjuvant effect due to their lipopolysaccharide (endotoxin) fraction. - Bordetella peussis acts as a good adjuvant for diphtheria and tetanus toxoid in triple vaccine.
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Variants of the morbidly adherent placenta are classified by the depth of trophoblastic growth.Placenta accreta indicates that villi are attached to the myometrium. With placenta increta, villi actually invade the myometrium, and placenta percreta defines villi that penetrate through the myometrium and to or through the serosa.Reference: Reference: William's Obstetrics; 25th edition; Chapter 41; Obstetric hemorrhage
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Computed Tomography severity index(CTSI) for acute pancreatitis CTSI= Balthazar grade score + necrosis score Highest attainable score =10 CTSI score 0-3: Moality 3%,Morbidity 8% 4-6: Moality 6%, Morbidity 35% 7-10: Moality 17%, Morbidity 92% Refer CTSI table Ref: Sabiston 20th edition Pgno :1527
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In electrochemistry, the Nernst equation is an equation that relates the reduction potential of an electrochemical reaction (half-cell or full cell reaction) to the standard electrode potential, temperature, and activities (often approximated by concentrations) of the chemical species undergoing reduction and oxidation Ref: guyton and hall textbook of medical physiology 12 edition page number:58,59,60
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Mammary gland is a modified sweat of apocrine variety.
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B i.e. Asthma
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Ans. is 'a' i.e., Microalbuminuria STAGES O F DIABETIC NEPHROPATHY: (IDDM)YearStageFindings0Io Raised GFR, increase in Renal size and plasma flow2IIo Thickening in glomerular capillary basement membrane6-10IIIo Microalbuminuria/Albumin excretion rate 30-300mg/day, Appearance of micro albuminuria important predictor of development of overt proteinuria10-15IVo Clinical nephropathy, gross proteinuria, Albumin>300mg/day. Now the changes are irreversible16-25Vo End stage renal diseaseo Microalbuminuria is defined as albumin excretion of 30-300 mg/dQo Overt nephropathy or overt proteinuria is defined as albumin excretion ereater than 300 mg/dQo The appearance of microalbuminuria in type I diabetes mellitus is an important predictor of progression to overt proteinuria >300 mg/day or overt nephropathy.REMEMBERo The early pathological changes and albumin excretion abnormalities are reversible with normalization of plasma glucoseQ.o However, once overt nephropathy develops the pathological chanees are likely irreversible. there is steady decline in GFR and ~50% of individuals reach ESRD in 7-10 yearsQ.
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312-causing miscarriage with consent 313-causing miscarriage without consent 314-death of mother due to miscarriage 315-Preventing the child being or cause it to die after bih 316-Causing death of the quick unborn child by act to culpable homicide Textbook of Forensic Medicine and toxicology ,5th edition pg number 387
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Ans. is 'a' i.e., Roger Haugen "A popular term 'cafe coronary * was coined by Dr. Roger Haugen, Medical Examiner of Broward County, Florida for such impaction of food in the respiratory passage ".-- Krishan Vij
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"Ligamentum teres of liver represents the obliterated left umbilical vein".Ligamentum teres (the obliterated umbilical vein) runs along the inferior edge of the falciform ligament from the umbilicus to the umbilical fissure.
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C ie Loss of pronation at radio ulnar joint
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Propoion Method This is the method recommended for DOTS-Plus sites in India. It enables precise estimation of the propoion of mutants resistant to a given drug. Several 10-fold dilutions of inoculum are planted on to both control and drug -containing media; at least one dilution should yield isolated countable (50 -100) colonies. When these numbers are corrected by multiplying by the dilution of inoculum used, the total number of ble colonies observed on the control medium, and the number of mutant colonies resistant to the drug concentrations tested may be determined. The propoion of bacilli resistant to a given drug is then determined by expressing the resistant poion as a percentage of the total population tested. The propoion method is currently the method of choice. The economic variant of propoion method is used for DOTS-plus. Ref:
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Halothane is a potent inhalational anaesthetic but is not a good analgesic or muscle relaxant. It potentiates the effect of competitive neuromuscular blockers.
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