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While admittedly rare in human medicine, the bacteria referred to should be appreciated for their role in human disease. Branhamella is a Gram-negative diplococcus. It has recently been renamed Moraxella catarrhalis. While it is a member of the normal flora, it may cause severe upper and lower respiratory tract infection, particularly in the immunosuppressed patient. Most isolates produce b-lactamase and are resistant to penicillin. Cardiobacterium, as the name implies, causes endocarditis. This small Gram-negative pleomorphic rod may take a few days to grow. Infection is usually endogenous in that Cardiobacterium is part of the normal flora of the gut. Capnocytophaga grows best in a carbon dioxide atmosphere as the name implies. It is isolated frequently from patients with periodontal disease but may also cause septicemia in susceptible patients. Rat-bite fever is caused by Spirillum and the agent of cat scratch disease is B. henselae.
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nasociliary nerve branch of ophthalmic division of trigeminal nerve carries pain sensation from ethmoid sinus. Ref Dhingra 6/e,p 188
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Ans. B: Laparoscopy Investigations in a case of PID: Physical examination Pregnancy test (to rule out anectopic pregnancy) White blood cell test (to rule out appendicitis) Genital culture (to look for gonorrhea and chlamydia). An endometrial biopsy (tissue sample removed from the endometrium) Sonogram (if abscesses are suspected) Culdocentesis (fluid sample taken from uterine sac) Laparoscopy are done. Laparoscopy is considered the "gold standard" for diagnosis of PID, because it allows visualization of the pelvic organs. The procedure involves inseing a tiny, flexible lighted tube through a small incision just below the navel. This procedure is recommended when results of the preliminary tests (physical exam, blood tests and cultures) are unclear.
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Electron microscope: the technique of shadow casting with vapourised heavy metals has made pictures with good contrast and 3D effect possible. Another valuable technique in studying fine structure is negative staining with phosphotungstic acid REF:Ananthanarayan & Panicker's Textbook of Microbiology 8th Edition pg no: 13
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Factors Affecting Algor Mois : i. Environmental temperature (major factor): Rate of fall of body temperature is directly propoional to the difference between the temperature of the dead body and the environmental temperature. ii. Air movement: Air movement over the surface of the dead body causes a quick fall of temperature due to increased evaporation of body fluids. iii. Humidity: Cooling is more rapid in a humid rather than in a dry atmosphere, since moist air is better conductor of heat. iv. Media of disposal: Cooling is earliest in water, and late in buried bodies. The ratio of the rates of fall of temperature in the three media, water:air: soil = 4:2:1. The rate is thus maximum in water, moderate in air and minimum in a buried body. v. Built of cadaver: Obese bodies cool slowly, and lean bodies rapidly, since fat is a bad conductor of heat. vi. Age and sex: Rate of loss of heat is more in children and the elderly, compared to adults because the surface area of the body is more in relation to the body volume. Females retain body heat for a comparatively longer period because of their subcutaneous fatty tissue. vii. Clothing or coverings of the body: A well-covered body retains heat for a longer period as compared to a naked or thinly clothed body, as clothes are bad conductors of heat.
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The highest risk of fetal infection with rubella occurs during the first trimester. In seronegative patients, the risk of infection exceeds 90%. However, before other measures (such as termination of pregnancy) are considered, a rubella immune status must be performed. A rubella titer of 1:10 is protective.
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Ans. is 'b' i.e., 6 monthso Gaze Fixation starts developing in the first month and is completed in 6 months,o Macula is fully developed by 4 - 6 months.o Fusional reflexes, stereopsis and accommodation is well developed by 4 - 6 months,o Cornea attains normal adult diameter by 2 years of age.o Lens grows throughout life.
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Ans. is 'b' i.e., Secondary mucoid carcinoma
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Several potential risk factors have been described, including the recent use of antibiotics and oral contraceptives, the presence of diabetes mellitus, dietary practices, gastrointestinal colonization by the organism, clothing and sanitary protection practices, sexual communicability of the organism, and HIV, DM, Ref ganong's review of medical physiology 25e 498
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WHO Measles Elimination strategy : Catch up, Keep up, Follow up. Catch up: Nationwide, vaccination targeting all children 9 months to 14 years of age, irrespective of history of Measles disease or vaccination status Keep up: Routine services aimed at vaccinating more than 95% of each successive bih coho. Follow up: Subsequent nationwide vaccination campaigns conducted every 2-4 years targeting usually all children born after the catch-up campaign Ref: Park 25th edition Pgno : 161-162
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Pituitary macroadenoma- size more than 10mm. 'Figure of 8' appearance is seen on MRI. Pituitary microadenoma - size less than 10mm. It shows delayed enhancement on dynamic contrast enhanced MRI as compared to normal pituitary gland .
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Ans. is 'c' i.e. 80% Attributable risk = T (Insolence of disease rate among exposed - incidence among non-exposed) /incidence rate among exposed) X 100 If the incidence of Ca CX among non-exposed = x then the incidence among exposed= 5xAR = ((5x - x)/5x) x 100 = 4/5 x 100= 80%
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Acute inflammation has three major steps: -
Among these three major steps “The hallmark of acute inflammation is increased vascular permeability leading to
escape of protein-rich fluid (exudates) into the extravascular tissue”.
Mechanism of increased vascular permeability
i. Formation of endothelial gaps in venules
ii. Direct endothelial injury resulting in endothelial cell necrosis and detachment.
iii. Delayed prolonged leakage
iv. Leucocyte mediated endothelial injury.
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. *The sensations that are transmitted only in dorsal and dorsolateral columns-kinesthetic and position sensations,vibration sensation, discrete localization and 2 point discrimination are lost on the side of transection because fibers in this column do not cross to opposite side until they reach medulla Brown-Sequard syndrome is characterized by loss of motor function (i.e. hemiparaplegia), loss of vibration sense and fine touch, loss of proprioception (position sense), loss of two-point discrimination, and signs of weakness on the ipsilateral (same side) of the spinal injury. ref Harrison20th edition pg 2700
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Ans. is 'd' i.e., MuscleGluconeogenesis occurs mainly in the liver and to a lesser extent in renal coex.Some gluconeogenesis can also occur in small intestine, but it is not significant.Some of the reactions of gluconeogenesis occurs in the mitochondria but most occur in cytosol.Gluconeogenesis cannot occur in muscles.Glucose-6-phosphatase is absent in muscles therefore, glucose-6-phosphate cannot be degraded to free glucose in muscles. Moreover, glucose-6-phosphate cannot diffuse out of the muscles. Therefore, muscle cannot provide glucose to maintain blood glucose level. Rather, muscle glycogen acts as a source of energy; the glucose-6phosphate enters the glycolysis to produce energy.
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Ans. is 'c' i.e., NADH
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Ans. is 'b' i.e. Filaria This question is one of the most often repeated question in PG examsThere are three types of biological transmission by vectors :Propagative:The infectious agent merely multiplies in the vector but no change in form.eg.plague bacilli in rat fleas.Cyclopropogative:The agent changes in form and number.eg. malaria parasite in mosquito.Cyclo-developmental:The disease agent undergoes only development but no multiplication.eg. microfilaria in mosquito.
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Loratidine Loratidine is paially metabolized by CYP3A4 to an active metabolite with a longer T1/2 of 17 hours but in contrast to terfenadine/astemizole, it has not produced cardiac arrhythmia in overdose.
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Villous adenomas causing profuse watery diarrhoea and hypokalemia is known as the McKittrick Wheelock syndrome after it was first described in 1954.
Metabolic abnormalities seen are hyponatraemia, hypokalaemic, and hypochloraemic metabolic acidosis.
Severe volume loss may cause acute renal failure and cardiovascular collapse.
The mechanism of fluid and electrolyte loss is unclear. Locally released prostaglandin E2 has been suggested as the secretagogue responsible for salt wasting, as has a cyclic AMP.
Treatment:
Reversal of the biochemical derangement is the cornerstone of successful management. Once resuscitated, immediate surgical resection of the tumor, is the treatment of choice.
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Metoclopromide Acetylation is a phase II metabolic reaction Phase II reactions serves to attach a conjugate to the drug molecule. After the phase II reactions all drugs becomes water soluble, so that they can be readily eliminated from the body. Phase II reactions includes - Glucuronidation - Acetylation - Methylation - Sulfation - Glycine conjugation Acetylation Drugs having amino or hydrazine resides are conjugated with the help of acetyl coenzyme A. Examples are : S - Sulfonamides (Dapsone) H- Hydralazine I - Isoniazid P - PAS Acetylation is a genetically mediated condition. Multiple genes control the acetyl transferases and the rate of acetylation shows genetic polymorphism
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Ans. is 'b' i.e., Inferior constrictor o Inferior constrictor has two partsUpper Propulsive Part - Thyropharyngeus with oblique fibers.Lower Sphineteric part - Cricopharyngeus with transverse fibers.o Between these two parts exists a potential gap called "Killian's dehiscence".o it is also called "Gateway of tears" as perforation can occur at this site during esophagoscopy.o This is also the site for herniation of pharyngeal mucosa in cases of pharyngeal pouch (pharyngeal diverticulum)
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Ans. is 'b' i.e., Infanticide * Infanticide refers to killing a child after delivery, to till 1 year after birth. Infanticide in India is considered equivalent to murder and is tried under section 302IPC. Law considers every child as born dead and therefore in a case of infanticide, it has to be proved that the child was born alive and was then killed. Thus the first question in the investigation of a case of infanticide is, whether the child was still born or dead born or whether it was born live.* Still born : A still-born child is one which is born after 28 weeks of pregnancy and did not show sign of life after being completely born (i.e. he remains still -> so still birth). Child was alive in utero just before delivery but died during the process of birth.* Abortion refers to expulsion of the product of conception at any period of gestation before full term. Abortions may be1) Natural (spontaneous/accidental) abortion : Occurs naturally or spontaneously without any intervention.2) Artificial abortion : It occurs as results of direct interference with the pregnancy. Artificial abortion mayi) Legal (justifiable) abortion : It comes under medical termination of pregnancy (MTP) act.ii) Criminal abortion : It is illegal.
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Interspinous diameter
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Ans. D: Isolation of virus from stool Poliomyelitis diagnosis may be confirmed with a laboratory diagnosis. Viral isolation Poliovirus may be recovered from the stool or pharynx of a person with presumed poliomyelitis. Isolation of virus from the cerebrospinal fluid (CSF) is diagnostic, but is rarely accomplished. If poliovirus is isolated from a person with acute flaccid paralysis, it must be tested fuher, using oligonucleotide mapping (fingerprinting) or genomic sequencing, to determine if the virus is "wild-like" or "vaccine-like." Serology Neutralizing antibodies appear early and may be at high levels by the time the patient is hospitalized and, therefore, a 4-fold rise may not be demonstrated. Cerebrospinal fluid (CSF) The CSF in poliovirus infection usually contains an increased number of white blood cells (10 to 200 cells/mm 3, primarily lymphocytes) and a mildly elevated protein from 40 to 50 mg/100 ml.
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Ans. is 'b' i.e., CytokeratinsMallory hyaline (mallory bodies) o Mallory bodies are eosinophilic intracytoplasmic inclusion bodies which are composed predominantly of keratin intermediate filaments.o They are also known as alcoholic hyaline.o These inclusions are characteristic but not specific feature of alcoholic liver disease, as they are also seen in other conditions.
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Causes of absent ankle jerks and upgoing plantars is a common question as it implies both upper and lower motor neuron involvement. The more common single causes include cord compression involving both the cord (UMN) and nerve ganglia roots (LMN) as well as subacute combined degeneration of the cord. Other more common causes include the presence of more than one pathology, e.g. stroke (UMN) with superimposed peripheral neuropathy (LMN) — usually in a diabetic patient. In Friedrich’s ataxia, both cord and peripheral nerve involvement accompany cerebellar degeneration. These patients also have sensory loss, pescavus and may have complications such as diabetes and hypertrophic cardiomyopathy. Multiple sclerosis may cause a mixture of pyramidal signs (UMN), sensory loss (dorsal columns) and ataxia (cerebellum), but will never involve the LMN.
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In Hypertrophic pyloric stenosis dehydration causes hypokalemic, hypochloremic metabolic alkalosis with paradoxical aciduria.
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Ans. is 'c' i.e., Cryptococcus Laboratory diagnosis of crvptococcal infectiono Lumbar puncture is the single most useful diagnositc testo Following tests are usedA) Serology# The most useful serological test is LPA test (Latex agglutination test for the detection of cryptococcal polysaccharide capsular antigen).# This is highly specific and sensitive; and gives better results than direct microscopy and cultures.B) Direct microscopy# Unstained wet preperations of CSF mixed with drop of India ink or nigrosine demonstrate the capsule as a clear halo.# Methenamine silver or periodic acid-Schiff are used for staining a tissue sample.C) Culture# Can be easily cultured from CSF on sabouroud's agar.
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The lesser omentum forms a sac known as the omental bursa, which forms a subdivision of the peritoneal cavity known as the lesser sac. The greater sac is the remaining pa of the peritoneal cavity. The greater and lesser sacs communicate with each other through the epiploic foramen (of Winslow). Boundaries of epiploic foramen:Anteriorly: The free border of the lesser omentum, containing the bile duct, the hepatic aery, and the poal veinPosteriorly: Inferior vena cavaSuperiorly: The caudate process of the caudate lobe of the liverInferiorly: The first pa of the duodenumRef: Moon D.A., Foreman K.B., Albeine K.H. (2011). Chapter 8. Serous Membranes of the Abdominal Cavity. In D.A. Moon, K.B. Foreman, K.H. Albeine (Eds), The Big Picture: Gross Anatomy.
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Ans. is 'd' is myotonic dystrophy The general rule in that:Myopathies have proximal muscle weakness.neuropathies have distal muscle weakness.Myotonic dystrophy is an exception to this general rule and mainly involves the distal muscles.
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Meralgia Paraesthetica results from compression neuropathy of the lateral cutaneous nerve of thigh. It is also called Bernhardt-Roth syndrome. This nerve can be compressed as it runs through the inguinal ligament, just medial to the Anterior superior Iliac spine. Pain, numbness, tingling and paresthesia localised to anterolateral aspect of thigh. Metabolic disorder most notably diabetes is identified as the potential cause of this condition. Ref: Apley's System of Ohopedics and Fractures 8th Edition, Page 252; Lippincott's Primary Care Ohopedics, 2008, Page 87.
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Decreased fibrinogen products
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<p> Malnutrition: Defined as a pathological state resulting from a relative or absolute deficiency or excess of one or more essential nutrients. It comprises: Undernutrition, Overnitrition, Imbalance and Specific deficiency. Main victims are children under 15 years. Children under 5 years are hit the hardest. Malnutrition in India is mainly attributed to kwashiorkar, marasmus, xerophthalmia, nutritional anemia and endemic goitre. Iron deficiency anemia is the most widespread micronutrient deficiency affecting all age groups in India. The effects are direct and indirect. Direct effects are occurence of frank and subclinical nutrition deficiency diseases such as kwashiorkar, marasmus, vitamin and mineral deficiency. Indirect effects are a high morbidity and moality among young children retarded physical and mental growth. Malnutrition predisposes to infection and infection to malnutrition. Waterlow&;s classification of PEM: It defines two groups- 1. Malnutrition with a retarded growth, in which a drop in height/age ratio points to a chronic condition - shoness/stunting. It is an index of duration of malnutrition 2. Malnutrition with a low weight fir a normal height, in ehich the weight for height ratio is indicative of acute condition of rapid weight loss/ wasting . It is an index of severity of malnutrition. Classification of grades of PEM is given by ICMR. IAP Classification of malnutrition: Based on % of ideal weight expected for the age. 1. Normal : >80% 2. Grade 1 PEM: 71-80% 3. Grade 2 PEM:61-70% 4. Grade 3 PEM:51-60% 5. Grade 4 PEM:<50% {Reference: Park&;s textbook of community medicine 23 rd edition, pg no. 640}
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Stratified randomization: Study population is ‘first stratified’ by each variable which is considered important, and then randomization is done to each treatment groups within each stratum.
- Comparison groups become similar as possible as regards participant characteristics that might influence the response to the intervention
- Equal numbers of participants with a characteristic thought to affect prognosis or response to the intervention will be allocated to each comparison group.
- Stratification increase the likelihood that two groups will be more comparable.
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Ans. is 'b' i.e., Lisfranc's Amputation AmputationLevelSyme's Amputationthrough ankle joint (0.6 cm proximal)Sarmiento's Amputation1.3 cm proximal to ankle jointWagner Amputationtwo stage syme's amputationChopart's Amputationthrough midtarsal jointsLisfranc's Amputationthrough tarso-metatarsal jointsPirogoff's Amputationanterior part of calcaneum is removed
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Crowd and mob are related terms.
Crowd means a large number of persons gathered together. A crowd can be a crowd of random people doing different things or it may be people with one intent or purpose.
Mob is highly emotional crowd whose members have with one intent or purpose and are engaged in or are ready to engage in, violence against specific target: a person, a category of people or physical property.
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Transverse carotid intimal tears is called Amussat's sign. Commonly seen in Judicial hanging.
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Ans. is 'a' i.e., Epitympanum o Prussak's space is a small space between the shrapnel's membrane / pars flaccida laterally, neck of malleus medially, short process of malleus below and lateral process of malleus above.o Prussak's space communicates with epitympanum through a posterior gap.o Prussak's space is important because it is a site for pars flaccida acquired cholesteatoma formation.
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In males and females, both internal and external urethral sphincters function to inhibit the release of urine. In males, the internal sphincher muscle of urethra functions to prevent reflux of seminal fluids into the male bladder during ejaculation. Females do have a more elaborate external sphincter muscle than males as it is made up of three pas: the sphincter urethrae, urethrovaginal muscle, and the compressor urethrae. Ref - semantischolar.org
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High performance (pressure) liquid chromatography (HPLC) is a modern refinement of column chromatography and is used for protein separation, purification and identification. It can not determine protein structure.Electrophoresis separates (& purifies) proteins based on migration of charged proteins in an electric field. It can not determine protein structure.Higher level (2deg, 3deg & 4deg) of protein structure is studied by X-ray crystallography, NMR sepectroscopy, infrared and ultraviolet spectroscopy.
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Ans. A. NimodipineNimodipine is cerebro selective calcium channel blocker. Given in patients with hemorrhagic stroke. Nicardipine also have similar effects. This drugs reverse the cerebral vasospasm.
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Ans. is 'a' i.e., Dense Collagen
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Ans. is 'a' i.e., Schwanomma * Schwannomas are benign tumors of the nerve sheath.* Schwannomas can arise from any peripheral nerve containing Schwann cells, including cranial nerves.* Although schwannomas can arise from any nerve in the body, the most common locations include the head, arms, legs and trunk.* The eighth cranial nerve is the most susceptible to schwannomas. Bilateral schwannomas of the eighth cranial nerve indicate the presence of type 2 neurofibromatosis.* Other benign nerve sheath tumors are neurofibromas and hemangiopericytoma.
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Ans. (d) IVThere are 4 types of thyroplasty done, depending on the pathology* Type I: Medialization (Done for Abducted Vocal Cord)* Type II: Lateralization(Done for Adducted Vocal Cord)* Type III: Relaxation, shortening (in order to lower down the pitch)* Type IV: tensioning, Lengthening (in order to increase the pitch)
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Ans. is 'b' i.e., Sternum o The state of microcirculation can be assessed by capillary filling time (CFT) o Firm pressure is applied over sternum or forehead by a ball of the thumb for 5 seconds. This leads to blanching. o On removal of pressure color returns. The time taken for complete return of color is designated as capillary filling time, the normal is less than or equal to 3 sec. o Prologed CFT is the earliest sign signifying impairment or microcirculation.
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Ans. is 'd' i.e. BromocriptineRef. K.D.T. 4th/ep244, K.D.T 5th/ep217Prolactin is under predominant inhibitory control of hypothalamus through prolactin releasing inhibitory hormone (PRIH).PRIH is a dopamine that acts on pituitary lactotrope D2 receptor.So, Dopaminergic agonists decrease plasma prolactin levels. These agonists are :Dopamine*Bromocriptine*Apomorphine*Dopaminergic antagonists and DA depletes will increase prolactin levelDopaminergic antagonists are :ChlorpromazineHaloperidolMetoclopramideDopamine depletes are :Reserpine Methyl dopaUses of Bromocriptine are :Hyperprolactinemia*AcromegalyParkinsonism Hepatic comaSuppression of lactation and breast engorgement after delivery.
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Ganer duct cysts are uncommon vaginal cysts develop from remnants of the mesonephric (Wolffian) ducts. They are typically asymptomatic and are usually found within the lateral vaginal wall. Symptoms may include dyspareunia, vaginal pain, and difficulty inseing tampons or other vaginal devices. Examination reveals a tense cyst that is palpable or seen to bulge beneath the lateral vaginal wall. Marsupialization or excision may be appropriate for symptomatic Ganer duct cysts.Ref: Hoffman B.L., Schorge J.O., Schaffer J.I., Halvorson L.M., Bradshaw K.D., Cunningham F.G., Calver L.E. (2012). Chapter 4. Benign Disorders of the Lower Reproductive Tract. In B.L. Hoffman, J.O. Schorge, J.I. Schaffer, L.M. Halvorson, K.D. Bradshaw, F.G. Cunningham, L.E. Calver (Eds), Williams Gynecology, 2e.
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Above 80% of COHb% causes rapid death from respiratory arrest. A cherry-red colouration of the skin, mucous membranes, conjunctiva, nail beds, areas of hypostasis, blood, tissues, and internal organs is seen in CO poisoning. This colour changes to dark-green, then to brown with the onset of decomposition. Ref: The Essentials of Forensic Medicine and Toxicology by Dr K. S.Narayan Reddy, 27th edition, Page 555.
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Cubitus valgus is a common complication.
It is caused by persistent upward displacement of the fractured condyle or by retardation of epiphyseal growth on the affected side from damage to the growing epiphyseal cartilage.
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IgA anti-endomysial antibodies are found in 90% coeliac patients. They are a very specific & sensitive marker for coeliac disease and dermatitis herpetiformis. The anti-endomysial antibody test has been suggested to be 98% sensitive and 98% specific for clinical or subclinical coeliac disease Ref Davidson edition23rd pg 805
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Anti epileptic with highest risk of teratogenicity - Valproate - causes neural tube defects Anti epileptic with lowest risk of teratogenicity- Lamotrigine Levetiracetam
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Ans. is 'd' i.e., Ethosuxamide Propanolol is the most commonly used drug for migraine prophylaxis. Anticonvulsants used for migraine prophylaxis are valproate, Gabapentine and topiramate (not ethosuxamide).
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Ans. C: Wassermann reaction The complement fixation test (CFT) was extensively used in syphilis serology after being introduced by Wasserman in 1906. However, there is now a trend to replace the CFT with the simple flocculation tests. Although CFT is considered to be a relatively simple test, it is a very exacting procedure because 5 variables are involved. In essence the test consists of two antigen-antibody reactions, one of which is the indicator system. The first reaction, between a known virus antigen and a specific antibody takes place in the presence of a predetermined amount of complement. The complement is removed or "fixed" by the antigen-antibody complex. The second antigen-antibody reaction consists of reacting sheep RBC with haemolysin. When this indicator system is added to the reactants, the sensitized RBCs will only lyse in the presence of free complement. The antigens used for CFT tend to be group antigens rather than type-specific antigens. In order for the CFT to be set up correctly, the optimal concentration of haemolytic serum, complement, and antigen should be determined by titration. The Wassermann test is no longer in use.
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(Braunwald, 15/e, pp 823, 893.) Erysipelas, the cellulitis described, is typical of infection caused by S.Pyogenes - Group A b- hemolytic Streptococci (GAS). There is often a preceding event such as a cut in the skin, dermatitis, or superficial fungal infection that precedes this rapidly spreading cellulitis. Anaerobic cellulitis is more often associated with underlying diabetes. S. epidermidis does not cause rapidly progressive cellulitis. Staphylococcus aureus can cause cellulitis that is difficult to distin guish from erysipelas, but it is usually more focal and likely to produce furuncles, or abscesses.
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Ans: a (pH = pKa) Ref: Vasudevan 4'k ecU p.346At values close to pKa, the buffer solution resists changes in pH most effectively. Buffering is the tendency of a solution to resist a change in pH more effectively after addition of a strong acid or base tha n does equal volume of water. Solutions of weak acids and their conjugate bases, and vice versa exhibit buffering. Strong acid /bases do not have buffering quality as great as the weak acid/ bases. pKa refers to the pH at which the concentration of acid equals that of base.* At pH = pKa, the solution would contain acid and base in equal amounts, and therefore would resist a change most effectively in either direction.Note:-The effective range of a buffer is one pH unit higher or lower than pKa.
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Uric acid the end product of purine catabolismis a strong reducing agent. Its role as an antioxidant is paicularly significant in the upper respiratory tract REF : DM VASUDEVAN TEXTBOOK ;8th EDITION ;Page no:547 and 548
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Post-mastectomy pain syndrome (PMPS) is defined as a chronic pain condition, typically neuropathy in nature, that can follow surgery to the breast. PMPS can occur with any surgery to the breast, including mastectomy, lumpectomy, reconstruction, and augmentation. PMPS can be divided into three categories: phantom breast pain, intercostobrachial neuralgia, and neuroma pain. Phantom pain consists of painful sensations in the area of the removed breast. The intercostobrachial nerve is the lateral cutaneous nerve of the second thoracic root. It courses along the axillary vein and then provides sensation to the axilla and breast. The intercostobrachial nerve is frequently stretched or sacrificed during axillary lymph node dissections and is a common cause of PMPS. The scar from breast surgery can be a generator of pain. The pain has been attributed to underlying neuroma formation, axon impingement, and scar retraction. The symptoms associated with PMPS include shooting, stabbing, burning, and pins and needles in the breast, axilla, or medial arm. Ref: Essentials of Physical Medicine and Rehabilitation: Musculoskeletal ... By Walter R. Frontera, Julie K. Silver, M. D., Thomas D. Rizzo, Jr. M.D., 2008, Page 589; Medical care of cancer patients by Sai-Ching Jim Yeung, Carmen R Escalante, Robe F. Gagel, Page 415
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Peliosis hepatis is an uncommon vascular condition characterised by multiple, randomly distributed, blood-filled cavities throughout the liver. The size of the cavities usually ranges between a few millimetres and 3 cm in diameter. In the past, it was a mere histological curiosity occasionally found at autopsies, but has been increasingly recognised with wide-ranging conditions from AIDS to the use of anabolic steroids. It also occasionally affects spleen, lymph nodes, lungs, kidneys, adrenal glands, bone marrow, and other pas of gastrointestinal tract.
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An epitope, also known as antigenic determinant, is the pa of an antigen that is recognized by the immune system, specifically by antibodies, B cells, or T cells. Ref: Ananthanarayan & Panikers textbook of microbiology 9th edition pg:88
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B i.e. Maintenance of airway
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The suprapleural membrane, also known as Sibson fascia is a strong fascial connective tissue layer above the superior thoracic inlet on each side, placed on top of the tips of the lungs. It's damage may cause bulge out appearance. Ref ganong's review of medical physiology 25e
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A person who has gross haematuria should be suspected of having infection with S. haematobium regardless of what other diagnoses may need to be enteained by the rest of the history. Infected humans inevitably excrete S. haematobium eggs in their urine, which finds its way into the water. Once thus excreted, these eggs develop into a very motile form called a miracidium that "homes in" on the intermediate host, which is a snail. In the snail, the fluke metamorphoses into a form called a cercaria, which swims freely in the water, waiting to penetrate the intact skin of a person who may be swimming or wading in this water. Once in the human, S. haematobium develops into adults, which migrate to the veins of the vesical plexus around the bladder. The female lays eggs, which create an inflammatory response that leads to bleeding, which is perceived by the infected individual as gross haematuria. The passage of these eggs, in urine, into water inhabited by the correct species of snail, completes the life cycle. The arrow points towards a terminal spine and when obtained from urinary bladder, is characteristic of S. hematobium species. TREATMENT INFECTION DRUG OF CHOICE S. haematobium, S. mansoni, S. intercalatum Praziquantel S. mekongi, S. japonicum Praziquantel C. sinensis, O. viverreni Praziquantel F. hepatica, F. gigantica Triclabendazole Echinostoma spp. Praziquantel F. buski Praziquantel P. westermani, P. kellicotti Praziquantel, Triclabendazole
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C i.e. Trans MetatarsalRef: Fundamentals of Orthopedics, 2nd edition, Mohindra and Jain, Jay pee Publishers, page 160Explanation:Lisfranc's Fracture DislocationThe Lisfranc joint consists of the tarsometatarsal joint complex, which includes the three cuneiforms, cuboid and their articulations with the five metatarsal bones.Dislocations of the Lisfranc joint are the most common dislocations of the foot*.Mechanism of injury: These injuries usually result from high-energy injuries like:Forced hyperflexion in road traffic accidents (Figure 1).Fall from height.On X-ray, there is increased space between the medial cuneiform and the second metatarsal (due to rupture of Lisfranc ligament that runs between these points) called as Fleck sign*.For treating the dislocation has to be reduced accurately either by closed or open means and has to be fixed with K wires or screws.
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Ans. is 'b' i.e., Ampicillin Drugs acting against Pseudomonas. Penicillins - Piperacillin, Carbenicillin, Ticarcillin, Mezlocillin. Cephalosporins - Ceftazidime, Cefoperazone, Cefepime. Carbapenems - lmipenem, meropenem Monobactams - Aztreonam. Aminoglycosides - Tobramycin, Gentamycin, Amikacin. Fluroquinolones - Ciprofloxacin, Levofloxacin, Norfloxacin. Other - Polymixin B, Colistin. For most of the infection of pseudomonas, treatment of choice is the combination of an antipseudomonal plactam and an aminoglycoside.
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Ans. is 'c' i.e., Quadrilateral * The septal cartilage of the nasal septum is a quadrilateral cartilage."Cartilage of the septum, also known as the quandragular cartilage because it is roughly quadrilateral in shape - separates the nostrils".Medial nasal wall or Nasal septum* Nasal septum is the osseo - cartilaginous partition between the two halves of the nasal cavity.* Nasal septum consists of1) Columellar septum It is formed by columella containing the medial crura of alar cartilages united together by fibrous tissue.2) Membranous septum It consists of double layer of skin with no bony or cartilaginous support.3) Septum properThis forms the major portion of nasal spetum and consists of osteocartilagenous framework which is coverd by mucous membrane. Its constituents arei) Osseous part# The vomer# Perpendicular plate of ethmoid# Nasal spine of frontal bone# Rostrum and crest of sphenoid# Nasal crest of nasal bone# Nasal crest of palatine bone# Nasal crest of maxillary bone ii) Cartilaginous part# Septal (Quadrilateral or Quadrangular) cartilage.
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Answer is A (They are infectious proteins): Prions are infectious proteins devoid of any nucleic acid - Harrisons Prions and Prion associated diseases Prions are infectious proteins devoid of any nucleic acid (RNA or DNA)q (Prions are the only known infectious agents that are devoid of nucleic acide) Prion diseases result from the accumulation of the abnormal prion protein 'Pr Ps"2 Prions are most resistant to physical and chemical agents such as heat, irradiation and.formalinee. The diseases caused by Prions include diseases in human & animals Prion Diseases share several distinguishing hallmarks Hallmarks of Prion Diseases The disease is confined to the ,ervous systemQ (Although agent may be recoverable from other organs) The basic features are Neurodegeneration and SpongifOrmQ changes Amyloid plaques may be present Clinical illness is preceded by a long incubation periodQ (months to decades) Onset of clinical illness is followed by chronic progressive diseaseQ (weeks to years) The disease is always fatalQ with no known cases of remissionQ or recovery The host shows no inflammatory response and no immune responses - Agents do not appear to be antigenice - No production of interferon is elicited - There is no effect on host B cell or T cell function Immunosupression of the host has no effected on pathogenesis
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Aplasia is the absence of an organ coupled with persistence of the organ anlage or a rudiment. Thus, aplasia of the lung refers to a condition in which the main bronchus ends blindly in nondescript tissue composed of rudimentary ducts and connective tissue. Dysraphic anomalies (choice C) are defects caused by the failure of apposed structures to fuse. Hypoplasia (choice D) refers to reduced size owing to the incomplete development of all or part of an organ. Examples include microphthalmia and microcephaly. Involution failures (choice E) reflect the persistence of embryonic or fetal structures that should involute at certain stages of development. A persistent thyroglossal duct is the result of incomplete involution of the tract that connects the base of the tongue with the thyroid.Diagnosis: Pulmonary aplasia
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Ans. b (Mizolastine) (Ref KDT 6th/158)KDT 6th/1S9:Mizolastine: is nonsedating antihistaminic is effective in allergic rhinitis and urticaria by single daily dosing despite a t 1/2 of 8-10 hr and no active metabolite.anticholinergic action can be graded as:HighLowMinimal/ AbsentPromethazineChlorpheniramineClemastineDiphenhydramineHydroxyzineTerfenadineDimenhydrinateTriprolidineAstemizolePheniramineCyclizineLoratadineCyproheptadine CetirizineSECOND-GENERATION ANTIHISTAMINICSThe second-generation antihistaminics (SGAs) are H, receptor blockers marketed after 1980with following properties:# Higher H1 selectivity: no anticholinergic side effects.# Absence of CNS depressant property.# Additional antiallergic mechanisms apart from histamine blockade: some also inhibit late phase allergic reaction by acting on leukotrienes or by anti-platelet activating factor effect.# They have poor antipruritic, antiemetic and antitussive actions.Terfenadine (withdrawn by most manufacturers).# It is the first SGA,- highly H1 selective,- rapid onset (1-2 hr) and- moderate duration (12-24 hr) of action - good for short term and intermittent use.# Terfenadine, but not its carboxy metabolite (the active H1 blocker), blocks cardiac K+ channels in overdose and has produced polymorphic v. tach (torsade de pointes).# The risk is markedly increased in liver disease or when inhibitors of CYP 3A4 (which generates the carboxy metabolite) are administered concurrently -Erythromycin, clarithromycin, ketoconazole and itraconazole are the most important drugs precipitating terfenadine cardiotoxicity, while azithromycin and fluconazole are probably safe.# Similar incidences have been reported with astemizole, but not with other SGAs except ebastine.Fexofenadine (active metabolite of terfenadine)# Does not block delayed rectifier K+ channels in the heart--does not prolong QTc interval.# Therefore it has been introduced as a substitute of terfenadine free of arrhythmogenic potential.# But it is not entirely safe in patients with long QT, bradycardia or hypokalemia.# Fexofenadine do not cross BBB- no sedation or impair psychomotor performance and is free of atropinic side effects.# Duration of action 24 hours.# Though erythromycin and ketoconazole increase its blood levels, but no arrhythmias have been observed.Astemizole# Actions of astemizole are similar to terfenadine, but it has slow onset (2-4 hr) and long duration (2-5 days) of action.# It is 97% plasma protein bound and metabolized with a tV2 of 20 hr.# Astemizole is better used for maintenance therapy.# Not suitable for rapid control of symptoms.# In perennial rhinitis it has shown better efficacy than terfenadine and chlorpheniramine.# Increased appetite, weight gain and flatulence occur in some patients. It shares the ventricular tachycardia producing potential of terfenadine. The risk is enhanced by coadministration of selective serotonin reuptake inhibitors, quinidine, some macrolides, azole antifungals and HIV protease inhibitors.Loratadine# Another long-acting selective peripheral H] antagonist that lacks CNS depressant effects; faster acting than astemizole.# It is partly metabolized by CYP3A4 to an active metabolite with a longer t 1/2 of 17 hr, but in contrast to terfenadine/ astemizole, it has not produced cardiac arrhythmia in overdose.# No interaction with macrolides or antifungals has been noted.# Good efficacy has been reported in urticaria and atopic dermatitis.Desloratadine# It is the major active metabolite of loratadine effective at half the dose.# Non-interference with psychomotor performance and cardiac safety are documented.Cetirizine# It is a metabolite of hydroxyzine with marked affinity for peripheral Hl receptors; penetrates brain poorly, but subjective somnolence has been experienced at higher doses.# It is not metabolized; does not prolong cardiac action potential or produce arrhythmias when given with erythromycin/ ketoconazole.# Cetirizine also inhibits release of histamine and of cytotoxic mediators from platelets as well as eosinophil chemotaxis during the secondary phase of the allergic response.# Superior efficacy in urticaria / atopic dermatitis.# It is indicated in upper respiratory allergies, pollinosis, urticaria,atopic dermatitis; also as adjuvant in seasonal asthma.Azelastine# This newer H1 blocker has good topical activity;# Also inhibits histamine release and inflammatory reaction triggered by LTs and PAF; and has bronchodilator property.# After intranasal application it has been shown to down-regulate ICAM-1 expression on nasal mucosa.# Its metabolism is inhibited by CYP 3A4 inhibitors.# Given by nasal spray for seasonal and perennial allergic rhinitis it provides quick symptomatic relief lasting 12 hr.# Stinging in the nose and altered taste perception are the local side effects.# Some somnolence after nasal use and weight gain noted after oral use.Mizolastine# This recently marketed nonsedating antihistaminic is effective in allergic rhinitis and urticaria by single daily dosing despite a t 1/2 of 8--10 hr and no active metabolite.Ebastine# Another newer SGA that rapidly gets converted to the active metabolite carbastine having a t 1/2 of 10-16 hr. It is nonsedating and active in nasal and skin allergies.# Animal studies have found it to prolong Q-Tc interval, which makes it liable to arrhythmic potential and CYP3A4 interaction, but actual reports are still few.H2 antagonist: The first H2 blocker Burimamide was developed by Black in 1972. Metiamide was the next, but both were not found suitable for clinical use. Cimetidine was introduced in 1977 and gained wide usage. Ranitidine, famotidine, roxatidine, and many others have been added subsequently. They are primarily used in peptic ulcer and other gastric hypersecretory states and are described.H3 antagonist: Though a selective H3 antagonist thioperamide has been developed, it has not found any clinical utility.
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Ans. is 'a' Serum acid phosphatse This pt. is suspected to have Ca Prostate as Prostatic Ca is the most common malignant tumor in men over 65 yrs. of age. Symptoms of Bladder outlet obstruction and back pains (due to bony metastasis in the pelvis & lumbar veebra) indicate towards prostate Ca. Serum acid phosphatase is a tumor marker of prostate Ca. But now serum acid phosphatase assay has been superseeded by PSA assay (Prostate specific antigen). Prostate specific antigen It is a glycoprotein produced only in the prostatic cells (both benign & malignant). It facilitates liquefaction of semen. It is neither sensitive nor specific for early prostate carcinoma (it is prostate specific and not prostate cancer specific), neveheless it gives some help in making a diagnosis. * Normal serum level ----> less than 4 ng/ml* * 4 - 10 ng/ml ----> this range is common for both BHP and Ca.* * More than 10 ng/ml --> approx 75% will have cancer.* Since PSA is not specific for Ca, PSA Velocity & PSA density are used to detect Prostate cancer. PSA velocity is the rate of change in PSA levels over time and is expressed most commonly as the PSA doubling time. For men with a PSA above 4, PSA velocity of more than .75 ng/ml year is suggestive of Ca. While for those with lower PSA levels, rates above 0.5 ng/mL per year should be used to advise biopsy. PSA density is calculated by dividing the serum PSA by the estimated prostate weight (measured by TRUS). It was developed to correct for the contribution of BPH to the total PSA level. - Values < 0.10 are consistent with BPH. - > 0.15 suggest cancer
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D i.e. All
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Esthesioneuroblastoma is a rare unique tumor of neural crest origin. Presents as a unilateral polypoidal mass in the upper third of the nasal cavity with symptoms of nasal obstruction, epistaxis and anosmia.
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Ans. is 'c' i.e., APC * Li-Fraumeni syndrome is due to germ line mutation in p-53 gene.SyndromeGeneChromosome* Familial adenomatous polyposis* APC* 5q21* Familial Wilms tumor* WTl* 11p13* Hereditary breasti ovarian cancer* BRCA1* BRCA2* 17q21* 13q12.3* Hereditary retinoblastoma* RBI* 13q14.2* Multiple endocrine neoplasia type 1* MENl* 1lq13* Multiple endocrine neoplasia type 2a* RET* 10q11.2* Neurofibromatosis type 1* NFl* 17q11.2* Neurofibromatosis type 2* NF2* 22q12.2* Li-fraumeni syndrome* p53* 17* Melanoma* p16INK4A
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Ans. is 'b' i.e., Superficial parotidectomy * "Though pleomorphic adenoma is encapsulated, it sends pseudopods into the surrounding gland which are left behind if the tumour is simply shelled out. It is therefore essential that surgical excision of the tumour should include normal gland tissue around it. In the parotid, it amounts to superficial parotidectomy."
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HTLV-1 is associated with adult T-cell leukemia/lymphoma. EBV is found in a subset of Burkitt lymphoma, 30% to 40% of Hodgkin lymphoma (HL), many B-cell lymphomas arising in the setting of T-cell immunodeficiency, and rare NK-cell lymphomas. In addition to Kaposi sarcoma, HHV-8 is associated with an unusual B-cell lymphoma (primary effusion lymphoma) that presents as a malignant effusion, often in the pleural cavity.
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ANSWER: (A) 8: 14REF: Wintrobe's clinical hematology 12th edition page 1604.1605, http://en.wikipedia.org/wiki/ LymphomaSee APPENDIX-29 below for "TRANSLOCATION" APPENDIX - 29TranslocationThe International System for Human Cytogenetic Nomenclature (ISCN) is used to denote a translocation between chromosomes. The designation t (A; B) (pi; q2) is used to denote a translocation between chromosome A and chromosome B. The information in the second set of parentheses, when given, gives the precise location within the chromosome for chromosomes A and B respectively--with p indicating the short arm of the chromosome, q indicating the long arm, and the numbers after p or q refers to regions, bands and sub bands seen when staining the chromosome with a staining dyeTranslocationAssociated diseasesFused genes/proteinsFirstSecondt (8; 14) (q24; q32)Burkitt's lymphomac-myc on chromosome 8, gives the fusion protein lymphocyte-proliferative abilityIGH (immunoglobulin heavy locus) on chromosome 14, induces massive transcription of fusion proteint(ll;14) (ql3;q32)Mantle cell lymphomacyclin D1 on chromosome 11, gives fusion protein cell- proliferative abilityIGH (Immunoglobulin heavy locus) on chromosome 14, induces massive transcription of fusion proteint(14; 18) fq32;q21)Follicular lymphomaIGH (immunoglobulin heavy locus) on chromosome 14, induces massive transcription of fusion proteinBcl-2 on chromosome 18, gives fusion protein anti- apoptotic abilitiest(11; 18) (q21; q21)MALT lymphomas t(10; (various)) (q11; (various))Papillary thyroid cancerRET proto-oncogene on chromosome 10PTC (Papillary Thyroid Cancer)- Placeholder for any of several other genes/proteinst(2: 3) (ql3; p25)Follicular thyroid cancerPAX8 - paired box gene 8 on chromosome 2PPARyl (peroxisome proliferator-activated receptor y 1) on chromosome 3t(8 ;21) (q22; q22)Acute myeloblastic leukemia with maturationETO on chromosome 8AML1 on chromosome 21t(9;22) (q34;qll)PhiladelphiachromosomeChronic myelogenous leukemia (CML), acute lymphoblastic leukemia (ALL)Abl1 gene on chromosome 9BCR ("breakpoint cluster region" on chromosome 22t(15; 17)Acute promyelocytic leukemiaPML protein on chromosome 15RAR-tr on chromosome 17t(12; 15) (pl3; q25)Acute myeloid leukemia, congenital fibrosarcoma, secretory breast carcinomaTEL on chromosome 12TrkC receptor on chromosome 15t(9; 12) (p24; pl3)CML, ALLJAK on chromosome 9TEL on chromosome 12t(12; 21) (pl2; q22)ALLTEL on chromosome 12AML1 on chromosome 21t(l; 11) (q42.1; ql4.3)Schizophrenia t(2; 5) (p23; q35)Anaplastic large cell lymphoma t(ll; 22) (q24; qll.2- 12)Ewing's sarcoma t(17; 22)Dermatofibrosarcoma protuberans (DFSP) t(l; 12) (q21; pl3)Acute myelogenous leukemia t(X; IS) (pll.2- qll.2)Synovial sarcoma t(l; 19) (qlO; plO)Oligodendroglioma and oligoastrocytoma
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High levels of ACTH are detected by the adrenal gland receptors which stimulate the secretion of coisol, causing blood levels of coisol to rise. As the coisol levels rise, they sta to slow down the release of coicotrophin-releasing hormone from the hypothalamus and ACTH from the pituitary gland. Ref : Nelson
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Stroke vol is the volume of blood pumped from left ventricle per beat SV can be calculated by 1) CO =SV*HR 2)Ejection fraction= SV/ End diastolic. volume 3) SV= EDV-ESV of each ventricle
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The cause of pulmonary edema in congestive hea failure is an increase in the hydrostatic pressure at the level of the capillaries of the lung. This increased pressure serves to drive fluid out of the capillaries and into the alveoli. The other reasons cited in the choices can also cause pulmonary edema, but occur in other clinical settings. Damage to endothelial cells can occur in vasculitis. Damage to the epithelial lining of the alveoli can occur in pneumonia and respiratory distress syndrome. Low serum albumin can be seen in liver and kidney disease.
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Fine, irregular contractions of individual fibers is known as fibrillations. This is the classic picture of a lower motor neuron lesion. If the motor nerve regenerates, the fibrillations disappear. Usually, the contractions are not visible grossly, and they should not be confused with fasciculations, which are jerky, visible contractions of groups of muscle fibers that occur as a result of pathologic discharge of spinal motor neurons.
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Ans. is'a'i.e., 5 ml/kgDuring mechanical ventilation of newborns, it has been found out that large tidal volumes can lead to lung injury, therefore small tidal volumes are recommended.In a healthy newly born tidal volume of 5-8 ml/kg may be used, however it a newbornwith ARDS, a tidal volume of 4-6mlkg k recommended.
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Ans. is 'c' i.e., Subclavian artery Internal thoracic arteryo It arises from 1st part of subclavian artery and descends through anterior ends of upper six intercostal spaces lying 1[?]25 cm lateral to sternal margin.o It divides into two terminal branches, musculophrenic and superior epigastric in (f intercostal space,o Branches of internal thoracic artery are (i) mediastinal branches, (ii) pericardial branches, (iii) sternal branches, (iv) pericardiophrenic branches, (v) anterior intercostal arteries (in upper six spaces), (vi) perforating branches, and (vii) two terminal branches, musculophrenic and superior epigastric.
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The uterus is a pear-shaped, thick-walled, muscular organ, situated between the base of the bladder and the rectum. The uterus measures about 8 cm long, 5 cm wide at the fundus and its walls are about 1.25cm thick. Its weight varies from 50-80 gm. It has got the following pas: 1) Body or corpus 2) Isthmus 3) Cervix. Note: The normal length of uterine cavity is 6.5-7 cm. Ref: Textbook of Obstetrics D.C.Dutta 6th Ed Page 79.
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GABA is the major inhibitory mediator in the brain and mediates both presynaptic and postsynaptic inhibition. GABA, which exists as -aminobutyrate in the body fluids, is formed by decarboxylation of glutamate by the enzymeglutamate decarboxylase (GAD), which is present in nerve endings in many pas of the brain. Glutamate is the main excitatory transmitter in the brain and spinal cord and has been calculated to be responsible for 75% of the excitatory transmission in the CNS. Glycine has both excitatory and inhibitory effects in the CNS. Ref: Barrett K.E., Barman S.M., Boitano S., Brooks H.L. (2012). Chapter 7. Neurotransmitters & Neuromodulators. In K.E. Barrett, S.M. Barman, S. Boitano, H.L. Brooks (Eds), Ganong's Review of Medical Physiology, 24e.
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Ans. is 'b' ie Meningocele "Meningocele (protrusion of the meninges with CSF), or Encephalocele (protrusion of the brain) or Meningoencephalocele (protrusion of the meninges as well as brain) are sometimes met with at the roof of the nose, the occipital region or anterior fontanelle. They are diagnosed by their typical situation (in the midline) impulse on coughing or crying and translucency"
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Ans. is 'b' i.e., 3 years Gross motor development milestonesNeck holding3 monthsSitting with support5 monthsProne to supine and supine to prone6 monthsSitting without support8 monthsCrawling9 monthsCreeping10 monthsWalking with support11 monthsWalk independently1 yearRun well, climbing upstairs and going downstairs with one step at a time2 yearsRide tricycle; climbing upstairs with alternate feet3 yearsHopping; going downstairs with alternate feet4 yearsSkipping5 years
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Because of their settling velocities in air, paicles >10-15 mm in diameter do not penetrate beyond the nose and throat. Paicles <10 mm in size are deposited below the larynx. These paicles are divided into three size fractions on the basis of their size characteristics and sources. Paicles ~2.5-10 mm (coarse-mode fraction) contain crustal elements such as silica, aluminum, and iron. These paicles mostly deposit relatively high in the tracheobronchial tree. Ref Harrison 19th edition pg 1688
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Ans. A. Ileum(Ref: Harper 31/e page 533-540)Site of absorption of Iron--Proximal DuodenumSite of absorption of Folic acid--Proximal jejunumSite of absorption of Cobalamin--Ileum
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Characteristic sign of alkaptonuria is darkening of urine on standing, especially if the urine is alkaline. Ref: Harrison's 16th Edition, Page 2334; Essential Pediatrics, OP Ghai - 6th Edition, Page 610; Nelson's Paediatrics 17th Edition, Page 403; Lippincotts 3rd Edition, Page 272.
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Option A - wrong, slow sand filter occupy more space Option B - wrong, it is less expensive Option C - correct, rate of filtration is very slow (2-3m.g.a.d.) hence takes longer time Option D - wrong, effective sand size in slow sand filter is 0.2-0.3 mm (PARK TB 25th edition pg 773)
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Ans. is 'b' i.e., Biceps
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Ans is 'd' i.e. 191IPC Section 191: Giving false evidence. Whoever, being legally bound by an oath or by an express provision of law to state the truth, or being bound by law to make a declaration upon any subject, makes any statement which is false, and which he either knows or believes to be false or does not believe to be true, is said to give false evidence.Section 193: Punishment for false evidence. Whoever intentionally gives false evidence in any stage of a judicial proceeding, or fabricates false evidence for the purpose of being used in any stage of a judicial proceeding, shall be punished with imprisonment of either description for a term which may extend to seven years, and shall also be liable to fine,
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ANSWER: (B) RETREF: Schwartz's Principles of Surgery 9th edition chapter 38, Sabiston 18th ed chapter 36
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A variety of psychopharmacologic agents, including clonidine, antidepressants, and buspirone, have been used with some success in the treatment of nicotine dependence. Bupropion (Zyban) was approved by the FDA in 1996 for this use. The latest drug is Varenicline, an alpha4 beta2 Nicotinic Acetylcholine Receptor Paial Agonist it is a very effective in tobacco dependence.
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Osteosarcoma is a radioresistant tumor; therefore treatment focuses on chemotherapy and surgery. Ref: Encyclopedia of Cancer, Volume 1, By Manfred Schwab, 2008, Page 2201; Aicle: Pahenolide and Ionizing Radiation Synergistically Induce Cell Death in LM7 Osteosarcoma Cells, 2012.
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Inokuchi shunt Interpostion of vein graft between the left gastric (coronary) vein and the IVC Also known as coronary-cabal fistula Choice (TIPS or shunt) is based on the predicted time to transplantation Ref:Sabiston 20th edition Pgno : 1440
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Ans. is 'd' i.e., Inve 16 often detected in the blasts and the eosinophil This is a case of ALL with hypereosinophillic syndrome. Inv (16) is associated with AML ( not ALL,) o The neoplastic cells are formed of lymphoblasts only. The eosinophils do not constitute the neoplastic cells. o The increased eosinophils are not blast cells, they are eosinophilic precursors. The eosinopilia is believed be a reactive process.
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Basic amino acid consists of those amino acids which have one 'COOH' group and 2 'NH2' gps. Their side chains accept protons. Basic Amino acids include Arginine, Lysine and Histidine. Ref: Textbook of Biochemistry By DM Vasudevan 3rd Edition, Page 12 ; Biochemistry By Mary K. Campbell, Shawn O. Farrell, Page 70 ; Harper's Biochemistry, 24th Edition, Page 29 and 25th Edition, Page 29
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Causes of Acute Pancreatitis
Common Causes
Gallstones (including microlithiasis) - most common
Hypertriglyceridemia
Endoscopic retrograde cholangiopancreatography (ERCP), especially after biliary manometry.
Trauma (especially blunt abdominal trauma)
Postoperative (abdominal and nonabdominal operation)
Drugs ( L-asparaginase, thiazide diuretics, furosemide, estrogens, azathioprine, 6-mercaptopurine, methyldopa.
sulfonamide, tetracycline, valproic acid, anti-HIV medications)
Sphincter of Oddi dysfunction
Uncommon causes
Vascular causes and vasculitis (ischemic-hypoperfusion states after cardiac surgery)
Connective tissue disorders and thrombotic thrombocytopenic purpura (TTP)
Cancer of the pancreas
Hypercalcemia
Periampullary diverticulum
Pancreas divisum
Hereditary pancreatitis
Cystic fibrosis
Renal failure
Rare causes
Infections (mumps, coxsackievirus, cytomegalovirus, echovirus, parasites).
Autoimmune (i.e., Sjogren's syndrome)
Causes to consider in patients with recurrent bouts of acute pancreatitis without an obvious etiology
Occult disease of the biliary tree or pancreatic ducts, especially microlithiasis, sludge
Drugs
Pancreatic cancer
Idiopathic
Hypertriglyceridemia
Sphincter of Oddi dysfunction
Pancreas divisum
Cystic fibrosis
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Southern Blot - DNA
Northern Blot - RNA
Western Blot - Proteins.
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