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Ans. is 'a' i.e., Spectroscopy Ultroviolet visible spectroscopy (UV-sis) can distinguish between enantiomers by showing a distinct cotton effect for each isomer.UV-sis spectroscopy sees only chromophores, so other molecules must be prepared for analysis by chemical addition of a chromophores such as antracene.Two methods are repoed : the octant rule and the excition chirality method.
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Ans:C-RationalizationRationalization or rationalisation (also known as making excuses) is a defense mechanism in which controversial behaviors or feelings are justified and explained in a seemingly rational or logical manner to avoid the true explanation, and are made consciously tolerable--or even admirable and superior--by plausible means. It is also an informal fallacy of reasoning.
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repeat
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Ans: c (Amblyopia)Ref: Pradeep Sharma, pg. 115 Usually paralytic squint is late onset, so sensory adaptation like amblyopia and suppression may not occur. Amblyopia is usually seen in concomitant strabismus. All others are features of paralytic strabismus.
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Lymphatic spread is commonest route for spreading of Papillary carcinoma and least for Follicular carcinoma.
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Boundaries of the lesser sac are:-
Anterior:- Right free margin of lesser omentum (contains portal vein, hepatic artery proper and bile duct).
Posterior:- IVC, right suprarenal gland and T12 vertebra.
Superior:- a Caudate lobe of the liver.
Inferior:- 1st part of duodenum and horizontal part of the hepatic artery.
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Ans. (d) Gastrocolic - reflex(Ref: Ganong, 25th ed/p.504)Distension of the stomach by food - causes contractions of the rectum leading to defecation. This reflex is called gastrocolic reflex
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B i.e. Pethidine Meperidine (pethidine, demerol), a phenylpiperidine is metabolized chiefly in liver to nonmeperidine, which is eliminated by the kidney and liver. In patients or addicts who are tolerant to the depressant effects of meperidine, large doses repeated at sho interval may produce an excitatory syndrome including hallncination, tremors, muscle twitches, dilated pupils, hyperactive reflexes and convulsions. These excitatory symptoms are d/t accumulation of normeperidine, which has a half life of 15-20 hours, compared to 3 hours for meperidine. In patients with cirrhosis, the bioavailability of meperidine is --80% increased and t1/2 of both meperidine and normeperidine are prolonged. Since normeperidine is eleminated by kidney and liver, decreased renal or hepatic function predispose to neurotoxic effects of nor-meperidineQ. Meperidine is also not recommended for the treatment of chronic pain b/o concerns of metabolite toxicity. It should not be used for longer than 48 hours or in doses > 600 mg/day. Major pathway for morphine metabolism is conjugation with glucuronic acid forming morphine -6- glucuronide and morphine -3- glucuronide. Morphine-6-glucuronide is twice as potent as morphine with somewhat longer t1/2. (t1/2 of morphine is 2 hours) and pharmacological actions indistinguishable from those of morphine. With chronic morphine administration, the 6-glucuronide accounts for most of analgesia and its blood levels exceed those of morphine. Morphine-6-glucuronide is excreted by kidney, so its levels increase in renal failure, perhaps explaining morphine's potency and long action in compromised renal function. So in patients with renal failure decreased protein binding of morphine (resulting in higher plasma free drug level) and accumulation of morphine -6- glucuronide predispose them to respiratory depression. So morphine is given cautiously in low doses in renal failure. Respiratory depression is also repoed in patients with CRF receiving sufentanyl. Except for slightly decreased protein binding, the free drug volume of distribution and clearance of alfentanil appears to be unaffected by renal failure. Fentanyl, has sho half life and its metabolites are inactive. Therefore, it is a good choice in patients with renal diseaseQ. In renal disease (renal failure) remifentanil > fentanyl > alfentanil > sufentanil are safe. Whereas morphine (d/t morphine 6 glucoronide) 1/t respiratory depression is used very cautiously in low dose and meperidine (pethidine) is contraindicated d/t very long acting metabolite nor-meperidine causing neurotoxic excitatory syndrome.
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Ans. is 'a' i.e., Extremely painful * Cutaneous anthrax is painless.
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Ans. is 'c' i.e., Diploma of CPS Schedules of MCI Act MCI was established in 1934 and MCI act was revised in 1956, 1964, 1993, 1999, and 2002. The schedules of MCI includes list of medical degrees recognized by MCI :- Schedule 1 :- Includes list of recognised degrees awarded by Indian universities(' ") and also DNB awarded by National Board of Examination, New Delhi. Schedule 2 :- Includes list of recognized medical degrees awarded by foreign universitiesorob'. Schedule 3 :- Includes list of medical qualifications awarded by Indian or foreign boards or societies, but are not included in schedule 1 or 2. It has two pas :? Pa I : Includes list of recognized degrees other than MBBS awarded by Indian Societies and Boards, e.g LMP and diploma of CPS. Pa II: Includes list of recognized degrees other than MBBS awarded by Foreign Societies and Boards
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t (x,18) is seen in synovial cell sarcoma and it produces fusion genes like SS18-SSXl-SSX2-SSX4
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Inderbir Singh&;s Human embryology; Tenth edition; Pg 239The cavity formed after the conus and proximal bulbus cordis have merged into the primitive ventricle has to be subdivided into right and left halves.Two ridges termed right and left bulbar ridges arise in the wall of the bulboventricular cavity.These ridges grow toward each other and form bulbar septum.
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In resting state, the heart is under vagal control. But when there is vagal denervation, the sympathetic activity is unhindered and the heart rate increases.
Conduction is from endocardium to epicardium.
During exercise, the duration of diastole is more decreased than systole.
Vagal stimulation does not decrease the force of contraction.
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Ans. A: R-L shunt Shunting of blood from the right side to the left side of the circulation (right-to-left shunt) is a powerful cause of hypoxemia. The shunt may be intracardiac or may be intrapulmonary. It has been traditionally thought that this cause could be readily distinguished from the others as the only cause that cannot be corrected by the administration of 100% oxygen.
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Ans. A H. moleSnowstorm signQ on USG. Seen in complete mole. In partial mole a gestational sac or fetal parts can be seen. MRI in modality of choiceQ for invasive mole or choriocarcinomaQ.
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Ans. is 'b' i.e. Gall Bladder Portal vein is formed by the union of the superior mesentric and splenic vein* behind the neck of the pancreas*.It then runs upwards first behind the neck of the pancreas, next behind the first part of duodenum and lastly in the right free margin of lesser omentum. It then ends by dividing into it & left branches which enter the liver.Thus the portal vein can be divided into infraduodenal, retroduodenal and supraduodenal parts.Relations :Infraduodenal partAnteriorly: neck of pancreasposteriorly: IVCRetroduodenal partAnteriorly : first part of duodenum: CBD: Gastroduodenal arteryposteriorly: IVCSupraduodenal arteryAnteriorly: hepatic artery: Bile ductPosteriorly: IVC (separated by epiploic foramen)
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Hilus cell tumours (pure Leydig cell tumours) are rare, unilateral tumors comprised of large lipid-laden Leydig cells with distinct borders and characteristic cytoplasmic structures called Reinke crystalloids.
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Ans. is 'a' i.e., INH o Isoniazid reacts with pyridoxal to form a hydrazone, and thus inhibits gneration of pyridoxal phosphate.o Isoniazid also combines with pyridoxal phosphate to interfere with its coenzyme function. Due to formation of hydrazones, the renal excretion of pyridoxine compounds is increasedo Thus, isoniazid therapy produces a pyridoxine deficiency state.
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Monckeberg medial sclerosis is characterized by calcification of the media of large and medium-sized aeries of older persons who are not otherwise affected by atherosclerosis . On gross examination, the involved aeries are hard and dilated. These aerial changes are usually asymptomatic. None of the other choices display calcification.
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Chorionic villous sampling (CVS) is generally performed at 10 to 13 weeks. 1. Second-trimester amniocentesis - for genetic diagnosis is usually performed between 15 and 20 weeks. 2. Early amniocentesis - this is performed between 11 and 14 weeks CVS for trophoblastic cells (derived embryologically from the same feilized eggs as the fetus is usually done during gestational weeks 11-13 The advantage of CVS is that the results are available early in pregnancy
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Acute akathisia * It was coined by Haskovec * Subjective state of restlessness and fidgety behaviour * <72 hours of staing antipsychotics * DD=agitated depression * If this is misdiagnosed as agitation and if antipsychotic is hiked there will be worsening of symptoms Propranolol id the TOC ref.kaplon and sadock, synopsis of psychiatry, 11 th edition, pg no.925
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Ans. is 'c' i.e., DDH Radiological features of DDH/CDH In Von Rosen's view following parameters should be noted . Perkin's line : Veical line drawn at the outer border of acetabulum Hilgenreiner's line : Horizontal line drawn at the level of tri-radiate cailage Shenton's line : Smooth curve formed by inferior border of neck of femur with superior margin of obturator foramen. Acetabular index : Normally is 30deg CE angle of Wiberg : Normal value is 15-30deg Normally the head lies in the lower and inner quadrant formed by two lines (Perkin's & Hilgenreiner's). Iu DDH the head lies in outer & upper quadrant Shenton's line is broken Delayed appearance & retarded development of ossification of head of femur Sloping acetabulum Superior & lateral displacement of femoral head Von-Rosen's line This is a line, which helps in the diagnosis of DDH in infants less than 6 months. For this AP view of pelvis is taken with both lower limb in 45deg abduction and full internal rotation. Upward prolongation of long axis of shaft of the femur points towards the lateral margin of the acetabulum and crosses the pelvis in the region of sacroiliac joint. In CDH, upward prolongation of this line points towards anterior superior iliac spine and crosses the midline in the lower lumber region ---> Positive Von-Rosen's sign.
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Destruction and disposal
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Five types of E.coli include:
1. ETEC (enterotoxogenic E.coli)
2. EIEC (enteroinvasive E.coli)
3. EPEC (enteropathogenic E.coli)
4. EHEC (enterohemorrhagic E.coli)
5. EAEC (enteroaggregative E.coli)
Traveller's diarrhoea is most commonly caused by enterotoxogenic E.coli and then the other common organism responsible is S. dysenteriae. Intestinal Pathogenic E. Coli.
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Ref-KDT 6/e p763,764 Fluconazole has maximum CNS penetration whereas itraconazole has limited entry in the brain. Therefore fluconazole is preferred over itraconazole for the treatment of cryptococcal meningitis. For all other conditions listed in the question, itraconazole is first choice drug.
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Blindness, Scalp tenderness, Jaw claudication, are feature of Giant cell ateritis.
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As the neonate has unconjugated hyperbilirubinemia along with high reticulocyte count, he seems to be having haemolytic anemia. Spherocytes are seen in Hypehermia Hereditary spherocytosis G6PD deficiency ABO incompatibility Hereditary spherocytosis is one of the most common reason for Neonatal hyperbilirubinemia along with G6PD deficiency Diagnosis of hereditary spherocytosis is usually based on:- Positive Family history (not mentioned in this case) Splenomegaly (Uncommon in neonates) Spherocytes on Peripheral smear Reticulocytosis Elevated MCHC Increased Osmotic Fragility
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Best thyroid function test is TSH as it helps in differentiating between primary and secondary thyrotoxicosis. The change of TSH values also indicates the improvement in the medical condition of the patient. For example, after resection of a pituitary adenoma secreting excess of TSH, the values of TSH will come back towards normal. Ref - Srb's manual of surgery 5e p483
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Ans. is 'a' i.e., Lateral and below
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Moral treatment of mentally ill patients using humane methods was first stressed by Pinel. Person Significance 1. Philippe Pinel The Moral Treatment of Insanity 2. Benedict Morel Coined the term 'Demence precoce". 3. Emil Kraepelin Divided major psychoses into 'Dementia praecox' and 'Manic-Depressive Psychosis' 4. Sigmund Freud founded psychoanalysis wrote the book'The Interpretation of Dreams'
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Islands of ectopic pancreatic tissue can be found in the sub mucosa in pas of the stomach,duodenum or small intestine(including meckel's diveiculum),gall bladder ,adjoining the pancreas, in the hilum of spleen and within liver Bailey & Love ,26th,1125.
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D. i.e. (Acoustic neuroma) (137 - Maqbool)SPEECH DISCRIMINATION SCORE (speech recognition or word recognition score) - tested at 30 to 40 dB, SLUSES1. It determines the extent of discrimination difficulty2. It aids in the diagnosis of the site of pathology in the auditory system eg poor in acoustic neuroma. The normal in conductive deafness3. It assists in rehabilitative measures like the fitting of a hearing aid***Hitzelberg sign seen in Acoustic neuromaVOCAL INDEX - is the relationship between hearing loss for speech and whispered voice* Small in conductive deafness and high in perceptive deafness* Laryngeal pseudosulcus is seen in - Laryngophrayngeal reflux**
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Nd :YAG
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Rheumatoid arthritis is reported in about 15 percent cases of Sjogren’s syndrome.
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Ans. is 'b' i.e., Dysgerminoma Dvsgerminomao It is the most common malignant germ cell tumor of ovary,o It affects young women and is usually unilateral.o Bilateral tumors are seen in 15 - 20% of the cases.o It is fleshy in consistency.o Histologically it shows presence of lymphocytic infiltration which is considered a good prognostic sign.
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B i.e. Greater petrosal
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Ans: a) Colour Doppler [ Ref:- Sutton - 7th edition Page No:-Doppler ultrasound is the imaging of choice for torsion testis. It helps in the diagnosis of torsion by virtue of reduced vascularity ( absence or poor colour flow, reduced peak systolic velocities) compared with the unaffected side.
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Although the estimated incidence of post-pill amenorrhea is given as 0.7 to 0.8%, there is no evidence to support the idea that oral contraception causes amenorrhea. Eighty percent of women resume normal periods within 3 months of ceasing use of the pill, and 95 to 98% resume normal ovulation within 1 year. If there were a true relationship between the pill and amenorrhea, an increase would be expected in infertility in the pill-using population. This has not been found. Infertility rates are the same for those who have used the pill and those who have not. Patients who have not resumed normal periods 12 months after stopping use of the pill should be evaluated like any other patients with secondary amenorrhea. Women who have irregular menstrual periods are more likely to develop secondary amenorrhea whether they take the pill or not.
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Ans. B. Antagonism of vasoconstrictionBeta blockers actually cause vasoconstriction via antagonizing the vasodilation caused by beta 2 receptor. Rest all are the pharmacological actions of beta blockers.
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SALMONELLA HEPATITIS High fever / Relative bradycardia . Biochemical profile suggestive of infiltrative process . Dispropoionately increased ALP is seen Many cases are anicteric ALT / LDH ratio is <4 . If the ratio is >5 is suggestive of viral hepatitis . liver histology show ballooning degeneration with vacuolation and biliary canalicular injury Occasionally lymphoid models seen. Fluoroquinolone is the therapy of choice. Other useful drugs- Azithromycin/ ceftriaxone / Cefotaxime. Ref: schiff's diseases of liver : E - 11.P-233.
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Ans. is 'a' i.e., Propanolol Wide spread neuropsvchiatric side effects has been attributed to propanololo Toxic psychosiso Hallucinations (hypnogogic and visusal)o Vivid dreams & nightmareso Insomniao Ataxiao Lightheadedness, fatigue, weaknesso Lethargyo Paresthesiao Depression
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Secondary restless leg syndrome can occur due to chronic renal failure, pregnancy, anemia, ferritin deficiency and peripheral neuropathy. It could be due to disordered dopamine function along with abnormality of iron metabolism. Restless leg syndrome is a neurologic disorder characterised by the presence of: An urge to move the legs, usually caused or accompanied by an unpleasant sensation in the legs The symptoms usually begin or worsen with rest The symptoms worsens during the evening or night. There is paial or complete relief by movement Ref: Olanow C.W., Schapira A.H. (2012). Chapter 372. Parkinson's Disease and Other Movement Disorders. In D.L. Longo, A.S. Fauci, D.L. Kasper, S.L. Hauser, J.L. Jameson, J. Loscalzo (Eds), Harrison's Principles of Internal Medicine, 18e.
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Ans. A: Candidiasis The most common fungal pathogens associated with invasive disease in humans are oppounistic yeasts (e.g., Candida albicans) or filamentous fungi (e.g., Aspergillus spp.).
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D i.e. Final trimming
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In patients with systemic lupus erythematosus, endocarditis is the most striking cardiac lesion, termed Libman-Sacks endocarditis. Libman-Sacks endocarditis(LSE) is a form of non-bacterial endocarditis that is seen in association with systemic lupus erythematosus (SLE) Nonbacterial vegetations are seen on the undersurface of the mitral valve close to the origin of the leaflets from the valve ring (Libman-Sacks endocarditis). There is fibrinoid necrosis of small vessels with focal degeneration of interstitial tissue. Rheumatic fever is not commonly associated with ANAs seen in this case.
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Ans. is 'c' i.e., 20 months Resistance (or intolerance) to HThroughout(6)RZEResistance (or intolerance) to RThroughout (12-18)HZEQResistance to H + RThroughout (at least 20 months)ZEQ + S (for another injectable agents)Resistance to all first-line drugsThroughout (at least 20 months)1 injectable agent + 3 of of these4 ethionamide cycloserine, Q, PASIntolerance to Z2HRE
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ANSWER: (B) Lesions have epidermal bullaeREF: Fitzpatrick dermatology 6th ed p. 558-73Dermatitis herpetiformis (DH) is an intensely pruritic, papulovesicular skin disease characterized by lesions symmetrically distributed over extensor surfaces (i.e., elbows, knees, buttocks, back, scalp, and posterior neck).Almost all DH patients have an associated, usually subclinical, gluten-sensitive enteropathy, and >90% express the HLA-B8/DRwT3 and HLA-DQw2 haplotypes. DH may present at any age, including childhood; onset in the second to fourth decades is most common. The disease is typically chronic.Biopsy:Small intestine shows partial villous atrophySkin lesions show sub-epidermal bullae and papillary tip abscess, IgA in papillary tips (on DIF)Treatment:Dapsone and gluten-free diet
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Poverty line
The poverty line is defined as expenditure required for a daily calorie intake of : -
2400 per person in rural areas
2100 per person in urban areas
Based on per capita expenditure, poverty line is defined as:-
Rural areas :- 444 Rs. Per capita per month
Urban area:- 512 Rs. Per capita per month.
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Ans. is 'b' i.e., Mycobacterium tuberculosis Common natural flora at various site of body ResidentTransient floraSkinCorynebacterium, Micrococcus,Coagulase negative staphylococci,PropionobacteriuntyPityrosporrum, Demodex follicularumStaph aureus, viridansStreptococci group A streptococci,Enterococcus Malassezia,E.coliy Proteus, Klebsiella,Candida, Trichophyton.Mouth & oropharynxStr. viridans, Coagulase negative staph.,Hemophillus, Peptostreptococci,Bacteriodes, Prevotella, Vellionella,Non-meningococcal neisseria, Fusobacterium,ActinomycesGroup A Streptococcus, LactobacillusN. meningitidis, Candida, CMV, HSV,Moraxella, Eikenella corrodens.Nose & NasopharvnxCoagulase negative staph., Corynebacterium,Strep, viridansNon-meningococcal & Meningococcal neisseria,Staph aureus, Str. pneumoniae, MorexellaVaginaLactobacillus, Streptococcus, Prevotella,Coagulase negative staphylococci,Gard. vaginaliSy ActinomycesCandida, Trichomonas vaginalis,Group B streptococci, Enterococcus.EyeCoagulase negative staph, Micrococci,Hemophillus, CorynebacteriumBacillus, Strep viridans, Propiono bacterium,Staph aureus, str. pneumoniaeStomach Streptococci, Lactobacillus, H. PyloriSmall intestineLactobacillus, Streptococcus, Vellionella,Prevotella, Porphyromonas, BifidobacterBacteroides, Clostridium, EnterobacteriaceaseCandida, Entamoeba coli, E.Nana,Trichomonas Hominis,Blastocystis hominisLarge intestineBilidobactor, Peptostreptococci, EnterococcusLactobacillus, Vellionella, Eubacterium,Fusobacterium, Prevotella, Porphyromonas,Bacteroides, Clostridium, EnterobacteriaceaeCandida, Corynebacterium, Pseudomonas,MAC, Entamoeba coli, E.nana,Trichomonas Hominis, Enterovirus,Blastocystis hominisUrethraCorynebacterium, Strept viridans,Coagulase negative staph, LactobacillusM. smegmetis, Enterococcus, Mycoplasma,Neoplasma, Bacteroides, Fusobacterium
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Typical cylinder (Ovoid) used for brachy therapy
Brachy therapy is indicated for only small tumor volumes.
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There is only 1 RNA polymerase in prokaryotes. There are 3 eukaryotic RNA polymerases Type Location RNA transcribed Effect of a-amanitin I Nucleolous 18, 5.8, 28 rRNA Insensitive II Nucleoplasm mRNA, miRNA, snRNA Highly sensitive III Nucleoplasm tRNA, 5s rRNA , U6 snRNA Less sensitive
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Inferior vesicular artery supplies the Ureter, not Superior vesicular artery
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Ans. is 'd' i.e., All of the above Dietary fibre Dietary fibre consists of unabsorbable cell wall and other constitutents of vegetable food like cellulose, lignin, hemicellulose, gums, pectins, glycoproteins and other polysaccharides. Dietary fibre absorbs water in the intestine, swells, increase bulk of stood by increasing water content of faeces and soften it, decreases transit time by facilitating colonic transit. "The presence of fibre shoens the transit times and increases the stool bulk" Dietary fibre is of two types: Soluble fibres: It absorbs upto 15 times its weight in water as it moves through GIT, producing softer stools. Its good sources are oat, flaxseeds, peas, beans, apple, citrus fruits, carrots, barley and psyllium. Insoluble fibre: It promotes movement of material through digestive system and increases stool bulk. Its good sources are wheat flour, wheat bran, nuts and vegetables. Advantages of fibres Dietry fibre contribute bulk by absorbing water 1-15 times of its own weight and thus hastens the passage through the gut, decreasing the transient time. By increasing the bulk, it provides a larger volume of indigestible material to colon. Dietary fibre is known to be associated with reduced incidence of coronary aery diseases. The mechanism of its action is attributed to its binding to bile salts and preventing its absorption and thus reducing cholesterol (LDL cholesterol) level in circulation. The fibre, paicularly the gum and pectin, when ingested with a diet, are repoed to reduce post-prandial glucose level in blood - helpful in DM. Dietary fibre reduce the incidence of diveiculitis, constipation, hemorrhoids, irritable bowel syndrome and colon cancer.
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Alkaptonuria Age of patient, calcification of interveebral disc, pigmentation and reaction with Benedict's reagent give away the diagnosis of Alkaptonuria. All the options mentioned in this question are inherited disorders of amino acid metabolism. Phenylketonuria, tyrosinemia type 2 and Arigininosuccinic aciduria present during infancy or childhood, whereas Alkaptonuria presents usually at 40 yrs of age. It may go unrecognized until middle life. Mental retardation is usually seen in all the other 3 options. (Mental retardation not seen in Alkaptonuria). Alkaptonuria Triad of: - Homogentisic aciduria - Black pigmentation of cailage and collagenous tissue (ochronosis) - Ochronotic ahritis It is a rare autosomal recessive disorder of tyrosine catabolism. There is deficiency of homogentisic acid oxidase which results in the accumulation of homogentisic acid pigment cailages and collagenous tissues (ochronosis). Large amount of homogentisic acid is excreted in urine which gets oxidised on exposure to air and impas urine a dark colour especially if the pH of urine is alkaline. Alkaptonuria is usually recognised by 30-40 yrs of age when degenerative joint disease and ochronosis (pigmentation) become noticeable. Ochronosis ahritis commonly involves shoulder, hips and knees. The interveebral discs are degenerated, spaces are narrowed and calcification occurs. Ochronosis or pigmentation can involve- hea valves, larynx, tympanic membrane, sclera, ear cailage and skin. Occasionally pigmented renal or prostatic calculi can occur. Homogentisic acid (HGA) is a strong reducing agent and gives positive reaction with Benedict's & Fehling's reagent. A greenish brown precipitate with brownish black supernatant develops with Benedict's reagent and transient blue green colour develops with Fehling's (FeC13) reagent. The diagnosis is confirmed by measurement of HGA concentration in urine by paper and thin layer chromatography. Low protein diet especially low in phenylalanine and tyrosine is advocated in combination with ascorbic acid, but not very effective. Addition of nitisinone (an inhibitor of the enzyme 4-hydroxyphenylpyruvate dioxygenase which catalyzes the formation of homogentisic acid) drastically reduces urinary excretion of homogentisic acid might prevent the long term complication of alkaptonuria.
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The lesion described is that of polyaeritis nodosa. This condition is often considered to be the prototype for the vasculitides, and characteristically affects small or medium-sized muscular aeries, with a predilection for the gastrointestinal tract and kidney (causing hematuria, albuminuria, or renal failure). Patients are typically young adult males, although both sexes and all ages may have the condition. Characteristically, vascular lesions of different stages may be present. Coicosteroid and cyclophosphamide therapy has improved a formerly poor prognosis. Atherosclerosis can cause bowel infarction, but the histologic description would be that of a plaque. Cystic medial necrosis predisposes for dissecting aoic aneurysm. Monckeberg's aeriosclerosis is a benign condition characterized by ring-like calcifications of vessel walls. Ref: Lin P.H., Kougias P., Bechara C., Cagiannos C., Huynh T.T., Chen C.J. (2010). Chapter 23. Aerial Disease. In F.C. Brunicardi, D.K. Andersen, T.R. Billiar, D.L. Dunn, J.G. Hunter, J.B. Matthews, R.E. Pollock (Eds), Schwaz's Principles of Surgery, 9e.
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d. Capnography(Ref: AAP guidelines 2015, Ghai 8/e p 126-133)Exhaled CO2 detection or Capnography is the recommended or confirmatory method to assess position of Endotracheal tubeOther methods are: bilateral chest movements, presence of equal breath sounds bilaterally, condensation in endotracheal tube.
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Storage Temperature Shelf life Whole blood 2-6degC 21 days (in citrate-phosphate-dextrose (CPD))35 days (in citrate-phosphate-dextrose-adenine (CPDA-1)) Platelets 20-24degC 5 days FFP -18degC 1 year Cryoprecipitate -18degC 1 year
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Hairy cell leukemia is a type of B-cell leukemia. Clinical feature: Massive splenomegaly Increase chances of infections DIAGNOSIS 1. BLOOD Pancytopenia Phase contrast microscopy- Hairy projections Staining- TRAP 2. Immunophenotyping CD11 + CD25+ CD103 + Annexin A1 + ( Best marker) 3.BM examination BM aspiration - Dry tap BM biopsy- Honey comb appearance - Fried egg appearance
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Niemann-Pick DiseaseThis is also an autosomal recessive disorder characterized by the accumulation of sphingomyelin and cholesterol due to a defect in acid sphingomyelinase.Two types have been described: type A and B.Type A is more common and typically presents in infancy and is characterized by hepatosplenomegaly, lymphadenopathy, rapidly progressive deterioration of CNS and physical underdevelopment. About a quaer of patients present with familial amaurotic idiocy with characteristiccherry-red spots in the macula of the retina (amaurosis = loss of vision without apparent lesion of the eye).Type B develops later and has progressive hepatosplenomegaly with development of cirrhosis due toreplacement of the liver by foam cells, and impaired lung function due to infiltration in lung alveoli.Microscopy shows storage of sphingomyelin and cholesterol within the lysosomes, paicularly in the cells of the mononuclear phagocyte system. The cells of Niemann-Pick disease are somewhat smaller than Gaucher cellsand their cytoplasm is not wrinkled but is instead foamy. These cells are widely distributed in thespleen, liver, lymph nodes, bone marrow, lungs, bowel, and brain. Ref: Harsh Mohan - Textbook of Pathology, 6th Edition.page no.263
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Ans. (a) Small white gestational ringRef: Rosen's emergency medicine 7th ed. /175* Although the blastocyst begins to implant in the endometrium at 3 weeks menstrual age (1 week after conception), the first definitive ultrasound sign of pregnancy is the "gestational sac." This is a sonographic not an anatomic term.* Before the appearance of the gestational sac, the endometrium is markedly echogenic and the arcuate vessels are somewhat prominent. This, however, is non- diagnostic and can often be seen in the normal late secretory phase. In ultrasound images, the gestational sac appears as a thick echogenic ring surrounding a sonolucent center.* Sonographically, the chorionic sac (gestational sac) is embedded in the depth of the thick endometrium (decidua) and appears on one side of the cavity line, not in the middle of it. This sonolucent center is actually the fluid-filled chorionic sac.* The sac grows mm/day in mean diameter during early pregnancy. With further growth, first the yolk sac and later the embryo become visible sonographically inside the chorionic cavity. The yolk sac has a very bright echogenic rim around a sonolucent center. When it first appears at <"5 weeks, it may only be 1 to 3 mm in diameter* Discriminatory size of the gestational sac for trans- vaginal visualization of the yolk sac is reported from 5 to 13 mm in mean sac diameter.
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Ans. is'b'i.e., TobramycinSome antibiotics potentiate neuromuscular block caused by competitive (non-depolarizing) blockers.Eg:Aminoglycosides (e.g. tobramycin)TetracyclinesPolypeptide antibioticsClindamycinLincomycin
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Minimum alveolar concentration is defined as the alveolar concentration of an inhaled anesthetic agent that prevents movement in 50% of patients in response to a standardized surgical stimulus. Low MAC - High potency MAC values of adult Halothane: 0.75 Sevoflurane: 2.0 Isoflurane: 1.2 Desflurane: 6.0 Enflurane: 1.7 Xenon: 70 N2O: 104
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Ans. is 'a' i.e., Alpha toxin Two impoant characteristic feature of Cl. perfringens are :?Target hemolysis (double zone hemolysis) on blood agar. It is a narrow zone of complete hemolysis by theta toxin which is surrounded by a wider incomplete hemolysis by alpha-toxin.Naegler's reaction detects alpha toxin (phospholipase or lecithinase C). When Cl. perfringens is grown on a medium with the antitoxin spread on one half of the plate, colonies on the other half without the antitoxin will be surrounded by a zone of opacity. There will be no opacity around the colonies on the half of the plate with the antitoxin, due to the specific neutralisation of the alpha-toxin.
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Ans. (a) X-linked inheritance.Hemophilia is an X-linked recessive disease. These diseases are more common in men than in women. An affected male will not pass the diseases to his sons, but all daughters will be carriers. X-linked recessive diseases are transmitted from carrier women to affected men.Image source- style="font-family: Times New Roman, Times, serif">
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Treatment of carbon monoxide Treatment consists of removal from the source of exposure, immediate administration of high-flow or 100% O2 and aggressive suppoive measures. i. Remove the victim from source of exposure.ii. Maintain patent airway, fresh air and ohobaric oxygen (100% oxygen at atmospheric pressure)Oxygen therapy is staed if COHb > 10% and should be given for 4-6 hoursiii. Blood transfusion, if required.iv. Gastric lavage to prevent aspiration pneumonia.v. Cerebral edema is treated by mannitol Extra:Tests which may be used for the diagnosis of CO poisoning: Spectroscopy Hoppe-Seyler's test Kunkel's test Potassium ferricyanide test Katayama's test
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Scotchbond 2 was the First dentin bonding system to receive “provisional” and “full acceptance” from the American Dental Association (ADA). It is an example of 3rd generation dentin bonding agent.
Sturdevant 7th edition page 143
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The essence of PE is to construct an Arrow Diagram. The diagram represents the logical sequence in which events must take place.It is possible with such a diagram to calculate the time by which each activity must be completed and to identify those activities that are critical (refer pgno:872 park 23 rd edition)
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Mesenteric fat wrapping around the circumferance of the intestine is called creeping fat. It is pathognomonic of Crohns disease.
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Nulliparity and late menopause are factors associated with increased exposure to estrogen, indicated in the etiology of Endometrial hyperplasia and Breast cancer Unopposed estrogen stimulation is not risk factor in Endometrial polyps, Cervical cancer, or Vulvar cancer.
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In retinal detachment to maintain chorioretinal apposition, scleral buckling is done. Inward indentation of sclera to provide external tamponade (scleral buckling). Scleral buckling is achieved by inseing an explant (silicone sponge or solid silicone band) with the help of mattress type sutures applied in the sclera. Ref: khurana 5 th edition , page no.297
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D i.e. Dermis First degree burns involve only the epidermis and is characterized by erythema. Where as second degree or paial thickness burns are deeper involving all the epidermis and some of the corium or dermisQ. The systemic severity of the burn and the quality of subsequent healing are directly related to the amount of undamaged dermis. Superficial burns are characterized by blister formation while deeper paial thickness burns have a reddish appearance or a layer of whitish non ble dermis.
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The term acute flaccid paralysis (AFP) is often used to describe a sudden onset, as might be found with polio. AFP is the most common sign of acute polio, and used for surveillance during polio outbreaks. AFP is also associated with a number of other pathogenic agents including enteroviruses other than polio, echoviruses, West Nile virus, and adenoviruses, among others. Botulism The Clostridium botulinum bacteria are the cause of botulism. Vegetative cells of C. botulinum may be ingested. Introduction of the bacteria may also occur endospores in a wound. When the bacteria are in vivo, they induce flaccid paralysis. This happens because C. botulinum produces a toxin which blocks the release of acetylcholine. Botulism toxin blocks the exocytosis of presynaptic vesicles containing acetylcholine (ACh).When this occurs, the muscles are unable to contract.Other symptoms associated with infection from this neurotoxin include double vision, blurred vision, drooping eyelids, slurred speech, difficulty swallowing, dry mouth, and muscle weakness. Botulism prevents muscle contraction by blocking the release of acetylcholine, thereby halting postsynaptic activity of the neuromuscular junction. If its effects reach the respiratory muscles, then it can lead to respiratory failure, leading to death. Curare Curare is a plant poison derived from - among other species - Chondrodendron tomentosum and various species belonging to the genus Strychnos, which are native to the rainforests of South America. Ceain peoples indigenous to the region - notably the Macusi - crush and cook the roots and stems of these and ceain other plants and then mix the resulting decoction with various other plant poisons and animal venoms to create a syrupy liquid in which to dip their arrow heads and the tips of their blowgun das. Curare has also been used medicinally by South Americans to treat madness, dropsy, edema, fever, kidney stones, and bruises.Curare acts as a neuromuscular blocking agent which induces flaccid paralysis. This poison binds to the acetylcholine (ACh) receptors on the muscle, blocking them from binding to ACh. As a result, ACh accumulates within the neuromuscular junction, but since ACh cannot bind to the receptors on the muscle, the muscle cannot be stimulated. This poison must enter the bloodstream for it to work. If curare affects the respiratory muscles, then its effects can become life-threatening, placing the victim at risk for suffocation. Other Flaccid paralysis can be associated with a lower motor neuron lesion. This is in contrast to an upper motor neuron lesion, which often presents with spasticity, although early on this may present with flaccid paralysis. Included in AFP's list are poliomyelitis (polio), transverse myelitis, Guillain-Barre syndrome, enteroviral encephalopathy] traumatic neuritis, Reye's syndrome, etc. An AFP surveillance programme is conducted to increase case yield of poliomyelitis. This includes collection of 2 stool samples within 14 days of onset of paralysis and identification of virus, and control of the outbreak and strengthening immunization in that area. Historical records from the 1950s, modern CDC repos, and recent analysis of patterns in India suggest that flaccid paralysis may be caused in some cases by oral polio vaccinations Venomous snakes that contain neurotoxic venom such as kraits, mambas, and cobras can also cause complete flaccid paralysis. Some chemical warfare nerve agents such as VX can also cause complete flaccid paralysis Ref Harrison20th edition pg 2234
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Ans. is 'a' i.e., Mucormycosis Mucormycosis* Mucormycosis is fungal infection of nose and paranasal sinuses, which may prove rapidly fatal if untreated.* It is seen in uncontrolled diabetics or in those taking immunosuppressive drugs.* It presents as black necrotic mass filling the nasal cavity and eroding the septum and hard palate.* From the nose and sinuses, infection can spread to orbit, cribriform plate, meninges and brain.* The rapid destruction associated with the disease is due to affinity of fungus to invade the arteries and cause endothelial damage and thrombus.* Treatment is by amphotericin B and surgical debridement.
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Ans. is 'd' i.e., Sodium nitrite followed by thiosulphate
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Ans is 'c' i.e. 2 to 5 yrs Transplantation of Human Organs Act, 1994.This Act provides for the regulation of removal, storage and transplantation of human organs for therapeutic purposes and for the prevention of commercial dealings in human organs and for matters connected therewith or incidental thereto.Punishment for removal of human organ without authority.Any person who renders his services to or at any hospital and who, for purposes of transplantation, conducts associates with, or helps in any manner in, the removal of any human organ without authority, shall bePunishable with imprisonment for a term which may extend to five years and with fine which may extend to ten thousand rupees.Where any person convicted under sub-section (1) is a registered medical practitioner, his name shall be reported by the Appropriate Authority to the respective State Medical Council for taking necessary action including the removal of his name from the register of the Council for a period of two years for the first offence and permanently for the subsequent offence.The above Act was amended in 2011; k/a The Transplantation of Human Organs (Amendment) Bill, 2011Amendment to the above section concerned with punishment is as below (changes are in bold):Punishment for removal of human organ without authority.Any person who renders his services to or at any hospital and who, for purposes of transplantation, conducts associates with, or helps in any manner in, the removal of any human organ without authority, shall bepunishable with imprisonment for a term which may extend to "ten years and with fine which may extend to twenty lakh rupees".Where any person convicted under sub-section (1) is a registered medical practitioner, his name shall be reported by the Appropriate Authority to the respective State Medical Council for taking necessary action including the removal of his name from the register of the Council for a period of "three years" for the first offence and permanently for the subsequent offence.Any person who renders his services to or at any hospital and who conducts, or associates with or helps in any manner in the removal of human tissues without authority, shall be punishable with imprisonment for a term which may extend to three years and with fine which may extend to five lakh rupees.
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Atopic dermatitis most commonly involves the cheeks in infantile stage and anti-cubital fossa in adults Decreased sudomotor function is involved in the formation of atopic eczema in the cubital fossa. . BACKGROUND: Eczema in the cubital fossa, which is susceptible to sweat, is frequently observed in atopic dermatitis (AD). However, there has been no direct evidence that sweating causes eczema in the cubital fossa. (Ref Harrison 20th edition pg 1267
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Meconium ileus is a neonatal manifestation of cystic fibrosis (also known as fibrocystic disease of pancreas). In cystic fibrosis there is pancreatic enzyme deficiency and abnormal chloride secretion in the intestine that results in the production of viscous water- poor meconium. Meconium ileus results because of impaction of thick meconium in the ileum. Meconium ileus presents sholy after bih with progressive abdominal distension and failure to pass that meconium with intermittent bilious vomiting. Abdominal X- ray shows Dilated loops of small intestine Air fluid level do not form inspite of complete small intestine obstruction, because the enteric contents are viscous and thick. Small bubbles of gas become entrapped in the inspissated meconium in the distal ileum, where they produce a characteristic 'ground glass' appearance on radiograph. In complicated meconium ileus in which perforation has occurred, intraperitoneal eggshell calcification are noted. Ref: Bailey & Love 25/e, Page 1199; Schwaz 9/e, Page 1429.
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Ans. A CalcitriolRef: Ganong, 25th ed. pg. 378The active metabolite of vitamin D3 is produced in kidney and is called calcitriol or 1,25 dihyroxycholecalciferol. The cells of proximal convoluted tubule produce an enzyme by name of 1 alpha hydroxylase that converts 25 hydroxycholecalciferol into 1,25 dihyroxycholecalciferol.
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Ans. is 'a' i.e., Septic ahritis
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In this patient (go stepwise)
No itching
Pain present (only two differentials, i.e. pemphigus and herpes zoster)
Flaccid vesicles on face
Mucosal involvement
Asymmetric distribution
Intercellular IgG in the epidermis
Diagnosis is pemphigus vulgaris
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Fovea centralis is the central depressed pa of the macula. It is situated about 2 disc diameters (3mm) away from the temporal margin of the disc. It is about 1.5mm in diameter and is the most sensitive pa of the retina. It is tightly packed with cones and there are no rods. Ref: Comprehensive Ophthalmology By A K Khurana, 4th Edition, Pages 249, 251.
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Ans. is 'c' i.e., 26.5% o Under 5 moality rate = (No of deaths of children less than 5 yrs of age in a given year / no. of live bihs inthe same year) x 100 o The multiplying factor is thousand in the original formula but since here the answer is in percent form so the multiplying factor will be 100 instead of 1000.
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Ans. is 'a' i.e., Lamivudine Treatment of acute hepatitis o Hepatitis B --> No treatment is required o Hepatitis C --> Pegylated Interferon (PEG - IFN) + ribavirin Treatment of chronic hepatitis o Hepatitis B --> Lamivudin, entecavir (preferred) or interferon o Hepatitis C --> Pegylated Interferon (PEG - IFN), entecavir plus ribavirin
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. Osteocalcin
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An entrapment syndrome when ulnar nerve passes through Guyon’s canal, is known as Guyon’s canal syndrome.
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Millon’s Test: The phenol group of phenylalanine and tyrosine containing proteins, when heated with mercuric sulfate in sulfuric acidand sodium nitrite (or, mercurous and mercuric nitrates in nitric acid) form red colored mercury phenolate.
Reference: Vasudevan 7th ed, pg 31
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Action potential develops in the axon and the impulse is transmitted along it till the end.
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Ans. is 'a' i.e., MEN 1
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Ans is 'b' i.e. Crystalloids * Crystalloid solutions seem to be the most appropriate type of fluids for initial resuscitation of septic shock patients & have been recommended as a first choice to resuscitate septic shock patientsFluid resuscitation in septic shock* The landmark of septic shock is systemic vasodilation, with different levels of hypovolemia. Fluid administration is the first-line intervention to restore the systemic hemodynamics and increase oxygen delivery to match oxygen demand in septic patients.* Fluid resuscitation is initiated to achieve a CVP of 8 to 12 mmHg* According to the Surviving Sepsis Campaign Guidelines, septic patients presenting tissue hypoperfusion, hypotension or signs of hypovolemia and admitted to the emergency department must receive an initial fluid load with 30mL/kg of body weight of crystalloids.* Crystalloid refers to solutions containing water, inorganic ions and small organic molecules. Crystalloids are composed of glucose or sodium chloride solutions, and can be hypotonic, isotonic or hypertonic* They supply water and electrolytes to maintain osmotic gradient between extravascular and intravascular compartments as they contain fluids and electrolytes that are normally found in the body.* Colloids have larger molecular-weight particles that give them oncotic plasma pressures similar to natural plasma proteins. This theoretically allows for better volume resuscitation by remaining in the intravascular space and supporting circulating volume as compared to crystalloids, which may have extravascular shift causing pulmonary and interstitial edema. However, in patients with increased vascular permeability as seen in sepsis and late hemorrhagic shock, leakage of these larger colloid molecules also exist.* Hypo-oncotic albumin solutions can be used as an alternative for those who need large amounts of fluids during the initial resuscitation phase.* Hydroxyethyl starches solutions must be avoided in septic patients due to the increased risk of acute renal failure, increased need for renal replacement therapy and increased mortality.
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Distinctive lesions of proliferation are called crescents owing to their shape as they fill Bowman's space. Crescents are formed both by the proliferation of parietal cells and by the migration of monocytes/macrophages into Bowman's space Ref:- Robbins book of basic pathology 10th Ed. pg 532.
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Ans. is 'd' i.e., Propanolol Drugs causing hemolytic anaemia o Isoniazid o Sulfonamide o Procainamide o Phenacetin o Melphalan o Rifampicin o Quinidine o Penicillin o Dapsone
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Ans. is 'b' i.e., Splicing Thalassemia syndrome o Adult hemoglobin is a tetramer, composed.of two a globin chains and two 13 globin chains. o Thalassemia is an inherited autosomal recessive disorder. o In Thalassemia, the gentic defect results in reduced synthesis of one of the globin chains of hemoglobin. o - Thalassemia is caused by deficient synthesis of 13-chain with normal a-chain synthesis. o a - thalassemia is caused by deficient synthesis of a-chain with normal 13-chain synthesis. o Molecular defect in pathogenesis of thalassemia. A) 13-thalassemia o Most common type of genetic abnormality in 13-thalassemia is point mutation, i.e. nonsense. o Some may also occur due to deletion or inseion i.e. framshift mutations. o Defect may occur at different steps of [3-chain synthesis - I') Splicing mutations Mutations leading to aberrant splicing are the most common cause of (3-thalassemia. ii) Chain terminator mutations This cause premature termination of mRNA translation. iii) Promoter region mutations This results in transcription defect B) a-thalassemia o The most common cause of reduced a-chain synthesis is deletion of a-globin genes. o Rarely nonsense mutation may also cause a-thalassemia.
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Ref:KDT 6/e p499 Digitalis compounds arecontraindicated in patients who are hypokalemic, or who have atrioventricular block or Wolff-Parkinson-White (WPW) syndrome. Impaired renal function leads to enhanced plasma levels of digoxinbecause digoxin is eliminated by the kidneys.
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option A is correct : Ionic monomers have three iodine atoms per two paicles in solution Ionic dimers and non ionic monomers have three iodine atoms per one paicle in solution Non ionic dimers have six iodine atoms per one paicle in solution option B is incorrect : High osmolar agents (ionic monomers) are only ionic low osmolar agents may be ionic or non ionic iso osmolar agents are only non ionic option C is incorrect : Gadolinium does not cross Blood brain barrier (BBB) option D is incorrect : Iohexol is low osmolar (non ionic monomer)
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Lisinopril is an ACE inhibitor . ACE stands for angiotensin conveing enzyme.Lisinopril is used to treat hypeension in adults and children who are at least 6 years old. It is also used to treat congestive hea failure in adults, or to improve survival after a hea attack . A reduction in dietary salt from the current intake of 9-12 g/day to the recommended level of less than 5-6 g/day will have major beneficial effects on cardiovascular health along with major healthcare cost savings around the world. The World Health Organization (WHO) strongly recommended to reduce dietary salt intake as one of the top priority actions to tackle the global non-communicable disease crisis and has urged member nations to take action to reduce population wide dietary salt intake to decrease the number of deaths from hypeension, cardiovascular disease and stroke . Ref - pubmed.com
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Ans. is 'c' i.e., Oxybutynin Oxybutynin this newer antimuscarinic has high affinity for receptors in urinary bladder and salivary glands alongwith additional smooth muscle relaxant and local anaesthetic propeies.
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10%
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Perception is physical sensation given meaning, the integration of sensory stimuli to form an image or impression, in a manner or configuration influenced by past experience.Heightened perception occurs in delirium, mania, after hallucinogens, and in the rare ecstatic states that occur as pa of acute schizophrenia or "transpoed" hysterical trances. Dulled perception occurs in depression and organic delirium. Ref: Nurcombe B., Ebe M.H. (2008). Chapter 4. The Psychiatric Interview. In M.H. Ebe, P.T. Loosen, B. Nurcombe, J.F. Leckman (Eds), CURRENT Diagnosis & Treatment: Psychiatry, 2e.
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Anaplastic cells often display the following morphologic features:
Pleomorphism (i.e. variation in size and shape).
Nuclear abnormalities, consisting of extreme hyperchromatism (dark-staining), variation in nuclear size and shape, or unusually prominent single or multiple nucleoli. Enlargement of nuclei may result in an increased nuclear-to-cytoplasmic ratio that approaches 1:1 instead of the normal 1:4 or 1:6. Nucleoli may attain astounding sizes, sometimes approaching the diameter of normal lymphocytes.
Tumor giant cells may be formed.
Atypical mitoses, which may be numerous. Anarchic multiple spindles may produce tripolar or quadripolar mitotic figures.
Loss of polarity.
Reference-Robbins BASIC PATHOLOGY 10th edition pg-193
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Ans. is 'b' i.e., Posterior
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