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Refer Goodman Gilman 12/e p 1296 The serious adverse effects noted with most of bisphoshonates is osteonecrosis of jaw bone Zoledronate can cause serious side effects as Nephrotoxicity and renal failure
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The inferior turbinate is a separate bone, while rest of the turbinates are a part of ethmoidal bone.
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Structures located between the X-ray source and moving center of rotation (orange zone) cast ghost images.
On the panoramic image, ghost images appear on the image on the opposite side of its true anatomic location and at a higher level, because of the upward inclination of the X-ray beam. Because the object is located outside of the focal plane and close to the X-ray source, the ghost image is blurred and significantly magnified. Several anatomic structures cast ghost images.
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A i.e. 50- 60 microns
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Pompe's disease (Type H glycogenosis) is due to deficiency of acid maltase (lysosomal α l →4 and α l→6 glucosidase).
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B i.e. HgF 2,3. DPG does not combine with fetal hemoglobin 2,3DPG & Hemoglobin 2,3 DPG is present in high concentration in erythrocytes (HbA> HbA2) 2,3 DPG greatly reduces the affinity of Hb to O2 Q (shifts O2-dissociation curve to right) Fetus Hb (HbF) consists of a2Y2, this tetramer has much lower affinity for 2-3 DPG than adult HbQ Corresponding a higher affinity for O2.
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Gallstones, which affect 10 to 20% of the adult population in developed countries, are divided into two main types. Cholesterol stones are pale yellow, hard, round, radiographically translucent stones that are most often multiple. Their formation is related to multiple factors including female sex hormones (such as with oral contraceptives), obesity, rapid weight reduction, and hyperlipidemic states. Their prevalence approaches 75% in some Native American populations. 7-a-hydroxylase is an enzyme involved in conveing cholesterol to bile acids. Decreased functioning of this enzyme, such as with a congenital deficiency or inhibition by clofibrate, causes excess secretion of cholesterol and an increased incidence of cholesterol gallstones. The other main type of gallstones are pigment stones, which are brown or black in color and composed of bilirubin calcium salts. They are found more commonly in Asian populations and are related to chronic hemolytic states, diseases of the small intestines, and bacterial infections of the biliary tree. In contrast to 7-a-hydroxylase and bile acid synthesis, 1-a-hydroxylase is involved in vitamin D synthesis, while 11-hydroxylase, 17-hydroxylase, and 21- hydroxylase are all enzymes found in the adrenal coex. A deficiency of these enzymes is seen with congenital adrenal hyperplasia Reference: Robbins & Cotran Pathologic Basis of Disease, 9edition
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The hematopoietic syndrome results from acute whole-body doses above 200 rads. A prodromal phase consists of nausea and vomiting within the first 12 hrs, with symptoms usually lasting up to 48 hrs. A latent period of 2-3 wks during which patients may feel quite well follows. Although patients are asymptomatic, bone marrow impairment has occurred. The most obvious laboratory finding is lymphocyte depression.
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Ans. Nervous tissue
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Ans-C
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Cushings reflex is a special type of CNS ischemic response. The cause is raised intracranial tension. When blood flow to the VMC is decreased., it suffers from ischemia. The VMC is stimulated leading to vasoconstriction and increase in BP. There is simultaneous stimulation of cardioinhibitory center by sinoaoic reflex mechanism. ie REFLEX hypeension is associated with bradycardia. Ref: Textbook of medical physiology by N Geetha, 2nd edition, page no. 164
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Ans. D: Echocardiography The presence of a nonejection click on physical examination is sufficient to make the diagnosis of mitral valve prolapse. The sound has a sharp high-frequency clicking quality and, although often confined to the bit apex, can be transmitted widely on the precordium. The cause of the sound is due to tensing of the AV valves during systole. As with other high-frequency cardiac sounds, it is produced by vibrations of the entire cardiohemic system when the elastic limits of the prolapsed valve are suddenly reached. Echocardiography is the investigation required for fuher evaluation.
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Ans. D. Identifying maladaptive assumptionsBehavioral Techniques:This includes the various sho-term modalities like social skills training problem solving techniques, asseiveness training, self-control therapy, activity scheduling & decision-making techniques.Among the behavioral techniques in cognitive therapy are scheduling activities, mastery and pleasure, graded task assignments, cognitive rehearsal, self-reliance training, role-playing, and diversion techniques.
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ANSWER: (D) Transitional carcinoma of the pelvis extending till ureterREF: Sabiston 18th ed chapter 77The standard treatment of renal pelvis and upper ureteral urothelial carcinomas includes complete nephroureterectomy with excision of the distal ureteral cuff from the bladder
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Decrease in PaO2 stimulates the peripheral chemoreceptors at high altitudes. This triggers hyperventilation. Hyperventilation results in CO2 washout and respiratory alkalosis. This is compensated by increased excretion of bicarbonates by the kidney.
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Section 320 IPC Grievous The following kinds of hu only are designated as "Grievous": First - Emasculation Second - Permanent privation of the sight of either eye Third - Permanent privation of the hearing of either ear Fouh - Privation of any member or joint Fifth - Destruction or permanent impairing of the powers of any member or joint, Sixth - Permanent disfiguration of the head or face Seventh - Fracture or dislocation of a bone or tooth, Eighth -Any hu which endangers life or which causes the sufferer to be during the space of twenty days in severe bodily pain, or unable to follow his ordinary pursuits Ref : Krishnan vij Textbook of Forensic medicine and Toxicology 5th edtion ; pg no -207
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RECTAL POLYPS Occur most commonly in children < 5 years of age. Occur as a single lesion of the rectum. Typical symptoms are rectal bleeding, mucus discharge, diarrhea, and abdominal pain. Can cause bleeding, or pain if it prolapses during defaecation
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Ciclopirox olamine(nail lacquer) is most effective topical drug for Rx of mild to moderate onychomycosis Drug for Rx onychomycosis Dose Terbinafine 250 mg/day for 6 and 12 wks in fingernail and toenail onychomycosis respectively. Itraconazole Pulse therapy: 200 mg twice daily for 1 wk/month for 2 and 3 consecutive months for finger and toenail onychomychosis respectively. Continuous regimen: 200 mg/day for 6 wks. Fluconazole 150 mg wkly for maximum period of 12 months
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Nissl bodies are basophilic bodies or granules composed of many thin, parallelly arranged, membrane-bounded cavities or cisternae which are covered by many minute paicles consisting of Ribose nucleoproteins i.e. RNA with proteins. Granule&;s size and number vary with physiological condition of the cell. For example, fatigue, ceain poisons, and sectioning of axon cause Nissl granules to disintegrate into fine dust and which finally disappears.Ref: Textbook of physiology, Dir. Prof. AK Jain, 5th edition.
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Vaccum Erection Device Therapy In patients who donot respond to or decline oral or local vasoactive pharmacotherapeutic options, vaccum erection device therapy may be alternatively explored. The principle of vaccum erection device therapy is to mechanically create negative pressure surrounding the penis in order to engorge it with blood and then restrain egress from the organ to maintain the erection-like effect. Efficacy rates in acheiving satisfactory erections of 67-90%, but satisfactory rates with the device are lower, ranging from 34 to 68% The device is more acceptable to older men in a steady relationship comared to young, single men. Success is limited in patients with severe vascular abnormalities such as proximal venous leakage or aerial insufficiency or fibrosis secondary to priapism or prosthesis infection. Fuher, it may offer a means to preserve the elasticity of penile tissues after priapsim or penile prosthesis explanation or after surgical correction of peyronie&;s disease. It has been suggested to facilitate erection recovery after treatments for prostate cancer. Ref: Campbell 11th edition Pgno: 738
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Retinoblastoma is the most common primary intraocular malignancy of children. Cell of origin of retinoblastoma is a neuronal progenitor. In approximately 40% of cases, retinoblastoma occurs in individuals who inherit a germline mutation of one RB allele In the sporadic cases, both RB alleles are lost by somatic mutations Retinoblastomas arising in those with germline mutations are often bilateral. In addition, they may be associated with pinealoblastoma ("trilateral" retinoblastoma), which is associated with a dismal outcome. Tumors may contain both undifferentiated and differentiated elements. The undifferentiated components appear as collections of small, round cells with hyperchromatic nuclei. In well-differentiated tumours there are Flexner-Wintersteiner rosettes and fleurettes reflecting photoreceptor differentiation. Zones of dystrophic calcification are characteristic of retinoblastoma. Retinoblastoma tends to spread to the brain and bone marrow and seldom disseminates to the lungs. Prognosis is adversely affected by extraocular extension and invasion along the optic nerve and by choroidal invasion.
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Moderate to severe protein energy malnutrition reduces risk of DHF/DSS in dengue-infected children
Treatment of DHF: None specific
– Paracetamol
– ORS, Oral fluids
– I/V fluids, IV colloids
– Blood transfusion
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Drugs causing DLE ( Drug induced Lupus Erythematosus ) can also be asked as drugs undergoing metabolism by liver acetylation. Such drugs are: C- SHIP C-Chlorpromazine S - Sulfonamides H - Hydralazine I - Isoniazid P - Procainamide
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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. Also know
The difference between myopathy and muscular dystrophy.
Myopathy
Any skeletal muscle disorder that causes structural changes or functional impairment of muscle. It also includes muscular dystrophies.
Muscular dystrophy
The muscular dystrophy means abnormal growth of muscle.
It is characterized by -
It is a primary myopathy iii) Course is progressive
It has genetic basis iv) Degeneration & Death of muscle fibers occur at some stage of the disease
So, muscular dystrophy is a type of myopathy.
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Here note that the serum peak oestradiol is very high and she had received an injection as a pa of her treatment for infeility which may have been human chorionic gonadotropin. This resulted in ovarian hyperstimulation syndrome. In Budd Chiari syndrome or Meigs syndrome oestradiol need not be this high. Note that thromboembolic complication may ensue ovarian hyperstimulation syndrome. Risk factors for ovarian hyperstimulation syndrome Age>35 years Asthenic habitus Pregnancy PCOS Serum oestradiol > 4000 pg/ml Luteal phase hcg stimulation >35 follicles Ref: Oxfords Handbook of clinical specialities, 8th Edition, Page 311
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Extensor digitorum Hybrid muscles are the muscles having more than one nerve supply Pctoralis major: lateral & medial pectoral nerves Brachialis: additional proprioceptive fibres from radial nerve, in addition to its muscular nerve, musculocutaneous nerve. Extensor digitorum is supplied by the posterior interosseous nerve only.
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The fibrous and parietal pericardia are supplied by phrenic nerves.They are sensitive to pain.Pain of pericarditis originates in the parietal pericardium alone. B D CHAURASIA'S HUMAN ANATOMY UPPER LIMB THORAX-VOLUME-1 SIXTH EDITION Page no-251
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Gallstones In the USA and Europe, 80% are cholesterol or mixed stones, whereas in Asia, 80% are pigment stones Cholesterol or mixed stones - 51-99% pure cholesterol Pigment stone contains <30% cholesterol Black stones - Insoluble bilirubin polymer + calcium phosphate + calcium bicarbonate Brown pigment stones- calcium bilirubinate+ calcium palmitate + calcium stearate+ cholesterol
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Tetralogy of Fallot (TOF) is a cardiac anomaly that refers to a combination of four related hea defects that commonly occur together. The four defects are: Ventricular septal defect (VSD) Tetralogy of Fallot results in low oxygenation of blood. This is due to: Mixing of oxygenated and deoxygenated blood in the left ventricle the ventricular septal defect (VSD) Preferential flow of the mixed blood from both ventricles through the aoa because of the obstruction to flow through the pulmonary valve. This is known as a right-to-left shunt. Infants with TOF -a cyanotic hea disease- have low blood oxygen saturation.Blood oxygenation varies greatly from one patient to another depending on the severity of the anatomic defects.Typical ranges vary from 60% to around 90%.[Depending on the degree of obstruction, symptoms vary from no cyanosis or mild cyanosis to profound cyanosis at bih.If the baby is not cyanotic then it is sometimes referred to as a "pink tet".Other symptoms include a hea murmur which may range from almost imperceptible to very loud, difficulty in feeding, failure to gain weight, retarded growth and physical development, labored breathing (dyspnea) on exeion, clubbing of the fingers and toes, and polycythemiaThe baby may turn blue with breast feeding or crying. Ref Davidson 23rd edition pg 453
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Gynecomastia is the abnormal growth of mammary glands in males. Polythelia refers to supernumerary nipples. Polymastia refers to supernumerary, or extra, breasts. Amastia refers to the absence of breasts.
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SAR of measles = 80% and Rubella = 90%
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B i.e. RV decreased
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Ans. is 'c' i.e. Microdochotomy
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Beckwith - Wiedmann syndrome :
Oragnomeagly seen like macroglossia, omphalocele, hemihypertrophy, adrenal cytomegaly.
There is increased risk of Wilm's tumour.
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Ans is 'c' i.e., Stage 2 NREM Stages of sleepo Sleep is basically divided into two phases :-Non-REM (NREM) or slow-wave sleep It is called Non-REM sleep because no rapid eye movement (REM) is there on eletrooculogram, rather there is slow or quiscent eye movement. It is also referred as S- sleep (synchronized sleep) or quiet sleep or orthodox sleep because there is diminished physiological functions and a low level of overall activity. It is further divided into : -Stage I It is a transition from wakefulness to sleep and is characterized by disappearance of alpha activity and appearance of theta activity. There is slow eye movements.Stage 2 It is characterized by typical EEG activity i.e., Sleep spindles and 'K-complex' .No eye movement occurs.Stage 3 & 4 Stage 3 & 4 are stages of deep sleep. These are also called slow wave sleep as these stages are characterized by slow delta waves. Delta wrave appearance starts in stage 3 and dominated in stage 4.REM sleep The REM sleep is so named as there is rapid roving movements of eye, i.e., rapid eye movement (REM)on electro-oculogram. It is also called paradoxical sleep because there is a paradoxical elevation of brain activity & metabolism and physiological activity. The high-amplitude slow waves seen in stage 3,4 of REM sleep is replaced by rapid lowr voltage activity (Beta wave). Features of REM sleep are:-EEG - Beta-wave, Reappearance of alpha wave. Saw-tooth wave (low voltage fast activity), Ponto-genital-occipital spikes.Dreamingiii) Other features :- Generalized muscular atony. Penile erection, autonomic hyperactivity (Increased pulse rate & BP) and intermittent movement of small muscle groups.o The NREM (with its four stages) and REM sleep repeat several times a night in cyclic manner, 4-6 times depending on the length of sleep. A typical cycle starts with stage 1 of the NREM sleep which is followed by second, third and fourth stages. After this the sleep returns to stage 3 and 2. The first REM sleep occurs now, 70-90 minutes after the the commencement of sleep (Note : - Stage 1 NREM sleep occurs only once at the start of the sleep as this is only a transition phase between wakefulness and sleep. Once the sleep starts the cycle rotates between stage 2, 3, 4 NREM and REM sleep). REM sleep occupies 20-30% of total sleep and NREM sleep occupies 60-70% (Stage-1 - 5-10%; Stage 2 - 40-50%; Stage 3 & 4 - 15-20%).
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Ref:Pathologic Basis of Disease (Robbins and cotran) 7th edition ,page no.765 Mediastinal tumors and other mass Superior Mediastinum Lymphoma Thymoma Thyroid lesions Metasttic carcinoma Parathyroid tumors Anterior Mediastinum Thymoma Teratoma Lymphoma Thyroid lesions Parathyroid tumours Posterior Mediastinum Neurogenic tumours Gastroenteric Hernia Middle Mediastinum Bronchogenic cyst Pericardial cyst Lymphoma
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Lumbar spinal stenosis is defined as narrowing of the spinal canal, its lateral recesses, and neural foramina that results in a compression of lumbosacral nerve roots. The hallmark of spinal stenosis is bilateral pseudoclaudication. It is induced by standing or walking and is relieved by sitting or flexing forward. Pedal pulses are preserved, symptoms are provocated by standing and walking, and maximal discomfo is in the thighs rather than the calves. Ref: CURRENT Rheumatology Diagnosis and Treatment, 2nd Edition, Chapter 10
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Ans. c. Previous classical cesarean section Trial of normal vaginal delivery is contraindicated in previous classical or inveed-T shaped uterine incision cesarean section. Vaginal Bih After Cesarean (VBAC) Trial of Labour (TOL Selection Criteria One previous lower segment transverse scarQ Pelvis adequate for the fetusQ Continued labour monitoring possibleQ Availability of resources (Anesthesia,blood transfusion and OT), for emergency cesarean section within 30 minutes of decision Informed consent of the women Contraindications Previous classical or inveed-T shaped uterine incisionQ Previous 2 or more LSCSQ Pelvis contracted or suspected CPDQ Presence of other complications in pregnancy- Obstetric(Pre-eclampsia, malpresentation, placenta prae) or medical Resources limited or emergency cesarean delivery or patient refusal
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(B) II & III degree heart block# Except for those drugs specifically approved for use in heart failure, beta blockers are contraindicated in heart failure patients> Side effects of beta-blockers are related to their cardiac mechanisms and include bradycardia, reduced exercise capacity, heart failure, hypotension, and atrioventicular (AV) nodal conduction block.> Beta-blockers are therefore contraindicated in patients with sinus bradycardia and partial AV block.> Non-selective beta-blockers are contraindicated in patients with asthma or chronic obstructive pulmonary disease which is not a contraindication for cardioselective beta blockers.
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Ans-A
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hea : strychinine , digoxin Skin- Hypodermic injections, snake bite, Corrosives. Hair, Nails- Heavy Metal Poisoning. Spinal Cord- Strychnine Poisoning CSF- Alcohol intoxication (in 1.0 mg NaF/ml of fluid) Urine- Narcotics Body Fat- Endrin , DDT(Organo Chlorines). Muscle- When internal organs are badly putrefied. ref : narayana reddy 9th ed
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(D) Neurosarcoidosis# NEUROSARCOIDOSIS generally occurs only in cases of sarcoidosis with substantial systemic involvement, and signs of neurologic involvement usually are seen in patients known to have active disease.> Strictly neurologic forms are seen in fewer than 10% of patients; a subset has predominantly neuromuscular involvement.> Definitive diagnosis of neurosarcoidosis requires the exclusion of other causes of neuropathy and the identification of noncaseating sarcoid granulomas by histologic analysis of nerve and muscle biopsy specimens.> Neurological involvement: Papilledema (6%); Cranial neuropathy (59%); Peripheral neuropathy (47%); Mononeuropathy (25%); Myopathy (25%); Psychiatric disorders (19%); Cerebellar ataxia (13%) & Hydrocephalus (6%)
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Metabolic syndrome/Syndrome X: Central obesity: Waist circumference >102cm in males,>88cm in females. Hyperiglyceridemia: >150mg% Low HDL cholesterol: <40mg%I(male), <50mg% (female) Hypeension: >130/80 mmHg Fasting blood glucose >100 mg% / previously diagnosed type 2 diabetes. NOTE:Raised LDL is NOT a feature of Metabolic syndrome.
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Ans. is 'c' i.e., Noncompetitive reversible inhibitor Brinzolamide is a white powder formulated as l% ophthalmic suspension to reduce intraocular pressure.Pharmacologically Brinzolamide is a highly specific noncompetitive reversible and effective inhibitor of carbonic anhydrase II (CA-II) which is able to suppress formation of aqueous humour in the eye.Carbonic anhydrase catalyzes the reversible reaction of water and carbon di-oxide to form negatively charged bicarbonate ions.In human tissues there are 7 different isoenzymatic forms of carbonic anhydrase, pancreas, eyes, central nervous system and lungs.In the eye the enzyme is expressed mainly in the ciliary processes of the ciliary body.The main ocular effect of Brinzolamide.Brinzolamide suppresses the formation of aqueous humour in the ciliary body and thus decrease intraocular pressure.In the ciliary epithelium the inhibition of carbonic anhydrase slows the formation of bicarbonate ions and their secretion into the posterior chamber of the eye.This reduces the sodium transport into the posterior chamber and decrease aqueous humour production resulting in lower intraocular pressure.Brinzolamide is used in ocular hypertension and primary oven angle glaucoma.Intraocular pressure reduction is fundamental in primary open angle glaucoma or in ocular hypertension to delay the onset or prevent the onset of primary open angle glaucoma in ocular hypertension or the progression of damage in primary open angle glaucoma.
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Ans. Southern blotting
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Ans. is 'a' i.e., Jealousy o Symptoms of conversion disorder:Sensory:- Anesthesia, paresthesia, hemianesthesia, deafness, blindness, tubular vision.Motor .--Abnormal movement, paralysis, weakness, gait disturbances, aphonia, torticollis, opisthotonus, blephrospasm.
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Reversal of the reaction catalyzed by pyruvate kinase in glycolysis involves two endothermic reactions. Mitochondrial pyruvate carboxylase catalyzes the carboxylation of pyruvate to oxaloacetate, Key Gluconeogenic Enzymes 1. Pyruvate carboxylase.Pyruvate Carboxylase Reaction Pyruvate in the cytoplasm enters the mitochondria. Then, carboxylation of pyruvate to oxaloacetate is catalysed by a mitochondrial enzyme, pyruvate carboxylase (Fig. 9.24). It needs the co-enzymes biotin and ATP.Ref: DM Vasudevan, 7th edition, Chapter 9
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Extra-ocular muscles are composed of white fibres (type II B), which contract quickly with peak tension attained within 7.5 msec of stimulation. Type I or 1 Type II A or 2A Type II B or 2X Other names Slow, Oxidative (SO) Fast, Oxidative, glycolytic (FOG) Fast Glycolytic (FG) Function Sustained forces, such as postural muscles Powerful fast movements Powerful fast movements Main source of ATP Oxidative phosporylation Oxidative phosphorylation Glycolysis Size of motor unit Small Large Large Mitochondria Many Intermediate Few Capillaries Many Many Few Myoglobin content High High Low Colour Red Red White Myosin ATPase activity Low High High Glycolytic capacity Low intermediate High Oxidative capacity High Intermediate Low Resistance to fatigue Fatigue resistant Fatigue resistant Fatigue susceptible Ref: Guyton and Hall Textbook Of Medical Physiology 13th edition \ Pgno: 84
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Ans. is `d' i.e., Oliguria due to uretic obstruction
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Ans: b (Anxiety) Ref: Ahuja, 6th ed, p. 95; Kaplan & Sadock, 8th ed, p. 1719Pharmacological treatment of anxiety disorders includes the use of benzodiazepines, beta blockers, buspirone and anti depressants.Antidepressants are among the most effective antianxiety agents available. SSRIs have been shown to help reduce or prevent various forms of anxiety, including panic anxiety, obsessive-compulsive symptoms, generalized anxiety, posttraumatic stress symptoms, and social anxiety. Most treatment algorithms begin treatment of each of these disorders with an SSRI.Serotonin-Norepinephrine reuptake inhibitor (SNRI) venlafaxine has been shown in randomized, controlled trials to be as effective as SSRIs in the treatment of generalized anxiety disorder and generalized social anxiety disorder.Beta blockers like propranalol and atenolol are particularly useful in management of anticipatory anxiety (anxiety occurring before going on stage, or before examinations)Buspirone is an anti anxiety drug which does not have any dependence potential, unlike benzodiazepines.Note on anxiety disordersAnxiety is the commonest psychiatric symptom in clinical practice and anxiety disorders are one of the commonest psychiatric disorders in general population.1) Generalised anxiety disorder: This is characterized by an insidious onset in the third decade and a stable, usually chronic course which may or may not be punctuated by panic attacks.The symptoms of anxiety should last tor at least a period of 6 months for a diagnosis of generalized anxiety disorder to be made. It is the commonest psychiatric disorder in the population.2) Panic disorder: This is characterized by discrete episodes of acute anxiety. Panic disorder can either present alone or with agoraphobia.Note on phobiasPhobia is defined as an irrational fear of a specific object. situation or activity, often leading to persistant avoidance of the feared object situation or activity, often leading to persistant avoidance of the feared object situation or activity.The common type of phobias are:a) Agoraphobia-It is the commonest type of phobia encountered in clinical practice.lt is characterized by an irrational fear of being in places away from the familiar setting of home. It includes fear of open spaces.public spaces, crowded spaces and any other place from where there is no easy escape to a safe place.A full blown attack may occur (agoraphobia with panic disorder) or only a few symptoms(like dizziness or tachycardia) may occur (agoraphobia without panic disorder)SSRIs are currently the drugs of choice .with paroxetine being the most widely used drug. "Nomophobia"-one of the latest additions to the phobia list. It is the fear of being out of of mobile phone contact.b) Social phobiac) Specific (simple) phobia
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All the exocrine glands are lined by pseudo stratified cuboidal/columnar epithelium with few exceptions. One of them is sebaceous gland duct which caries the epithelium same as that of the skin (stratified squamous epithelium) Ref: IB textbook of histology 6e pg 54.
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WORKING PRINCIPLE : light bulbs heat air in the bottom pa of the incubator,the air passes over a container with evaporating water, so that its humidity increases,the warm, humid air then flows upwards (chimney effect) into the baby compament Reference: GHAI Essential pediatrics, 8th edition.
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Trigeminal
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(Ref: Katzung 14th ed. P 755)Insulin glargine is a soluble, "peakless" (i.e. having broad concentration plateau), long acting insulin analogue.Onset: 1-1.5 hours. Duration of action: 11-24 hours.Summary of bioavailability characteristics of the insulinsInsulin preparationsOnset of actionPeak actionEffective durationInsulins lispro, aspart, glulisine5-15 minutes1-1.5 hours3-4 hoursHuman regular30-60 minutes2 hours6-8 hoursTechnosphere inhaled insulin5-15 minutes1 hour3 hoursHuman NPH2-4 hoursFlat 24 hoursInsulin detemir0.5-1 hoursFlat17 hoursInsulin degludec0.5-1.5 hoursFlat>42 hours
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Ans. is 'd' i.e., Succinate thiokinase o There are 2 types of phosphorylation of ADP to ATP.Substrate level phosphorylationOxidative phosphorylation at respiratory' chain levelo Substrate level phosphorylation is the production of ATP at the substrate level without participation of ETC.o It occurs in TCA cycle and glycolysis CitricAcid cydeSuccinate thiokinaseSuccinyi Co-A ---------------------------------------------------------- SuccinatePhosphnplyoerate kinaseGlycolys1. 1,3-Biphosphoglycerate ------------------------------------------------ 3-Phosphogly ceratePyruvate kinase2. Phosphoenolpvruvate ----------------------------------------------Pyruvate
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The biological tests for pregnancy are: 1) Aschheim - Zondek test 2) Rapid rat test 3) Friedman test 4) Hogben or Female toad test 5) Male frog test 6) Galli - Mainini test Alo know: Indirect and direct latex slide tests are immunological tests. Ref: Textbook of Forensic Medicine and Toxicology by Narayan Reddy, Edition 21, Page - 332, 333
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Ans. is 'a' i.e., G1- S phaseo Phosphorylation of RB is a molecular "On-off' switch for cell cycle.o It regulates cell cycle at G,- S phase (has been explained in details in previous explanations).
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Inguinal triangle is a region defined by the following structures:Rectus abdominis muscle (medially)Inguinal ligament (inferiorly)Inferior epigastric vessels (superior and laterally)It is the region in which direct inguinal hernias protrude through the abdominal wall.The Hesselbach triangle is bounded by the inguinal ligament, the inferior epigastric vessels, and the lateral border of the rectus muscle. A weakness or defect in the transversalis fascia, which forms the floor of this triangle, results in a direct inguinal hernia. Ref: Deveney K.E. (2010). Chapter 32. Hernias & Other Lesions of the Abdominal Wall. In G.M. Dohey (Ed), CURRENT Diagnosis & Treatment: Surgery, 13e
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Ans. B. 63 degrees for 30 minutes.a. Holder method of pasteurization-moist heat at 63 C for 30 minutesb. Flash method of pasteurization-moist heat at 72 C for 15-20 seconds followed by quickly cooling to 13 C.c. Ultra-High Temperature (UHT) of pasteurization-moist heat 140degC for 15 sec/ 149deg C for 0.5 sec.
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Ans. (B). ScaldsLocal effects of heat & cold:Dry heat: Flame burnsMoist heat: scaldsDry cold: Frost biteMoist cold: Immersion foot
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.ACHALASIA CARDIA is a failure of relaxation of cardia (oesophagogastric junction) due to disorganised oesophageal peristalsis, as a result of a failure of integration of parasympathetic impulses causing functional obstruction.Aetiology comprises of, * There is absence or less numbered ganglions in myenteric plexus. - Stress. - Vit B1 deficiency. - Chaga's disease. - Diffuse oesophageal spasm (Cork-screw oesophagus). Common in females between 20 and 40 years age group. * Chest pain occurs in an early stage. * Achalasia with diffuse oesophageal spasm is called as 'vigorous achalasia'. * Presents with progressive dysphagia, which is more for liquid than to solid food. * Regurgitation and recurrent pneumonia are common (10%). * Malnutrition and general ill health. * Lung abscess formation. * Odynophagia and weight loss.Barium swallow is diagnostic (bird beak appearance ) Ref: SRB&;s manual of surgery,3 rd ed, pg no 745
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In TOF hea will be normal in size. In ebstein anomaly first hea sound is split. Ref : Ghai essential of pediatrics, eighth edition, p.no:424
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Answer is B (IgM fixes complements): IgM and IgG .fix complement the classical pathway
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Chemoprophylaxis against Diphtheria:- * Close contacts are subjected to throat cultures to establish their carrier status. * Irrespective of culture results, all contacts are staed on chemoprophylaxis. Chemoprophylaxis Drug options: * Oral Erythromycin (1g/day for adults; children - 40mg/Kg/day): once a day for 7-10 days in patients over 6 months of age. * IM Benzathine Penicillin G (1.2 MU) one dose for contacts >6 years. Half the dose in paediatric contacts less than 6 years. * Apa from Chemoprophylaxis, Immunization of the Contacts of Diphtheria patients is based on their vaccination status. Diphtheria antitoxin vaccine is given to contacts if their vaccination status is unceain or questionable. Ref:- Harrisons Principles of Internal Medicine 20th Ed; Pg Num:- 1098
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Surveillance after treatment
Clinical surveillance of cases after completion of treatment is an important part of the current recommendations for multidrug therapy.
It is essential for the assurance of the long-term success of treatment and for the early detection of any relapses.
The recommendations are -
i) Paucibacillary leprosy → clinical examination at least once a year for a minimum period of 2 years after completion of treatment.
ii) Multibacillary leprosy → clinical examination at least once a year for a minimum period of 5 years after completion of treatment.
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Bishop Koop Operation
Done for meconium ileus.
It is resection of most dilated segment with an end to side anastomosis of colon to ileum. The distal eleal opening is formed into ileostomy.
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Ans. A. Diazepam is helpful in reducingExplanationDiazepam is used to treat alcohol withdrawal tremors.In Parkinsonism slow resting tremors 3-6 Hz are seen. Treatment of parkinsonism is with:Anticholinergic drugs like trihexiphenidyl, Benztropine, amantadine and selegilineDopamine agonist like Pramipexole, Ropinirole, PergolideLevodopaBeta blockers are used for treatment of tremors in performance anxiety.
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Glycogen is the reserve carbohydrate in animals. It is stored in liver and muscles.The phosphorylated enzyme is less sensitive to allosteric inhibitors. Thus even if cellular ATP and glucose-6-phosphate are high, Phosphorylase will be active. The glucose-1-phosphate produced from glycogen in the liver may be conveed to free glucose for release to the blood.
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Phospholipids are :Glycerophospholipids (glycerol containing) :- Phosphatidylcholine (lecithin), phosphatidylethanolamine (cephaline), phosphatidylserine, phosphatidylinositol, plasmalogens, lysophospholipids, cardiolipin.Sphingophospholipids (sphingosine containing) :- Sphingomyeline
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Roth spots Round retinal hemorrhages with white centers Seen in : Infective endocarditis SLE Serum sickness Polyaeritis nodosa Severe anemia Leukemia Prolonged anesthesia
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*The functional residual capacity and residual volume are decreased due to elevated diaphragm. GFR increases by 50% Cardiac output increases by 40% Hemoglobin and hematocrit decreases. Reference : William's Textbook of Obstetrics 24th edition page 62
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Ans. is 'a' i.e., Edinger westphal nucleusPupillary light reflex (Light reflex)* Pupillary light reflex refers to constriction of pupil in response to light. When a sudden light is thrown into the eye, the pupil of that eye constricts (direct light reflex). The pupil of other eye also constricts (Consensual or indirect light reflex). The pathway for pupillary reflex involve (sequentialy): -i) Afferent: - Retina - Optic nerve - Optic chiasma - Optic tract - Pretectal nucleus - Internuncial neurons - EWN (Edinger westphal nucleus).ii) Efferent: - Edinger westphal nucleus - Occulomotor (3rd) nerve - Ciliary ganglion Short ciliary nerve - Sphinctor pupillae.* Some fibres decussate at optic chiasma and go to contralateral side which is responsible for consensual or indirect light reflex. From retina upto the Pretectal nucleus is afferent pathway and from EWN of third nerve to sphincter pupillae is efferent pathway.
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Ans. is 'd' i.e., All of the above Pubey is triggered by a release of gonadotropins (FSH and LH) from pituitary gland. These hormones act as signals to the gonads (testes/ovaries) that trigger the production of - i) Estrogen, progesterone and some testosterone in women. ii) Testosterone in men. In both males and females, testosterone is responsible for development of pubic hair, accelerated bone growth, body odor and acne during pubey. For boys, testosterone is responsible for the process of virilization, including the enlargement of the penis, increased libido and growth of facial and chest hair. Estrogen is the major hormone responsible for female puberal development. It causes development of breast and thickening of endometrium. Progesterone causes proliferation of acini in mammary glands and conves watery cervical secretion to viscid and scanty. Leptin facilitates release of gonadotropin releasing hormone (GnRH), thereby helping in pubeal onset. Other hormones which are involved in pubey are thyroxine and growth hormone.
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Ans. Retinoblastoma
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Pheochromocytoma must be operated on first.
These tumors are generally (>50%) bilateral. Total thyroidectomy is the treatment of choice for patients with MTC because of the high incidence of multicentricity, the more aggressive course, and the fact that 131I therapy usually is not effective.
Central compartment nodes frequently are involved early in the disease process, so that a bilateral central neck node dissection should be routinely performed.
In patients with palpable cervical nodes or involved central neck nodes, ipsilateral or bilateral, modified radical neck dissection is recommended.
The role of prophylactic lateral neck dissection is controversial.
However, in patients with tumors >1 cm, ipsilateral prophylactic modified radical neck dissection is recommended because >60% of these patients have nodal metastases.
If ipsilateral nodes are positive, a contralateral node dissection should be performed.
In the case of locally recurrent or metastatic disease, tumor debulking is advised not only to ameliorate symptoms of flushing and diarrhea, but also to decrease risk of death from recurrent central neck or mediastinal disease.
External beam radiotherapy is controversial, but is recommended for patients with unresectable residual or recurrent tumor.
There is no effective chemotherapy regimen.
Radiofrequency ablation done laparoscopically appears promising in the palliative treatment of liver metastases >1.5 cm.
In patients who have hypercalcemia at the time of thyroidectomy, only obviously enlarged parathyroid glands should be removed.
The other parathyroid glands should be preserved and marked in patients with normocalcemia, as only about 20% of patients with MEN2A develop HPT.
When a normal parathyroid cannot be maintained on a vascular pedicle, it should be removed, biopsied to confirm that it is a parathyroid, and then autotransplanted to the forearm of the nondominant arm.
Total thyroidectomy is indicated in RET mutation carriers once the mutation is confirmed.
The procedure should be performed before age of 5 years in MEN2A patients and before age 1 year old in MEN2B patients.
Central neck dissection can be avoided in children who are RET -positive and calcitonin-negative with a normal ultrasound examination.
When the calcitonin is increased or the ultrasound suggests a thyroid cancer, a prophylactic central neck dissection is indicated.
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Atractyloside inhibits oxidative phosphorylation by inhibiting the transpoer of ADP into and ATP out of the mitochondrion. Reference: Harper; 30th edition; Page no: 132
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Ans. is b i.e. Is due to increase in blood flow through the dilated uterine vessels Uterine souffle is a soft blowing systolic murmur The sound is synchronous with maternal pulse It is due to increase in blood flow through the dilated uterine vessels Heard low down at the sides of the uterus, best on the left side It can also be heard in big uterine fibroid. Note Soft blowing murmur synchronous with the fetal hea sound is called Fetal / Funic souffle.
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* Narcoanalysis is a test carried out on a patient or suspect when he/she, after administering truth serum, comes in a sleep like state, and his/her repressed feelings are released. * Truth serum are drugs used in narcoanalysis. Two most common drugs used in narcoanalysis are Sodium amytal, which is also known as amobarbital or amylobarbition, and Sodium Pentothal commonly known as thiopental or thiopentone * Polygraph measures and records physiological actions of human body especially autonomic nervous system while the subject is asked questions relating to the crime and he answers them. * It is based on the principle that autonomic nervous system changes are beyond reasonable control of an individual and hence autonomic nervous system response changes transpires when the subject tries to tell a lie. * Brain mapping measures the P300 evoked potential. In this test the suspect is made to sit in evoked potential recording machine and is shown objects relating to crime scene or is made to hear sounds peaining to crime site. The sensors from his head pick the event related potentials in the form of Brain Mapping only if the person has been at the site of crime. The accuracy of Brain Mapping is almost 100%.
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The typical findings in acquired or inherited forms of classic distal A (type 1 A) include hypokalemia, non-AG metabolic acidosis, low urinary NH4+ excretion (positive UAG, low urine ), and inappropriately high urine pH (pH > 5.5). Most patients have hypocitraturia and hypercalciuria, so nephrolithiasis, nephrocalcinosis, and bone disease are commonReference: Harrison&;s Principles of Internal Medicine; 19th edition; Chapter 66; Acidosis and Alkalosis
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D i.e. LSD
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Furious Rabies generally manifests as headache, fever, irritability, restlessness and anxiety. It is associated with dilated pupils, lacrimation, salivation and perspiration. Muscle pains, salivation and vomitting may follow. A few days following exposure the patient may experience a stage of excitement or muscle spasms initiated from the ingestion of of saliva or water. As a result these individuals have a tendency to drool and begin to fear water or hydrophobia. This excited phase continues for a few days until the patient lapses into a coma and dies. Dumb Rabies manifests itself in the opposite manner as Furious Rabies. Instead of demonstrating excitement the patient experiences depression and paralysis followed by a coma. Death eventually results from respiratory arrest. This form of the virus is often difficult to diagnose from a clinical perspective.
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RV = Total lung capacity minus vital capacity. RV is volume remained in lungs after forceful expiration.
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The gene for CRP is on chromosome 1. CRP is an abnormal protein which appear in blood in response to inflammatory cytokines such as IL 6. It is one of the most sensitive acute pahse reactant. It is elevated following severe trauma, bacterial infections, inflammation, surgery or neoplastic proliferation.
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Hb Ba: Most severe form of Alpha thalassemia As Hb Ba's consists of 4-gamma chains - have very high oxygen affinity Thus, it cannot release oxygen to fetal tissues.
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Topical steroid
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A panel discussion is designed to provide an oppounity for a group to hear several people knowledgeable about a specific issue or topic present information and discuss personal views. A panel discussion may help the audience fuher clarify and evaluate their positions regarding specific issues or topics being discussed and increase their understanding of the positions of others. A workshop describes an office or conference room meeting intended to create or generate plans, analysis, or design to suppo organizational effos. Symposium is ameeting or conference for discussion of a topic, especially one in which the paicipants form an audience and make presentations. Seminar is asmall group of advanced students in a college or graduate school engaged in original research or intensive study under the guidance of a professor who meets regularly with them to discuss their repos and findings.
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REF : ANANTHANARYANA MICROBIOLOGY
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Isozymes/Isoenzymes are different forms of same enzyme,catalyzing same reaction in same species, Example:- There are five isozymes of Lactate Dehydrogenase (LDH-1 to LDH-5), All conve Pyruvate to Lactate. Same for Isoenzymes Reaction Species Different for Isoenzymes Structure (subunits) Km, Vmax Electrophoretic mobility Genes (but closely relate) Heat stability Susceptibility to inhibitor If species different, then it is known as Alloenzyme Isoenzymes may be present in same/different tissues
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The trapezoid body is located in the caudal pons, or more specifically the pontine tegmentum. The trapezoid body is pa of the auditory pathway where some of the axons coming from the cochlear nucleus decussate, or cross over to the other side before traveling on to the superior olivary nucleus. This is believed to help with localization of sound. (Ref: vishram Singh textbook of clinical neuroanatomy second edition pg 80)
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Leprosy
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Epigenetic changes include:- alterations of chromatin structure mediated by methylation of cytosine residues in CpG dinucleotides modification of histones by acetylation or methylation. The transcriptional regulatory regions of active genes often contain a high frequency of CpG dinucleotides (referred to as CpG islands), which are normally unmethylated. Acetylation of the amino terminus of the core histones H3 and H4 induces an open chromatin conformation that promotes transcription initiation. Hypermethylation of promoter region is common mechanism by which tumor-supressor loci are epigentically silenced in cancer cells.
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The synopsis of forensic medicine & toxicology ; Dr k.s.narayan reddy ;28th edition ; Pg .no. 110 Blunt force on areas where the skin is close to bone ,and the subcutaneous tissues are scanty ,may produce a wound that looks like a incised wound . In the options given forehead is the most applicable answer as it fulfils all the required condition to produce a incised looking wound .
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Palliative procedures like palliative paial gastrectomy, anterior gastrojejunostomy, Devine's exclusion procedure, luminal stenting in proximal inoperable growths, chemotherapy are used in inoperable cases. * In early carcinoma proper lymph nodal clearance is impoant. Antrectomy is also called as hemi-gastrectomy. Removal of 60-75% stomach is called a paial gastrectomy. Removal of more than 80% of the stomach is called a subtotal gastrectomy. Distal pancreatectomy or central pancreatectomy or total pancreatectomy for cystadenocarcinoma of pancreas depending on the extent and size of a tumour . Ref: SRB&;s manual of surgery,3 rd ed, pg no 636
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Ans. is 'b' i.e., Median nerve Anterior interosseous nerve is a branch of median nerve. Anterior interosseous aery is a branch of ulnar aery.
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Zinc deficiency is characterized by growth retardation, loss of appetite, and impaired immune function. In more severe cases, zinc deficiency causes hair loss, diarrhea, delayed sexual maturation, impotence, hypogonadism in males, and eye and skin lesions. Reference: GHAI Essential pediatrics, 8th edition
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Osteosarcoma - New bone is laid down along the blood vessels within the tumor growing centrifugally giving rise to a 'Sun -ray appearance' on x -ray. Chondrosarcoma- "Speckled" calcification on x-ray Ewings sarcoma - Second most common malignant. Classic x-ray appearance is the "onion skin"
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*Rivastigmine is used in Alzheimer's disease. It inhibits acetylcholinesterase and increases the level of ACh. *Tricyclic antidepressants have strong anticholinergic actions.Therefore,these can reduce the efficacy of rivastigmine. Depression is commonly seen in patients with Alzheimer's disease. The anti-depressants that are used should have minimum anticholinergic activity, therefore SSRI or MAO-inhibitors are preferred. Ref: KATZUNG 14TH ED.
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TRANSPOSABLE GENETIC ELEMENTS Ceain structurally and genetically discrete segments of DNA have been identified that have the ability to move around in a cut and paste manner between chromosomal and extrachromosomal DNA molecule within the cells. These DNA molecules are called transposons(jumping genes) A transposon is a segment of DNA with one or more genes in the center and the two winds carrying inveed repeat sequences of nucleotides -nucleotides sequence complementary to each other but in reverse order. Because of this feature, each strand of the transposon can form a single-stranded loop carrying the gene and a double-stranded stem formed by hydrogen bonding between the terminal inveed repeated sequences. Small transposons are known inseion sequences or are. transposon attach at ceain regions of chromosomal, plasmid or phage DNA. Inseion of a transposon leads to the acquisition of new characteristic by the recipient DNA molecule. Unlike plasmids, transposons are not self-replicating and depend on chromosomal or plasmid DNA for replication REF:Ananthanarayan and Panicker's Textbook ofMicrobiology 8thEdition pg no: 67
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