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Vitamin B1, or thiamine, is the coenzyme required (as the pyrophosphate) for the decarboxylation of alpha-ketoacids. An example of this reaction is pyruvate decarboxylase reaction in alcoholic fermentation. Other reactions such as that catalyzed by pyruvate dehydrogenase also rely on thiamine pyrophosphate for decarboxylation, but require other cofactors as well. Thiamine is also required for the generation of pentose phosphates for nucleotide synthesis in the pentose phosphate pathway (hexose monophosphate shunt), serving as a cofactor for transketolase. Vitamin B2, or riboflavin, is a constituent of FMN (flavin mononucleotide) and FAD (flavin adenine dinucleotide). It functions in hydrogen and electron transpo. Vitamin B3, or niacin (nicotinic acid), is a coenzyme that is also involved in hydrogen and electron transpo. Nicotinic acid functions in the form of NAD and NADP. Vitamin B5, or pantothenic acid, is conjugated with coenzyme A to act as a carboxylic acid carrier. Ref: Ender D.A. (2011). Chapter 44. Micronutrients: Vitamins & Minerals. In D.A. Bender, K.M. Botham, P.A. Weil, P.J. Kennelly, R.K. Murray, V.W. Rodwell (Eds),Harper's Illustrated Biochemistry, 29e.
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Ans. C. VIIIHaemophilia's are the most common hereditary clotting defects occurring as X-linked recessive disorders. Haemophilia A is caused by factor VIII deficiency and haemophilia B due to factor XI deficiency:
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BCG, DPT-1,OPV-1,Measles. Reference: Park's textbook of preventive and social medicine, K.Park,23rd edition, page no:123.
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The doctor who has operated on the wrong side of the patient has committed criminal negligence. Sec. 304- A IPC deals with criminal negligence.
It states that "Whoever causes the death of any person, by doing any rash or negligent act not amounting to culpable homicide shall be punished with imprisonment up to two years or with fine or with both.
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Menstrual blood is predominantly aerial, with only 25% of the blood being of venous origin. It contains tissue debris, prostaglandins, and relatively large amounts of fibrinolysin from the endometrial tissue. The usual duration of the menstrual cycle is 3-5 days. The average amount of blood loss is 30 mL. Loss of more than 80 mL is abnormal. Ref: Alford C., Nurudeen S. (2013). Chapter 4. Physiology of Reproduction in Women. In A.H. DeCherney, L. Nathan, N. Laufer, A.S. Roman (Eds), CURRENT Diagnosis & Treatment: Obstetrics & Gynecology, 11e.
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By changing the injection site every day, the incidence of lipodystrophy can be reduced significantly. Ref: KD Tripathi 8th ed.
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Ans. (c) Superficial lobe tumors can present with trismus as early presentationRef: Sabiston Textbook of surgery 20th Edition Page 807* Salivary gland tumors are usually slow growing and well circumscribed.* Patients with a mass and findings of rapid growth, pain, paresthesias, and facial nerve weakness are at increased risk of harboring a malignancy* Additional findings ominous for malignancy include skin invasion and fixation to the mastoid tip.* Trismus suggests invasion of the masseter or pterygoid muscles by deep parotid lobe malignancies.* MRI is the most sensitive study to determine soft-tissue extension and involvement of adjacent structures.* Diagnosis of salivary gland tumors is frequently aided by the use of FNA.* Excision of the gland is used to confirm the final diagnosis.* Encapsulated but sends pseudopodia (finger-like projections) into surrounding glands, enucleation is not done to avoid recurrence.
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ANSWER: (A) Reverse TranscriptaseREF: Lippincott s biochemistry 4th Ed Page 408, Harper 29th ed Table 39-3CLASSES OF PROTEINS INVOLVED IN REPLICATIONProteinFunction-DNA polymerasesDeoxynudeotide polymerizationHeli casesProcessive unwinding of DNATopoisomerasesRelieve torsional strain that results from helicase-induced unwindingDNA primaseInitiates synthesis of RNA primersSingle-strand binding proteinsPrevent premature reannealing of dsDNADNA ligaseSeals the single strand nick between the nascent chain and Okazaki fragments on lagging strand SOME OP THE ENZYMES USED IN RECOMBINANT DNA RESEARCHEnzymeReactionPrimary useAlkaline phosphataseDephosphorylates 5' ends of RNA and DNARemoval of 5 -PO4 groups prior to kinase labeling; also used to prevent seif-ligationBAL31 nudeaseDegrades both the 3' and 5' ends of DNAProgressive shortening of DNA moleculesDNA ligaseCatalyzes bonds between DNA moleculesJoining of DNA moleculesDNA polymerase ISynthesizes double-stranded DNA from single-stranded DNASynthesis of double-stranded cDNA; nick translation; generation of blunt ends from sticky endsDNase IUnder appropriate conditions, produces single-stranded nicks in DNANick translation; mapping of hypersensitive sites; mapping protein- DNA interactionsExonuclease IIIRemoves nucleotides from 3' ends of DNADNA sequencing; mapping of DNA- protein interactionsX ExonucleaseRemoves nucleotides from 5' ends of DNADNA sequencingPolynucleotide kinaseTransfers terminal phosphate (g--position) from ATP to 5'-OH groups of DNA or RNA32P end-labeling of DNA or RNAReverse transcriptaseSynthesizes DNA from RNA templateSynthesis of cDNA from mRNA; RNA (5' end) mapping studiesSI nucleaseDegrades single-stranded DNARemoval of "hairpin" in synthesis of cDNA; RNA mapping studies (both 5' and 3' ends)Terminal transferaseAdds nucleotides to the 3' ends of DNAHomopolymer tailingA reverse transcriptase is involved in the replication of retroviruses, such as human immunodeficiency virus (HIV). These viruses carry their genome in the form of ssRNA molecules. Following infection of a host cell, the viral enzyme, reverse transcriptase, uses the viral RNA as a template for the 5'- 3' synthesis of viral DMA, which then becomes integrated into host chromosomes. Reverse transcriptase activity is also seen with transposons, DNA elements that can move about the genome. In eukaryotes, such elements are transcribed to RNA, the RNA is used as a template for DNA synthesis by a reverse transcriptase encoded by the transposon, and the DNA is randomly inserted into the genome. Reverse transcriptases, then, are RNA-directed DNA polymerases.cDNA libraries: If a gene of interest is expressed at a very high level in a particular tissue, it is likely that the messenger RNA (mRNA) corresponding to that gene is also present at high concentrations in the cell. For example, reticulocyte mRNA is composed largely of molecules encoding the a-globin and b-globin chains of hemoglobin. This mRNA can be used as a template to make a complementary dsDNA (cDNA) molecule using the enzyme reverse transcriptase. The resulting cDNA is thus a double-stranded copy of mRNA. cDNA can be amplified by cloning or by the polymerase chain reaction. It can be used as a probe to locate the gene that coded for the original mRNA (or fragments of the gene) in mixtures containing many unrelated DNA fragments. If the mRNA used as a template is a mixture of many different size species, the resulting cDNA are heterogeneous. These mixtures can be cloned to form a cDNA library. Because cDNA has no interveningsequences, it can be cloned into an expression vector for the synthesis of eukaryotic proteins by bacteria . These special plasmids contain a bacterial promoter for transcription of the cDNA, and a Shine-Dalgamo sequence that allows the bacterial ribosome to initiate translation of the resulting mRNA molecule.
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The image shows nodules on extensor distribution along with peripheral smear showing presence of normocytic anemia. The first differential to be considered is rheumatoid ahritis. The nodules are non-tender and are a late feature and hence not considered in diagnostic criteria for Rheumatoid ahritis. "Piano-key movement" of the ulnar styloid occurs due to inflammation about the ulnar styloid and tenosynovitis of the extensor carpi ulnaris. "Z-line deformity" is due to subluxation of the first MCP joint with hyperextension of the first interphalangeal (IP) joint due to damage to the tendons, joint capsule.
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(C) Chondrosarcoma # MALIGNANT PRIMARY BONE TUMORS include osteosarcoma, chondrosarcoma, Ewing's sarcoma, malignant fibrous histiocytoma, fibrosarcoma, and other sarcoma types. Multiple myeloma is a hematologic cancer which also frequently presents as one or more bone tumors.# CLASSIFICATION of BONE TUMOURS:> Cartilage tumors Osteochondroma: Chondromas Enchondroma Periosteal chondroma Chondroblastoma Chondromyxoid fibroma Chondrosarcoma Dedifferentiated Mesenchymal Clear cell Periosteal> Osteogenic tumors: Osteoid osteoma (B), Osteoblastoma> Fibrogenic tumors: Desmoplastic fibroma of bone, Fibrosarcoma of bone> Fibrohistiocytic tumors: Histiocytoma of bone> Ewing sarcoma/Primitive neuroectodermal tumor> Giant cell tumors: Giant cell tumor> Notochordal tumors: Chordoma> Vascular tumors: Haemangioma and related lesions, Angiosarcoma> Myogenic, lipogenic, neural and epithelial tumors: Leiomyosarcoma of bone, Lipoma of bone, Adamantinoma and osteofibrous dysplasia> Tumors of undefined neoplastic nature: Aneurysmal bone cyst Simple bone cyst; Fibrous dysplasia (B); Langerhans cell histiocytosis (LCH)
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Cytarabine is pyrimidine analogue At higher dose it is known to cause cerebellar toxicity like ataxia, dysahria. other side effects- myelosuppression,mucositis,nausea and vomiting. Cyclophosphamide causes hemorrhagic cystitis Cisplatin is most emetogenic anticancer drug. Actinomycin D and doxorubicin can cause vomiting,stomatitis,diarrhoea,erythema,desquamation of skin,alopecia and bone marrow suppression.
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Ans. (b) Polycystic kidneyAlso Know* Driven snow appearance - Pindborg s tumor* Sunray appearance - Osteogenic Sarcoma , Ewing Sarcoma* Floating Water Lily sign - Lung Hydatid , Echinococcus* Popcorn calcification - Pulmonary Hamartoma * Honeycomb appearance - RA , Scleroderma , Interstitial Lung Disease* Egg shell calcification - Sarcoidosis , Silicosis , Lymphoma , T.B., Histoplasmosis* Spring water cyst = Pluero Pericardial cyst* Rib notching - Neurofibromatosis , Aortic Aneurysm, Taussig-Bing Operation , Aortic obstruction , Coarctation of aorta.* Coeur en Sabot, Flask shape heart - TOF* Candle wax sign -Melorheostosis* Football Sign - Pneumoperitoneum* Snowman Sign - TAPVC ( Total Anomalous Pulmonary Venous Connection)* Figure of 8 in CXR - TAPVC* Egg on side - Uncorrected TGV* Thumb Print Sign - Epiglotis , Ischemic Colitis I* Double bubble sign - Duodenal Atresia* Single bubble sign - Pyloric stenosis* Soap bubble appearance - Meconium ileus* Meniscus appearance - CBD stone on cholangiography* Central dot sign - Caroli s disease* Chain of lakes appearance - Chronic pancreatitis* Spongy appearance with central sunburst calcification sign - serous cyst adenoma* Rim sign in IVP - Hydronephrosis* Cobra head deformity - Ureterocele* B/L spider leg sign - Polycystic Kidney* Golf hole ureter - T.B.* Flower Vase pattern of pelvis in IVP - Horse shoe kidney
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SIADH there is decrease in serum osmolality with inappropriate increase in urine osmolalitye.
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Ans. is 'c' i.e., n-carotene and iron
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Ans. Rotatory
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Methotrexate:- * Methotrexate, a first line Disease Modifying Rheumatoid Ahritis Drug is the first choice of drug in management of early Rheumatoid Ahritis. * It is the first choice conventional DMARD and an anchor drug chosen for most Anti-Rheumatoid ahritis combination therapies. * Methotrexate is used in dosage of 10-25mg/week oral or subcutaneous along with Folic acid 1mg/day as a pa of toxicity amelioration. Subcutaneous dosing is better in terms of bioavailability and pharmacodynamics attained. Recommendation Summary for use of Methotrexate in RA: - * Administration of a high initial dose of Methotrexate followed by rapid down titration to optimal dose can improve the response to oral Methotrexate without much compromise on patient safety or tolerability. * Response to treatment following optimal oral Methotrexate takes a minimum of 3 months, and at least 6 months to monitor accurate effect on disease progression * Patients not responding or showing inadequate clinical response to oral Methotrexate may be "rescued" by switching to subcutaneous Methotrexate. * While changing over from oral to subcutaneous dosing of Methotrexate, the same oral dose received by patient should be matched and given, following which on a later course, the dose may be altered. * If Methotrexate monotherapy fails to produce clinical improvement, another agent may be considered for combination. Ref:- Goodman & Gilman's Pharmacological basis of Therapeutics 13th Ed; Pg Num:- 2537
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B i.e. Laser photocoagulation of both eyes
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The Karolinska Institute in Sweden first noted that low concentrations of the serotonin metabolite 5-hydroxyindoleacetic acid (5-HIAA) in the lumbar cerebrospinal fluid (CSF) were associated with suicidal behavior. CSF, neurochemical, and receptor studies suppo the hypothesis that reduced central serotonin is associated with suicide. Reference: Synopsis of Psychiatry, pages 766,767.
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Ans. is 'b' i.e., Borrelia * Pathogenic spirochetes belong to three genera: Treponema, Borrelia and Leptospira.SpirocheteSpeciesDiseaseTreponemaPallidumSyphilis EndemicumBejel PertunaeYaws CarateumPintaBorreliaBurgdorferiLyme disease RecurrentisRelapsing fever VincentiVincent anginaLeptospiraInterrogansWeil's disease
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Budd-Chiari syndrome is a manifestation of hepatic venous outflow obstruction that was first described by George Budd in 1845. Primary Budd-Chiari syndrome -obstruction of the hepatic venous outflow tract is the result of an endoluminal venous lesion (thrombosis or web) Secondary when the obstruction results from the presence in the lumen of material not originating from the venous system or from extrinsic compression by a neighboring tumor. MUST KNOW: Classification of BCS According to the Level of Obstruction Type I - Obstruction of IVC with or without secondary hepatic vein occlusion Type II - Obstruction of major hepatic veins Type III - Obstruction of the small centrilobular venules (considered by some as veno-occlusive disease). Ref: J Ultrasound Med 2006; 25:373-379.
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Ans. d (Flea). (Ref. Park, PSM, 17th ed., 230).ARTHROPOD-BORNE DISEASES (MH 2005) ArthropodDiseases transmitted1.HouseflyTyphoid and paratyphoid fever, diarrhoea, dysentery, cholera, gastroenteritis, amoebiasis, helminthic infestations, poliomyelitis, conjunctivitis, trachoma, anthrax, yaws, etc.2.SandflyKalaazar, oriental sore, sandfly fever, oraya fever, leishmaniasis3.Tsetse flySleeping sickness4.LouseEpidemic typhus, relapsing fever, trench fever, and pediculosis5.Rat fleaBubonic plague, endemic typhus6.Black flyOnchocerciasis7.Reduviid bugChagas diseaseRICKETSSIAL DISEASES DiseaseCaused byVector1.Epidemic typhusR. prowazekiiLouse2.Endemic typhusR. typhiRat flea3.RMSFR. rickettsiiTick4.Rickettsial poxR. akariMite5.Scrub typhusR. tsutsugamushiMite6.Trench feverRoxielia quintanaLouse7.Q feverCoxiella burnettiTick
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Ans. is 'b' i.e.t Old post menopausal women Lefort's repairo It is reserved for very elderly menopausal women with an advanced prolapse or those women who are poor medical risks and are considered unfit for major surgical procedures.o In this the flaps of vagina from the anterior and posterior vaginal wall are excised, and the raw areas apposed with catgut sutures.Fotheririll's procedure is done for young women desiring child bearing.
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Ans. CO poisoning
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Please don't get confused with the diureruc6 therapy because it can lead to increased ADH release and thus may lead to Hyponatremia Dilutional hyponatremia, also known as water intoxication, it is a potentially life-threatening condition which occurs when a person consumes too much water without an adequate intake of electrolytes.
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8-aminoquinoline derivatives are primaquine, bulaquine, and tafenoquine.4 Aminoquinoline is Chloroquine.Ref: Sharma and Sharma 2nd edition; pg 809.
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Ans. A. Ulcerative colitisComplications of Ulcerative colitis:a. Massive hemorrhage.b. Toxic mega colon with perforation.c. Colonic epithelial dysplasia and carcinoma. The risk of neoplasia increased with duration and extend of the disease.
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Ans. C. Acetyl: CoA carboxylase(Ref: Harper 31/e page 217)Six enzyme activities of fatty acid synthase complex are:Ketoacyl SynthaseMalonyl-acetyl transacylaseHydrataseEnoyl reductaseKetoacyl reductaseThioesterase (Deacylase)
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Ans. is'd'i.e., Secondary active transpo(Ref: Principles of medical physiology p. 789)Absorption of glucose - Secondary active transpo (cotranspo) with Na+Absorption of lipids - Passive diffusion.Absorption of fructose - Facilitated Diffusion.Absorption of amino-acids -Secondary active transpo (cotranspo) with Na+.
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Answer- C. T4d Inflammatory breast carcinoma is one of the most malignant form of breast cancer. It has been specifically assigned a special T code, T4d (which falls under stage IIIb disease).
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Ans. is 'a' i.e., Etanercept BIOLOGIC RESPONSE MODIFIER (BRMs)* Several recombinant proteins/monoclonal antibodies that bind and inhibit cytokines, especially TNFa or IL-1 have been used succesfully in autoimmune diseases like RA, IBD, psoriosis or scleroderma.A. TNF-a inhibitorsa. Etanercept# It is a recombinant fusion protein of TNF - receptor and Fc portion of human IgG1'# It is administered by S.C. injection.b. Infliximab# It is a chimeral monoclonol antibody which binds and neutralizes TNF-a.# It is given by i.v. route.# It is indicated in RA, psoriotic arthritis, Crohn's disease, Wegener's granulomatosis and sarcoidosis.c. Adalimumab# This recombinant monoclonal anti-TNF antibody.# It is administered by S.C. route.B. IL-1 antagonistAnakinra# It is a recombinant human IL-1 receptor antagonist.# It is less effective than TNF inhibitors.# It is administered by S.C. route.C. T-cell costimulatory blockersAbatacept# It is a fusion protein that combines the extracellular domain of the molecule CTLA4 (CD 154) with the Fc portion of a human immunoglobulin.# It interfere with the interactions between antigen presenting cells and T lymphocytes. Therefore, it affects early stages in the pathogenic cascade of event in RA.D. B-cell depletersRituximab# B-cells are inflammatory cells with multiple functions in the immune response. The depletion of B cells has been shown to be effective in reducing signs and symptoms of RA and in slowing radiographic progression.# Rituximab is a chimeric monoclonal antibody that binds to the CD20 molecule on the B cell surface leading to the removal of B cells from the circulation.
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Answer is B (Intestinal Metaplasia) Barret's esophagus is a metaplasia of the esophageal mucosa caused by replacement of squamous epithelium with columnar epithelium. Specialized intestinal epitheliutn (intestinal metaplasia) is the most common and most impoant type of columnar epithelium seen in Barret's esophagus.
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The obstetric conjugate is the shoest distance between the promontory of the sacrum and the symphysis pubis. It generally measures 10.5 cm. Because the obstetric conjugate cannot be clinically measured, it is estimated by subtracting 1.5 to 2 cm from the diagonal conjugate, which is the distance from the lower margin of the symphysis to the sacral promontory. The true conjugate is measured from the top of the symphysis to the sacral promontory. The interspinous diameter is the transverse measurement of the midplane and generally is the smallest diameter of the pelvis. Ref:Cunningham F.G., Leveno K.J., Bloom S.L., Hauth J.C., Rouse D.J., Spong C.Y. (2010). Chapter 2. Maternal Anatomy. In F.G. Cunningham, K.J. Leveno, S.L. Bloom, J.C. Hauth, D.J. Rouse, C.Y. Spong (Eds), Williams Obstetrics, 23e.
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Glaucoma REF: Goodman and Gillman's 11TH edition page 1103, http://en.wikipedia.org/wiki/Latanoprost "Latanoprost ophthalmic solution is a topical medication used for controlling the progression of glaucoma or ocular hypeension by reducing intraocular pressure. It is a prostaglandin analogue (more specifically an analogue of Prostaglandin F2a)" "The PGF2a analogs consist of Latanoprost, travoprost, bimatoprost, and unoprostone. PGF2a analogs appear to lower IOP by facilitating aqueous outflow through the accessory uveoscleral outflow pathway. The mechanism by which this occurs is unclear"
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Adenomyosis is the presence of benign glands and stroma within the myometrium. It is a common cause of diffuse uterine enlargement and menstrual irregularities; however, it is not a precancerous lesion. Ref: Shaw&;s Textbook of Gynaecology; 16th edition; Chapter 30; Endometriosis and Adenomyosis
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WHO defines elimination of measles as the absence of endemic measles for a period of > 12 months in the presence of adequate surveillance.
One indicator of measles elimination is a sustained measles incidence < 1/100, 000 population.
In 2005, the World Health Assembly set a goal of achieving a 90% reduction in global measles mortality by 2010 as compared with level in 2000.
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Ans. b (2 mL) (Ref. Shaw's textbook of Gynaecology 14th ed., p 53)ANATOMICAL CHANGES AFTER MENOPAUSE# The ovaries shrink and their surface become grooved and furrowed.# The tunica albuginea thickens.# The menopausal ovary measures < 2 x 1.5 x 1 cm in size (8 mL in volume) as seen on ultrasound.# Fifteen years later, it should not measure more than 2 mL.# The plain muscle in the fallopian tube undergoes atrophy, cilia disappears from tubal epithelium, and the tubal plicae are no longer prominent.# The uterus becomes smaller through atrophy of its plain muscle, so that the connective tissues are more conspicuous. The endometrium is represented by only basal layer.# The cervix becomes smaller and its vaginal portion is represented by a small prominence at the vaginal vault.# The vaginal fornices gradually disappear.
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The given ECG shows bradycardia, beta blockers are contraindicated in bradycardiaRef: HL Sharma; 7th ed. Pg 191
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Polar bodies are one of two small cells formed by the first and second meiotic division of oocytes; the first is usually released just before ovulation, the second not until discharge of the oocyte from the ovary; in mammals, the second polar body may fail to form unless the oocyte has been penetrated by a sperm.Ref: Ganong&;s review of medical physiology; 24th edition; page no: 401
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Snowman or Figure of 8 or Cottage Loaf sign is seen in TAPVC.
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CYSTOID MACULAR EDEMA (CME) It refers to collection of fluid in the outer plexiform(Henle's layer) and inner nuclear layer of the retina,centred around the foveola. Etiology It is associated with a number of disorders. A fewcommon causes are as follows: 1. As postoperative complication following cataract extraction and penetrating keratoplasty. 2. Retinal vascular disorders e.g., diabetic retinopathy and central retinal vein occlusion. 3. Intraocular inflammations e.g., pars planitis, posterior uveitis, Behcet disease. 4. As a side-effect of drugs e.g., following use of adrenaline eyedrops, especially for aphakic glaucoma. 5. Retinal dystrophies e.g., retinitis pigmentosa. Pathogenesis CME develops due to leakage of fluid following breakdown of inner blood-retinal barrier (i.e., leakage from the retinal capillaries). Clinical features 1. Visual loss. Initially there is minimal to moderate loss of vision, unassociated with other symptoms. If oedema persists, there may occur permanent decrease in vision. 2. Ophthalmoscopy in clinically established cases reveals a typical 'Honey-comb appearance' ofbmacula (due to multiple cystoid oval spaces) CME is best examined with a fundus contact lens on slit-lamp or +90D lens. 3. Fundus fluorescein angiography demonstrates leakage and accumulation of dye in the macular region which in a well-established case presents a 'flower petal appearance. Ref comprehensive ophthalmology AK Khurana 4/E pageno 243.
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The SA nodal aery arises from the right coronary aery in 55-60% and the left circumflex aery in 40-45% of persons. One-third to one-half of patients with SA node dysfunction develop supraventricular tachycardia, usually atrial fibrillation or atrial flutter. Ref: Harrisons Principles of Internal Medicine, 18th Edition, Page 1869
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- Linzenmeyer is old technique used to measure eythrocyte sedimentation rate.
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A delta nerve fiber is involved in transmitting pain and temperature in the body. It's conduction velocity is 12-30 m/s. A alpha fiber is involved in carrying proprioception and somato motor sensation. It's conduction velocity is 70-120 m/s. A beta fiber is involved in carrying touch and pressure sensation. It's conduction velocity is 30- 70m/s. A gamma acts as motor to the muscle spindle. It's conduction velocity is 15 - 30m/s. Ref: Barrett K.E., Barman S.M., Boitano S., Brooks H.L. (2012). Chapter 4. Excitable Tissue: Nerve. In K.E. Barrett, S.M. Barman, S. Boitano, H.L. Brooks (Eds), Ganong's Review of Medical Physiology, 24e
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The reason for administering muti-drug therapy in tuberculosis is to prevent develompment of resistance. Resistance to individual drugs in Mycobacterium tuberculosis occurs by spontaneous point mutations that occur at a low but predictable rate (10 to 10 ). The development of drug-resistant tuberculosis (TB) is almost invariably the result of monotherapy, i.e., the failure of the health care provider to prescribe at least 2 drugs to which the tubercle bacilli are susceptible. Hence, multi-drug therapy is recommended for tuberculosis. Common point mutations in M.tuberculosis which cause drug resistance Rifampin : rpoB gene Isoniazid : katG gene & inhA Pyrazinamide : pncA gene Ethambutol : embB gene Aminoglycosides : rrs gene fluoroquinolones : gyrA-gyrB genes Reference: Ananthanarayan and Paniker&;s Textbook of Microbiology Tenth edition
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Erb's point is opposite chassaignac's tubercle (tubercle on transverse process of C6 vertebra), 2-3 cm above the clavicle, slightly outside the lateral border of sternocleidomastoid.
Chassaignac's tubercle is carotid tubercle on C6 vertebra, and it lies at the level of Erb's point.
Option 'b' also requires some explanation here. Stellate ganglion block is given most commonly by using chassaignac's tubercle as a landmark. But stellate ganglion itself lies at the level of the transverse process of C7 vertebra.
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Liver pathology is normal in Gilbert, Crigler Najjar, Rotor Syndrome.
In Dubin Johson syndrome liver is darkly pigmented. Liver biopsy is not normal in wilson's disease, Hemochromatosis.
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The diagnosis of chronic bronchitis requires the presence of chronic productive cough for over at least 3 months of the year for 2 successive years. The symptoms in this patient (green productive sputum, fever) suggest that he has an acute infection superimposed on chronic bronchitis (history of cigarette smoking, history of excessive mucus production over many years). Histologically, the mucus-producing glands in the bronchi would show hyperplasia and hyperophy and extend to a greater depth in the bronchial wall, resulting in a higher Reid index (ratio of thickness of mucus gland to thickness of bronchial wall).Although the patient is a smoker and is at increased risk for bronchogenic carcinoma, this is unlikely to be the cause of his symptoms. Hemoptysis and weight loss might also be present if he had cancer. Cystic fibrosis presents earlier in life and may be associated with severe production of mucus, especially if bronchiectasis supervenes. The age of the patient and the relative late onset of disease preclude this diagnosis. This patient may also have emphysema, as chronic bronchitis and emphysema are often coexistent. However, although pure emphysema might cause dyspnea, it would not be associated with a fever or a productive cough. Ref:Tallman T.A. (2011). Chapter 67. Acute Bronchitis and Upper Respiratory Tract Infections. In J.E. Tintinalli, J.S. Stapczynski, D.M. Cline, O.J. Ma, R.K. Cydulka, G.D. Meckler (Eds), Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 7e.
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Hepatobiliary ParasitismCommon in Southern China Biliary tract is infested by adult helminths or their ovaCauses:Trematodes (Liver or biliary flukes): Most CommonClonorchis sinensisOpisthorchis viverrini or O. felineusFasciola hepaticaNematode (Ascaris lumbricoides by intraductal migration of adult worm)
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Many causes of end-stage lung disease have been appropriately treated with lung transplantation. Whether one lung or both lungs are replaced at the time of transplantation depends on recipient factors. Patients with restrictive processes like primary pulmonary fibrosis do well with a single lung transplant. For patients with primary pulmonary hypertension, unloading of the right ventricle with single lung transplantation has been adequate and replacement of both lungs has not been necessary in most cases. Cystic fibrosis patients do well after lung transplantation but double lung transplant is frequently necessary because of chronic infections. Secondary pulmonary hypertension is due to left ventricular failure with concomitant increases in pulmonary pressures secondary to increases in left ventricular end-diastolic pressures. Reactive secondary pulmonary hypertension is best treated with heart transplantation. Long-standing secondary pulmonary hypertension that is chiefly fixed is best treated with combined heart-lung transplantation.
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The portal vein is formed by the union of the superior mesentric and splenic veins behind the neck of the pancreas.
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Ans. is 'c' i.e., |ed bone matrix formation o Steroid causes Decreased healing of the wound Water retention | bone-matrix formation o Glucocorticoids cause decreased osteoid formation and increased resorption of bone, o They decrease intestinal Ca' absorption, o There is decalcification (not calcification) of bones. GLUCOCORTICOID ACTIONS Carbohydrate and protein metabolism Glucose - There is hyperglycemia o | Glycogen synthesis o | Peripheral utilization of glucose, o | Gluconeogenesis o | release of glucose from the liver. Protein - Glucocorticoids are catabolic o | protein breakdown and aminoacid mobilization from peripheral tissues - negative nitrogen balance. Uricosuric action - Glucocorticoids increase uric acid excretion. Fat metabolism - Action is permissive in nature o T Lipolysis due to glucagon, GH, Adr & thyroxine o Redistribution of body fat - Extremities lose fat which is deposited over face* neck and shoulder - moon face, fish mouth, buffalo h ump. o Mechanism of redistribution - # Peripheral adipocytes are less sensitive to insulin, corticosteroid enhanced lipolytic action fo GH and Adr predominates, whereas truncal adipocytes respond mainly to enhanced insulin level under the influence of glucocorticoids. Calcium metabolism o |intestinal absorption & | renal excretion. o | loss of calcium from bone especially from spongy bone (vertebrae, ribs). Water excretion o Glucocorticoids maintain normal GFR (not aldosterone). CVS o Restrict capillary permeability, maintain the tone of arterioles and myocardial contractility', o They have a permissive effect on presser action of Adr and agiotensin --> Hypertension may occur. CNS o Have a mild euphoric effect Stomach o t gastric acid and pepsin secretion --> may aggravate a peptic ulcer. Skeletal muscles o Optimum level of corticosteroids is needed for normal muscular activity, o Both hypo & hypercorticism cause weakness. 9. Blood cells o | in numbers of RBCs, platelets and neutrophils. o | in lymphocytes, eosinophils and basophils - not due to destruction, but due to their sequestration in tissues. 10. Inflammatory responce o All components and stages are suppressed. o The most important overall mechanism is the limitation of recuitment of inflammatory cells at the local site (chemotaxis) and production of proinflam mat ory mediators like PGs, LTs, PAF through inhibition of phospholipase A2. o This is through the production of lipocortins that are responsible for the inhibition phospholipase A2 11. Immunological response o Glucocorticoids suppress all type of hypersensitivity and allergic reactions. o They cause greater suppression of cell mediated immunity (delayed hypersensitivity and graft rejection) - basis of use in autoimmune diseases and organ transplantation, o Effect is due to suppression of recruitment of leukocytes at the site of contact with antigen and of inflammatory response to immunologic injury. o Antibody production and complement function is not impaired. Note - o Corticoids have some direct and some permissive actions. Direct - Corticoids themselves produce an effect. Permissive - Corticoids do not themselves produce an effect, their presence facilitates the action of other hormones.
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Ans. (b) GlycopyrrolateRef: Ajay yadav's anesthesia 4th ed./48* To control secretions, anti-cholinergics are used: Glycopyrrolate, Atropine and Scopolamine.* Glycopyrrolate is preferred over atropine and scopolamine because it doesn't cross blood brain barrier. Therefore it is devoid of central side effects.Drugs Used for Premedication:* Sedative/Anti-anxiety:# Lorazepam MC used# Midazolam in day care surgery* Anti-emetics: Hyoscine (Most potent), Ondensatron, Metoclopramide* To decrease pain: Morphine and Pethidine
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SAPHO syndrome does not include seborrhea. SAPHO: S- Synovitis A- Acne P- Pustulosis H- Hyperostosis O- Osteitis On other hand , seborrhea is constituent of SAHA syndrome
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Ans. Malignant melanoma(Ref: Bailey & Love's Surgery, 27th Ed; Page No-608)MnemonicDiagnosis of malignant melanoma is based on characteristics of: ABCDEAsymmetrical pigmented nodule.Border irregularity: Nodule shows scallops and notches.Color variability: This is very striking.Diameter: Size >5 mm.Elevation irregularity.Excise all doubtful lesions for histopathological examination. Histological grading using Breslow's method. Breslow's method: measures the vertical distance (in mm) from granular cell layer to the deepest part of tumor, using a microscopic micrometer.
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Most serious complications after splenectomy are OPSI (Opportunistic Post Splenectomy Infections) it is most common in young children and immunocompromised adults.
“Therefore it is essential to save the spleen in children.” Now spleen salvage methods are the management of choice even in adults.
Splenectomy is usually indicated under the following circumstances (Ref: Sabiston 18/e pi639 (17/e} p 1694)
1. the pt. is unstable
2. the spleen is extensively injured with continuous bleeding
3. bleeding is associated with hilar injury
4. other injuries require prompt attention
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Treatment of vernal keratoconjunctivitis
Steroids
Mast cell stabilizers as di-sodium-chromoglycate and olopatadine & idoxamide tromethamine.
Topical antihistaminics, cyclosporine & vasoconstrictor like nephazoline.
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Ans. is. 'c' i. e., Haemophillus ducreyi
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Cadherin.
in Pemphigus vulgaris (Intraepithelial), autoantibodies are formed against Desmosomes(Cadherin) whereas in Bullous pemphigoid(Subepithelial), autoantibodies are formed against Hemidesmosomes
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Ans. D. Enriched medium.Enriched mediumThe media containing ingredients which enhance their growth-promoting qualities are enriched media e.g. blood agar, chocolate agar and Loeffler medium.The usual media employed for cultivation of the diphtheria bacillus are Loeffler's serum slope and tellurite blood agar.Diphtheria bacilli grow on Loeffler's serum slope very rapidly and colonies can be seen in 6-8 hours, long before the other bacteria grow.TYPES OF Bacteriological Media MediaCommente.g.1.Ordinary culture mediaThese are routinely employed in a laboratorye.g. nutrient broth, nutrient agar, infusion broth and lysate media.2.Enriched mediaCertain organisms do not grow on ordinary nutrient media. They require growth- promoting ingredients such as blood, glucose, serum, egg, etc. The media containing ingredients which enhance their growth- promoting qualities are enriched mediae.g. blood agar, chocolate agar and Loeffler medium.3.Enrichment mediaEnrichment media are liquid media containing chemical constituents which inhibit some normal flora and allow pathogens which may be present in very small number in the specimen, to grow unhampered and thus enriching them. Isolated colonies of these organisms may be obtained by subculturing onto solid media.An example of enrichment media is selenite F broth used for primary isolation of enteric bacteria.4.Differential/ Indicator mediaDifferential media have got some chemical constituents which characterize different bacteria by their special colonial appearances in the culture e.g. MacConkey agar contains lactose as a substrate and neutral red as an indicator. Bacteria fermenting lactose produce acid and this will change the colour of the indicator and thus the colonies will turn red. The red lactose fermenting colonies can be differentiated from the pale non-lactose fermenting colonies.1. Eosin methylene blue (EMB), which is differential for lactose and sucrose fermentation2. MacConkey (MCK), which is differential for lactose fermentation3. mannitol salt agar (MSA), which is differential for mannitol fermentation4. X-gal plates, which are differential for lac operon mutants5. Selective mediaSelective media will selectively permit the growth of pathogens and inhibit the commensals. In addition, it may differentiate the pathogen from commensals that grow by the colour and opacity of the coloniese.g. blood tellurite medium for C. diphtheriae.Buffered charcoal yeast extract agar, which is selective for certain gram-negative bacteria, especially Legionella pneumophila6. Transport mediaTransport media are also frequently used to sustain the viability of organisms when a clinical specimen is to be transported from the periphery to laboratory.The transport medium prevents the outgrowth of contaminants during transit and sustains the pathogen.Cary and Blair and Stuart media.Venkat-Ramakrishnan(VR) medium for v. cholerae.Thioglycolate broth for strict anaerobes.Loeffler MediaIt is primarily used for the isolation of Corynebacterium diphtheriae from clinical specimens. It is also used to determine the proteolytic activity and pigment production of various microorganisms.PRINCIPLE:Recovery is further enhanced when Loeffler Media is used in combination with Potassium Tellurite CystineAgar Media and blood agar. On Loeffler Media, C. diphtheriae produces characteristic metachromatic granules that can be detected by staining with methylene blue; it also demonstrates the characteristic Chinese-letter formation which is due to the cells snapping off when they divide. With the above information, a presumptive identification can result in 16-18 hours. Loeffler Media enhances the demonstration of the organism's natural morphological and physiological characteristics, i.e. pigmentation.FORMULA: Approximate, per 250 ml of deionized filtered water.Loeffler Media: Beef Extract..................................0.75 gDextrose.......................................1.25Sodium Chloride.............................1.25Proteose Micro Peptone....................2.50Horse Serum.................................750.00 mlInterpretation:Corynebacterium diphtheriae BiotypesMetachromatic GranulesMorphologyMitisIntensely stainedLong, pleomorphic but rigid rodsintermediusCells frequently swollen with terminal granules Irregularly barredHighly pleomorphic with very long and short rodsgravisNo granules but alternate bands of light and dark blueShort rods with many cocci of pear-shaped formsAdditional Educational points:Stains1Congo redAmyloid; apple-green birefringence in polarized light (because of a-pleated sheets).2Giemsa'sBorrelia, Plasmodium, trypanosomes, Chlamydia.3PAS (periodic acid-Schiff)Stains glycogen, mucopolysaccharides; used to diagnose Whipple's disease.4Ziehl-NeelsenAcid-fast bacteria.5India inkCryptococcus neoformans.6Silver stainFungi, PCP, Legionella.
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Two carpal bones aiculate with radius: Scaphoid and lunate.
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Ans. is 'a' i.e., Castleman's diseaselRef: Multiple myeloma, an issue of hematology oncology clinics E boohKenneth C Anderson p. 9171Siltuximab (Anti IL-6):IL-6 is produced by the stromal cells of the bone marrow, and plays a crucial role in the proliferation and survival of multiple myeloma cells.
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(Dacrocystitis): (546-48- Parson 21st/ edition; 514-Nema 6th/ed; 477-Khurana 5th/ed)Causes of childhood blindness* Vitamin A deficiency* Measles* Conjunctivitis* Ophthalmia- neonatorum* Congenital cataract* Retinopathy of prematurity (ROP)* Common causes of childhood blindness in India include corneal scar (26%). Congenital anomalies of the globle (25%) disease of the retina (21%) and cataract (12%). The corneal scarring is mainly due to vitamin A deficiency, trachoma and conjunctivitis (514- Nema 6th/ed)* Nutritional blindness can occur at any age but is most frequently seen in under privileged young children in the developing countries because the main contributing factors - measles, frequent diarrhea, protein energy malnutrition and other febrile illness are more common in them, Severe Karatomalacia is usually seen below 5 years of age and is particularly common in children between 6 months and 3 years of age. Since affected individuals are young the impact in number of blind person- years is tremendousCauses of impaired vision in childhoodAnatomical classificationWhole globe microphthalmos, anophthalmos, phthisis bulbi atrophic bulbiCornea: scar, anterior staphyloma, dystrophyLens: cataract, dislocation, aphakiaUvea: aniridia, coloboma, uveitisRetina: retinopathy of prematurity, retinal dystrophy, retinal detachment, vasculitisGlaucoma: buphthalmosOptic nerve optic atrophy, hypoplasiaOther: cortical blindness, amblyopiaAetiological classificationHereditary: chromosomal disorder, single-gene defectsIntrauterine: congenital rubella, foetal alcohol syndromePerinatal: ophthalmia neonatorum, retinopathy of prematurity, birth traumaChildhood: vitamin A deficiency, measles, traumaUnclassified impossible to determine the underlying cause
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Answer B. ChromoblastomycosisThe patient lived in a rural area and had walked barefoot for most of his life. Several nodular and verrucous lesions were seen in the distal region of the foot. Analysis of a skin-biopsy specimen revealed findings diagnostic for chromoblastomycosis. Chromoblastomycosis is a chronic, soft-tissue fungal infection commonly caused by Fonsecaea pedrosoi, Phialophora verrucosa, Cladosporium carrionii, or F. compacta. The infection occurs in tropical or subtropical climates and often in rural areas.
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Ans. is 'c' i.e., Keratoconus Keratoconus is a progressive, noninflammatory, bilateral ectatic corneal disease, characterizedparaxiastromal thinning and weakening that leads to corneal surface distoion. Essential pathological changes are thinning and ectasia which occur as a result of defective synthesis of mucopolysaccharide and collagen tissue. It usually stas at pubey and progresses slowly. Symptoms usually begins as blurred vision with shadowing around images. Vision becomes progressively more blurred and distoed with associated glare, halos around lights, light sensitivity and ocular irritation. Visual loss occurs primarily from irregular astigmatism and myopia. and secondarily from corneal scarring The hallmark of keratoconus is central or paracentral stromal thinning, apical protrusion of anterior corneaand irregular astigmatism. The cornea thins near the centre and progressively bulges forwards, with the apex of cone always being slightly below the centre of the cornea. Impoant findings an examination are - Distaed window reflex (Corneal reflex)Q. Fleisher's rine. Yawning reflex (Scissor reflex). Oil drop reflex. Munson's signs Treatment includes :? Spectacles for regular or mild irregular astigmatism. Rigid gas permeable contact lens for higher astigmatism. Epikeratoplasty in patients intolerant to lens and without significant corneal scarring. Keratoplasty penetrating or deep lamellar if there is significant corneal scarring.
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Periampullary Carcinoma
1. Adenocarcinoma of head of the pancreas (40-60%)
2. Adenocarcinoma of ampulla of vater (10-20%)
3. Distal bile duct adenocarcinoma (10%)
4. Duodenal adenocarcinoma (5-10%)
Patients with pancreas adenocarcinoma involving the body or tail of the gland are more likely to have weight loss and abdominal pain as their initial complaints.
These lesions can grow to a larger size before producing symptoms and are often diagnosed at a later stage with a poorer prognosis.
Most body and tail cancers have already metastasized to distant sites or extended locally to involve nodes, nerves, or major vessels by the time of diagnosis.
Best prognosis: Duodenal adenocarcinoma >Ampullary carcinoma >Distal Bile duct adenocarcinoma >Head of pancreas >Body and tail of Pancreas (DAD Head Body and Tail).
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Answer is C (<5%): Recurrent Spontaneous Hemahrosis is commonly seen in patients with Hemophilia when factor VIII levels are less than 5 percent of normal (Moderate; Moderately severe form). Classification Levels of factor VIII Implications Mild 6-36 % of Normal (>5%) Bleeding generally occurs in response to mild trauma Moderate 2-5% of normal (<5%) Associated with spontaneous bleeding. Recurrent Hemahrosis is the most common manifestation Severe <1% of normal Life threatening Bleeding manifestations may be seen
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Ans. A. Prostate cancerProstate cancer leads to osteosclerotic metastasis because of release of PTH like proteinsa. Prostate carcinoma cells secrete factors that directly and indirectly alter the osteoblastic function and express factors critical for normal bone development and remodeling, including bone morphogenetic proteins (BMPs), TGF-b, platelet- derived growth factor, adrenomedullin, insulin-like growth factor (IGF-1), fibroblast growth factor and vascular endothelial growth factor (VEGF).b. The osteolytic factor, PTHrP, is also abundantly expressed in Prostate carcinoma metastases, despite the fact that these lesions are primarily blastic. It has been demonstrated that PTHrP increases osteoblastic progenitor cell proliferation and induces early Osteoblastic differentiation.c. Another study says that Wants (a large family of proteins that promote bone growth) contribute to prostate cancer- mediated osteoblastic activity. Prostate cancer bone metastases have both an osteolytic and osteoblastic component, there is a shift in the balance from osteolytic to osteoblastic activity as prostate cancer progresses, which results in osteosclerotic (Osteoblastic) metastasis.
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The macrolides (especially azithromycin) and the respiratory quinolones are now the antibiotics of choice and are effective as monotherapy. Compared with erythromycin, the newer macrolides have superior in vitro activity, display greater intracellular activity, reach higher concentrations in respiratory secretions and lung tissue, and have fewer adverse effects. The pharmacokinetics of the newer macrolides and quinolones also allow once- or twice-daily dosing. Quinolones are the preferred antibiotics for transplant recipients because both macrolides and rifampin interact pharmacologically with cyclosporine and tacrolimus Ref Harrison 19th edition pg 1017
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Ans. B: Streptococcus pyogenes The primary site of invasion of human body by streptococcus pyogenes is the throat. Primary bacterial pathogens that account for approximately 30% of cases of pharyngitis include Streptococcus pyogenes /Group A Beta Hemolytic Streptococci (common), group C streptococci (uncommon), group G streptococci (uncommon), Neisseria gonorrhoeae (uncommon), Corynebacterium diphtheriae (rare), and Corynebacterium hemolyticum (extremely rare). Viruses are isolated in approximately 40% of cases and include rhinovirus, adenovirus, parainfluenza virus, coxsackievirus, coronavirus, echovirus, herpes simplex virus, Epstein-Barr virus (mononucleosis), and cytomegalovirus. Other probable copathogens for pharyngitis in children include Staphylococcus aureus, Haemophilus influenzae, Branhamella catarrhalis, Bacteroides fragilis, Bacteroides oralis, Bacteroides melaninogenicus, Fusobacterium species, and Peptostreptococcus species.
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(B) Erysipelothrix # Erysipelothrix rhusiopathiae> E. rhusiopathiae is a natural parasite of many animals.> It causes swine erysipelas & human erysipeloid.> Human infection usually occurs on the hand or fingers of persons handling animals fish or animal products> Lesions are painful, edematous and erythematous, usually involving the local lymphnodes and joints.> Occasional cases of endocarditis have been reported.> The bacillus is sensitive to penicillin, erythromycin and broad spectrum antibiotics.
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Ans. Neisseria meningitidis
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Ans. is 'd' i.e., Magnetic resonance cholangiopancreatography (MRCP) Causes of Acute Pancreatitis Common causes Gallstones (including microlithiasis) - most common Hyperiglyceridemia Endoscopic retrograde cholangiopancreatography (ERCP), especially after biliary manometry. Trauma (especially blunt abdominal trauma) Postooperative (abdominal and nonabdominal operation) Drugs (L-asparginase, thiazide diuretics, frusomide, estrogens, azathioprime, 6-mercaptopurine, methyldopa, sulfonamide, tetracyclin, valproic acid, anti-HIV medicacations) Sphincter of Oddi dysfunction Uncommon causes Vascular causes and vasculitis (ischemic-hypoperfusion states after cardiac surgery) Connective tissue disorders and thrombotic thrombocytopenic purpura (TTP) Cancer of the pancreas Hypercalcemia Periampullary diveiculum Pancreas divisum Hereditary pancreatitis Cystic fibrosis Renal failure
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NaSSA * IMPOANCE Nor adrenergic and specific serotonergic antidepressant * MECHANISM * Alpha 2 adrenergic receptor antagonism=== increase serotonin and NA * 5HT2,3 antagonist============increase sleep and appetite * DRUGS miazapine * USE Elderly with depression * SIDE EFFECTS hyperlipidemia Ref. kaplon and aock, synopsis of psychiatry, 11 th edition, 955
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Good cholesterol ratio vs. bad cholesterol ratio High-density lipoprotein, or HDL, is considered "good" cholesterol. It makes up 20-30 percent of a person's total cholesterol level. Low-density lipoprotein, or LDL, is considered "bad" cholesterol and makes up 60-70 percent of the total in the body. A high HDL cholesterol number lowers your risk for coronary hea disease. A high LDL cholesterol number raises your risk for coronary hea disease. By comparing your total cholesterol number with your HDL cholesterol number, your healthcare provider can get another number called your total-cholesterol-to-HDL ratio Ref Davidson 23rd edition pg 556
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3 out of 64 codons do not code for any amino acid. These have been termed nonsense codons. These nonsense codons are utilized in the cell as termination signals; they specify where the polymerization of amino acids into a protein molecule is to stop. The remaining 61 codons code for 20 amino acids. Thus, there must be degeneracy in the genetic code, ie; multiple codons must decode the same amino acid. Some amino acids are encoded by several codons; for example six different codons, UCU, UCC, UCA, UCG, AGU, and AGC all specify serine. Other amino acids, such as methionine and tryptophan, have a single codon. In general, the third nucleotide in a codon is less impoant than the first two in determining the specific amino acid to be incorporated, and this accounts for most of the degeneracy of the code. However, for any specific codon, only a single amino acid is indicated; with rare exceptions, the genetic code is unambiguous--that is, given a specific codon, only a single amino acid is indicated. The distinction between ambiguity and degeneracy is an impoant concept. Ref: Weil P. (2011). Chapter 37. Protein Synthesis & the Genetic Code. In D.A. Bender, K.M. Botham, P.A. Weil, P.J. Kennelly, R.K. Murray, V.W. Rodwell (Eds), Harper's Illustrated Biochemistry, 29e.
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For ideal action of proton pump inhibitor, an acidic pH in the parietal cell canaliculi is prerequisite because the drug is activated in this acidic pH.
Hence it should be taken at least 30 minutes before meals.
It is preferably administered before breakfast so that peak serum concentration coincides with maximum activity of proton pump secretion.
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CHALAZION CLAMP is used to fix the chalazion and achieve haemostasis during the incision and curettage operation CHALAZION SCOOP it is used to scoop out contents of the chalazion during incision and curettage.
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(Anemia): (284-85-Dutta 7th edition)Neonatal complication of PM* Hypo glycaemia (<37mg/dl)* Respiratory distress syndrome* Hyperbilirubinaemia* Polycythaemia* Hypocalcaemia (< 7mg/dL)* Hypomagnesemia(< 7mg/dL)* CardiomyopathyMAJOR BIRTH DEFECTS IN INTANTS OF DIABLTIC MOTHERS (6 -10TH)CNS and skeletalCardiovascularRenalGastrointestinalOthers* Neural tube defects* VSD, ASD* Renal agenesis* Duodenal atresia* Single umbilical artery* Hydronephrosis* Anorectal atresia* Anencephaly* Coarctalion of aorta* Double ureter* Omphalocoele * Microcephaly * Caudal regression syndrome* Transposition of great vessels * Situs inversus* Polycystic kidneys* Tracheo oesophageal fistula * Sacral agenesis* Fallot's tetralogy
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Drugs causing AKI are Aminoglycosides Iodinated contrast PPI'S, NSAID's Cisplatin Angiotensin receptor blockers and ace inhibitors. Cyclosporine. Rifampicin Acyclovir Methotrexate Calcineurin inhibitors ref:HARRISON 20 th edition pg no. 2099 tab 304-1,2101 fig 304.3
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In a labour room when opoid narcotics are being given to reverse the respiratory depression induced by them, Naloxone should be available. It is given to the mother 0.4 mg IV in labour. Ref: Datta Obs 9e pg 479.
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Following techniques have been used for cleft lip repair
Thompson
Le Muserier
Tennison-Randall
but 'Rotation advancement technique' by Millard is the most widely used method
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Vein of Galen malformations are congenital vascular malformations characterized by extensive aerial feeders draining into an enlarged vein of Galen. It is a aeriovenous fistulae. Newborns can present with high-output cardiac failure due to the aeriovenous shunting. Hydrocephalus is common from compression of the cerebral aqueduct by the malformation. Seizures are also associated with these lesions. The extensive aeriovenous shunting can produce a steal effect and result in cerebral ischemia and infarction. The prognosis is often poor for patients diagnosed in early infancy with hea failure. The prognosis is better for those diagnosed later in life. Treatment is by endovascular embolization of feeding aeries. Ref: Cowan J.A., Thompson B. (2010). Chapter 36. Neurosurgery. In G.M. Dohey (Ed), CURRENT Diagnosis & Treatment: Surgery, 13e.
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Use of ergot derivatives is contraindicated in Rh negative mother to avoid chances of feto-maternal micro transfusions. ref Katzung 12 th ed.
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C i.e. Cocaine
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(Warfarin): Ref: 571-72-KDT (609-602-KDT 6th)ANTIPLATELET-DRUGS (Antithrombotic drugs)* Aspirin* Clopidogrel* Dipyridamol* Abciximab* Ticlopidine (GPII b/IIIa antagonist)* Antifibrinolvtics - Epsilon amino-caproic acid (EACA) Transexaemic acid Aprotinin* Fibrinolytics (Thrombolytics) - Streptokinase, urokinase, Alteplase* Warfarin is oral anticoagulants
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Ans is 'a' i.e. MRI "Impacted fractures may be extremely difficult to discern on plain x-ray. If there is a fracture it will show up on MRI or a bone scan after a few days. "- ApleyHistory of fall, leg in externally rotated position and tenderness in Scarpa's triangle highly suggest fracture neck femur.An impacted, undisplaced fracture is likely to miss on an x-ray. An MRI or a bone scan would be needed to diagnose the lesion.
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Oedipus complex - seen in boy. child develop sexual feeling to opposite sex parent and develop jealousy or hostile feeling to parent of same sex Its develop between 3 to 5 year of age. Same thing in girl known as Electra complex
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At the end of the Isovolumetric contraction, aoic and pulmonary valves open so that the ventricles can eject blood into the aoa and pulmonary trunk Ref: Ganong 25th ed/page 540
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Beilby layer
Sir George Thomas Beilby proposed that when a metal is polished, a film forms on the surface due to plastic flow of the metal. He inferred that when a solid is caused to flow, as in polishing due to heat generated, the crystalline surface is broken down to form a harder and denser surface layer.The Beilby layer explains the hardening of metals under cold working. This worked layer thus can be defined as an amorphous, disorganized molecular surface layer of a highly polished metal, which is a result of melting and surface flow during machining of the molecular layers such as using a series of abrasives of decreasing coarseness during the polishing processes.
Materials Used in Dentistry- S. Mahalaxmi page 578
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Ans. b (Quartz) (Ref: A user's guide to diagnostic ultrasound by Shirley Cusick-XVI, Rumac Diagnostic Ultrasound Vol I, 2nd/pg.10)# The ultrasound probe or the transducer is any device that converts one form of energy to another. In case of ultrasound, the transducer converts electric energy to mechanical energy and vice versa.# The ultrasound transducer uses the principle or property of piezoelectricity, which occur naturally in some materials whereby an applied electric field produces a change in linear dimensions.- Quartz, a naturally occurring piezoelectric material having the unique ability to respond to the action of an electric field by changing shape and to the change in polarity of voltage applied by generating small potentials and thus producing an ultrasound image.- Lead Zirconate titanate is synthetic material with piezoelectric property, currently used in USG probes.
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- an attitude has been defined as a relatively enduring organization of beliefs around an object, subject or concept which predisposes one to respond in some preferential manner. - these are acquired characteristics of an individual. Reference: Park's textbook of preventive and social medicine, 25th edition, pg no:732 <\p>
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Diarrhea, Poliomyelitis, and cholera are transmitted by faeco-oral route Malaria is a vector-borne disease transmitted by Anopheles mosquito. Hence sanitary toilets and hand washing practices cannot prevent Malaria. Park's Textbook of Preventive and Social Medicine, 25th Edition, Pg 831
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propagative life cycle is the one in which the agent merely multiplies in vector ,but no change in form that is in the case of plague bacilli in rat fleas.parks textbokk,22 nd ed,pg no 94
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Ans. is 'D' i.e., The base is occupied by a condylar articular surface for scaphoid Characteristics of first metacarpal bone: 1 .Shortest and stoutest of all metacarpal bones. Base is occupied by a concavoconvex articular surface for trapezium. Dorsal surface of the shaft is uniformly convex. Head is less convex and broader from side to side than the heads of other metacarpals. The ulnar and radial comers of the palmar surface show impressions for sesamoid bones. It is rotated medially through 90 degrees relative to other metacarpals. As a result, movements of the thumb occur at right angles to those of the digits. It does not articulate with any other mtacarpal bones.
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Demonstration of intracellular Monosodium Urate Crystals (MSU) in synol fluid from affected joint is diagnostic of gout. Ref: Harrison's Principles of Internal Medicine, 16th Edition, Page 2046; Current Rheumatology Diagnosis and Treatment, 2nd Edition, Page 467
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a Option 3 is correct, knee joint Osteosarcomas are bone producing malignant mesenchymal tumor. Although any bone can be involved, most tumors arise in the metaphyseal regions of long bones of the extremities, with almost 60%occuring about knee, 15%around hip, 10%at the shoulder, and 8% in the jaw. Robbins basic pathology 9th edition page no 776,heading =Osteosarcoma
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The technique of FFA comprises rapidly injecting 5 ml of 10 percent solution of sterile sodium fluorescein dye in the antecubital vein and taking serial photographs (with fundus camera) of the fundus of the patient who is seated with pupils fully dilated. The fundus camera has a mechanism to use blue light (420-490 nm wavelength) for exciting the fluorescein present in blood vessels and to use the yellow-green filter for receiving the fluorescent light (510-530 nm wavelength) back for photography. Reference : A K KHURANA Comprehensive Ophthalmology; edition 4; page-487
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Hyperhomocystinemia is the only mixed disorder, which can cause both venous and arterial thrombosis.
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Trapezoid body is a trapezium-shaped mass of white matter lying in the anterior pa of tegmentum, posterior to basilar pa of pons.It is formed by decussation of transversely running fibres arising from cochlear nuclei of both sides before it reaches the superior olivary nucleus. This decussation is believed to help in localization of sound.(Ref: Vishram Singh textbook of clinical neuroanatomy second edition pg 80)
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openlifescienceai/medmcqa
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