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Ref Harrison 19 th ed pg 1731 Type I respiratory failure is characterized by an increase in alveolar aerial O2 gradient,due to ventilation perfusion mismatch.
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Vibrio cholerae possess the lipopolysaccharide O antigen(LPS, endotoxin). It does not play any role in the pathogenesis of cholera but is responsible for the immunity induced by the killed vaccines. The watery diarrhea of cholera results from the action of a cholera toxin which is a potent protein enterotoxin produced by the organism in the small intestine. It has 2 subunits A and B, Ganglioside GM1 serves as receptor for subunit B which in turn promotes the entry of subunit A into the cell. Activation of subunit A1 cause increase in level of cAMP and results in prolonged hypersecretion of water and electrolytes. Ref: Textbook of Microbiology By Ananthanarayan And Paniker page 311. Jawetz, Melnick, & Adelberg's Medical Microbiology, 26e chapter 17.
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Ans. is 'c' i.e., Osteomylitis of frontal bone Pott's puffy tumouro Pott puffy tumour is a non-neoplastic complication of acute sinusitis characterised by subperiosteal abscess and osteomyelitis, usually related to the frontal sinus but sometimes also related with the mastoid. Forehead swelling is seen, which explains the name of this pathology.o Other rare causes, besides sinusitis, are trauma, intranasal cocaine/methamphetamine abuse and craniotomy.Epidemiologyo Although it may affect patients of any age, it has a higher incidence in adolescence. Since the advent of antibiotics, it is infrequently seen.Pathologyo The infection erodes through the wall of the obstructed infected sinus to form a subperiosteal abscess. As expected it can be associated with extension intracranially with epidural abscess, subdural empyema, meningitis, and cerebral abscess formation. Dural sinus thrombosis is an other possible complication.Treatmento Treatment is typically surgical with drainage of the abscess and IV antibiotics (6 to 8 weeks).
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McArdle's disease is also known as glycogenosis type V, which is an inherited glycogen storage disorder due to deficiency of myophosphorylase deficiency.
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* 30-35% children with UTI have VUR Recurrent UTI are observed in 30-50% children, usually within 3 months of the first episode. Predisposing factors for recurrent UTI include female sex, age below 6 months, obstructive uropathy, severe vesicoureteric reflux (VUR), habitual postponement of voiding (voiding dysfunction), constipation and repeated catheterization, e.g. for neurogenic bladder.
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The "T sign" and Twin-peak sign(or lambda (l)sign) and is used in ultrasound assessment of multifetal pregnancy. T sign refers to the thin intervening septa denoting a Monochorionic pregnancy. Twin peak sign/Lambda sign denotes Dichorionic Diamniotic Twin Gestation
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In Dense Irregular connective tissue, the collagen fibres are densely packed but are not arranged in parallel bundles (irregular). The Papillary region of dermis is composed of Loose Areolar connective tissue, but the Reticular Dermis is composed of densely packed collagen fibers but randomly arranged (not parallel). Lamina Propria is a thin layer of Loose Areolar connective tissue (not dense) which lies beneath the epithelium in the mucosa. Tendon and aponeurosis have Dense collagen fiber bundles, arranged in a uniform parallel (regular) fashion. Location Dense irregular: Capsule of visceral organs Periosteum, perichondrium Sheaths of nerves, muscles etc Dense regular Tendons, aponeurosis, ligament Deep fascial
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Ref: R Alagappan - Manual of Practical Medicine 4th Edition.pg no:182 Risk Factors Category I (For which interventions have been proved to lower CVD risks) 1. Raised LDL cholesterol 2. Reduced HDL cholesterol 3. Atherogenic diet 4. Cigarette smoking 5. Hypeension 6. LVH 7. Thrombogenic factors Category II (For which interventions are likely to lower CVD risks) 1. Diabetes mellitus 2. Physical inactivity 3. Increased triglycerides 4. Small dense LDL 5. Obesity Category III (Associated with increased CVD risk that, if modified, might lower risk) 1. Psychosocial factors 2. Increased Lipoprotein a (normal level--0-3 mg/dl) 3. Hyperhomocysteinemias 4. No alcohol consumption 5. Oxidative stress 6. Post-menopausal status Category IV (Associated with increased CVD risk which cannot be modified) 1. Age 2. Male gender 3. Low socio-economic status 4. Family history of early onset CVD
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Ans. is A Normal serum potassium Rothera test o Used to detect ketone bodies o Positive in diabetic ketoacidosis Benedict test o Used to detect urine sugar o Positive in diabetic ketoacidosis o Plasma potassium is normal or increased in diabetic ketoacidosis.
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Dapsone, PAS, Sulphonamide > inhibit DHPS enzyme Pyrimethamine, Methotrexate, Trimethoprim - acts by inhibiting DHFR (Dihydrofolate reductase) enzyme.
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ratelimiting enzyme in TCA cycle is SUCCINATE THIOKINASE which is responsible for subtrate level phosphorylation one GTP is produced in this step imp point : when ever a enzyme with KINASE suffix produce ATP. ref : vasudevan 7th ed
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In glycolysis; During anaerobic (oxygen deficient) condition, when one molecule of glucose is conveed into 2 molecules of lactate, there is a net yield of 2 molecules of ATP. (refer,table:9.4)Ref: DM Vasudevan, 7th edition, page no: 112
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Ans. C 6Ref: Internet Source* Hyoid bone has a body, two greater and two lesser cornua or horns.* The hyoid bone develops from 2nd & 3rd pharyngeal arches, the lesser cornu from 2nd the greater cornu from 3rd and body from fused ventral, ends of both.* Ossification proceeds from 6 centers i.e. a pair for body and one for each conu. Ossification begins in the greater cornu towards the end of intrauterine life, in body shortly after birth and in lesser cornu around puberty.
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Adrenal adenoma exhibit rapid washout on contrast enhanced CTscan. On CT adrenal adenomas are usually solitary and well encapsulated lesions less than 3cm in diameter. They are typically homogenous in their attenuation and enhancement pattern. Benign adrenal adenomas have high intracellular lipid content therefore has lower attenuation Ref: Clinical MRI of the Abdomen : Why, How, When By Nicholas Gousoyiannis, Page 305; Adrenal Imaging By Michael A. Blake, Giles W. L. Boland, Page 54; Endocrine Neoplasia By Cord Sturgeon, Page 127
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Adultery Sexual intercourse with another man's wife with her consent and without the consent of that man is adultery. Man who commits the offence of adultery shall be punished with imprisonment up to 5 years or with fine or both. In such cases, the wife shall not be punishable as an abettor. Ref: FORENSIC MEDICINE AND TOXICOLOGY Dr PC IGNATIUS THIRD EDITION PAGE 308
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Ans. Rifampicin
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The disorder is due to missing or inactive PHEX gene. PHEX inactivates phosphatonins that mediate phosphate wasting. Thus, patients with Vitamin D resistant rickets cannot retain phosphate, leading to renal phosphate wasting. ref - Harrisons internal medicine 20e p2920
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B i.e. t RNAAll RNA molecules (eg r RNA, tRNA, mRNA etc) are produced from transcription of DNAQ. Whereas, as a new strand of DNA is formed by DNA polymerase III enzyme in process of DNA synthesis/ replication. And complementary (c) DNA is prepared by using mRNA as a template by enzyme reverse transcriptase (= RNA dependent DNA polymrase)Q in process of reverse transcription.
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Immune hydrops fetalis is caused by red blood cell alloimmunisation haemolytic disease. All other causes are described as non-immune hydrops fetalis (NIHF). Hydrops is a symptom of a wide range of conditions which have resulted in an imbalance in fetal fluid between the vascular and interstitial space.Diagnostic criteria are fluid in at least two body cavities (pleural space, pericardial space, peritoneal space, skin or placental enlargement). The prognosis depends on associated prematurity, the underlying cause, the severity of any associated pulmonary hypoplasia and the severity of the ongoing post-natal fluid accumulation. Reference: GHAI Essential pediatrics, 8th edition
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ANSWER: (A) Pia and arachnoidREF; Fundamentals of Anesthesia, Tim Smith Colin Pinnock Ted Lin, 3rd Edition, p 118Spinal anesthesia requires the injection of a small volume of local anesthetic agent directly into the cerebrospinal fluid (CSF) in the lumbar region, below the level of Ll/2, where the spinal cord ends.A line joining both iliac crests (Tuffiers line) passes across the spine of L4 and is a reliable landmark for locating the L3/4 interspace, which is the L3/4 interspace, which isusually easily defined and is the one most often used.Method: Sterilize the skin over the lumbar spine and raise a skin weal with lidocaine 1% over the appropriate interspace. Inject 2-3 ml more lidocaine into the subcutaneous tissue. Insert the needle or introducer in the midline at 90 degrees to the skin.Feedback from the needle tip will monitor the progress of the needle through the supraspinous and interspinous ligaments, the ligamentum flavum and sometimes the dura mater. If bone is contacted, withdraw the needle to the subcutaneous tissue and redirect slightly cephalad in the first instance.Puncture of the dura is usually obvious, and when the stylet is removed CSF should flow freely.
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. Edge of ulcer
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Ans. is 'b' i.e., Nuclear receptors in breast(Ref: Principles of medical physiologlt p. 777).Estrogen binds to nuclear receptors --> Estrogen receptors (ERs)
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Disrupting cell membrane motility
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Ans. is 'b' i.e., Bite cell (+) o Glucose -6-Phosphatase dehydrogenase (G6PD) deficiency is an X-linked inherited disorder which is seen more frequently in boys.
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Substrate Concentration, A small Km indicates that the enzyme requires only a small amount of substrate to become saturated. Hence, the maximum velocity is reached at relatively low substrate concentrations. A large Km indicates the need for high substrate concentrations to achieve maximum reaction velocity.
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Streptomycin is a tuberculocidal drug which is less effective than isoziazid or rifampicin. It is less commonly used as an antitubercular drug due to potential for nephrotoxicity and ototoxicity. It acts only on extracellular bacilli. It penetrates the tubercular cavities, but do not cross the CSF and has poor action in acidic medium. Common side effects of anti tubercular drugs: Isoniazid: Peripheral neuritis, hepatitis. Rifampin: Hepatitis, respiratory syndrome, cutaneous syndrome, flu syndrome, orange red colured body secretions. Pyrazinamide: Hepatotoxicity, ahralgia, flushing, loss of diabetes control. Ethambutol: Loss of colour vision or visual acuity, hyperuricemia.
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Drugs which increase uterine contraction: Ergot Hydrastis canadensis Quinine Lead Pituitary extract Decoctions of cotton root bark, nitrobenzol, picrotoxin, and strychnine (Nux vomica) Ref: The Essentials of Forensic Medicine and Toxicology by Dr. K. S. Narayan Reddy, 27th edition, Page 374.
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One unique feature of rotaviruses is the ease with which the 11 RNA segments can undergo reassoment. Reassoment has enabled the development of live vaccines that combine genes from readily cultivated animal rotaviruses with human rotavirus genes that encode serotype-specific capsid proteins. Ref: Ray C.G., Ryan K.J. (2010). Chapter 15. Viruses of Diarrhea. In C.G. Ray, K.J. Ryan (Eds), Sherris Medical Microbiology, 5e.
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These are balancing side interferences and slopes of either of the involved cusp tips should be reduced.
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Answer is C (Mycosis fungoides) Mycosis fungoides is included in the Miscellaneous group. Q It does not fall in the intermediate grade. All' diffuse' fall into intermediate grade. Intermediate grade includes only one more variant, which is follicular, large cell. Intermediate grade includes: Diffuse small cleaved Q Diffuse mixed small and large cell Q Diffuse large cell, and Q Follicular large cell Q
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Chronic myeloid leukemia (CML) have least life expectancy especially juvenile form compared to other leukemia. Reference: GHAI Essential pediatrics, 8th edition
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Ans. B. Degeneracy(Ref: Harper 31/e p395)Genetic Code--Salient features of Genetic CodeTriplet Codon: Each amino acid is represented by triplet sequence.Degenerate (Redundant)--More than 1 codon represent a single amino acid. Degeneracy of the codon lies in the 3rd Base.Nonoverlapping-- Reading of genetic code do not involve overlapping sequence.Unambiguous--A codon can represent only one amino acid.Universal--A specific codon represent a specific amino acid in all the species.Exception to this rule-Codons of Mitochondrial DNAInitiator codon#In eukaryotes--AUG codes for Met#In Prokaryotes--AUG codes for N-Formyl MethionineTerminator Codons#UAG--Amber#UGA--Opal#UAA--OchreWobbling PhenomenonThe base pairing at the 3rd nucleotide between the anticodon in the tRNA and Codon in the mRNA is not stringently regulated.
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Ans. (a) It takes 74 daysRef. Textbook of Human Embroyology / 24* Spermatogenesis - Process of formation of spermatozoa from primitive germ cell (spermatogonia)* Spermiogenesis - Formation of spermatozoa from spermatid.* Spermatogenesis begins at-puberty (oogenesis begins intrauterine life)* Spermatogenesis continue-throughout life (oogenesis- stops at menopause)* Average time-74 days* Site- seminiferous tubule* Sperm size- 55-65 pm* Parts- head, neck, middle piece, principal piece, end piece.* Acquire motility in- epididymis.
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Mass spectrometry, infrared gas analysis, ultraviolet gas analysis and paramagetism are used to monitor vapour concentration in a breathing system.
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Hydroxyapatite Hydroxyapatite crystals are the major mineral of bone Hydroxyapatite (also k/a bone mineral) is the salt of calcium and phosphorus with the formula Calc(PO4)6(01)2. Structural composition of bone : Also know Bone has to be 50% mineralised to be visible on radiographs.
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Fibrous dysplasia, bone island and bone infarct are the non-neoplastic conditions which may simulate a primary bone tumour.
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Rural health scheme ,1977 was an impoant recommendation of Shrivatsav committee.it was that primary health care should be provided wothin the community itself through specially trained workers so that the haelth of people is placed in hands of the people. Steps iniatiated are: A)For involvement of medical colleges in total health care of selected PHC s within the objective of reorienting medical education to needs of rural people. B) reorientation training of multipurpose workers engaged in control of various communicable disease programmes into unipurpose workers. Parks textbook of preventive and social medicine.K Park. Edition 23.Pg no: 875
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Ludwig's angina is a rapidly spreading bilateral cellulitis that involves the floor of mouth, under the tongue.
Floor of mouth is comprised of sublingual space, submandibular space and submental space. Ludwig's angina usually begins in the submandibular space, and then rapidly spreads to involve the sublingual space, usually on a bilateral basis.
Most common cause is infection of the root of the teeth (Dental infection), especially 2nd and 3rd mandibular molar. Other causes are mouth injury, mandibular fracture, and submandibular sialadenitis.
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Ans. is 'a' i.e., Lignocaine; 'b' i.e., Propranolol; 'c' i.e., Salbutamol
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o Fibroblasts produce the glycosaminoglycans, collagens, elastic fibers, reticular fibres and glycoproteins that can be seen in the extracellular matrix. They also produce cytokineTSLP.
o Fibroblasts are originally derived from primitive mesenchyme and therefore display the filament protein vimentin, which acts as a marker of mesodermal origin.
o Inactive fibroblasts are called fibrocytes. When tissue damage has occurred, the fibrocytes are stimulated to undergo mitosis or multiplication by replication and division.
o Transforming growth factor P induces proliferation offibroblasts. It is chemotactic for fibroblasts
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Ans. a. Esophageal atresiaESOPHAGEAL ATRESIA (EA) AND TRACHEOESOPHAGEAL FISTULA (TEF)Three basic types:Isolated EAIsolated (H-type) TEFEA and distal TEFMost common anatomy is upper esophagus ends in blind pouch and TEF connected to distal esophagusH-type--presents chronically and diagnosed later in life with chronic respiratory problemsHalf with associated anomalies--VACTERL associationVACTERL AssociationNonrandom association of birth defects:Vertebra! anomaliesAna! atresiaCardiac defectTracheoEsophageal fistulaRenal anamoliesLimb abnormalitiesClinical presentation in neonate (EA or EA+TEF)Bubbling, Frothing, cyanosis, cough, and respiratory distressWith feedings - immediate regurgitation and aspirationClinical presentation with just TEF--feeding problems and recurrent aspirationDiagnosisInability to pass nasogastric/orogastric tubeIsolated TEF: Esophagram with contrast media (or bronchoscopy or endoscopy with methylene blue)Esophageal atresia: X-ray shows coiled nasogastric tube in blind pouch with no distal gas (gasless abdomen)Esophageal atresia and distal fistula: Coiled nasogastric tube in blind pouch the large amount of air in stomach and intestinesTreatment--surgical ligation of TEF and resection with end-to-end anastomosis of esophageal atresia
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Answer is A (Regular insulin): The drug of choice for managing hyperglycemia in diabetic ketoacidosis is regular insulin The drug of choice for managing hyperglycemia in diabetic ketoacidosis is regular insulin because of its rapid but sho- duration actions. Regular (fast-acting) insulin is the primary insulin preparation used in the management of Diabetic Ketoacidosis (DKA) and is the only insulin that should be given intravenously or intramuscularly. Lente insulin is a longer-acting form of insulin than regular and should not be used. Oral Hypoglycaemic agents are never used, for initial management of Diabetic Ketoacidosis.
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ASO titre may be positive due to streptococcal infection even in normal people.in some individuals with rheutamatic carditis ASO titre may not be elevated. In PSGN the titre of anti DNA se B antibody is elevated more commonly than ASLO. (ref Robbins 9/e559,8th/566)
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Lower motor neurons are motor neurons located in either the anterior grey column, anterior nerve roots or the cranial nerve nuclei of the brainstem and cranial nerves with motor function Lower motor neurons are classified based on the type of muscle fiber they innervate:
Alpha motor neurons innervate extrafusal muscle fibers, the most numerous type of muscle fiber and the one involved in muscle contraction.
Beta motor neurons innervate intrafusal fibers of muscle spindles with collaterals to extrafusal fibers
Gamma motor neurons innervate intrafusal muscle fibers, which together with sensory afferents compose muscle spindles. These are part of the system for sensing proprioception
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House flies are called poers of infection. M.domestica,M.vicinia are the common house flies. They transmit infections by Mechanical transmission, vomit drop and defaecation. They are vectors of many diseases like Typhoid and paratyphoid fevers, diarrhoeas, dysentery, cholera, gastroenteritis, amoebiasis, helminthic infestations, poliomyelitis, conjunctivitis, trachoma, anthrax, yaws. Park's Textbook of Preventive and Social Medicine, 25th Edition, Pg 834
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Ans. (b) Congo redRef: Robbin's pathology 9th ed. 1257* In biochemistry and histology, Congo red is used to stain microscopic preparations especially as a cytoplasm and erythrocyte stain.* Apple-green birefringence of Congo red stained preparations under polarized light is indicative for the presence of amyloid fibrils.* Additionally, Congo Red is used in microbiological epidemiology to rapidly identify the presence of virulent serotype 2A ShigellaFlexneri, where the dye binds the bacterium's unique lipopolysaccharide (LPS) structure
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Ans. (C). Active principle is aconitinePic show semicarpus anacardium (marking nut)Active principles are semicarpol, bhilawanolMarking nut juice is used for artificial bruise.
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Ans. B. Regional lymph nodesThe metastatic potential of BCC is very low with rates ranging from 0.0028to0.1%, The head and neck region is the most frequent location of the primary tumor with regional lymph nodes being the most common site of metastasis. The lungs, bone, liver, and pleural are also potential sites of metastasis
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Pressure of the gas is least likely to affect the turbulence Ref: guyton and hall textbook of medical physiology 12 edition
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In T1N0M0 glottic cancer, tumor is confined to the vocal cord with normal mobility without any regional lymph node involvement or distant metastasis. At this stage, the treatment of choice is external beam radiotherapy. It has about 90% cure rate if vocal cord mobility is not impaired. The added benefit of this procedure is that voice production is preserved. In ceain cases if radiotherapy is refused or not available, excision of the cord by endoscopic CO2 laser or laryngofissure is performed.
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Ans. is 'd' i.e., Familial hypercholesterolemia
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A left skewed distribution or negatively skewed distribution because it's long tail is in the negative direction on a number line. The mean is to the left of the peak.(mode) The tail is longer on the left. In most cases, the mean is to the left of the median. mean < median < mode
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Barrett's esophagus is specialized columnar metaplasia that replaces the normal squamous mucosa of the distal esophagus in some persons with GERD. Barrett's epithelium is a major risk factor for adenocarcinoma of the esophagus and is readily detected endoscopically, due to proximal displacement of the squamocolumnar junction. Ref: Wong-Kee-Song L.M., Topazian M. (2012). Chapter 291. Gastrointestinal Endoscopy. In D.L. Longo, A.S. Fauci, D.L. Kasper, S.L. Hauser, J.L. Jameson, J. Loscalzo (Eds), Harrison's Principles of Internal Medicine, 18e.
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PEEP improves oxygenation by increasing functional residual capacity by keeping the alveoli open at the end of expiration. Extravascular lung water is shifted from the alveolar to the interstitial space. The overall result is to increase surface area for diffusive exchange of gases. Potential negative effects of increased PEEP include alveolar overdistention resulting in barotraumas (pneumothoraces), decreased venous return and decreased cardiac output, and increased minute ventilation requirements due to increased dead-space ventilation.
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VWD characterized by functional defect in the platelets (but normal platelet count) Reduced functional half-life of clotting factor VIII VWD has three subtypes I /II/III I and III subtypes characterized by deficiency of Von Willebrand factor(quantitative problem) Subtype II is characterized by functional defect of von Willebrand factor because of genetic mutation Mucus membrane bleeding is seen in patients
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Other Operations where Facial Nerve may be Damaged- Stapedectomy- Removal of acoustic neuroma
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Trimethoprim-sulfamethoxazole (Cotrimoxazole) is the drug of choice of Pneumocystis carini pneumonia. Other drugs effective in its treatment are dapsone, pentamidine, atovaquone, primaquine and clindamycin. Methylprednisolone is also indicated in HIV positive patients with moderate to severe PCP. Fluoroquinolones are not indicated in its treatment.
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Macular sparing is seen in: - (i) Anterior occipital cortex lesion; (ii) Sometimes in total optic radiation lesions.
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The test of choice for documenting of H. pylori eradication is the laboratory-based validated monoclonal stool antigen test or a urea breath test (UBT).The patient must be off antisecretory agents when being tested for the eradication of H. pylori with UBT or stool antigen. Serologic testing is not useful for the purpose of documenting eradication because antibody titers fall slowly and often do not become undetectable.Ref: Harrison; 19th edition; Page no: 1924
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Answer is A (Contralateral foot weakness): The paracentral lobule is located on the medial frontal lobe and is involved in anterior cerebral aery occlusion. The involvement of paracentral lobule leads to contralateral lower limb (foot) weakness and urinary incontinence.
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Ans. B ThymusRef: BDC, 6th ed. vol. II pg. 147T cells originate in the bone marrow but mature in the thymus. So, T stands for 'Thymus'.* Thymus and bone marrow are primary lymphoid organs.* Lymph node and spleen are secondary lymphoid organs.
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5-Mar
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Ans. is 'd' i.e., Uteruso Hysteroscopy is a procedure that allows your doctor to look inside your uterus in order to diagnose and treat causes of abnormal bleeding. Hysteroscope in the scope used for visualization of the uterus.
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PLP is the coenzyme for many reactions if amino acids containing sulphur. PLP plays an impoant role in methionine and cysteine metabolism. Homocysteine + Serine - Cystathionine. (Enzyme Cystathionine synthase) Cystathionine - Homoserine + Cysteine (Enzyme Cystathionase) Both these reactions require PLP. Hence in vitamin, B6 deficiency homocysteine in the blood is increased. Homocysteine level is correlated with myocardial infarction. Therefore, pyridoxine is used to prevent homocysteinemia. Ref: DM Vasudevan - Textbook of Biochemistry, 8th edition, page no: 471
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Blowout fractures mainly involve orbital floor and medial wall. When an external force is applied to the globe, intraorbital pressure increases to the point that one or more of the thin-walled bones of the orbit "blow-out" or fracture. The most common bone fractured is the maxillary bone which comprises the floor of the orbit. The orbital contents can be significantly displaced inferiorly after orbital blowout fracture. Ref: Shirakbari A.A., Hall M. (2011). Chapter 23. Maxillofacial & Neck Trauma. In R.L. Humphries, C. Stone (Eds), CURRENT Diagnosis & Treatment Emergency Medicine, 7e.
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Ezetimibe is used in hyperlipidemias. Inhibits intestinal absorption of cholesterol by inhibiting NPCIL1 Ref: KD Tripathi 7th ed pg 641
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ANSWER: (B) shellfishREF: Food and nutrition at risk in America: food insecurity, By Sari Edelstein Page 24,Seafood safety: economics of hazard analysis and Critical Control Point by James C. Cato, Food and Agriculture Organization of the United Nations page 10."The most common source of Vibrio bacteria is oysters and other shellfish, especially from the Gulf of Mexico. V. vulnificus and V. parahaemolyticus are halophilic, requiring salt for survival""CDC reported shellfish outbreaks (40 when etiology known) were associated with Vibrio parahaemolyticus (15), Hepatitis A. virus (7), Shigella (4), Salmonella (3), Vibrio cholerae Ol, other viral, Non-Ol V. cholera, clostridium perfringens, bacillus cereus (2 each) and staphylococcus (1).
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Refer katzung 11e p181 Verapamil, is a medication used for the treatment of high blood pressure, angina, and supraventricular tachycardia. It may also be used for the prevention of migraines and cluster headaches. It is given by mouth or by injection into a vein
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b. Sarcoidosis(Ref: Nelson's 20/e p 2269-2271, Ghai 8/e p 433-443)Important causes of pericarditis/pericardial effusion in children:Infectious* Viral (Coxsackie virus B, EBV, Influenza, Adenovirus); Fungal (Histoplasmosis, Actinomycosis)* Bacterial (TB, Streptococcus, Pneumococcus, Staphylococcus, Meningococcus, Mycoplasma, Tularemia, Listeria, Leptospirosis)* Immune complex (Meningococcus, Hemophilus influenzae)* Parasitic (Toxoplasmosis, Echinococcosis) Connective tissue diseasesMetabolic-endocrineRheumatoid arthritisRheumatic feverSystemic lupus erythematosusSystemic sclerosisSarcoidosisWegener granulomatosisUremiaHypothyroidismChylopericardiumOut of the causes given in the options, Sarcoidosis is the least common.
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The western blot is a widely used analytical technique used in molecular biology, immunogenetics and other molecular biology disciplines to detect specific proteins in a sample of tissue homogenate or extract. Ref : Ananthanarayana textbook of Microbiology 9th edition Pgno : 579
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The NPP 2000 anticipates that proper implementation of this policy will help limit the population to 1,107 million (110 crores) in 2010, instead of 1,162 million (116 crores) as projected by the Technical Group on Population Projections. It is hoped that the TFR will reach the replacement level of 2.1 by 2010. The long-term objective of achieving a stable population by 2045, at a level consistent with the requirements of sustainable economic growth, social development, and environment protection will also require considerable effo and efficient implementation of the NPP. Ref:
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Ref: InternetExplanation:Nephelometry is a technique used in immunology to determine levels of the antibodies Immunoglobulin M, Immunoglobulin G, and Immunoglobulin A.It is performed by measuring the turbidity in a water sample by passing lightIn nephelometry the measurement is made by measuring the light passed through a sample at an angle.This technique is widely used in clinical laboratories because it is relatively easily automated.It is based on the principle that a dilute suspension of small particles will scatter light (usually a laser) passed through it rather than simply absorbing it.The amount of scatter is determined by collecting the light at an angle (usually at 30 and 90 degrees).
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Ans: b (Congenital megacolon)Ref: Bailey & Love, 24th ed, p.l 153 & 23rd ed, p. 1027
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In citric acid cycle, the initial reaction between acetyl-CoA and oxaloacetate to form citrate is catalyzed by citrate synthase, which forms a carbon-carbon bond between the methyl carbon of acetyl-CoA and the carbonyl carbon of oxaloacetate. The thioester bond of the resultant citryl-CoA is hydrolyzed, releasing citrate and CoASH--an exothermic reaction. In the subsequent reactions, two molecules of CO2 are released and oxaloacetate is regenerated; hence oxaloacetate can be considered as playing a catalytic role. Ref: Bender D.A., Mayes P.A. (2011). Chapter 17. The Citric Acid Cycle: The Catabolism of Acetyl-CoA. 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. is 'b' i.e., VSD VSD is the commonest CHD. VSD is the commonest acyanotic CHD. Acyanotic congenital hea diseases o Acyanotic hea diseaes may be of two types : ? A) Left to right shunts. (ASD, VSD, PDA) B) Obstructive lesions (PS, AS, Coarctation of aoa). A) Left to right shunts Patients with left to right shunts have following features : ? 1. Frequent respiratory tract infection --4 Because pulmonary circulation is overloaded which may result in pulmonary edema, CHF and infection. 2. No cyanosis --> Most of the blood is in pulmonary circulation. So there is no impairment in oxygenation of blood. 3. Precardial buldge --> Frequent chest infections with tachypnea causes the soft rib cage being drawn inward at the diaphragmetic attachments of the ribs. This combined with cardioamegaly gives them a precordial buldge. 4. Hyperkinetic precordium 5. Delayed diastolic murmur in tricuspid or mitral area --> Due to increased flow through these areas depending on the type of CHDs. 6. Cardiomegaly with plethoric pulmonary vasculature on chest X-ray Due to increased flow through pulmonary circulation (plethoric lung) there is increased volume overload to left side of hea ---> Cardiomegaly. B) Obstructive lesions o Obstructive congenital diseases have following features. 1) Absence offrequent chest infection --> Pulmonary circulation is not overloaded. 2) Absence of cyanosis ---> No defect in pulmonary oxygenation and there is no shunt where aerial and venous blood can mix. 3) Absence of precardial buldge There is no chest infection or Cardiomegaly. 4) Heaving (forcible) cardiac impulse --> Obstructive lesions cause concentric hyperophy of ventricles that produce forcible contraction. 5) Systolic thrill due to systolic ejection murmur --4 When hyperophied ventricles forcibly pump the blood through stenotic pulmonary or aoic valve, systolic thrill and systolic ejection murmur are produced. 6)Absence of delayed diastolic murmur in mitral or tricuspid area --> Blood flow through these area is not increased. 7)Presence of delayed corresponding second sound (A2 in AS and P2 in PS) --> Because prolonged flow through these area results in delayed closure of that valve. 8)Normal sized hea and pulmonary vasculature in chest x-ray --> There is concentric hyperophy, i.e., hyperophy without dilatation. So, hea size is normal on x-ray.
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The diagnostic criteria for allergic fungal sinusitis (AFS) are the presence of characteristic allergic mucin, type I hypersensitivity (eosinophilic-lymphocytic inflammation), absence of fungal invasion, immuno-compromised individuals and radiological confirmation (areas of high attenuation on CT scan).
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(B) Ignac Semmelweis # Hand washing was introduced by Ignaz Philipp Semmelweis.> Austrian obstetrician Ignac Semmelweis showed that puerperal sepsis could be reduced from over 10% to under 2% by the simple act of hand-washing between cases, particularly between post-mortem examinations and the delivery suite.> Louis Pasteur recognised that micro-organisms were responsible for spoiling wine, turning it into vinegar.> Joseph Lister introduced hand washing with carbolic acid, a disinfectant.> Lister then experimented with hand-washing, sterilizing instruments and spraying carbolic in the theatre while operating, in order to limit infection. Lister introduced both Antiseptic Technique & Aseptic Technique.> His lowered infection rate was very good and Listerian principles were adopted throughout many countries by a number of surgeons.> Lister is now known as 'Father of Antiseptic Surgery'> Robert Koch laid down the first definition of infective disease (Koch's postulates).
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Ans. is 'b' i.e., Hexosaminidase
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Congenital unilateral cataract involving visual axis requires urgent surgery, as early as possible, i.e. within days.
However, you should keep in mind that surgery is inadvisable after 16 weeks (4 months) of age as the amblyopia is refractory
Congenital bilateral cataract
Dense :- Early surgery by 4-6 weeks of age.
Partial :- Regular follow-up.
Congenital unilateral cataract
Dense or involving visual axis :- Urgent surgery within days.
Partial:- Observation.
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(Ref: Katzung 10/e p842) The diagnosis is Tinea capitis and terbinafine is used for the treatment. Male pattern baldness stas from anterior poion and scalp and are non-pruritic will family history. Tghe treatment of latter is finasteride.
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Ans. (a) HydrochlorthiazideRef KDT 6th. / 274Drugs causing glucose intolerance (hyperglycemia)* Glucocorticoids* Thiazides* Phenytoin* Pentamidine* Diazoxide* b blockers (non selective)* Protease inhibitors* b-IFN* Clozapine* b adrenergic agonist* Thyroid hormone* Nicotinic acidNote:* Sulfonylureas are oral hypoglycemic agents. They causes hypoglycemia.* ACE inhibitors also causes hypoglycemia.* Other agents causing hypoglycemia: Quinine, Pentamidine, Octreotide, Insulin.
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The central chemoreceptors monitor the H+ concentration of cerebrospinal fluid (CSF), including the brain interstitial fluid.CO2 readily penetrates membranes, including the blood-brain barrier, whereas H+ and HCO3- penetrate slowly. The CO2 that enters the brain and CSF is promptly hydrated. The H2CO3 dissociates so that the local H+ concentration rises. The H+ concentration in brain interstitial fluid parallels the aerial PCO2. Experimentally produced changes in the PCO2 of CSF have minor, variable effects on respiration as long as the H+ concentration is held constant, but any increase in spinal fluid H+ concentration stimulates chemoreceptorsRef: Ganong's Review of Medical Physiology Twenty-Third Edition, Page No: 629
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Down's syndrome
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Ans. (b) Megaloblastic anaemiaRef: Harrison 19th ed. / 81 e-3fThe presence of macrocytes with hyper segmented neutrophils confirms the answer as megaloblastic anaemia.
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It is the most common method used for giving anaesthesia in oral surgeries as it provides a good field for surgeons to operate.Other options are contraindications.
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Ans. is 'b' i.e., Pilocytic Optic nerve glioma o Optic nerve glioma, also referred to as juvenile pilocytic astrocytoma, is the most frequent tumor of the optic nerve in childhood. o It is a developmental hamaoma. o It is either stationary or only slowly progressive. o Tumor may arise in any poion of nerve --> i) Intraorbital, ii) Intracanalicular iii) Intracranial
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The initial response of an arterial wall to injury is intimal thickening with neointimal smooth muscle cell proliferation and production of an increased intimal extracellular matrix. Note that "injury" can be caused by inflammation, immune reactions, and toxins as well as the local physical trauma from hypertension and abnormal flow. The trauma does not produce immediate injury with endothelial cellular disruption, but a response of endothelial dysfunction that signals smooth muscle cell migration. This process takes years to show changes of vascular narrowing. As atheromatous plaques progress, there is participation by lymphocytes producing cytokines, as well as monocytes that are transformed into macrophages that accumulate lipid to evolve into foam cells. Eventually, plaque disruption may incite platelet aggregation.
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Ref: Parks 23rd edition pg 57 Mid year population is considered. Hence July 1st is taken.
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The screening for a disease comes under secondary prevention. Secondary prevention is done when disease has already staed in the body. It includes doing early diagnosis and treatment. All screening and diagnostic test by default come under Secondary level of prevention. Primary prevention can prevent the disease whereas secondary cannot.
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Ans is 'c' i.e. imperforate hymen It is a clear cut case of hematocolposAn imperforate hymen causing hematocolpos is quite common in young girls in whom, menarche has not yet set in .As the vagina gets progressively and increasingly distended with the menstrual blood, pressure symptoms occur, which are:Patients presents with colicky abdominal pain which is often cyclic.There is difficulty in micturition which finally ends up with urinary retention.On examination a hypogastric or suprapubic bulge is obvious which may cause discomfort on palpation.On separation of labia a bluish bulging labia is recognized.T/T-Surgical excision of the hymen and drainage of hematocolpos.If the hematocolpos is left untreated it may lead to hematometra and hematosalpinx.
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Post Prandial here means after ingestion of fruit juices (typically in child after weaning when fruit juices are staed in the diet). The fructose in fruit juice will sequester all Pi in the form of Fructose -1-phosphate but cannot conve it to energy by glycolysis. So body tries to switch to glycogen degradation for energy. But, Glycogenolysis gets inhibited also due to pi sequestration hence no glucose from glycogenolysis causing hypoglycemia (see fig) Hereditary fructose intolerance: Autosomal recessive Deficiency of Aldolase B Glycogen storage disorders are associated with fasting hypoglycemia. Fanconi-Bickel disease: Glycogen storage disease Type XI similar to Von-Gierke's disease. Mutation in GLUT2
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(C) Autoimmunity # Primary adrenal insufficiency is most commonly caused by autoimmune adrenalitis. Isolated autoimmune adrenalitis accounts for 30-40%, whereas 60-70% develop adrenal insufficiency as a part of autoimmune polyglandular syndromes (APS). APS1, also termed APECED (autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy), is the underlying cause in 10% of patients affected by APS# Classification of Adrenal insufficiency> Primary Adrenal Insufficiency: Anatomic destruction of gland (chronic or acute) "Idiopathic" atrophy (autoimmune, adrenoleukodystrophy) Surgical removal Infection (tuberculous, fungal, viral--especially in AIDS patients) Hemorrhage Invasion: metastatic Metabolic failure in hormone production Congenital adrenal hyperplasia Enzyme inhibitors (metyrapone, ketoconazole, aminoglutethimide) Cytotoxic agents (mitotane) ACTH-blocking antibodies Mutation in ACTH receptor gene Adrenal hypoplasia congenita> Secondary adrenal Insuffiency: Hypopituitarism due to hypothalamic-pituitary disease Suppression of hypothalamic-pituitary axis By exogenous steroid, by endogenous steroid from tumor
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Ans. is 'c' i.e., High myopia Cause: retinal detachment Rheugmatogenous High myopia, Cataract extraction (Aphakia, pseudophakia), Trauma, Retinal degeneration (1 I ice degeneration, snail track degeneration, retinoschisis). Exudative Systemic disease Toxaemia of pregnancy, renal hypeension, blood dyscrasias & polyaetitis nodosa. Ocular disease Inflammation : Harada's disease, sympathetic ophthalmitis, posterior scleritis & orbital cellulitis q Vascular : Central serous retinopathy, exudative retinopathy of coats Neoplasm : Malignant melanoma of choroid, retinoblastoma (exophytic type) Sudden hypotony : perforation of globe, intraocular operation Other causes : Uveal effusion syndrome, choroidal neovascularisation, haemangioma & metastatic tumour of choroid. Tractional Penetrating injury, Proliferative diabetic retinopathy, sickle cell retinopathy, Retinopathy of prematurity, CRVO, Eale's disease, post- hemorrhagic retinitis proliferan - Toxoc iasis, plastic cyclitis
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Pioglitazone cause activation of genes regulating fatty acid metabolism and lipogenesis in adipose tissue contributes to the insulin sensitizing action. (REF.Essential of medical pharmacology K D TRIPATHI 6 Edition, Page No - 270)
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Grievous Hu: S 320 IPC defines grievous hu and lists eight kinds of hu which it lables as "grievous". These clauses are not mutually exclusive for there can be injuries which may fall in more than one clause. However, the list is exhaustive in the sense that, the framers of the Code have used the term "only", while listing the type of hus which they designated as "grievous". This positively shows that the list is exhaustive and no hu outside the list given in S. 320 can be termed as 'grievous hu'. The following kinds of hu only are designated as "grievous" Emasculation. Permanent privation of the sight of either eye. Permanent privation of the hearing of either ear Privation of any member or joint. Destruction or permanent impairing of the powers of any member or joint. Permanent disfiguration of the head or face. Fracture or dislocation of a bone or tooth. 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. Where injury was caused on the abdomen with a sharp edged weapon and the doctor had stated that the injury had penetrated the abdominal cavity but had not involved any vital organs/ impoant structures, but had just touched the stomach, it was held that the accused had caused only simple hu. Similarly, cutting of a tendon or a muscle does not make the injury fall under purview of any clauses of S 320 IPC. Ref: Dr. Dasari Harish, Prof & Head; Dr. K H Chavali, Assoc. prof; Dr. Amandeep Singh & Dr. Ajay Kr, Asst. Profs, Dept. Forensic Medicine & Toxicology, Government Medical College & Hospital, Sector 32, Chandigarh - 160030.
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As the condition for the patient shows to escape from the situation.
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Fusion
Fused teeth arise through union of two normally separated tooth germs. Depending upon the stage of development of the teeth at the time of the union, fusion may be either complete or incomplete. It has been thought that some physical force or pressure produces contact of the developing teeth and their subsequent fusion. If this contact occurs early, at least before calcification begins, the two teeth may be completely united to form a single large tooth. If the contact of teeth occurs later, when a portion of the tooth crown has completed its formation, there may be union of the roots only. The dentin; however, is always confluent in cases of true fusion. The tooth may have separate or fused root canals, and the condition is common in the deciduous as well as in permanent dentition.
Radiological signs
The tooth has a notched incisal margin and there is evidence of conjoined dentine between the involved teeth. The fused tooth may present with two distinct pulp chambers/pulp canal systems or a joined system.
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The poison fluoroacetate is found in some of the plants, and their consumption can be fatal to grazing animals. Some fluorinated compounds used as anticancer agents and industrial chemicals (including pesticides) are metabolized to fluoroacetate. It is toxic because fluoroacetyl-CoA condenses with oxaloacetate to form fluorocitrate, which inhibits aconitase, causing citrate to accumulate. Reference: Harper; 30th edition; Page no: 162
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Uterus bicornis unicollis
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Acanthosis nigricans is probably the most readily recognized skin manifestation of diabetes and most cases are linked to obesity and insulin resistance. True association is rare between acanthosis nigricans and malignancy. It presents as brown to gray-black papillomatous cutaneous thickening in the flexural areas, including the posterolateral neck, axillae, groin, and abdominal folds. Ref: Kalus A.A., Chien A.J., Olerud J.E. (2012). Chapter 151. Diabetes Mellitus and Other Endocrine Diseases. In L.A. Goldsmith, S.I. Katz, B.A. Gilchrest, A.S. Paller, D.J. Leffell, N.A. Dallas (Eds), Fitzpatrick's Dermatology in General Medicine, 8e.
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