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As is the case for TS, the clinical features of TR result primarily from systemic venous congestion and reduction of CO. With the onset of TR in patients with PA hypeension, symptoms of pulmonary congestion diminish, but the clinical manifestations of right-sided hea failure become intensified. The neck veins are distended with prominent v waves and rapid y descents, marked hepatomegaly, ascites, pleural effusions, edema, systolic pulsations of the liver, and a positive hepatojugular reflex. ref : Harrison&;s principle of internal medicine,20th edition,pg no.1948
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A i.e. Rest to the ciliary muscle In inflamatory glaucoma (glaucoma with uveitis) pilocarpine (miotic) & prostaglandin analogue e.g. latanoprost are contraindicated Q because - Pilocarpine 1/t development of posterior synechiae - Prostaglandin analogue enhance breakdown of aqueous barrier and exacerbate cystoid macular edema.
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Robbins basic pathology 9th edition page no 237,Heading =Deletion syndrome DiGeorge syndrome is caused by a small interstitial deletion of band 11 on the long arm of chromosome 22
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Ans. is'c'i.e., Secrete blood group antigen in sweat/saliva
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Ans. is 'a' i.e., Peyer's Patch Hyperophy Bailey writes - "The condition is encountered most commonly in children, in whom it occurs in an idiopathic form, with a peak incidence at 3-9 months. Between 70% and 90% cases are classed as idiopathic, and an associated illness such as gastroenteritis or urinary tract infection is found in 30%. It is believed that hyperplasia of Peyer's patches in the terminal ileum may be the initiating event. This may occur secondary to weaning. In light of the seasonal variation, with peak incidence in spring and summer, it may be related to upper respiratory tract infection pathogens such as adenovirus or rotavirus."Intussusception associated with a known pathologic lead point is seen in older children. The most common lead point is Meckel's diveiculum.This patient is 10 months old, so most likely the cause should be hyperophy of Peyer's patches.
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Naegleria fowleri infects people when water containing the ameba enters the body through the nose. This typically occurs when people go swimming or diving in warm freshwater places, like lakes and rivers. The Naegleria fowleri ameba then travels up the nose to the brain where it destroys the brain tissue. Ref Harrison20th edition pg 2443
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Paraganglioma is a term used to describe catecholamine producing tumors in the skull base and neck. The classic rule of tens is valid for pheochromocytoma. Organ of Zuckerkandl is a collection of chromaffin cells near the origin of the inferior mesenteric aery or near the aoic bifurcation. It is the most common extra-adrenal site of pheochromocytoma. Urinary VMA is used for diagnosis of neuroblastoma and not pheochromocytoma. The most sensitive test for pheochromocytoma is urinary fractionated metanephrine
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a. Bite cells(Ref: Nelson's 20/e p 2335-2356, Ghai 8/e p 339)Bite cells are characteristic finding of G6PD deficiency while others can be seen in any intravascular hemolysis.
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IgG2 is directed against polysaccharide antigens and is an impoant host defense against encapsulated bacteria. Since this patient is suffering from recurrent infections caused by organisms having polysaccharide capsules he should be investigated for IgG2 deficiency. Each IgG molecule consists of two L chains and two H chains linked by disulfide bonds. There are four subclasses (IgG1 to IgG4), based on amino acid sequence differences in the H chains and on the number and location of disulfide bonds. IgG1 constitutes 65% of the total IgG.
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Veraguth's sign Objective sign of depression. It was described by Otto Veraguth. It is a triangular fold on the nasal side of the upper eye lid. The patient appears to have a distant stare.
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Ans. is 'a' i.e., Mercury Pink disease or Acrodvniao It is thought to be an idiosyncratic hypersensitivity reaction particularly seen in children,o This can be caused by chronic mercury exposure in any form usually in children.o The onset is insidious with anorexia, insomnia, sweating, skin rash and photophobia,o Hands and feet become puffy, pinkish, painful, paraesthetic with peeling of skin,o Teeth may be shed.
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Most common cause of vitreous hemorrhage in diabetic patients is proliferative diabetic retinopathy. In proliferative diabetic retinopathy new vessels arise on the disc or anywhere on retina. These new vessels are friable and tends to break easily leading to vitreous hemorrhage. Most common cause of vitreous hemorrhage in non diabetic patients are posterior vitreous detachment, retinal tear and retinal detachment.
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Paragangliomas are tumors arising from adrenal medulla or extra-adrenal paraganglia. These include pheochromocytoma - intraadrenal paraganglioma, extraadrenal sympathetic paraganglioma, and extraadrenal parasympathetic paraganglioma, including tumors termed chemodectoma, and carotid body glomus tumor. Sympathetic paragangliomas consist of endocrine cells which can produce catecholamines. These tumors are located intraabdominally. Parasympathetic paragangliomas develop from the paraganglias of parasympethicus such as paraganglium caroticum, jugulare, tympanicum and intravagale. These tumors are predominantly found in the area of head, neck, and mediastinum. Angiogram of carotid body tumor reveals widening of the carotid bifurcation with prominent tumor vascularization. Ref: Stem Cells and Cancer Stem Cells, Volume 1: Stem Cells and Cancer Stem Cells ... edited by M.A. Hayat, 2011, Page 38 ; Harrison's internal medicine 17th edition chapter 337 ; Devita 6thedition section 30.4 ; Anatomic Basis of Tumor Surgery edited by William C. Wood, Charles Staley, John E. Skandalakis, 2010, Page 123
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Ans. is 'a' i.e., HBV; 'b' i.e., Rabies; 'c' i.e., Diphtheria Read the question carefully, examinar is asking about postexposure prophylaxis (not post-exposure immunization). o In previous explanation, I have explained the diseases for which post-exposure prophylaxis is done by immunization (vaccine or immunoglobulin or both). o In some diseases post-exposure prophylaxis is done by drugs, i.e., post-exposure chemoprophylaxis : - i) HIV --> Antiretroviral therapy ii) Herpes --> Famciclovir iii) Diphtheria iv) Miningococcal meningitis
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Ans.(c) Anti- smith antibodyTest Description* ANA Screening test has sensitivity 95% not diagnostic without clinical features* Anti-dsDNA Antibody: High specificity, sensitivity only 70% and levels are variable based on disease activity* Anti-Sm antibody: Most specific antibody for SLE* AntiSSA (Ro) or Anti-SSB (La) Present in 15% of patients with SLE and other connective tissue disease such as Sjogren syndrome* Lupus anticoagulant* Direct Russell viper venom test to screen for inhibitors in the clotting cascade in antiphospholipid antibody syndrome* Direct Coombs test* Anti-histone : Drug-induced lupus (e.g with procainamide or hydralazine)
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Ans. is 'a' i.e., CAH Female pseudohermaphroditism. Gentotype is XX Gonads are ovaries External genitalia are virilized (male differentiation). As there is no mullarian inhibiting factor, mullarian duct develops into uterus tubes and ovary. But due to presence of androgen external genitalia are virilized. Causes are: Congenital adrenal hyperplasia(most common) 21 hydroxylase deficiency 11 beta hydroxylase deficiency Maternal virilizing tumor Arrhenoblastoma Maternal medications with androgen.
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The temperature safely tolerated by pulp is 115-140 °F
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Clonal selection
B-cells are able to make a specific antibody against a specific antigen. It is due to the presence of specific receptor on B-cells - B-cell receptor (BCR), that is usually an immunoglobulin Ig M or Ig D. An antigen interacts with B-cell that shows best fit by virtue of its BCR. The antigen binds to this receptor, and the B-cell is stimulated to divide and form a clone (clonal selection). This clone of cells will become plasma cells that will secrete antibody of a particular specificity and same class.
Plasma cells make an antibody of a single specificity, of a single immunoglobulin class and allotype, and of a single light chain type only. An exception is seen in the primary antibody response, when a plasma cell producing IgM initially, may later be switched to IgG production (called isotype switching or class switching).
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Ans. B i.e. MenorrhagiaMenstrual irregularities may be seen in 80% of patients of Cushing syndrome
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Subdural hematoma
Cresent (concavo-convex) shaped
Hyperdense (2/3) or mixed (1/3) in acute cases
Isodense in subacute
Hypodense in chronic
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Ans. is 'c' i.e., 'y toxin; . Staphylococcal leucocidin and gamma lysin have been grouped as synergohymenotropic toxins. . Leucocidin is also called the Panton-valentine toxin.
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Bilirubin metabolism and bile The liver plays a central role in the metabolism of bilirubin and is responsible for the production of bile (Fig. 22.6). Between 425 and 510 mmol (250-300 mg) of unconjugated bilirubin is produced from the catabolism of haem daily. Bilirubin in the blood is normally almost all unconjugated and, because it is not water-soluble, is bound to albumin and does not pass into the urine. Unconjugated bilirubin is taken up by hepatocytes at the sinusoidal membrane, where it is conjugated in the endoplasmic reticulum by UDP-glucuronyl transferase, producing bilirubin mono- and diglucuronide. Impaired conjugation by this enzyme is a cause of inherited hyperbilirubinaemias . These bilirubin conjugates are water-soluble and are expoed into the bile canaliculi by specific carriers on the hepatocyte membranes. The conjugated bilirubin is excreted in the bile and passes into the duodenal lumen. Once in the intestine, conjugated bilirubin is metabolised by colonic bacteria to form stercobilinogen, which may be fuher oxidised to stercobilin. Both stercobilinogen and stercobilin are then excreted in the stool, contributing to its brown colour. Biliary obstruction results in reduced stercobilinogen in the stool, and the stools become pale. A small amount of stercobilinogen (4 mg/day) is absorbed from the bowel, passes through the liver and is excreted in the urine, where it is known as urobilinogen or, following fuher oxidisation, urobilin. The liver secretes 1-2 L of bile daily. Bile contains bile acids (formed from cholesterol), phospholipids, bilirubin and cholesterol. Several biliary transpoer proteins have been identified . Mutations in genes encoding these proteins have been identified in inherited intrahepatic biliary diseases presenting in childhood, and in adult-onset disease such as intrahepatic cholestasis of pregnancy and gallstone formation. Urine tests If the blood level of conjugated bilirubin becomes elevated, e.g. due to liver disease, excess conjugated bilirubin is excreted in the urine, indicating a pathological process. Unconjugated bilirubin is not water-soluble and so is not excreted in the urine. Ref Davidson edition23rd pg 851
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<p>Historically , radiotherapy to lymph nodes alone has been used to treat localised stage 1A disease effectively ,with no adverse prognostic features.</p><p>Davidson&;s principles & practice of medicine 22nd edition pg no 1043</p>
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Hyperuricemia and ahralgia caused by pyrazinamide can usually be managed by the administration of acetylsalicylic acid; however, pyrazinamide treatment should be stopped if the patient develops gouty ahritis. Individuals who develop autoimmune thrombocytopenia secondary to rifampicin therapy should not receive the drug thereafter. Similarly, the occurrence of optic neuritis with ethambutol is an indication for permanent discontinuation of this drug. For patients with symptomatic hepatitis and those with marked (five- to six fold) elevations in serum levels of aspaate aminotransferase, treatment should be stopped and drugs reintroduced one at a time after liver function has returned to normal.
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ALKALINE PHOSPHATASE. Serum alkaline phosphataseis produced by many tissues, especially bone, liver,intestine and placenta and is excreted in the bile. Most of thenormal serum alkaline phosphatase (range 33-96 U/L) isderived from bone. Elevation in the activity of the enzyme canthus be found in diseases of the bone, liver and in pregnancy. Inthe absence of bone disease and pregnancy, an elevatedserum alkaline phosphatase levels generally reflecthepatobiliary disease. The greatest elevation (3 to 10 timesnormal) occurs in biliary tract obstruction. Slight to moderateincrease is seen in parenchymal liver diseases such as inhepatitis and cirrhosis and in metastatic liver disease. It ispossible to distinguish serum hepatic alkaline phosphatasefrom bony alkaline phosphatase by fractionation intoisoenzymes but this is not routinely done. ALP increases in multiple myeloma only when associated with fractures HARSH MOHAN Textbook of pathology 6th edition pg no 595
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Ans: a (Intermittent hydronephrosis) Ref: Bailey & Love, 24th ed,Died crisis is seen in intermittent hydronephrosis.Dietel crisisAfter an attack of a/c renal pain a swelling in loin is found. Pain is relieved and swelling disappears following the passage of a large volume of urine some hours later.Note:Unilateral hydronephrosis is most commonly caused by idiopathic pelviureteric junction obstruction or calculus. Right side is more commonly involved.
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Variable number of tandem (one after another) repeats (VNTR), is unique for any individual & therefore serves as molecular DNA fingerprint. VNTR may be short tandem (microsatellite) or large tandem (minisatellite) repeats.
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The patient has primary amenorrhea. Her secondary sex characteristics are normal, indicating an adequate exposure to estrogen, hence ruling out hypoestrogenism and hypopituitarism. Although her external genitalia examination is normal, the proof of the lack of an end-organ abnormality ( such as Imperforate hymen / transverse vaginal septum/ unresponsive endometrium) is that she was able to bleed after being given progesterone. This also proves that her endometrial mucosa was primed with estrogen.
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Gonococci
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The symptoms of the patient are due to hypersensitivity type I reaction Type I is mediated by IgE and it flairs up within minutes. The symptoms range form rashes to anaphylactic shock with vasodilation hypotension and bronchiolar spasm.
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Congenital rubella is characterized by nuclear pearly cataract but there is no dislocation of the lens Refer: Khurana 6th edition page number236
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Ans. (a) TB kidneyThe clinical history is suggestive of sterile pyuria. The gross morphology shows greyish white are caseating necrotic material which is formed in patches, predominantly in the cortical areas involving the while circumference of the kidney. Hence, the first possibility is renal TB.
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Pottasium iodide
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The herd structure not only involves host population belonging to the herd species but also the presence and distribution of alternative animal hosts and possible insect vectors as well as those environmental and social factors that or or inhibit the spread of infection from host to host Ref: 25th edition, Park's Textbook of Preventive and Social Medicine, Page no. 110
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ANSWER: (A) Does not require further examinationsREF: APPENDIX-71 APPENDIX - 71HPV VACCINE- CERVARIXType: Protein subunit Pregnancy category: BTarget disease: Human papillomavirus (Types 16 and 18, additionally some cross-reactive protection against virus strains 45 and 31 were shown in clinical trials)Cervarix vaccine will not block infection from cervical cancer-causing HPV strains other than HPV 16, 18,31 and 45 (ie however bivalent protects against four)"Two of these types (16 and 18) are believed to cause 70 per cent of these cases (76.7 per cent in Indian women).Type 16 is also associated with oropharyngeal squamous-cell carcinoma, a form of throat cancer.Cervarix shots will not block infection from cervical cancer-causing HPV types other than HPV types 16 and 18, so experts continue to recommend routine cervical Pap smears even for women who have been vaccinated.IngredientsHuman Papillomavirus type 16 LI protein 20 microgramsHuman Papillomavirus type 18 LI protein 20 microgramsAdjuvanted by AS04 (Adjuvant system 04) containing: 3-0-desacyl-4'- monophosphoryl lipid A (MPL) 50 micrograms adsorbed on aluminium hydroxide, hydrated (Al(OH)3) 0.5 milligrams *41 3 + in totalThe other ingredients are sodium chloride (NaCl), sodium dihydrogen phosphate dihydrate (NaH2P04.2 H20) and water for injections.BiotechnologyCervarix is created using the LI protein of the viral capsid. Recombinant activity in a baculovirus vector produces LI protein spheres, which are very immunogenic. The viral proteins induce the formation of neutralizing antibodies. The vaccine contains no live virus and no DNA, so it cannot infect the patient.LI protein is in the form of non-infectious virus-like particles (VLPs) produced by recombinant DNA technology using a Baculovirus expression system which uses Hi-5 Rix4446 cells derived from the insect Trichoplusia ni.HPV Vaccine AdministrationThe vaccine should be delivered through a series of three intra-muscular injections over a six-month period. The second and third doses should be given two and six months after the first dose (0,2,6)The vaccine can be administered at the same visit as other age-appropriate vaccines, such as Tdap, Td, MCV4, influenza, and hepatitis B vaccines.Storage:The vaccine should be stored at 2degC-8T (36degF-46degF) and not frozen.Cervarix vs Gradasil CervarixGradasilValencyBivalent vaccineQuadrivalent vaccineStrainsHPV viruses Types 16 and 18HPV viruses 16,18, 6,11ProtectionTypes 16 and 18, 45 and 31Types 16,18, 6,11Age group10 to 45 yrs9 to 26yrsImmune responseStronger and longerWeaker and shorterPregnancySafeContraindicatedOn the face of it a quadrivalent vaccine seems to be the better choice. In reality that is not so. The vaccine protects against the HPV viruses 16, 18, 6,11, of which only the first two are responsible for cervical cancer, while the other two are responsible for genital warts.On the other hand Cervarix gives protection against 16 and 18. It is better because, there is cross- reactive protection against the virus strains 45 and 31, two other viruses causing cervical cancer.Cervarix is formulated with AS04, a propriety adjuvant that boosts the immune system response for a longer period of time.Both vaccines are against the human papilloma virus but Cervarix seems to be more effective against cancer cervix.Cervarix can be given to females between 10 to 45 yrs old, whereas Gardasil can be given to females between 9 to 26 years only.Both the vaccines are given in the schedule of 0, 2t 6 months. Cervarix is the costlier one being priced at Rs. 3200 per dose. Cervarix seems to win against Gardasil because of its stronger immune response and broader protection.The study found that Cervarix generated more than 2x more antibodies than Gardasil for HPV type 16 and more than 6x more for HPV type 18 at seven months in all women aged 18-45 years (P<0.0001).At seven months Cervarix also induced 2.7x more memory B cells than Gardasil for both HPV types 16 and 18 (P< 0.0001) in women with no detectable B-cell response before vaccination.The vaccine has also been proven to be 99% effective in the prevention of genital warts caused by HPV types 6 and 11, which are responsible for 90% of all genital warts casesGardasil is not recommended for use in pregnant women, have immune problems, like HIV infection, cancer, or you take medicines that affect your immune system, have a fever over 100degF (37.8degC)Clinical trialsPhase II trials demonstrated 100% protection of the vaccine against types 16 and 18 HPVVaccination has been shown to offer protection for at least 6.4 years. In the clinical trials, women were given three doses over a six-month span--at 0 month, 1 month, and 6 months.Phase 3 trial data also suggest that the vaccine, formulated with a proprietary adjuvant system called AS04, is highly immunogenic and generally well-tolerated, with antibody levels at least 10 times greater than those produced by natural infection.Side effectsSerious side effects are less common. The most common side effects include:1. Reactions at the injection site, such as: Pain, Swelling, Redness, ItchingFeverUpset stomach (nausea)Dizziness.Groups for Which Vaccine is Not LicensedVaccination of Females Aged <9 Years and >26 YearsRecommendations for Routine Use and Catch-UpRoutine Vaccination of Females Aged 11-12 YearsCatch-Up Vaccination of Females Aged 13-26 YearsVaccination of MalesQuadrivalent HPV vaccine is not licensed for use among males. Although data on immunogenicity and safety are available for males aged 9-15 years, no data exist on efficacy in males at any age. Efficacy studies in males are under way.Special Situations among Females Aged 9-26 YearsEquivocal or Abnormal Pap Test or Known HPV InfectionFemales who have an equivocal or abnormal Pap test could be infected with any of approximately 40 high-risk or low-risk genital HPV types. Such females are unlikely to be infected with all four HPV vaccine types, and they might not be infected with any HPV vaccine type. Vaccination would provide protection against infection with HPV vaccine types not already acquired. With increasing severity of Pap test findings, the likelihood of infection with HPV 16 or 18 increases and the benefit of vaccination would decrease. Women should be advised that results from clinical trials do not indicate the vaccine will have any therapeutic effect on existing HPV infection or cervical lesions.Genital WartsA history of genital warts or clinically evident genital warts indicates infection with HPV, most often type 6 or 11. However, these females might not have infection with both HPV 6 and 11 or infection with HPV 16 or 18. Vaccination wrould provide protection against infection with HPV vaccine types not already acquired. However, females should be advised that results from clinical trials do not indicate the vaccine will have any therapeutic effect on existing HPV infection or genital wTarts.Lactating WomenLactating women can receive HPV vaccine.Immunocompromised PersonsBecause Quadrivalent HPV vaccine is a noninfectious vaccine, it can be administered to females wrho are immunosuppressed as a result of disease or medications. However, the immune response and vaccine efficacy might be less than that in persons who are immunocompetent.Vaccination During PregnancyQuadrivalent HPV vaccine is not recommended for use in pregnancy. The vaccine has not been causally associated with adverse outcomes of pregnancy or adverse events in the developing fetus. However, data on vaccination during pregnancy are limited. Until additional information is available, initiation of the vaccine series should be delayed until after completion of the pregnancy. If a woman is found to be pregnant after initiating the vaccination series, the remainder of the 3-dose regimen should be delayed until after completion of the pregnancy.
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In some situation, for initial 2-3 hours, dead body may gain temperature, known as postmortem caloricity.
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Most sensitive - anti nuclear antibody.
Most specific - anti smith antibody.
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Ans is a ie Meniscus sign
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Hepato Pulmonary Syndrome is a Contra Indication of TIPSS . Indications of TIPSS:- 1.Prevention of acute variceal bleeding (MC) 2.Refractory variceal bleeding 3.Refractory ascites 4.Refractory hepatic hydrothorax 5.Hepatorenal syndrome 6.Budd Chiari syndrome 7.Veno-occlusive disease 8.Poal hypeensive gastropathy
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A i.e. Choroid plexus
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Ans. is 'c' i.e., Female genital tract * After the ejaculation the sperm cells go through several essential physiological changes during their time in the female genital tract before they, at the end, are able to penetrate the oocyte membrane.* The first change in this cascade is capacitation. The sperm cells accomplish this during the ascension through the female genital tract (in contact with its secretions). It has to do with a physiological maturation process of the sperm cell membranes, which is seen as the precondition for the next step to follow, namely the acrosome reaction.* Capacitation is a functional maturation of the spermatozoon. The changes take place via the sperm cell membrane in which it may be that receptors are made available through the removal of a glycoprotein layer. The area of the acrosomal cap is also so altered thereby that the acrosome reaction becomes possible.* Through the membrane alterations, the motile properties of the spermatozoon also change. Discharging whipping movements of the tail together with larger sideways swinging movements of the head take place. This type of motility is designated as hyperactivity. One can therefore say that the visible consequences of capacitation consist in hyperactivity of the spermatozoon.
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The term "contraction alkalosis" refers to the development of metabolic alkalosis (excess plasma HCO3-) when there is a loss of extracellular fluid volume (hypovolemia). Hypovolemia evokes numerous homeostatic reflexes that act to normalize extracellular fluid volume, including stimulation of the renin-angiotensin-aldosterone system. In the kidney, elevated levels of angiotensin II and aldosterone increase Na reabsorption through processes that are ultimately coupled to hydrogen secretion. Consequently, volume regulation results in a net increase in plasma HCO3-. Correction is obtained when the lost volume is replenished through intake of water and sodium. Loop diuretics such as furosemide act primarily on the thick segment of the medullary and coical ascending limbs of Henle's loop. They inhibit the coupled transpo of Na+ and Cl- that results in the production of large volumes of relatively iso osmotic urine. Excessive use of these drugs can result in hypovolemia and contraction alkalosis. Antacid and infant formula can result in metabolic alkalosis but not as a result of hypovolemia. In patients with renal insufficiency, antacids containing calcium carbonate can increase the plasma HCO3- concentration. Infant formulas that contain sodium but very little chloride enhance Na+ reabsorption in the renal tubule and, like volume contraction, this results in an increase in urinary H+ secretion. Administration of laxatives or acetazolamide promotes metabolic acidosis. Laxatives result in the loss of intestinal fluids that are relatively alkaline and contain large amounts of HCO3-. Acetazolamide inhibits the enzyme carbonic anhydrase. As a result, acetazolamide reduces the reabsorption of HCO3- in the renal tubule. Acetazolamide is often used in combination with loop diuretics to correct the alkalosis caused by these compounds. Ref: Barrett K.E., Barman S.M., Boitano S., Brooks H.L. (2012). Chapter 35. Gas Transpo & pH. In K.E. Barrett, S.M. Barman, S. Boitano, H.L. Brooks (Eds),Ganong's Review of Medical Physiology, 24e.
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B i.e. Low pH
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Reccurent epistaxis in a 10 year old boy with unilateral nasal mass is diagnostic of juvenile nasopharyngeal fibroma. Ref Dhingra 6/e,p 246.
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Pentose phosphate pathway/Phosphogluconate pathway/Hexose monophosphate shuntIt is a process that generates NADPH and pentoses (5-carbon sugars).There are two distinct phases in the pathway.- The first is the oxidative phase, in which NADPH is generated, and the- Second is the non-oxidative synthesis of 5-carbon sugars.This pathway is an alternative to glycolysis.While it does involve oxidation of glucose, its primary role is anabolic rather than catabolic.For most organisms, it takes place in the cytosol
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Ans. (c) ITP(Ref: 9th/pg 657-658; 8th/pg 667-668)A 7 year old boy presented with sudden onset petechiae and purpura with a history of URTI 2 weeks back and there is no hepatosplenomegaly. He is most probably suffering from ITP. For complete discussion on ITP; Refer to pretext of this chapter.
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Hydrops fetalis in the previous pregnancy and positive ICT now is suggestive of maternal isoimmunisation Now the next step is to quantify fetal anemia/ fetal hemolysis. This is best done by MCA PSV measurement on fetal doppler since it is very sensitive and non invasive. Methods for detection of fetal anemia are: MCA peak systolic velocity: very sensitive, non invasive Amniocentesis and bilirubin estimation: invasive Cordocentesis: most invasive technique , associated with fuher fetoplacental bleed, thrombosis, fetal bradycardia and IUD. Hence not preferred. Done in cases of: fetal hydrops Zone 3 on Liley's cha MCA PSV of >1.5 MoM Intrauterine Exchange transfusion: Done when fetal hematocrit on cordocentesis is < 30 %
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Sodium channels are membrane bound proteins that are composed of one large and subunit through which Na ions pass, and one or two smaller b subunits. Voltage - gated Na channels exist in three stages - resting, open and inactivated local anesthetics bind a specific region of the & subunit and inhibit voltage - gated Na channels preventing channel activation and Na influx associated with membrane depolarization. Main mechanism of action of local anesthetics is through inhibition ofActivated, voltage-gated Na channel. Local anesthetics have a greater affinity for the channel in the open or inactivated state than in the resting state. Local anesthetic binding to open or inactivated channels, or both, is facilitated by depolarization. The fraction of Na channels that have bound a local anesthetic increases with frequent depolarization (eg, during trains of impulses).This phenomenon is termed use-dependent block Local anesthetic inhibition is both voltage and frequency dependent, and is greater when nerve fibers are firing rapidly than with infrequent depolarizations Sodium passess through voltage gated sodium channel and cause change in membrane potential and cause depolarization. Local anesthetic attaches to sodium channel and prevents propogation & depolarization
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The ETC is localised in the mitochondria. The outer membrane of mitochondria is permeable to most of the small molecules. There is an intermediate space which presents no barrier to passage of intermediates. The inner membrane shows a highly selective permeability. It has transpo systems only for specific substances such as ATP, ADP, pyruvate, succinate, a-ketoglutarate, malate and citrate etc (Refer Fig. 10.1). The enzymes of the electron transpo chain are embedded in the inner membrane in association with the enzymes of oxidative phosphorylation. Extramitochondrial system: This is a radically different and highly active system responsible for de novo synthesis of palmitic acid from 2-carbon unit acetyl-CoA.Ref: MN Chatterjea Textbook of Medical Biochemistry, 8th edition, page no: 138 & 414
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Ans. is 'c' i.e., Squamous cell carcinoma * Adenocarcinoma is the most common type of lung carcinoma in non-smokers and females.Remember* Adenocarcinoma is the overall most common type of lung carcinoma.* Adenocarcinoma is the most common type of lung carcinoma in non-smokers and females.* Squamous cell (epidermoid) carcinoma is the most common type of lung carcinoma in India.* Squamous cell carcinoma is the most common type of lung carcinoma in smokers and males.* M.C Variety in young Patients - Adenocarcinoma* Histological Variety that cavitates - Squamous cell Ca* M.C Histological variety to metastasize - Small cell Ca* Ca which metastasize to opposite lung - Adenocarcinoma* Clubbing least common in which Ca - Small cell Ca* Gynecomastia is seen in which type of Ca - Large Cell Ca* Thrombophlebitis is seen with which Ca -Adenocarcinoma* The most common site for metastasis from ca lung - Brain* Lung Ca with worst prognosis - Small cell Ca* The variety most responsive to chemotherapy - Small cell Ca* The variety most responsive to radiotherapy - Small cell Ca* M.C Endocrine Gland to be involved by metastasis - Adrenal* Variety with best prognosis - Squamous cell Ca* The variety that is central in location - Squamous cell & small cell Ca* The variety that is peripheral in location - Adenocarcinoma* Most common variety with Cushing's syndrome - Small cell Ca* Most common variety with Hypercalcemia d/t PTH like substance Secretion Squamous cell Ca.
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- Crohn's disease is associated with transmural inflammation whereas only superficial layers are involved in ulcerative colitis. Feature Crohn Disease Ulcerative Colitis Macroscopic Bowel region involved Any site of GIT Colon only Distribution Skip lesions Diffuse Stricture Yes Rare Wall appearance Thick Thin Microscopic Inflammation Transmural Limited to mucosa, submucosa Pseudopolyps may/ may not be present Markedly present Ulcers Deep, knife-like Superficial, broad-based Lymphoid reaction Marked Moderate Fibrosis Marked Mild to none Serositis Marked Mild to none Granulomas Yes ( 35%) No Fistulae/sinuses Yes No Clinical Perianal fistula Yes (in colonic disease) No Fat/vitamin malabsorption Yes No Malignant potential With colonic involvment yes Yes Recurrence after surgery Common No Toxic megacolon No Yes All feature may not be present in a single case. TRUE LOVE CLASSIFICATION OF UC.
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Ans. is 'a' i.e., 0*7 % Dexamethasone Ozurdex is a dexamethasone implant in a concentration of 0.7 mg which is used for the treatment of macular edema due to central retinal vein occlusion. The standard care for CR VO used to be observation but now, the standard care is to watch the patient closely initially, but to use Ozurdex or an anti-VEGF. Earlier, macular edema is CRVO was treated with intravitreal steroid (triamcinolone) injections. This injection has been gradually replaced over past few years by anti VEGF injections and Ozurdex implants. Ozurdex is a slow release implant and continue to have effect for 3-6 months and hence is a good option for treating macular edema along with Anti VEGF injections. Ozurdex is a rod shaped implant which is placed inside the eye in the vitreous cavity. It contains the steroid dexamethasone in concentration of. 7mg which is slowly released into the eye. The implant is biodegradable. It slowly dissolves into the eye and does not need to be removed. Steroids have an antiinflammatory effect and block chemical pathways that lead to swelling or leakage from blood vessels. The implant continues to release the drug into the eye for 3-6 months and thus a long lasting effect compared to intravitreal steroid injection.
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Ans. is 'b' i.e., Immediate evacuvation
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Ans. is 'a' i.e., Elasticity o The extent to which the lungs will expand for each unit increase in transpulmonary pressure is called the lung compliance.o The total compliance of both lungs together in the normal adult human being averages about 200 milliliters of air per centimeter of w ater transpulmonary pressure.o That is, every time the transpulmonary' pressure increases 1 centimeter of water, the lung volume, after 10 to 20 seconds, will expand 200 milliliters.o The characteristics of the compliance diagram are determined by the elastic forces of the lungs.o These can be divided into twro parts: (I) elastic forces of the lung tissue and (2) elastic forces caused by surface tension of the fluid that lines the inside walls of the alveoli and other lung air spaces,o The elastic forces of the lung tissue are determined mainly by elastin and collagen fibers
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Ans. is 'a' i.e., Anterioinferior o Perforation is seen most commonly in anteroinferior quadrant.Otoscopy signs for ASOMo There is congestion of pars tensao Leash of blood vessels appear along the handle of malleus and at the periphery giving it a cartwheel like appearacne.o Translucency is reduced.o Later tympanic membrane appears red and bulging with loss of landmarks,o Tympanic membrane is immobile on pneumatic otoscopy.o In later stages - perforation,'rupture of tympanic membrane may be visible most commonly in the antero inferior quadrant or there may be filling of pus in ear canal which would make visibility of tympanic membrane difficult.o There may be pulsatile otorrhea which can give light house effect (reflection of light).
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Malignant Hypeension Associated with Hyperplastic aeriolosclerosis - onion skin appearance of blood vessel. This lesion occurs in severe hypeension; vessels exhibit concentric, laminated("onion-skin") thickening of the walls with luminal narrowing. The laminations consist of smooth muscle cells with thickened, reduplicated basement membrane; in malignant hypeension, they are accompanied by fibrinoid deposits and vessel wall necrosis (necrotizing aeriolitis), paicularly in the kidney .
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Refer robbins 9/e p506 It is systemic vasculitis manifested by transmural necrotising inflammation of small and medium sized aeries Renal aery is most commonly involved whereas pulmonary circulation is spared Most common causes are fever of unknown cause, malice,weight loss, hypeension, abdominal pain,melena, diffuse muscular pains and peripheral neuritis
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Ans. (d) Vibrio cholera is associatedRef: Bailey 26th edition Page 1116* MC type of cancer is Adenocarcinoma - Nodular and infiltrative* Squamous cell cancer can arise but rare* MC association is Gall stones* Carries poor prognosis
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Ans. is 'b' i.e., 4.75% o The scheme is run by contribution by employees and employers and grants from central and state governments - i) Employers contribution --> 4.75% of total wages bills ii) Employee contribution --> 1.75% of total wages bills iii) The state government's share of expenditure on medical care is 'Is of total cost of medical care. iv) The ESI corporations share of expenditure on medical care is 1/ of total cost of medical care.
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X-ray findings of TAPVC
Cardiomegaly
Plethoric lung fields
Snowman or figure of 'V configuration ---> In supracardiac TAPVC.
Ground glass appearance of lung —> In obstructive TAPVC.
Clinical manifestations of TAPVC
Nonobstructive TAPVC -4 Patients presents with mild cyanosis and CHF at 6-8 weeks.
Obstructive TAPVC —> Paients presents with severe cyanosis and CHF within first week.
EOG
.Right axis deviation with right ventricular hypertrophy.
In obstructive TAPVC pulmonale.
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Ans. B: TB Ahritis
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Ans. b (Radial nerve palsy) (Ref. Maheshwari orthopedics 3rd ed., p 59; Table 10.6.)RADIAL NERVE PALSY# This is a common injury after a humerus and if there is no prospect of return of function, then transfers of flexor tendons to the extensor side will stabilise the wrist and allow extension of the fingers.# The classic transfer is the Robert Jones.# Pronator teres is inserted into extensor radialis iongus to restore wrist extension.# Flexor carpi ulnaris is inserted into extensor digitorum to restore finger extension.# Palmaris iongus when present is inserted into extensor potlicis Iongus to restore thumb extension.# Splintage: cock-up splintSome important splints used in orthopedic practiseSplints and castsClinical useCock-up splintShoulder abduction splintKnuckle-bender splintFoot-drop splintRadial nerve palsy (Extensors of the wrist and MP joints paralysed)Axillary nerve (Deltoid paralysis)Ulnar nerve palsy (Lumbricals paralysis)Sciatic nerve or common peroneal nerve palsy Cylinder/tubular castFracture patellaHanging castFracture humerusPatellar tendon bearing castFracture tibiaMinerva castCervical spine fractureTrunk Buckle castScoliosisRisser's castScoliosisAluminium splintImmobilization of fingerThomas splintFracture femurBohler Braun splintFracture femurToe rising splintFoot dropKnuckle bender splintUlnar nerve palsyDennis Brown splintCTEVSome important splits and casts used in orthopedic practiseDunlop tractionFracture elbowGallow's tractionFracture femur - shaft (below 2 years)Bryant's tractionFracture femur - shaft (below 2 years)Russell's tractionTrochanteric fracturePerkin's tractionFracture shaft femur in adults
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<p>LICHEN PLANUS:- Inflammatory T cell mediated auto immune disorder affecting skin, hair,nails and mucous membranes. Four Ps- purple , polygonal and pruritic papule. Classic lesion- small polygonal shaped, and red/ violet, flat topped papule. Surface is slightly shiny/ transparent,and a network of fine,white lines called 'Wickhams striae' or small grey white puncta is also seen. violaceous pruritic papules, pterygium and cictricial alopecia are charecteristics of lichen planus IADVL textbook of dermatology, page 1070
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Ans. b. Naegleria fowleri (Ref: Harrison 19/e p1367, 18/e p1686)A 15-year old boy came back to his village after a vacation to his relatives. He developed severe headache and purulent nasal discharge and was diagnosed as acute bacterial meningitis. He died 5 days later. The above presentation is consistent with atypical free-living amoeba infection, most probably due to Naegleria fowleri.Naegleria fowleri:Naegleria prefers warm freshwater, and most cases occur in otherwise healthy children, who usually have swum in lakes or swimming pools during the previous 2 weeks.Naegleria enters the central nervous system via water inhaled or splashed into the nose, with trophozoites disrupting the olfactory mucosa, invading through the cribriform plate, and ascending via the olfactory nerves into the brain.Earliest manifestations are anosmia (usually perceived as alterations in taste), headache, nasal discharge, fever, photophobia, nausea, and vomiting.Death usually occurs within 7-10 days of the onset of symptomsLaboratory findings in the CSF resembles those in bacterial meningitis, with high opening pressures, low glucose levels, high protein concentrations, and elevated polymorphonuclear cell-predominant white blood cell counts.Diagnosis of PAM is based on the finding of motile Naegleria trophozoites in wet mounts of freshly obtained cerebrospinal fluid (CSF).Naegleria fowleri* Naegleria (the 'brain-eating amoeba') is the causative agent of primary amebic meningoencephalitis (PAM)Q.* Pathogenic free living amoebaeQSpread of Infection:* Naegleria prefers warm freshwater, and most cases occur in otherwise healthy children, who usually have swum in lakes or swimming pools during the previous 2 weeksQ.* Naegleria enters the central nervous system via water inhaled or splashed into the nose, with trophozoites disrupting the olfactory mucosa, invading through the cribriform plate, and ascending via the olfactory nerves into the brainQ.Pathology:* Hemorrhagic necrosis of brain tissue (often most prominent in the olfactory bulbs)Q* Evidence of increased intracranial pressureQ* Scant purulent material that may contain a few amoebas* Marked leptomeningitisQClinical Features:* Earliest manifestations are anosmia (usually perceived as alterations in taste), headache, nasal discharge, fever, photophobia, nausea, and vomitingQ.* Cranial nerve palsies, especially of the 3rd, 4th and 6th nerves, are documented and rapid progression of disease, with seizures and comaQ* Death usually occurs within 7-10 days of the onset of symptomsQDiagnosis:* Diagnosis of PAM is based on the finding of motile Naegleria trophozoites in wet mounts of freshly obtained cerebrospinal fluid (CSF)Q.* Laboratory findings in the CSF resembles those in bacterial meningitis, with high opening pressures, low glucose levels, high protein concentrations, and elevated polymorphonuclear cell-predominant white blood cell countsQ.* PAM should be suspected in any patient who has an appropriate history and purulent meningoencephalitis with negative gram stains, negative antigen detection and PCR tests for other pathogens, and negative bacterial culturesQ.Treatment:* The few survivors who have been reported were treated with high-dose amphotericin B and rifampin in combinationQ.Prognosis:* Unfortunately, the prognosis for PAM is dismalQ.
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According to Schwaz Massive transfusion is a single transfusion of 2500 or 5000 ml over a period of 24 hours .
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Ans. is 'c' Residual disability if treatment is delayed. (Ref. Harrison, 16/e, p 2514, 2516 (15/e, p 2507)).In Guillain-Bare syndrome 85% of the patients achieve a full functional recovery within several months to years.There is some confusion over choice (d) because bladder can be involved in G.B. syndrome but it is involved in only severe cases and the involvement is usually transient Moreover Harrison states "if bladder dysfunction is prominent feature and comes early in the course, possibilities other than G.B. syndrome should be considered". So we can take the option (d) as true. Clinical feature of G.B. syndrome;Areflexic motor paralysis* with or without sensory disturbance.Ascending paralysis*Legs are more affected than arm*Facial nerve involvement in 50%patients*Lower cranial nerves are also frequently involved*Deep tendon reflexes usually disappear within few days of onset*.CSF characteristically contain a high protein concentration with a normal cell count*.
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Esthesioneuroblastoma (ENB), also known as olfactory neuroblastoma, is a rare neoplasm originating from olfactory neuroepithelium superior to middle turbinate. They are initially unilateral and can grow into the adjacent sinuses, contralateral nasal cavity and they can spread to orbit and brain. It can cause paraneoplastic syndrome by secreting vasoactive petides. Since it can spread intracranially craniofacial resection is the surgery of choice. Combination therapy (Surgery + + CT) is used in management. Contrary to other nasal malignancies it is M/C in females
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Erection is mediated parasympathetic stimuli, while ejaculation is under control of sympathomimetic agents. Thus sympathomimetic agents will not help in erectile dysfunction. Ref: Richard Finkel, Michelle Alexia Clark, Pamela C. Champe, Luigi X. Cubeddu (2009), Pharmacology, 4th Edition, Lippincott Williams and Wilkins Publications, United States Page 65 ; Principles of Anatomy and Physiology By Taora 10th Edition, Page 580
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Ans. is 'b' i.e., Primary Life style & behavioral changes, e.g. doing exercise is health promotion, a type of primary
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Purpura fulminans is a severe form of DIC resulting from thrombosis of extensive areas of the skin. It predominantly affects young children following viral or bacterial infection, paicularly those with inherited or acquired hypercoagulability due to deficiencies of the components of the protein C pathway.
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Ans. (b) Neutrophil(Ref: Robbins 9th/pg 71; 8th/pg 44)This is a case of acute appendicitisThe principal inflammatory cell in this case of acute appendicitis is the neutrophil.
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Rifampicin can result in failure of oral contraceptives due to its enzyme-inducing property.
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Ans. is 'd' i.e., All of the aboveo Central chemoreceptors - On ventral surface of medulla.o Peripheral chemoreceptors - At bifurcation of common carotid artery (carotid body) and arch of aorta (aortic bodies)
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Agastrinomais a gastrin-producing tumor usually located in the pancreas or the duodenal wall. Gastric acid hypersecretion and aggressive, refractory peptic ulceration result (Zollinger-Ellison syndrome).Diagnosisis by measuring serum gastrin levels. Treatment is proton pump inhibitors and surgical removal.
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Constipation can be functional or organic . Organic causes of constipation INTESTINAL DRUGS METABOLIC NEUROMUSCULAR OTHERS Hirschsprung disease narcotics cystic fibrosis cerebral palsy low fibre diet anal stenosis vincristine hypothyoidism spinal cord lesions milk protein allergy anal fissure psychotropics panhypopituitarism myotonic dystrophy anteriorly displaced anal opening,stricture neuropathy or myopathy of GI tract Ref : ESSENTIAL PEDIATRICS,O.P.GHAI,PG NO:255,7th edition
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The gestational sac can be visualized as early as 41/2 weeks by transvaginal USG and 5 weeks by transabdominal USG.
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Ans. C: Affects damaged valvesNonbacterial thrombic endocarditis (NBTE)/marantic endocarditis is most commonly found on previously undamaged valves.As opposed to infective endocarditis, the vegetations in NBTE are small, sterile, and tend to aggregate along the edges/ line of closure of the valve or the cusps.Also unlike infective endocarditis, NBTE does not cause an inflammation response from the body.NBTE usually occurs during a hypercoagulable state such as system wide bacterial infection, or pregnancy, though mucinous adenocarcinoma where Trousseau syndrome can be encountered.it is also sometimes seen in patients with venous catheters. NBTE may also occur in patients with cancers, paicularly Typically NBTE does not cause many problems on its own, but pas of the vegetations may break off and embolize to the hea or brain, or they may serve as a focus where bacteria can lodge, thus causing infective endocarditis.
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Rajiv Gandhi Shramik Kalyan Yojna scheme of ESI: Beneficiary : People with insurance, rendered unemployed involuntarily d/t retrenchment / closure of factory / permanent invalidity arising out of non-employment injury etc. People contributed under this scheme for >= 5 yrs, are entitled to claim unemployment allowance for max period of 6 months during his/her entire service. During this period, he/she is eligible for medical care for themselves & his/her family from ESI dispensaries/ panel clinics & ESI hospitals to which he/she was attached prior to date of loss of employment.
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Midline swelling of the neck from above downwards Ludwigs angina Enlarged submental lymph nodes Sublingual dermoid Lipoma in the submental region Thyroglossal cyst Subhyoid bursitis Goitre Lipoma & enlarged lymph nodes in the suprasternal space of burns Retrosternal goitre Thymic swelling (A dermoid cyst may occur anywhere in the midline) Ref : Bailey & Love 25/e p729
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Ref: R Alagappan - Manual of Practical Medicine 4th Edition.pg no:188 Thrombolytic therapy (Streptokinase, Urokinase, Tissue plasminogen activator) may be given and is paicularly useful if given within 6 hrs of onset of Comparison of Anterior and Inferior Wall Myocardial Infarction Features Anterior MI Inferior MI 1. Extent of necrosis Large Small 2. Extent of coronary atherosclerosis Small Large 3. Complications a. Ventricular septal rupture Apical, easily repaired Basal, difficult to repair b. Aneurysm Common Uncommon c. Free wall rupture Uncommon Rare d. Mural thrombus Common Uncommon e. Hea blocks Uncommon Common f. Bundle branch blocks Common Uncommon 4. Prognosis Worse than that of inferior MI Better than that of anterior MI 5. Diagnosis a. Symptoms Gastrointestinal symptoms unusual Gastrointestinal symptoms (nausea, vomiting, hiccough) common b. Physical examination Tachycardia; hypotension uncommon. Bradycardia; hypotension common. Jugular venous distention less Jugular venous distention common. common than with inferior MI. 20% have S3 50% have S3 c. ECG Features of anterior wall MI Features of inferior wall MI d. Echocardiogram Abnormal left ventricular wall Abnormal left ventricular wall motion motion is anterior in location. is inferior in location. Right ventricular No abnormal right ventricular abnormal wall motion present in wall motion approximately one-third of patients. symptoms, but may be given upto 12 hrs after onset of symptoms. Ideal--door to needle time 30 min. Thrombolytic agents for Myocardial Infarction Agents with fibrin specificity: 1. Alteplase (-PA) 15 mg IV bolus followed by 0.75 mg/kg IV infusion (upto 50 mg) over 30 minutes then 0.5 mg/kg (upto 35 mg) by IV infusion over 60 minutes (maximum dose 100 mg IV over 90 minutes) 2. Reteplase (r-PA) 10 mg IV bolus over 2 minutes followed by another 10 mg IV bolus after 30 minutes. 3. Tenecteplase (TNK-tPA) 0.5 mg/kg IV bolus (<60 kg-30 mg, 61-70 kg -35 mg, 71-80 kg-40 mg, 81-90 kg- 45 mg, >90 kg-50 mg) Agents without fibrin specificity: 1. Streptokinase - 1.5 million units IV infusion over 60 minutes 2. Urokinase Because of the development of antibodies, patients who were previously treated with streptokinase should be given an alternate thrombolytic agent.
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C i.e. Systemic toxicity of Local Anaesthetics Systemic toxicity of LA include - CNS toxicity, cardiovascular system, methemoglobinemia & Allergies. CNS is paicularly vulnerable to toxicity & is the site of premonitory signs of overdose in awake patients. Coical inhibitory pathways are most susceptible resulting in excitatory motor phenomenon in initial stages of LA toxicity. Hypercapnia, respiratory & metabolic acidosis exacerbates CNS toxicityQ. Increased PaCO2 increases cerebral blood flow delivering greater dose of LA more rapidly to brain. And decreased intracellular pH ours formation of non diffusable cationic (protonated) form of LA, which is trapped within neuron. Finally plasma protein binding of LA is decreased in acidic environment resulting in increased availability of free drug for diffusion into brain. But the involvement of the peripheral nerve is characterized by parathesies, numbness, hypaesthesia, pain and neurological dysfunction. So, this patient is having peripheral nerve injury. It could have happened d/t: - Open (crush) injury 1/ t laceration of nerves. As the patient underwent debriment, so he is a case of open injury. Nerve injury during debriment. Nerve injury during reduction & manipulation. Tourniquet pressure palsy Nerve injury d/t tight bandage or cast.
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C i.e. Norepinephrin
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A Bezold abscess is a complication of acute otomastoiditis where the infection erodes through the coex medial to the attachment of sternocleidomastoid, at the attachment site of the posterior belly of the digastric muscle, and extends into the infratemporal fossa.
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MERCURY (QUICKSILVER) Chronic Poisoning (Hydrargyrism):- This may result from (1) continuous accidental absorption (2) excessive therapeutic use, (3) fromrecovery from a large dose, and ( 4) if ointment is used as external application for a long time. Chronic exposure leads to classic triad of gingivitis and salivation, tremors and neuropsychiatric changes. The symptoms are salivation, inflammation of gums and occasionally a blue line at their junction with teeth, sore mouth and throat, loosening of teeth , gastrointestinal disturbances, anaemia, anorexia, loss of weight and chronic inflammation of kidneys with progressive uraemia. Tremors (sometimes called Danbury tremors):- occur first in the hands, then progress to lips and tongue and finally involve arms and leg. The advanced condition is called hatter&;s shakes or* glass-blower&;s shakes, because they are common in persons working in glass-blowing and hat industries. The patient then becomes unable to dress himself. write legibly or walk Properly. The most severe form is known as concussio mercurialis, in which no activity is possible. Mercurial erethism:- is seen in persons working with mercury in minor manufacturing firms. This term is used to refer to the psychological effects of mercury toxicity. These include anxiety, depression, shyness, timidity, irritability, loss of confidence, mental depression, delusions and hallucinations, or suicidal melancholia, or manic depressive psychosis (mad hatter), emotional instability, loss of memory and insomnia. Mercurialentis:- is a peculiar eye change due to exposure to the vapour of mercury. It is due to brownish deposit of mercury through the cornea on the anterior lens capsule. Slit-lamp examination demonstrates a malt-brown reflex from the anterior lens capsule. It is bilateral and has no effect on visual acuity. Renal damage results in membranous glomerulonephritis with hyaline casts and fatty casts in the urine. Kidney is the primary target. Acrodynia or pink disease :- (because it is characterised by a generalised body rash) is thought to be an idiosyncratic hypersensitivity reaction paicularly seen in children. This can be caused by Chronic mercury exposure in any form. The onset is insidious with anorexia, insomnia, sweating, skin Rash and photophobia. Hands and feet become puffy, Pinkish, painful, paraesthetic with peeling of skin. Ref:- k s narayan reddy; pg num:-542,543
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Leucocoria (60%)
Strabismus (22%)
Decreased vision (5%).
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Endometrium has 2 zones
→ Functionalis layer
→ Basalis layer
Functionalis layer is shed during menstruation
Functionalis layer lines the uterine cavity and has surface epithelium with subepithelial capillary plexus.
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Ans. B: Delayed deep tendon reflexes Features of hypehyroidism Increased heat production - warm, moist skin, heat intolerance Telangiectasia, palmar erythema, pretibial myxoedema, onycholysis Weight loss, increased appetite, increased frequency of bowel movement but frank diarrhoea is uncommon. Oligomenorrhoea Tachycardia, exeional dyspnoea, hyperdynamic circulation; systolic hypeension is common and diastolic hypeension can occur in up to 30% of patients Tiredness, irritability, nervousness Fine tremor, hyperkinesias, hyperreflexia, muscle wasting There are eye signs in Graves' disease Others: Occasionally, bone pain due to osteoporosis In elderly patients, there may be atrial fibrillation or cardiac failure Alopecia, pruritus, pretibial myxoedema, acropachy (form of clubbing) Atypical presentation may include: Atrial arrhythmias in middle aged patients Severe proximal myopathy with normal CK values Deterioration or unmasking of myasthenia gravis Hypokalaemic periodic paralysis - especially in orientals Chronic diarrhoea Hypercalcaemia Osteoporosis Gynaecomastia
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Usually 300microgram IM is given after delivery to all non immunised Rh negative mothers.This will neutralise about 15 ml of Rh positive red cells or 30ml of fetal whole blood. TEXT BOOK OF OBSTETRICS,Sheila Balakrishnan,2nd edition,page no.310
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Nutritionally, amino acids are of two types: (a) Essential and (b) Non-essential. (c) There is also a third group of semi-essential amino acids. (a) Essential amino acids: These are the ones which are not synthesized by the body and must be taken in the diet. They include valine, leucine, isoleucine, phenylalanine, threonine, tryptophan, methionine and lysine. For remembering the following formula is used--MATT VIL PHLY. (b) Non-essential amino acids: They can be synthesized by the body and may not be the requisite components of the diet. (c) Semi-essential amino acids: These are growth promoting factors since they are not synthesized in sufficient quantity during growth. They include arginine and histidine. They become essential in growing children, pregnancy, and lactating women.Ref: Textbook of medical biochemistry, MN Chatterji, 8th edition, page no: 80
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Ans. is 'a' i.e., CitrullinemiaDisorders caused by genetic defects of urea cycle enzymesDisordersDefective enzymeProducts accumulatedHyperammonemia type-ICarbamoyl phosphate synthase-IAmmoniaHyperammonemia type-IIOrnithine transcarbamoylaseAmmoniaCitrullinemiaArgininosuccinate synthaseCitrullineArgininosuccinic aciduriaArgininosuccinate lyaseArgininosuccinateArgininemiaArginaseArginine
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Ref khurana 6th edition pg 567 Differential Diagnosis for Hard exudates Differential Diagnosis for soft exudates i. Diabetic retinopathy ii. HTN retinopathy iii. BRVO iv. CRVO v. Coats' disease vi. Retinal aery macro aneurysm vii. Radiation retinopathy viii. Eales' disease Retinopathy of toxemia of pregnancy _ Diabetic retinopathy _ Anaemic retinopathy _ LE, PAN, and scleroderma _ Leukaemic retinopathy _ Retinopathy of AIDS - Hypeensive retinopathy - Eales' disease
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- Eversion - Movement of sole of the foot outward. Foot eversion occurs at subtalar joint by Peroneus longus, Peroneus brevis and Peroneus Teius. - Inversion: Movement of the sole of the foot inward so that the soles face toward each other. Done by Tibialis anterior and Tibialis posterior.Additional information:
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Eyeball - Not a perfect sphere but an Ablate spheroid Dimensions of an adult eyeball Anteroposterior diameter - 24 mm Horizontal diameter - 23.5 mm Veical diameter - 23 mm Circumference - 75 mm Volume - 6.5 ml Reference : Khurana Ophthalmology; 4th edition Page 3
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Deficiency of any of the urea cycle enzymes result in hyperammonemia. Carbamoyl phosphate synthetase1 deficiency or hyperammonemia type 1 is comparatively rare and is characterized by severe hyperammonemia.Ref: DM Vasudevan - Textbook of Biochemistry, 7th edition, page no: 205
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DPT should be stored in a refrigerator between 2 to 8oC. Ref: PARK&;S TEXTBOOK OF PREVENTIVE AND SOCIAL MEDICINE 23rd edition , Page :162
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Ans. B: Sapheno-femoral Incompetence A test to assess the competence of the sapheno-femoral junction (sfj). Some textbooks refer to the trendelenburg test and the tourniquet test interchangeably. However, other sources describe the trendelenburg test as being essentially identical to the tourniquet test, but finger pressure is used to occlude the sfj instead of a tourniquet
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Ans. is 'd' i.e., Hemochromatosis 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 Rare causes Infections (mumps, coxsackievirus, cytomegalovirus, echovirus, parasites). Autoimmune (i.e., Sjogren's syndrome)
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Paradoxical splitting: Reverse of normal physiology, splitting of second hea sounds during expiration, singular during inspiration Seen in conditions that cause delayed conduction down the left bundle (LBBB, pre-excitation of the right ventricle, right ventricular pacing, premature RV beats), aoic stenosis ref - Harrisons internal medicine 20e pg1802-1805
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Ans. (a) Ductal carcinoma(Ref Bailey and Love 27th edition Page 873)* Paget's disease of nipple is the manifestation of underlying Ductal carcinoma, Nipple gets eroded completely and disappears.* Large ovoid cells with abundant Pale staining cytoplasm in malphigian layer of skin is Paget's cells
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Ans. Macula
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