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Ans. (C) Propylthiouracil(Ref: KDT 7th/e p964)Among the given options, the best answer seems to be propylthiouracil. Although, the latter can cause hepatotoxicity in mother.
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Ans:. (c) Sensorineural hearing lossRef Dhingras ENT. 5th ed. /124ACOUSTIC NEUROMA* Acoustic neuroma is also known as vestibular schwannoma, neurilemmoma or eighth nerve tumor.* It arises from superior division of vestibular nerve.* The tumor arises from the Schwann cells of the vestibular, but rarely from the cochlear division of 8th nerve within the internal auditory canal.Clinical Features* Age and sex: Mostly seen in age group of 40-60 years. Both sexes are equally affected.* Cochleovestibular symptoms# They are the earliest symptoms.# Most commonly manifests by Progressive unilateral sensorineural hearing loss, often accompanied by tinnitus.# Vestibular symptoms are imbalance or unsteadiness.* Cranial nerve involvement# Cranial nerve 5th is the earliest nerve to be involved (after 8th)causing loss of corneal reflex# MC clinical finding of acoustic neuroma- loss of corneal reflex# CN 7th involvement: although rare, it causes numbness or paraesthesia of face# Hitzelberger sign: Hypoaesthesia around posterior auricular area (due to CN 7th involvement)# In CN 8th Sensory fibres are affected early.# 9th and 10th nerves: There is dysphagia and hoarseness due to palatal, pharyngeal and laryngeal paralysis.* Brainstem involvement# There is ataxia, weakness and numbness of the arms and legs with exaggerated tendon reflexes.* Cerebellar involvement# Revealed by finger-nose test, knee-heel test, dysdiadochokinesia, ataxic gait, inability to walk along a straight line with tendency to fall to the affected side.* Raised intracranial tension* This is also a late feature.* There is headache, nausea, vomiting, diplopia and papilloedema with blurring of vision.
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There is very good evidence that ACE inhibitors should be used in patients with heart failure (HF) and a depressed left ventricular ejection fraction. ACE inhibitors stabilize left, ventricular remodeling, improve symptoms, reduce hospitalization, and decrease mortality. Beta- blocker therapy represents a major advance in the treatment of patients with HF and depressed systolic function. These drugs interfere with the harmful effects of sustained activation of the adrenergic nervous system by competitively blocking beta-receptors. When given with ACE inhibitors, beta-blockers stabilize left ventricular remodeling, improve patient symptoms, reduce hospitalization, and decrease mortality. An aldosterone antagonist is recommended for patients with NYHA class III or IV symptoms who have a left ventricular ejection fraction of less than 35% and who are still symptomatic despite receiving standard therapy with diuretics, ACE inhibitors, and beta-blockers. Likewise, digoxin may improve symptoms and decrease hospitalization rates in patients with HF but has not been shown to prolong life. Neither of these drugs is indicated in this patient with mild symptoms. Furosemide is used to improve symptoms but does not prolong survival. Since this patient wants to minimize medications, an ACE inhibitor and beta-blocker are better first choices because they confer a survival advantage. An implantable defibrillator is indicated in systolic heart failure with left ventricular ejection fraction less than 35% in order to prevent sudden cardiac death but is not indicated in this patient whose ejection fraction is 40%.
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Ans. (D) Milrinone(Ref: Goodman and Gilman, 11th/e p575, Harmon 17th/e p1455)Inotropic drugs are not used for treatment of right sided heart failure where the major treatment is diuretics and vasodilators. Milrinone being a phosphodiesterase inhibitor act as an inodilator. Thus, this is the only inotropic drug that should be used in right sided failure due to its ability to produce vasodilation. It is indicated in right heart failure with pulmonary hypertension.
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Radiological signs of mitral stenosis
Due to left atrial enlargement:- Straightening of left heart border, elevation of left main bronchus with the widening of the carina, double atrial shadow (Double density sign), posterior displacement of the esophagus on barium swallow, Prominent posterosuperior part of the cardiac shadow.
Due to pulmonary venous hypertension :- Diversion of blood flow from the lung bases to the upper zone (cephalization of pulmonary vascularity), pulmonary hemosiderosis, peribronchial cuffing, Kerley B lines and sometimes Kerley 'A' lines, perihilar haze, alveolar edema, small pleural effusion, pulmonary ossicles, fine punctate calcification in lung.
Due to elevated pulmonary hypertension:- Enlargement of central pulmonary vessels with peripheral pruning.
There is increased blood flow (plethora) in upper lung fields due to the diversion of blood flow to the upper zone.
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Viral thyroditis has initial hyperthroid state due to release of harmones due to gland destruction.
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The adaptive immune system consists of 2 types of lymphocytes: T-cells (70-80% of the adaptive immune force) and B cells (10-20% of the adaptive immune force).Antigens (triangular shapes above) are ingested (1), paially digested (2) and then presented to helper T cells by special cells called macrophages (3). This process activates the helper T cell to release hormones (lymphokines) that help B cells develop (4). These hormones, along with recognition of fuher antigens (5), change the B cell into an antibody-producing plasma cell (6). The antibodies (Y shapes above) produced can be one of several types (IgG, IgM, IgA, IgE and IgD) (7). The antibody "fits" the antigen much like a lock fits a key. The antigen is thus rendered harmless. The helper T cells also aid in development of cytotoxic T cells (8), which can kill antigens directly; memory T cells are produced (9) so that re-exposure to the same antigen will provide a more rapid and effective response (10). Reff: www.mayoclinic.com
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Ans. is 'a' i.e., Loss of antithrombin III Causes of Hypercoagulability in nephrotic syndrome o Loss of antithrombin III o Increased synthesis of fibrinogen by liver. o Altered activity of protein C and S o Increased platelet aggregability. o Hypercoagulability can cause renal vein thrombosis.
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Fever is a minor criteria
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Atracurium is preferred in CLD patients since it is metabolised by Hoffmann elimination.
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Ref-KDT 6/e 824,825 Vincristine is a chemotherapy drug that belongs to a group of drugs called vinca alkaloids. Vincristine works by stopping the cancer cells from separating into 2 new cells. So, it stops the growth of the cancer by polymerization
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Answer is D (Renal failure) Renal failure occurs in nearly 25% of Myeloma patients and some renal pathology is noted in over half. Multiple Myeloma is associated with Lvtic bone lesion and Bone Resorption The bone lesions of Myeloma are caused by activation of osteoclasts that destroy bone and suppression of osteoblasts that form bone. Bone lesions are thus lytic in nature and not sclerotic. There is a net resorption of bone and not bone deposition. Multiple Mveloma is associated with Hypercalcemia and not Hypocalcemia Hypercalcemia is caused by substantial mobilization of calcium from bone due to associated bony lysis.
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(A) Submental disorderMajority of children with Down syndrome function in mild to moderate range of mental retardation.[?]Down syndrome/Trisomy 21:Chromosome 21 genetic disorder, associated with physical growth delays, characteristic facial features and mild to moderate intellectual disability.Neurodevelopmental disorder for studying the biological consequences of polygenic, complex disorders, as the source of polygenic disruption (trisomy 21) is well established.Among these, a characterization of the DS developmental brain transcriptome found that approximately 5 percent of genes on all chromosomes were dysregulated at some point in development, with a roughly equal number of up- and down-regulated genes, with the exception of 18 percent of Chr21 genes, all of which were up-regulated.Revealed prominent hypomyelination, disorganization of myelinated fibers, and slower conductance through myelinated fiber tracts as features of DS neuropathology.Neurological Features of Down Syndrome:Most individuals with Down syndrome haveMild (IQ: 50-69) orModerate (IQ: 35-50) intellectual disabilitySevere (IQ: 20-35) difficulties.Typically have IQ scores 10-30 points higher.Typically perform less well than their same-age peers.After 30 years of age some may lose their ability to speak.This syndrome causes about a third of cases of intellectual disability.Many developmental milestones are delayed with the ability to crawl typically occurring around 8 months rather than 5 months and the ability to walk independently typically occurring around 21 months rather than 14 months.Down syndrome have better language understanding than ability to speak.Between 10 and 45% have either a stutter or rapid and irregular speech, making it difficult to understand them.Do fairly well with social skills.Behavior problems are not generally as great an issue as in other syndromes associated with intellectual disability.Mental illness occurs in nearly 30% with autism occurring in 5-10%.Experience a wide range of emotions.Are generally happy, symptoms of depression and anxiety may develop in early adulthood.Are at increased risk of epileptic seizures, which occur in 5-10% of children and up to 50% of adults.Increased risk of a specific type of seizure called infantile spasms.Many (15%) who live 40 years or longer develop Alzheimer disease.In those who reach 60 years of age, 50-70% have the disease.Other Options[?]Oligophrenia:Oligophrenia Old term for mental retardation.[?]Madness:Insanity, a spectrum of behaviors characterized by certain abnormal mental or behavioral patterns.Mental disorder, a diagnosis of a behavioral or mental pattern that may cause suffering or poor ability to function.[?]Mentally unstable or Mental Illness:Mental instability, or mental illness, is a condition that greatly affects a person's thoughts and behaviors.Individuals who are mentally unstable often experience difficulty coping with the everyday functions, demands and challenges of life.There are several signs and symptoms that indicate a person is suffering from a mental instability.With treatment and care, many individuals are able to learn to cope with mental illness.
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"Any patient of diabetic retinopathy with floaters and vision loss need urgent referrel to rule out vitreous hemorrhage". — Basics of Ophthalmology
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Ans. is 'a' i.e., Meckel's diveiculum See 4th point (It is due to peptic ulcer in Meckel's diveiculum)
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Ans. is a, b and c i.e. GnRH against; Danazol; and Mifepristone
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Ans. B: Clostedium difficile Pseudomembranous colitis is an acute inflammatory disease of the colon that in mild cases may appear as minimal inflammation or edema of the colonic mucosa. In more severe cases, the mucosa often is covered with loosely adherent nodular or diffuse exudates. These raised exudative plaques are 2-5 mm in size. Coalescence of these plaques generates an endoscopic appearance of yellowish pseudomembranes lining the colonic mucosa, Pseudomembranous colitis usually is associated with antibiotic use, which may alter the balance of normal gut flora and allow overgrowth of ceain organisms. C difficile, a gram-positive, spore-forming, anaerobic bacillus, is isolated in almost all of the cases of Pseudomembranous colitis. Clindamycin, lincomycin, ampicillin, and cephalosporin have been implicated in most of the repoed cases, but any antimicrobial agent (including antifungal, antiviral, and metronidazole) could incite the disease, regardless of the amount administered or the route of administration. Rare cases have been related to Staphylococcus aureus, Salmonella species, Clostridium perfringens, Yersinia species, Shigella species, Campylobacter species, cytomegalovirus, Entamoeba histolytica, and Listeria species. Conditions other than antimicrobial administration could predispose to C difficile pseudomembranous colitis. Such conditions include bowel ischemia, recent bowel surgery, uremia, dietary change, change in bowel motility, malnutrition, chemotherapy, shock, and Hirschsprung disease.
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Erythrasma is caused by corynebacterium minutissimum.
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Structures related to sphenoid sinus are foramen rotundum (maxillary nerve), optic canal (optic nerve and ophthalmic artery), vidian canal (with nerve), internal carotid artery.
Mandibular nerve is not related to sphenoid sinus.
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Ans. is 'b' i.e., B cells o Insulin is a polypeptide hormone which is synthesized as a larger preprohormone (preproinsulin).o Asthepreprohormone enters the endoplasmic reticulum, 23 amino-acid signal peptide is removed and it is converted to prohormone (proinsulin).o Proinsulin is made up A and B chain connected by a connecting peptide (C-peptide or C-chain).o C-peptide is detached in the granules before secretion. Normally, 90-97% of the product released from B cells is insulin along with equimolar amounts of C-peptide.o Insulin is a two chain polypeptide having 51 aminoacids: The A chain has 21 while B-chain has 30-aminoacids.o Half life of insulin is about 5 minutes.
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Hypeension Mivacurium belongs to non depolarizing blocker or competitive skeletal muscle relaxants. This class of drugs acts by competitively inhibiting the Nm receptors and thus causing relaxation. The action of these drugs can be reversed by anticholinesterase like neostigmine. Mivacurium is the only noridepglarising neuromuscular blocker that is metabolised by plasma cholinesterase. Mivacurium is the shoest acting non depolarizing muscle relaxant. The usual intubuting dose is *15-.2 mg/kg. Mivacurium causes histamine, release but it generally does not cause serious side effects except for small degree Mivacurium causes histamine release due to direct action on mast cells, release of histamine which leads to hypotension, flushing and bronchospasm. of hypotension. But when mivacurium is given in large doses to increase the onset of action it causes increased On increasing the dose, the onset of action is increased.
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P-32 is a radio-active substance. It is a beta emitter with a half-life of 14 days. It is used for systemic radiotherapy of Polycythemia Vera. I-127 is a normal iodine and it is not a radio-active substance
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8-hydroxyquinoline like quiniodochlor can result in SMON Ref-KDT 6/e p801
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B i.e. Congenital Megacolon
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Ans. Answer is B (Liver): Most common primary site- LIVER (primary complex in liver is suggestive of congenital TB) Most common site is- LUNG The form of disease is usually miliary with multiple organ involvement. Lungs are involved in almost all cases. Other sites frequently involved are liver, spleen, lymph nodes, the gastrointestinal tract and kidney'. -Textbook of Pulmonary Medicine by Behera 2"a/495
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Onchocerca volvulus causes river blindness and is transmitted by the bite of a black fly. The patient may be able to detect movement in the eye. Ancylostoma braziliense -hookworm not associated with eye infection Trichinella spiralis-not associated with eye infection. infection by ingestion Dracunculus medinensis- infection by drinking water from stagnant pool, present with papule
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INDERBIR SINGH'S TEXTBOOK OF HUMAN HISTOLOGY-PAGE NO:204 Sebaceous glands The outermost layer are small and rest on a basement membrane.the inner cells are larger,more rounded,and filled with lipid .this lipid is discharged by disintegration of the inner most cells that are replaced by proliferation of outer cells.the sebaceous glands are therefore,examples of holocrine glands
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Since the stomach is connected both to oesophagus and dudoenum so double ligature along the greater curvature of stomach is usually done so that stomach could be taken out for post moem examination.
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Ans, is 'c' i.e., Both live and inactivated o Two types of hepatitis A vaccines are usedFormaldehyde inactivated vaccineLive attenuated vaccineLive 'attenuated' vaccinesKilled 'inactivated' vaccinesBCGOPV (Sabin - Oral polio vaccine)Measles vaccineMumps vaccineRubella vaccineYellow fever vaccineTyphoralHepatitis - APertussis1PV (Salk - Inactivated polio vaccine)Rabies vaccineCholera vaccineMeningococcal vaccineHepatitis B vaccineTyphim - Vi vaccineHepatitis - A
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option A is false regarding MR, explanation : MRI is considered most sensitive to detect implant rupture.
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Furosemide Free water clearance Kidney excretes some solutes in the urine daily. The volume of water in urine, excreted per unit time in excess of that required to excrete the contained solutes isoosmatically with plasma is called free water clearance. Free water clearance is positive dilute urine, negative when concentrated urine is passed and zero when isotonic urine is passed. For example, if 1 lit water is required to excrete the contained solutes per day following three conditions may occur (numerical value are just for example). - If urine output is 1.5 litre than free water clearance will be + (positive) *5 lit/day. - If urine output is 1 litre per day, the free water clearance will be zero. - If urine output is *5 litre per day, the free water clearance will be -- (negative) .5lit/day. Action of diuretics To understand the effect of different diuretics on free water clearance one should know the following facts. The nephron of the kidney is arranged in such a way that some poion of it lies in the coex and some poion of it lies in the medulla. - Pas of nephron in the coex - Proximal convoluted tubule Distal convoluted tubule Thick ascending limb of Henle's loop Coical collecting duct - Pas of nephron in the medulla -9 *Descending thin limb of Henle's loop Ascending thin limb of Henle's loop Medullary collecting duct The coical poion of the nephron are responsible for diluting the urine (i.e., positive free water clearance) The medullary poions of the nephron are responsible for concentrating the urine (i.e.. negative free water clearance) Thus the diuretics which act on both medulla and coex can affect both the positive and negative free water clearance where as diuretics which act on either coex or medulla cannot affect both the negative and positive free water clearance. Furosentide Furosemide is a drug which act on both coex and medulla. It acts on the ascending limb of loop of henle which has both coical and medullary component i.e. the thin ascending pa is situated in the coex and the thicker poion is situated in the medulla. Furosemide acts in the following ways: - In hypovolemia medullary pa of ascending limb concentrate the --) negative free water clearance urine to preserve water --> block negative free water clearance - Furosemide blocks the concentrating ability of the ascending limb pa of medullary pa - In volume overload, coical poion of ascending limb of henle --) positive free water clearance loop dilute the urine to decrease the volume overload - Furosemide blocks this diluting ability as well block positive free water clearance. Thus Furosemide can block positive as well as negative free water clearance. Thiazide diuretics act on DCT and proximal pa of CD, block positive free water clearance but has no effect on negative free water clearance. In hypervolumia DCT dilute the urine to decrease the volume overload -4 positive free water clearance --> blocked by thiazide. As thiazide diuretics no effect on medullary interstitium (in contrast to furosamide) so it does not effect the kidney's ability to concentrate urine during hypovolemia --4 no effect on negative free water. Two more options given in the question block free water clearance Vincristine Vincristine increases the secretion of the hormone A.D.H. Inreased A.D.H blocks free water clearance. Chlorpropamide Chlorpropamide sensitizes the kidney to ADH action. Thus it may impair the free water clearance and in some patients may result in hyponatremia and water intoxication. The impoant point to remember about chlorpropamide is that its action depends on small amount of ADH it won't act in the absence of ADH. Most probably the question should have been framed as "All of the following blocks free water clearance, except" But if you have to choose one answer, go for Furosemide as it will always block free water clearance whereas other drugs will cause them occasionally as their adverse effect.
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<p>Davidson&;s principles and practice of medicine 22nd edition. *Timor secreted gastrin which stimulated gastrin production to its maximum capacity.</p>
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PA catheter & thermodilution technique are invasive procedure.
Echo is noninvasive old technique to measure cardiac output.
Recent noninvasive advance to measure C.O. is electrical impedance cardiography technology
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• Sabiston says “Stab and low-velocity wounds to the colon with minimal contamination and hemodynamic stability can be managed by primary repair.”
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Urea cycle * Cleavage of argininosuccinate by argininosuccinate lyase, results in formation of arginine and release of the aspaate skeleton as fumarate (funnelled into TCA cycle) * Subsequent addition of water to fumarate forms l-malate, with subsequent oxidation forms oxaloacetate, followed by its transamination by glutamate aminotransferase then re-forms aspaate. * Argininosuccinate synthase links aspaate and citrulline forms argininosuccinate. * Thus the urea cycle is linked to TCA cycle through fumarate Ref:- Harper 30/e; pg num:- 294
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Ans. is 'a' i.e., 2, 4 and 6 months o In category I, sputum examination is done at 2 months after the treatment, i.e. at the end of intensive phase of treatment. i) If test is negative, continuation phase is staed and sputum is tested again at 4 and 6 months. If test is positive, intensive phase is continued for one more month. o The number before the letters refers to the number of months of treatment. The subscript after the letters refers to the number of doses per week. H : Isoniazid (600 mg), R : Rifampicin (450 mg), Z : Pyrazinamide (1500 mg), E : Ethambutol (1200 mg), S : Streptomycin (750 mg). Patients who weight more than 60 kg receive additional Rifampicin 150 mg. Patients more than 50 years old receive streptomycin 500 mg. Patient in categories I and II, Who have a positive sputum smear at the end of the initial intensive phase, receive an additional month of intensive phase treatment. o Examples of seriously ill extra-pulmonary TB cases are meningitis, disseminated TB, tuberculous pericarditis, peritonitis, bilateral or extensive pleurisy, spinal TB with neurological complications and intestinal and genito-urinary TB. o In rare and exeptional cases, patients who are sputum smear-negative or who have extra-pulmonary disease can have relapse or failure. This diagnosis in all such cases should always be made by an MO and should be suppoed by culture or histological evidence of current, active tuberculosis. In these cases, the patient should be categorized as 'other' and given category II treatment. o Any patient treated with category I who has a positive smear at 5 months of treatment should be considered a Failure and staed on category II treatment, afresh. If category I sputum smear-ye case fails to improve or if patient develops pulmonary signs and positive smear at the end of intensive phase, it is considered treatment failure. Sta category II treatment and confirm failure by culture and perform DST.
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Family history & genetic vulnerability, Co-morbid personality disorder and peer pressure are etiological factors for substance use disorder.
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Regardless of the cause, the classical histological picture of RPGN is characterized by the presence of crescents in most of the glomeruli.
So, RPGN is also known as crescentic glomerulonephritis.
Crescent formation
Despite the wide variety of diseases that causes RPGN, all types of RPGN are characterized by glomerular injury and the formation of crescents.
Severe injury and GBM rupture lead to the leakage of plasma proteins through the GBM.
Of these proteins, fibrin is thought to contribute most strongly to the crescent formation.
Parietal epithelial cells lining the bowman capsule respond to the leaked fibrin and proliferate.
Infiltrating white blood cells such as monocytes and macrophages also proliferate.
These proliferating cells surround and compress the glomerulus, forming a crescent-shaped scar that is readily visible on light microscopy of a renal biopsy.
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MastoidIt is an air sinus in the petrous temporal bone.Its upper anterior wall has the opening of aditus, while medial wall is related to posterior semicircular canal (SCC).Posteriorly lies the sigmoid sinus.The posterior belly of digastric muscle forms a groove in the base of mastoid bone.The corresponding ridge inside the mastoid lies lateral not only to sigmoid sinus but also to facial nerve and is a useful landmark.The roof is formed by tegmen antri separating it from middle cranial fossa and temporal lobe of brain. o Anteroinferior is the descending pa of facial nerve canal (or fallopian canal).Lateral wall is formed by squamous temporal bone and is easily palpable behind the pinna.
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(B) Achalasia cardia[?]Achalasia, a disorder of esophagus characterized by progressive inability to swallow solids & liquids.Causes include weakened esophageal muscles & issues with lower esophageal sphincter relaxationHeller Myotomy, surgical procedure offers long term symptomatic relief to these patients.It involves weakening of muscles at gastroesophageal junction, allowing the valve between oesophagus & stomach to remain open.[?]Achalasia Treatment: 2 main methodsHeller's Myotomy:Surgical therapy now involves usually performing only an anterior myotomy, via either abdominal or thoracic approach. In addition to laparosocopic myotomy, thoracoscopic myotomy has also been described.Thoracic approach does have certain drawbacks.Heller's Cardiomyotomy - surgical 7-10 cm long incision made through lower oesophageal end & carried over to stomach, muscles are cut till mucosa bulges out. Myotomy should be extended up to aortic arch & distally up to stomach to 1-2 cm below the junction.Forceful dilatation - using Pneumatic Balloon under fluoroscopic control within LOS (300 mmHg pressure applied for 15 sec).Injection Treatment - Injection Botulinum toxin is injected in LES endoscopically, blocks ACh release.Drugs - Sublingual nifedipine gives short term relief.Endoscopic MyotomyLaparoscopic Heller's Myotomy (LHM):Myotomy from 1.5-3 cm distal to the ECJ dividing the longitudinal & oblique muscle to 6-8cm proximal to the ECJ dividing longitudinal & circular muscle of esophagus.Partial fundoplication is routinely performed as incidence of reflux after Heller's myotomy is >50%.It is due to loss of the ganglion cells in the myenteric (Auerbach's) plexus & cause is unknown.Chaga's disease (due to Trypanosoma cruzi) has marked similarities to achalasia.Other Options[?]Hiatus Hernia:True paraoesophageal hernias with cardia remains in its anatomical position are rare.Vast majority of rolling hernias are mixed hernias in which the cardia is displaced into the chest & greater curve of the stomach rolls into the mediastinum.Elective surgery includes reduction of the hernia, excision of the sac, reducing the crural defect & retention of the stomach in the abdomen.[?]Gastro Oesophageal Reflux Disease:Classical triad of symptoms is retrosternal burning pain (heartburn), epigastric pain (sometimes radiating through to the back) and regurgitation.GORD treated by medical management by proton pump inhibitor therapy +H2 receptor antagonists.Surgery includes;1. Allison repair of hiatus hernia; 2. Nissen fundoplication; 3. Hill procedure; 4. Belsey mark IV operation.[?]Duodenal stenosis:Duodenal atresia is the congenital septum of duodenal obstruction at the commencement of the third part of the duodenum.Repaired by duodenoduodenostomy.
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The dose of parenteral iron is calculated using formula given in Q. 14. If the dose is more than 50 ml (each ml has 50 mg of iron i.e. 2500 mg iron), then half the dose is given on day one and second half on next day. Thus maximum iron which can be given in a day is 2500 mg.
ACOG recommends the use of iron sorbitol as it is safer than iron dextran.
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Ans: (b) BupivacaineRef: KDT 6th ed. 1357* Bupivacaine is a local anesthetic agent from Amide group.* It is most cardiotoxic LA.* Shortest acting LA: Chlorprocaine* Longest acting LA: Dibucaine* Most commonly used LA: Lignocaine* Local anesthetic which causes methhemoglobinemia: Prilocaine
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Mayer Rokitansky Kuster Hauser syndrome ; Mullerian Agenesis Disorder of genital development charecterised by absence of vagina, an absent or hypoplastic uterus and normal or hypoplastic fallopian tubes Typically ovaries are normal Secondary sexual charecters are well developed May be associated with urologic anomalies and Skeletal malformations Ref: Clinical Gynecologic Endocrinology and Infeility; Eigth Edition, Chapter 9
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PNH * Paroxysmal nocturnal hemoglobinura (PNH ) is an acquired intrinsic defect in RBC membrane * Its due to mutation in PIGA gene (phosphatidyl inositol glycan complementation group A) PNH red cell are deficient in :- * CD55 or decay accelerating factor * CD 59 or membrane inhibitor of reactive lysis * C8 binding protein * Characterised by pancytopenia, hemolysis and thrombosis * Diagnosed by FLOWCYTOMETRIC ANALYSIS * Thrombosis is the leading cause of disease related death Ref:- Robbins Basic Pathology 10th Edition; Pg num:- 642,643
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Ans: (b) Stimulate CNSRef: Kaplan and Sadock's Comprehensive Textbook of Psychiatry, 10th editionANALEPTICSAnaleptic drugs are basically CNS stimulants*.They also stimulate respiration by neural and other mechanisms.They are grouped based on their mechanism of action:Serotonin receptor agonists - BuspironeAMPA agonists - Ampakines (under trial)Adenosine antagonists - Caffeine (Methylxanthines)Potassium channel blockers - DoxapramUses:Serotonin receptor agonists - Depression*AMPA agonists - Used for research purposesAdenosine antagonists - Bronchodilator (Respiratory distress syndrome, Reactive airway disease)Potassium channel blockers - Reversal of respiratory depression (Following anesthesia, drug overdose, neonatal apnea, respiratory failure etc.)Side Effects:Excessive CNS stimulation - Irritability, anxiety, tremors, palpitations, seizures, insomnia, elevated pulse and BP.
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Avulsion It is a lacerated wound that is produced by a tangential force at an acute angle( shearing force). A poion of skin with soft tissues is found detached. This type of laceration usually occurs in traffic accidents. This happens when a heavy weight produces a shearing and rotatory force, like a lorry wheel passes over a limb. This is called flaying. ref: FORENSIC MEDICINE AND TOXICOLOGY Dr PC IGNATIUS THIRD EDITION PAGE NO 121
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Bell’s palsy is an idiopathic, lower motor neuron type of Facial nerve palsy
Facial nerve palsy secondary to VZV/Herpes zoster is called Ramsay Hunt Syndrome
Contralateral facial involvement with sparing of upper half is typical of UMN facial nerve palsy, because of bilateral representation of the upper part of the face.
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The clinical features of tetanus are:
Trismus combined with pain and stiffness of neck, abdomen and back.
Dysphagia.
Anxious expression (risus sardonicus).
The muscles of neck and trunk become rigid and the back is slightly arched (opisthotonus).
Respiratory failure.
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Ans- D 12-15 months Timing of elective surgery for various conditions Cleft lip 3mon Cleft soft palate. 3mon Cleft hard palate. 12-15 Mon Combined soft and hard palate. 1 y Combined lip plus soft palate - 3 months Umbilical hernia - conservative till 2 years of age. Surgery if still symptomatic Hypospadias. 6-12 Mon Inguinal hernia. As early as possible Hydrocele. >1 y Undescended testis. 6m - 1 y PDA. At birth COA. 3-4 y or as soon as the child is medically fit.
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Tacrine was not discontinued due to hepatotoxicity Donepezil, gallatamine, rivastigmine can be used which are lipid soluble and can cross BBB easily Pyridostigmine and neostigmine are quaernary amines which do not cross BBB hence not used in Alzheimers Ref: KDT 6th ed pg 104
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250 ml of NS contains 200 mg x 2 = 400 mg vaso-pressure1 ml NS contains = 1.6 mg vaso-pressureVaso-pressure staed 10 micro/kg/min or 80 x 10 micro g/min = 800 micro g/min or 0.8 mg /minVaso-pressure staed 0.8 mg/ min 0r 0.5 ml/ min (1 ml NS contains = 1.6 mg vaso-pressure) or 8 drops/ min (1 ml = 16 drops)
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Ans. is `c' i.e., Glucose SugarNumber of carbon atoms Aldoses (Aldosugars)Ketoses (ketosugars)Trioses2 GlyceraldehydeDihydroxyacetoneTetroses4 ErythroseErythrulosePentoses5 Ribose, XyloseRibulose, xyluloseHexoses6 Glucose, galactase, mannoseFructoseHeptoses7 GlucoheptoseSedoheptulose
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Increase in Blood glutamine indicates hyperammonemia, which occurs in all enzyme defect of urea cycle Increased uracil indicate Ornithine trans carbamoylase deficiency Orotic acid, OMP, UMP are increased in OTC defect. OTC deficiency (Excess carbamoyl phosphate from mitochondria enters cytoplasm and takes pa in pyrimidine synthesis) WITH REGARDS TO OTHER OPTIONS If citrulline is increased then it is Argino succinate synthetase deficiency. ( OPTION II) CPS-II (carbamoyl phosphate synthetase-II) is enzyme involved in pyrimidine synthesis, not in urea cycle. (OPTION III)
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A i.e. Chalcosis
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de Quervain&;s tenosynovitis results from inflammation of common sheath of abductor pollicis longus and extensor pollicis brevis tendons. Finkelstein&;s test can be done in this case Reference - Essential ohopaedics-Maheshwari-5th edn-pg no 303
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Damage to spinal accessory nerve causes drooping of the shoulder, difficulty in overhead abduction and difficulty in shrugging of the shoulder due to paralysis of the trapezius.
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CPDA is Citrate-Phosphate-Dextrose buffer supplemented with adenine. The shelf life of RBC concentrates in CPDA is 35 days. In CPD buffer life span is 28 days.
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Receptor Types 1. Ion-channel Receptors (Ionotropic Receptors) 2. G-Protein Coupled Receptors (Metabotropic receptors) 3. Kinase-linked Receptors 4. Intracellular Receptors (Cytosolic Receptors) 5. Enzymes as Receptors 6. Drugs which act through Modulation of Voltage Gated Ion Channels (Voltage-Operated Channels) POLYCYTHEMIA VERA * Polycythemia vera (PV) is a slow-growing type of blood cancer in which your bone marrow makes too many red blood cells. Polycythemia vera may also result in production of too many of the other types of blood cells -- white blood cells and platelets. * PV is a clonal stem cell disorder in which there is an alteration in the pluripotent progenitor cell leading to excessive proliferation of erythroid, myeloid and megakaryocytic progenitor cells. Over 95% of patients with PV have acquired mutations of the gene Janus Kinase 2 (JAK2) ref /: (kumar and clark&;s clinical medicine).
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Octreotide is a synthetic octapeptide with actions similar to somatostatin. Routes of administration: - Intravenous (v. sho duration of action) - Subcutaneous - Intramuscular (depot preparation) It is 40 times more potent than somatostatin in suppressing GH secretion. It is being preferred over somatostatin for acromegaly and secretory diarrheas associated with carcinoid, AIDS, cancer chemotherapy or diabetes. Uses Based on propeies of inhibiting secretion of various hormones (GH, TSH, PL, insulin, glucagon), all gi secretions (including gastrin & HCI) and constriction of splanchnic, hepatic and renal blood vessels. Carcinoid and Vipoma induced secretory diarrhea and systemic symptoms such as flushing and wheezing. Diarrhea due to vagotomy and dumping syndrome, sho bowel syndrome or AIDS. GI bleeding Pancreatic fistula, insulinoma, glucagonoma, pancreatic ascites Oncogenic osteomalacia Acromegaly Adverse effects: Abdominal pain, nausea, steatorrhoea, diarrhea, gall stones.
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Ans. is 'b i.e., Halophilic V. Vulnificus V. vulnificus is a halophilic vibrio. It has been linked to two distinct syndrome.
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ParvovirusClinical manifestations:Erythema infectiosumPolyahropathy syndromeTransient aplastic crisisPure red cell aplasia/chronic anemiaHydrops fetalisHepatitis, vasculitis, myocarditis, glomerulosclerosis, CNS manifestationsNote:Tropical sprue is most often caused by infectious agents like G. lamblia, Yersinia enterocolitica, C. difficle, Cryptosporidium parvum, and Cyclospora.(Ref: Harrison's 18/e p1435, 1478 ; 17/e p1116-1117)
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Severe periodontitis occurs in patients with neutrophil defects.
Defective neutrophil function is seen in:
Papillon Lefeure syndrome.
Chediak Higashi syndrome.
Juvenile periodontitis.
Neutropenia
Agranulocytosis
Diabetes
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Munsell system is used to measure different colours quantitatively.
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Ans. (b) AnticholinergicRef. KDT 6th ed. /107; Katzung Pharma 10th ed. Ch 8 MOA oxybutynin - cholinergic-muscarinic receptor antagonist* Oxybutynin is a selective M3 receptor blocker, used to relieve bladder spasm after urologic surgery, eg, prostatectomy. It is also used to relieve urinary and bladder difficulties, including frequent urination and inability to control urination, by decreasing muscle spasms of the bladder.* It competitively antagonizes the M3 subtypes of the muscarinic acetylcholine receptor.* M3 receptor blockers: (Mn: SOFT blaDar)# Solifenacin, Oxybutynin, Flavoxate, Tolterodine and Darifenacin
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The child is showing features of beta thalssemia intermedia. Definitive diagnosis of this condition can be made by hemoglobin electrophoresis which shows HbF in the range of 10-50%, High HbA2 >4%. Criteria for diagnosing beta thalassemia intermedia includes: Clinical: Late presentation 2-5years, with relatively high hemoglobin 8 -10 g/dl and moderate bone changes and hepatosplenomegaly. Serum electrophoresis showing HbF in the range of 10-50%, High HbA2 >4% Genetics: One or both parents can be a silent carrier, absence of heterozygosity for beta thalassemia or presence of high HbF beta thalassemia. Molecular: Mild beta thalassemia mutation, Co inheritance of alpha thalassemia, co inheritance of high fetal hemoglobin. Ref: Harrison's Internal Medicine, 18th Edition, Page 859 ; Kochars Clinical Medicine for Students By Dario.M.Torre, Page 582
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Ans. 50% of cases
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proactin is more in NREM sleep in ovulation its low ref : dutta 9th ed
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Ans. is 'b' i.e., Antiplatelet action
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Systemic coicosteroids - Not recommended for psoriasis, because the disease tends to recur in more severe form after cessation of therapy. Have sho term effectiveness. Can be used in extensive or severe form of generalized pustular psoriasis as a life saving measure when other drugs are contraindicated or ineffective.
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Remember after CVS:
Anti-D immunoglobulin 50 m gm IM should be administered to a Rh-negtive woman.
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(d) Allergic rhinitis(Ref. Scott Brown, 8th ed., Vol 1; 1150)Rhinosporidiosis is a Protistan Protozoa infection and does not lead to septal perforation.
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Has a large veebral body.CharacteristicsCervicalThoracicLumbar* Foramen transverversarium intransverse processpresent (transmitsveebral aery)absentabsent* Veebral foramentriangularcirculartriangular* Veebral bodysmall & broad fromside to sidemedium sized &hea shapedlarge & kidneyshaped* Sup. aicular facetsface backwards &upwardsbackwards &laterallyface medially* Inf. aicular facetsface downward &forwardface forward andmediallyface laterally* Facets for aiculation with ribs onbody & transverse processesabsentpresentabsent* Spinous processsmall & bifidlong & inclineddownwardssho, flat,quadrangular &project backward
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Ans. (a) Chlonorchis sinensisRef: Bailey 26th edition Table page 1115* Opisthorcis vivernii and Clonorchis sinensis are associated with Cholangiocarcinoma.
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Ans. is 'd' i.e., 5HT4 Mosapride* It is a congener of cisapride with similar gastrokinetic and LES tonic action due to 5-HT4 agonistic (major) and 5-HT3 antagonistic (minor) action in the myenteric plexus.* Like cisapride, it has no clinically useful antiemetic action and does not produce extrapyramidal or hyperprolactinaemic side effects because of absence of D2 blocking property.* Side effects are diarrhoea, abdominal pain, headache, dizziness and insomnia.* Preclinical studies showed that it may not have the potential to prolong Q-T interval and carry risk of arrhythmias. Therefore, it was introduced as a safe prokinetic. However, after general use some reports of Q-T prolongation and arrhythmias, including torsades de pointes , among recipients have appeared.* Like cisapride, its plasma concentration is elevated by erythromycin and other CYP3A4 inhibitors increasing the risk of Q-T prolongation.* Though, it has not been banned, it may not be as safe as considered earlier.* Indications of mosapride are--nonulcer dyspepsia, diabetic gastroparesis, GERD (as adjuvant to H2 blockers/ PPIs), and some cases of chronic constipation. However, efficacy is not impressive.
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Ways to prevent intraventricular hemorrhage in a preterm neonate: Antenatal steroid use Minimal & gentle handling Avoiding rapid boluses or infusion of hyperosmolar solution Avoiding high pressures during mechanical ventilation
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The specimen in the picture is typical of leiomyomas or fibromyoma, or fibroids of the uterus. Gross Features of Uterine Leiomyoma (Fibroid, Myofibroma. Fibromyoma, Leiomyofibroma, Fibroma, Myoma) Sharply circumscribed, round, firm, grayish white masses The tumor is well circumscribed, but not encapsulated Often shells out Cut surface has a white whorled appearance that has been likened to raw silk. Often has a bulging and trabeculated cut surface. Usually within myometrium (intramural), may be submucosal or subserosal May be multiple Leiomyomas are the most common uterine tumors of smooth muscle origin, often admixed with variable amount of fibrous tissue component. Ref: Harsh Mohan , Atlas of Surgical Pathology
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Answer is B (Lung cancer): Bronchiectasis is not a premalignant condition. Complications of Bronchiectasis: Massive hemoptysis. Empyema with or without bronchopleural fistula. Purulent pericarditis. Respiratory failure with chronic cor pulmonale. Metastatic abscesses in brain and bones. Secondary amyloidosis with nephrotic syndrome. Lung abscess: Bronchiectasis is a predisposing factor for Lung abscess .
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ERCP - Considered the gold standard for the diagnosis of CP, the advent of secretion MRCP and EUS have significantly decreased its role as a diagnostic test ERCP : detection of early pathologies and simultaneous treatment possible (e.g., duct dilation, stent inseion) Ductal stones, seen as filling defects"Chain of lakes" or "string of pearls" appearance (characteristic feature)Irregularity, dilation of the main pancreatic duct Ref: Sabiston 20th edition Pgno :1535
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Ans. (a) Normal level is 10-14ng/mL.Ref: Campbell Urology 11th Edition, Page 2418* Normal serum concentration in men aged 50 to 80 years without prostatic disease range from 1to4ng/ml1.
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Rubeola is the other name for measles.
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Electroretinography (ERG) measures the electrical response of the retina to flashes of light, the flash electroretinogram, or to a reversing checkerboard stimulus, the pattern ERG (PERG).All other test in the option tests the integrity of optic nerve. Perimetry or Tangent Screen examination is used to examine the central and peripheral visual fields. Usually performed separately for each eye, it assesses the combined function of the retina, the optic nerve, and the intracranial visual pathway. The visual evoked response (VER) measures the electrical potential resulting from a visual stimulus. However, because it is measured by scalp electrodes placed over the occipital coex, the entire visual pathway from retina to coex must be intact in order to produce a normal electrical waveform reading. Ref : Chang D.F. (2011). Chapter 2. Ophthalmologic Examination. In P. Riordan-Eva, E.T. Cunningham, Jr. (Eds), Vaughan & Asbury's General Ophthalmology, 18e.
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Ans. is 'c' i.e., Heating at 80degC for 30 minutes Inspissation: It is heat exposure method that is employed with high protein material, like egg containing media, that cannot withstand the high temperature used in autoclaving. The medium is exposed to 80degC for 30 minutes for three successive days in inspissator. It can be used for LI medium and loeffler serum slop.
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The diaphragm receives somatic motor fibers only from the phrenic nerves. However, the peritoneum on the central pa of the diaphragm receives sensory fibers from the phrenic nerve, and the peripheral pa of the diaphragm receives such fibers from the lower intercostal nerves. The subcostal nerve supplies the peritoneum inferior to the diaphragm. The vagus and greater splanchnic nerves do not carry pain fibers from the peritoneum.
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Ans. is 'a' i.e., Radial nerve NERVE INJURIES ASSOCIATED WITH VARIOUS FRACTURESFRACTURENERVE INVOLVEDFracture Shaft HumerusRadial NerveSupracondylar humerus fractureAnterior Interosseus nervePosterior dislocation of hipSciatic nerveFracture neck of fibulaCommon peroneal nerveFracture medial epicondyle of humerusUlnar nerveFracture radial headPosterior interosseus nerve
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Ans. is 'a' i.e., Mu (m) receptor BuprenorphineReceptor p(mu) - Partial agonistK (kappa) - Antagonist (moderate) d (delta) - Also know -Buprenorphine produces ceiling effect
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Ans. is 'd' i.e. 7th C.N. Muscles of the ossicles in middle ear : Stapedius - N.S. is VII CN Tensory Tympanis - N.S. is Mandibular nerve (a br. of trigeminal (V) CN).
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Apparent exophthalmoses [Ref: Adams victor principles of neurology 8/e p. 2541 Horner's syndrome is a classic neurologic syndrome whose signs include: -- Miosis, - Ptosis, and - Anhidrosis Also called oculosympathetic paresis, a Horner's syndrome can be produced by a lesion anywhere along the sympathetic pathway that supplies the head, eye, and neck. Neuroanatomy Horner's syndrome can result from a lesion anywhere along a three-neuron sympathetic (adrenergic) pathway that originates in the hypothalamus - The first-order neuron - Descends caudally from the hypothalamus to the first synapse, which is located in the cervical spinal cord (levels C8-12, also called ciliospinal center of Budge). - The second-order neuron - Travels .from the sympathetic trunk, through the brachial plexus, over the lung apex. It then ascends to the superior cervical ganglion, located near the angle of the mandible and the bifurcation of the common carotid aery. - The third-order neuron - Then ascends within the adventitia of the internal carotid aery, through the cavernous sinus, where it is in close relation to the sixth cranial nerve. The oculosympathetic pathway then joins the ophthalmic (VI) division of the ,fifth cranial nerve (trigeminal nerve). In the orbit and the eye, the oculosympathetic fibers innervate the iris dilator muscle as well as Muller's muscle, a small smooth muscle in the eyelids responsible for a minor poion of the upper lid elevation and lower lid retraction. Clinical features The classic signs of a Horner's syndrome are: ? - PtosisQ - Miosise - A n hidrosisQ The degree of anisocoria is more marked in the dark than in light. - There is associated dilation lag, an asymeetry in papillary redilation between the two eyes when the light source is moved away .from the eye. - The homer's pupil will redilate more slowly (by 15 to 20 seconds) than the normal pupil. The ptosis is minor (less than 2 mm) and occurs as a result of paralysis of the Muller's muscle, which is innervated by the sympathetic pathway. The lower as well as the upper lid is affected producing the so-called "upside-down ptosis". Anhidrosis is present in central or preganglionic (first or second order) lesions. The sympathetic fibers responsible for facial sweating and vasolidation branch off at the superior cervical ganglion from the remainder of the oculosympathetic pathway; thus, anhidrosis is not a feature of postagangkonic or third-order lesions. This sign is .frequently not apparent to patients or clinicians. A congenital Horner's syndrome should be suspected when anisocoria is associated with heterochromia (unequal iris color, with the affected iris being lighter). - This occurs because formation of iris pigment in the first several months of age is under sympathetic control. This may only be apparent if the natural color is relatively dark. ETIOLOGY The etiology of Horner's syndrome in adults relates to the lesion location. First-order syndrome (central) Lesions of the sympathetic tracts in the brainstem or cervicothoracic spinal cord can produce a first-order Homer's syndrome. Lateral medullary syndromes (M.C.) - Brainstem disease (stroke, tumour, demyelinating disorder) - Syringomyelia - Cervical cord trauma (including surgery) - Spinal cord tumour - Diabetic autonomic neuropathy - Multiple sclerosis Second-order syndrome (preganglionic) - Trauma or surgery involving spinal cord, thoracic outlet lung apex. - Pancoast tumour - Carotid and Aoic aneurysm and dissection - Lumbar epidural anaesthesia. Third-order syndrome (Postganglionic) - Lesions of internal carotid aery such as - Dissection, thrombosis - Otitis media - Cavernous sinus mass Surgery for raynaud's syndrome (cervical sympathectomy) may cause trauma to cervical spinal cord.
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Volvulus neonatorum
The fetal alimentary canal returns from the extraembryonic coelom into the abdomen at 8-10 weeks and the bowel undergoes rotation and fixation at certain points by the attachment of its mesentery to the posterior abdominal wall.
When the process is incomplete or deviates from the normal plan, the result is malfixation or malrotation.
Commonly, the normal oblique attachment of the mesentery from duodenojejunal flexure of the caecum is absent, and the small bowel is attached to the posterior abdominal wall by a narrow stalk based around superior mesenteric vessels. The caecum is undescended, i.e., situated in the right hypochondrium and abnormally fixed by peritoneal bands running laterally across the second part of the duodenum.
The poorly attached small bowel undergoes volvulus around the axis of the 'universal mesentery', which is twisted so that the flow of blood is cut off, producing a strangulating obstruction of the small bowel. This typically occurs in the newborn, hence the term `Volvulus neonatorum'. The terminal ileum and caecum are drawn into the volvulus and are wrapped around the stalk of the mesentery in two or three tight coils.
Clinical feature
A young infant, previously healthy, starts bile-stained vomiting during the first few days of the live. The abdomen is soft and non-distended; however, abdominal distension may occur which is limited to upper abdomen (epigastrium).
No obstruction may occur in the first day or two after birth and meconium may be passed normally. Then, with variable suddenness, bowel actions cease with onset of obstruction.
The signs vary, depending on the degree of intestinal obstruction versus ischemia. When strangulation occurs there are signs of shock, especially pallor and a vague mass of congested bowel may be palpable in the centre of the abdomen. Blood or blood-tinged mucus may be passed rectally.
Ischemia may result in gangrene and perforation.
Investigations
Barium contrast studies with fluoroscopy (Barium meal follow through) is the investigation of choice as X-ray is not reliable in early stages of volvulus.
However, if the perforation is suspected, barium contrast should not be used because of the risk of peritonitis. Water-soluble contrast studies (iodine based) should be used. Plain X-ray of abdomen/chest is the initial investigation to demonstrate free air under the diaphragm in suspected cases of perforation.
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Globe thermometer is used for Radiant temperature Kata Thermometer is also used for temperature measurement and is less sensitive to air velocity Anemometer is used to measure the velocity of the wind Psychrometer is used to measure humidity Park's Textbook of Preventive and Social Medicine, 25th Edition, Pg 810
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Membranes usually rupture after full dilatation of cervix or sometimes even beyond, in the second stage.
Early Rupture of Membranes:
Rupture of membranes any time after the onset of labour but before full dilatation of cervix.
Premature Rupture of Membrane:
Rupture of membranes before the onset of labour.
Sometimes the membranes remain intact until completion of delivery, the fetus is then born surrounded by them and the portion covering the head of the newborn infant is known as the Caul.
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When one or more incisor teeth have to be replaced in the future, the lingual plate is preferred because additional teeth can be added by attaching retention loops to it.
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All above REF: Jawetz's 24th ed chapter 8 Cell mediated immunity is effected by T cells Helper T cells, suppressor T cells, cytotoxic T cells are types of T Cells
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Ans. B: Subjective sense of imbalance In veigo, patient gets a feeling of rotation of himself or of his environment. Veigo ("a whirling or spinning movement") It is a type of dizziness, where there is a feeling of motion when one is stationary. The symptoms are due to a dysfunction of the vestibular system in the inner ear. It is often associated with nausea and vomiting as well as difficulties standing or walking. The most common causes are benign paroxysmal positional veigo, concussion and vestibular migraine while less common causes include Meniere's disease and vestibular neuritis. Excessive consumption of ethanol (alcoholic beverages) can also cause notorious symptoms of veigo. A number of conditions that involve the central nervous system may lead to veigo including: migraine headaches, lateral medullary syndrome, multiple sclerosis Veigo is a sensation of spinning while stationary. Repetitive spinning, as in familiar childhood games, can induce sho-lived veigo by disrupting the ineia of the fluid in the vestibular system Veigo is classified into either peripheral or central depending on the location of the dysfunction of the vestibular pathway Peripheral: Veigo caused by problems with the inner ear or vestibular system is called "peripheral", "otologic" or "vestibular". - The most common cause is benign paroxysmal positional veigo (BPPV) but other causes include Meniere's disease, superior canal dehiscence syndrome, labyrinthitis and visual veigo. - Any cause of inflammation such as common cold, influenza, and bacterial infections may cause transient veigo if they involve the inner ear, as may chemical insults (e.g., aminoglycosides) or physical trauma (e.g., skull fractures). - Motion sickness is sometimes classified as a cause of peripheral veigo. Central: If veigo arises from the balance centers of the brain, it is usually milder, and has accompanying neurologic deficits, such as slurred speech, double vision or pathologic nystagmus. - Brain pathology can cause a sensation of disequilibrium which is an off-balance sensation.
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Crumbled egg appearance in liver is seen in hyadatid disease
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Enuresis was originally denoted as incontinence of urine, but now, it is a term restricted to those children who are over the age of 3 who wet the bed. Most children have achieved normal bladder control by that time, girls earlier than boys. At age six years, 10% have enuresis. It is impoant to rule out other possible causes of enuresis, but usually, investigation will reveal only normal results. It is believed that up to 50% of cases are caused by delayed maturation of the nervous system or intrinsic myo neurogenic bladder dysfunction. 30% are of psychologic origin and 20% are secondary to more obvious organic disease. The bladder capacity of bed wetters and non-bedwetters is the same. The difference is that the non-bed wetters are able to hold their urine in their bladders throughout the night. When compared with normal children, the majority of children with bedwetting problems score just as well on tests of intelligence and school achievement. These children are no more likely to suffer from permanent neurological abnormalities, poor school achievement, low IQs, or severe learning disability. It is true that bed-wetting children are more likely to get urinary tract infections if their personal hygiene is poor; it is not true that such infections are the main cause of bedwetting.
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Complement is a complex of nine different fractions, C1 to C9. All classes of immunoglobulin do not fix complement. - only IgM,IgG 3,1 and 2 fix complement. - IgG 4, IgA, IgD or IgE do not fix complement Reference : Anathanarayan & paniker's 9th edition, pg no:120 <\p>
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Ans. (d) Diffuse large B cell lymphoma(Ref: Robbins 9th/pg 597; 8th/pg 607; WHO Hemato- lymphoid Tumors 4TH ed 2008, pg231, 264)Discussing the options one by one,*. BCL-6: Burkitts lymphomaTrue, CD19, CD20, CD22, CD10, Bcl6 are positive in Burkitt's*. BCL-2: Follicular lymphomaTrue, CD19, CD20, CD22, CD10, Bcl2 are positive in Follicular Lymphoma*. CD-10: Mantle cell lymphomaTrue, CD19, CD20, CD22, CD5, FMC-7, CD43 positive while Cd10 & Bcl6 negative in Mantle cell Lymphoma;Blastoid / pleomorphic variants are CD5 -ve, CD10+, Bcl6 +ve*. CD 34: Diffuse large B cell lymphomaFalse CD19, CD20, CD22, CD79a, CD10 & Bcl6 are positive is DLBCLCD34 is a marker of blasts, so positive in Acute Leukemia
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Facilitated diffusion is the process of spontaneous passive transpo of molecules or ions across a cell&;s membrane specific transmembrane integral proteins.
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Ans. is 'a' Plasmacytoma If multiple myeloma occurs as a solitary lesion it is K/a PlasmacytomaAge gp is 6th-7th decade, Rare before 40yrs of ageSo the lytic lesion in a 13yrs old boy cannot be a plasmacytoma
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