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ANSWER: (D) SelegilineREF: KDT 6th Ed p. 415DRUGS USED FOR PARKINSONISMDrugs affecting dopaminergic system Dopamine precursorLevodopaPeripheral decarboxylase inhibitorsCarbidopa, benzaserideDopaminergic agonistsBromocriptine , ropinerole , pramipexoleMAO-B inhibitorSelegilineCOMT inhibitorEntacapone , tolcaponeDopamine facilitatorAmantadineDrugs affecting brain cholinergic systemCentral anticholinergicsTrihexyphenidyl, procvclidine , biperidinAntihistaminesOrphenadrine, promethazine
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Hydro-pneumothorax - On Erect chest radiography, it shows an air-fluid level. On Supine radiography, sharp pleural line is bordered by increased opacity lateral to it within the pleural space. Pleural effusion :- Blunting of CP angle and presence of Meniscus sign. Lung collapse :- lung appears to be collapsed to one side
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Ans. is 'a' i.e., Epidemic typhus Rickettsial diseasesDiseaseAgentInsect vectorMammalian reservoir1. Typhus groupa) Epidemic typhusb) Murine typhus (Endemic typhus)c) Scrub typhusR. prowazekiiR. typhiR. tsutsugamushiLouseFleaMiteHumansRodentsRodents2. Spotted fever groupa) Indian tick typhusb) Rocky mountain spotted feverc) Rickettsial poxR.conoritR.rickettsiiR. akariTickTickMiteRodents, dogsRodents, dogsMice3. Othersa) Q feverb) Trench feverC. burnetiiRocholimacaQuintanaNilLouseCattle, sheep, goats.Humans
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Answer is A (Right Parasternal Heave): Pulmonary Hypeension is associated with Right Ventricular Hyperophy which presents as Left Parasternal Heave (Not Right Parasternal Heave). The Right Ventricle is situated just beneath the left 3rd ,4th, and 5th intercostal spaces close to the sternum and is palpable as a Left Parasternal Heave in cases of Pulmonary Hypeension.
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The epiploic appendices are small pouches of the peritoneum filled with fat and situated along the colon, but are absent in the rectum. Ref - researchgate.net
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Arch of aorta lies in superior mediastinum.
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Cocaine use produces a mild physical, but a strong psychic dependence. A triphasic withdrawal syndrome follows an abrupt discontinuation of chronic cocaine use. Signs and symptoms : In the early phase (crash phase, 9 h to 4 days), there is anorexia, depression, agitation, excessive craving, hypersomnia, fatigue and exhaustion which is followed by normal mood, anxiety and anhedonia (next 4-7 days). In third phase (extinction phase, after 7-10 days), there are no withdrawal symptoms, but increased vulnerability to relapse. Treatment : Bromocriptine and amantadine are useful in reducing cocaine craving. Gabapentin is being used in adult addicts.
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Ans. is 'c' i.e., Aicular cailageCharacteristic features of aicular cailage 1) Hyaline cailage2) No innervation (no nerve supply).3) No blood supply (avascular).4) No lymphatics5) Only hyaline cailage which has no perichondrium.6) No ability to repair or regenerate itself.
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Pleiotropism : A gene that has multiple phenotypic effects It is a special interest because it helps in understanding the relationships between different organisms of the same individuals Examples: I. Drosophila bar eyed individuals may be significantly altered by the wing nature II. Seed coat colour gene of sweet pea controls flower colour and also red spot in leaf axils II. Sickle cell anemia in human . Reference: GHAI Essential pediatrics, 8th edition
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The Nottingham prognostic index (NPI) is used to determine prognosis following surgery for breast cancer.
Its value is calculated using three pathological criteria: the size of the lesion; the number of involved lymph nodes; and the grade of a tumour.
Size of the lesion is least important.
The extent of axillary lymph node involvement by breast cancer—is the most established and reliable prognostic factor for subsequent metastatic disease and survival
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Oxycephaly results due to premature closure of coronal, sagittal, and lambdoid suture. The most common type of primary craniosynostosis is simple sagittal synostosis.
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Ans. d. Stratum corneumStratum corneum is underdeveloped in preterm or very low birth weight (VLBW) infants in initial 7 days.The development of the layers of the epidermis starts from below upwards. Therefore, stratum basale is first to be form and stratum corneum is the last layer to form.In preterm infants, stratum corneum is permeable and becomes similar to the adult and full term infant after 2 to 3 weeks postnatal maturation.
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Corynebacteria of veterinary impoance are Corynebacterium pseudotuberculosis. Also called as Preisz - Nocard bacilli. Causes pseudotuberculosis in sheeps and suppurative lymphadenitis in horses. Reference: Textbook of Microbiology; Anathanarayan and panicker&;s; 9th edition; Page no: 242
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Ans. is 'a' i.e., Ia * The basis of mortality data is death certificate. For ensuring national and international comparability, it is necessary to have a uniform and standardized system of recording and classifying deaths. For this purpose WHO has recommended international death certificate.* Consist of four lines:-# Line Ia: Disease or condition directly leading to death# Line Ib: Antecedent/ underlying cause# Line Ic: Main antecedent / underlying cause# Line II: Other significant conditions contributing to death but not related to disease! condition causing it* Example of a death certificate:-# Line Ia: Renal failure# Line Ib: Diabetic nephropathy# Line Ic: Diabetes mellitus# Line II: Hypertension* Concept of underlying cause, Line Ic is the most important line in death certificate, thus also known as 'Essence of Death Certificate\
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.<p>hypochlorites are the most widely used chlorine disinfectants.sodium hypochlorite is available as a liquid.aqueous solutions of this of 5.25 to 6.15 percent is called "house bleach".they have a broad spectrum of antimicrobial activity.do not leave toxic residues,are unaffected by hardness of water are inexpensive and fast acting remove driede or fixed organisms and biofilms from surfaces.</p><p>ref;park&;s textbook of preventive and social medicine,22 nd edition,pg no 120</p>
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Erythroid hyperplasia in the bone marrow is a response of the erythroid series to erythropoietin stimulation. These stimuli include hypoxemia (e.g., chronic, obstructive pulmonary disease), anemia less than 7 gm/ dl, a left-shifted oxygen dissociation curve (e.g., carbon monoxide poisoning), a bleed more than 5 to 7 days, and testosterone. Anemia of chronic disease, thalassemia minor, and iron deficiency have problems in hemoglobin synthesis, so these would not be expected to have a reticulocyte response. In chronic renal disease, there is a decreased concentration of erythropoietin, which results in a normocytic anemia and no reticulocyte response. Ref - Harrison's internal medicine 20e pg 391, 391f, 684, 696
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Telecanthus- consists of increased distance between the medial canthi due to abnormally long medial canthal tendons. Inter pupillary distance is normal. It should not be confused with hypeelorism in which there is wide bony separation of the orbits. Inter pupillary distance is increased. Ref: kanski's 8th edition, page no. 59
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Ans. is 'c' i.e., Typhoid o Chronic carriers are seen in typhoid fever, hepatitis B, dysentery, meningitis, malaria, gonorrhea and diphtheria.
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Nephrotic syndrome is indication for Renal biopsy.
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Bater's syndrome, thiazide diuretic therapy and recurrent vomiting results in metabolic alkalois. Mineralocoicoid deficiency results in metabolic acidosis. Ref: Harrisons principles of internal medicine, 18th edition, Page: 369.
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PLAN A : Age Amount of ORS given after each stool amount of ORS to provide for use at home Less than 24 months 50-100ml 500ml/day 2-10 years 100-200 ml 1000ml/day 10 year or more asmuch as wants 2000 ml/day Ref : ESSENTIAL PEDIATRICS,O.P.GHAI,PG NO:264, 7TH EDITION
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Meningitis caused by H. influenzae cannot be distinguished on clinical grounds from that caused by pneumococci or meningococci. The symptoms described are typical for all three organisms. H. influenzae is a small, gram-negative rod with a polysaccharide capsule. It is able to grow on laboratory media if two factors are added. Heme (factor X) and NAD (factor V) provide for energy production. Use of the conjugate vaccine (type b polysaccharide) reduces the disease incidence more than 90%. Pneumococci are gram-positive diplococci, and meningococci are gram-negative diplococci, which grow on blood agar and chocolate agar with no X and V factors needed, respectively. Salt-mannitol agar is used to distinguish S. aureus from other oral flora. Streptococci do not produce catalase while many other organisms do. Coagulase production is another test to identify S. aureus. Commercial kits are available for immunologic detection of H. influenzae antigens in spinal fluids, but currently none are available to measure specific antibody in CSF.
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Ans. a. An stephensi
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Ans. A i.e. First day of last menstruation
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Restrictive cardiomyopathy along with deposition of extracellular eosinophilic hyaline material suggest the diagnosis of Amyloidosis
Myocardial involvement with amyloid is a common cause of secondary restrictive cardiomyopathy. Amyloid is a pathological proteinaceous substance deposited between cells in various tissues and organs of the body.
With the light microscopic and standard tissue stains amyloid appears as an amorphous, eosinophilic, hyaline extracellular substance, that with progressive accumulation encroaches on and produces pressure atrophy of adjacent cells.
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Bronchoalveolar lavage in patients with idiopathic pulmonary fibrosis, a chronic inflammatory disorder of the lower respiratory tract characterized by dyspnea and reticulonodular infiltrates on chest radiography, discloses an abundance of alveolar macrophages. Probably related to locally generated immune complexes, alveolar macro phages become activated and then produce several mediators that recruit and induce fibroblast proliferation, which causes secondary damage. Macrophage-derived mediators believed to be important in this process include fibronectin, a 200-kDa dimeric glycoprotein that interacts with connective tissue matrix as well as specific receptors on fibroblasts, and platelet-derived growth factor, whose chain is encoded by the c-sis protooncogene. Platelet-derived growth factor is believed to play an important role in recruiting fibroblasts to the site of inflammation. Macrophages also producechemotaxins such, as leukotriene 84 and interleukin 8, which attract neutrophils and eosinophils into the region.
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Reid's index is a ratio between the thicknss of the submucosal mucus secreting glands and the thickness between the epithelium and cailage that covers the bronchi. Normal Reid's index is less than 0.4, the thickness of the wall is always more than double the thickness of the glands it contains. Chronic smoking causes submucosal gland hyperophy and hyperplasia, leading to a Reid's index of >0.5 indicating chronic bronchitis. Chronic bronchitis can be defined as a chronic productive cough lasting more than 3weeks. have a higher predisposition to develop chronic bronchitis. In chronic bronchitis, Reid's index is increased. Ref Davidson edition23rd pg 574
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In PS obstruction can be supravalvular,valvular, subvalvular. Ref : Ghai essential of pediatrics eighth edition, p.no:433
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Retrolental fibroplasia (Retinopathy of prematurity)
Predisposing factor → Prematurity (less gestational age)
Precipitating factor → Hyperoxia
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The amount of saliva that is produced in a healthy person per day; estimates range from 0.75 to 1.5 litres per day while it is generally accepted that during sleep the amount drops to nearly zero. In humans, the submandibular gland contributes around 70-75% of secretion, while the parotid gland secretes about 20-25% and small amounts are secreted from the other salivary glands. Ref: guyton and hall textbook of medical physiology 12 edition page number: 400,401,402
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Ans. is 'c' i.e., Follicular Carcinoma thyroid Follicular Ca metasizes primarily through the blood, and Lymph node metastasis is quite rare. Lymph nodes are frequently involved in patients with - Papillary - Medullary - Huhle cell carcinomas and - Anaplastic
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The best management in this patient presenting with grade 3 placenta pre, bleeding per vagina and uterine contraction is emergency LSCS. Also know: Other indications of LSCS in patients with placenta pre are: Severe degree of placenta pre (type II posterior, type III, type IV) Lesser degree of placenta pre when amniotomy fails to stop bleeding or fetal distress appears. Complicating factors associated with lesser degrees of placenta pre where vaginal delivery is unsafe. Ref: Textbook of Obstetrics By D.C Dutta, 6th edn, page 252
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Lithium is contraindicated in patients with Hypersensitivity to lithium Brugada syndrome Creatinine clearance less than 30
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Skin with all of its appendages is known as Integumentary system. It protects the body from external damage, loss of water etc. It includes hair and nails as well.(in case of animals/birds/reptiles- includes scales, feathers, hooves as well)
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Main functions of large intestine are absorption of water, formation of the fecal mass from indigestible material, and production of mucus that lubricates the intestinal surface.Ref: Textbook of Human Histology By Inderbir Singh, 4th Edition, Page 244 ; Junqueira's Basic Histology: Text and Atlas, 12th Edition, Chapter 15
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Ring of sommerring and Elsching's pearls are seen in after cataract.
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Pulmonary embolism and surgery Blood pools or collects in the veins and blood clots can form. Less common causes include bone marrow from a long, broken bone, as well as tissue from a tumor, and even air bubbles. The veins are the blood vessels that return blood to the hea. And those undergoing day surgery are unlikely to be considered for preventive therapy at all. The risk of venous thromboembolism (a collective term for deep vein thrombosis and pulmonary embolism) is known to increase after surgery, paicularly after major ohopaedic (joint) surgery
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Ans. is a i.e. 63 days RU-486 i.e. Mifepristone, is an analogue of the progestin "norethindrone". which has strong affinity for progesterone receptors but acts as an antagonist of progesterone. Given alone, the drug was moderately useful in causing aboion of early pregnancy, however the combination of mifepristone with analogue of prostaglandin E, i.e. misoprostol is very effective. hegimen : FDA approved protocol - (Original protocol) : 600 mg of Mifepristone (i.e. 3 tablets) given orally on day 1 followed 2 days later by oral misoprostol 400 pg (2 tablets) on day 3. The treatment should be staed no more than 49 days from the sta of the last menstrual period. But according to the recent protocol : 200 mg of mifepristone (it is as effective as 600 mg of mifepristone) is given orally on Day 1 followed 2 days later by vaginal misoprostol 800 pg. ibis regime provides highest efficacy within 63 bays of amenorrhea. Role of mifepristone in Medical aboion : Mifepristone blocks progesterone receptors in the endometrium which leads to disruption of the embryo. production of prostaglandins and a decrease in human chorionic gonadotropin levels. The success rate is dependant on the length of pregnancydeg - the more dependant the pregnancy is on progesterone from the corpus luteum, the more likely that the progesterone antagonist, mifepristone will result in aboion. The production of prostaglandins leads to softening of the cervix as well. Also Know : Contraindications of Medical aboion with mifepristone / misoprostol : ectopic pregnancydeg an IUCD in placedeg chronic adrenal failuredeg concurrent long term coicosteroiddeg therapy history of allergy to mifepristone, misoprostol or other prostaglandinsdeg inherited porphyrias Severe anemia, coagulopathy or anticoagulant use. - Active liver disease Uncontrolled seizure disorder. - Cardiovascular disorder. Relative Contraindication--renal disease
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Frei's test is used in the diagnosis of Lymphogranuloma venereum. NAATS is currently recommended by the CDC as the diagnostic assay of choice. Lymphogranuloma venereum is a sexually transmitted infection of lymphatic tissue caused by Chlamydia trachomatis serotypes L1, L2, and L3. It is transmitted through sexual contact with men more frequently affected than women. The most common presentation in heterosexuals is the presence of a tender, usually unilateral inguinal and/or femoral lymphadenopathy. Ref: Gaydos C.A., Quinn T.C. (2012). Chapter 176. Chlamydial Infections. In D.L. Longo, A.S. Fauci, D.L. Kasper, S.L. Hauser, J.L. Jameson, J. Loscalzo (Eds),Harrison's Principles of Internal Medicine, 18e.
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Infiltration of the gingivae, skin, soft tissues, or the meninges with leukemic blasts at diagnosis is characteristic of the monocytic subtypes (M4 and M5). Significant gastrointestinal bleeding, intra-pulmonary hemorrhage, or intracranial hemorrhage occur in M3 AML. Bleeding associated with coagulopathies occur in M5 AML.
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Hemangioendotheliomas Von hippel lindau syndrome :? It is an autosomal dominant inherited neurocutaneous dysplasia in which the affected patients develop tumour within the :? - Cerebellar hernispheres12, - The retitle, - BrainstemQ and - Spinal corddeg Patients may also have cysts involving the pancreas, liver and kidneys and have a propensity to develop renal cell carcinoma of the kidney. The gene for VHL is a tumour suppressor gene and is located on chromosome 3 and encodes protein (pVHL) Systemic manifestation of VHL are as follows Retina Hemangioblastomaeand retinal angiomatosise Central nervous system Hemangioblastomadeg in cerebellum, cerebrum, medulla oblongata and spinal cord. Labyrinth Endolymphatic sac neoplasms Lung Cyst Hea Rhabdomyomae Kidney Hemangioblastomae, renal cell adenomas, renal cell Cue. Bladder Hemangioblastoma Epidydymisitestis Cysts of the epidydymis, clear cell papillary cystadenoma of the epidydymis. Broad ligament Papillate cystadenoma Adrenal gland Pheochromocytoma0 Pancreas Hemangioblastoma, cystse, cystadenoma, islet cell adenoma and islet cell carcinoma. Liver Cysts, adenoma, angioma Spleen Angioma and cysts Skin Naevue and cafe aulait spots Bone Cyst and hemangioma Polycythemia0 Approximately 10% of hemangioblastoma are associated with polyeythemie the tumour has been shown to be a source of erythropoietin.
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The preferred fuel for the body in:- Fed state is mainly Carbohydrates i.e. Glucose. Fasting state is mainly Fats. Fats stored in adipose tissues are broken down to fatty acids to give energy during fasting and starvation.
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Ans. is 'b' i.e., Latent infection
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These include exposure to infections (including human immunodeficiency virus and viral hepatitis); percutaneous exposure incidents, dental materials, radiation, and noise; musculoskeletal disorders; psychological problems and dermatitis; respiratory disorders; and eye insults.
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In Glycolysis--in Absence of O2 (Anaerobic Phase) * In absence of O2, reoxidation of NADH at glyceraldehyde-3-P-dehydrogenase stage cannot take place in the electron-transpo chain. * But the cells have limited coenzyme. Hence to continue the glycolytic cycle NADH must be oxidised to NAD+. This is achieved by reoxidation of NADH by conversion of pyruvate to lactate (without producing ATP) by the enzyme lactate dehydrogenase. SECTION FOUR * It is to be noted that in the reaction catalysed by glyceraldehyde-3-P-dehydrogenase, therefore, no ATP is produced. In anaerobic phase per molecule of glucose oxidation 4 - 2 = 2 ATP will be produced. + 2 ATPRef: MN Chatterjea Textbook of Medical Biochemistry, 8th edition, page no: 332
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Empty sella syndrome (ESS) is the condition when the pituitary gland shrinks or becomes flattened, filling the sella turcica with cerebrospinal fluid instead of the normal pituitary patients with empty sella syndrome can have headaches as symptoms of elevated spinal fluid pressure; symptoms of hypopituitarism; or visual symptoms, which can sometimes be due to downward, prolapse of the optic chiasm into the empty sella. Ref Harrison20th edition pg 2478
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Ans. is 'b' i.e. Secondary prevention Primary prevention is action taken prior to the onset of disease.Secondary prevention is action which halts the progress of the disease at its incipient stage and prevents complications.Thus giving Benzathine pencillin in RHd is a type of secondary prevention.
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For the spontaneously breathing patient, pressure support ventilation (PSV) has been advocated to limit barotrauma and to decrease the work of breathing. Airway pressure support is maintained until the patient's inspiratory flow falls below a certain cutoff. PSV is frequently the mode of choice in patients whose respiratory failure is not severe and who have an adequate respiratory drive.
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Transbronchial biopsy helps differentiate idiopathic pulmonary fibrosis (IPF) from similar syndromes with specific treatments. These include chronic hypersensitivity pneumonitis, cryptogenic organizing pneumonia, and sarcoidosis.
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Causes of hypoproliferative anemia are early iron deficiency (before hypochromic microcytic red cells develop), acute and chronic inflammation, renal disease, protein malnutrition, endocrine deficiencies and anemias from marrow damage. Reference: Harrisons Principles of Internal Medicine, 18th Edition, Page 844
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clinical cardiology the term "diastolic function" is most commonly referred as how the hea fills. The energy that drives the suction process is generated from phase of systole. During systole, to overcome the peripheral aerial load at ejection, ventricle contracts, which also compresses elastic tissues internal to and external to the myocardium. Then, when cardiac muscle relaxes, the energy captured by compressed elements releases, driving the recoil of ventricular wall until a new balanced equilibrium state is reached. During diastole, the ventricle of hea must remain elastic or compliant enough and have capacity to hold incoming blood to guarantee effectiveness of the filling phase. Hence stiffness and relaxation are ventricle's intrinsic feature parameters that are practical in evaluating and quantifying diastolic function.In addition, volumetric load serves as an extrinsic indicating parameter that modulates diastolic function. Ref Davidson 23rd edition pg 453
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Answer is C (Hepatic vein): Budd chiari syndrome is characterized by post sinusoidal obstruction outside the liver at the level of hepatic veins
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Ref-KDT 6/e p841 By inhibiting the enzyme IMP dehydrogen,mycophe mycoph inhibits the de novo synthesis of purines
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Ans. is 'c' i.e., Both o Parasympathetic supply is motor to detrusor muscle and inhibitory to sphinchter vesicae. Sympathetic supply is motor to sphincter vesicae and inhibitory to detrusor muscle.Nerve supply of bladdero Bladder is supplied by both sympathetic and parasympathetic fibers.Parasympathetic : Preganglionic fibers arise from S2 to S4 cord segments, pass via pelvic splanchnic nerves. After relay in ganglion cells in pelv ic plexus (inferior hypogastric plexus) and in bladder w all, postganglionic fibers supply detrusor muscle. Contraction of detrusor muscle is mediated by cholinergic muscarinic receptors (Mj).Preganglionic parasympathetic neurons at S2. S3, and S4 cord segments innervating bladder form sacral micturition center.Sympathetic : Preganglionoic fibers arise from lateral horn cells of T11-L2 cord segments and pass via lower lumbar splanchnic nerves, superior hypogastric plexus (presacral nerve of Latarjet) to reach inferior hypogastric (pelvic) plexus. After relay in pelvic ganglia, postganglionic sympathetic fibers (i) stimulate sphincter vesicae (internal urethral sphincter) via a1 adrenoceptors and (ii) cause relaxation of detrusor muscle via b2 adrenoceptors. It can also inhibit presynaptically the parasympathetic ganglia via a2. adrenoceptors1. Visceral afferents : (1) pain fibers from bladder pass through both parasympathetic and sympathetic pathway and enter T11-L2 and S2-S4 cord segments, hence referred pain is felt in lower part of anterior abdominal wail (hypogastrium), upper part of front of thigh, scrotum or labium majus, penis or clitoris, and perineum. Centrally, spinothalmic pathway conducts pain impulses from bladder.2. Stretch afferents : arising from stretch receptors in the bladder wall pass via pelvic splanchnic nerves, enter S2, S3 and S4 cord segments and establish reflex connections with sacral micturition center, which innervates detrusor.So afferent and efferent limb of this micturition reflex is formed by pelvic splanchnic nerves.Sacral mictmition center and the micturition reflex are controlled by facilitatory and inhibitory centers located in pons and paracentral lobule of frontal lobe of cerebum.
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Ans. is 'b' i.e., Seen only in infancy Xanthogranulomatous pyelonephritiso Xanthogranulomatous pyelonephritis is a form of chronic pyelonephritis characterised by destruction of renal parenchyma and the presence of granulomas, abscesses and collection of lipid laden foamy macrophages (foam cells).o Age of presentation ranges from infancy to 16 yearso Focal form being more common in children- Appear healthyo Those who affected diffusely, present with non-specific symptoms of chronic infection.i) Weight lossii) Feveriii) Lethargyiv) Failure to thriveo Proteus is the most common causative organism.
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"Open Pneumothorax is one in which full thickness segment of the chest wall has been destroyed and the negative intrapleural pressure sucks air directly through the chest wall defect rather than through the trachea into the alveoli. It occurs most commonly after shotgun blasts explosion with flying debris. The pt. is stabilized by any mechanical covering over the open wound. As soon as convenient a wateight dressing should be placed and an intercostal catheter inseed into the pleural cavity. Early debridement and formal closure of the wound should then be performed." Ref : Schwaz, 7/e p684
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Harrison's textbook of internal medicine 17th edition...Davidson's principles and practice of Medicine 23 rd edition. *Hemorrhage usually presents as abrupt onset of focal neurological deficit and can be considered as a spectrum of symptoms from transient (TIA) to persistent(stroke).. *Deficit typically worsen steadily over 30 -90 min(if symptoms progress over hours and days ,other diagnoses must be excluded)it is associated with diminished level of consciousness ,signs of increased ICT-headache,vomiting ,prominent sensory deficit involving all modalities .
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The given clinical history and the presence of tiny yeast forms within macrophages are suggestive of Histoplasmosis which is also called Darling&;s disease. Histoplasmosis: It is also known as Darling&;s disease, Cave&;s disease, OHIO disease. The causative agent is Histoplasma capsulatum, a dimorphic fungus. Transmission occurs inhalation of conidia. After inhalation, the conidia develop into yeast cells and are engulfed by alveolar macrophages. Within macrophages, the yeasts may disseminate to reticuloendothelial tissues, such as the liver, spleen, bone marrow, and lymph nodes. Biopsy reveals tiny (2-4microns) oval-shaped yeast cells inside macrophages. On culture and microscopy, tuberculate macroconidia and hyaline septate mold with microconidia are seen Reference: Ananthanarayan and Paniker&;s Textbook of Microbiology Tenth edition
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Pipestem colon is seen in ulcerative colitis
String sign of Kantor is seen in Crohn 's disease.
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JH reaction is produced by syphilis, Borreliosis (Lyme disease, Tick-borne relapsing fever), cat scratch disease, Q-fever, Brucellosis, Bartonellosis, Typhoid fever.
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Ans: a (Inguinal) Ref: Bailey, 24th ed, p. 1274- Most common hernia in men - Indirect inguinal hernia (right side)- Most common hernia in females - Indirect inguinal hernia- Femoral hernia is more common in females. (F:M -4:1)(You should have a clear idea about this)Inguinal herniaIndirectContents enter the deep inguinal ring and traverse the whole length of the inguinal canal to come out through superficial inguinal ring.Most common of all forms of hernia.More common on right side.Bilateral in 12% of cases.More common in males (~20 times)DirectHere the contents protrude through the posterior wall of the inguinal canal medial to the inferior epigastric vessels, (through Hesselback triangle)Practically never seen in females.Neck is wide so rarely strangulate.Three types of indirect inguinal hernia.Bubonocele - hernia limited in the inguinal canal.Funicular - processes vaginalis closed at its lower end.Complete or vaginal or congenital - here the processes vaginalis is patent throughout.Hernia sac is continuous with the tunica vaginalis of the testis.Management of inguinal hernias1) Treatment of hernial saca) Indirect hernias - Sac is dissected free and opened and herniated contents are reduced. Sac is ligated at the internal inguinal ring,b) Direct hernias - Sac is not opened but simply inverted into peritoneal cavity.2) Inguinal floor reconstructiona) Primary tissue repairPost wall of inguinal canal is strengthened by just approximation of tissues with sutures. No use of any prosthetic material.Commonly performed are:1) Bassini repair2) Halsted repair3) McUay (Cooper ligament) repair4) Shouldice repair.5) Darn repair.b) Anterior tension - free mesh repair - Current practices in hernia management employ a synthetic mesh prosthesis to bridge the defect. Recurrence rate is quite low.Commonly employed techniques are:1) Lichtenstein repair.2) Patch and plug technique.c) Laparoscopic and Preperitoneal repairs1) TAPP (Trans - abdominal pre - peritoneal)2) TEP (Totally extraperitoneal repair)Note - Different types of hernias are mentioned in 2007 Surgery paper. Just go through It.
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STEP wise approach to surveillance (STEPS): Is a simple, standardized method by WHO for surveillance
Is of two types:
STEP-wise approach to chronic disease risk factor surveillance
STEP-wise approach to Stroke surveillance
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In few cases, foramen ovale remains patent throughout life and gives rise to cyanosis, a condition called as Morbus caeruleus.(Refer: Nelson's Textbook of Pediatrics, SAE, 1st edition, pg no. 2162)
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Ans. c. Re-experiencing and avoidance of trauma
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Ans. is c, i.e. Compression of IVC (inferior vena cava)Ref. Dutta Obs. 7/e, p 53, 54Supine hypotension syndrome:During late pregnancy Q the gravid uterus produces a compression effect on the inferior vena cava, when the patient is the supine position.This, generally results in opening up of collateral circulation by means of paravertebral and azygous veins.In some cases (10%) when the collateral circulation fails to open, the venous return of the heart may be seriously curtailed which results in production of hypotension, tachycardia and syncope. Normal blood pressure is quickly restored by turning the patient to lateral position.
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Migratory thrombophlebitis is seen in Pancreatic cancer (most commonly) - Lung cancer Gastrointestinal cancer - Ovarian cancer Prostate cancer - Lymphoma Migratory thrombophlebitis is also k/a Trousseau's syndrome
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Structures as pierced by spinal needle during spinal block (from outside to inside): iii)Supra spinous ligament i) Interspinous ligaments ii) Ligamentum flavum iv) Epidural space
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Epidural space is closed superiorly at foramen magnum.
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Ans. is 'b' i.e., Cycloserine
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Ref: Parks 23rd edition Disease will be Prevalent so long it exist in the community. Longer the duration of the illness, longer will it persist in the community and hence higher will be its prevalence.
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Dying back neuropathy or distal axonopathy is the result of some metabolic or toxic derangement of neurons. It is the most common response of neurones to metabolic or toxic disturbances, and may be caused by metabolic diseases such as diabetes, renal failure, malnutrition, toxins, drugs etc. GBS is a post infectious polyneuropathy that causes demyelination in mainly motor but sometimes also sensory nerves. It is not predominant distal axonopathy. Ref: Fundamentals of Neurology: An Illustrated Guide By Marco Mumenthaler, Heinrich Mattle, Page 176
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Ans. b (Ultrasound) Ref: AK Khurana, 4th ed, p. 193In phacoemulsification nucleus is emulsified & aspirated by phacoemulsification. Phacoemulsifier acts through a titanium needle ( hollow 1 mm needle)It vibrates in its longitudinal axis at an ultrasonic speed of40000 times a second and thus emulsifies nucleusAdvantage: Very small corneoscleral incision (3.2-3.5 mm), hence sutureless surgeryNOTE:Various surgical techniques with length of corneoscleral incisionECCE- 7-8 mm (120deg)ICCE- 10-12 mm (180deg)Small incision cataract surgery (SICS) - 4-6 mmPhacoemulsification- 3.2-3.5 mm (30deg)
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The primary structure is the sequence of the amino acids in a polypeptide chain.Secondary structure is the folding of sho (3- to 30-residue), contiguous segments of the polypeptide into geometrically ordered units.Teiary structure is the assembly of secondary structural units into larger functional units such as the mature polypeptide and its component domains.The specific biological function of each immunoglobulin class is determined by the teiary structure of the constant domains (Fc region).
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Ans. is 'a' i.e., Treatment by doctor Primary heath care o "Primary health care is essential health care made universally accessible to individuals and acceptable to them, through their full paicipation and at a cost the community and country can afford." o There are 4 main principles of primary health care : 1. Equitable distribution Community paicipation intersectorial coordination Appropriate technology o Primary health care involves: health care of mother and child, immunization, prevention and control of locally endemic diseases, as well as appropriate treatment of common diseases and injuries. However, it is not essential to deliver these elements throught the agencies of doctors under the primary health care. Root level workers, such as village health guides. are appropriately trained to deliver these elements, at the village level.
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Answer is D (Lesion at the level of the pons): Benedict's syndrome also known as dorsal mid brain syndrome results from a lesion in the midbrain tegmentum / red nucleus. It is not a pontine syndrome. In benedict's syndrome injury to the red nucleus midbrain results in ipsilateral occulomotor palsy and contralateral tremor ,chorea and athetosis. -- Harrison Benedikt's s ndrome / Dorsal midbrain s ndrome The dorsal midbrain syndrome or Benedikt's syndrome results from a lesion in the red nucleus or tempmentum of midbrain. It is caused by occlusion of the paramedian / penetrating branches of the basilar or posterior cerebral aery or both. Signs include Ipsilateral occulomotor paresis / ptosis and dilated pupil (damage to fascicle of 3rd CN including parasympathetic fibres) Contralteral involuntary movement -- tremor , chorea , athetosis ( damage to red nucleus interrupts fibers from opposite cerebellar hemisphere ) Contralateral hemiparesis may be present if lesion extends ventrally (damage to descending coicospinal tract ) Contralateral hemianaesthesia may be present if lesion extends laterally (damge to spinothalamic tract and medial meniscus ) Other Midbrain syndromes in association with injury to fascicle / nucleus of CN Ill: Harrison 17th/ 193 Weber's syndrome (Injury to cerebral peduncle) Nothnagel's syndrome (Injury to superior cerebellar peduncle) Claude's syndrome (Injury to red nucleus + superior cerebellar peduncle) * * 1psilateral occulomotor palsy Contralatral hemiparesis * * 1psilateral occulomotor palsy. Contralatral cerebellar ataxia * * Ipsilateral occulomotor pasly Contralateral cerebellar ataxia tremor, chorea, athetosis (Benedikt's + nothnogel's)
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A i.e. Self resolving
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BIRD-SHOT RETINOCHOROIDOPATHY It is a rare, idiopathic, bilaterally symmetrical chronic multifocal chorioretinitis characterised by numerous flat creamy-yellow spots due to focal chorioretinal hypopigmentation, resembling the pattern of 'bird-shot scatter from a shotgun'. The disease, more common in females than males, typically affects middle-aged healthy persons who are positive for HLA-A29. It runs a long chronic course of several years. Treatment with coicosteroids is usually not effective. Ref:comprehensive ophthalmology-AK Khurana -4/E pageno:161.
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Ans. B Long thoracic nerveRef: BDC, 6th ed. vol. I pg. 55-56; 3rd ed. Vol. I pg. 45-50; 180,181* Winging of scapula is due to damage of long thoracic nerve due to paralysis of serratus anterior muscle.* Serratus anterior helps in vertical overhead abduction (assisted by trapezius), forward punch (assisted by pectoralis minor) & forced inspiration.* Its paralysis leads to winging of scapula.* Nerve Supply of Serratus anterior- Long Thoracic Nerve (Nerve of Bell) (C5, C6, C7)* Action of Serratus anterior muscle# Rotates the scapula so that glenoid cavity is raised upward & forward- Helps in Vertical over head abduction (in this action assisted by Trapezius muscle).# Draws the scapula forward around the thoracic wall so paralysis leads to winging of scapula.# Also used when arm is pushed forward in horizontal position as in forward punch (helped by Pectoralis minor in this action).# Steadies the scapula during weight carrying.# Helps in forced inspiration (Accessory muscle of inspiration).# Because of greater pull exerted on the inferior angle, inferior angle passes laterally and forward and the glenoid cavity is raised upward & forward; in this action the muscle is assisted by trapezius.
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Ans. is 'a' i.e., Factor Xa o Low molecular (fractionated) heparins inhibits -4 Factor Xa o Unfractionated inhibits --) Factor Ha & Xa
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A highly ionized drug is lipid insoluble, it is therefore not reabsorbed across the renal epithelial membrane and is easily excreted by the kidneys. Non Ionized Drugs Ionized Drugs Non ionized drugs are lipid soluble Ionized drugs are lipid insoluble Rapidly pass across placenta Poorly pass across placenta Rapidly absorbed from stomach & intestine Poorly absorbed from stomach & intestine Ref: Nutrition Therapy and Pathophysiology By Marcia Nahikian Nelms, Page 303; Small Animal Clinical Pharmacology By Jill E. Maddiso, Page 34
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9 days After ovulation the ruptured graffian follicle develops into corpus luteum. The lile cycle ot corpus luteum has four stages viz : Proliferation Vascularisation Maturation Begression Corpus luteum reaches it maximum maturity by 22nd day of cycle (gze = 2 cms or more). Ovulation occurs on day 14 i.e. 8th days atter ovulation corpus luteum reaches its maximum maturity. Colour of corpus luteum in early stages is greyish yellowdeg due to presence of lipids and later is distinctive yellow due to pigment carotene.deg lf pregnancy does not occur corpus luteum stas degenerating from the eight post ovulatory day and forms coruous albicans. lf pregnancy occurs, HCG similar lo LH stimulates corpus luteum to secrete progesterone. it's groMh roaches a peak at 8th week ol gestation and it remains functionally active till 10-12 weeks of geNation, where by placenta takes over its lunction of producing progesterone. This is followed by degenerative changes in corpus luteum.
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IgM antibody appears following an acute infection. It is not specific for a disease. Ref: Baveja textbook of microbiology; 4th edition
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Ans. is b' i.e., AlbeThe diphtheria bacillus was first observed and described by Klebs (1883) but was first cultivated by Loeffler (1884).Therefore, it is known as Klebs - Loeffler bacillus (KLB).Corynebacterium diphtheria is gram positive slender rod (bacilli) which is noncapsulated and non-motile.The bacilli are arranged in a characteristic fashion in smears, being at various angles to each other, resembling the letter V or L Chinese letter or .nneiform arrangement. There is chracteristic 'Clubbed appearance'.Characteristic feature is irregular staining due to presence of granules, called Babes Ernest or volutin granules. These granules are also called metachromatic granules or polar bodies.
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Ans. is 'b' i.e. Endoscopic sphincterotomy
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Ans. is 'd' i.e., Periampullary carcinoma Old age with significant loss points towards a neoplastic etiology Dilatation of both CBD and pancreatic duct is a strong evidence in our of Periampullary ca. Periampullary Ca includes a group of malignant neoplasms arising at or near the ampulla of Vater. Because of this common location they require similar management for both curative resection (pancreaticoduodenectomy) and palliation. It includes: - Pancreatic head cancer (most common) - Ca of distal CBD - Cancer of the ampulla of Vater - Ca of duodenum The early symptoms of periampullary carcinomas are usually vague and include anorexia, weight loss, abdominal discomfo and nausea. Specific symptoms usually develop only after invasion or obstruction of a nearby structure. These are jaundice and pain. Since periampullary ca, by definition, arises near the distal biliary tree, obstructive jaundice is the hallmark presentation. Jaundice is progressive and often is associated with significant pruritis. Duodenal obstruction may occur in late cases.
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Opium (afim) is the dried extract of the poppy plant (Papaver somniferum). The unripe opium capsules are incised to obtain the extract, which is milky fluid Active principles Opium contains alkaloids, which are divided into two groups: 1. Phenanthrene group: have narcotic propeies * Morphine * Codeine * Thebaine (non-analgesic). 2. Benzoisoquinoline group: have mild analgesic but no narcotic propeies * Papaverine * Noscapine (narcotine REF;THE SYNOPSIS OF FORENSIC MEDICINE:KS NARAYANA REDDY;28th EDITION;PAGE NO 334
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Hypotension and bronchoconstriction (increase in airway resistance) are impoant adverse effects caused by histamine. This is confirmed to be due to histamine because of reversal with diphenhydramine. * Maximum histamine release is caused by d-tubocurarine. * Vecuronium does not cause histamine release, therefore is preferred agent in asthmatic patients.
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Physiologic Effects of Calcitonin Bone: Calcitonin suppresses resorption of bone by inhibiting the activity of osteoclasts, a cell type that "digests" bone matrix, releasing calcium and phosphorus into blood. Kidney: Calcium and phosphorus are prevented from being lost in urine by reabsorption in the kidney tubules. Calcitonin inhibits tubular reabsorption of these two ions, leading to increased rates of their loss in urine .R Ref - Harrisons internal medicine 20e p2923
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Ans. A: None (Its Indices of Urinary excretion of Iodine) Neonatal hypothyroidism is a sensitive pointer to environmental iodine deficiency and is thus an effective indicator for monitoring the impact of the iodine deficiency control programme. Neonatal thyroid screening using serum thyrotropin (TSH) as the primary screening test detects not only permanent sporadic congenital hypothyroidism, whose incidence is about 1 per 4000 bihs, but also compensated or transient primary hypothyroidism, whose incidence can be as high as 1 in 10 neonates and whose main cause is iodine deficiency. Elevated serum TSH in the neonate indicates insufficient supply of thyroid hormones to the developing brain, and therefore, constitutes the only indicator that allows prediction of possible impairment of mental development at a population level, which is the main consequence of iodine deficiency. Therefore, the World Health Organization (WHO), United Nations International Children's Emergency Fund (UNICEF), and the International Council for Control of Iodine Deficiency Disorders (ICCIDD) included neonatal TSH as one of the indicators for assessing iodine deficiency disorders (IDD) and their control.
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Ans. is 'c' i.e Max. Mid expiratory flow rates. * The following lines from Harrison support the answer.In obstructive lung disease, the hallmark is a decrease in expiratory flow rates. With fully established disease, the ratio of FEV1/FVC in decreased, as is the FEF25-75 %'( Max. mid expiratory flow rate).With early obstructive disease, which originates in the small airways, FEV1/FVC may be normal, the only abnormalities noted on routine testing of pulmonary function may be a depression in FEF25-75% and an abnormal configuration in the terminal portion of the forced expiratory flow-volume curve. "
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Ans. is 'b' i.e., Pirenzepine Pirenzepine is a selective M1 AntagonistCalcium channel blockers.Phenyl alkylamine - VerapamilBenzodiazepine -DiltiazemDihydropyridines - Nifedipine, Felodipine, Amlodipine, Nitrendipine, Nimodipine, Lacidipine More questions on calcium channel blocker -Only voltage sensitive L type channel are blocked by calcium channel blockers.CCB's causing ankle edema - NifedipineCCB's causing Reflex tachycardia - Nifedipine (C/I in angina)CCB's having most depressant affect on heart - Verapamil
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Ref Harrison 19 th ed pg 2152 Table :381-2 Major manifestations Carditis Polyahritis Chorea Erythema marginatum Subcutaneous nodules
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Ref: Ananthanarayana textbook of Microbiology 9th edition Pgno : 110,181 Agglutination - Insoluble antigen + antibody at a suitable temperature and pH - Clumps formation Slide agglutination Identification of bacterial isolates from clinical specimens Blood grouping, Cross-matching Tube agglutination WIDAL Typhoid Standard agglutination test Brucellosis Microscopic agglutination test Leptospirosis Heterophile agglutination test Weil Felix test Rickettsial infection Streptococcal MG agglutination test Primary atypical pneumonia Paul Bunnell test Infectious mononucleosis Antiglobulin test Direct Coombs test Detect fetal Rh Ab Indirect Coombs test Detect maternal Rh Ab Passive agglutination test Hemagglutination Rose Waaler test Latex agglutination test Detection of ASO, CRP, RA factor, HCG Co-agglutination test Diagnosis of Legionellosis, Gonorrhea
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Senile ectropion: Involutional ectropion usually develops as a result of laxity of the suspensory system of the lower eyelid, and the medial and lateral canthal ligaments, allowing the lid to fall away from the globe. This laxity is accompanied by a horizontal lengthening of the lid. In the presence of a complete ectropion, the lower retractors or the capsulopalpebral tissues need to be reattached. Must know: Ectropion is an outward turning of the lid margin. It may be involutional, paralytic, cicatricial, mechanical or congenital. Involutional ectropion is the result of horizontal eyelid laxity from aging. Paralytic ectropion follows facial nerve palsy. Cicatricial ectropion is caused by contracture of the skin of the lid from trauma or inflammation. Mechanical ectropion usually occurs because of bulky tumors of the lid. Ref: Parsons' Diseases of the Eye By Ramanjit Sihota & Radhika Tandon, 21st edition, Page 449.
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Ketoconazole, erythromycin and clarithromycin are potent inhibitors of microsomal enzymes. Astemizole, terfenadine and cisapride are the drugs that can block cardiac K+ channels at high concentration. If administered along with microsomal enzyme inhibitors, these drugs can result in torsades de pointes, a serious polymorphic ventricular tachycardia.
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Triple swab test is the investigation of choice to establish the diagnosis of a suspected vesico vaginal fistula. It confirms the presence of vesico vaginal fistula, and also differentiate it from uretero vaginal and urethro vaginal fistula. Ref: William's Gynecology, 1st Edition, Page 574; Textbook of Gynecology By DC Dutta, 4th Edition, Page 386, 7.
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Answer- B. Mucinous carcinomaFamilial cancers (or around 3% of all breast cancer) can be attributed to two highly penetrant autosomal dominant genes BRCA-1 on chromosome 17 (52%) and BRCA-2 on chromosoine 13.
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C i.e. Inferior colliculus
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ANSWER: (A) Carcinoma CervixREF: Current Diagnosis 8; Treatment Obstetrics & Gynecology, 10th edition Chapter 30The currently accepted indications for classical cesarean section are:1. Perimortem Cesarean DeliveryPlacenta previa with fetal malpresentation such as transverse lie.Preterm delivery in which the lower uterine segment is poorly developed.Carcinoma cervix
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