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Ans. b. Oral isotretinoin Oral isotretinoin is the preferred treatment option for acne in a 24-year old girl with multiple nodules, cysts and intercommunicating sinuses
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Ans. is 'd' i.e., Alkaline phosphataseRegan enzyme (isoenzyme) is the isoenzyme of alkaline phosphatase.It arises from placenta know as carcinoplacental enzyme.It is elevated in about 15% fo cases of carcinoma of lung, liver and gut.
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Harrison's principles of internal medicine 17th edition. *Charcot-Marie-Tooth neuropathy is the most common heritable neuromuscular disorder with an incidence of 17 -40 cases per 100,000
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Lesser sac (Omental bursa) is left posterior intraperitoneal space, also called left subhepatic space.
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The laboratory results indicate that the aerial pH, aerial PCO2, and plasma HCO3- concentrations are all low. These changes clearly demonstrate metabolic acidosis, which occurs commonly when a carbonic anhydrase inhibitor is administered. The carbonic anhydrase enzyme attached to the brush border of the tubular epithelial cells normally catalyzes the dissociation of carbonic acid into water and carbon dioxide. Inhibition of carbonic anhydrase prevents the removal of bicarbonate ions from the tubular fluid, which initially increases urine pH. The result is heavy spillage of bicarbonate in the urine, which is the hallmark of type 2 A (renal tubular acidosis). However, once the plasma levels of bicarbonate have decreased sufficiently, the bicarbonaturia ceases and the plasma HCO3- levels stabilize at a lower than normal level. Consequently, the urine pH falls typically to 4.5-5.0. Ref: Reilly R.F., Jackson E.K. (2011). Chapter 25. Regulation of Renal Function and Vascular Volume. In L.L. Brunton, B.A. Chabner, B.C. Knollmann (Eds), Goodman & Gilman's The Pharmacological Basis of Therapeutics, 12e.
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M.C. position of veex is Left occipito Transverse(40%) LOT > LOA M.C. malposition of veex presenting pa is Right Occiputo posterior.
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The cholangiocyte is a target of an immune-mediated inflammatory response, as is characteristic of primary biliary cirrhosis Primary biliary cirrhosis Primary biliary cirrhosis is occurs predominantly in women. Patients may present with jaundice, pruritus and fatigue is common. The skin is often hyperpigmented and detection of xanthelasma or xanthomata related to hypercholesterolemia is highly suggestive of the diagnosis. Serologic testing (antimitochondrial antibodies) is generally sufficient to establish a diagnosis Ref:Sleisenger and Fordtran's,E-9,P-328
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Ans: a (Amenorrhoea) Ref: Ahuja, 6th ed, 157; Kaplan & Sadock, 8th ed, p. 2012Amenorrhoea is not a feature of bulimia nervosa; it is seen in anorexia nervosaFluoxetine is an anti-depressant that has been approved for use in bulimia nervosaCharacteristics of anorexia nervosa and Bulimia nervosaClinical CharacteristicsAnorexiaNervosa"Bulimia NervosaOnsetM id-adolescenceLate adolescence/early adulthoodFemalermale10:110:1Lifetime prevalence in women1%1-3%W eightM arkedly decreasedUsually normalMenstruationAbsentUsually normalBinge eating25-50%Required for diagnosisM ortality5% per decadeLowPhysical and Laboratory Findings" Skin/extremitiesLanugo Acrocyanosis Edema CardiovascularBradycardia Hypotension GastrointestinalSalivary gland enlargementSalivary gland enlargement Slow gastric emptyingDental erosion Constipation Elevated liver enzymes HematopoieticNormochromic, normocyctic anemia Leukopenia Fluid/ElectrolyteIncreased BUN, creatinineHypokalemia HypokalemiaHypochloremia AlkalosisEndocrineHypoglycemia EndocrineHypoglycemia Low estrogen or testosterone Low LH and FSH Low-normal thyroxine Normal TSH Increased cortisolBoneOsteopenia
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Treatment of anal condyloma depends on the location and extent of disease. Small was on the perianal skin and distal anal canal may be treated by the topical application of bichloracetic acid or podophyllin. Imiquimod is an immunomodulator that recently was introduced for topical treatment of several viral infections, including anogenital condyloma. Ref: Bullard Dunn K.M., Rothenberger D.A. (2010). Chapter 29. Colon, Rectum, and Anus. In F.C. Brunicardi, D.K. Andersen, T.R. Billiar, D.L. Dunn, J.G. Hunter, J.B. Matthews, R.E. Pollock (Eds), Schwaz's Principles of Surgery, 9e.
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The fern test can determine the presence or absence of ovulation or the time of ovulation. When cervical mucus is spread on a clean, dry slide and allowed to dry in air, it may or may not assume a frondlike pattern when viewed under the microscope. The fern frond pattern indicates an estrogenic effect on the mucus without the influence of progesterone; thus, a non-frondlike pattern can be interpreted as showing that ovulation has occurred. Progesterone makes the mucus thick and cellular. Ref: Kawada C., Hochner-Celnikier D. (2013). Chapter 35. Gynecologic History, Examination, & Diagnostic Procedures. In A.H. DeCherney, L. Nathan, N. Laufer, A.S. Roman (Eds), CURRENT Diagnosis & Treatment: Obstetrics & Gynecology, 11e.
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Dental anchorage in which the manner and application of force tend to displace the anchorage unit bodily in the plane of space in which the force is being applied is termed stationary anchorage. If a tooth can be grasped with an appliance in such a manner that any movement requires the tooth to move without any change in its axial inclination, this resistance is considerably greater than a tipping force. A good example of this type of anchorage is the retraction of maxillary incisors, using the first molars as the anchorage unit.
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Ans. a (USG cranium). (Ref. Grainger, Diagnostic Radiology, 4th ed., 2469)Cranial ultrasound of Infants# USG cranium is best method to diagnose hydrocephalus through the anterior and posterior fontanalles.# Progression of hydrocephalus can be estimated by comparison with previous studies.# USG is also helpful in following ventricular decompression in patients treated for hydrocephalus.# Neonatal hydrocephalus can also be evaluated by Doppler to assess indirectly intracranial pressure and help to determine the need for shunt placement.Cranial CT# CT enable us to evaluate the brain structure and ventricular size by noninvasive highly reliable technique.# But due to the ionizing radiations hazard, CT as a screening investigation is less preferable.Qhstretk. (Fetal) Cranial ultrasound# Obstretic ultrasound study is one of the best methods for antenatal diagnosis of hydrocephalus as it is noninvasive & hazard free not only to fetus as well as to mother. However assessment prior to GA of 20 weeks may be difficult, as ventricles constitute a large portion of cranial vault.# Signs suggestive of fetal hydrocephalus on obstretic USG study are:- Atrial size > 10 mm- Dangling "Choroid plexus" sign- BPD > 95th percentile- +- PolyhydramniosEducational points:# Lemon sign:- Concave/linear frontal contour abnormality located at coronal suture strongly associated with spina bifida.# Banana sign:- Cerebellum wrapped around posterior brainstem + obliteration of cisterna magna secondary to small posterior fossa + downward traction of spinal cord in Chiari II malformation.# Key points about Obstetric color Doppler study:- Assessment of flow in MCA is important parameter to diagnose fetal anemia.- Assessment of flow in umbilical vessels is important parameter to diagnose fetoplacental insufficiency.- Reduced diastolic flow in umbilical artery is the earliest sign of fetoplacental insufficiency.- Reversal of flow in umbilical artery (as well as pulsatile flow in umbilical vein) is the most ominous sign and may indicate impending fetal death.
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Continuous incontinence
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Ans. is 'd' i.e., Prions o Prions are infectious particle which contains protein onlyo They do not have nucleic acid. Prions have been defined as -Small proteinaceous infectious particle which resist inactivation by procedures that modify nucleic acids.
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Toxic Multinodular goiter C/F- Palpitations Weight loss Increased appetite. Ix - | T3 ,T4 , | TSH Negative TSH-R ab. USG - Multiple nodules Isotope scan- Several areas of increased uptake. Rx After achieving euthyroid state , Near total thyroidectomy is preferred Near total Thyroidectomy- Leaving < 1 gram of thyroid tissue adjacent to recurrent laryngeal nerve at ligament of berry. Only in elderly ,subtotal thyroidectomy is done.
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Ans. is 'a' i.e.. Acute Pulmonary Embolismo Acute Pulmonary! Embolism is the most common cause of Preventable Hospital DeathAcute Pulmonary Embolism is the third most common cause of hospital death in the united states after heart failure and cancer.Acute Pulmonary Embolism is the most common cause of preventable hospital death.Acute Pulmonary Embolism is the most common cause of death after surgery in a surgical patient.
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DNA hypomeyhylating agents are used in the treatment of myelodyplastic syndromes The agents in this group include Azacytidine Decitabine Refer Harrison 17th/671
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Sputum can be disinfected using 5% cresol or autoclaving or by boiling. Mycobacterial tuberculosis is resistant to chlorhexidine, acids and alkalies. Of the phenols o-phenylphenol is effective, alcohols, formaldehyde, formaldehyde alcohol, iodine alcohol and ethylene oxide are tuberculocidal agents. Disinfectants commonly used: Faeces and urine: disinfectants used are bleaching powder, formalin, cresol and phenol Room: First wash with soap water Mopping with 5% phenol or 2.5% cresol Spraying of formalin 500ml/1000cu ft Expose to formaldehyde vapor for 24 hours Linen: Boiling, steam disinfection. Exposure formalin gas Dead bodies: 10% formalin or 5% phenol Instruments: 3% Lysol
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Seven of the reactions of glycolysis are reversible and are used in the synthesis of glucose by gluconeogenesis. Thus, seven enzymes are common to both glycolysis and gluconeogenesis : (i) Phosphohexose isomerase; (ii) Aldolase; (iii) Phosphotriose isomerase, (iv) Glyceraldehyde 3-phosphate dehydrogenase; (v) Phosphoglycerate kinase; (vi) Phosphoglycerate mutase; (vii) Enolase. Three reactions of glycolysis are irreversible which are circumvented in gluconeogenesis by four reactions. So, enzymes at these steps are different in glycolysis and gluconeogenesis.
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Serum calcium should be estiamated in this baby to rule out hypocalcemia. Infants of diabetic mothers are at high risk of developing Hypoglycemia Hypocalcemia Hypomagnesemia Hypocalcemia is defined as a total serum calcium concentration of less than 8 mg/dl for a term baby and less than 7 mg/dl for a preterm baby. Ref: Nelson textbook of pediatrics 21st edition Pgno: 913
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Subarachnoid hemorrhage Rupture of sacular Berry aneurysm which is usually located in one of the vessels in the Circle of Willis. Berry aneurysm occurs due to congenital defect or degenerative change in the muscle layer and internal elastic lamina. Only the initimal layer and adventitia of the aery form the dome of the aneurysm. Ref: FORENSIC MEDICINE AND TOXICOLOGY Dr PC IGNATIUS THIRD EDITION PAGE 174
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In secondary healing :
More granulation tissue and fibrosis occurs.
Scar is loss cosmetic.
Secondary healing occurs slower.
Surgical wounds are clean cut, hence they heal by secondary healing.
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.GALLSTONE ILEUS is a type of acute intestinal obstruction, often seen in elderly and is due to blockage by a bolus or mass of gallstones which commonly enter the intestine through cholecystoduodenal fistula or rarely through cholecystointestinal or -gastric fistulas .Gallstones in the gallbladder | Cholecystitis | Suppuration and adhesion over the duodenal wall | Communication of gallbladder into the duodenum | Gallstones pass into the duodenum forms a bolus ('Rolling stone gather mass') | Blocks narrow pa in the ileum. | Gallstone ileus ref:SRB&;S manual of surgery,ed 3,pg no 594
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Ans. B i.e. Fetal pas palpation
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Ans. Opticneuritis
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Ans. is 'b i.e., Double stranded Anti-DNA is specific for SLE "Antibodies to double - stranded DNA and the Smith (Sm) antigen are viually diagnostic of SLE". -- Robbins Antibodies in SLE SLE is an autoimmune disease and the fundamental defect is a failure of mechanism that mantain self tolerance. o Failure of tolerance results in formation of autoantibodies and autoimmunity. o Amongst these antibodies, most impoant are antinuclear antibodies (ANA). ANAs are directed against several nuclear antigens and can be of following types. 1. Generic antinuclear antibody o Most common (between 95 to 100% of the patients). o Against DNA, RNA and proteins. o Most sensitive antibodies for SLE --> best screening test. o But, not specific because patients with other autoimmune diseases also show positive test. 2. Anti ds DNA antibody o Most specific for SLE o Not sensitive 3. Anti Smith (Sm) antibody o Along with anti ds DNA antibody, most specific for SLE. o Not sensitive 4. Antihistone antibody Paicularly seen in drug induced SLE. 5. Anti RNP- SS - A (Ro), SS-B (La) Seen in neonatal lupus with congenital hea block and in subacute cutaneous lupus. o Associated with decreased risk of lupus nephritis. o More common in sjogren syndrome (Sicca syndrome). 6. Anti Ui RNP Seen in patients that have overlap feature of several rheumatic syndromes including SLE Mixed connective tissue disease. 7. Anti DNA topoisonerase (Scl - 70) o In less than 5% of patients of SLE. o More common in patients with systemic sclerosis. 8. Anticentromere In less than 5% of patients of SLE. More common in patiens with localized form of systemic sclerosis, i.e. scleroderma. 9. Anti-histidyl t-RNA systhatase In less than 5% of SLE patiens. o More common in patiens with inflammatory myopathies. Besides antinuclear antibodies following antibodies are also seen in SLE ? 1. Antiphospholipid (lupus anticoagulant) 2. Antierythrocyte ---> causes hemolytic anemia 3. Antiplatelet --> Causes thrombocytopenia 4. Antiribosomal P 5. Antineuronal
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Ans is 'c' i.e., Kyanasur Forest disease KFD is a febrile disease associated with haemorrhages caused by an arbovirus flavivirus and is transmitted to man by bile of infective hard ticks.
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Chaperones attach to nascent polypeptide chains and prevent wrong foldings so that folding is allowed only in the correct direction. They help in the assembly of teiary and quaternary structure of protein. They are not pa of mature protein. They have ATPase activity. Ref: Vasudevan Biochemistry, 3rd Edition, Page 361
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Ans. is 'b' i.e., VP reaction (+)ve o El Tor Vibrio has following characteristics (in comparison to classical vibrio)i) It is much hardier than classical vibrios, capable of surviving in the environment much longer.ii) The severity of illness is much less, with a large proportion of mild and asymptomatic infections.iii) Mortality is low and the carrier rate is high.iv) Fewer secondary cases in affected families (secondry attack rate is less).TestClassical choleraEl TorHemolysis-+Voges-Proskauer-+Chick erythrocyte-+Aggulination Polymyxin B+-Sensitivity Group IV phage+-Susceptibility-+E1 Tor phage 5 susceptibility
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Ans. d. End tidal capnography (Ref: Bethune, R. W. M., and Brechner, V. L. (1968). Detection of venous air embolism by carbon dioxide monitoring. Anesthesiology, 29, 178)Brechner and Bethune are associated with end-tidal capnography.
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Rectified spirit cannot be used as a preservative in the following poisoning cases: kerosene Alcohol Phenol Phosphorus Paraldehyde Acetic acid Ref: FORENSIC MEDICINE AND TOXICOLOGY Dr PC IGNATIUS THIRD EDITION PAGE 404
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Tetracycline - Binds reversibly to the 30S subunit of the bacterial ribosome, blocking the binding of aminoacyl-tRNA to the acceptor site on the m-RNA ribosome complex. Chloramphenicol - It binds reversibly to the 50S subunit of the bacterial ribosome and inhibits peptide bond formation. Macrolides - Inhibit the translocation Aminoglycosides - protein synthesis is inhibited in three ways: 1. Cause misreading of mRNA-affect permeability. 2. interference with the initiation complex of peptide formation 3.Breakup of polysomes into nonfunctional monosomes.
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Ans. is 'a' i.e., Mitral stenosis Radiological signs of mitral stenosisDue to left atrial enlargement :- Straightening of left heart border, elevation of left main bronchus with widening of carina, double atrial shadow (Double density sign), posterior displacement of esophagus on barium swallow, Prominent posterosuperior part of 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 some times 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 prunning.
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Ans. b. B.P.>140/90 mm HgCriteria for severe Preeclampsia:A persistent SBP of > 160 mm Hg systolic or DBP of > 110 mmHgPersistent severe epigastric painCerebral or visual disturbancesOliguria <400ml/24hrProtein excretion of > 5gm/dayHELLP syndromeRetinal haemorrhage, exudates or papilledemaIntrauterine growth restriction of the foetusPulmonary oedema
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Regulation of TCA Cycle 1. As the primary function of TCA cycle is to provide energy, respiratory control the ETC and oxidative phosphorylation exes the main control. SECTION FOUR 2. In addition to this overall and coarse control, several enzymes of TCA cycle are also impoant in the regulation. Three Key enzymes are: * Citrate synthase * Isocitrate dehydrogenase (ICD) *aaa-oxoglutarate dehydrogenase These enzymes are responsive to the energy status as expressed by the ATP/ADP ratio and NADH/NAD+ ratio * Citrate synthase enzyme is allosterically inhibited by ATP and long-chain acyl-CoA. * NAD+-dependent mitochondrial isocitrate dehydrogenase (ICD) is activated allosterically by ADP and is inhibited by ATP and NADH. * a-oxoglutarate dehydrogenase regulation is analogous to PDH complex. 3. In addition to above, succinate dehydrogenase enzyme is inhibited by OAA and the availability of OAA is controlled by malate dehydrogenase, which depends on NADH/NAD+ ratio. Most of ATP is formed as a result of oxidative phosphorylation resulting from re-oxidation of reduced coenzymes, viz., NADH and FADH2 by the respiratory chain. The remainder is generated by Phosphorylation at substrate level.Ref: MN Chatterjea Textbook of Medical Biochemistry, 8th Edition, Page no: 342 & 343
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Autoinfection is seen in- C- Cryptosporidium parvum H- H. nana E- Enterobius vermicularis S- Strongyloides stercoralis T- Taenia solium Reference- Paniker Textbook of Parasitology 8th Ed pg no 148 Q209 Smallest helminth..... Sol- - H-nana (Dwarf tapeworm) - smallest tapeworm with an adult length of 15-44mm - H. diminuta (Rat tapeworm) - cestode of mainly rodents with an adult length of 20-60cm -Balantidium coli is the only pathogenic ciliate -D. latum is 30 feet.
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Antrochoanal polyp is usually single and unilateral. More tendency to grow posteriorly and do not bleed. Unilateral nasal obstruction is the presenting symptom. Obstruction may become bilateral when polyp grows posteriorly into the nasopharynx and stas obstructing the opposite choana. (Ref - PL DHINGRA diseases of ear nose and throat, 7th edition, page no 193)
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B i.e. Inquest repo
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Herald patch or mother patch is a characteristic feature of Pityriasis rosea Pityriasis rosea is a type of skin rash.Classically, it begins with a single red and slightly scaly area known as a "herald patch". This is then followed, days to weeks later, by a pink whole body rash. It typically lasts less than three months and goes away without treatment. Sometime a fever may occur before the sta of the rash or itchiness may be present, but often there are few other symptoms The symptoms of this condition include: An upper respiratory tract infection may precede all other symptoms in as many as 69% of patients. A single, 2- to (rarely) 10-cm oval red "herald" patch appears, classically on the abdomen.Occasionally, the "herald" patch may occur in a 'hidden' position (in the armpit, for example) and not be noticed immediately. The "herald" patch may also appear as a cluster of smaller oval spots, and be mistaken for acne. Rarely, it does not become present at all. 7-14 days after the herald patch, many small (5-10 mm) patches of pink or red, flaky, oval-shaped rash appear on the torso. The more numerous oval patches generally spread widely across the chest first, following the rib-line in a characteristic "christmas-tree" distribution. Small, circular patches may appear on the back and neck several days later. In 6% of cases an "inverse" distribution may occur, with rash mostly on the extremities. In children, presentation can be atypical or inverse, and the course is typically milder. About one in four people with PR have mild to severe symptomatic itching. (Moderate itching due to skin over-dryness is much more common, especially if soap is used to cleanse the affected areas.) The itching is often non-specific, and worsens if scratched. This tends to fade as the rash develops and does not usually last through the entire course of the disease. The rash may be accompanied by low-grade fever, headache, nausea and fatigue Ref Harrison 20th edition pg 1290
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Metoprolol is a cardioselective (b1 selective) blocker and not b2 selective. Esmolol is the shoest acting b -blocker and is useful for acute treatment. Nadolol is a non-selective b-blocker. It blocks both b1 as well as b2 receptors. Propanolol possesses maximum local anaesthetic activity whereas timolol lacks this propey.
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Fatal dose of methyl alcohol is 60-250 ml in adults, but as little is 15 ml can cause blindness.
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Waste such as anatomical waste , solid waste,soiled waste , chemical waste is collected in yellow coloured bag and treated and disposed by incineration
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Ans: D (Action potentials) Ref: W F Ganong. Vision. In: Review of Medical Physiology. 23rd ed. California: McGraw-Hill Companies; 2010.Explanation:"Unlike most neurons, bipolar cells communicate via graded potentials, rather than action potentials "Genesis of Electrical Responses in RetinaElectrical responses of most of the other neural elements in the retina are local, graded potentialsOnly in the ganglion cells, all-or-none action potentials (transmitted over appreciable distances) are generatedResponses of the rods, cones, and horizontal cells are hyperpolarizingTable 1 : Normal transport of substances bv the intestine and location of maximum absorption or secretion Small Intestine Absorption of:Upper(Duodenum & Jejunum)MidLower(Terminalileum)ColonSugars (glucose, galactose, etc.+++++++0Amino acids+++++++0Water-soluble and fat-soluble vitamins except vitamin B12+++++00Long-chain fatty acid absorption and conversion to triglyceride++++++0Bile salts+++++ Vitamin B120++++0Na++++++++++++K++++SecretedCa2+++++++?Fe2++++-+++?Cl-+++++++SO42-+++0? Table 2 : Function of HypothalamusRegionAreaNucleusFunctionAnteriorMedialMedial preoptic nucleus* Regulates the release of gonadotropic hormones from the adenohypophysis* Contains theseally dimorphic nucleus, whch releases GnRH, differential development between sexes is based upon in utero testosterone levels* Vasopressin releaseSupraopticnucleus (SO)Paraventricularnucleus* (PV)* Thyrotropin-releasing hormone release* Corticotropin-re lea sing hormone release* Oxytocin releaseAnterior hypothalamicnucleus (AH)* Thermoregulation* Panting* Sweating* Thyrotropin inhibition Supra chiasmatic nucl eus(SC)Lateral preoptic nucleus* Circadian rhythmsLateralLateral nucleus (LT)* Thirst and hungerPart of supracptic nucleus (SO) Dorsomedial hypothalamic nucleus (DM)Ventromedialnucleus (VM)Arcuate nucleus (AFt) TuberalMedial* Blood Pressure* Heart Rate* Gl stimulation* Satiety* Neiroendocrine control* Growth hormone-re lea sing hormone (GHRH)* Feeding* Dopamine* Thirst and hungerLateralLateral nucleus (LT) Lateral tuberal nucleiPosteriorMedialMammillary nuclei(part of mammillary bodies) (MB)Posterior nucleus (PN)* Memory* Increase bbod pressure* Pupillary dilation* Shivering* Vasopressin releaseLateralLateral nucleus (LT) * Responses of the bipolar cells are either hyperpolarizing or depolarizing.* Aniacrine cells produce depolarizing potentials.
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Anterior mediastinum - Thymona.
Middle mediastinum - Tortuous innominate artery.
Posterior mediastinum : Bochdalek's hernia.
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Ans. A i.e. Goodpasture syndrome Goodpasture's syndrome is a type II hypersensitivity-like reaction
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Rate of progression of CIN
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Ans. B: 2 months of treatment The treatment in Category I consists of an intensive phase of H, R, Z and E administered under a direct supervision thrice weekly on alternate days for 2 months, followed by a continuation phase of H and R thrice weekly on alternate days for 4 months In the Category 1 follow-up, sputum examination is done at 2, 4 and 6 months of treatment. If smear is positive after 2 months, the intensive phase is extended for one more month and sputum examinations done at 3, 5 and 7 months.
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Among given options Central obesity is seen in Cushing's disease. CUSHING'S DISEASE: Form of Cushing's syndrome in which pituitary gland releases too much of ACTH Features of Cushing's syndrome: Moon facies Centripetal Obesity Proximal myopathy Violet/ purple Striae, Thin skin, Purpura Buffalo hump Weight gain / Lemon on sticks description | Peripheral resistance - HTN Insulin resistance - sugar FBS > 126 mg%; 2hr > 200 mg% Coisol | - Activates ENaC - causes salt & water retention; Hypokalemic alkalosis Coisol | - Activates Sex steroid receptors Female - Hirsutism, weight gain, oligomenorrhea, infeility Hyperpigmentation: (+-)
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Pellagra Pellagra occurs due to Vitamin B3 (Niacin) deficiency Pellagra is characterized by by 4D's : 1.Diarrhoea 2.Dermatitis 3.Dementia 4.Death. Skin rash in Pellagra may appear as pigmented and scaly in areas exposed to sunlight. Especially neck when it is known as 'Casal's Necklace' Ref: Park 25th edition Pgno : 657 Harrison's 15th edition Pgno : 463
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Answer is C (Anagrelide ) This is a case of essential thrombocytosis. Interferon a and Anagrelide are the recommended treatment modalities for reducing platelet count in this disorder. Previous editions of Harrisons and most other texts recommend hydroxyurea as the standard modality of treatment, but in view of the text mentioned in Harrisons 16th ,hydroxyurea cannot be picked as the answer. Essential thrombocytosis (essential thrombocythaemia; idiopathic thrombocvtosis; hemorrhagic thrombocythaemia) Essential thrombocytosis is a myeloproliferative disorder characterized by overproduction of platelets without a definable cause. Clinical features Laboratory Diagnostic features Symptoms * Elevated platelet count is hallmark (often >1000x103/ uL) * Haematocrit and RBC morphology normal * WBC count is mildly elevated/normal * Haemorrhagic tendencies : Easy bruising deg * Thrombotic tendencies : Microvascular occlusions - Erythromelalgia (mild neutrophillic leucocytosis) - Migraine (headache) * LAP is normal or elevated - Transient ischemic attacks * Philadelphia chromosome is absent Signs * Splenomegaly : usually mild/moderate massive splenomegaly is more characteristic ()1 other myeloproliferative disorders. Management in asymptomatic patient Management in symptomatic patient Elevated platelet count in asymptomatic patient Elevated platelet count in symptomatic patients * No therapy is recommended because agents used in treatment * Symptoms must be clearly identified to be a consequence of place the patient at risk of developing acute leukemia elevated platelet count Therapy with risk of acute leukemia Platelet reduction * Radioactive phosphorus * IFN a * Hydroxyuria * Anagrelide * Alkylating agents * Hydroxyurea: should be considered only if the above agents are not effective or tolerable .- Harrison
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Physical quality of life index (PQLI) includes Infant moality rate, Life expectancy at 1 year and literacy. Ref: Park, 20th Edition, Page 16.
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Ans. is 'd' i.e., Trichophyton
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3rd stage of labour.
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Ans. (a) Multiple myelomaRef.'.Apley's 8/e, p 191)
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ANSWER: (D) c AMP pathwayREF: Guyton 12th ed pg 948Glucagon causes glycogenolysis in the liver and this in turn increases the blood glucose levels by the following mechanismGlucagon activates adenylyl cyclase in the hepatic cell membraneThis causes formation of cAMPActivation of protein kinase regulator proteinActivation of protein kinaseActivation of phosphorylase b kinaseConversion of phosphorylase b to phosphorylase aDegradation of glycogen to glucose 1 phosphateDephosporylation and release of glucose
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Ans. (d) All of aboveRef: Bailey & Love 26th ed. 1899-900* Buerger's disease is an inflammation of the arteries, veins, and nerves in the legs, principally, leading to restricted blood flow. Left untreated, Buerger's disease can lead to gangrene of the affected areas. Buerger's disease is also known as thrombo-angitis obliterans.* Early symptoms include decrease in the blood supply (arterial ischemia) and superficial (near the skin surface) phlebitis. The main symptom is pain in the affected areas. Inflammation occurs in small and medium-sized arteries and veins near the surface of the limb. The pulse in arteries of the feet is weak or undetectable. The lack of blood flow can lead to gangrene. A cold sensitivity in the hands, similar to that seen in Raynaud's disease, can develop.
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Ans. is 'a' i.e., Trichophyton . Dermatophytes can be identified by their colonial appearance and microscopic morphology after growth for 2 weeks at 25degc on sabouraud's dextrose agar. . Differential diagnosis of Dermatophytes on the basis of Macroconidia and microconidia General Microconidia Macroconidia Trichophyton Abundant microconidia, arranged in clusters along hyphae Relatively scanty, elongated with blunt ends Microsporum Single microconidia (multicellular) Single macroconidia (multicellular) Epidermophyton No microcondia Macroconidia in groups of 2 or 3
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Tumors of the CNS Gardner syndrome is a variant of the disease 'familial adenomatous polyposis' (FAP), an inherited disease that is characterised by gastrointestinal polyps, multiple osteomas (benign bone tumours), thyroid tumors, dental abnormalities and skin and soft tissue tumours. Polyps tend to form at pubey with the average age of diagnosis around 25 years of age. In almost all patients, polyps will progress to malignancy, resulting in colorectal cancer so that timely detection is essential. Clinical features of Gardner syndrome can be divided into two types, cutaneous and non-cutaneous. The most noticeable cutaneous feature of Gardner syndrome is the appearance of epidermoid cysts. These cysts can be differentiated from ordinary epidermoid cysts by the following factors: - Epidermoid cysts of Gardner syndrome occur at an earlier age (around pubey) than ordinary cysts - Epidermoid cysts occur in less common locations such as the face, scalp and extremities compared to ordinary cysts - Cysts tend to be multiple in over half of the patients with Gardner syndrome As with ordinary epidermoid cysts, cysts in Gardner syndrome are usually asymptomatic (without symptoms), however in some cases they may be pruritic (itchy) and/or inflamed, and they may rupture. Other cutaneous features include fibromas, lipomas, leiomyomas, neurofibromas and pigmented skin lesions. Non-cutaneous features include: - Gastrointestinal polyps that nearly always transform into colonic adenocarcinomas (colon cancer). - Osteomas - these benign bone tumours are essential in making the diagnosis of Gardner syndrome. They occur most commonly in the mandible (jawbone) but may also grow in the skull and long bones. - Dental abnormalities - as well as osteomas in the jaw there may be other dental abnormalities such as unerupted extra teeth and caries - Multifocal pigmented lesions of the fundus in the eye - seen in 80% of patients. These lesions may be present sholy after bih and can be the first marker of the disease.
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The earliest symptom of many patients with acoustic neuroma is mild unilateral sensorineural hearing loss. Tinnitus is common, veigo may or may not be present. Acoustic neuromas arise predominantly from the superior half of the vestibular poion of the vestibulocochlear nerve. Very large tumors may cause brain stem compression and obstructive hydrocephalus.
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Ans. (c) Stage 2 NREM(Ref: Ganong, 25th ed/p.273)Stage 2 NREMWaves with frequency 12-14Hz called sleep spindles seenhigh voltage biphasic waves called K complexes also seen
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ALKALINE PHOSPHATASE. Serum alkaline phosphatase is produced by many tissues, especially bone, liver, intestine and placenta and is excreted in the bile.
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Bunion Painful bony bump that develops on the inside of the foot at the MTP of great toe associated with Hallux Valgus Hallux Calgus is the lageral detion of the greater toe with prominence of the 1st MTP Pathology: Prominence of the first metatarsal head is due to subluxation of the MTP joint; increasing shoe pressure on the medial side leads to the development of an overlying bursa and thickened soft tissues, additional changes that combine to form the defining 'bunion' that eventually accompanies the great-toe deformity Not a true exostosis
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(d) Acromegaly(Ref. Scott Brown, 6th ed., 4/8/29)Acromegaly occurring due to growth hormone secreting pituitary adenoma is characterised by enlargement of the nose.
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Ans. is 'b' i.e., Mediate response of extracellular hormones and neurotransmitter
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Heroine : Smack, Junk, Brown Sugar, Tar Heroine + cocaine: Speed Ball Amphetamine: Superman's Drug, Speed Crystal MDMA: Ecstasy, Rave Drug, Club Drug, Hug drug MDMA + marijuana:Love boat LSD: Battery Acid, Golden Dragon, Heavenly Blue, Hippie Ketamine; Super K, Purple Drug Morphine: Miss Emma, God's Machine
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Cereal pulse rationis 3:1.sprouted pulses have more nutrients.rice water left after cooking should be mixed with dal if these are cooked seperately.fermentation improves nutritive value.REF.PARK'S TEXTBOOK OF PREVENTIVE AND SOCIAL MEDICINE.Editon-21.Page no.-612.
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Type III hyperlipoproteinemia is due to defect in ApoE. Chylomicron remnants and VLDL remnants gets elevated in the body.
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Celiac plexus is present on the anterior side of the aorta around the beginning of celiac trunk .
It lies over the anterolateral surface of the aorta at the T12 / L1 vertebral level.
Celiac plexus is retroperitoneal and located behind the stomach and the omental bursa, and in front of the crura of the diaphragm.
In pictorial representation it appear anteromedial to sympathetic trunks as well, though no such statement is mentioned in standard textbooks.
Frequently celiac plexus block (fluoroscopically guided injection) is performed by pain management specialists and radiologists is performed via CT guidance.
Intractable pain related to chronic pancreatitis is an important indication for celiac plexus ablation.
KEY CONCEPT:
Celiac plexus is the largest visceral plexus and is located deep in the retroperitoneum, over the anterolateral surface of the aorta and around the origin of the celiac trunk.
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Ans. is 'c' i.e., TriazolamLong actingT 1/2 Clinical UsesFlurazepam50-100 (Longest)Chronic Insomnia, short - term insomnia with anxiety; Frequent nocturnal awakening; Night before operation.Diazepam30-60 Nitrazepam30Short acting Alprazolam12Individuals who react unfavourably to unfamiliar surroundings or unusual timings of sleep. Sleep onset difficulties.Temazolam8-12 Triazolam2-3 (shortest)o This question is a direct repeat from NEET 2012-13.
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Ans. is 'a' i.e., Split russel traction * In children, conservative treatment is given by:-i) 0-2 yeas : - Plaster spica or modified Bryant or Gallow's traction or pavllic harness (< 6 month of age).ii) 2-10 years: - Split Russel tractioniii) 10-15 years : - 90-90deg femoral skeletal traction.
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Causes of Facial Nerve Palsy:- Most common cause is idiopathic bell's palsy paralysis acute onset Bell's palsy idiopathic, Ipsilateral lower motor neuron palsy Loss of forehead and brow movements Inability to close eyes drooping of eyelids Loss of nasolabial folds, drooping of lower lip Herpes zoster oticus/Ramsey hunt syndrome LMN facial nerve palsy Vesicular rash in the external auditory canal and pinna Ear pain Mastoid surgery is the most common Iatrogenic cause of facial nerve palsy
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Ans. is 'a' i.e., Peroneus brevis Muscles of the anterior compartment of the leg and dorsum of the footMusclesNerve supplyAction1. Tibialis anteriorDeep peroneal nervea) Dorsiflexor of footb) Invertor of the footc) Keeps the leg vertical while walking on uneven groundd) Maintains medial longitudinal arch of the foot2. Extensor hallucis longusDeep peroneal nerveDorsiflexor of foot and extends metatarsophalangeal and interphalangeal joints of the big toe.3. Extensor digitorum longusDeep personal nerveDorsiflexor of the foot. Extends metatarsophalangeal, proximal and distal interphalangeal joints of 2nd-5th toes.4. Peroneus TertiusDeep peroneal nerveDorsiflexor of foot and evertor of the foot.5. Extensor digitorum brevisLateral terminal branch of the deep peroneal nerveMedial tendon known as extensor hallucis brevis extends metatarsophalangeal joint of the big toe. The other three lateral tendons extend the metatarsophalangeal and interphalangeal joints of 2nd, 3rd, and 4th toes, particularly in a dorsiflexed foot.Muscles of the lateral compartment of the leg The peroneal musclesMusclesNerve supplyAction1. Peroneus IongusSuperficial peroneal nervea) Everton of foot especially when the foot is off the groundb) Maintain lateral longitudinal arch and transverse arch of the foot.Peroneus longus and tibialis anterior are inserted into the same two bones, the two together form a 'stirrup' beneath the middle of the sole. The presence of the sling keeps the middle of foot pulled up and prevents flattening of its arches.2. Peroneus brevisSuperficial peroneal nerveEvertor of foot
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Baker's cyst:- It is a pulsion diveiculum of knee joint.- It usually found in the posterior aspect of the knee joint.- It is associated with medial meniscal injury.
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a. Baby born at 28 weeks gestation(Ref: Nelson's 20/e p 3050, Ghai 8/e p 666)Indications of Screening for Retinopathy of prematurity (ROP):Birth weight <1,500g or gestational age < 32 wk &Selected neonates with a birth weight between 1,500 and 2,000g or gestational age of >32 wk with an unstable clinical course, including those requiring cardiorespiratory support.
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A i.e. I
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Wall of hea enlarged in mitral stenosis - left atria
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During periods of endemic disease, about 10% of the general population harbour Neisseria meningitidis in the nasopharynx.
Since N. meningitidis is a strict human pathogen and most patients have not been in contact with other cases, asymptomatic carriers are presumably the major source of the pathogenic strains.
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THe maxillary sinuses are innervated by infra-orbital and alveolar branches of the maxillary nerve
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Ans. (a) Gametocyte Infective forms for human is sporozoites in saliva of mosquito Infective forms for mosquito is gametocytes in human blood. At least 12 gametocytes per cubic mm of blood must be present to infect mosquito. Gametocytes are maximum in number during the early stages of infections (may exceed 1000 per cubic mm of blood). Nonmotile zygote conveed into motile ookinete in about 18 - 24 hours.
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Ans. c. Early stage of congenital syphilisRhagades are fissures, cracks or linear scars especially at angle of mouth & nose
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Le dance sign is empty right iliac fossa, seen in Intussusception.
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The white pulp comprises lymphatic tissue consisting of b-lymphocytes and macrophagesThe red pulp consists of blood filled venous sinuses.The spleen is covered by dense connective tissue called the capsule.Reference: BD Chaurasia&;s handbook of general anatomy, 5th edition, page no.198
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A. i.e. (Defective genes) (161 - Dutta)* Genetic factor (50%) of early miscarriage are due to chromosomal abnormality in the conceptus. Autosomal trisomy is the commonest (50%) cytogenic abnormality in FIRST TRIMESTER*** Cervical incompetence (congenital or acquired) is the most common abnormality in SECOND TRIMESTER*** The cause of fetal death in ectopic pregnancy is postulated as vascular accident*** Most valuable diagnostic test in a case of suspected ectopic pregnancy is - Transvaginal USG**
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Ans. A. Glossopharyngeal nerve. (Ref. BD Chaurasia, Anatomy, Vol 3, 2nd/pg.215).# Nerves which supply the sensation and taste of the tongue differ between the anterior and posterior parts.# Anteriorly, the sensation of taste is passed along the chorda tympani, a branch of the facial nerve. Sensation is passed along the lingual nerve, a branch of the trigeminal nerve.# Posteriorly, both taste and sensation are passed along the glossopharyngeal nerve.# All intrinsic and extrinsic muscles of the tongue are supplied by the hypoglossal nerve, with the exception of the palatoglossus. The palatoglossus is innervated by the vagus nerve.# Vallate papillae lie in front of sulcus terminalis, contain taste buds & glossopharyngeal nerve carries general & taste sensation from them & posterior 2/3rd of tongue.# Circumvallate papillae are present on anterior 2/3rd of the tongue, just in front of sulcus terminalis. They are supplied by glossopharyngeal nerve, which is the nerve of taste for posterior l/3rd of tongue.# Fungiform and filliform papillae are other papillae in tongue. Filiform Papillae are numerous on anterior 2/3rd of tongue & fungiform are scattered on sides & apex & both are supplied by lingual nerve (general sensations) & chorda tympani (taste).Tongue development: 1st and 2nd branchial arches form anterior 2/3 (thus sensation via CN V3, taste via CN VII). 3rd and 4th branchial arches form posterior 1/3 (thus sensation and taste mainly via CN IX, extreme posterior via CN X). Motor innervation is via CN XII. Muscles of the tongue are derived from occipital myotomes.Taste--CN VII, IX, X (solitary nucleus).Pain-CNV3, IX, X.Motor--CN XII.
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Safe surgical exploration distances during orbitotomy Safe distances for the periorbital dissection from the intact outside rim of the adult orbit to vital interior structures are specified in millimeters. Generally an exploration depth of 25 mm along the lateral and inferior walls is regarded as safe. A 30 mm distance from the supraorbital rim and the anterior lacrimal crest are also considered safe exposure of the roof and the medial wall respectively. Along the medial wall, impoant landmarks are described as measurements from the anterior lacrimal crest : - 24 mm* to the anterior ethmoidal foramen - 36 mm* to the posterior ethmoidal foramen (12 mm from the anterior ethmoidal foramen) - 42 mm* to the optic canal (6 mm from the posterior ethmoidal foramen) * Mnemotechnic formula (rule of halves): 24-12-6.
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Types of fingerprints: Loops (about 67%) Radial Ulnar Whorls (about 25%) Concentric Spiral Double spiral Almond-shaped Arches (about 6-7%) Plain Tented Exceptional Composite form (about one to two percent) Central pocket loops Lateral pocket loops Twinned loops Accidentals Ref: The Essentials of Forensic Medicine and Toxicology by Narayan Reddy, 27th edition, Page 76.
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Ans. is 'd' i.e., Just before commincement of menarche Mensus typically appears around the peak in height velocity -Nelson Menarche usually occurs after peak velocity has been attained and as the growth rate begins to decline. Remember o Growth acceleration begins in early adolescence, but peak growth velocities are not reached until middle adolescence.
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Ans. (a) Fungal corneal ulcerRef: A.K. Khurana 6th ed. H06, Khurana 4th ed./100* Fungal corneal ulcer aka fungal keratitis is most commonly caused by Aspergillus fusarium. Patient in this condition presents with history of trauma with vegetative matter.* Symptoms shown by patients here are milder than signs. Signs are dry looking, greyish white corneal ulcers with feather finger like extensions (due to hypae)Signs of Fungal Keratitis:* Satellite nodule (satellite lesion present around ulcer)* Large organized hypopion (non-sterile)* Immune ring of pessaryPredisposing factors- topical steroids, organic matter. Worst prognosis.Treatment: 5% natamycin or .2%fluconazole for 6-8 weeks.
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Ans. c. Flurometholone Flurometholone: Flurometholone is a steroid. Topical coicosteroids and anestheticsQ are contraindicated in bacterial ulcers Latest trial about the use of topical steroids in corneal ulcer-"Adjunctive topical coicosteroid use does not improve 3-month vision in patients with bacterial corneal ulcers."- Olapatadine: Used in treatment of allergic conjunctivitis. Can be used in treatment of refractory vernal ulcers Chloroamphenicol: Topical chloramphenicol is recommended for treatment of bacterial corneal ulcer.\\ Methylcellulose: Used as a lubricant to prevent corneal ulcers in dry eye Topical coicosteroids and anestheticsdeg are contraindicated in corneal ulcer. These should not be used on any type of corneal ulcer because: They prevent healingdeg May lead to superinfection with fungi and other bacteriadeg Often make the condition much worse Treatment of Corneal Ulcers Proper diagnosis is essential for optimal treatment Bacterial corneal ulcers Intensive foified antibiotic therapy to treat the infectionQ Fungal corneal ulcers Intensive application of topical anti-fungal agentsQ Viral corneal ulcers For herpes virus, antivirals like topical acyclovir ointment instilled at least five times a dayQ Treatment of Corneal Ulcers Suppoive therapy: Pain medications are given, including topical cycloplegics like atropine or homatropinedeg to dilate the pupil and thereby stop spasms of the ciliary muscledeg. Superficial ulcers may heal in less than a week. Deep ulcers and descemetoceles may require conjunctival grafts orconjunctival flaps, soft contact lenses, or corneal transplantQ. Proper nutrition, including protein intake and Vitamin C are usually advised. In cases of Keratomalacia, where the corneal ulceration is due to a deficiency of Vitamin A, supplementation of the Vitamin A by oral or intramuscular route is given Drugs contraindicated in Corneal Ulcer Topical coicosteroids and anestheticsQ These should not be used on any type of corneal ulcer because: They prevent healingQ May lead to superinfection with fungi and other bacteriaQ Often make the condition much worseQ
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Amniotic fluid embolism-cardinal signs
Branchospasm
Hypoxemia
Shock
Maternal acidosis
Coagulopathy (DIC)
Altered mental status
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The co-transpo system may either be a sympo or an antipo. In sympo, (Fig. 2.12) the transpoer carries two solutes in the same direction across the membrane, e.g. sodium-dependent glucose transpoer (Chapter 8). Phlorhizin, an inhibitor of sodium-dependent co-transpo of glucose, especially in the proximal convoluted tubules of the kidney, produces renal damage and results in renal glycosuria. Amino acid transpo is another example for sympo.Ref: MN Chatterjea Textbook of Medical Biochemistry, 6th edition, page no: 17
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.It may be that preganglionic sympathetic fibers are more resistant to local anesthetic block than previously thought. Anesthesiologists often assume that, when a motor block is present during spinal or epidural anesthesia, sympathetic nerve transmission is blocked. Ref Robbins 9/e pg 346
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Refer katzung 11e p 97 Acetylcholine is a neurotransmitter, which is a chemical released by a nerve cell or neuron. ... Acetylcholinecauses muscles to contract, activates pain responses and regulates endocrine and REM sleep functions. Deficiencies in acetylcholine can lead to myasthenia gravis, which is characterized by muscle weakness Acetylcholine itself does not have therapeutic value as a drug for intravenous administration because of its multi-faceted action(non-selective) and rapid inactivation by cholinesterase.
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Trauma can occasionally cause a new growth or cancer. For accepting trauma as a cause of new growth/cancer Ewing's postulate should be satisfied. According to this postulate: There must be evidence of previous site normal prior to normal The application of adequate trauma must be proved. There must be proof of reasonable time interval between injury and appearance of tumor. The disease must develop in the exact locality of the injury. The nature of the tumor must be proved by microscopy. Ref: Principles of Forensic Medicine and Toxicology By Rajesh Bardale page 251.
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Ans. is 'd' i.e., Glucuronidation o Phase I reactions: - Oxidation, reduction, hydrolysis, cyclization, decyclization.o Phase II reactions: - Acetylation, glutathione conjugation, glucoronide conjugation (glucuranization), glycine conjugation, methylation, sulfate conjugation (sulfuranation), nucleotide synthesis.
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Functions: Transpo Systems An essential role of biomembranes is to allow movement of all compounds necessary for the normal function of a cell across the membrane barrier. These compounds include a vast array of substances like sugars, amino acids, fatty acids, steroids, cations and anions to mention a few. These compounds must enter or leave the cells in an orderly manner for normal functioning of the cell. A. 1. Ion Channels Ion channels are transmembrane channels, pore-like structures composed of proteins. Specific channels for Na+, K+, Ca++, and Cl- have been identified. Cation conductive channels are negatively charged within the channel and have an average diameter of about 5 to 8 nm. All ion channels are basically made up of transmembrane subunits that come together to form a central pore through which ions pass selectively. All channels have gates and are controlled by opening and closing. Types of Gates Two types of gated channels. They are a. Ligand-gated channels: In this, a specific molecule binds to a receptor and opens the channel. Example: Acetylcholine receptor is present in the postsynaptic membrane. It is a complex of five subunits, having a binding site for acetylcholine. Acetylcholine released from the presynaptic region binds with the binding site of the postsynaptic region, which triggers the opening of the channel and influx of Na+. b. Voltage-gated channels: These channels open or close in response to changes in membrane potential. Some propeies of ion channels * Composed of transmembrane protein subunits. * Highly selective. * Well regulated by the presence of "gates". * Two main types of gates: Ligand-gated and voltage-gated. * Activities are affected by ceain drugs. * Mutations of genes encoding transmembrane proteins can cause specific diseases. 2. Ionophores Ceain microorganisms can synthesize small organic molecules, called ionophores, which function as shuttles for the movement of ions across the membrane. Structure: These ionophores contain hydrophilic centres that bind specific ions and are surrounded by peripheral hydrophobic regions. Types: Two types: (a) Mobile ion carriers: Like valinomycin (Refer uncouplers of oxidative phosphorylation). (b) Channel formers: Like gramicidin. 3. Water Channels (Aquaporins) In ceain cells, e.g. in red blood cells, and cells of the collecting ductules of the kidney, the movement of water by simple diffusion is enhanced by movements of water through water channels, composed of tetrameric transmembrane proteins called aquaporins. About five distinct types of aquaporins have been recognised. CLINICAL ASPECT Recently mutations in the gene encoding AP-2 (Aquaporin 2) protein, have been shown to be the cause of one type of nephrogenic diabetes insipidus. 4. Gap Junction Ceain cells develop specialized regions on their membranes for intercellular communications which are in close proximity. Function: They mediate and regulate the passage of ions and small molecules upto 1000 to 2000 mol wt, through a narrow hydrophilic core connecting the cytosol of adjacent cells. Structure: They are primarily composed of protein, called connexon which contains four membrane-spanning a-helices. the mitochondrial membrane also has paicularly energy coupling mechanism.Ref: MN Chatterjea Textbook of Medical Biochemistry, 8th edition
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In women seeking treatment for infertility, early detection and treatment of hypothyroidism of any degree is advised.
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Choledocholithiasis Risk factors for Choangiocarcinoma - Primary sclerosing cholangitis - Choledochal cyst - Ulcerative colitis - Clonorchis sinensis - Chronic typhoid carriers * Other risk factors - Hepatolithiasis - Biliary enteric anastomosis - Liver flukes - Dietary nitrosamines - Exposure to thorotrast, dioxin Mnemonic 5 C's
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Propofol has replaced the barbiturates for induction of anesthesia in the ambulatory setting because of its orable recovery profile. Recovery after induction of anesthesia with propofol is faster than with the barbiturate compounds and it is associated with low incidence of post operative nausea and vomiting. Ref: Essentials of Medical Pharmacology By K D Tripathi, 5th Edition, Page 344 ; Miller's Anesthesia, 6th Edition, Pages 2602-3
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Ans. is 'c' i.e., Ferrous ions are conveed to ferric ions o Free radicals are generated through Fenton's reaction. o In this reaction iron is conveed from its ferrous to ferric form and a free radical is generated. i.e. (H202+Fe2+ --> Fe3++ OH++ OH-) o Note :- H202 can also react with copper instead of iron to produce free radicals. Free radicals o Free radicals are chemical species that have a single unpaired electron in the outer orbit. o Most of these are paially reduced reactive oxygen forms that are produced as an unavoidable byproduct of mitochondrial respiration --> also known as reactive oxygen species. o The most impoant are hydrogen peroxide (11202), Superoxide anion (02) and hydroxyl radical (OH). o Free radicals are highly reactive species and toxic --> they can damage the cell membrane and nucleic acids. o Free radicals initiate autocatalytic reactions, whereby molecules with which they react are themselves conveed into free radicals to propagate the chain of damage. o Free radicals are produced in several ways : ? I. Ionizing radiations (UV rays, X-rays) can hydrolyze water into hydroxyl (OH) and hydrogen (H) free radicals. Enzymatic metabolism of exogenous chemicals, e.g., CC14 can generate CC13. The reduction - oxidation reaction during normal metabolic process. During normal respiration, molecular oxygen is sequentially reduced by addition of electron to generate water. In this process small amount of H202, 02- and OH- are produced. o H202 generated, can interact with 02 to generate OH through the Haber-weiss reaction. H202+ 02 --> OH- + OH + 02 Rapid burst of superoxide (02) occur in activated neutrophils during inflammation with the help ofNADPH oxidase. Some intracellular oxidases, e.g., xanthine oxidase generate superoxide radicals. Transition metal such as iron and copper donate or accept free electrons and catalyze free radical formation (see above fenton reaction). Nitric oxide (NO) generated in endothelium, macrophages and neurons can also act as free radical. o Free radicals cause cell injury by ? I. Lipid peroxidation and subsequent damage of cellular and mitochondrial membrane. Oxidative modification and subsequent degradation of intracellular proteins. DNA strand break.
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