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Ref: Park 25th edition Pgno : 666
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Answer is A (Commonest Malignancy of lung): The commonest malignancy opting is Adenocarcinoma and not small cell carcinoma The most common malignancy of lung is Adenocarcinoma (overall world wide) Most common lung cancer worldwide is Adenocarcinoma Most common lung cancer in India is squammous cell carcinoma Most common lung cancer in women is adenocarcinoma Most common lung cancer in smokers is squammous cell carcinoma Most common lung cancer in nonsmokers is adenocarcinoma Most common lung cancer in young patients is adenocarcinoma Most common lung cancer to metastasize is small cell carcinoma Small cell carcinomas are associated with paraneoplastic syndromes Small cell carcinomas are the most common type associated with ectopic hormone production Ectopic hormones produced by small cell carcinoms ACTH SIADH/ANP Calcitonin Gonadotropins Paraneoplastic syndrome Cushing's syndrome Hyponatremia Hypocalcemia Gynaecomastia Small cell carcinomas are an established cause for SVC obstruction The most common type of Lung cancer associated with SVC syndrome is small cell carcinoma. Small cell carcinomas are chemosensitive `Small cell carcinomas are paicularly sensitive to radiation and chemotherapy' -Robbins 7th/763 Small cell carcinomas commonly present with metastasis to brain (Harrison 16th/508) Small cell carcinomas are aggressive tumors that metastisize widely (>95% patients). Common sites of metastasis include Brain, Bone Liver and Adrenals
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Spalding sign : It is the irregular overlapping of the cranial bones on one another, due to liquefication of brain matter and softening of the ligamentous structures suppoing the vault. Appears 7 days after death. Ref: Datta Obs 9e pg 303.
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D i.e. Any of the above Though duration of disease is the most impoant and best predictor Q of diabetic retinopathy, all the options mentioned here are, infact risk factors for DR, so, its best to go for Option D.
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Even androgen therapy can cause gynecomastia but among all options given in the question, the best answer is androgen therapy.
Some important causes of Gynaecomastia
Leprosy
Testicular tumours
Lung cancer - Small cell type
Adrenal disease
Liver disease
Hyperthyroidism
Hyperprolactinemia
Castration
Orchitis
Drugs -
Digitalis
Spironolactone
Cimetidine
Clomiphene
Methyldopa
Androgens
Gonadotrophins
Estrogens
Progesterones
Ketoconazole.
Gynecomastia refers to the enlargement of the male breast
Hormone effects
Like the female breast, the male breast is also subject to hormonal influences, and gynecomastia occurs as a result of an imbalance between estrogens which stimulate breast tissue and androgens which counteract these effects.
Usually, gynecomastia is caused by an estrogen excess and is usually the result of an increased estrogen/androgen ratio, caused by -
Increased estrogen
Decreased androgen
hCG producing tumours (hCG stimulates Leydig cells to produce estrogen).
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All other options are relative contraindications of porcelain veneers.
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Ans. is 'c' i.e., Aoic Stenosis o Nerve deafness is the single most common clinical finding among infant with congenital Rubella syndrome. o PDA is the most common CHD in congenital rubella syndrome. o Classical triad of congenital rubella consists of -3 Cataract, Deafness, CHD o Mental retardation is also common.
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Fibrinous exudates may be dissolved by fibrinolysis and cleared by macrophages. If the fibrin is not removed, over time it may stimulate the ingrowth of fibroblasts and blood vessels and thus lead to scarring. ref robbins 9th ed page 90
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The Moyers, Tanaka-Johnston and Staley-Kerber predictions are all based on data from white school children of northern European descent. If the patient fits this population group, the Staley-Kerber method will give the best prediction, followed by the Tanaka-Johnston and Moyers.
On the other hand, if the patient does not fit the population group, as an African or Asian child would not, direct measurement from the radiographs is the best approach.
Huckaba analysis:
The formula recommended by Huckaba was used in all radiographic measurements:
X = (y) (x1)/(y1)
where X is the estimated size of the permanent tooth, x1 is the radiographic size of the permanent teeth, y is the size of the primary mandibular second molar on the cast and y1 is the radiographic size of the primary molar.
Contemporary orthodontics, William Proffit, 4th edition page 198
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Ans. is 'b' i.e., Griseofulvin Contraceptive failure may occur if the following drugs are given concurrently : (a) Enzyme inducer Enhances the metabolism of estrogen & progesterone. Phenytoin 3. Carbamazepine 5. Primidone 2. Phenobarbitone 4. Rifampicin 6. Griseofulvin (b) Suppression of intestinal microflora enterohepatic circulation. 1. Tetracyclines 2. Ampicillin
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d. Severe dehydration(Ref: Nelson's 20/e p 1854-1874)In this case, sunken eyes and skin "goes back very slowly" (in 5 seconds) in a "lethargic" (drowsy) child, so it is a case of severe dehydration.
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Solitary adenoma common cause around 80% of primary hyperparathyroidism Ref - ( Harrison 17 pg 2380)
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Ans. is 'a' i.e., Scabies Vesicobullous lesion in an infant can be seen in Scabies Infantile eczema Seborrheic dermatitis The clincher here is involvement of palms and soles. This is a characteristic feature of scabies in infants * Differential diagnosis Scabies Infantile eczema Characteristic distribution: Lesions present on palms, soles and genitalia Spares palms and soles Burrows present. Absent Typical lesions in a family member May have atopic diathesis in family H/O asthma not relevant History of Asthma Infantile Seborrheic dermatitis Infantile eczema Begin in infants <3 months In infants > 3 months Asymptomatic Extremely itchy Scalp, major flexures (axillae, groins) Face, other parts of the body Family or personal history of atopy. Also, know, In scabies in adults, the scalp, face, palms, and soles are characteristically spared, but in infants scalp, face, palms, and soles are typically involved.
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Cataplexy is the most common accessory symptom of Narcolepsy.
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Ans. is 'c' i.e., Ptosis Clinical features of Bell's palsyo Acute onset, ipsilateral facial paralysis.o Facial paralysis is usually preceded by pain behind the ear.o Patient is unable to close his eyes.o Bells phenomenon, i.e. on attempting to close the eye, eyeball turns up and out.o Face becomes asymmetrical and saliva dribbles from angle of mouth,o Ipsilaieral loss of taste sensation, salivation and lacrimation.o Intolerance to high pitched or loud sound (hyperacusis).o Most patients (80%) recover within few weeks to months.
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Ans. Membranous conjunctivitis
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Examples of stupefying poisons : Alcohol dhatura cannabis chloral hydrate
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Categories of bio-medical waste in IndiaCategory NoWaste category1Human anatomical waste2Animal waste3Microbiology and biotechnology waste4Sharps5Discarded medicines and cytotoxic drugs6Solid waste 7Solid waste 8Liquid waste9Incineration ash10Chemicals used in the production of biologicalsColor codingType of containerWaste categoryTreatment optionsYellowPlastic bagCat 1, 2, 3 & 6Incineration/deep burialRedDisinfected container/plastic bagCat 3, 6 & 7Autoclaving/Microwaving/Chemical treatmentBlue/White translucentPlastic bag/Puncture proof containerCat 4 & 7Autoclaving/Microwaving/Chemical treatment and Destruction/ShreddingBlackPlastic bagCat 5, 9 & 10 Disposal in secured landfillRef: Park; 23rd ed; Pg 793, 794
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Ans: C i.e. Ringer lactate 3 types of fluids are used for fluid resuscitation of burn patients. The most common is Ringer's lactate/ Hamann's solution; some centres use human albumin solution or fresh frozen plasma, and some centres use hypeonic saline.
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Urethritis can be broadly divided into gonococcal and non-gonococcal urethritis. Gonococcal urethritis is caused by Neisseria Gonorrhoeae. Absence of pus cells rules out gonococcal infection. Chlamydia is the most common cause of non gonococcal urethritis accounting for 30-40% of cases. Cell culture used to isolate chlamydia are McCoy cells, HeLa-229 cell line, BHK-21 cells or L-929 cells. Ref: Bacterial Infections of Humans: Epidemiology and Control, 3rd edition, Alfred S. Evans, Chapter 10, Page 200; Sexually Transmitted Infections: Diagnosis, Management, and Treatment, Jonathan M. Zenilman, Page 129; Harrison 16th Edition, Page 764; Ananthnarayanan 7th Edition, Page 425.
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As the patient is able to recall the episode, it is a REM phase disorder, i.e Night mare.
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TSS occurs when measles vaccine is contaminated or the same l is used for more than one section on the same day or next day, the vaccine should not be used after 4hrs of opening the l. Symptoms - watery diarrhoea, vomiting and high fever are repoed within few hours of measles vaccine. Ref: Park&;s textbook of preventive and social medicine; 23rd edition
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In zonular cataract the main mass of the lens internal and external to the zone of cataract is clear, except for small linear opacities like spokes of a wheel (riders) which may be seen towards the equator.
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HBeAg-positive women in third trimester frequently transmit infection to the fetus (80-90%) in the absence of immunoprophylaxis, whereas those who are negative rarely infect the fetus. Ref: Kliegman, Behrman, Jenson, Stanton (2008), Chapter 355, "Viral Hepatitis", In the book, "NELSON TEXTBOOK OF PEDIATRICS", Volume 2, 18th Edition, New Delhi, Page 1683.
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The three features of Verrill’s sign are:
Partial ptosis (50%).
Blurring vision
Slurring speech that indicate the correct level after Diazepam sedation
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Fibroids are usually more cellular than surrounding myometrium.
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Ans. is 'd' i.e., Columnar cells Corneal epithelium is stratified squamous non-keratinized type and becomes continuous with epithelium of bulbor conjunctiva at the limbus.It consists of 5-6 layers of cells. The deepest (basal) layer is made up of columnar cells, next 2-3 layers of wing or umbrella cells and most superficial two layers are of flattened cells.
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This question is basically asking for the differential diagnosis of symptoms of ' sadness of mood, talking less and staying on the bed" in a patient of schizophrenia who has been staed on antipsychotics. 1. The sadness of mood and decreased interaction can be of course due to depression 2. Negative symptoms of schizophrenia have a similar presentation where avolition can result in 'staying on the bed' and asociality and alogia may result in decrease interaction 3. Fuher, the use of antipsychotics can cause drug-induced parkinsonism which again looks quite similar to negative symptoms. The fouh option 'responding to external stimuli' doesn't explain the symptoms and hence is the answer
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Enolase
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Ans. (a) Hernia En GlissadeRef: Sabiston 20th edition Page 1104* Sliding hernia (Hernia en Glissade) is one in which the posterior wall of sac contains retroperitoneal structures like Sigmoid (MC), Cecum, Bladder.
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Ebola transmission occurs through direct skin - skin contact, exposure to infected bodily fluids and tissues. there is no evidence of transmission by aerosol or respiratory droplets.
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Ans. is 'd' i.e., Any of the above
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Duchenne muscular dystrophy: MC hereditary neuromuscular disease in children. X-linked recessive deletion of dystrophin gene ( Xp 21)- one of the largest gene C/F: More common in males. Family history present Pseudohyperophy of calf muscles Cardiac involvement Recurrent respiratory infection Proximal muscle weakness in limbs Intellectual disability 'GOWER SIGN'is positive- Gowers' sign indicates weakness of the proximal muscles, esp of the lower limb. Mx- Phase 3 trials have shown benefits from ETEPLIRSEN - FDA APPROVED
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ERGONOMICS: Definition: Is the application of scientific information concerning objects, systems and environment for human use. Pre-placement examination: Fitting job to workers. Right man in Right job. Post-placement examination- Regular periodic examination: Annual - most occupational exposures. Every 2 months - Radiation exposure. Monthly - lead, dye, radium exposures. Daily - dichromates.
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Tuning fork tests: Rinne's test Weber test Absolute bone conduction (ABC) test Schwabach's test Bing test Gelle's test Common tuning fork tests and their interpretation: Test Normal Conductive deafness SN deafness Rinne AC>BC (Rinne positive) BC>AC (Rinne negative) AC>BC Weber Not laterized Laterized to poorer ear Laterized to better ear ABC Same as examiner's Same as examiner's Reduced Schwabach's Equal Lengthened Shoened
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Cocaine [Ref- Miller Anaesthesia, Lee Synopsis of Anaesthesia I2th/e p. 591-5921 The origin of modern local anaesthesia is credited to Carl poller, an ophthalanzologist who demonstrated the use of topical cocaine for surgical anaesthesia of the eye. - Cocaine had been isolated from the coca plant in 1855 by Gaedicke and later purified in 1860 by Albe neimann. - In 1884 the Surgeon William Halsted demonstrated the use of cocaine for intradermal infiltration and nerve blocks (including the .facial nerve, the brachial plexus, the pudendal nerve and posterior tibial nerve).
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Ans. is 'b? i.e., Tamil Nadu o Overall, least neonatal mortality is recorded in Kerala. However, among the given options Tamilnadu has minimum neonatal mortal tiy.Neonatal mortality rates and percentage share of neonatal deathsto infant deaths by residence. India and major states, 2012India and major statesNeonatal mortality ratePercentage of neonatal deaths to infant deaths TotalRuralUrbanTotalRuralUrbanIndiaAndhra PradeshAssamBiharChhattisgarhDelhiGujaratHaryanaHimachal PradeshJammu & KashmirJharkhandKarnatakaKeralaMadhya PradeshMaharashtraOdishaPunjabRajasthanTamil NaduUttar PradeshWest Bengal29272928311628282630272373918391735153722333331293225333127323029842224116391840231612101228141720151912123231227181811211668[?]565[?]452 164[?]067[?]464[?]972[?]766[?]372[?]277[?]272[?]473[?]058[?]469[?]271[?]374[?]460[?]471[?]071[?]369[?]867[?]670[?]471[?]853[?]566066[?]770-173-267[?]772[?]778-575[?]581[?]563[?]870[?]073[?]074[?]853-772[?]876[?]671[?]968[?]756[?]840[?]630[?]335[?]072[?]463[?]371[?]060[?]960[?]866[?]744[?]448[?]234[?]462[?]366[?]869[?]275[?]658[?]261[?]554[?]062[?]1
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Sarcoidosis and hodgkins Lymphoma
Produces non-caseating granuloma
Option a,c,d produces caseating lymphoma.
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Patient in the question is positive for HBsAg and HBeAg, so he is more likely to be highly infectious and must be associated with the presence of Hepatitis B virions and a detectable HBV DNA. Ref: Harrisons Internal Medicine, 18th Edition, Chapter 304, Page 2540 ; Review of Medical Microbiology and Immunology By Warren Levinson, 11th Edition, Chapter 41
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Ans. is 'd' i.e., Calymmatobacteriumgranulomatis Granuloma inguinale or Granuloma venerum or Donovanosiso Caused by Calymmatobecterium granulomatis, a gram negative intracellular bacteria,o IP is 1- 4 weeks.o Begins as one or more subcutaneous nodules that erode through skin to produce ulcer. Ulcer has following characterstics.PainlessBleeding withred granulation tissueInduratedo Subcutaneous granulomas of inguinal region in Donovenosis look like enlarged lymph nodes but these are not enlarged lymph nodes. Therefore, these are known as Pseudobubos. Sites of the lesions are genitalia (90%), inguinal (10%), and anal regions.o Complications are pseudoelephentiasis, phimosis, paraphymosis.Diagnosiso Preferred method is demonstration of typical intracellular Donavan Bodies within large mononuclear cells v isualised in smear prepared from lesion or biopsy specimen. It shows safety pin appearance.Treatmento Azithromycin is the DOC. Alternatives are doxycycline (2nd choice) and chloremphentcol.o Streptomycin, once used, is not used now.
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The steps of delivery shown in video clip are delivery by extension, external rotation and lateral flexion. Shoulder dystocia results from a size discrepancy between the fetal shoulders and the pelvic inlet. McRobes maneuver is done for management of shoulder dystocia .
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The duration of spinal anesthesia depends upon the dose The level and duration is directly based on dose of the drug
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The mean age of menarche became younger during this century. Therefore, the definition of primary amenorrhea changed:Primary amenorrhea is defined as the absence of menses by 13 years of age when there is no visible development of secondary sexual characteristics or by 15 years of age in the presence of normal secondary sexual characteristics. The ages defining primary amenorrhea were decreased by 1 year to continue to represent two standard detions above the mean age of developing secondary sexual characteristics and menses.Reference: Berek and Novak's gynecology; 14th edition; Chapter 30; Amenorrhea
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Ans. is 'd' i.e., Immunoglobulins & Hepatitis B Vaccine "Infants born to Hbs Ag positive mothers should receive both HBIG and HB vaccine intramuscularly at seperate sites within 12 hours of bih, followed by 2nd and 3rd dose of vaccine at 1 and 6 months respectively."
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Various pressures in thoracic cage. 1. Intra pleural pressure - - Intra pleural pressure is the pressure of the fluid in the thin space b/w the lung pleura & the chest wall pleura - It's a slight negative pressure. - Normal pleural pressure at the beginning of inspiration is about - -5 cm H2O (at rest) - At rest - - 5cm H2O - At normal inspiration - - 7.5 cm H2O 2. Intra alveolar pressure - Pressure in alveolus - This is equal to atmospheric pressure. - It is considered to be zero at rest. Transpulmonary pressure - difference b/w alveolar & pleural pressure. Transthoracic pressure - Transthoracic compliance - Alveolar pressure - Atmospheric pressure
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Ref. The Short Textbook of Pediatrics. Pg 108
AGE SPECIFIC BEHAVIOURAL DISTURBANCES:
INFANCY AND PRESCHOOL YEARS:
Temper tantrums
Breath holding spells
Pica
Sleep problems
CHILDHOOD AND ADOLESCENCE:
Lying
Stealing
Truancy and running away
Fire setting
Aggression and bullying
Self injurious behavior
Truancy:
Represent disorganization within the home,caretaking needs of younger siblings,developing conduct problems or emotional problems
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Dopamine is the drug of choice for cardiogenic shock with oliguric renal failure. It acts on D1 (at a dose of 1-2 mg/kg/ min.), b1 (at 2-10 mg/kg/min.) and a1 (at > 10 mg/kg/min.) receptors. It causes renal vasodilation by acting on D1 receptors and maintains renal perfusion and GFR. Other ionotropic agents like NA cause renal vasoconstriction and thus worsen renal failure.
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Atypical ductal or lobular hyperplasia are proliferative disease with atypia. Lobular carcinoma in situ carries the highest riskHISTOLOGIC DIAGNOSIS ESTIMATESRRNonproliferative disease1.0Proliferative disease without atypia1.3-1.9Proliferative disease with atypia3.7-4.2Proliferative disease with atypia and strong family history4-9LCIS >7Ref: Sabiston 20e, page: 832
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Ans. is 'd' i.e., K+Fluid in inner ear There are two main fluids in the inner ear : -(i) Perilymph (ii) EndolymphPerilymphIt resembles ECF and is rich in Nu+ ions. It fills the space between bony and the membranous labyrinth, i.e., Scala vestibuli and scala tympani. It communicates with CSF through the aqueduct of Cochlea which opens into the scala tympani near the round window. Therefore It closely resembles CSF. It is formed by : -i) It is a filterate of blood serum and is formed by capillaries of the spiral ligament.ii) It is a direct continuation of CSF and reaches the labyrinth aqueduct of cochlea.EndolymphIt fills the entire membranous labyrinth including scala media (cochlear duct). It resembles intracellular fluid, being rich in IC ions. It is secreted by the secretory cells of the stria vascularis of the cochlea and by the dark cells (present in the utricle and near the ampullated ends of semicircular ducts).
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All of the mentioned tests may be used as detection assays for C. difficile. However, only the tissue culture toxin detection assay is the gold standard laboratory test. Laboratory diagnosis of C. difficile: Stool culture on selective media, such as CCFA (cefoxitin cycloserine fructose agar) or CCYA (cefoxitin cycloserine egg yolk agar). Stool culture is highly sensitive but not specific. Toxin demonstration is more meaningful and is done by : Enzyme immunoassay for toxin A and/toxins B in stool is rapid, but not sensitive. PCR for C. difficile toxin B gene in stool is highly specific and sensitive. Colonoscopy is highly specific if pseudomembranes are seen, but sensitivity is low. Histopathology of colonic pseudomembrane is also highly specific.
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Ans. (c) Young femaleRef. Dutta 7/e 202Twin pregnancy associated with increased maternal age.The incidence of Dizygotic twins increases with:* Increasing maternal age* Increasing parity* Family history of twinning* Ovulation induction with clomiphene citrate or gonadotrophins.
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A i.e. Pyloric obstruction
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Primary aldosteronism, or Conn syndrome, is a syndrome of hyperaldosteronism originating in the adrenal gland. The causes include an aldosterone-secreting adrenocoical adenoma, hyperplasia of the zona glomerulosa, and very rarely, an adrenal carcinoma. It is characterized by hypeension secondary to sodium retention, hypokalemia, and decreased serum renin due to negative feedback of increased blood pressure on renin secretion. Clinical manifestations can include episodic weakness, paresthesias, transient paralysis, tetany, and personality disturbances. Cushing syndrome is the result of increased glucocoicoid production, paicularly coisol. Physical signs typically include "moon facies", truncal obesity, "buffalo hump", and purple abdominal striae. Mallory-Weiss syndrome is a laceration of the lower end of the esophagus induced by severe vomiting. May-White syndrome is a form of familial progressive myoclonus epilepsy with lipomas, deafness, and ataxia.
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In acute hepatitis following serological markers are present:
HBs Ag
Ig M anti HBc Ag (in recent infection) or IgG anti HBc Ag (in remote infection).
Hbe Ag (with high infectivity) or Anti Hbe Ag (with low infectivity).
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Blaschko's Lines: a. The lines of Blaschko were delineated over 100 years ago. b. First described by Blaschko in 1901. The pattern is attributed to the lines of migration and proliferation of epidermal cells during embryogenesis (i.e., the bands of abnormal skin represent clones of cells carrying a mutation in a gene expressed in the skin).
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Ans. is 'c' i.e., High larynx o The infant larynx differs markedly from its adult counterpa. Although it is about one - third adult size, it is propoionately larger. Its lumen is sho and funnel - shaped and dispropoionately narrower than that of adult. It lies higher in the neck than the adult larynx. At rest, the upper border of the infant epiglottis is at the level of the second or third cervical veebra; when the larynx is elevated, it reaches the level of the first cervical veebra. This high position enables an infant to use its nasal airway to breath while sucking.
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Periapical pocket cyst:
The cyst contains an epithelial-lined cavity that is open towards the root canal of the affected tooth.
It was originally designated as bay cyst and is now redesignated as the periapical pocket cyst.
The periapical pocket cyst is probably initiated by the accumulation of neutrophils around the apical foramen in response to microbial biofilm present in the apical portion of the root canal.
This forms a microabscess that gets enclosed by the proliferating epithelium, forming a collar with epithelial attachment on contacting the root tip.
Textbook of Endodontics Nisha GARG 3rd ED
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Ans. is 'a' i.e., 50-70 CategoryIQMild50-70Moderate35-49Severe20-34Profound<20
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The symptoms of the patient are d/t hypersensitivity type I reaction Type I is mediated by IgE and it airs up within minutes.
The symptoms range from rashes to anaphylactic shock with vasodilatory hypotension and bronchiolar spasm.
Examples of type I
Eczema* Hay fever* Asthma* Anaphylactic shock* Urticaria* A cute dermatitis
* Theobald Smith reaction *
Other hypersensitivity reactions Type II is characterized by an antigen antibody reaction on the surface of a host cell*.
Mediated by IgG or IgM. Examples
Blood transfusion reactions *
Transplant rejection *
Auto immune hemolytic anaemia*
Auto immune thrombocytopenic purpura *
Diabetes disease*
Good pasture’s syndrome *
Grave's disease*
Myasthenia gravis*
Pemphigus
Pernicious anaemia
1. Rheumatic fever* Type HI reactions Mediated by antigen / antibody complex*.
Examples
PAN*
Post streptococcal glomerulonephritis*
Rheumatoid arthritis*
Systemic lupus erythematosis*
Acute viral hepatitis*
Penicillamine toxicity*
Serum sickness*
Arthus reaction*
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Transitional cell carcinoma is the most common malignant tumor of the urinary bladder, and the incidence of bladder cancer is increased in aniline dye workers. These azo dyes are converted to water-soluble carcinogens in the liver. They are excreted in the urine, where they primarily affect the transitional epithelium of the bladder. Benzene exposure (choice C) is associated with leukemia. Vinyl chloride exposure (choice E) has been associated with hepatic angiosarcomas.Diagnosis: Transitional cell carcinoma of bladder
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Ans. (b) Gastric ulcer* Malignant transformation is very rarely seen in gastric ulcer (<1%) - Not so common.* Giant gastric ulcer (>2cm) is associated with cancer in 6-15% cases* Of the above choices we can opt for choice B' only - but it is not so common.
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Fibroblasts are specialized cells that differentiate from resting mesenchyme cells in connective tissue. They do not arrive in the wound cleft by diapedesis from circulating cells.
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Oncocytes are epithelial cells with accumulations of mitochondria. They are predominantly found in the salivary gland tissue and is also found in the thyroid, parathyroid, respiratory tract, pituitary, pancreas and kidney. Oncocytomas usually presents in the sixth through ninth decade of life as a solitary parotid mass with rare multicentric and bilateral occurrence. It accounts for 1% of of salivary gland neoplasms, originate from oncocytes and are found mostly in parotid gland, occasionally in submandibular gland and rarely in minor salivary glands. Ref: Salivary Gland Diseases: Surgical and Medical Management edited by Robe Witt page 128.
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Triple assessment of the breast includes
History and clinical examination
Imaging
Histology
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<p> Incidence rate measures population at risk. Reference:Park&;s textbook of preventive and social medicine,K.Park,23rd edition,page no:60. <\p>
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Ans. is 'c' i.e., Quadriceps Locking muscle --Quadriceps femoris (especially vastus medialis pa).Unlocking muscle --Politeus.
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VEGFs, mainly VEGF-A, stimulates both migration and proliferation of endothelial cells, thus initiating the process of capillary sprouting in angiogenesis. It promotes vasodilation by stimulating the production of NO and contributes to the formation of the vascular lumen.
Newly formed vessels are leaky because of incomplete interendothelial junctions and because VEGF, the growth factor that drives angiogenesis, increases vascular permeability.
TGF-β suppresses endothelial proliferation and migration, and enhances the production of ECM proteins.
Robin’s Textbook of pathology 10th ed Page 91
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C i.e. Trabeculotomy with trabeculectomy - Marked photophobia, blepharospasm, watering with blue and large eye (bupthalmos), hazy frosted glass large cornea with Habb's striaeQ and backward subluxated anteroposteriorly flat lensQ are seen in congenital or infantile glucoma. - Congenital glaucoma is characterized by - Therefore, enlarged eye globe (causing lid lag) with enlarged corneal diameter (>_13 mm) with characteristic double contour round opacities concentric to limbus (i.e. Habb's stria) suggest the diagnosis of congenital glaucoma. - 5 Bs: Boys (more affected), Bilateral, Blepharospasm, Blue, Bull (ox or large) eye. - Photophobia & lacrimationQ - Cornea is large, hazy (frosted glass appearance) with Habb striae (double contoured opacities concentric to limbus) & diminished sensation.Q - Lens is anteroposteriorly flat & backward subluxated Q On the basis of cause Primary congenital glaucoma is due to failure or abnormal development of trabecular meshwork e.g. Presence of cellular Barkan's membrane Abnormal cleavage of anterior chamber Iris may not completely separate from the cornea so that the angle remains closed by persistent embryonic tissue Secondary congenital glaucoma is developmental glaucoma with associated ocular anomalies e.g. - Aniridia (50%), iridocorneal dysgenesis - Ectopia lentis syndrome (eg Marfan/Weil-Marchesani syndrome, homocystinuria) & phakomatosis (Sturge weber/ Von RecklingHusen syndrome) - Neurofibromatosis - Sturge - Weber Syndrome (cavernous haemangiomas of eye & brain and cutaneous angioma of face) - Rubella syndrome, Lowe's syndrome, Congenital Microcornea, naevus of ota. Mesodermal dysgenesis (Rieger's & Peter's anomaly)
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The NWTS staging system is most widely used and is based on surgical and pathologic findings. The original classification was used in the first and second NWTS trials and was modified for NWTS III. Fuher modifications have been introduced to the staging in the NWTS V study. NWTS staging system for Wilms tumor: Stage I Tumor limited to kidney and completely excised Stage II Tumor extends beyond the kidney but is completely removed Stage III Residual non-hematogenous tumor confined to abdomen Stage IV Hematogenous metastases to lung, liver, bone, and brain Stage V Bilateral renal involvement at diagnosis Ref: Konety B.R., Williams R.D. (2008). Chapter 21. Renal Parenchymal Neoplasms. In E.A. Tanagho, J.W. McAninch (Eds), Smith's General Urology, 17e.
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Answer is C (Gait disorder, Urinary incontinence & Dementia): Normal Pressure Hydrocephalus (NPH) is a communicating hydrocephalus with a patent aqueduct of sylvius, caused by obstruction to normal flow of CSF over the cerebral convexities and delayed absorption into the venous system. Clinical triad Abnormal gait Q Dementia Q Urinary incontinence Q Neuroimaging Enlarged lateral ventricles Q (Hydrocephalus) Q with little or No Coical-Atrophy Q CSF picture Pressure : High normal range (Hence called NPH) Q Protein : Normal Q Sugar : Normal Q Cell count : Normal Q
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Adrenaline is the drug of choice in anaphylactic shock 0.3 - 0.5 ml of 1:1000 solution. IM is the preferred route as absorption by subcutaneous route is not reliable in shock.It is not repeated every 2-4 hours. From medical pharmacology padmaja 4th edition page no 96
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Organic brain syndrome, also known as organic brain disease, organic brain disorder, organic mental syndrome, or organic mental disorder, refers to any syndrome or diseaser of mental function whose cause is alleged to be known as organic rather than purely of the mind Ref - https://en.wikipedia.org/wiki/Organic_brain_syndrome
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(a) Grommet insertion(Ref. Scott Brown, 8th ed., Vol 2; 125)Since Eustachian tube function takes time to come back to normal Myringotomy with grommet should have been done along with adenoidectomy in the mentioned child.
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Predisposing factors for nasal myiasis (maggots in the nose)Poor hygieneAtrophic rhinitisSuppurative sinusitisComatose patientsUncontrolled diabetesMalignancy maxillaGranulomatous conditions- Leprosy, syphilis, Wegner&;sRef: Hazarika; 3rd ed; Pg 351
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Type I Anorexia nervosa or Restrictive subtype is seen in 50% of the cases, characterized by avoidance of food & highly restricted food.
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Bispinous diameter can be measured by anteroposterior view and not on lateral view of X-ray pelvimetry.
X-ray pelvimetry is of limited value in the diagnosis of pelvic contraction or cephalopelvic disproportion. Apart from pelvic capacity there are several other factors involved in successful vaginal delivery. These are the fetal size, presentation, position and the force of uterine contractions. X-ray pelvimetry cannot assess the other factors. It cannot reliably predict the likelihood of vaginal delivery neither in breech presentation nor in cases with previous cesarean section.
X-ray pelvimetry is useful in cases with fractured pelvis and for the important diameters which are inaccessible to clinical examination.
Techniques: For complete evaluation of the pelvis, three views are taken — anteroposterior, lateral and outlet. But commonly, X-ray pelvimetry is restricted to only the erect lateral view (the femoral head and acetabular margins must be superimposed) which gives most of the useful information. Anteroposterior view can give the accurate measurement of the transverse diameter of the inlet and bispinous diameter.
Hazards of X-ray pelvimetry includes radiation exposure to the mother and the fetus. With conventional X-ray pelvimetry radiation exposure to the gonads is about 885 millirad. So it is restricted to selected cases only.
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Ref: Clinical Diagnosis- of Congenital Heart Disease, M. Sat pat hy, Page 38Explanation:FEATURES OF INCREASED PULMONARY BLOOD FLOW (PULMONARY PLETHORA)Blood vessels become visible in the outer third of lung field (At least 6 vessels can be traced to the outer third. When hilar and intrapulmonary vessels are uniformly changed, it is very suggestive of shunt lesions.Ratio of right descending pulmonary artery to trachea >1.Right descending pulmonary artery diameter >14 mm suggests increased blood flow and >17 mm is very strongly suggestive.Prominent end-on vessels seen at hilum.Enface vessels below 10th posterior rib.Prominent vessels seen below crest of diaphragm.Ratio of vessel to adjacent bronchus >2.1.KERLEY B LINES - NOT SEEN IN INCREASED PULMONARY BLOOD FLOWThese are 1-2 cm thin lines in the peripheries of the lung.They are perpendicular to and extend out to the pleural surface.They represent thickened subpleural interlobular septa.Usually seen at the lung bases.Indicate pulmonary venous hypertension.Seen in:o CCF.o Punionary edemao Pulmonary fibrosis.
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Ans. B: Ovulation Asymmetrical cell division (cytokinesis) leads to the production of polar bodies during oogenesis. To conserve nutrients, the majority of cytoplasm is segregated into either the secondary oocyte and, or ovum, during meiosis I or meiosis II, respectively. The remaining daughter cells generated from the meiotic events contain relatively little cytoplasm and are referred to as polar bodies. Eventually, the polar bodies degenerate. There may be one or two polar bodies in the ovum. The first polar body is one of the two products in the first stage of meiosis, just before ovulation and is considered diploid, with 23 duplicated chromosomes. The second polar body is haploid, with 23 unduplicated chromosomes and is produced only when a sperm penetrates the oocyte.
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The first generation antihistaminic agents cause sedation and impairment of psychomotor function.
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This child is suffering from hypertensive crisis.
Hypertensive crisis
In hypertensive crisis, BP is rapidly rising or a high BP level is associated with neurological manifestations, heart failure or pulmonary edema.
Hypertensive crisis may be divided : -
Hypertensive emergencies ---> Situations in which immediate reduction of BP is needed (within minutes), usually with parentral therapy.
Hypertensive urgencies Situations in which reduction of BP is needed within hours, usually with oral agents.
Accelerated malignant hypertension ----> Situations in which papilledema, hemorrhage, and exudate are associated with markedly elevated BP. The diastolic pressure is usually greater than 140 mm. Hg.
Hypertensive encephalopathy --> Situations in which markedly elevated BP is associated with severe headache and various alteration in consciousness.
So, the child in question having hypertensive encephalopathy i.e., markedly elevated BP with impaired sensorium.
Hypertensive encephalopathy may develop in any cause of secondary hypertension if BP is markedly elevated.
Most common cause of secondary hypertension in a child is chronic glomerulonephritis.
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DUPLICATING MATERIALS
Both types of hydrocolloids are used in the dental laboratory to duplicate dental casts or models for the construction of prosthetic appliances and orthodontic models. Agar hydrocolloid is more popular in the lab because it can be used many times. In addition, with intermittent stirring, agar hydrocolloid can be kept in a liquid form for 1 or 2 weeks at a constant pouring temperature. These factors make the cost of reversible impression materials quite reasonable.
These property requirements are identified in ANSI/ADA Specification No. 20 (ISO 14356; Dentistry—Duplicating material).
NOTE: Both alginate and agar are considered as accurate impression materials. Owing to the extensive use of agar as a duplicating material, agar can be a better choice.
Reference: PHILLIPS’ SCIENCE OF DENTAL MATERIALS, 12th ed page no 176
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ECG shows epsilon wave at the end of S wave and is seen in case of Arrhythmogenic RV dysplasia. Choice A is seen in Upswing of R wave Choice C is seen after T waves Choice D is a negative deflection after P wave.
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It has long been considered to be a fungus but it has been difficult to classify this organism. It has not been cultured so far. Some consider it to be a protozoa or a fish parasite belonging to DRIP clade (Dermocystidium, Rosette agent, Ichthyophonus and Psorospermum). Ref: Dhingra 7e pg 177.
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Triad of WG: a. Acute necrotizing granulomas of respiratory tract b. Necrotizing or granulomatous vasculitis of small to medium-sized vessels c. Focal necrotizing often crescentic GN
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Insulin and insulin like growth factor stimulate fetal growth.
Thyroxine has no effect on linear growth but it has effect on skeletal maturation.
Fetal or maternal GH is not essential for fetal growth in utero.
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Ca Nasopharynx
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Developmental milestones:- GROSS MOTOR DEVELOPMENT: 2 months: Holds head in plane of rest of the body when held in ventral suspension. In prone position in bed, the chin lifts momentarily. 3 months:lift head above the plane of the body. Head control stas by 3 months and fully developed by 5 months. 4 months:Remain on forearm suppo if put in prone position, lifting the upper pa of the body off the bed. 5 months: Rolls over. 6 months:sit in tripod fashion. 8 months: sits without suppo., crawling 9 months: Takes a few steps with one hand held. Pulls to standing and cruises holding on to furniture by 10 months. 10 months: creeps 12 months:creeps well, walk but falls, stand without suppo. 15 months: walks well, walks backward/ sideways pulling a toy. May crawl upstairs. 18 months: Runs, walks upstair with one hand held. Explores drawers 2 years: walk up and downstairs, jumps. 3 years : rides tricycle, alternate feet going upstairs. 4 years: hops on one foot, alternate feet going downstairs. 5 years:skips FINE MOTOR DEVELOPMENT:- 2 months- eyes follow objects to 180 deg. 3 months-Grasp reflex disappears and hand is open most of the time. 4 months- Bidextrous approach( reaching out for objects with both hands). 6 months- Unidextrous approach( Reach for an object with one hand). 8 months- radial grasp sta to develop. Turns to sound above the level of ear. 9 months- immature pincer grasp, probes with forefinger. 12 months-Unassisted pincer grasp. Releases object on request.Uses objects predominantly for playing, not for mouthing. Holds block on each hand and bang them together. 15 months- imitate scribbling , tower of two blocks 18 months- scribbles, tower of 3 blocks.turn pages of a book, 2-3 at a time. 2 years- tower of 6 blocks, veical and circular stroke. 3 years-Tower of 9 blocks, dressing and undressing with some help, can do buttoning. 4 years- copies cross, bridge with blocks 5 years- copies triangle, gate with blocks. SOCIAL AND ADAPTIVE MILESTONES: 2 months: social smile(smile after being talked to).watches mother when spoken to and may smile. 3 months:Recognizes mother, anticipates feeds. 4 months: Holds rattle when placed in hand and regards it . Laughs aloud. Excited at the sight of food. 6 months:recognizes strangers, stranger anxiety . Enjoy watching own image in mirror, shows displeasure when toy pulled off. 9 months:waves bye bye 12 months:comes when called, plays simple ball game.kisses the parent on request. Makes postural adjustments for dressing. 15 months:jargon, stas imitating mother. 18 months: copies parents in tasking, dry by day, calls mother when he wants potty, points to three pas of body on request. 2 years: ask for food, drink, toilet, pulls people to show toys. 3 years:shares toys, know fullname and gender, dry by night. 4 years:Plays cooperatively in a group, goes to toilet alone, washes face, brushes teeth. Role play . 5 years:helps in household task , dresses and undresses. LANGUAGE MILESTONES: 1 month: Ales to sound. 2 month:respond to sound by stale or quitening to a smooth voice. 3 months: babbles when spoken to. Makes sounds (ahh,coos, ) laughs. 4 months: laughs aloud. 6 months: monosyllables 9 months: understands spoken words, bisyllables. 12 months: 1-2 words with meaning. 15months : vocabulary of 6 words 18 months: vocabulary of 10 words. Can name one pa of body. 2 years: 3 word simple sentences 3 years:asks questions, knows full name and gender. 4 years: says songs or poem, tells story, knows three colours. 5 years: ask meaning of words. Reference: GHAI Essential pediatrics, 8th edition
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Broca&;s area 44 is in the frontal lobe immediately in front of the inferior end of motor coex ( which is inferior frontal gyrus). Ref: Ganong&;s review of medical physiology;23rd edition; pg:297
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Ans. B Urinary bladderRef: Grays, 41sted. pg. 1261* The epithelial lining of cervix is varied. Ectocervix is composed of non keratined stratified squamous epithelium and endocervix is composed of simple columnar epithelium.* Blood supply of cervix-descending cervical branch of uterine artery.Extra Mile* Size of cervix- 2.5 cm (25 mm)* MC site of cervical CA is squamocolumnar junction.* Lining of vagina: Nonkeratinized stratified squamous epithelium (same as mouth, tongue, pharynx, esophagus, cornea and conjunctiva)* Lining of urinary pathway: Transitional epitheliumExtra Mile* Gallbladder: Columnar epithelium with brush border (microvilli are irregularly placed)* Thyroid: Cuboidal epithelium* Stomach: Columnar epithelium
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Splenic Marginal Zone Lymphoma This tumor originates in the marginal zone of the spleen white pulp (Tumor of small lymphocytes) Splenic hilar nodes are involved The circulating tumor cells are called villous lymphocytes The cells express surface immunoglobulin and CD20 The median age of patients is fifties Patients present with incidental splenomegaly and lymphocytosis in the peripheral blood Autoimmune anemia / thrombocytopenia present The clinical course of disease is indolent Long remissions after splenectomy Ref: Harrison, E-18, e-21.
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Ans. is 'a' i.e., CCS * Scoring scales such as the Abbreviated Injury Scale (AIS), Injury Severity Score (ISS), Pediatric Trauma Score and Revised Trauma Score are used to predict mortality as well as morbidity in patients sustaining trauma in general.* They use physiological parameters to predict patient outcome.* CCS (Children Coma Score) is the paediatric counterpart of Glasgow Coma Score for patient with head injury.Children Coma Score:Eye Opening (Total Possible Points 4)Spontaneous4 To voice3 To pain2 None1 Verbal Response (Total Possible Points 5)Older Children Anfants and Young Children Oriented5Appropriate words, smiles, fixes, and follows5Confused4Consolable crying4Inappropriate3Persistently imitable3Incomprehensible2Restiess, agitated2None1None1Motor Response (Total Possible Points 6)Obeys6 Localized pain5 Withdraws4 Flexion3 Extension2 None1
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Answer is A (chronic Hepatitis B) Chronic viral hepatitis including Chronic Hepatitis B is associated with macronodular Cirrhosis and not micronodulai cirrhosis. Alcohol, hematochromatosis and large bile duct obstruction are all associated with micronodular cirrhosis. Morphological Classification of Cirrhosis Macronodular Cirrhosis (Parenchymal nodules > 3mm) Micronodular Cirrhosis (Parenchymal nodules < 3mm) Aetiology Frequency Aetiology Frequency * Chronic viral hepatitis 10-20% * Alcohol 60-70% * Wilson 's disease Rare * 'Primary' biliwy cirrhosis 5% * a-Antittypain deficiency Rare * Large bile duct obstruction <5% * Various drugs and toxins Rare * Haemochromatosis 5% * Hereditary haemorrhagic Rare * Intestinal bypass Rare telangiectasis * Cystic fibrosis Rare * Coptogenic cirrhosis Common * Indian childhood cirrhosis Rare
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The contents of middle ear : Three small bones or ossicles-malleus, incus and stapes Two muscles-tensor tympani and stapedius Two nerves-chorda tympani and tympanic plexus Vessels supplying and draining the middle ear Ligaments of the ear ossicles AirRef BDC volume3,sixth edition pg 275
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Ans. b. 80-200 mg/dL (Ref: Reddy 33/e p570, 29/e p511)In a case of alcohol intoxication, motor incordination and judgment errors occur at blood alcohol levels of 80-200 mg/dL (best choice among the given options).Physiological Effects of AlcoholBlood alcohol concentrationEffects0-50 mg%No significant effect or mild euphoriaQ50-100 mg%Decreased inhibition and attention span, increased seif confidence, slurring of speech, mild incoordination, alteration of judgment, nystagmusQ.100-150 mg%Some mental confusion, emotional stability, loss of critical judgment, ataxia, impaired memory, sleepiness, slow reaction timeQ150-300 mg%Loss of muscular coordination, staggering gait, marked mental confusion, drowsiness, exaggeration of emotions, dizziness, decreased pain response, disorientation, thickened speechQ300-400 mg%Stupor, marked incoordination, marked decrease in response to stimuli, possibly comaQ400 mg% and aboveAnaesthesia, depression of response, respiratory failure, deep coma and deathQ
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c. Spot urine sample for protein/creatinine ratio(Ref: Nelson 20/e 2518)Though 24 hr urine for protein and creatinine, is more accurate, but due to difficulty in collecting 24 hour urinary sample in children, Spot urine sample for protein/creatinine ratio is preferred.
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Pyridoxine: Abolishes therapeutic effect by .enhancing peripheral decarboxylation of dopa; less is available to cross to the brain. REF:ESSENTIALS OF MEDICAL PHARMACOLOGY KD TRIPATHI 8TH ED. page 429
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Endosteum is the most metabolically active part in bone
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Egg
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Ans: D (HAV) Chronic hepatitis is seen in hepatitis B infection.Wilson's disease may prevent as chronic hepatitis before neurological manifestation and formation of K.F. ring.Liver is first organ involved in haemochromatosis. In haemochromatosis there may be fibrosis cirrhosis or hepatocellular carcinoma (30% cases)Chronic hepatitis never seen in hepatitis A infectionQTable: Clinical and Laboratory Features of Chronic HepatitisType of HepatitisDiagnosticAutoantibodiesTherapyChronic hepatitis BHBsAg, IgG anti- HBc, HBeAg, HBV DNAQUncommonIFNa, PEG IFN-a, lamivudine, adefovir, entecavirChronic hepatitis CAnti-HCV, HCV RNAQAnti-LKM1Q oPEG IFN-a plus ribavirinChronic hepatitis DAnti-HDV, HDV RNA, HBsAg, IgG anti-HBcAnti-LKM3IFN-a PEG IFN-aAutoimmune hepatitisANAc (homogeneous), anti-LKM1 (+-), HyperglobuiinemiaANA, anti-LKM1, anti-SLAd Prednisone, azathioprine Drug- associated--UncommonWithdraw drugCryptogenicAll negativeNonePrednisone (?), azathioprine (?)
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autosomal recessive, or X-linked. Autosomal Dominant Inheritance Familial hypercholesterolemia Huntington disease Marfan syndrome Ehlers-Danlos syndrome Hereditary spherocytosis Neurofibromatosis, type 1 Adult polycystic kidney disease Autosomal Recessive Inheritance Cystic fibrosis Phenylketonuria Tay-Sachs disease Severe combined immunodeficiency a- and b-Thalassemias Sickle cell anemia Mucopolysaccharidoses--all types Glycogen storage diseases--all types Galactosemia X-linked Recessive Inheritance Hemophilia A Duchenne/Becker muscular dystrophy Fragile X syndrome (Robbins Basic Pathology,9th edition,pg no. 219)
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