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Ans. is 'a' i.e., Cell shrinkage Morphological changes in apoptosiso Features of apoptosis areCell shrinkage : It is the earliest changes. It is due to damage to cytoskeleta! proteins.Chromatin condensation (pyknosis)/nuclear compaction : It is the most characteristic feature.Formation of cytoplasmic blebs : It is the end stage of apoptosis.Cytoplasmic eosinophilia.Chromosomal DNA fragmentation ; It is due to activity of endonuclease and caspases.Formation of apoptotic bodies : These are membrane bound round masses of eosinophilic cytoplasm with tightly packed orgaelles which may contain nuclear debries. Important examples of apoptotic bodies are civatte bodies, kamino bodies, councilman bodies, Tingible bodies, sunburn cells, satellite dyskeratotic cells, and eosinophilic globules,Phagocytosis of apoptotic cells and bodies by adjacent macrophages or healthy parenchymal cells.Considerable apoptosis may occur before it becomes apparent on histological section.o Two very important differentiating features from necrosis areAbsence of inflammation.Intact cell membrane.
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Ans. (c) BlueRef: K. Park 23rd ed. / 795-97* In a disaster management, categorization of victims are done on the basis of likelihood of survival.Triage color code and their significanceCategoryColorRemarks/stepsCategory 1RedHighest priority- patient immediate resuscitations or life-saving surgery (0 to 6 hr)Category 2Yellow/ blueHigh priority resuscitation or life saving surgery (within 6 to 24hr)Category 3GreenAmbulatory/ low minor injuries; non-life threatingCategory 4BlackDead, Moribund; least priority
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Ans. Uses EEG on lead
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Displacement
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The child in the question is suffering from Pityriasis Alba. It is characterised by the presence of hypopigmented scaly macules of variable size. It is commonly found in the cheek of children and is self limiting. Topical steroids/ tacrolimus may have a role in ceain cases, but is not usually necessary. Ref: Clinical Manual of Emergency Pediatrics By Ellen F. Crain, 5th Edition, Page 130.
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Ans. is 'a' i.e., Gram - positive cocci Gram positive bacteria . There are 6 classic grain positive bacteria that cause human disease. . Of these 2 are cocci Staphylococci Streptococci (including anaerobic peptostreptococci) . Other 4 are bacilli Corynebacterium 3. Clostridium Bacillus 4. Listeria
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Ans. is 'b' i.e., Phagocytosis (Ref: Ananthanarayan, 9th/e, p. 137and 8th/e, p. 131 - 132)* Monocytes and Macrophages originate from bone marrow and their main functions are phagocytosis and Ag presentation.
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DisorderOnset in PregnancyHyperemesisEarlyCholestasisLateFatty liverLatePreeclampsiaMid to lateHepatitisVariable(Ref: William's Obstetrics; 25th edition)
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Ans. is 'b' i.e., Neurosensory retina and pigment epithelium o Retina has total ten layers from with out inward(i) Pigmented epithelium, (ii) Layers of Rods & cones, (iii) External limiting membrane, (iv) Outer nuclear layer, (v) Outer plexiform layers, (vi) Inner nuclear layer, (vii) Inner plexiform layer, (viii) Ganglionic cell layer, (ix) Nerve fibre layer, (x) Internal limiting membraneo Broadly these layers are subdivided into two layers based on the function :-Neurosensory layer or sensory layer (containing layers ii to x of above 10 layers)for vision.Pigmented epithelium (layer i)Provide metabolic support to neurosensory layer and acts as an antireflective layer.o So, inner layers are included in neurosensory layer and outer most layer is retinal pigmented epithelium(RPE).o Retinal detachment is a disorder of eye in which retina peels away from its underlying layer of support tissue. Usually there is separation between the neuroepithelium (neurosensory epithelium or sensory epithelium) and the pigmented layer, because there is a potential space between these two layers where fluid can accumulates and can cause separation.
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For effective group discussion, the group should not be less than 6 and more than 12 members.
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Interface dermatitis includes diseases in which the primary pathology involves the dermo-epidermal junction. (hence called interface). The salient histological findings include basal cell vacuolization, apoptotic keratinocytes (colloid or Civatte bodies), and obscuring of the dermo-epidermal junction by inflammatory cells. Lupus erythematosus, dermatomyositis, lichen planus, graft versus host disease, erythema multiforme, fixed drug eruptions are some examples. Ref Harrison 20th edition pg 1234
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Ans. is 'a' i.e., Presence of more than 5 WBC/hpf for girls and more than 3 WBC/hpf for boys o Pyuria is the presence of more than 5 WBCs / high power field, both for boys and girls. --CPDT o Pyuria suggests infection, but infection can occur in the absence of pyuria. --Nelson o Pyuria can present without UTI. -- Nelson o So, Isolated pyuria is neither confirmatory nor diagnostic for UTI.
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Spontaneous placental delivery reduces risk of operative blood loss and infection.
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ATP Formation in the Glycolysis pathway Reaction Catalyzed by Method of ATP Formation ATP per mol of Glucose Glyceraldehyde-3-phosphate dehydrogenase Respiratory chain oxidation of 2 NADH 5* Phosphoglycerate kinase Substrate-level phosphorylation 2 Pyruvate kinase Substrate-level phosphorylation 2 Total 9 Consumption of ATP for reactions of hexokinase and phosphofructokinase 2 Net 7 *This assumes that NADH formed in glycolysis is transpoed into mitochondria by the malate shuttle. If the glycerophosphate shuttle is used, then only 1.5 ATP will be formed per mol of NADH. Reference: Harper; 30th edition; Page no: 169
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Preauricular appendages form due to development of accessory hillocks where as preauricular sinus/pits occur due to abnormal development of auricular tubercles/hillocks(six mesodermal thickenings) REFERENCE: TEXTBOOK OF CLINICAL EMBRYOLOGY... VISHRAM SINGH SECOND EDITION..PAGE NO:312
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Autoimmune polyglandular syndrome 1 Hypoparathyroidism with muco-cutaneous candidiasis Autoimmune polyglandular syndrome 2 Hypothyroidism, hypehyroidism, vitiligo, Type 1 diabetes mellitus, pernicious anaemia and premature ovarian failure. Triple A syndrome Addison Alacrimia Achalasia Isolated autoimmune adrenalitis Associations with CTLA-4 gene
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Penicillin G is the drug of choice for infection caused by organisms susceptible to it, unless the patient is allergic to this antibiotic. However, use has declined very much due to fear of causing anaphylaxis. 1 . Streptococcal infections Like pharyngitis otitis media, scarlet fever, rheumatic fever respond to ordinary doses of PnG given for 7-10 days. For subacute bacterial endocarditis (SABE) caused by Strep. viridans or faecalis high doses (10-20 Ml. i.v. daily) along with gentamicin given for 2-6 weeks is needed. 2. Pneumococcal infections PnG is not used now for empirical therapy of pneumococcal (lobar) pneumonia and meningitis because many strains have become highly penicillin resistant However, PnG 3-6 MU i.v. every 6 hours is the drug of choice if organism is sensitive. 3. Meningococcal infections are still mostly responsive; meningitis and other infections may be treated with intravenous injection of high dose 4. Gonorrhoea :PnG has become unreliable for treatment of gonorrhoea due to spread of resistant strains. The treatment of ophthalmia neonatorum 5. Syphilis T. pallidum has not shown any resistance and PnG is the drug of choice. Early and latent syphilis is treated either with daily injection of 1 .2 M U of procaine penicillin for 10 days or with 1-3 weekly doses of 2.4 MU benzthine penicillin. For late syphilis, benzathine penicillin 2.4 MU weekly for 4 weeks is recommended. Cardiovascular and neurosyphilis requires 5 MU i.m. 6 hourly o f sod. PnG , . 2 weeks followed by the above regimen. Leptospirosis: PnG 1 .5 MU injected i. v. 6 hourly for 7 days is curative. 6. Diphtheria Antitoxin therapy is of prime impoance. Procaine penicillin 1-2 MU daily for 10 days has adjuvant value and prevents carrier state. 7. Tetanus and gas gangrene Antitoxin and other measures are more impoant; PnG 6-12 MU I day is used to kill the causative organism and has adjuvant value. 8. Penicillin G is the drug of choice for rare infections like anthrax, actinomycosis, trench mouth, rat bite fever and those caused by Listeria monocytogenes, Pasteurella multocida. 9. Prophylactic uses (a) Rheumatic fever: Low concentrations of penicillin prevent colonization by streptococci responsible for rheumatic fever. Benzathine penicillin 1 .2 MU every 4 weeks till 18 years of age or 5 years after an attack, whichever is more. (b) Bacterial endocarditis: Dental extractions, endoscopies, catheterization, etc. cause bacteremia which in patients with valvular defects can cause endocarditis. PnG can afford protection, but amoxicillin is preferred now. (c) Agranulocytosis patients: Penicillin may be used alone or in combination with an aminoglycoside antibiotic to prevent respiratory and other acute infections. ESSENTIALS OF MEDICAL PHARMACOLOGY K.D.TRIPATHI SIXTH EDITION PAGE NO:698,699
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Ans. is 'b' i.e., Alkylatings agents Alkylating agents may contribute to sterility by the following effects : Azoospermia in males Amenorrhea and ovarian atrophy in females Specific toxicity of impoant alkylating agents. o Cyclophosphamide ---> Cystitis, alopecia, SIADH o Ifosfamide ---> Cystitis, SIADH, neurotoxicity o Cisplatin ---> Nephrotoxicity, peripheral neuropathy, ototoxicity, vomiting. o Busulfan ---> Adrenal insufficiency, hyperpigmentation,pu/monaryfibrosis. o Procarbazine ---> Disulfiram like reaction, secondary leukemias, CNS effects.
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In heparin overdose an antagonist is needed to arrest it&;s anticoagulant effects. Protamine sulphate given IV (1mg for every 100 units of heparin) neutralizes heparin. From medical pharmacology padmaja 4th edition Page no 337
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Ans. (c) Neisseria Gram negative oxidase positive bacteria can be none other than neisseria, and here in this case it is N. gonococci. Occular gonorrhea in adults Results from autoinoculation from an infected genital site Manifestations range from mild to very severe Severe signs include markedly swollen eyelid, chemosis, profuse purulent discharge. Occasionaly there may be corneal ulceration and rarely perforation. Diagnosis is confirmed by culture of purulent discharge.
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It is present in tRNAPresent in the DHU OR D arm of tRNAServe as the recognition site for the enzyme which adds the amino acidRef: DM Vasudevan, 7th edition, page no: 597
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Ans. (d) Juxtaglomerular apparatus(Ref: Ganong, 25th ed/p.672)Juxtaglomerular cells synthesize, store and release an enzyme called renin
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(D) Assam [?]Leishmaniasis are a group of protozoal diseases caused by parasites of the genus Leishmania, and transmitted to man by the bite of female phlebotomine sandfly.oResponsible for various syndromes in humans kala-azar or visceral leishmaniasis (VL), cutaneous leishmaniasis (CL), muco-cutaneous leishmaniasis (MCL), anthroponotic cutaneous leishmaniasis (ACL), zoonotic cutaneous leishmaniasis (ZCL), post-kala-azar dermal leishmaniasis (PKDL), etc (1). The visceral type of disease, kala-azar, is still an important disease in India.oLeishmaniasis is endemic in many countries in tropical and subtropical regions, including Africa, Central and South Americas, Asia and the Mediterranean region.oKala-azar is endemic in 52 districts in Bihar, Jharkhand, West Bengal and Uttar Pradesh.oAbout 130 million population is at risk of the disease.oThe present situation is shown in Table 1. While both cutaneous (ZCL and ACL) and visceral (VL) disease occur in India, kala-azar is by far the most important leishmaniasis in India.STATE WISE KALA-AZAR CASES & DEATHS IN INDIAState2013CasesDeaths*. Bihar10,73017*. West Bengal5950*. Uttar Pradesh111*. Jharkhand2,5150*. Delhi60*. Assam40India3,86920 [?]Status of Kala-azar in IndiaoKala-azar is endemic in 52 districts (31 in Bihar, 4 in Jharkhand, 11 in West Bengal & 6 in Utter Pradesh.oDuring the 2013 year, 13,869 cases and 20 deaths have been reported.o165 million people are estimated to be at riskoEstimated number of cases much higheroNo accurate data on burden of PKDL.oAltitude:-Kala-azar is mostly confined to the plains; it does not occur in altitudes over 2000 feet (600 metres).oSeason:-In the past epidemics, two peaks, one in November and another in March-April were reported. Generally there is high prevalence during and after rains.oClimate Changes:-Kala-azar is climate sensitive, and is strongly affected by changes in rainfall, temperature and humidity. Global warming and land degradation together affect the epidemiology of kala-azar in many ways.oRural Areas:-The disease is generally confined to rural areas, where conditions for the breeding of sandflies readily exist compared to urban areas.oVectors:-In India, P argentipes is a proven vector of kala-azar.-Cutaneous leishmaniasis is transmitted by P papatasi and P. sergenti.-Sandflies breed in cracks and crevices in the soil and buildings, tree holes, caves etc.-Overcrowding, ill-ventilation and accumulation of organic matter in the environment facilitate transmission.-Their habits are primarily nocturnal.-Only the females bite.
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Group Recommended intake (mg/day) Man 17 Woman (non-pregnant) & lactating women 21 Pregnancy 35
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(D) VagusVena Cava (8 letters) - Passes through the diaphragm at T8.Oesophagus (10 letters) - Passes through the diaphragm at T10.Aortic Hiatus (12 letters) - Passes through the diaphragm at T12.OPENINGS THROUGH THE DIAPHRAGM & THEIR CONTENTSDescriptionVertebral levelContentsCava! opening lies in central tendon of DiaphragmT8 (to the right side of the median plane)Caval opening passes through the central tendon of the diaphragm. Contains Inferior vena cava, & some branches of the Right Phrenic nerve.Esophageal hiatuslies in Masseter part of diaphragmT10 (to the of the median plane)Esophageal hiatus is situated in the posterior part of the diaphragm, located slightly left of the central tendon through the muscular sling of the right crus of the diaphragm.Oesophagus & anterior & posterior Vagal trunks.Lymphatics from the lower third of the esophagusAortic hiatus OsseoaponeuroticT12 (in the median plane)Aortic hiatus is in the posterior part of the diaphragm, between the left & right crus.Aorta, Azygos vein & Thoracic duct.Two lesser apertures of right crusGreater & Lesser Right splanchnic nervesTwo lesser apertures of left crusGreater & Lesser Left Splanchnic nerves & Hemiazygos veinBehind the diaphragm, under the medial lumbocostal archSympathetic trunkAreolar tissue between the sternal & costal parts (Foramina of Morgagni)Superior epigastric branch of the internal thoracic artery & some lymphatics from the abdominal wall & convex surface of the liverAreolar tissue between the fibers springing from the medial & lateral lumbocostal archesThis interval is less constant; when this interval exists, the upper & back part of the kidney is separated from the pleura by areolar tissue only.OTHER STRUCTURES PASSING THROUGH DIAPHRAGMSplanchnic nerves - which pierce the cruraInferior hemiazygos - Vein which pierce the left crus.Psoas major Muscle.Sympathetic trunk (pass deep to the medial arcuate ligament).Quadratus lumborum.Subcostal Nerve, Vessels (pass deep to the lateral arcuate ligamentClinical Importance:Lumbocostal triangle or Bochdalek's foramen, Diaphragmatic hernia, Diaphragmatic paralysis, Congenital eventration of diaphragm, Hiccup.Aortic opening (Aortic hiatus) is one the three major apertures through the diaphragm & lies at the level of T12.A number of structures pass through the aortic hiatus: aorta, azygos vein, thoracic duct, greater splanchnic nerve.
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Ans. is 'a' i.e., Preformed antibodies
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Ans. is 'c' i.e. Montelukast Montelukast (and Zafirlukast) is a Leukotriene receptor antagonist Leukotrienes mediate many of the critical elements of asthma. They are potent bronchoconstrictor. Montelukast (and Zafirlukast) are effective in blocking their action. These drugs provide protection against exercise induced asthma and reduce the frequency of exacerbation, but are of limited usefulness is acute asthma. Drugs used in Acute Asthma are Beta - 2 agonists* Salbutamol (Albuterol) Bitolterol, Pirbuterol, Terbutaline Anticholinergics* Ipratropium bromide Systemic corticosteroids* methylprednisolone, Hydrocortisone I think the option Hydrocortisone needs some extra explanation. Even though glucocorticoids are the first line agents for chronic asthma, they are also used in acute asthma. Harrison writes - "Systemic or oral steroids are most beneficial in acute illness when severe airway obstruction is not resolving or is worsening despite intense optimal bronchodilator therapy." Also Remember Another class of drugs blocking the action of leukotrienes is 5 - lipoxygenase inhibitors* eg. - Zileuton* It prevents the synthesis of leukotrienes by inhibiting 5 - lipoxygenase.
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Treatment of choice for rhabdomyosarcoma is Radiotherapy followed by chemotherapy.
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Ref:The essential of forensic medicine and toxicology Dr.K.S NARAYAN REDDY 32nd edition g no :320 In acute starvation, there is a feeling of hunger for the first 30 to 48 hours which is followed by the pain in the epigastrium which is relieved by pressure
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2.0 cm
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Ans. is 'd' i.e., StomachHistological features of stomacho Mucosa is thrown into temporary longitudinal folds rugae, which disappear when stomach is distended.o Lining epithelium is simple columnar epithelium with small irregular gastric pits. Several long, tubular gastric glands open in gastric pitso Gastric glands are divided into three groupsi) Pyloric glands :# In these glands mucus secreting cells predominate. These glands also contain neuroendocrine G cells (secreting gastrin) and cells which secret lysozyme. Parietal cells are few and chief cells are absent.ii) Cardiac glands :# These glands mainly contain mucus secreting cells. Chief and parietal cells are sparse.iii) Principal (main) glands :# These glands are found in body and fundus. These glands contain mainy chief (peptic or zymogen) cells and parietal (oxyntic) cells. These glands also contain mucous neck cells, stem cells and enteroendocrine cells (argentaffin cells).
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Predisposing factors for carcinoma esophagus Squamous cell carcinoma Adenocarcinoma - Alcohol - Smoking -Ingested carcinogens 1. Nitrates, nitrites, nitrosamines 2. Smoked opiates 3. Fungal toxins in pickled vegetables - Mucosal damage: 1. Chronic achalasia 2. Lye (caustic) ingestion 3. Long term ingestion of hot liquids 4. Radiation induced strictures - Plummer-Vinson syndrome - Tylosis palmaris et plantaris. Congenital hyperkeratosis & pitting of palms and soles - Human papilloma virus - Esophageal diveicula - Bulimia - Deficiency: vitamin A, zinc, molybdenum - GERD (leading to Barrett's esophagus) - Obesity - Scleroderma Scleroderma: smooth muscle atrophy in lower 2/3rd of Esophagus - incompetent LES - GERD - stricture - Diet deficient in fruits and vegetables - Diet high in animal protein and cholesterol
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Coeliac artery is the artery of foregut and supplies foregut derivatives i.e. lower part of esophagus, stomach, proximal part of duodenum, liver, spleen and major part of pancreas.
Jejunum is midgut derivative which is supplied by superior mesenteric artery.
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Ans: A (a cell) [Ref. Ganong 24th/432-33,23rd/316,328-30/The alpha cells, about 25 per cent of the total, secrete glucagonQ'The beta cells, constituting about 60 per cent of all the cells of the islets, lie mainly in the middle of each islet and secrete insulin and amylin, a hormone that is often secreted in parallel with insulin, although its function is unclear.The della cells, about 10 per cent of the total, secrete somatostatin0In addition, at least one other type of cell, the PP cell. is present in small numbers in the islets and secretes a hormone of uncertain function called pancreatic polypeptide.
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congenital or acquired hypothyroidism,brush field spots in iris,and ventricular septal defect IS seen in a case with down syndrome.
Undescended testis is not a feature.
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Name Defect Remarks Familial hyperalphalipoproteinemia Increased concentrations of HDL A rare condition apparently beneficial to health and longevity Hepatic lipase deficiency Deficiency of the enzyme leads to accumulation of large triacylglycerol-rich HDL and VLDL remnants Patients have xanthomas and coronary hea disease Familial hypercholesterolemia (type IIa) Defective LDL receptors or mutation in the ligand region of apo B-100 Elevated LDL levels and hypercholesterolemia, resulting in atherosclerosis and coronary disease Familial hyperiacylglycerolemia (type IV) Overproduction of VLDL often associated with glucose intolerance and hyperinsulinemia Cholesterol levels rise with the VLDL concentration. LDL and HDL tend to be subnormal. this type of pattern is commonly associated with coronary hea disease, type II diabetes mellitus, obesity, alcoholism, and administration of progestational hormones Reference: Harper; 30th edition; Page no: 275
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A Multicentre Growth Reference Study was undeaken between 1997 to 2003 in 6 countries including India, Ghana, Brazil, Norway, USA and Oman. Growth related data was accumulated in 9440 healthy breast fed babies. They were followed up from 0-60 months. In 2006, the WHO growth chas were published based on these data. Ref: Park, 21st Edition, Page 502.
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Sensation carried
Posterior column (Dorsal column)
Proprioception (Position of body or limb, the position of joint)
Fine touch (two point discrimination, topognosis, stereognosis)
Vibration
Kinesthesia
Anterolateral system
Anterior spinothalamic tract → Crude touch
Lateral spinothalamic tract → Pain, Temperature
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Kidney REF: Lee synopsis of anesthesia 12th e p. 215 See previous question for explanation
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Ans. D: Fluoxetine The two medications proven to be most effective in the treatment of OCD are tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs). Serotonin is a chemical in the brain called a neurotransmitter that may be imbalanced in people with OCD. While both drugs are very effective, SSRIs have generally become the preferred medication for anxiety disorders including OCD. SSRIs have less side effects than other forms of antidepressants, less withdrawal symptoms, less danger in the event of an overdose and overall are considered safer that other types of drugs (TCAs and SSRIs are both very safe drugs, however). Common SSRIs include fluoxetine, fluvoxamine, seraline, paroxetine, citalopram, and escitalopram.
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Ref : harrisons-manual-of-medicine-16th-edition pg no: 622-624 TREATMENT Initial Therapy Initial goals are to: (1) quickly identify if patient is candidate for reperfusion therapy, (2) relieve pain, and (3) prevent/treat arrhythmias and mechanical complications. * Aspirin should be administered immediately (162-325 mg chewed at presentation, then 162-325 mg PO qd), unless pt is aspirin-intolerant. * Perform targeted history, exam, and ECG to identify STEMI (1 mmST elevation in two contiguous leads or new LBBB) and appropriateness of reperfusion therapy , which reduces infarct size, LV dysfunction, and moality. * Primary PCI is generally more effective than fibrinolysis and is preferred at experienced centers capable of performing procedure rapidly , especially when diagnosis is in doubt, cardiogenic shock is present, bleeding risk is increased, or if symptoms have been present for 3 h. * Proceed with IV fibrinolysis if PCI is not available or if logistics would delay PCI 1 h longer than fibrinolysis could be initiated (Fig. 123-1). Dooo- needle time should be 30 min for maximum benefit. Ensure absence of contraindications before administering fibrinolytic agent. Those treated within 1-3 h benefit most; can still be useful up to 12 h if chest pain is persistent or ST remains elevated in leads that have not developed new Q waves. Complications include bleeding, reperfusion arrhythmias, and, in case of streptokinase (SK), allergic reactions. Heparin should be initiated with fibrinolytic agents other than SK ; maintain aPTTT at 1.5-2.0 control (50-70 s). * If chest pain or ST elevation persists 90 min after fibrinolysis, consider referral for rescue PCI. Later coronary angiography after fibrinolysis generally reserved for pts with recurrent angina or positive stress test. The initial management of NSTEMI (non-Q MI) is different . In paicular, fibrinolytic therapy should not be Additional Standard Treatment (Whether or not reperfusion therapy is undeaken): * Hospitalize in CCU with continuous ECG monitoring. * IV line for emergency arrhythmia treatment. * Pain control: (1) Morphine sulfate 2-4 mg IV q5-10min until pain is relieved or side effects develop ; (2) nitroglycerin 0.3 mg SL if systolic bp 100 mmHg; for refractory pain: IV nitroglycerin (begin at 10 g/min, titrate upward to maximum of 200 g/min, monitoring bp closely); do not administer nitrates within 24 h of sildenafil or within 48 h of tadalafil (used for erectile dysfunction); (3) -adrenergic antagonists * Oxygen 2-4 L/min by nasal cannula (maintain O2 saturation 90%). * Mild sedation (e.g., diazepam 5 mg PO qid). * Soft diet and stool softeners (e.g., docusate sodium 100-200 mg/d). * -Adrenergic blockers reduce myocardial O2 consumption, limit infarct size, and reduce moality. Especially useful in pts with hypeension, tachycardia, or persistent ischemic pain; contraindications include active CHF, systolic bp 95 mmHg, hea rate 50 beats/min, AV block,or history of bronchospasm. Administer IV (e.g., metoprolol 5 mg q5-10min to total dose of 15 mg), followed by PO regimen (e.g., metoprolol 25-100 mg bid). * Anticoagulation/antiplatelet agents: Pts who receive fibrinolytic therapy are begun on heparin and aspirin as indicated above. In absence of fibrinolytic therapy, administer aspirin, 160-325 mg qd, and low-dose heparin (5000 U SC q12h for DVT prevention). Full-dose IV heparin (PTT 2 control) or low-molecular-weight heparin (e.g., enoxaparin 1 mg/kg SC q12h) followed by oral anticoagulants is recommended for pts with severe CHF, presence of ventricular thrombus by echocardiogram, or large dyskinetic region in anterior MI. Oral anticoagulants are continued for 3 to 6 months, then replaced by aspirin. * ACE inhibitors reduce moality in pts following acute MI and should be prescribed within 24 h of hospitalization for pts with STEMI--e.g., captopril (6.25 mg PO test dose) advanced to 50 mg PO tid. ACE inhibitors should be continued indefinitely after discharge in pts with CHF or those with asymptomatic LV dysfunction ; if ACE inhibitor intolerant, use angiotensin receptor blocker (e.g., valsaan or candesaan). * Serum magnesium level should be measured and repleted if necessary to reduce risk of arrhythmias.
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Ans. is 'b' i.e., Stabilization of mRNA At the 51-end, mRNA possesses a 7-methylguanosine triphosphate cap which helps in the recognition of mRNA in protein biosynthesis and it helps to stabilize the mRNA by preventing attack of 51-exonuclease. At its 31-end, there is a poly-A tail made up of several adenylate residues which stabilize mRNA by preventing attack of 31-exonuclease.
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Anorexia nervosa Anorexia nervosa is a eating disorder where the patient has decreased weight and altered body image and persistent desire to maintain thinness * Gender==== more common in females * Age=======adolescence * Comorbidity=== depression and social phobia * Duration====3 months * Criteria= * Intense fear of becoming fat * Restriction of food intake * Restricting type * Binge eating and purging type * Amenorrhea is not needed for diagnosis, previously amenorrhea is considered as a diagnostic criteria for diagnosis, in recent DSM 5 amenorrhea is considered for a diagnosis * Association= * OCD and depression * Decreased interest in sex * Complication * 7-14% moality * ECG changes * Hypokalemic alkalosis because of induced vomiting * Gastric dilation * Drugs * Cypro hepatidine * SSRI * Management * Admit in severe cases * Prevent vomiting by making restroom inaccessible for 2 hours after food intake * Avoid laxatives * Small frequent meals * Avoid refeeding syndrome Ref. kaplon and sadock, synopsis of psychiatry, 11 th edition, pg no. 509
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Technetium 99m Sulphur colloid scan: Taken up by reticuloendothelial cells, Macrophages and Kupffer cells Therefore, used for Phagocytes study Evaluate splenic disease Detect occult abscess It shows hot uptake in focal nodular hyperplasia (because it has increased number of Kupffer's cells) Liver Fibrolamellar variant of HCC (has increased hepatocyte) | On Sulphur colloid scan No hot uptake Focal nodular hyperplasia (has increased hepatocyte and Kupffer cells) | hot uptake
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FeaturesRed infarctsWhite infarctsCause Aerial occlusion in loose tissues or organ having a dual blood supplyVenous occlusion Aerial occlusions in solid organs with end aerial circulation Affected organs Lung and small intestine Solid organs (hea, spleen, kidney )PropeiesIll-defined hemorrhagic margins which change in color to brown Well defined margins and progressively paler with time Edema Usually present Usually absent (Refer: Robbins & Cotran's - Pathologic Basis of Disease, SAE, 1st edition, Vol II-pg no: 129-130)
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Ans. d (23 X)Secondary oocyte consist of 23 X chromosomes.The chromosomal complement of a primary oocyte is 46 XX and that of secondary oocyte is 23 X.Sequence of maturation of ovarian primordial follicle after primary follicle stage:Primordial follicle(Single layered ovarian follicle)Spermatogonium (diploid, 2N) ||Primary Spermatocyte (diploid, 2N)Primordial follicle ||Secondary Spermatocyte (haploid, N)Secondary follicle (Antral follicle) ||Spermatid (haploid, N)(Spermatogenesis begins with Spermatogonia.Full development takes 2 months.It occurs in seminiferous tubules)Graffian follicle|Corpus luteum| Corpus albicans # While majority of oogonia divide, some enter into prophase of first meiotic division and are primary oocytes. These are surrounded by flat cells, which are called primordial follicles, and are present in cortex of the ovary.# At birth, there is no more mitotic division and all the oogonia are replaced by primary oocytes, which have finished prophase of first meiotic division and remain in resting phase between prophase and metaphase.# The first stage of maturation occurs with full maturation of ovarian follicle just prior to ovulation but the final maturation occurs only after fertilization.# The primary oocyte undergoes first meiotic division giving rise to secondary oocyte and one polar body.# Secondary oocyte has haploid number of chromosomes.# Ovulation occurs soon after formation of secondary oocyte.# The secondary oocyte completes the second meiotic division only after fertilization by the sperm in the fallopian tube.
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Answer- C. Strength of antagonists remains the same as examiner uses increased force to change limb positionIt is ako called paratonia or paratonic rigidity.It is the voluntary opposition of patient to passive movement of limb.It is the movement of the limb to counteract any movement made by the examiner.The resistance offered to passive movement is variable and fluctuating in nature.Patient is unable to relax a group of muscles on command due to inattentiveness.Strength of antagonists increases as examiner uses increasing force to change the limb position.Resistance is present throughout the range of motion.It is also described as stifening of limb in response to contact.It is a sign of bilateral frontal lobe dysfunction" especially mesial coex and superior convexity
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*Since each blood bag (usually 250 mL or 500 mL) contains a relativelysmall number of platelets, it can take as many as a dozen blood bags(usually from 5 to 10 bags, depending on the size of the bloodbags and each donor's plateletcount) to accumulate a single unit ofplatelets (enough for one patient). Apheresis platelets are usually called single donor platelets because they are collected from a single donor with an automated cell separator. Donors usually have an IV line in each arm. ... Single donor platelets offer several advantages over random donorconcentrates including: Less inventory and pooling. Refer bailey and love 27th edition ,pg 21
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Ans. is 'b' i.e., StaphylococcusImpetigoo Impetigo is a highly contagious, Gram-positive bacterial infection of superficial layer of epidermis. Impetigo occurs in Two forms : -1. Non - bullous impetigo (Impetigo contagiosa)It is the most common bacterial infection of children (occurs mainly in children in contrast to Bullous impetigo which occurs in infants). It is caused by both staphylococcus aureus and hemolytic group A streptococcus (Str. pyogens), though it is mostly caused by staph aureus. Most commonly occurs on face, i.e., around nose & mouth; and exposed parts, i.e., arms, legs. Presents erythematous macule/papule which changes into vesicle which soon ruptures with formation of crusting. Crust has characteristic features : -Honey-yellow colour in streptococcal impetigo.Waxy in staphylococcal impetigo.Lesion heal without scarring. Mucous membrane involvement is rare. Lymphadenopathy is common2. Bullous impetigoIt is caused by staphylococcus aureus most often phage type 71. It usually occurs in infants and manifests as vesicle that develop into bulla and later a pustule without any surrounding erythema. It mainly occurs on face. Mucous membrane may be involved (in contrast to impetigo contigiosa). Lymphadenopathy is rare.
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The significant observation in this question is the description of lymphangitic inflammatory streaking up the inner aspect of the patient's leg. This is highly suggestive of a streptococcal infection.
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Ref Robbins 9/e p292_293 familial case of retinoblastoma 1 defective and 1 normal gene at bih (heterozygous) second mutation causes both genes to be defective loss of heterozygosity Increased chances of cancer sporadic case of retinoblastoma both normal gene at bih _ homogeneous normal genes Both mutations occur somatic Ally within a single cell (homozygous abnormal genes ) increased chances of cancer
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Ans. Spindie - A melanoma
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Ans. is 'a' i.e., Maple Syrup urine diseaseMAPLE SYRUP URINE DISEASE In this disorder, the branched-chain keto acids derived from isoleucine, leucine, and valine appear in the urine, giving it a maple syrup-like odor.This condition results from a deficiency in the branched-chain -keto acid dehydrogenase.It is a mitochondrial, enzyme complex consisting of a-ketoacid decarboxylase , Dihydrolipoyl dehydrogenase and Transacylase The early steps in the metabolism of these three amino-acids are similar. One of the steps - decarboxylation is accomplished by a complex enzyme system i.e. branched chain oc-keto acid dehydrogenase using thiamine pyrophosphate (vitamin B1) as a coenzyme.The elevated keto acids cause severe brain damage, with death in the first year of life.The disease is characterized by feeding problems,vomiting, dehydration, severe metabolic acidosis, and a characteristic maple syrup odor to the urine. If untreated, the disease leads to mental retardation, physical disabilities, and even death.Treatment. A few cases respond to megadoses of thiamine (vitamin B1). Otherwise, synthetic diets low in branched-chain amino acids are given.
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Protein losing enteropathy Presents with puffy eyes and pedal edema and low serum albumin in patients with GI diseases. If the loss of albumin exceeds the rate of synthesis, hypoalbuminemia -edema develops Intestinal lymphangiectasia , dilatation of intestinal lymphatics leads to loss of lymph fluid into gastrointestinal tract, leading to the development of hypo-proteinemia and resultant edema. The test used for diagnosis is Tc 99 radio-nuclide scan Choice B is the wrong statement since it says normal flow of Lymphatics.
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From the arcuate arteries, radial branches originate at right angles, traverse inward through myometrium, enter endometrium and branch there to become basal arteries or coiled spiral arteries, spiral arteries supply functionalis layer.
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Rhinophyma is slowly progressive condition due to hypertrophy of the sebaceous gland of the tip of nose often seen in cases of long standing acne rosacea.
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One of the possible causes of 18 year old girl with primary amenorrhea is Imperforate Hymen which leads to hematocolpos and hematometra. This hematocolpos compresses the bladder neck against the symphysis pubic causing urinary retention. Urinary tract infection and cervical fibroid may also cause urinary retention, but would not present with primary amenorrhea.
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Ans. is 'a' i.e., Atrophic rhinitisSurgical treatment of Atrophic rhinitisYoung's operationModified Young's operationNarrowing of the nasal cavity by (Lautenslagers operation) -Lautenslagers operation
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Kallman syndrome- Hypothalamic failure, Low FSH Klinefelters will have Testicular atrophy high FSH Undescended testes also will have high FSH Normal FSH and testosterone will be seen in obstructive azoospermia such as obstruction of vas deferens
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Anal Canal Carcinoma- - NIGRO regimen - Chemotherapy followed by radiation * 5- fluorouracil + Mitomycin-C followed by radiation
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Answer- B. 16DThe diopteric power of reduced eye is + 6OD, of which + 44D is contributed by cornea and + 16D by the crystalline lens.
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Enlargement of uterus
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HHH syndrome is due to defect in Ornithine permease of mitochondrial membrane. Hyperornithinemia: As ornithine can't enter mitochondria, it accumulates in blood. Hyperammonemia: As ornithine is not available, urea cycle can't operate i.e. NH3 can't be detoxified. Homocitrullinuria: As ornithine is not available, ornithine homologue lysine reacts with Carbamoyl phosphate to produce homocitrulline. (Difference between lysine and ornithine is just one CH2 group)
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Diagnosis: Palpation of the pyloric tumor or olive in the epigastrium or right upper quadrant by a skilled examiner is pathognomonic of the diagnosis of HPSQ If the olive is palpated, no additional diagnostic testing is necessaryQ. IOC - USG ABDOMEN. Barium Meal: - String SignQ:indicating a narrowed elongated pyloric canal that does not relax is seen - Shoulder SignQ caused by t he hyperophied muscle indenting the antrum - Double - track signQ: Caused by the redundant mucosa.
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Postural hypotension is due to blockade of sympathetic system. Ganglion blockers inhibit the transmission through both sympathetic as well as parasympathetic ganglia whereas muscarinic blockers inhibit only parasympathetic activity.
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Ans. 25-30%
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Glomerular filtration rate (GFR) is the volume of fluid filtered from the renal (kidney) glomerular capillaries into the Bowman&;s capsule per unit time.Renal plasma flows (RPF) the amount of plasma that perfuses the kidneys per unit time. Approximately 90% of the total constitutes the effective renal plasma flow, the poion that perfuses functional renal tissue, such as the glomeruli.Ref: Ganong&;s review of medical physiology; 24th edition; page no; 680
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b. Craniopharyngioma(Ref: Nelson's 20/e p 2453-2460, Ghai 8/e 612-613)CraniopharyngiomaIt is a solid tumor with cysts and calcification located in the suprasellar region.It presents with (short stature), visual field defects & hydrocephalus.
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Sarcomatous degeneration is extremely rare, and the incidence is not more than 0.5% Secondary Changes (Degenerations) and Complications Associated with Leiomyomas Hyaline change, cystic degeneration and atrophy Calcareous degeneration, osseous degeneration Red degeneration Sarcomatous change(Rarest) Torsion, haemorrhage Infection/ulceration, paicularly in the dependent pa of a submucous polyp Inversion of the uterus Endometrial carcinoma associated with fibromyoma(3% cases)
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" The purpose of health planning is to meet the health needs and demands of the people. Health needs as seen by the people are not exactly the same as seen by the experts. some needs may not be perceived at all; others vaguely perceived, and still other awaken only on contact with new way of life. In a democratic society people’s needs may be presented as demands."
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Ans. is 4b' i.e., Hydatid cysto Radiological signs of hydatid cyst of lungMeniscus signWater-lilly signCamalote signRising sun signSerpent signEmpty cyst sign
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Structure most often calcified - Globus pallidus.
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Clearance of a substance is the volume of plasma cleared of the substance in unit time ie in one minute. (REF: TEXTBOOK OF MEDICAL PHYSIOLOGY GEETHA N 2 EDITION, PAGE NO - 353)
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Stellate cells (Ito cells) in space of Disse get transformed by cytokines to myofibroblasts - collagen producing cells.
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Ans. is a, i.e. CuT380ARef: Shaw 15th/ed, p227; Novak 14th/ed, p263Most of the IUCDs have an average life span of 3 years.Exceptions are:* Nova T/Multiload 375/Levonova- 5 years* CuT 380 A (also known as Paragard)- 10 years - Distributed free of cost* Progestasert- 1 years* CuT200 B- 4 years, in US and 3 years in India and in European countries* Levonorgestrel containing IUCD can be used for: (Mirona)- 7-10 years, but is approved for 5 years
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Usually big hypopyon is present even if the ulceration is small.Unlike bacterial ulcer,the hypopyon may not be sterile as the fungi can penetrate into the anterior chamber without perforation Reference:Comprehensive ophthalmology,AK Khurana,6th edition,page no.106
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during acceleration downward, force acting toward the head (negative g) increases aerial pressure at head level. But intracranial pressure also rises, so that the vessels are suppoed and do not rupture. The cerebral vessels are protected during the straining associated with defecation or delivery in the same way. If the body is accelerated upward (positive g), blood moves toward the feet and aerial pressure at the level of the head decreases Ref: Ganong's Review of Medical Physiology Twenty-Third Edition Page No:575
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Follicular carcinoma can normally only be differentiated from follicular adenoma by the architecture of histology.Histologic diagnosis of FTC depends on the demonstration of follicular cells occupying abnormal positions, including capsular or vascular invasion. The cells may not demonstrate nuclear atypia; however, when present, marked nuclear atypia is associated with a worse prognosis.Ref: Sabiston 20e, page no: 927
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Physiological jaundice- always unconjugated hyperbilirubinemia
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Ans. D. Female genital tract. (Ref Longman's Embryology 9th/pg. 38; Ganong 22nd/427).Longman's Embryology.9th/pg. 38........"Capacitation is a period of conditioning in the female reproductive tract that in the human lasts approximately 7 hours. Much of this conditioning, which occurs in the uterine tube, entails epithelial interactions between the sperm and mucosal surface of the tube. During this time a glycoprotein coat and seminal plasma proteins are removed from the plasma membrane that overlies the acrosomal region of the spermatozoa. Only capacitated sperm can pass through the corona cells and undergo the acrosome reaction".Spermatozoa are not able to fertilize the oocyte immediately upon arrival in female genital tract & must undergo:# Capacitation (glycoprotein coat and seminal plasma proteins are removed from spermatozoon head), and# Acrosome reaction, during which acrosin and trypsin-like substances released to penetrate the zona pellucida.Capacitation# Capacitation of sperm takes 2-6 hr.# Only the capacitated sperms can penetrate zona pellucida.# Once ejaculated into the female, the spermatozoa move up the uterus to the isthmus of the uterine tubes, where they slow down and undergo capacitation. This further maturation process involves two components:- Increasing the motility of the spermatozoa and- Facilitating their preparation for the acrosome reaction.# However, the role of capacitation appears to be facilitatory rather than obligatory, because fertilization is readily produced in vitro.# From the isthmuses the capacitated spermatozoa move rapidly to ampulla, where fertilization takes place.The phases of fertilization include: phase 7, penetration of the corona radiata; phase 2, penetration of the zona pellucida; and phase 3, fusion of the oocyte and sperm cell membranes.
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Ans: b. Provision of free....Elements of primary health care: 8 Essential component:Education concerning prevailing health problems & the methods of preventing & controlling themPromotion of food supply & proper nutrition,An adequate supply of safe water & basic sanitation.Maternal & child health care including family planningImmunization against major infectious diseasesPrevention & control of locally endemic diseaseAppropriate treatment of common diseases & injuriesProvision of essential drug
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Ans. is 'a' i.e., Hering Breuer reflexo Hering-Breuer inflation reflex : This reflex is mediated by pulmonary stretch receptors in w hich inflation of lungs above a particular volume results in reflex inhibition of inspiration and initiation of expiration. The reflex tends to limit the tidal volume while increasing the respiratory frequency.o Hering-Breuer deflation reflex : - Rapid deflation of lungs tends to initiate prolonged inspiration, i.e., reflex hyperpnea in response to deflation.NameLocationStimulationAfferentResponseBaroreceptorsArterialCarotid sinus-9th nerve Aortic arch-1 Oth nerve|BPAff.-9th 10th NTS Eff.-Buffer n.|Sympathetic vasoconstrictor tone |Sympathetic discharge to heart |Parasympathetic discharge to heartCentral venous pressure receptorLt. atrium Pulmonary veins wall of great veins (SVC/Jugular veins) 10th nerve ChemoreceptorsCentralMedullaCO; HyperventilationPeripheralCarotid & Aortic bodyHemorrhage Hypoxia Hypercapnia acidosisStimulates VMCPeripheral Vasoconstriction |CO,|THR,|BPBainbridge ReflexesRt. atrium/vena cavaeRapid infusion of blood'saline (atrial distension) reflex tachycardiaBezold-Jariseh/ Coronary ChemoreflexLt. VentricleInj. of 5-HT, Veratrum Capsaicin, Nicotine in coronary artery Apnea, |-BP, |HR Tachypnea later onJ. Reflex/Pulmonary chemoreflexJuxtacapillary in walls of alveoli. C-fibresHyperinflation of lung (normal inspiration) -do-Cushing ReflexVMC|ICT | in blood supply ot VMC | systemic BP reflex | in HRHering Breuer Reflex-Inflation -DeflationAirway SM cellsSteady Lung inflation Mark deflation of lung| expiration | expiration
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Carbamazepine It is an antiepileptic Chemically related to imipramine, it was introduced in the 1960s for trigeminal neuralgia; is now a first line antiepileptic drug. Its pharmacological actions resemble phenytoin, but impoant differences have been noted in experimental studies. Adverse effects Carbamazepine produces dose-related neurotoxicity-sedation, dizziness, veigo, diplopia and ataxia. Vomiting, diarrhoea, worsening of seizures are also seen with higher doses. Acute intoxication causes coma, convulsions and cardiovascular collapse. Hypersensitivity reactions are rashes, photosensitivity, hepatitis, lupus like syndrome, rarely agranulocytosis and aplastic anaemia. Some degree of leucopenia due to hypersensitivity is more common. Water retention and hyponatremia can occur in the elderly because it enhances ADH action. Increased incidence of minor foetal malformations has been repoed. Its combination with valproate doubles teratogenic frequency. Ref KD Tripati 8thh ed.
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Investigation of choice for Bronchiectasis is HRCT.
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The route of infection of rubella virus is the respiratory tract, with spread to lymphatic tissue and then to the blood (viremia). Maternal viremia is followed by infection of the placenta, which leads to congenital rubella. Many organs of the fetus suppo the multiplication of the virus, which does not seem to destroy the cells but reduces the rate of growth of the infected cells. This leads to fewer than normal numbers of cells in the organs at bih. Therefore, the earlier in pregnancy infection occurs, the greater the chance for the development of abnormalities in the infected fetus. A vast percentage of maternal infections that occur during the first trimester of pregnancy result in such fetal defects as pulmonary stenosis, ventricular septal defect, cataracts, glaucoma, deafness, mental retardation, and other maladies. Ref: Brooks G.F. (2013). Chapter 40. Paramyxoviruses and Rubella Virus. In G.F. Brooks (Ed), Jawetz, Melnick, & Adelberg's Medical Microbiology, 26e.
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Ans. is 'a' i.e., Vitello intestinal duct
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(C) Anomia # Clinical Examination of Language should include the assessment of naming, spontaneous speech, comprehension, repetition, reading, and writing.> A deficit of naming (anomia) is the single most common finding in aphasic patients.# Anomic Aphasia:> Anomic aphasia is the single most common language disturbance seen in head trauma, metabolic encephalopathy; and Alzheimer's disease.# Pure Alexia without Agraphia:> This is the visual equivalent of pure word deafness.> The lesions (usually a combination of damage to the left occipital cortex and to a posterior sector of the corpus callosum- -the splenium) interrupt the flow of visual input into the language network.
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Pelkan spur is seen in scurvy.
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Ans. is 'd' i.e., All the aboveo Hysteroscopy is the endoscopic technique of visualizing the interior of uterus directly.o It is both diagnostic and therapeutic.A hvsteroscope can visualize the interior of uterus so. it can diaenoseo Any congenital malformation of uterus and can also help in differentiating between a bicornuate uterus from a septate uterus.o Any uterine synechiae (as in Ashermann syndrome).o Misplaced IUCD.o Submucous fibroid.A hvsteroscope can visualize the cornua so. it can diagnoseo Any cornual pathology:-Hvsteroscope can directly visualize the endometrium so. it can diaenoseo Endometrial lesions like-endometrial polyp, endometrial hyperplasia, endometrial cancer, endometrial T.B.o Pregnancy related conditions like : Molar tissue or products of conception.Also knowo Most common distension media used in diagnostic hysteroscopy - CO2o Most common distension media used in therapeutic - Glycine hysteroscopy
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Ans. is 'a' i.e., 1-4 hours
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Apo(a) of Lp(a) is structurally related to plasminogen and appears to be atherogenic by interfering with fibrinolysis of thrombi on the surfaces of plaques. Improant - Apo(a) shares a remarkable degree of homology with plasminogen in 3 main respects: a) multiple tandem repeats of domains similar to kringle four b) a single region resembling kringle five c) pseudoprotease segment. Plasminogen and apo(a) are genetically linked on chromosome 6 and may have arisen from a common ancestral gene. Ref: Hajjar K.A., Marcus A.J., Muller W.A. (2010). Chapter 117. Vascular Function in Hemostasis. In J.T. Prchal, K. Kaushansky, M.A. Lichtman, T.J. Kipps, U. Seligsohn (Eds), Williams Hematology, 8e.
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Oesophagitis including HIV and CMV oesophagitis usually manifest as one or more large ovoid or diamond-shaped ulcers.
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pH - 7.55 (alkaline) PCO2 - 12 (low) HCO3 - 20 (low) -Respiratory alkalosis * For every 10 mm | in CO2 -HCO3 to be | by 2 meq. * So PCO2 | ~ 30 mm Hg * HCO3 to be | by 2x3=6 * So 26-6 = 20 * But pH - | * So paially compensated compensation is paial because pH is not normalized(normal pH ranges 7.35-7.45)
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CREMASTER MUSCLE:- Consists of muscle fasciculi embedded in cremasteric fascia. The fasciculi form superficial loops from middle one-third of upper surface of inguinal ligament and deep loops from pubic tubercle, pubic crest, and conjoint tendon. Fully developed in males. In females only few fibres. Muscle along with the intervening connective tissue forms a sac-like cremasteric fascia around spermatic cord and testis. Nerve supply:- genital branch of genitofemoral nerve. Action: suspend the testis and elevate it. Cremasteric reflex:- Stroking the upper pa of the medial side of the thigh there is reflex contraction of the cremaster muscle, as is evidenced by elevation and retraction of the testis. In UMN lesions above segment, L1 reflex is lost. {Reference: BDC 9E}
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Ans. is 'a' i.e., Trisomy [Ref: Williams 24th/e p. 351* Abortion occurring without medical or mechanical means to empty the uterus is referred to as spontaneous.* More than 80% of abortions occur in the first 12 weeks of pregnancy, and at least half result from chromosomal anomalies.* After the first trimester, both the abortion rate and the incidence of chromosomal anomalies decrease.* Trisomy 16 is the most common abnormal karyotype found in the abortus.* Monosomy X (45 X), the second most frequent chromosomal abnormality (after trisomy), usually results in abortion and much less frequently in live born female infants (Turner syndrome).* Trisomies have been identified in abortus for all except chromosome 1
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Ans. is 'a' i.e., Phenylpropanolamine Many repos associating phenylpropanolamine use for weight loss with haemorrhagic stroke among women, appeared in U.S.A.
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Hea
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Ans. is 'b' i.e., Produce deep penetration o Dum-dum bullets produce limited penetration:o Dum-dum bullet (expanding bullet) : It is a jacketed bullet with is nose tip chiseled or cut off. It is designed to increase in diameter and expand upon striking the target, thus producing larger diameter wounds of limited penetration.
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Levofloxacin would be effective for most strains of Streptococcus pneumoniae, Legionella pneumophila, and other likely pathogens. Other commonly used drugs for community-acquired pneumonia are high-dose amoxicillin, ceftizoxime, trimethoprim-sulfamethoxazole, and doxycycline. Theoretically, empiric therapy should be guided by knowledge of local resistance patterns.
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