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Granulomatosis with polyangiitis (Wegener's granulomatosis):Three pathologic hallmarks of are granulomatous inflammation, vasculitis, and necrosis.Classic triad of upper and lower respiratory tract disease and glomerulonephritis.The histopathologic hallmarks of granulomatosis with polyangiitis are necrotizing vasculitis of small aeries and veins together with granuloma formation, which may be either intravascular or extravascular.Lung involvement typically appears as multiple, bilateral, nodular cavitary infiltrates, which on biopsy almost invariably reveal the typical necrotizing granulomatous vasculitis.In its earliest form, renal involvement is characterized by a focal and segmental glomerulitis that may evolve into a rapidly progressive crescentic glomerulonephritis.Granuloma formation is only rarely seen on renal biopsy.In contrast to other forms of glomerulonephritis, evidence of immune complex deposition is not found in the renal lesion of granulomatosis with polyangiitis. Ref: Langford C.A., Fauci A.S. (2012). Chapter 326. The Vasculitis Syndromes. In D.L. Longo, A.S. Fauci, D.L. Kasper, S.L. Hauser, J.L. Jameson, J. Loscalzo (Eds), Harrison's Principles of Internal Medicine, 18e.
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Hemorrhage
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Ans. is 'd' i.e., Decreased pH
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Answer- C. Macular edemaReduced nonproliferative and proliftrative retinopathyMicroalbuminuriaClinical nephropathyNeuropathyImproved glycemic control
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Ans. is 'a' i.e., HDL o Lecithine-Cholesterol acetyltransferase (LCAT) esterifes cholesterol in HDL during reverse cholesterol transport,o All nucleated cells in different tissues synthesize cholesterol, but the excretion of cholesterol is mainly by liver in the bile or by enterocytes in gut lumen. So, cholesterol must be transported from peripheral tissue to liver for excretion2. This is facilitated by HDLQ and is called reverse cholesterol transport because it transports the cholesterol in reverse direction to that is transported from liver to peripheral tissues through VLDL - LDL cycle.Processo HDL is synthesized in liver and small intestine. Nascent HDL contain phospholipids and unesterified cholesterol and Apo-Ar, C, E. This nascent HDL is secreted into circulation where it acquires additional unesterified cholesterol from peripheral tissues. Within the HDL particle, the cholesterol is esterified by lecithin - cholesterol acetyltransferase (LCAT) to form cholesteryl ester and additional lipid are transported to HDL from VLDL and chylomicrons. Apo-A, activates LCAT.o There are two pathway by which this cholesterol is transported to liver.Indirect pathwayo Cholesteryl ester is transferred from HDL to VLDL and chylomicrons in exchange with triglyceride by the cholesteryl ester transfer protein (CETP).o This cholesteryl ester is then transported to liver (see previous explanation).Direct pathwayo HDL cholesterol can also be taken up directly by hepatocytes via the scavenger receptors class BI (SR - BI).
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Ans. is 'b' i.e., Herpes `Herpes simplex (in the developed world) and chancroid (in Africa) are the most common cause of genital ulceration in HIV infected patients.' - 'An Atlas of differential diagnosis in HIV disease' by Lipman, Gluck and Johnson 1st (1995) p. 30
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Ans. is a i.e. TESA Friends, we have studied in detail IVF and IUI but either of them cannot be performed if appropriate methods for sperm recovery are not available in cases of male infeility. Sperm retrieval or Recovery can be done by : Microsurgical Epididymal Sperm aspiraton : MESAdeg Percutaneous Epididymal Sperm aspiration : PESAdeg Testicular sperm extraction : TESEdeg Percutaneous Testicular sperm fine needle aspiration : TESAdeg (also called as Fine Needle Aspiration FNA). The choice of the method depends on : the underlying diagnosis, whether goal of the procedure is diagnostic or therapeutic whether, isolated sperm will be used immediately or cryopreserved. TESA Is a percutaneous method which requires No/Local anesthesia and retrieves sperms from the testis when spermatogenesis is normal as in cases of post-testicular azoospermia (i.e. either there is congenital absence or obstruction of ',as deferens/ejaculatory ducts or Retrograde ejaculation). MESA Also indicated in cases of post testicular azoospermia. It is done when one need's to know the nature of obstruction or if surgical correction of the obstruction is to be performed at the same time of sperm recovery. (Done under GA/Regional anesthesia). Another advantage of MESA is that a very large number of sperms are usually retrieved so that cryopreservation and avoidance of repeat surgery may be possible PESA Percutaneous epididymal sperm aspiration can also be used in cases of Post testicular azoosperma but it is a blind procedure. Bleeding . epididymal injury and postsurgical fibrosis can occur. TESE Indicated in men with testicular azoospermia or Gonadal failure. Intracytoplasmic sperm injection : i.e. ICSI Here a single sperm is injected into the cytoplasm of the oocyte which is then incubated over night. The procedure involves stripping of the aspirated cumulus complex of all surrounding Granulosa cells, so that micromanipulation can be performed on the egg itself. A holding pipette is used to stabilize the egg while an injection pipette is used to inse a ble sperm into the cytoplasm of the egg. Advantage : This procedure bypasses events like capacitation and acrosome reaction by the sperms. Indication : It is indicated in male factor infeiliy : When sperm is count is less than 5 million / ml (severe oligospermia). Absolute indications : asthenospermia i.e. < 5% progressive motility. Teratospermia i.e. < 4% normal sperms. No.of motile sperms is < 0.5X106/m1 (as in these conditions IUI cannot be done). If sperms lack acrosome. Abnormal sperm morphology. In cases where sperms are being surgically retrieved (as number of sperms are less). H/O 2 previous feilization failures with conventional IVF technique. GIFT : (Gamete Intra Fallopian Transfer) / ZIFT : (Zygote Intra Fallopian Transfer) They are alternatives to IVF in which oocytes and sperm (in GIFT) or zygote (in ZIFT) are transferred to fallopian tube instead of Uterus laparoscopy. Once commonly used. as they offered high success rates to women with normal tube anatomy (whereas IVF is mainly used in cases where tubal pathology is present), both procedures are relatively rare now.
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Sponging, paracetamol ibuprofen ,intermittent diazepam are treated for febrile seizures Most children with typical febrile seizures do not require specific treatment except for vigorous antipyretic therapy during febrile illnesses. Children experiencing excessively frequent or prolonged febrile seizures may be treated using diazepam 0.5mg/kg rectally during high fevers or prophylactically using <a href=" at standard doses.</p> Ref : Ghai pediatrics eighth edition pg no 556
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An infarct is an area of ischemic necrosis caused by occlusion of the vascular supply to the affected tissue Infarcts are classified on the basis of their colour into Red infarct with venous occlusions in loose tissues eg:- lung in tissues with dual circulations such as lung and small intestine, in previously congested tissues when the flow is reestablished after infarction has occurred white infarct occur with aerial occlusions in solid organs with end-aerial circulations (e.g., hea, spleen, and kidney) ref Robbins 9/e pg 92
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Ans. All are true
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The concentration of magnesium in serum is closely regulated within the range of 0.7–1 mmol/L (1.5–2 meq/L; 1.7–2.4 mg/dL), of which 30% is protein-bound and another 15% is loosely complexed to phosphate and other anions. One-half of the 25 g (1000 mmol) of total body magnesium is located in bone, only one-half of which is insoluble in the mineral phase. Almost all extraskeletal magnesium is present within cells, where the total concentration is 5 mM, 95% of which is bound to proteins and other macromolecules.
Because only 1% of body magnesium resides in the ECF, measurements of serum magnesium levels may not accurately reflect the level of total body magnesium stores.
Regulation of serum magnesium concentrations is achieved mainly by control of renal magnesium reabsorption. Only 20% of filtered magnesium is reabsorbed in the proximal tubule, whereas 60% is reclaimed in the cTAL and another 5–10% in the DCT. Magnesium reabsorption in the cTAL occurs via a paracellular route that requires both a lumen-positive potential, created by NaCl reabsorption and tight-junction proteins encoded by members of the Claudin gene family. Magnesium reabsorption in the cTAL is increased by PTH, but inhibited by hypercalcemia or hypermagnesemia, both of which activate the CaSR in this nephron segment.
Reference: :Harrison’s medicine page no 2916
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NaSSA * IMPOANCE Nor adrenergic and specific serotonergic antidepressant * MECHANISM * Alpha 2 adrenergic receptor antagonism=== increase serotonin and NA * 5HT2,3 antagonist============increase sleep and appetite * DRUGS miazapine * USE Elderly with depression * SIDE EFFECTS hyperlipidemia re. kaplon and sadock, synopsis of psychiatry, 11 th editionm, 955
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Vaccine Strains Dengue/Dengavaxia : CYD-TDV BCG : Danish 1331 Measles : Edmonston Zagreb Mumps : Jeryl Lynn Rubella : RA 27/3 YF : 17D Varicella : Oka JE : SA 14-14-2 H1N1 : A7/California/2009 Mosquirix : S,S/AS01 (World's first & only licensed malaria vaccine. It is prepared from circumsporozoite protein of plasmodium falciparum using hepatitis B surface antigen) HIV : mvA (Modified vaccinia ancara) Typhoral : Tyz21a Anthrax : Sterne
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Hairy male Army Serous discharge Pilonidal sinus Pilonidal sinus - Acquired - M/C in hairy males, Army personnel - Cyst in - Post-natal cleft region - Cyst - Contains hair - Sinus - Abscess formation due to tract blockage - Hair follicles have not seen in the walls of the sinus. - The hairs projecting from the sinus are dead hairs, with their pointed ends directed towards the blind end of sinus. Management Surgical treatment of chronic pilonidal disease - Laying open of all tracks with or without marsupialisation - Excision of all tracks with or without primary closure - Excision of all tracks & closure by Limberg's flap, Karydakis flap or rhomboid flap - Bascom's procedure: Incision lateral to the middle to gain access to the sinus cavity, which is rid of hair & granulation tissue and excision & closure of midline pits. The lateral wound is left open.
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Ans. is 'c' i.e., Sulph - meth hemoglobin Signs of putrefaction The signs and effects of putrefaction are as follows :? 1. Colour changes The earliest sign of decomposition is greenish discoloration of body, seen in right iliac fossa externally and under liver internally. This is due to involvement of caecum. Which contains more liquid and is full of bacteria. In these areas, it appears in 12-18 hours and slowly spreads to whole body in 24-48 hours. Greenish discoloration is due to formation of sulph-meth-haemoglobin. Morbling occurs when Hb dissociates from RBCs and the colour of Hb is taken up by vessels, which are seen as prominent lines having purple or green or brown colour. Marbling occurs in 24-48 hours. 2. Formation of foul smelling gases Due to action of bacteria, foul smelling gases are formed, e.g. SO, , H2S, ammonia, methane and CO2. 3. Effects of gases Bloating up of body occurs in 34-48 hours. At the same time following changes occurs : i) Appearance of stomach contents and froth on nose and mouth. ii) Degloving and destocking with appearance of putrefactive blisters. iii) Emptying of hea due to pressure of gas. In 48-72 hours prolapse of rectum and uterus occur and postmoem delivery may occur if the dead woman is pregnant. Color of postmoem staining also changes to brown and finally to black. False rigidity (putrefactive rigidity) may occur at this time. 4. Appearance of maggots Flies lay their eggs in wounds, exposed natural orifices and exposed moist pas of the body and folds of skin, e.g. neck, axilla, nostrils, mouth etc. Flies lay eggs in 6-12 hours after death and these eggs change in larva (maggot) in 1-2 days. Thus maggots appear in 2-3 days after the death. After fuher 4-5 days, the maggots change into pupa, which conve into adult flies in next 3-5 days. Thus adult flies will be coming out of the body after total 8-12 days of death. Thus appearance of maggot determine the time since death. 5. Other late changes In 3-5 days : Nails and teeth become loose and can be pulled out, sutures of skull may separate. In 7-12 days : Liquefaction of body (colliquative putrefaction) occurs. In 1-3 months : Skeletonization of dead body occurs. Finally : Bones also decompose : Exposed bones in 1-5 years and deep burried bone (> 2 meters) in 25-100 years. 6. Internal changes Liver becomes spongy and is called as foamy or swiss cheese or honeycombed liver. In 7-12 days lequefaction of internal organs occur. 7. Floatation of body (if body is in water) Floatation of body occurs due to occumulation of sufficient putrefactive gases. Abdomen is above (due to gases) and spine is below during floatation. Time required for floatation is ordinarily 24 hours after death in summers and 2-3 days in winter. Factors affecting floatation are :- i) Causing early.floatation : Newborn mature infant, females, in summer, clothed body, obese, in sea water and in still pond water. ii) Causing delayed floatation : Still bih/immature newborn, male, in winter, naked body, thin built, in fresh water and in running stream water. Inspiration and expiration before death has no effect on floatation as floatation is due to putrefactive gases (not due to respiratory air).
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Ans. is 'c' i.e., Cl?Among the given options, Cl- has lowest permeability coefficient and maximum permeability.Permeability of membraneAs the major middle poion of membrane (core of the membrane) is formed by hydrophobic region of phospholipids, this poion is impermeable to the usual water-soluble substances, such as ions, glucose and urea. Conversely, fat-soluble substances, such as oxygen, carbon dioxide, and alcohol, can penetrate this poion of the membrane with ease.The permeability coefficients of small molecules in the lipid bilayer correlate with their solubilities in nonpolar (hydrophobic) region and thus their permeability.
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Lithium has to be stopped 24 hrs prior to surgery.
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Ans. is 'b' i.e., 30 minuteso The metabolic rate of the hea is high, and its stores of substrate are low.o So, hea is critically dependent on a continuous supply of oxygen and nutrients.o Ischemia of myocardium induces profound functional, biochemical and morphological consequences.o Myocardial function is more sensitive to ischemia (loss of contractility occurs within 60 seconds) than myocardialstructure (irreversible injury occurs in 20-40 minutes, thus myocardial necrosis begins at approximately 30 minutesafter coronary occlusion.Key events in ischemic cardiac myocytes Feature TimeOnset of ATP depletion SecondsLoss of contractility < 2 minutesATP reduced to 50% 10 minutesATP reduced to 10% 40 minutesIrrversible injury 20-40 minMicrovascular injury > 1 hr
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<p>In case of anemia of chronic disorder, anemia is not related to bleeding ,hemolysis or marrow infiltration,is mild,with normal MCV (normocytic normochromic) though this may be reduced in long standing inflammation .</p><p>Reference :Davidson&;s principles &practice of medicine 22nd edition pg no 1023.</p>
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Protein buffers in blood include haemoglobin (150g/l) and plasma proteins (70g/l). Buffering is by the imidazole group of the histidine residues which has a pKa of about 6.8. This is suitable for effective buffering at physiological pH. Haemoglobin is quantitatively about 6 times more impoant than the plasma proteins as it is present in about twice the concentration and contains about three times the number of histidine residues per molecule.
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ref : kd tripathi 8th ed
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Propylthiouracil, carbimazole and methimazole act by inhibiting the enzyme, thyroid peroxidase. It catalyses:
Oxidation of iodine
Organification
Coupling
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SRBs manual of surgery,4th edition According to parkland regimen, 4ml/%burn/bodyweight/24hours.
i.e 4*45*50=9000ml. Fluid requirements, first 24hours=9L first 8hours=4.5L 4.5L are infused in the next 16hours Hartmann's solution or ringer lactate is recommended
Regular assessment of the adequacy of resuscitation should be performed Blood products and colloid may also be given in addition to their requirements.
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Ans. is 'b' i.e., CBC,reti count with peripheral smear In above question, if child is stable, then no need to give blood transfusion. Before staing Iron, we have to rule out types of anemia as Iron is indicated only in nutritioral anemia. Hb ele ctrophoresis is indicated if there is featuer of hemolytic anemia (thalassemia) so over all our next step is complete hemogram with manual peripheral smear examination. (obtion b).
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D. i.e. Inferior oblique
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Burkholderia spp:Burkholderia malleiBurkholderia pseudomallei--Non motile bipolar stained organism --On Potato - Honey like growth--Class B agent of biological warfare --Induces Strauss reaction--Diagnosis - Mallein test & Molecular methods by 16s rRNA gene sequencing --Rx - Ceftazidime or Carbapenems --Causative agent of Melioidosis --Motile, oxidase positive organism --Causes hemoptysis resembling TB --Latency and reactivation occur due to intracellular survival --Typical bipolar safety pin appearance --Rx - Ceftazidime or CarbapenemsOBurkholderia cepacia: MDR strain impoant among nosocomial pathogensO1st MC pathogen among cystic fibrosis patients leads to recurrent respiratory tract infections and biofilm forming agent in intravascular catheters leads to bacteremiaRef: Ananthanarayan 9th edition, p317
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Ans. (d) PathogenesisThe causative factors of disease include AGENT, HOST, ENVIRONMENT . These 3 are referred as Epidemiological triad. Interaction of these 3 factors is required for development of disease .
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Irrigation of the cul de sac can reduce the halos in conjunctivitis Halos due to immature senile cataract are broken by slit (Fincham test) Halos due to corneal edema in glaucoma is reduced by decrease in IOP
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Posterior pa
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Answer is A(Anti-Jo-1): Anti-Jo-1 Antibodies (Antibodies to histidyl - tRNA) are the most common and most clinically assayed Myositis Specific Antibodies (MSA) Myositis Specific Antibodies (MSA) Myositis Specific antibodies are autoantibodies, usually directed against intracellular ribonucleoproteins that are involved in protein translation. The three best described Myositis Specific Antibodies (MSA) are Anti-Jo-1(directed to t-RNA histidyl-synthetase), Anti-Mi2 and Anti - SRP (Anti Signal Recognition Paicle) The sensitivity of these antibodies is believed to be low Specific MSA are however associated with ceain clinical features and prognosis. M.S.A Association Clinical Features Prognosis Anti-Jo-I Polymyositis * Relatively Acute Onset * Moderate (30% sensitive) * Predicts deforming ahritis, Reynaud's Phenomenon and Pulmonary fibrosis * Moderate Response to therapy but persistent disease Anti-Mi-2 Dermatomyositis * Relatively Acute Onset * Good (5%) sensitive * Predicts classical dermatomyositis rash (`V' sign, Shawl sign) and cuticular over growth * Good response to therapy and good prognosis Anti- SRP Polymyositis / * Very Acute onset * Poor Dermatomyositis (< 5% sensitive) * Predicts severe weakness, palpitations (no rash) * Poor response to therapy and poor prognosis
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(5000 rads) (2588-H 15th)OrganInjuryMinimum tolerance doseMaximum tolerance doseWhole or partial organ(Field size or length)Bone marrowAplasia250450Whole Pancytopenia300004000SegmentalLiverAcute hepatitis25004000*Whole Chronic hepatitis15002000Whole (Strip)StomachPerforation, ulcer, hemorrhage45005500100 cmIntestineUlcer, perforation45005500400 cm Haemorrhage50006500100 cmBrainInfarction necrosis5000*6000WholeSpinal cordInfarction necrosis4500550010 cmHeartPericarditis,4500550060% Pan carditis7000800025%LungAcute and chronic pneumonitis30003500100 cm 15002500WholeKidneyAcute and chronic nephrosclerosis15002000Whole (strip) 20002500WholeFetusDeath200400Whole
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Ans. is 'a' i.e., Group A Streptococci Rheumatic fevero Rheumatic fever (RF) is an acute, inununologically mediated, multisystem inflammatory disease classically occurring a few weeks after an episode of group A streptococcal pharyngitis; occasionally, RF can follow streptococcal infections at other sites, such as the skin.
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Proto-OncogeneAssociated tumorKRASColon, lung, and pancreatic tumorsBRAFMelanomas, leukemias, colon carcinoma, othersRETMultiple endocrine neoplasia 2A and B, Familial medullary thyroid carcinomasKITGastrointestinal stromal tumors, seminomas, leukemiasRef: Robbins and Cotran Pathologic Basis of Disease; 9th edition; Chapter 7; Neoplasia; Page no: 184; Table no: 7-5
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Pathogenesis of HIV infection and AIDS
Primary infection of cells through the blood and mucosa.
The initial entry of the virus may be through a mucosal surface, as in sexual intercourse (via rectal or cervical mucosa) or via blood exposure e.g. (after intravenous drug abuse).
From the mucosa the virus is carried to the regional lymph nodes by dendritic cells while the virus initially inoculated into the blood is rapidly cleared by the spleen and lymph nodes.
Thus, with either mode of entry, the virus initially replicates in the lymphoid organs and then spills over into the blood.
Infection established in lymphoid tissue e.g, lymph node
After the infection is established in the lymph node the virus spills into the blood the patient will now experience the acute HIV syndrome.
Acute HIV syndrome, the spread of infection throughout the body
This phase is characterized initially by high levels of virus in plasma and widespread seeding of the virus in lymphoid tissues.
Sometimes there is an abrupt reduction in CD4+ T cells.
During this period, the HIV virus can be readily isolated from the blood, and there are high levels of HIV p24 antigen in serum.
Soon, however virus specific immune response develops
Immune response
The viremia is readily controlled by the development of an antiviral immune response.
It is estimated that 40% to 90% of individuals who acquire a primary infection develop the viral syndrome 3-6 weeks after infection and this resolves spontaneously in 2 to 4 weeks.
The resolution of viremia occurs due to the immune response.
Virus-specific antibodies develop evidenced by seroconversion (usually within 3-7 weeks of presumed exposure) and more importantly virus-specific CD8+ cytotoxic T cells also develop.
HIV specific CD8+ T cells are detected in the blood, at this time, viral titres begin to fall and are most likely responsible for containment of HIV infection.
As viral replication stops CD4+ T cells return to near normal numbers, signalling the end of the acute phase.
Clinical Latency
The clinical latency or the middle chronic phase represents a stage of relative containment of the virus.
Although the plasma viremia declines, there is widespread dissemination and seeding of the virus, especially in the lymphoid organs.
The viral load at the end of the acute phase reflects the equilibrium reached between the virus and the host after the inital battle and in a given patient may remain fairly stable for several years.
This level of steady state viremia, or the viral "set point" is a predictor of the rate of decline of CD4+ T cells and therefore progression of HIV disease.
In one study, only 8% of patient with a viral load of less than 4350 copies of viral mRNA/ 1 progressed to full blown AIDS in 5 years, where as 62% of those with a viral load of greater than 36, 270 copies had developed AIDS in the same period.
From a practical standpoint, therefore the extent of viremia, measured as IIIV-tRNA is a useful surrogate marker of HIV disease progression and is of clinical value in the management of people with HIV infection.
However, in patients treated with highly active antiretroviral therapy (HAART), clinical improvement is often greater than the decrease in plasma viremia and it is generally accepted that virenzia as well as the blood CD4+ T cell counts should be considered in the management.
Regardless of the viral burden, during the middle or chronic phase, there is continuing battle between HIV and the host immune system.
The CD8+ cytotoxic T cell response remains activated and extensive viral and CD4+ cell turnover continues.
However, because of immune regenerative capacity of the immune system a large proportion of the lost CD4+ cells is replenished.
Thus the decline in CD4+ cell count in blood is modest.
After an extended variable period, there begins a gradual erosion of CD4+ T cell and full blown AIDS ensues AIDS
In this phase the host defence begins to wane.
There is loss of CD4+ T cells.
Concomitant with this loss, the proportion of the HIV virus in the blood increases.
It is characterized by a breakdown of the host defence, a dramatic increase in plasma virus and clinical disease.
Typically the patient presents with long lasting fever (> 1 months), fatigue, weight loss and diarrhoea.
After a variable period, serious opportunistic infections, secondary neoplasms or clinical neurological disease (grouped under the rubric AIDS indicator disease, discussed below), supervene and the patient is said to have developed AIDS.
It should be evident from our discussion that in each of the three phases of HIV infection, viral replication continues to occur .
Even in the chronic phase, before the severe decline in CD4+ cell count and the development of AIDS, there is extensive turnover of the virus.
In other words HIV infection lacks a phase of true microbiologic latency, thus it is a phase during which all the HIV is in the form of proviral DNA and no cell is productively infected.
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Abreaction is a process by which repressed material is remembered back, relived again along with expression of associated emotions.
It is a type of Catharasis (purging of emotions) used as therapy in few psychiatric disorders.
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Inclusion body in case of psittacosis is Levinthalcole Lillie. HP body:-seen in case of trachoma Miyagawa corpuscles:-LGV Henderson Peterson:-molluscum contagiosum
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Adenomyosis is characterised by myometrial cyst, which is most specific sign.
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In case of superimposed bacterial infection, coagulative necrosis is modified by the liquefactive action of the bacteria and the attracted leukocytes (resulting in so-called wet gangrene)
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Elution is found only in viruses that possess neuraminidase REF:ANANTHA NARAYANAN MICRO BIOLOGY NINTH EDITION PAGE.430
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Tension Pneumothorax :- Reduced blood supply to lungs | Affected lung has collapsed and contralateral lung will not be able to do the work of both the lungs. | This results in carbon dioxide retention ultimately leading to Respiratory Acidosis
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Ans. is 'd' i.e., All the above * ARF with urine output > 600 ml/day is defined as non-oliguric renal failure-* Important drugs cousing non-oliguric renal failure are -i) Aminoglycosides (e.g. gentamycin)iv) Ifosfomideii) Amphotericin Bv) Radiocontrast agentsiii) Cisplatinvi) Cyclosporine
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Ans. is 'd' i.e., Beta-2 receptor stimulationo Pneumonia and CHF (Cardiopulmonary disease) require dose reduction (not increased dose).Theophyllineo Theophylline is one of the three naturally occurring methylated xanthine alkaloids (methyl xanthines) - Caffeine, theophylline and theobromine,o Mechanism of actiona) Inhibition of phosphodiesterase -| degradation of cAMP or cGMP|bronchodilatation - increased intracellular cAMP or cGMP.Blockade of adenosine receptorsRelease of Ca+2 from sarcoplasmic reticulum especially in skeletal and cardiac muscles.Recently it has been found that theophylline at low doses exert antiinflammatory action by activating a nuclear enzyme, histone deacetylase-2.Proposed mechanisms of action of theophyllineo Phosphodiesterase inhibition (Non selective)o Adenosine receptor antagonism (A1 A2)o Increased histone Deacetylase activity (|ed efficacy of corticosteroids)o Inhibition of intracellular calcium releaseo Stimulation of catecholamine releaseo Inhibition of NF - a B translocation into the nucleus (|nuclear translocation)o Mediator inhibition (Prostaglandins, TNF a)
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Ans. is 'a' i.e., Elective open cholecystectomy for cholelithiasis
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Cp - > Cp/2 in 1 half-life i.e. 50.0 % lost 50.0 % Cp - > Cp/4 in 2 half-lives i.e. 25.0 % lost 75.0 % Cp - > Cp/8 in 3 half-lives i.e. 12.5 % lost 87.5 % Cp - > Cp/16 in 4 half-lives i.e. 6.25 % lost 93.75 % Cp - > Cp/32 in 5 half-lives i.e. 3.125 % lost 96.875 % Cp - > Cp/64 in 6 half-lives i.e. 1.563 % lost 98.438 % Cp - > Cp/128 in 7 half-lives i.e. 0.781 % lost 99.219 % Ref-KDT 7/e p30
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Ans. is 'b' i.e., Niacin
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MEN 1 is an autosomal dominant disorder due to a defect in 11q13, which encodes for a 610-amino-acid nuclear protein, menin. Patients with MEN1 develop hyperparathyroidism due to parathyroid hyperplasia in 95-100% of cases, pituitary adenomas in 54-80%, adrenal adenomas in 27-36%, bronchial carcinoids in 8%. Ref: Harrisons Principles of Internal Medicine, 18th Edition, Page 3060.
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. t(9:22), t(8:14), t(4:11)
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Digoxin is primarily eliminated unchanged by glomerular filtration Digitoxin is eliminated by hepatic metabolism.
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Winged scapula is caused by paralysis of the serratus anterior muscle that results from damage to the long thoracic nerve, which arises from the roots of the brachial plexus (C5-C7)
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In the small intestine, Paneth cells residing at the bottom of the intestinal crypts are the key effectors of innate mucosal defense. -Paneth cells provide host defense against microbes in the small intestine. They are functionally similar to neutrophils. -Paneth cells secrete a number of antimicrobial molecules into the lumen of the crypt, thereby contributing to the maintenance of the gastrointestinal barrier. -Paneth cells are stimulated to secrete defensins, lysozyme & phospholipase A2. Ref: guyton and hall textbook of medical physiology 12 edition page number: 395,396,397
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Ans. D i.e. H. pylori Peptic ulcer/Peptic ulcer disease It is defined as mucosal erosions equal to or greater than 0.5 cm. As many as 70-90% of such ulcers are associated with Helicobacter pylori, a helical-shaped bacterium that lives in the acidic environment of the stomach. Four times as many peptic ulcers arise in the duodenum--the first pa of the small intestine, just after the stomach--as in the stomach itself. About 4% of gastric ulcers are caused by a malignant tumor, so multiple biopsies are needed to exclude cancer. Duodenal ulcers are generally benign.
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• Meta-analysis (Highest clinical relevance: GOLD STANDARD)
• Systematic review
• Cohort study
• Case control study
• Case series
• Case report
• Ideas, Editorials, Opinions
• Animal research
• In-vitro (test-tube) research (Lowest clinical relevance)
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Ans. is 'b' i.e., 0.0475 inch o The best pattern of mosquito net is the rectangular net.o There should not be a single rent in the net.o The Size of openings in the net is of utmost importance, the size should not exceed 0.0475 inch in any diameter.o The number of holes in one square inch in usually 150.
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Ans. is 'b' i.e., beta-Blocker Drugs causing hvperiglyceridemia ? o Estrogen o Furosemide o Bile acid - binding resin o HIV protease inhibitors. o beta-blockers o Glucocoicoids o Retinoic acid
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Bimolar technique or Gardner's view shows the lateral oblique view of the right and left halves of the jaw in the same radiograph. The 1st exposure is done of one side (right/left), while covering the other half of the cassette with a lead shield with the conventional technique for the lateral oblique view of the mandible. The second exposure is done with the conventional method of the second side (right/left), while covering the previously exposed side with the lead shield.
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(D) All of the above # Genetic Hypothesis: The life-time risk for the first degree relatives of bipolar mood disorder patients is 25%, and of recurrent depressive disorder patients is 20%.> The life-time risk for the children of one parent with mood disorder is 27% and of both parents with mood disorder is 74%.> The concordance rate in bipolar disorders for monozygotic twins is 65% and for dizygotic twins is 20% and the concordance rate in unipolar depression for monozygotic twins is 46% and for dizygotic twins is 20%.# Sleep studies> Sleep abnormalities are common in mood disorders (e.g. decreased need for sleep in mania; insomnia & frequent awakenings in depression).> In depression, commonly observed abnormalities are decreased REM latency (i.e. the time between falling asleep and the first REM period is decreased), increased duration of the first REM period, and delayed sleep onset.# Brain Imaging> In mood disorders, brain imaging studies (CT scan/MRI scan of brain, PET scan, and SPECT) have yielded inconsistent, yet suggestive findings (e.g. ventricular dilatation, changes in blood flow and metabolism in several parts of brain, like prefrontal cortex, anterior cingulate cortex, and caudate).
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Adenylyl cyclase is a transmembrane protein, and it crosses the membrane 12 times. Ten isoforms of this enzyme have been described and each can have distinct regulatory propeies, permitting the cAMP pathway to be customized to specific tissue needs. Notably, stimulatory heterotrimeric G proteins (Gs) activate, while inhibitory heterotrimeric G proteins (Gi) inactivate adenylyl cyclase (Figure 2-28). When the appropriate ligand binds to a stimulatory receptor, a Gs a subunit activates one of the adenylyl cyclases.(Ref: Ganong&;s review of medical physiology 23rd edition Page no: 56)
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At T8 - IVC hiatus in central tendon through which IVC and few branches of Rt. phrenic nerve passes At T10 - Oesophageal opening is present through which passes: Esophagus Esophageal branch of left gastric aery Anterior and posterior vagal trunk At T12 - Aoic hiatus posterior to diaphragm formed by median arcuate ligament through which passes: Aoa Thoracic duct Azygous vein
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Ans. is 'a' i.e., 376Laws related to rapeo 375 - Define rapeo 376- Lays down the punishment for offence of rape which may extend from 7 years to life imprisonment and also fine unless the victim is his ow n w ife and is not under 12 years, if raped woman is his own wife (but not under 12 years) the imprisonment may extend to 2 year with or without fine. Whoever commits rape in custody/taking advantage of his official (public servant) position'being on management or staff of hospital/ on a pregnant women/woman<12 years/or commits gang rape shall be punished with rigorous punishment of not less than 10 years or life imprisonment and also fine. Whoever commits rape on a woman<10 years of age or incestuous rape on a woman shall be punished with death.o 376 A, B, C, D - Intercourse with his own wife living separately under a decree of separation or under any custom without her consent is punished with imprisonment upto 2 years and also fine. (376A)Intercourse (not amounting to rape) by public sen-ant (376B), superintendent or manager of remand home etc (376C) any member of management of staff of hospital (376D) with any woman in their custodyo 114A - Lays down that in prosecution for rape if W'omen alleged to have been raped states that she did not consent, the court shall presume that she did not consent. This applies to custodial and gang rape,o 228A - Prohibits disclosure of the identity of the rape victim. Whoever prints, or publishes the name of any matter which may make known the identity of a rape victim shall be punished with imprisonment extending upto 2 years.o 354 - Lays down punishment for indecent assault.
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Ans. is 'a' i.e., Calcitonin The cells of medullary carcinomas, similar to normal cells, secrete calcitonin. In some instance other hormones are secreted such as somatostatin, serotonin, and VIP. Medullary carcinoma thyroid Accounts for approximately 7% of malignant tumour of thyroid. It arises from ultimobranchial bodies (from the parafollicular C cells derived from neural crest and not from thyroid follicles). It contains amyloid stroma Familial medullary carcinoms occurs in 25% of patients (Marfanoid habitus, Amyloidosis and Hirschsprung's disease also occur in patients with familial medullary cancer). Medullary carcinoma occurs in association with (MEN) syndrome. All patients with medullary carcinoma of thyroid should be screened for RET point mutation on chromosome 10. Medullary Ca thyroid secretes calcitonin, this cause hypocalcemia. Calcitonin also acts as tumour marker. Involvement of lymph node is very common in medullary carcinoma. It is seen in 50-60% of cases.
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Ans. B: Pre senile
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Ans. is 'a' i.e., Hb < 11.5 gm/dl during 3rd trimester of pregnancy
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The rapid decline in dependency ratios has been associated with rapid economic development. Demographic bonus is the period when dependency ratio declines because of decline in feility until it stas to rise again because of increasing longevity. Ref: Park, 22nd edition pg: 446
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A variety of topical local anesthetic formulations have been developed to penetrate intact skin. EMLA, which is a eutectic mixture of 2.5% lidocaine base and 2.5% prilocaine base, is widely used for venipuncture, intravenous cannulation, skin grafting, and a range of other uses, including circumcision Ref: Miller's anesthesia-7th ed, Chapter 30.
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Ans. is 'd' i.e., More than 1 year after cure Carriers Bacilli presist in the gall bladder or kidney and are eliminated in the feces (fecal carriers) or urine (urinary carrier), respectively. The development of the carrier state is more common in women and in older age groups ( over 40 yrs) Carriers are the more frequent source of infection than cases. Urinary carriage is less frequent but more dangerous than intestinal carrier - Park PSM Urinary carrier is generally associated with some urinary lesions such as calculi or schistosomiasis. Presence of Vi antibody indicates the carrier state.
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ANSWER: (D) Medial cutaneous nerve of armREF: Schwartz 9th ed chapter 18, Bailey 25th ed page 733, Mastery of Surgery, Volume 1 edited by Josef E. Fischer, Kirby I. Bland, Mark P. Callery 5th ed Vol 1 page 323Virtually any part of brachial plexus can be injured in RND. Read following lines of Gray's anatomy.The medial cutaneous nerve of the arm is the smallest and most medial branch of the brachial plexus, and arises from the medial cord (C8, Tl). It crosses the axilla, either anterior or posterior to the axillary vein, then passes medial to the axillary vein, communicates with the intercostobrachial nerve, and descends medial to the brachial artery and basilic vein. It pierces the deep fascia at the midpoint of the upper arm to supply the skin over the medial aspect of the distal third of the upper arm. (Gray's anatomy 40th ed chapter 46)Safety or Holy layer; the layer of prevertebral fascia that covers the brachial plexus and phrenic nerve. It is advisable to stay superficial to this layer in order to avoid damage to these vital structures (Ref: Step by step Neck dissection Dr Chintamani page 5)MASTERY OF SURGERY 5TH ED VOL 1 TABLE 6 PAGE 323TYPES OF NECK DISSECTIONSDissectionLymph Node Levels RemovedNon nodal Structures RemovedIndicationsComprehensive neck dissectionsRadical/ Classical/ Crile {RND)Levels I-VSpinal accessory nerve (SAN) Internal jugular vein (IJV) Sternocleidomastoid muscle (SCM)Submandibular glandNr neck for SCC when SAN is involvedMRND type 1Levels I-VPreserves SANN+ neck for SCC when SAN is free (most commonly used for SCC of upper aerodigestive tract)MRND type 2Levels I-VPreserves SAN & SCMN+ neck for SCC when LA7 is involved but SAN is freeMRND type 3Levels I-VPreserves SAN, IJV & SCMMost commonly used for metastatic Ca of thyroidSelective neck dissectionsSupraomohyoidLevel I- IIIPreserves SAN, IJV & SCMN-ve neck SCC of oral cavity and oropharynx N-ve neck malignant melanoma anterior to earExtendedsupraomohyoidLevel I- IVPreserves SAN, IJV & SCMN-ve neck SCC of lateral tongueLateral NDLevel II- IVPreserves SAN, IJV & SCMN-ve neck SCC of Larynd & HypopharynxPosterioLateral NDLevel II- V,Suboccipital,RetroauricularPreserves SAN, IJV & SCMN-ve neck malignantmelanoma posterior to earNote:Structure preserved in RND: ICA, EC A (may be sacrificed), Brachial plexus, Hypoglossal nerve, Vagus nerve, Phrenic nerve, Facial nerve (cervical and marginal mandibular branches), Sympathetic trunkCommonest incisions in RND:Crile's incision (modified Y incision)Macfees incision (double horizontal incision) in irradiated neck.The main disability that follows the RND is weakness and drooping of the shoulder due to paralysis of the trapezius muscle as a consequence of excision of the spinal accessory nerve.
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Ans. is 'a' i.e. X-rays and Gamma-rays X-rays and gamma rays are electromagnetic waves with highest penetrating power.For deep seated tumours rays with maximum penetrating power is required so x-rays and gamma rays are used.Harrison 141h/e states - "Megavoltage X-rays are used to irradiate internal deep seated lesions since high energy penetrating beams deliver a less intense superficial dose and spares the skin".
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Ans. is 'd' i.e., Stomach * GISTs are the most common mesenchymal neoplasm of gastrointestinal tract. GIST represents a distinct group of gastrointestinal tumors that originate from the interstial cells ofcajal which control gastrointestinal peristalsis.* GISTs can occur anywhere in the gastroinstestinal tract; the most common site being the stomach followed by small intestine.
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Deficiency of Tyrosine Transaminase leads to Tyrosinemia type II
Mnemonic: T + T = II T
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Ans. is 'b' i.e., Binding of inhibitor to other site and inhibition of enzyme Some enzymes, called allosteric enzymes, posses a site, in addition to substrate binding (catalytic) site, known as the allosteric site. Binding of allosteric modulator at the allosteric site affects the conformation of catalytic site. Such enzymes are called allosteric enzymes. The allosteric modulator (regulator) may facilitate the conformational change of catalytic site, required for substrate binding. Such regulators are called allosteric activators (positive allosteric modifier); for example, fructose-2, 6-bisphosphate is an allosteric activator of Phosphofructokinase-I. Some allosteric regulators prevent the conformational change required for binding of the substrate. Such regulators are called allosteric inhibitors (negative allosteric modifier); for example, citrate is an allosteric inhibitor of phosphoructokinase-I.
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C i.e. Blood flow remains unchanged
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A i.e. Acute cholecystitis; B i.e. Mucosal thickening; C i.e. Cholesterosis
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Ans. is 'a' i.e., Autosomal dominant It is estimated that the combined incidence of mendelian inheritance (autosomal dominant, autosomal recessive, x-linked) in man is about 1% of all live born individuals. a As many as 793 autosomal dominant phenotypes. 629 autosomal recessive traits and 123 sex linked diseases have been catalogued to date.
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DIFFERENTIAL DIAGNOSIS OF NEONATAL SEIZURES
Hypoxic ischemic encephalopathy → Most common cause (60%).
Intracranial hemorrhage
Hypoglycemia
Hyponatremia
Pyridoxine deficiency
Drug withdrawal
Benign familial neonatal seizures
Infection
Hypocalcaemia, Hypomagnesaemia
Disorder of amino and organic acid metabolism, hyperammonemia
Developmental defects
No cause found
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Ans. D. Hirschsprung's diseaseAnorectal manometry should ideally be performed in all newborns with symptoms of lower bowel obstruction. This technique is useful in assessment of changes in anal pressure which are recorded during and after rectal distention. It is most helpful for diagnosing or excluding Hirschsprung's disease.
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(c) Petrositis(Ref. Cummings, 6th ed., 2165)Since the air cells of the petrous bone communicate with the mastoid, in any patient, if there is persistent ear discharge following cortical or modified radical mastoidectomy, petrositis should be ruled out by CT and MRI. Also retroorbital pain is suggestive of petrositis (due to involvement of ophthalmic division of trigeminal).Labyrinthitis per se does not lead to ear discharge once the middle ear and mastoid disease has been cleared by surgery. Moreover, in labyrinthitis there will be vertigo along with hearing loss. So this is not the complication in the given case.Latent mastoiditis or masked mastoiditis can be a consequence of inadequate medical management; but there is no question of it arising after modified radical mastoidectomy.
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ACTIONS OF ACETAZOLAMIDE: i) Lowering of intraocular tension due to decreased formation of aqueous humor (it is rich in HC03). 2) Raised level of C02 in the brain and lowering of pH - sedation and elevation of seizure threshold. 3) Alteration of C02 transpo in lungs and tissues: - used in high altitude or mountain sickness ( Essentials of Medical Pharmacology, K.D Tripathi,6th edition )
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Mc Ardle disease (Type V GSD) due to muscle phosphorylase deficiency is the most common GSD to present in adolescents & adults.
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The 1st line treatment regimens recommended by the CDC for uncomplicated infection in men and non pregnant women are Azithromycin 1gm single dose or Doxycycline 100 mg twice daily for 7 days. Ref: Kliegman, Behrman, Jenson, Stanton (2008), "Nelson Textbook of Pediatrics",; Chapter 223, "Chlamydia Trachomatis", Volume 1, Page 1285; Textbook of Medical Microbiology By Ananthnarayanan, 7th Edition, Pages 424-25; Lippincott's Microbiology, 2nd Edition, Pages 179-80; Medical Microbiology By Murray, 6th Edition, Page 446
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Radioluscent lesion with surrounded sclerosis and pain relived by a salicylate are characteristic of Osteoid osteoma Refer Maheshwari 9TH ED p 235
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It is commonly occurring bursa between the fascia lata or superficial (transverse) prepatellar aponeurosis and the intermediate (oblique) prepatellar aponeurosis formed by the medial and lateral patellar retinacular layers (extensions of the vastus tendons) anterior to the patella A synol bursa (plural bursae or bursas) is a small fluid-filled sac lined by synol membrane with an inner capillary layer of viscous synol fluid (similar in consistency to that of a raw egg white). It provides a cushion between bones and tendons and/or muscles around a joint. This helps to reduce friction between the bones and allows free movement. Bursae are found around most major joints of the body. Ref - medscape.com
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Ans. d (All of the above) (Ref. Sabiston I8,h / Table 34-17; H-17,h/Table 86-3)Endocrine-Active Agents Used in the Treatment of Breast Cancer ClassCommon examplesClinical use1Selective estrogen receptor modulators (SERMs)QTamoxifen, Raloxifene, ToremifeneAdjuvant therapy for metastatic disease2Aromatase inhibitors (AIs)Anastrozole Letrozole Exemestane Adjuvant therapy for metastatic disease3Pure antiestrogensFulvestrantSecond-line therapy for metastatic disease4LHRH agonistsGoserelin, LeuprolideAdjuvant therapy for metastatic disease5Progestational agentsMegestrolSecond-line agent for metastatic disease6AndrogensFluoxymesteroneThird-line agent for metastatic disease7High-dose estrogensDiethylstilbestrolThird-line agent for metastatic diseaseHORMONAL THERAPY FOR CARCINOMA BREASTIn patients with node-negative cancer, certain groups may suffer higher relapse rates, and the absolute benefits of chemotherapy are greater. Poor prognostic signs follow:1. Tumor size >2 cm2. Poor histologic and nuclear grade3. Absent hormone receptors4. High proliferative fraction (S phase)5. Content of certain oncogenes such as erb-B2 (HER-2/neu)Drug tamoxifen is an estrogen agonist-antagonist and currently the first-line Rx of estrogen-sensitive breast cancer.Educational PointsNew Agents for Ca breast# Trastuzumab (Herceptin) is a humanized murine monoclonal ab raised against the erb-B2 or HER-2 surface receptor.# Agents that specifically target EGFR include erlotinib and gefitinib and the monoclonal antibody cetuximab. These drugs have found most use in non-small cell lung, pancreatic, and colorectal cancer.# Dual inhibitors of both EGFR and HER-2 have been developed and are finding their way into the treatment of breast cancer (e.g., lapatinib, a dual inhibitor of both enzymes).Age GroupLymph Node StatusEndocrine Receptor (ER) StatusTumorRecommendationPremenopausalPositiveAnyAnyMultidrug chemotherapy + tamoxifen if ER-positive + trastuzumab in HER-2/neu positive tumorsPremenopausalNegativeAny>2 cm, or 1-2 cm with other poor prognostic variablesMultidrug chemotherapy + tamoxifen if ER-positive + trastuzumab in HER-2/neu positive tumorsPost-menopausalPositiveNegativeAnyMultidrug chemotherapy + trastuzumab in HER-2/neu positive tumorsPostmenopausalPositivePositiveAnyAromatase inhibitors and tamoxifen with or without chemotherapy + trastuzumab in HER-2/neu positive tumorsPostmenopausalNegativePositive>2 cm, or 1-2 cm with other poor prognostic variablesAromatase inhibitors and tamoxifen + trastuzumab in HER-2/neu positive tumorsPostmenopausal NegativeNegative>2 cm, or 1-2 cm with other poor prognostic variablesConsider multidrug chemotherapy + trastuzumab in HER-2/neu positive tumors.
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Anterior relation of the right kidney
- Right suprarenal gland
- Liver
- The second part of the duodenum
- Hepatic flexure of the colon
- Small intestine
Anterior relation of the left kidney
- Left suprarenal gland
- Spleen
- Stomach
- Pancreas
- Splenic vessels
- Splenic flexure and descending colon
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Answer is A (Inflammatory bowel disease): Enteropathic Ahis (Ahritis associated with inflammatory bowel disease) is a seronegative ahropathy that is characterized hr the absence of Rheumatoid factor. Causes of False Positive Rheumatoid factor SLE (Associated with a positive Coomb's test) Sjogren syndrome Chronic Liver disease Sarcoidosis Interstitial Pulmonary Fibrosis Infectious mononucleosis Hepatitis B (Associated with HbsAg) Tuberculosis Leprosy Syphilis (Associated with a positive VDRL) Subacute bacterial endocarditis Visceral leishmaniasis Schistosomiasis Malaria
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Periungal fibroma is not included under diagnostic criteria for NF - 1.
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Zoster or shingles occurs due to reactivation of latent VZV present in the trigeminal ganglia that occurs mainly in adult life. Rashes are unilateral and segmental, confined to the area of skin supplied by affected nerves Ref: essentials of Medical microbiology apurba sastry 1st edition page 438
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Ans. is 'a' i.e., Sporothrix schenckii(Ref: Harrison, 18th/e, 1665; Jawetz, 23rd/e, p. 633-634)Series of ulcers in a row suggests the diagnosis of sporotrichosis.
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Ans. is 'b' i.e., Rubrospinal tract [Ref: Ganong 25th/e p. 241 & 24th/ep. 239-240* Pyramidal (corticospinal) tract and extrapyramidal tracts concerned with the muscles of the trunk and proximal portion of limbs (i.e., the muscle mainly concerned with the postural control) occupy anterior white column of spinal cord and terminate in the medial ventral horn on the medial group of interneurons. These tracts are collectively called medial pathways. Medial pathways include ventral (anterior) corticospinal tract, vestibulospinal tracts, reticulospinal tract and rubrospinal tract.* On the other hand, descending tracts concerned with distal muscles of the limb (i.e., those muscles which mediate fine skilled movements) occupy lateral white column and are called lateral pathways. Lateral pathways include lateral corticospinal tract and rubrospinal tracts.* So, grouping descending fibers in lateral and medial pathways is more meaningful than grouping in pyramidal and extrapyramidal tracts.Medial pathwaysLateral pathways* Anterior (ventral) corticospinal tract* Vestibulospinal tract* Reticulospinal tract* Tectospinal tract* Lateral corticospinal tract* Rubrospinal tract
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Ans. is `b > c > a' i.e., Primaquine > Quinine > Chloroquine o Among antimalarial drugs, primaquine, quinine and occasionally chloroquine can cause hemolytic anemia in G6PD deficiency. But, primaquine has the highest potential to cause hemolytic anemia in patients with G6PD deficiency and, the patients with G6PD dificiency are highly senstive to primaquine. o The hemolytic potential in G6PD deficiency patients - Primaquine (maximum) > Quinine > Chloroquine (rare).
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Propofol produces doses-dependent respiratory depression with apnea occurring in 25% to 35% patients after induction close. The ventilator response of co2 and apnea also reduces. They are potent bronchodilator. It preserves hypoxic pulmonary vasoconstriction. Blunts upper airway reflexes
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Conversion disorder is a neurosis. There are no delusions or hallucinations in neurosis.
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Acoustic neuromas are slow-growing tumors that can eventually cause a variety of symptoms by pressing against the eighth cranial nerve. Hearing loss in one ear (the ear affected by the tumor) is the initial symptom in approximately 90 percent of patients.
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D- Xylose absorption test: Mucosal disease in Small Intestine Fecal Fat animation: Steatorrhea Breath Hydrogen test: Carbohydrate malabsorption Urine aminoaciduria: Fanconi Syndrome
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Sternocleidomastoid muscle receives its blood supply from branches of occipital and posterior auricular arteries (upper part of muscle), the superior thyroid artery or branches of the external carotid artery (middle part of muscle) and the suprascapular artery (lower part of muscle) — Gray's - 441
Although the suprascapular artery is a branch of thyrocervical trunk, it seems to be the most appropriate answer as all other options directly supply the muscle.
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Ans Ctomegaloviruys
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ANSWER: (B) Small cell cancerREF: Harrison's 18th ed chapter 89Prophylactic Cranial Irradiation:Prophylactic cranial irradiation (PCI) should be considered in all patients with LD (local disease) - and ED (extended disease)-Small cell lung cancer (SCLC) who has responded to initial therapy. A meta-analysis including 7 trials and 987 patients with LD-SCLC who had achieved a complete remission following primary chemotherapy reported a 5.4% improvement in overall survival for patients treated with PCI. In patients with ED-SCLC who had responded to first- line chemotherapy, PCI reduced the occurrence of symptomatic brain metastases and prolonged disease-free and overall survival compared to no radiation therapy. Long-term toxicides includingdeficits in cognition have been reported following PCI and are difficult to sort out from the effects of chemotherapy or normal aging.
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Large and/or small sharply defined radiolucencies may be present in the maxilla and/or mandible.
Absence of the lamina dura and ‘ground-glass’ appearance of the bone.
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All 4 phases may be seen in different parts of the same lung
Congestion (1-2 days)
Red hepatization (2nd-4th day)
Gray hepatization (5th-8th day)
Resolution (8th-9th day)
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Otolith organs (present in maculae) are concerned with linear acceleration, gravity and head tilt movements and they also help to maintain static equilibrium.
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Ans- B Ref- Clinical manifestations Due to the lack of typical symptoms and signs, early-stage breast cancer (ESBC) is often neglected by patients and typically found during physical examination or breast cancer screening. The typical signs of breast cancer, as listed below, usually occur in the more advanced stages. 2.1.1. Breast Mass About 80% of breast cancer cases were first diagnosed with breast masses. Patients often recognize their breast mass unintentionally, and the mass tends to be single and hard, with irregular margins and less smooth surface. Most breast cancers are manifested as a painless mass, and only a few had varied degrees of pain or tingling. 2.1.2. Nipple discharge Nipple discharge can be sanguineous (bloody), serous, mucinous, milky, or purulent. It can also occur half year after the termination of breastfeeding. Causes for nipple discharge vary but commonly include intraductal papilloma, breast hyperplasia, dilation of mammary duct, and breast cancer. The bloody discharge which is effused from unilateral single hole should be further examined; more attention should be paid if the nipple discharge is accompanied with breast mass. 2.1.3. Skin changes A variety of skin changes can occur in patients with breast cancer. Most commonly, the tumor invades the Cooper's ligament and then adheres to the skin, showing a "Dimple sign". When the cancer cells block the lymphatic vessels, an orange peel like texture of the skin occurs. In patients with advanced breast cancer, the cancer cells can infiltrate into the skin along the lymphatic vessels, glandular vessels, and/or fibrous tissue, and then proliferate to form satellite nodules of skin over breast. 2.1.4. Abnormalities of nipple and areola If the tumor is located deep inside nipple, it can cause the retraction of nipple. In some patients, although tumor is relatively far away from the nipple, it can invade and shrink the large ducts within the mammary gland, and thus cause the retraction or elevation of nipple. Eczematoid carcinoma of nipple, also known as Paget's disease, is clinically manifested as the itchy nipple, erosion, ulceration, crusting, scaling, which can be associated with causalgia; in addition, nipple retraction also can be found. 2.1.5. Axillary lymphadenectasis In patients with occult breast cancer, the mass usually is impalpable during physical examination, with axillary lymphadenectasis as the first symptom. The metastasis of axillary lymph node can be detected in one third or more inpatients. The ipsilateral axillary lymph node(s) may become swollen at the early stage, and some swollen lymph nodes can hard, scattered, and movable. With the progression of the disease, the lymph nodes fuse together gradually and adhere to and even fix with the skin and surrounding tissues. The metastatic lymph nodes can be palpable in the supraclavicular area or contralateral axilla in patients with advanced breast cancer. ]More on Ca Breast- TNM staging of breast cancer B.1 Primary tumor (T) The clinical and pathological definitions for the stages of primary tumors are same. If the size of a tumor is assessed during physical examination, it can be presented as T1, T2, or T3. When other measurements (such as mammography or pathology) are applied, the four subgroups of T1 can be used. The size of tumor is accurate to 0.1 cm. TX means that the tumor size cannot be assessed. T0: No evidence of primary tumor. Tis: Carcinoma in situ. Tis ductal carcinoma in situ Tis lobular carcinoma in situ Tis Paget's disease of the nipple with no associated tumor. Note: Paget's disease associated with a tumor is classified according to the size of the tumor. T1: Tumor 2.0 cm or less in greatest dimension T1mic: Microinvasion 0.1 cm or less in greatest dimension; T1a: Tumor more than 0.1 cm but not more than 0.5 cm in greatest dimension; T1b: Tumor more than 0.5 cm but not more than 1.0 cm in greatest dimension; T1c: Tumor more than 1.0 cm but not more than 2.0 cm in greatest dimension; T2: Tumor more than 2.0 cm but not more than 5.0 cm in greatest dimension; T3: Tumor more than 5.0 cm in greatest dimension; T4: Tumor of any size with direct extension to (a) chest wall or (b) skin. T4a: Extension to chest wall; T4b: Edema (including peau d'orange) or ulceration of the skin of the breast or satellite skin nodules confined to the same breast; T4c: Both of the above (T4a and T4b); T4d: Inflammatory carcinoma. B.2 Regional lymph nodes (N) Clinical NX: Regional lymph nodes cannot be assessed (e.g., previously removed); N0: No regional lymph node metastasis; N1: Metastasis to movable ipsilateral axillary lymph node(s); N2: Metastases in ipsilateral axillary lymph nodes that are clinically fixed or matted; or,metastases in clinically detected ipsilateral internal mammary nodes in the absence of clinically evident* axillary lymph node metastases. N2a: Metastases in ipsilateral axillary lymph nodes fixed to one another (matted) or to other structures. N2b: Metastases only in clinically detected ipsilateral internal mammary nodes and in the absence of clinically evident axillary lymph node metastases. N3: Metastases in ipsilateral infraclavicular lymph node(s) with or without axillary lymph node involvement; or, metastases in clinically detected ipsilateral internal mammary lymph node(s) with clinically evident* axillary lymph node metastases; or, metastases in ipsilateral supraclavicular lymph node(s) with or without axillary or internal mammary lymph node involvement. N3a: Metastases in ipsilateral infraclavicular lymph node(s). N3b: Metastases in ipsilateral internal mammary lymph node(s) and axillary lymph node(s). N3c: Metastases in ipsilateral supraclavicular lymph node(s). B.3 Distant Metastases (M) MX: Distant metastasis can not be assessed. M0: No distant metastasis M1: Distant metastasis. B.4 AJCC stage groupings
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openlifescienceai/medmcqa
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