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Ans. (b) IgM Ref. jawetz 25/e, p 130, 27/e p 98 IgM is the first antibody to be produced, after exposure to both antigen or allergin "IgM is the first antibody formed in every response" ...Medical Microbiology by BS Napoba Thogh ovaalbumin is an allergin, its initial injection would produce IgM first, then IgE. If it is injected again IgE production would be first response.
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Most sensitive → Antinuclear antibody (ANA)
Most specific → Anti-double stranded antibody and the antibody against Smith (Sm)
Associated with neonatal lupus and congenital heart block → Anti Ro, Anti LA antibody
Associated with lupus psychosis → Anti P antibody
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Astigmatism It is that condition of refraction wherein a point focus of light cannot be formed' upon the retina. It includes those anomalies in the optical system wherein an appreciable error is caused by the unequal refraction of light in different meridians. Hence it may be an error either of curvature, of centering or of refractive index. There fore this question is controversial as both the options are given. But since the commonest form of astigmatism is due to curvature defect, this will be the answer.
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Ans. is Gaucher Gaucher's o Autosomal recessive, o Deficiency of glucocerebrosidase. o Accumulation of glucosyl ceramides in cells of RES. o Spleen enlarged with S/o hypersplenism (leukopenia thrombocytopenia), o Liver enlarged, o Expansion of bone marrow. Tay sachs o Autosomal recessive, o Deficiency of hexosaminidase, o Accumulation of ganglioside GM2 in nervous system, o C/F Apathy Hypotomia Visual defect Develop mental defect o Fundus = Cherry red spot hepatosklema o Fabry o X-link recessive. o Dificiency of ceramide trihexosidase. o Accumulation of trihexose in CNS, skin, kidney. Blood vessel, heart, sweat, comea'bone marrow, o Recurrent episodes of burning pain and paresthesia, o Skin lesion, o Corneal opacity cataract, o Necrosis of femoral head, o Hyperkalemia. o Renal failure, hepatospleno megaly o.
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. <p>INFLUENZA:- Influenza viruses classified under the family ohomyxoviridae. 3 viral subtypes-A,B and C. These three are antigenically distinct.No cross immunity between them. Influenza A and B - responsible for epidemics throughout the world. Influenza A has 2 distinct surface antigens- hemagglutinin(H) and neuraminidase(N). The influenza A virus is unique among the viruses because it is frequently subjected to antigenic variation, both major and minor. ANTIGENIC SHIFT:- 1. Sudden complete or major change. 2. Results from genetic recombination of human with animal/an viruses providing a major antigenic change. 3. Can cause major epidemic/pandemic involving most/ all age groups. ANTIGENIC DRIFT:- 1. Antigenic change is gradual over a period of time. 2. Occurs due to point mutation in the gene owing to selection pressure by immunity in the host population. 3. Affected by previous antibodies. {Reference: park&;s textbook of preventive and social medicine, 23rd edition, pg no.154 }</p>
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Ans. D: Unilateral pneumonitis
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A. i.e. HHV-7
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Ans. is 'd' i.e. Cancer in opposite breast Adverse effects of Tamoxifen: - Hot flushes, nausea vomiting (most common side effects)*Menstrual irregularities, vaginal bleeding, discharge, pruritus vulvae & dermatitisEndometrial cancerThromboembolismCataractsRetinal deposits & decreased visual acuityUses of Tamoxifen: -Estrogen receptor positive breast cancer: used in both pre and postmenopausal women.May slow the development of osteoporosis in postmenopausal women (due to its estrogenic effect)
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Unstable relationships suicidal attempts & mood swings are suggestive of Borderline personality disorder.
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Sodium hypochlorite: Sodium hypochlorite a compound of chlorine is the best disinfectant for surface blood spills, with a concentration of 0.5- 5%. 0.1% Hypochlorite - To disinfect colonized/infected pt. bed in isolation room after cleaning with detergent for 10 mins. 1% Hypochlorite - For decontamination of suction jar, suction tubes, ventilator circuits, oxygen mask, nasal prongs. Blood & body fluid stained instruments and linens (spot soak for 10 min). 2% Hypochlorite - To decontaminate soiled bed pan, toilet basin, commodes for 10 mins. 10% Hypochlorite - To decontaminate large blood spill >10 ml for 15 mins.
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Robbins basic pathology 9th edition, page no:46 Platelets contain the enzyme thromboxane synthase producing thromboxane A2.
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Ans. is 'a' i.e. W.B.C. casts RememberThey have specifically asked about pyelonephritis, not urinary tract infection. There are three basic forms of urinary tract infectionPyelonephritisCystitisAsymptomatic bacteriuriapyelonephritisUrinary tract infection involving the renal parenchyma, if there is no parenchymal involvement, the condition may be termed pyelitis.cystitisIt indicates bladder involvement.asymptomatic bacteriuriaIt refers to individuals who have a positive urine culture without any manifestation of infection and occur almost exclusively in girls. Remember that casts can only be formed in the kidney. The presence of cast is specific for kidney. Casts cannot be formed from anywhere else in the urinary tractCasts are the only elements found in urinary sediments which are unique to the kidney.Thus whenever WBC casts are present in a patient suspected of having urinary tract infection it confirms pyelonephritis.According to Harrison "leucocyte casts can be detected in urine of only selected patients but the detection of these casts is pathognomic"About "Bacteria in gram stain"Bacteria in gram stain can be positive in any type of urinary tract infection whether it is pyelonephritis, cystitis, or urethritis.Presence of bacteria confirms the urinary tract infection but the exact site is detected by W.B.C. casts.Still of am not sure of the answer, because on page 251 Harrison states "The presence of bacteria suggests infection and white blood cell casts with bacteria are indicative of pyelonephritis. White blood cells and or white blood cell casts may also be seen in tubulointerstitial processes such as interstitial nephritis, S.L.E and transplant rejection"Nitrite testMore than 90% of common urinary pathogen (gram negative rods) are nitrite producing bacteria.In the presence of infection urinary nitrate is converted to nitrite which can be detected in urine.A positive nitrite test indicates infection with nitrite producing bacteria.Leucocyte esterase testA positive test is seen in presence of WBC's in urine and suggestive of pyuria.A positive leucocyte esterase test results from the presence of WBC. A negative leucocyte esterase test indicates that an infection is unlikely and that without additional evidence of urinary tract infection urine culture need not be.Once again, make it clear"Although white cell casts may be observed in other conditions they are along with other features of UT1 specific for acute pyelonephritis "'
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beriberi, may or may not be associated with hea failure and edema acute pernicious (fulminating) beriberi, in which hea failure and metabolic abnormalities predominate Wernicke encephalopathy is associated especially with alcohol and narcotic abuse ref harper 13th ed page 556
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(A) Streptobacillus moniliformis # Rat Bite Fever (RBF) is characterised by relapsing fever, rash and arthralgia occurring days or weeks after a rat bite.> Two different bacteria can cause this condition-Streptobacillus moniliformis and Spirillum minus, both of which are natural parasites of rodents.
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Ans. is 'a' i.e., Erythromycin Control of whooping cough o Control of whooping cough requires :? 1) Management of cases and contacts 2) Prevention by active immunization Cases: Erythromycin is the DOC. Alternatives are ampicillin, tetracyclin & septran. Contacts : Those who are exposed ---> 10 days erythromycin
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Ans. is 'a' i.e.. Generalised lymph adenopathy Revised WHO clinical staging of HI V,'A IDS for infants and childreno Clinical Stage 1AsymptomaticPersistent generalized Lymphadenopathyo Clinical Stage 2HepatosplenomegalyPapular pruritic eruptionsSeborrhoeic dermatitisExtensive human papilloma virus infectionExtensive molluscum contagiosumFungal nail infectionsRecurrent oral ulcerationsLineal gingival erythema (LGE)Angular cheilitisParotid enlargementHerpes zosterRecurrent or chronic RTIs (otitis media, otorrhoea, sinusitis)o Clinical Stage 3Moderate unexplained malnutrition not adequately responding to standard therapyUnexplained persistent diarrhoea (14 days or more )Unexplained persistent fever (intermittent or constant, for longer than one month)Oral candidiasis (outside neonatal period )Oral hairy leukoplakiaAcute necrotizing ulcerative gingivitis-periodontitisPulmonary TBSevere recurrent presumed bacterial pneumonia Conditions where con?rmatory diagnostic testing is necessaryChronic HIV-associated lung disease including bronchiectasisLymphoid interstitial pneumonitis (LIP)Unexplained anaemia (<8g/dl), and or neutropenia (<1000/mm3) and or thrombocytopenia (<50 000/ mm3) for more than one montho Clinical Stage 4Unexplained severe wasting or severe malnutrition not adequately responding to standard therapyPneumocystis pneumoniaRecurrent severe presumed bacterial infections (e.g. empyema, pvomyositis, bone or joint infection, meningitis, but excluding pneumonia).Chronic herpes simplex infection; (orolabial or cutaneous of more than one month's duration)Extrapulmonaiy TBKaposi's sarcomaOesophageal candidiasisCNS toxoplasmosis (outside the neonatal period)HIV encephalopathyConditions where confirmatory diagnostic testing is necessaryCMV infection (CMV retinitis or infection of organs other than liver, spleen or lymph nodes; onset at age one month or more)Extrapulmonaiy cryptococcosis including meningitisAny disseminated endemic mycosis (e.g. extrapulmonaiy' histoplasmosis, coccidiomycosis, penicilliosis)CryptosporidiosisIsosporiasisDisseminated non-tuberculous mycobacteria infectionCandida of trachea, bronch i or lungsVisceral herpes simplex infectionAcquired HIV associated rectal fistulaCerebral or B cell non-Hodgkin lymphomaProgressive multifocal leukoencephalopathy (PML)HIV-associated cardiomyopathy or HIV-associated nephropathy
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Ans. d. Ring fracture of foramen magnum with lumbar spine injury (Ref: Ready 33/e p247; Parikh's 6/4.94-4.97)"Ring fracture: This term is commonly used to signify any fracture around the foramen magnum. Technically it means a fissured fracture about 3.5 cm outside the foramen magnum at the back, involving middle ear sideways and roof of nose anteriorly. It is rare and usually requires a lot of force to produce. It results from fall from a height on feet or buttocks, sudden violent turn of head on spine, severe blow on the vertex which drives the skull downwards on the vertebral column or heavy blow directed underneath the occiput or chin. "Ring or Foramen FracturesIt is fissured fracture, which encircles the skull in such a manner that the anterior third is separated at its junction with the middle and posterior third.But usually the term is applied to a fracture, which runs at about 3 to 5 cm outside the foramen magnum at the back and sides of the skull, and passes forwards through the middle ears and roof of the nose, due to which the skull is separated from the spine.They are rare and occur after falls from a height on to the feet or buttocks.QSkull-vault fractureType of fractureDescriptionDiastatic fracture(sutural fractures)* Separation of suturesQ* Occurs only in young persons due to blow with blunt weapon or from cerebral edemaQFissured fracture* A linear fracture or crack involving the outer or inner table or both.* Fracture only involving inner table cannot be detected on X-ray. It can be detected at autopsyDepressed fracture* Caused by a heavy weapon with a small striking surface e.g., hammer* Its shape may indicate the type of weapon with which it is produced. It is therefore called as signature fractureQ.Comminuted fracture* It has stellate appearance when there is no displacement of fragments.* Also called spider web fractureQPond fracture* Occurs in children due to elasticity of their bones* Also called indented fracturesQGutter fracture* When a part of thickness of bone is removed to form a gutter e.g., glancing oblique bullet woundsQElevated fracture* Result from a blow of moderately heavy sharp edge weapon e.g., axe which elevate one end of bone above the surface while other end may dip down to injured duraQRing fracture* Any fracture around the foramen magnumQ
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Zygote first divide into blastomere, 16 cell stage is known as Morula.
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Prostatic urethra is the widest and most dilatable pa of the urethra and is concave anteriorly.
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The nymphal and adult mites do not feed on veebral host but instead exists as free living forms in the soil. It is the larva (chigger) which feed on the veebral hosts and pick up the rickettsiae. The scrub typhus is caused by R. tsutsugamushi and the true reservoir is trombiculid mite. Tetracycline is the drug of choice with the use of which the moality is nil. Ref: Park's Textbook of Preventive and Social Medicine, 19th Edition, Page 251; Harrison Textbook of Internal Medicine, 17th Edition, Page 1064; Ananthnarayan Textbook of Microbiology, 7th Edition, Page 416.
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Criteria for Diagnosis of Myeloma: Major criteria: Plasmacytomas on tissue biopsy Marrow plasmacytosis >30% plasma cells Monoclonal globulin spike on serum electrophoresis >3.5 gm/dL for immunoglobulin (Ig) G or >2.0 gm/dL for IgA; 1.0 gm/ 24 hrs of kappa or lambda light-chain excretion on urine electrophoresis in the absence of amyloidosis. Minor criteria: Marrow plasmacytosis 10-30% Monoclonal globulin spike present, but less than the levels defined above Lytic bone lesions Normal IgM The diagnosis of plasma cell myeloma is confirmed when at least one major and one minor criterion or at least three minor criteria are documented in symptomatic patients with progressive disease. The presence of features which suppos the diagnosis are anemia, hypercalcemia, azotemia, bone demineralization, or hypoalbuminemia. Ref: van Rhee F., Anaissie E., Angtuaco E., Bael T., Epstein J., Nair B., Shaughnessy J., Yaccoby S., Barlogie B. (2010). Chapter 109. Myeloma. In J.T. Prchal, K. Kaushansky, M.A. Lichtman, T.J. Kipps, U. Seligsohn (Eds),Williams Hematology, 8e.
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Nasopharyngeal carcinoma Due to obstruction of eustachian tube , there is serous otitis media and leads to hearing loss. M/C site of origin - Fossa of Rosenmuller M/C type - Squamous cell carcinoma M/C Presentation - cervical lymphadenopathy (Neck Mass)
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Ans. C. Corrosive acid poisoningGastric Lavage is contraindicated when patients havea. Corrosive substance poisoningb. Convulsion (strychnine, tetanus)c. Comad. Volatile poisons (kerosene)e. Hypothermiaf. patients at risk of gastrointestinal hemorrhage or perforation.g. aluminum phosphide poisoning
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MSH causes loss of appetite and thus agonists to this agent can be used for the treatment of obesity
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Fulminant meningococcemia (purpura fulminans or Waterhouse – Friderichsen syndrome) is the most rapidly lethal form of septic shock experienced by humans.
It differs from most other form of septic shock by the prominence of hemorrhagic skin lesions (petechiae, purpura) and the consistent development of DIC.
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A i.e. Atropine
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Ans. is 'c' i.e. Projection o Projection is a narcissistic defense mechanism.Defence mechanismsNarissistic/PsychoticImmatureNeuroticMatureo Denialo Distortiono Projectiono Blockingo Introjectiono Passive - Aggressive behavioro Acting outo Hypochondriasiso Regressiono Schizoid fantasyo Somatizationo Controllingo Displacemento Inhibitiono Extemalizationo Intellectualizationo Rationalizationo Dissociationo Reaction formationo Repressiono Sexualizationo Conversiono Undoingo Inhibition (Aim inhibition)o Asceticismo Suppressiono Altruismo Sublimationo Humoro Antipation
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Borderline ovarian tumours grade 0 tumors may demonstrate papillary tufting,stratification,epithelial atypia,exfoliation of cellular clusters,minimal mitotic activity No stromal invasion Patients have a high survival rate. runs a typical indolent course spontaneous regression of peritonial implants multiple sections examined to exclude invasion SHAW&;S TEXTBOOK OF GYNECOLOGY,Pg no:373,374,15th edition
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Ans: (c) SevofluraneRef: KDT 6th ed./373-374SEVOFLURANE* Sevoflurane is one of the inhalation (volatile liquid) anesthetic agents.* Induction and emergence of anesthesia is rapid with sevoflurane.* Absence of pungent smell makes it pleasant and administrate through face mask and is considered as anesthesia of choice in pediatric patient.* Side effect: respiratory depression and arrhythmia.PESFLURANE* Desflurane is one of the inhalation (volatile liquid) anesthetic agents.* It is fastest acting but less soluble than isoflurane.* It has the most pungent odor, which make it unsuitable for induction.* It irritates air passage, which may induce coughing, laryngeal spasm.PROPOFOL* Anesthesia of choice for day care surgery.* Short acting, action diminishes the same day.* Advantage: has anti emetic property. It is safe in porphyria.* Disadv: Causes myocardial depression and hypotension, KETAMINE* Has maximum analgesic property.* Produces dissociative anesthesia.* Induction agent of choice in asthma patient.
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Deoxyribonuclease I (DNAase I) Acts on single-stranded DNA, double-stranded DNA, and chromatin. Makes single stranded cuts in nearly any segment of DNA i.e. has low sequence specificity. Digest DNA that is not protected/not bound by protein, into its component deoxynucleotides. Used in DNA Foot Printing. E.g. (DNase I) nick the single strands of double-stranded DNA.
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When sodium fluoride solution is applied on the tooth surface as a topical agent, it reacts with the hydroxyapatite crystals in enamel to form calcium fluoride, which is the main end product of the reaction.
As a thick layer of calcium fluoride gets formed, it interferes with the further diffusion of fluoride from the topical fluoride solution to react with hydroxyapatite and blocks further entry of fluoride ions. This sudden stoppage of the entry of fluoride is termed as the "Choking off effect".
Fluoride then slowly leaches from the calcium fluoride. Thus, calcium fluoride acts as a reservoir for fluoride release.
It is for this reason that after each application of sodium fluoride onto the tooth surface, it is left to dry for 4 minutes.
Essentials of preventive and community dentistry
Soben Peter
5th edition
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Vivid hallucinations, Clouding of consciousness and Vivid hallucinations are the classic triad of symptoms of delirium tremens. The symptoms peak at 72-96 hours (3-4 days). Death occurs in 5% of the cases. Autonomic disturbance, ataxia, insomnia, poor attention span, insomnia and dehydration are also symptoms of DT. Coarse nystagmus and ophthalmoplegia are symptoms of Wenicke's enchephalopathy. Ref: A Sho Text Book of Psychiatry by Niraj Ahuja, 2006, Page 41
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Ans. is 'd' i.e., Plague o NVBDCP includes 6 vector home diseases of public health importance in India :i) Malariaii) Dengueiii) Filariaiv) Kala-azarv) Japenese encephalitisvi) Chikungunyafever
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Ans. A Lowers blood volume* Pressure diuresis lowers arterial pressure by lowering blood volume and, thereby, lowering cardiac output.* All of the other choices do lower arterial pressure, but are not caused by pressure diuresis.
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Fresh gas flow is important determinant of carbon dioxide elimination in breathing circuits.
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The inferior angle lies over the 7th rib or the 7th intercoastal space. Reference:page no:17 - vishram singh - upper limb & thorax, 2nd edition.
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Meissner corpuscles are dendrites encapsulated in connective tissue and respond to changes in texture and slow vibrations.Merkel cells are expanded dendritic endings, and they respond to sustained pressure and touch. The capsule is located relatively superficially, either in the basal epidermis (Merkel) or just below the epidermis(Meissner). Ruffini corpuscles are enlarged dendritic endings with elongated capsules, and they respond to sustained pressure. Pacinian corpuscles consist of unmyelinated dendritic endings of a sensory nerve fiber, 2 mm in diameter, encapsulated by concentric lamellae of connective tissue that give the organ the appearance of a cocktail onion. These receptors respond to deep pressure and fast vibration. Both these receptors lie deeper in the dermis and connective tissue and therefore are sensitive to stimuli applied over much larger territory. Zoster can cause some destruction of nerve fibers in the middle and lower dermis, detectable with silver-impregnation techniques.
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Some patients with hepatitis C may not respond well to treatment with interferon as expected. They are harboring genetic variation in IL28B usually. Ref: Harrison, Edition-18, Page-42
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Aspirin
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HNPCC / lynch is diagnosed bt modified emstredam eciteria.
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B i.e. Haematoidin
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Ans. is 'c' i.e., Guthrie Card
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Ans. is 'c' i.e., Complication of paial gastrectomy
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Ans. is d, i.e. All of the aboveRef: SK Chaudhary 7th/ed, p125-126,14Actions of the progesterone component of combined oral contraceptives:* Suppresses ovulation by its inhibitory action on the pituitary and the hypothalamus. This is predominantly achieved by estrogens but even by progesterone.* Causes atrophic changes in the endometrium and prevents nidation even if fertilization occurs.* Acts on the cervical mucus, making it thick and tenacious and impenetrable by sperms.The third-generation progestogens have a higher affinity for progesterone receptor and have a role in inhibiting ovulation.The main function of progestogens in combined pills is, to counteract the undesirable effects of estrogen such as endometrial hyperplasia and heavy withdrawal bleeding.
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Ans. is 'b' i.e., Glycogen storage disease type II o Hepatosplenomegaly, characteristics E.C.G. findings and coarse facies are seen in Glycogen storage Type II or pompe's ds. o Death of infant before 2 yrs of age. o Pompe's disease is caused due to absent or reduced level of acid alpha glucosidase (acid maltase) activity. o Hurler's and Hunter syndrome are mucopolysaccharidosis that presents with hepatomegaly and coarse facies, but characteristic ECG pattern of Pompe's disease clinches the diagnosis in our of Pompe's disease.
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The picture shows Anti TNF Alpha monoclonal antibodies which are used in various conditions like rheumatoid ahritis(DMARD), ulcerative colitis, Crohn&;s disease etcRef: KD Tripathi 7th ed pg 883
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The intensity of uterine contractions describes the degree of uterine systole. During pregnancy uterus is quiescent, the tone is 2-3mmHg. During the first stage of labor it varies from 8-10 mmHg, it is inversely propoional to relaxation. D.C.DUTTA'S TEXTBOOK OF OBSTETRICS,pg no:117,7th edition
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i.e. (Borrellia Recurrentis): (509-KDT 6th)Indication of Mebendazole use are* Round worm-Ascaris - lumbricoides* Hook worm-Ancylostoma duodenale, Necator americanus* Whip worm-Trichuris trichura* Thread worm-Enterobius vermicularis* Trichinella spiralis-Less effective than albondazole* Hydatid disease-Less effective than albendazole MebendazoleParasitic infections - Ascariasis, Capillariasis, eosinophilic enterocolitis, enterobiasis, hook worm, trichinellosis, trichostrongliasis, trichoriasis, visceral larva migrans (1272-H17th)Metronidazole: IndicationsMetronidazole is the drug of choice for sympathetic intestinal and extraintestinal amebiasis as well as infections with Trichomonas vaginalis and Giardia lambia. It is quickly and reliably effective against Gardnerella vaginosis.Anaeobic infections (e.g. cerebral abscesses, intra-abdominal abscesses, gynecological infections of the pelvic organs, soft tissue infections, osteomyelitis) are well documented indications. Metronidazole also has an advantageous effect on parodontopathy. Anaerobic infections of the lower respiratory tract respond better to penicillin or clindamycin. Metronidazole is sometimes more efficient than sulfasalazine for Crohn's disease, however, the tolerance of long-term administration is not established.Applied topically, metronidazole has proven effective against rosacea, acne, and foul-smelling skin lesions (tumours, decubitus ulcer).Borrelia recurrentis - causes louse-borne (epidemic) relapsing fever (1052-H17th)Treatment - Doxycycline (or another tetracycline) erythromycin or chloramphenicol highly effectiveFor children <8 years of age and for pregnant women erythromycin or Penicillin G may be preffered given the potential adverse effects of tetracyclinesTreatment of Giardiasis (*Gierdia lamblia) 1313-H17th* Drug of choice - Metronidazole, other Tinidazole, Nitazoxanide (alternative)* Drug of choice for pregnant women - Paromycin
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Ans. is 'd' i.e., Standard of living o Life expectancy at birth is a dimension of HDI (not life expectancy at one year).HUMAN DEVELOPMENT INDEX (HDDo HDI is a composite index combining indicators representing three dimensions.Components of HDIRecent (23"Ve & 22nAle of Park)Old (Previous editions)1. Longevity: - Life expectancy at birth2. Knowledey Mean years of schoolingy Expected years of schooling3. Income:-GNI per capita1. Longevity: - Life expectancy at birth2. Knowledgey Mean years of schooling (gross enrolment ratio)y Adult literacy rate3. Income: - GDP per capita
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The alveolar PO2 is found from the alveolar gas equation: PAO2 = PIO2 - PACO2/R We can assume that the inspired PO2 is the sea level normal value of 149 mm Hg. Therefore, neglecting the small correction factor, the alveolar PO2 is 149 - 20/1 or 129 mm Hg. Thus the alveolar-aerial PO2 diffusion is 129 - 90 = 39 mm Hg. The PCO2 of 20 mm Hg means that the patient is hyperventilating. The combination of the low PCO2 and low pH means that plasma bicarbonate concentration is reduced. Ref: Barrett K.E., Barman S.M., Boitano S., Brooks H.L. (2012). Chapter 35. Gas Transpo & pH. In K.E. Barrett, S.M. Barman, S. Boitano, H.L. Brooks (Eds),Ganong's Review of Medical Physiology, 24e.
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Traumatic glaucoma causes:Inflammatory glaucoma due to iridocyclitis (anterior uveitis) (D-shaped pupili)HyphemaAngle recessionSubluxation of lensTrabecular edemaGhost cell glaucomaVasomotor reactionAdherent glaucoma
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Ans. d. (To make more of L-Dopa available to cross the blood brain barrier) (Ref. KDT 6th/418.)# Carbidopa & Benserazide are peripheral Decarboxylase inhibitor.# When administrated with L-dopa, they increase peripheral half-life of L-dopa & make more of it available to cross blood brain barrier.LEVODOPA# Levodopa is rapidly absorbed from the small intestine, but its absorption depends on the rate of gastric emptying and the pH of the gastric contents.# Food will delay the appearance of levodopa in the plasma.# Plasma concentrations usually peak between 1 and 2 hours after an oral dose, and the plasma half-life is usually between 1 and 3 hours, although it varies considerably between individuals.# Unfortunately, only about 1-3% of administered levodopa actually enters the brain unaltered, the remainder being metabolized extracerebrally, predominantly by decarboxylation to dopamine, which does not penetrate the blood-brain barrier.# This means that levodopa must be given in large amounts when it is used alone.# However, when it is given in combination with a dopa decarboxylase inhibitor that does not penetrate the blood- brain barrier, the peripheral metabolism of levodopa is reduced, plasma levels of levodopa are higher, plasma half-life is longer, and more dopa is available for entry into the brain.# Indeed, concomitant administration of a peripheral dopa decarboxylase inhibitor may reduce the daily requirements of levodopa by approximately 75%.
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The mucons membrane of the cystic duct forms a series of 5-12 crescentic folds, arranged spirally to form the so called spiral valve of Heister. This is not a true valve.
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Ans. Keratoconus
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Ans. is 'a' i.e., 1-2 days Incubation periods of imoortant GIT infectionsDiseaseCausative organismIncubation periodPoliomyelitisPoliovirus7-14 daysHepatitis AEnterovirus 72 (Picomavirus)15-45 daysHepatitis BHepadnavirus45-180 daysHepatitis CHepacivirus30-120 daysHepatitis DDeltavims30-90 daysHepatitis ECalcivirus21-45 daysCholeraVibrio cholerae1-2 daysTyphoid feverSalmonella typhi10-14 daysStaphylococcal food poisoningStaphylococcus aureusl -6 hoursAscariasisAscaris lumbricoids2 monthsAncylostomiasis (Hookworm)A. duodena le5 weeks-9 monthsGuinae worm (Dracuncutiasis)Dracunculus medinensis1 year
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For easy to remember :
Sensitivity → "I know my patient has the disease. What is the chance that the test will show that my patient has it".
Specificity → "I know my patient doesn't have the disease. What is the chance that the test will show that my patient doesn't have it".
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Paget's disease of the nipple is superficial manifestation of an intraductal breast carcinoma. The malignancy spreads within the duct up to the skin of the nipple and down into the substance of the breast. It mimics eczema of nipple and areola. In Paget's disease, there is a hard nodule just underneath the areola, which later ulcerates and causes destruction of nipple. Histologically, it contains large, ovoid, clear Paget's cells with malignant features. Paget's hyperchromatic cells are located in rete pegs of epidermis containing intracellular mucopolysaccharides as clear halo in cytosol. Reference : page 533 SRB's manual of surgery 5th edition
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Norplant is implanted under the skin in the upper arm of a woman, by creating a small incision and inseing the capsules in a fanlike shape. Once inseed, the contraceptive works within 24 hours and lasts up to five years. Norplant should not be used in women with liver disease, breast cancer or blood clots. It releases levenorgestrol and failure rate is 0.1/100 women year. It inhibits ovulation.
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Young maternal age is not risk factor for placenta pre , whereas advanced maternal age is a risk factor. Risk factor for placenta Pre: Prior history of placenta pre Multifetal gestation: Due to larger placental area Maternal age: Increasing frequency with increasing maternal age Multiparity: Increasing frequency with increasing parity Cigarette smoking: Increased frequency in women who smoke (2X) Elevated prenatal screening MSAFP levels: Unexplained abnormally elevated prenatal screening levels of maternal serum alpha-fetoprotein (MSAFP) are at increased risk of pre. Ref: Williams Obstetrics 25th edition PGno: 775
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Infant is suffering from pneumococcal pneumonia (Gram positive α-hemolytic cocci).
Pneumococci is differentiated from other α hemolytic Gram positive cocci by its susceptibility to optochin and bile solubility.
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Ans. is 'b' i.e., Brochioalveolar carcinoma Bronchioloalveolar carcinoma o It is a histological type of adenocarcinoma. o It occurs in the pulmonary parenchyma in the terminal bronchioloalveolar pattern. o The tumor is almost always in the peripheral poion of the lung. o More often it occurs as multiple diffuse nodules that sometimes coalesce to produce a pneumonia - like consolidation. o The key feature of bronchioloaveolar carcinomas is their growth along preexisting structures without destruction of the alveolar architecture. This growth pattern has been termed "lepidic" an allusion to the neoplastic cells resembling butterflies sitting on a fence. o Stromal, vascular or pleural invasion is characteristically absent. o Bronchioloalveolar carcinoma consists mucin secreting bronchiolar cells, clara cells, or rarely type II pneumocytes. o These tend to have aerogenous spread and patient usually dies of suffocation (not by metastatic spread). o Bronchioloalveolar carcinoma has two subtypes ? (i) Nonmucinous --> Rare aerogenous spread and therefore amenable to surgical resection. (ii) Mucinous --> Tend to spread aerogenously, forming satellite tumors.
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In systemic capillaries pO2<CO2The decrease in O2 affinity of hemoglobin when the pH of blood falls is called the Bohr effect and is closely related to the fact that deoxygenated hemoglobin which occure in systemic capillaries. The pH of blood falls as its CO2 content increases, so that when the PCO2 rises, the curve shifts to the rightIncrease in hematocrit because of chloride shift occurs in capillariesBecause the rise in the HCO3- content of red cells is much greater than that in plasma as the blood passes through the capillaries, about 70% of the HCO3- formed in the red cells enters the plasma. The excess HCO3- leaves the red cells in exchange for Cl-.Note that for each CO2 molecule added to a red cell, there is an increase of one osmotically active paicle in the cell-- either an HCO3- or a Cl- in the red cell. Consequently, the red cells take up water and increase in size. This increase hematocritpH decreases due to the formation of HO3- anion, and H2CO3Ref: Ganong's Review of Medical Physiology Twenty-Third Edition Page No:611
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Serum ACE was studied to determine the effect of chronic lung disease upon the blood level of an enzyme believed to originate from the lungs. The assay was performed in approximately 200 control subjects and 200 patients with chronic lung disease using hippuryl-L-histidyl-L-leucine as substrate. Enzyme activity greater in male control subjects than in female subjects of comparable age and greater in children than in adults. Serum ACE was significantly reduced in patients with chronic obstructive lung disease, lung cancer, tuberculosis and cystic fibrosis, as compared to control subjects, and was even lower in those receiving coicosteroids. Of greatest interest, however, was that levels in patients with active sarcoidosis not receiving steroids were greater than 2 standard detions above the mean for the adult control subjects (greater than 11.6 units) whereas levels in patients with sarcoidosis receiving steroids and in those with resolved disease were normal. Ref - Conditions that may cause higher levels of ACE include: Sarcoidosis Primary biliary cirrhosis Alcoholic liver disease Hyperparathyroidism Hypehyroidism Diabetes Multiple myeloma Lung disease Amyloidosis Gaucher disease Leprosy
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Key Concept:
Hyoglossus muscle inserts into lateral part of tongue.
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Ceain lysyl residues are modified by lysyl oxidase, a copper-containing protein that conves e-amino groups to aldehydes. The aldehydes can either undergo an aldol condensation to form a C = C double bond or to form a Schiff base (eneimine) with the e-amino group of an unmodified lysyl residue, which is subsequently reduced to form a C - N single bond. Menkes syndrome, characterized by kinky hair and growth retardation, reflects a dietary deficiency of the copper required by lysyl oxidase, which catalyzes a key step in the formation of the covalent cross-links that strengthen collagen fibers. Ref: Harper's Illustrated Biochemistry, 30E (2015) pg no 47.
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(C) (Kidney) (681 - Ganong 23rd)Vitamin Do Vitamin D is the major vitamin involved in the absorption of calciumo Beside dietary intake, cutaneous synthesis is the other and more important source of vitamin D (cholecalciferol) in the body. The keratinocytes of stratum corneum of the epidermis of skinQ contain 7- dehydrocholesterol which is converted vitamin D3 (Cholecalciferol) by the action of sunlight (UV light),o This vitamin D3 (cholecalciferol) is converted to calcidiol (calcifediol or 25 hydroxy cholecalciferol or 25- hydroxyl vitamin D3) BY 25 hydroxylase in the liverQo Calcidiol is the major circulating form of vitamin D3o Calcidiol is then converted to Calcitriol (1-25 dihydroxy-cholecalciferol or 1-25 dihydroxy vitamin D3) BY 1-a hydroxylation in kidneyQ.o The final hydroxylation in kidney is rate limiting stepQo Calcitriol is the active form of vitamin DQo Dietary vitamin D is absorbed in ileum 0 and requires bile salts.o When Ca+2 level is high , little calcitriol is produced, and the kidney produce the relatively inactive metabolite 24, 25 dihydroxycholecalciferol insteadQ7-Dehydrocholesterol
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Ans: B (Osteopetrosis) Ref: Harrison s Principles of Internal Medicine, 18th ed & Nelson Textbook of PediatricsExplanation:OsteopeniaIt is a condition where bone mineral density is lower than normal.It is considered to be a precursor to osteoporosis.However, not every person diagnosed with osteopenia will develop osteoporosis.Technically, Osteopenia is defined as a bone mineral density T-score between -1.0 and -2.5.What is T-score?The T-score is the relevant measure when screening for osteoporosis.It is the bone mineral density (BMD. at the site when compared to the young normal reference mean.It is a comparison of a patient's BMD to that of a healthy thirty-year-old.The criteria of the World Health Organization are:Normal is a T-score of -1.0 or higherOsteopenia is defined as between -1.0 and -2.5Osteoporosis is defined as -2.5 or lower. meaning a bone density that is two and a half standard deviations below the mean of a thirty-year-old man/woman.Causes of OsteopeniaRicketsMetabolic hone diseaseOsteoporosis esp Postmenopausal womenOsteomalaciaRheumatoid arthritisAnkylosing spondylitisOsteomyelitisOsteonecrosisMultiple myelomaCoeliac disease
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Mid palmar space Infection from thumb and index finger --- thenar space Middle and ring finger--mid palmar space Little finger-- fore arm space of Parona
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Ans. is 'c' i.e., Number of daughters a newborn girl will have during life time Net reproduction rate Net reproductive rate is defined as "The no. of daughters a new born girl will bear during her lifetime assuming fixed age specific feility and moality rates" It is the only feility related statistics which also takes moality rates into consideration. NRR of one is equivalent to attaining approximately the two child norms. Goal of NRR=1 can be achieved only if atleast 60%* of the eligible couples are effectively practicing family planning.
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1-3mm/day REF: Ganong's 22' ed p. 427, Guyton 11th edition page 999 Speed of sperm is 3mm/day (Ganong) The normal motile, feile sperm are capable of flagellated movement though the fluid medium at velocities of 1 to 4 mm/min. (Guyton)
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The indications for operation are bouts of renal pain, increasing hydronephrosis, evidence of parenchymal damage and infection. Nephrectomy should be considered only when the kidney has largely lost most of its function (<10% split function). Mild cases should be followed by serial ultrasound scans and operated upon if dilatation is increasing ( ref : Bailey 27th ed , chapter 76 , pg no : - 1412 ) UPJO ( uretopelvic junction obstruction ) may not become apparent until middle age or later . Occasionally, if the patient is asymptomatic and the physiologic significance of the obstruction seems indeterminate, careful observation with serial follow-up renal scans is appropriate. ( ref :- Campbell-Walsh urology 11th ed , chapter 49 , pg no 1408 )
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Answer- D. 17ERBB2, a known proto-oncogene, located at the long arm of human chromosome 17 (17q12)HER2 is a member of the human epidermal growth factor receptor (HER/EGFR/ERBB) which is plasma membrane-bound receptor tyrosine kinase.
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SCFE Males are more commonly affected Commonly occurs during adolescence- presents with pain, antalgic limp, with the affected side held in a position of increased external rotation A classical sign is tendency of thigh to rotate in to progressively more external rotation, as the affected hip is flexed called as Axis detion. Cause - Endocrinopathies(Hypothyroidism) and Growth spu IOC - MRI
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Ans. is 'b' i.e., Prussian blueo Fontana-Masson method : most commonly used. It relies upon the melanin granules to reduce ammoniacal silver nitrate.o Ped's iron stain/Prussian blue method : It is the classic method for demonstrating iron in tissues. The section is treated with dilute hydrochloric acid to release ferric ions from binding proteins. These ions then react with potassium ferrocyanide to produce an insoluble blue compound (the Prussian blue reaction).o Masson trichrome stain : It helps to highlight the suppoing collagenous stroma in sections from a variety of organs.o Congo red : It stains amyloid in the tissue.
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B i.e. Tetracaine
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Ans. is 'c' i.e., Nephrotoxicity
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Luteinising Hormone LH is a water-soluble glycoprotein of high molecular weight secreted by beta cells of the anterior pituitary gland LH surge initiated by estrogen lasts for 48 h. LH level doubles up in 2 hrs and peak plateaus for 14 hours before declining. Minimum of 75 ng/ml is required for ovulation Ref: Shaw's Textbook of Gynaecology, 16th edition, page no: 39
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Ans. A. Waldenstrom macroglobulinemiaExplanationMYD88L 265P is expressed in 90 to 95% of WM cases when more sensitive allele-specific PCR has been employed.Waldenstrom's macroglobulinemia (WM):It is a IgM-secreting lymphoplasmacytic lymphoma (LPL).Clinical manifestations:Cytopenia resulting from bone marrow infiltration by lymphoplasmacytic cells,Paraprotein-related cryoglobulinemia,The cold agglutinin syndrome,Demyelinating neuropathySymptomatic hyperviscosity.Oncogenic basis: not been defined.Familial clustering of Waldenstrom's macroglobulinemia and other B-cell disorders suggests that genetic factors play a role in certain patients.IgM monoclonal gammopathy of unknown significance (MGUS) is characterized by the presence of a monoclonal IgM protein and the absence of bone marrow disease involvement on histologic examination. IgM MGUS can progress to Waldenstrom's macroglobulinemia or other B-cell lymphoproliferative disordersMYD88 L265P is a commonly recurring mutation in patients with Waldenstrom's macroglobulinemia that can be useful in differentiating Waldenstrom's macroglobulinemia and non-IgM LPL from B-cell disorders that have some of the same features.
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Ans. Micropsia
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Ans. is 'b' i.e., Local recurrence is common after excision
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The natural cycles of JE vrirus are:-
a. Pig → Mosquito → Pig
b. Ardeid bird → Mosquito → Ardeid bird
Japanese encephalitis
Caused by a group B arbovirus (flavivirus)
It is a Zoonotic disease i.e., infecting mainly animals and incidentally man.
In the south, epidemics have occurred in Karnataka, Andhra Pradesh. Tamil Nadu, and Kerala.
Vector → mosquito (Culex tritaeniorhynchus) that breeds in rice fields.
Hosts
Pigs → Amplifiers
Cattle and buffalos → Mosquito attractants
Man → Incidental dead-end host
Herons → Reservoir hosts
Cycles
a. Pig → Mosquito → Pig
b. Ardeid bird → Mosquito → Ardeid bird
Incubation period → 5-35 days.
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Answer is D (Bronchopulmonary Aspergillosis) Bronehoptilmoi.ary Aspergillosis has not been mentioned as a cause for pneumothorax. Aificial ventilation is an established cause for iatrogenic pneumothorax while Marfan's syndrome and Eosinophilic granuloma are established causes for secondary spontaneous pneumothorax.
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FREE RADICAL SCAVENGING SYSTEM
Antioxidants fall into two classes:
Preventive antioxidants, which reduced the rate of chain initiation.
They are Glutathione Peroxidase, Catalase.
Chain-breaking antioxidants, which interfere with chain propagation.
They are Superoxide Dismutase, Uric Acid, Vitamin E.
Reference- Review of biochemistry Rebecca James Perumcheril Pg-412
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Fracture Thoracic spine is most commonly seen spinal injury . It is usually due to hyperflexion injuries due to rapid deceleration when the aircraft strikes the ground. Most of the aircraft accidents occur on landing (35 %) or take off (35 %)
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Ans. is 'd' i.e., Phenobarbitone Theophylline poisoning Theophylline has a narrow margine of safety. Dose dependent toxicity stas from the upper pa of therapeutic concentration range. Adverse effects are primarily referable to the GIT, CNS and CVS. Children are more liable to develop CNS toxicity. Treatment Prophylactic administration of diazepam in combination with phenytoin or phenobarbital. - Goodman & Gilman Ilth/e - 729 Lidocaine may be used for ventricular arrhythmia. Seizures refractory to anticonvulsant therapy, sometimes requiring general anaesthesia.
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Ans. (d) MRI(Ref Schwart 10th edition Page 527)* Mammography - IOC for women >35 years* Mammography - IOC for Screening purpose* MRI- IOC for screening in High risk Women* Mammography - IOC for detecting Ductal carcinoma In-situ lesions* Mammography - IOC to detect Micro calcifications (Which is the only feature for DCIS)* USG - IOC for women <35 years* MRI - IOC for Implanted breasts* MRI - IOC for doing Breast Conservative surgery in Cancer breast* MRI - IOC for Scarred breast* PET scan - IOC for detecting local and distant recurrences
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Thornwaldt's disease or Pharyngeal bursitis is an infection of pharyngeal bursa located in the midline of the posterior wall of the nasopharynx. Ref: Textbook of ENT, Dhingra; 6th edition; Pg no: 245 ref img
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Suicide is the most common cause of premature death. Around 20-50% of patients with schizophrenia attempt suicide and around 5-10% of patients with schizophrenia commit suicide. If you have to chose a single figure, the best answer would be 10% of patients with schizophrenia commit suicide. The most impoant factor for suicide in schizophrenia is the presence of a major depressive episode.
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Although the DCT is the shoest segment of the nephron, spanning only about 5 mm in length in humans (1), it plays a critical role in a variety of homeostatic processes, including sodium chloride reabsorption, potassium secretion, and calcium and magnesium handling Ref: guyton and hall textbook of medical physiology 12 edition page number:460,461,462
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There is no cailage between tragus and crus of the helix and an incision made in this area will not cut through the cailage and is used for the endaural approach in surgery of external auditory canal and mastoid. Reference: Dhingra 6th edition; page no 2
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A bicyclist directly lands on his perineum leading to spongy urethrs / Bulbar urethral injury.
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Pancreas divisum occurs when the embryologic ventral and dorsal pancreatic anlagen fail to fuse, so pancreatic drainage is mainly through the accessory papilla. It is the most common congenital anatomic variant of the human pancreas. Reference: Harrisons Principles of Internal Medicine, 18th Edition
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Chronic poisoning called 'Iodism' can occur due to prolonged use of iodine salts. The common clinical features of iodism are metallic taste, anorexia, parotid swellings sometimes referred to as iodide mumps, lymphadenopathy, rhinorrhoea, stomatitis, and conjunctivitis.RK Sharma concise textbook of forensic medicine 3e pg: 243
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Ans. is 'a' i.e., No cause of death is found on gross as well as histopathological examination Types of autopsy1) Normal autopsy - cause is apparent from gross examination2) Defective autopsy - cause was ascertainable, but was not ascertained due to constrains on the part of doctor, hospital, facilities etc3) Obscure autopsy - gross findings are minimal, indecisive or obscure, as in adrenal insufficiency, anesthetic overdose, myxedema, rare plant poisons, thyrotoxicosis etc. subsequent examination like histology, microbiology, toxicology or serology reveal the cause.4) Negative autopsy / inconclusive autopsy - Cause is not clear from gross as well as subsequent examinations.
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Ans. is 'a' i.e., Radiation
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Posterior communicating aery is a branch of the cerebral pa of the internal carotid aery. The cerebral pa lies at the base of the brain.
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Ans. C. Gouta. Acute gout causing swelling, erythema and extreme pain and tenderness of the first metatarsophalangeal joint.b. This is also known as Podagra- Colchicine and indomethacin are the drug of choice in this acute attack.
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A i.e. Autosomal dominant disorder Autosomal dominant disease cannot occur in offspring of an unaffected individuals. Because the allele is dominant it will always express phenotypically (clinically) and hence both parents can't be normal in autosomal dominant disorders even if they have a single abnormal gene.
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