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Ans. is 'd' i.e., Co poisoning o Hypoxia is a state in which tissues suffer from oxygen deficiency, i.e., O2 deficiency at tissue level. Depending on the cause it is generally divided into four categories: -1) Hypoxic hypoxia# If hypoxia is due to a decrease in oxygen supply, it is called hypoxic hypoxia.# There is a fall in PO2 of arterial blood and there is low O2 content.# Hypoxic hypoxia is the most common type of hypoxia.# Hypoxic hypoxia is seen in hypoventilation (e.g., in restrictive lung diseases, COPD etc), reduced oxygen diffusion capacity of lung, high altitude, V/Q mismatch and right to left shunt (e.g., cyanotic CHD or AV malformation).2) Anemic hypoxia# If hypoxia is due to a decrease in the oxygen carrying capacity of blood, it is called anemic hypoxia. Since almost the entire oxygen transported by blood is in combination with hemoglobin, the oxygen carrying capacity of blood is reduced in anemia; hence the term anaemic hypoxia.# The O2 content of blood is low despite normal PO2. This is due to low oxygen saturation of hemoglobin.# Similar situation also arises in carbon monoxide poisoning because carbon monoxide has a much greater affinity for hemoglobin than oxygen. In carbon monoxide poisoning, carbon monoxide uses up the hemoglobin by combining with it, thereby leaving very little hemoglobin for combining with oxygen. Therefore the situation is similar to anemia where the hemoglobin level of blood is low. That is why the hypoxia produced by CO poisoning is also called anaemic hypoxia.# As PO2 is normal, respiration is not stimulated by anemic hypoxia. This is because peripheral chemoreceptos are sensitive only to PO2.3) Stagnant hypoxia (Hypoperfusion hypoxia)# This type of hypoxia occurs because of sluggish blood flow, e.g., in CHF or circulatory shock.# In the arterial blood PO2 and oxygen content are normal. However, the volume of blood flow in the tissues per minute is reduced.# The venous blood contains larger amount of deoxygenated hemoglobin, because of greater O2 extraction, as blood stays in the capillaries for a longer time than normal due to sluggish blood flow.# Therefore, cyanosis is a prominent feature. Arterio-venous O2 difference (A-V O2 difference) is maximum in stagnant hypoxia.4) Histotoxic hypoxia# This type of hypoxia results because the tissues are unable to use the oxygen brought to them by blood, i.e., tissues suffer from hypoxia despite an adequate delivery of O2.# Arterial blood PO2 and oxygen content are normal.# The best example of histotoxic hypoxia is cyanide poisoning which inhibits cytochrome oxidase. Therefore, O2 cannot be utilized by tissues due to inhibition of oxidative metabolism. In Histotoxic hypoxia (e.g, cyanide poisoning), A-V O2 difference is markedly reduced and it may be zero.
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"MRI or CT scans are often unable to distinguish radiation necrosis from recurrent tumor, but PET or SPECT scans may demonstrate that glucose metabolism is increased in tumor tissue but decreased in radiation necrosis."
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A i.e. Cytomegalovirus Ocular Involvement In AIDS Earliest & most consistent finding of HIV retinopathy is cotton wool spots Q In AIDS most common ocular infection is CMV chorioretinitisQ Cotton wool spots are most common ophthalmoscopic finding in CMV infection in AIDS. M.C. cause of chorioretinitis is CMVQ (mostly < 50 cells/mm3 CD4 cell count) Treatment of CMV retinitis is Ganyclovir & FoscanetQ M.C. ocular neoplasm is Kaposi sarcoma M.C. ocular lesion is microvasculopathy involving conjunctiva & retina.
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Ans is'b' i.e. 1 hour before UVA Psoralens (mostly 8- MOP) is given orally 1-3 hours (average 2 hours) before exposure to UVA.
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Carcinoma cervix
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D i.e. It contains Apo-B4LDL has highest cholesterol and cholesteryl ester contentQ and possesses only apo B-100 as their major apoproteinQ. Its primary function is to provide cholesterol (whether dietary or endogenous) to peripheral (extrhepatic) tissueQ. So it is most potent atherogenic lipoprotein, increasing the risk of cardiovascular diseaseQ and showing a positive correlation between the incidence and plasma concentration of LDL cholesterol.
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Physiological Actions of GlucagonGlucagon is the most potent hyperglycemic hormone. It is anti-insulin in nature. Therefore, the net effect is decided by the insulin-glucagon ratio (Fig.24.8).Glucagon is mainly glycogenolytic. The active form of glycogen phosphorylase has formed under the influence of glucagon. Liver is the primary target for the glycogenolytic effect of glucagon.It depresses glycogen synthesis.Gluconeogenesis is ored by glucagon by inducing enzymes like PEPCK, glucose-6-phosphatase, and fructose-1,6-bisphosphatase.Glucagon increases plasma free fatty acid level. In adipose tissue glucagon ors beta-oxidation, as it activates carnitine acyltransferase. The mitochondrial acetyl CoA level increasesKetogenesis is ored.Ref: DM Vasudevan - Textbook of Biochemistry, 6th edition, page no: 284-285
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(A) Culex mosquito# West Nile virus (or WNV) is a virus of the family Flaviviridae. Part of the Japanese encephalitis (JE) antigenic complex of viruses, it is found in both tropical and temperate regions. It mainly infects birds, but is known to infect humans, horses, dogs, cats, bats, chipmunks, skunks, squirrels, and domestic rabbits. The main route of human infection is through the bite of an infected mosquito.> Transmission The proboscis of an Aedes albopictus mosquito feeding on human blood. Under experimental conditions, the Aedes albopictus mosquito (also known as the Asian Tiger Mosquito) has been found to be a vector of West Nile Virus. The virus is transmitted through mosquito vectors, which bite and infect birds. The birds are amplifying hosts, developing sufficient viral levels to transmit the infection to other biting mosquitoes which go on to infect other birds (in the Western hemisphere the American robin and the American crow are the most common carriers) and also humans. The infected mosquito species vary according to geographical area; in the US Culex pipiens (Eastern US), Culex tarsalis (Midwest and West), and Culex quinque- fasciatus (Southeast) are the main sources
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About three fourths of world's population lives in the developing countries.
95% of growth of population is occurring in developing countries.
China is most populous country in the world.
India is 2nd most populous country in the world (17.5% of world's population).
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Ans. (c) Tail of pancreasRef: Sabiston 20th edition Page 952Passaro triangle* 70-90% Gastrinomas are located in this triangle
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He is showing features of cystoid macular edema. Cystoid macular edema refers to a condition in which there is fluid accumulation in honeycomb like spaces of the outer plexiform and inner nuclear layers. Fluorescein angiography done shows leakage of fluorescein dye from the perifoveal retinal capillaries and peripapillary region, and accumulating in a flower-petal pattern around the fovea. It most frequent occur following cataract surgery, especially if the surgery was complicated or prolonged. It usually manifests at 4-12 weeks postoperatively. Ref: Fletcher E.C., Chong N., Augsburger J.J., Correa Z.M. (2011). Chapter 10. Retina. In P. Riordan-Eva, E.T. Cunningham, Jr. (Eds), Vaughan & Asbury's General Ophthalmology, 18e
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Ref Harrison 19 th ed pg 1454 ,1505 The most commonest cause of acute cor pulmonale is pulmonary thromboembolism. The most common cause of chronic cor pulmonale is COPD.
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The most convenient form is a combination of a -0.5D sphere with a + 1.0D cylinder which has an effective strength of + 0.5D cylinder in one meridian and -0.5D in other.
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Ans. (a) Contrast CTRef: Bailey 26th ed. /192, 1121* CECT can be used to assess the severity of acute pancreatitis and to estimate the prognosis. Balthazar et al developed a grading system in which patients with acute pancreatitis are classified into one of the following 5 grades:# Grade A - Normal-appearing pancreas# Grade B - Focal or diffuse enlargement of the pancreas# Grade C - Pancreatic gland abnormalities associated with peri-pancreatic fat infiltration# Grade D - A single fluid collection# Grade E - Two or more fluid collections
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The citric acid cycle is not only a pathway for oxidation of two carbon units, but is also a major pathway for interconversion of metabolites arising from transamination and deamination of amino acids, and providing the substrates for amino acid synthesis by transamination, as well as for gluconeogenesis and fatty acid synthesis. Because it functions in both oxidative and synthetic processes, it is amphibolic. Reference: Harper; 30th edition; Page no: 164
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Duct ectasia is the dilatation of lactiferous duct due to muscukar relaxation of duct wall with periductal mstitis. C/f:greenish discharge from nippleindurated mass under areolaslit like retravtion of nipple,may present as mastalgia. Treatment is cessation of smokingantibioticscone excisionof invilved duct-Hadfields operation. SRB's Manual of Surgery.Edition -5. Pg no:525
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Ans. Diabetes mellitus
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1. Key points towards diagnosis: - Recurrent rhinitis, nasal discharge, bilateral nasal blockade. - H/O asthma and allergy - Hyphae with dichotomous branching at 45 degree 2. All points goes towards Aspergillus infection. - Most common type of fungal infection of nose and paranasal sinuses are due to aspergillus. - Aspergillus has septate hyphae that branch typically at 45 degree (V shaped). 3. Hyphae with dichotomous branching at 45 degree in Gomori Methenamine Silver stain: -Broad aseptate hyaline hyphae with wide angle branching seen in members of Zygomycetes.i.e rhizopus and mucor - Candida: GPOBYC (gram positive oval budding yeast cell) with pseudohyphae.
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Ans. is 'b' i.e. 5 HTIB/ID Triptans are new class of antimigrane drugs that act by safe actively activating serotonin receptor (5-HT IB/ID)Serotonin (5 Hydroxytryptamine (5 HT)) is a potent depolarizer of nerve endings and mediates various physiological action in the body. But serotonin has no application as drug. However several drugs act on various receptor subtypes of serotonin and are effective in various diseases.Serotonin mediates its action through following receptors:5-HT15 HT1A5HTIb/Id,5HT2A5-HT35-HT4The Triptans act on 5 HTIB/m receptor of the serotoninThe 5-HT] receptor is localized to the brain and is classified into two types 5HT1a - present in raphe nuclei 5HTib/id - constricts cranial blood vesselsTriptans are selective activators of 5-HTIB/ID receptor.The selective activation of 5HT1B/1D receptor results in vasoconstriction of cranial vessels. This relieves migraine as migraine is believed to be caused by the dilatation of extracerebral cranial blood flow.Dilation of blood vessels during migraine attack is believed to divert blood away from the brain parenchyma.Triptans also inhibit the release of vasodilating peptides and antiseizure agents.Sumatriptan and its congeners are currently the first line therapy for acute severe migraine attacks in most patients.The efficacy of Triptan 5-HT1B/1D agonist in migraine is equal to or greater than that of other acute drug treatments e.g. alkaloid.More on triptans * All these drugs are given orally.They are contraindicated in patients with coronary artery disease because they can cause coronary vasospasm (chest discomfort occurs in 1-5% of patients).Although the pharmacological mechanism of the Triptans is similar, their pharmacokinetic properties are distinct:Bioavailability of Triptan ranges from 14% sumatriptan to 74% naratriptan.Half life of ranges from 2 hours for sumatriptan to 25 hours for rovatriptan.
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ANSWER: (C) ECTREF: Kaplan synopsis 10th ed p. 557ECT is therapy of choice depression with:Suicidal tendencyPsychomotor retardationPsychotic and delusional features with somatic syndromeIntolerance , contraindication, refractory to drugs
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Dental flourosis is the main cause of mottling of dental enamel.decreased.flourine causes dental cariesREF.PARK'S TEXTBOOK OF PREVENTIVE AND SOCIAL MEDICINE.Editon-21.Page no.-595)
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Ans. is 'a' i.e., Renal cell carcinoma Hematuria without other symptoms (silent hematuria) must be regarded as a symptom of tumor of the bladder or kidney until proved otherwise." - Smith's Urology Among the given causes Renal Cell Carcinoma & Wilm's tumor, both can cause gross, painless hematuria. RCC being a much more common cause is the option of choice.
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Paranasal sinuses develop as outpouchings from the mucous membrane of a lateral wall of the nose.
The growth of sinuses continues during childhood and into early adult life.
Radiologically maxillary sinuses can be identified at 4-5 months, ethmoids at 1 year, sphenoid at 4 years and frontals at 6 years.
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Acute pericarditis is characterised by PR segment depression
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RBC can utilise only glucose even during fasting / starvation.
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Granuloma with necrosis
TB → caseous necrosis
Syphilis → caseous necrosis
Coccidiodomycosis → caseous necrosis
Histoplasmosis → caseous necrosis
Wegner’s granulomatosis – Non-caseous necrosis
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Supernumerary teeth are those which are additional or in excess of the normal number. The most common site is upper incisor. Ref: K.S.Narayan Reddy's synopsis of Forensic Medicine and Toxicology 29 th edition Chapter 4,page- 59.
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- Oxygen level in aerial blood is given as 20ml / 100ml of blood. - Oxygen level in venous blood is given as 16ml / 100ml of blood. - O2 consumption = 300 ml / min - for entire blood volume (i.e given in liters)- By Fick's formula,
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Ans. B i.e. Ulnar nerveWhen the ulnar nerve compression occurs at the elbow, it is called "cubital tunnel syndrome."
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The facilities is not effective at the given particular treatment centers.
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Ans. is b' i.e., OCPs predispose Fibromuscular dvsplasia It is focal irregular thickening of the walls of medium and large muscular aeries, including renal, carotid, splanchnic, and veebral vessels. Segments of vessel wall are focally thickened by a combination of irregular medial and intitnal hyperplasia and fibrosis, causing luminal stenosis. In renal vessels, it may cause renovascular hypeension. Aneurysm may develop in the vessel segment with attenuated media, and can rupture in some cases. There is no association with use of oral contraceptives or sex hormone abnormalities.
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Ans. is 'c' i.e., 16%
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Retroviral protease Inhibitors (Pis) An aspaic protease enzyme encoded by HIV is involved in the production of structural proteins and enzymes (including reverse transcriptase) of the virus. The large viral polyprotein is broken into various functional components by this enzyme. This protease acts at a late step in HIV replication, i.e. maturation of the new virus paicles when the RNA genome acquires the core proteins and enzymes. Five protease inhibitors-Indinavir (IDV), Nelfinavir (NFV), Saquinavir (SQV), Ritonavir (V) and Lopinavir (in combination with ritonavir LPV /r) have been marketed in India for use against HIV. They bind to the protease molecule, interfere with its cleaving function, and are more effective viral inhibitors than AZT. Because they act at a late step of viral cycle, they are effective in both newly and chronically infected cells. Under their influence, HIV-infected cells produce immature noninfectious viral progeny-hence prevent fuher rounds of infection. Saquinavir: Two types of formulations (hard gel and soft gel capsules) with differing, but low oral bioavailability have been produced. The tablet load is large and side effects are frequent; photosensitivity can occur. It is a weak inhibitor of CYP3A4. ESSENTIALS OF MEDICAL PHARMACOLOGY K.D.TRIPATHI SIXTH EDITION PAGE NO:772
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Ans. c (7). (Ref. Harrisons Medicine, 18th/735)LIGNOCAINE# Maximum safest dose 3 mg/kg or 200 mg and with adrenaline 7 mg/kg or 500 mg.# Duration of effect 45 to 60 min and with adrenaline it is 2-3 hours.# Should not be given in patients with history of malignant hyperthermia.# Concentration usedo Surface topical analgesia- 4%o As jelly, for urethra- 2%o Nerve blocks/epidural/infiltration block-- 1-2%o Spinal- 5%# Lignocaine is an amide# It is 4 times less potent than bupivacaine# Drug of choice for lignocaine-induced arrhythmia is bretylium tosylate (SGPGI 2002)# Repeated doses of 4-5 mL of 0.5% bupivacaine or 1% lignocaine are used to maintain epidural analgesia.# 'Transient neurological symptoms' is an disntinct side-effect of LignocaineEducational point:The baricity of the local anesthetic solution. Baricity is defined by the ratio of the density of the local anesthetic solution to the density of CSF. A solution with a ratio > 1 is hyperbaric and tends to sink with gravity within the CSF. An isobaric solution has a baricity of 1 and tends to remain in the immediate area of injection. A ratio < 1 is a hypobaric solution, which rises in the CSF.
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AKT1 is a member of the serine-threonine kinase class that plays a key role in cellular processes, including growth, proliferation, survival, and angiogenesis. It is a downstream mediator of phosphatidylinositol 3-kinase which, along with AKT1, is a key mediator of proliferation and survival pathways frequently activated in cancer .The single hotspot mutation AKT1 has been described in several cancers, with the highest incidence observed in breast cancer.
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Ans. is 'a' i.e., Cytokeratin; 'b' i.e., S-100 & 'c' i.e, Vimentin o Immunohistochemisny: these tumors have spindle cells which are positive for vimentin and epithelial components positive for cytokeratin. More recently, molecular diagnostic studies have identitied a unique translocation, t (X;18), producing SYT/SSX1 or - SSX2 fusion genes. S-100 staining may give positive results.
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Answer is C (Desmopressin) : Desmopressin has no role in the management of SIADH. In Acute SIADH, the keystone of treatment is to restrict total fluid intake to less than the sum total of insensible losses and urinary output. If more rapid correction of hyponatremia is desired, the fluid restriction can be supplemented by intravenous infusion of hypeonic saline. In chronic SIADH, the hyponatremia can be minimized by treatment with demeclocycline or fludrocoisone.
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Closed head injuries may result in cerebral concussion from depression of the reticular formation of the brainstem. This type of injury is usually reversible. Local bleeding and swelling (intracranial or extracranial) produce an increase in the intracranial pressure. A characteristic symptom pattern occurs initiated by progressive depression of mental status. Increasing intracranial pressure tends to displace brain tissue away from the source of the pressure; if the pressure is sufficient, herniation of the uncal process through the tentorium cerebri occurs. Pupillary dilation is caused by compression of the ipsilateral oculomotor nerve and its parasympathetic fibers. If the pressure is not relieved, the contralateral oculomotor nerve will become involved and, ultimately, the brainstem will herniate through the foramen magnum and cause death. Hypeension and bradycardia are preterminal events. Emergency measures to reduce intracranial pressure while preparing for localization of the clot or for a craniotomy or both include hyperventilation, dexamethasone (Decadron), and mannitol infusion. Of these, hyperventilation produces the most rapid decrease in brain swelling.
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Lateral medullary syndrome also known as Wallenberg syndrome. Lateral medullary ischemia d/o ipsilateral veebral aery (in most cases) or PICA(in few cases) I/L Horner's + I/L sensory alternation of pain and temp on face (V nerve nucleus involvement) I/L Cerebellar ataxia (involvement of inferior cerebellar peduncle) C/L Alternation of pain and temp on body (Spinothalamic tract involvement) I/L Loss of taste (involvement of Nucleus tractus solitarious) Difficulty in speech and swallowing (involvement of Nucleus ambiguus)
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"Inferior (downward/subglenoid) dislocation of shoulder is known as luxatio erecta". Inferior dislocation of shoulder It is caused by severe hyper abduction force. With the humerus as the lever and acromion as fulcrum, the humeral head is lifted across the inferior rim of the glenoid socket and pokes into axilla (subglenoid position). It is rare and also called luxatio erecta because the humeral head is subluxated (dislocated anteriorly and humerus shaft points upwards (erected). The staing picture of a patient with his/her arm locked in almost full abduction/ elevation, should make the diagnosis quite easy. The patient comes with his/her arm fixed almost by the side of the head. Potentially serious consequences e.g. neurovascular damage is quite common. It is reduced by pulling upward in the line of abducted arm with counteraction downwards. Ref: Rockwood and Green's Fractures in Adult 6/e, Page 1287.
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Deposition of circulating immune complexes. Type III hypersensitivity reactions are characterized by immune complex deposition, complement fixation, and localized inflammation. Antibody directed against either a circulating antigen or an antigen that is deposited in a tissue can give rise to a type III response. Diseases that seem to be most clearly attributable to the deposition of immune complexes are systemic lupus erythematosus, rheumatoid arthritis, and varieties of glomerulonephritis. Streptococcal infection in this case led to the deposition of antigens and antibodies in glomerular basement membranes, resulting in clinical features of nephritic syndrome (e.g., hematuria, oliguria, and hypertension). Post-streptococcal illnesses do not include any of the other choices.Diagnosis: Postinfectious glomerulonephritis
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Indications of Induction of Labour
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Answer is C (Mental retardation):
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B i.e. Back side
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Trytophan is an essential amino acid and is precursor of Serotonin, Melatonin & Niacin.Clinical effects of Serotonin or 5Htase: Symptoms occur due to effect on smooth muscle. Cutaneous vasomotor episodes of flushing.- Potent vasoconstriction.- Chronic diarrhoeaRespiratory distress & bronchospasm.Albinism accompanies defective melanine, product of tyrosine biosynthesis
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* The mitral valve is the most commonly and severely affected valve in chronic rheumatic disease. * Chronic rheumatic valvulitis is characterized by irregular thickening and calcification of the leaflets, with fusion of the commissures and chordae tendineae -the valve orifice becomes reduced to a "fish mouth" or "buttonhole"stenosis *The pressure in the left atrium rises and is transmitted the pulmonary veins to the pulmonary vasculature. -Image shows Rheumatic vegetation on mitral valve in chronic rheumatic disease -Image shows "fish mouth" or "buttonhole"stenosis * In cases of aoic insufficiency or stenosis, the left atrium is initially protected by closure of the mitral valve. The other choices are not associated with atrial enlargement or pulmonary edema.
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CO2 is the major green house gas
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8 weeks
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Ans. (b) B-cells(Ref: Robbins 9th/pg 191; 8th/pg 187)B-cells have IgM and IgG on the surface of cells, which are used to identify them
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Prostate has 3 zones
a) Central zone
b) Transition zone - BPH
c) Peripheral zone - Carcinomas.
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The tumors are serous papillary cystadenocarcinomas of the ovaries. These tumors express CA-125 and are apparently derived from the surface epithelium of the ovaries. Alpha-fetoprotein is not produced by this type of ovarian tumor, but can be produced by testicular tumors, and less commonly, by ovarian tumors with a yolk sac tumor component. Bombesin is a marker for neuroblastoma, small cell carcinoma, gastric carcinoma, and pancreatic carcinoma. PSA is a marker for prostatic carcinoma. Ref: Hoffman B.L., Schorge J.O., Schaffer J.I., Halvorson L.M., Bradshaw K.D., Cunningham F.G., Calver L.E. (2012). Chapter 35. Epithelial Ovarian Cancer. In B.L. Hoffman, J.O. Schorge, J.I. Schaffer, L.M. Halvorson, K.D. Bradshaw, F.G. Cunningham, L.E. Calver (Eds), Williams Gynecology, 2e.
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D i.e. Tetra hydrocannabinol
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Network analysis
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Ref BDC volume3,6th edition pg 87 CONTENTS OF OCCIPITAL TRIANGLE NERVES: Spinal accessory nerve Four cutaneous branches of cervical plexus; lesser occipital, great auricular,anterior cutaneous nerve of neck,suprascapular Muscular branches; two small branches to the levator scapulae, two small branches to the trapezius,nerve to rhomboids C5, C6 roots of brachial plexus VESSELS: Transverse cervical aery and vein Occipital aery LYMPH NODES: Supraclavicular nodes Occipital nodes NOTES: Suprascapular nerve is present in subclan triangle.
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Distal obstruction of the urinary tract is more frequent in male fetuses, and the most common etiology is posterior urethral valves. Characteristically, there is dilatation of the bladder and proximal urethra, termed the"keyhole" sign, and the bladder wall is thick (Ref: William's Obstetrics; 25th edition)
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Functional residual capacity: Amount of air remaining in the lungs after a normal tidal expiration (RV + ERV). Around 2400 mlRef: Ganong review of medical physiology 23rd edition Page no: 593
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Ans: A (Fetal anomalies) Ref: DC Dutta's Textbook of Obstetricsf pg: 98Explanation:Advantages of 18- 20 weeks scan during pregnancyDetailed fetal anatomy survey to detect any structural anomalies.Placental localization.USG examination is performed as a routine at 18-20 weeks to rule out fetal anomalies.o Open spina bifida and Arnold Chiari malformationBanana sign - flattening of cerebellar hemispheres.Lemon sign- scalloping of frontal bones,o Anencephaly - frog's eye appearance (absence of calvarium).Stomach bubble seen normally by 20 weeks. Absent stomach bubbie-esophageal atresia.Gastroschisiso Paraumbilical defect.o Not covered by membrane - herniated smalt bowel loops floating free in ammotie fluid..o Not associated with chromosomal anomalies, prognosis is good..Omphaloceleo Midline defect, cord inserted on the herniated mass,o Covered by membrane-hernia contains intestines, liver or both,o 40-60% associated with chromosomal anomalies, prognosis is poor.Advantages of First Trimester Scan During PregnancyDetects early pregnancyo An intrauterine gestational sac should be seen by:TVS when maternal serum Beta hCG level is 1000-1200 mlU/ml.TAS when maternal serum Beta hCG level is 6000 mlUJml.Confirms intrauterine pregnancy - to rule out Ectopic and Molar pregnancy.o Ectopic pregnancy features in USG - pseudo gestational sac sign, echogenic fluid in POD, ring of fire {Echogenic ring) in Doppler.o Molar pregnancy in USG - snow storm appearance.Confirms viability of fetus - cardiac activity should appear by 7 weeks in TAS and 6 weeks in TVS.Accurate dating - USG is the best method to estimate gestational ageo CRL (crown rump length) is the most accurate parameter in first trimester,o Accuracy in estimating GA iso +/- 1 week in 1st: trimestero +/- 2 weeks in 2nd trimestero +/- 3 weeks in 3rd trimesterNumber of fetuses.Identifies any uterine or adnexal pathology.Fetal nuchal fold thickness of > 3 mm by USG is a strong marker for chromosomal anomalies in 1S1 trimester between 11-13 weeks.Advantages of 3rd Trimester Scan During PregnancyEstimated fetal weight - by measuring FL, BPD. HC. AC.Fetal growth profile - Abdominal circumference {AC) is die single most important parameter for assessment of fetal growth.
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Allogeneic SCT was considered first-line CML therapy before 2000. The maturing positive experience with TKIs has now relegated its use to after first-line TKI failures. An impoant question is the optimal timing and sequence of TKIs and allogeneic SCT (whether allogeneic SCT should be used as second- or third-line therapy). Among patients who present with or evolve to blastic phase, combinations of chemotherapy and TKIs should be used to induce remission, followed by allogeneic SCT as soon as possible. The same applies to patients who evolve from chronic to accelerated phase. Patients with de novo accelerated-phase CML may do well with long-term TKI therapy (estimated 8-year survival rate 75%); the timing of allogeneic SCT depends on their optimal response to TKI (achievement of complete cytogenetic response). Among patients who relapse in chronic phase, the treatment sequence depends on several factors: (1) patient age and availability of appropriate donors; (2) risk of allogeneic SCT; (3) presence or absence of clonal evolution and mutations; (4) patient's prior history and comorbidities; and (5) patient and physician preferences Nowdays with the availability of effective TKI primary treatment modality for chronic and accelerated phase of CML is TKI therapy.If patient fails to respond to TKI then allogenic stem cell transplantation is the treatment of choice.so SCT is still the most effective treatment for accelerated and blast phase of CML Tyrosine kinase inhibitors are used as an interim therapy to achieve minimal CML burden. Interferons are given when allogeneic SCT is not feasible. Hydroxyurea, a ribonucleotide reductase inhibitor is used for controlling cell counts.
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Ref:Textbook of pathology (Harsh mohan) 6th edition,page no.500 Adenocarcinoma: Adenocarcinoma, also called peripheral carcinoma due to its location and scar carcinoma due to its association with areas of chronic scarring,is the most common bronchogenic carcinoma in women and isslow-growing. Recent estimates on adenocarcinoma place this as the most frequent histologic subtype of lung cancer. Adenocarcinoma is fuher subclassified into 4 types: i) Acinar adenocarcinoma which has predominance of glandular structure and often occurs in the larger bronchi. ii) Papillary adenocarcinoma which has a pronounced papillary configuration and is frequently peripherally located in the lungs and is found in relation to pulmonary scars (scar carcinoma). iii) Bronchiolo-alveolar carcinoma is characterised by cuboidal to tall columnar and mucus-secreting epithelial cells growing along the existing alveoli and forming numerous papillary structures. Ultrastructurally, these tumour cells resemble Clara cells or less often type II pneumocytes. iv) Solid carcinoma is a poorly-differentiated adenocarcinoma lacking acini, tubules or papillae but having mucuscontaining vacuoles in many tumour cells.
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Marking Nut Botanical name: Semicarpus anacardium Common name: Marking nut, bhilawa, biba Toxic Principle * Semecarpol * Bhilawanol REF;THE SYNOPSIS OF FORENSIC MEDICINE:KS NARAYANA REDDY;28th EDITION;PAGE NO317
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Ans. is 'b' i.e., 72 Nutritive value of milks compared (value per 100 grams) BuffaloCowGoatHumanFat(g)6[?]54[?]14[?]53[?]4Protein(g)4-33[?]23[?]31[?]1Lactose(g)51444[?]67[?]4Calcium(mg)21012017028Iron(mg)0[?]20[?]20[?]3 Vitamin C(mg)1213Minerals(g)0[?]80[?]80[?]80[?]1Water(g)81[?]08786[?]888Energy(kcal)117677265
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Famciclovir is the prodrug of penciclovir which is a Guanosine analogue used against herpes.
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Sodium valproate is contra-indicated in children less than 3 years due to risk of hepatitis. Other side effects of valproate- Vomtimg Alopecia Liver toxicity Pancreatitis,PCOD Rash Obesity Ataxia Teratogenic
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A gene is a locus (or region) of DNA which is made up of nucleotides and is the molecular unit of heredity.:Glossary The transmission of genes to an organism&;s offspring is the basis of the inheritance of phenotypic traits. Most biological traits are under the influence of polygenes (many different genes) as well as gene-environment interactions. Some genetic traits are instantly visible, such as eye colour or number of limbs, and some are not, such as blood type, risk for specific diseases, or the thousands of basic biochemical processes that comprise life. Genes can acquire mutations in their sequence, leading to different variants, known as alleles, in the population. These alleles encode slightly different versions of a protein, which cause different phenotype traits. Colloquial usage of the term "having a gene" (e.g., "good genes," "hair color gene") typically refers to having a different allele of the gene. Genes evolve due to natural selection or survival of the fittest of the alleles. The concept of a gene continues to be refined as new phenomena are discovered. For example, regulatory regions of a gene can be far removed from its coding regions, and coding regions can be split into several exons. Some viruses store their genome in RNA instead of DNA and some gene products are functional non-coding RNAs. Therefore, a broad, modern working definition of a gene is any discrete locus of heritable, genomic sequence which affects an organism&;s traits by being expressed as a functional product or by regulation of gene expression.
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ethionamide is structurally similar to methimazole that has been shown to inhibit thyroid hormone synthesis hence causing hypothyroidism
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ANSWER: (A) LymphomaREF: Harrison's 18th ed ch:189Most common CNS tumour with HIV is primary CNS lymphomaMost common site of extra nodal non hodgkin's lymphoma in HIV: CNSPrimary CNS lymphomas are usually positive for EBVNo predliction for any age groupThe median CD4+ T cell count at the time of diagnosis is 50/ micro LCNS lymphoma. Primary CNS lymphoma generally presents with focal neurologic deficits, including cranial nerve findings, headaches, and/or seizures. MRI or CT generally reveals a limited number (one to three) of 3- to 5-cm lesions* The lesions often show ring enhancement on contrast administration and may occur in any location. Contrast enhancement is usually less pronounced than that seen with toxoplasmosis. Locations that are most commonly involved with CNS lymphoma are deep in the white matter. The main diseases in the differential diagnosis are cerebral toxoplasmosis and cerebral Chagas' disease
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Primordial prevention is the prevention of the emergence or development of risk factors in countries or population groups in which they have not yet appeared. In primordial prevention, effos are directed towards discouraging the children from adopting harmful lifestyles. The main intervention is through individual and mass education. Ref: Park's Textbook of Preventive and Social Medicine; 24th edition - Page no. 45
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Ans. is 'b' i.e., Epstein Barr virusEtiology of Nasophary ngeal carcinomao Nasopharyngeal carcinoma is multifactorial in origin, the three risk factors are1) Genetic: Chinese have a higher genetic susceptibility to nasopharyngeal cancer. Even after migration to other countries2) Viral: Epstein- Bar virus is closely associated with nasopharyngeal cancer. Specific viral markers are being developed to screen people in high incidence areas.3) Environmental: Air pollution, smoking of tobacco and opium, nitrosamines from dry salted fish, smoke from burning of incense and wood have all been incriminated.
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Normally, Oxidation occurs
↓
Energy generated in used for ATP production by phosphorylation
This is known as Coupling of oxidation with phosphorylation.
In Newborn: Due to Brown fat,
Energy generated from oxidation is used for heat production not ATP production to prevent hypothermia.
This Mechanism is Non - shivering thermogenesis or Uncoupling of oxidation with phosphorylation.
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The limiting amino acid in wheat is lysine and threonine. REF. PARK'S TEXTBOOK OF PREVENTIVE AND SOCIAL MEDICAL 21ST EDITION. PAGE NO - 579)
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Activation of the complement cascade by the classical or alternative pathway leads to the cleavage of complement fragments and the formation of active enzymatic complexes. The C5b fragment aggregates with complement proteins C6, C7, CS, and C9, resulting in the polymerization of the final product, known as the “membrane-attack complex” (MAC). MAC lyses cells by inserting into the plasma membrane and destroying the permeability barrier.
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(D) Supravalvular aortic stenosis # WILLIAMS SYNDROME shares some features with autism (such as difficulty understanding the state of mind of conversational partners) and Fetal alcohol syndrome (e.g., certain facial features, possible mental retardation, and negative potential outbursts), although persons with Williams generally possess very good social skills, such that this condition is sometimes called "cocktail- party syndrome. Supravalvular aortic stenosis is common
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Ans. is 'a' i.e., Scleroderma o The skin involvement in Crohn's disease causes erythema nodosum, scleroderma does not occur in Crohn's disease. o Other extra intestinal manifestations of Crohn's disease: 1. Migratory polyahritis 4. Sacroiliaitis 7. Ankylosing spondylitis 2. Uveitis 5. Hepatic pericholangitis 8. Primary sclerosing cholangitis
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Anencephaly
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Ans is 'c' i.e. Caffeine is associated with the occurrence of the diseases [Ref: Park 20/e, p 69 (18/e, p 68, 17/e p64, 16/e,p62)[Cause and effect relationship is not established by case control study. It can be established by cohort study. A case control study cannot distinguish between causal factors and associated factors.A case control study can measure only the odd ratio ( an estimate of relative risk)A case control study does not establish a cause and effect relationship but it definately tells that caffeine is associated with the disease under study.
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Bilateral shortness of sternomastoid has not been mentioned as a feature of Klippel-Feil syndrome.
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TB meningitis (Tuberculous meningitis) is caused by the Mycobacterium tuberculosis bacteria. Infection begins elsewhere in the body, usually the lungs, but in about 1 - 2% of cases the bacterium causes TB meningitis. TB meningitis Characteristic cerebrospinal fluid (CSF) findings of TBM include a lymphocytic-predominant pleiocytosis, elevated protein, and low glucose. CSF acid-fast smear and culture have relatively low sensitivity but yield is increased with multiple, large volume samples. Ref Harrison20th edition pg 2345 .
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.
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Torsemide is the longest acting loop diuretic.
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Lafora's disease - It is a progressive myoclonic epilepsy with AR inheritance. -Onset: 6-19 years -Death within 10 years -Brain degeneration a/w polyglucosan intracellular inclusion bodies in numerous organs. - IOC: DNA sequencing which shows abnormality in EPM2A and EPM2B gene. -Demonstration of Lafora bodies within the apocrine sweat gland of the skin is seen by an axillary skin biopsy examination. -Rx: Zonisamide
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Ans. is 'a' i.e., Cisapride
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Ans. is 'c' i.e., miRNA According to recent sudies a very large number of genes do not encode proteins. Instead, their products play impoant regulatory functions. The most recently discovered among this class of genes are that encode for gene-silencing RNAs, i.e. RNAs that do not encode proteins but instead inhibit gene expression (unlike classical RNAs which encode for proteins) Two gene-silencing RNAs are: Micro RNAs (miRNAs) Small interfering RNAs (siRNAs) 1. Micro RNA (miRNAs) Because of their profound influence on gene regulation, miRNAs are assuming central impoance in understanding normal developmental pathways, as well as pathologic conditions, such as cancer. o By current estimates there are approximately 1000 genes in humons that encodes miRNAs. Transcription of miRNA gene produces primary miRNA transcripts, which is processed within the nucleus to form another structure, called pre-miRNA. Pre-miRNA is transpoed to cytoplasm by a transpoor (Expo) protein. Dicer (an enzyme) does the additional cutting of this pre-miRNA that are about 21-30 nucleotide in length (hence called "micro"). At this stage mRNA is still double stranded. Next, the miRNA unwinds, and single strands of this duplex are incorporated into a multiprotein complex called RNA-induced silencing complex (RISC). Base-pairing between the miRNA strand and it target mRNA (messenger RNA) directs RISC to either cause mRNA cleavage or repress its translation. In this way, the gene from which the target was derived is silenced (at a post-transcription level). A single miRNA can silence many target genes. 2. Small interfering RNAs (siRNAs) siRNAs work in similar manner as miRNA Unlike miRNA, siRNA precursors are introduced by investigators into cells. siRNA are becoming powerful tools for studying gene function and may in the future be used therapeutically to silence specific genes, such as oncogenes, whose products are involved in neoplastic transformation.
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Ans. is 'd' i.e., Validity of vaccination begins immediately after vaccination Yellow fever Yellow fever is a zoonotic disease caused by ar abro-virus. It affects principally monkeys. Agent - Flavivirus fibricus a group B arbovirus of togavirus family. Vector - Aedes aegypti mosquito. Reservoir - Monkeys and forest mosquitoes. Transavarian transmission of the virus in mosquitoes has been shown to occur in adverse conditions (e.g., during extended dry seasons), in the absence of susceptible hosts. o There is no evidence that yellow fever has ever been present in Asia. Environmental factor for yellow fever. A temprature of 24degC or more is required for the multiplication of the virus in the mosquito. It should be accompnied by a relative humidity of over 60% for the mosquitoes to live long. Urbanization is leading to extension of yellow fever in Africa. Measures designed to restrict the spread of yellow fever are specified in the "International health regulation" of WHO. These are implemented by the Govt of India through stringent aerial and maritime traffic regulations. Broadly these comprise : - i. Travellers All travellers (including infants) exposed to yellow fever or passing through endemic zones of yellow fever must posses a valid international ceificate fo vaccination against yellow fever before they are allowed to enter yellow fever receptive areas like India. The validity of the ceificate begins 10 days after the date of vaccination and extends up to 10 years. Revaccination performed before the end of the validity of ceicicate renders the ceificate valid for a fuher period of 10 years staing on the day of revaccination. If no such ceificate fo vaccination is available, the travellar is placed on quarantine for 6 days from the date of leaving an infected area. ii. Mosquitoes The aircraft and ships arriving from endemic areas are subjected to aerosol spraying with prescribed insecticides. Airpos and Seapos are kept free from the breeding of insect vectors over an area extending at least 400 metres around their perimeters. The "aedes aegypti index" is kept below 1.
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"Ideally, the tube tip should be 5 ±2 cm from the carina when the head and neck are in neutral position".
___ Fundamental of anaesthesia
Neck flexion causes a 2 cm descent of endotracheal tube towards carina, and neck extension causes a 2cm ascent of trachial tube tip from the carina. Therefore correct position of tip of the tube is :-
5 ±2 cm from carina → When neck is neutral
3 ±2 cm from carina → When neck is flexed
7 ±2 cm from carina → When neck is extended
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WHO definition-&;&; the extension to all people of the benefits of medical psychological and related knowledge is essential to the fullest attainment of health &;&;. Health education is not only delivered through public agencies, but also NGOs ref; PARK 23RD edition, page 43
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Parasite invades cribriform plate Travels along olfactory nerves to brain Leads to a rapidly fatal condition known as primary amoebic meningo encephalitis (refer pgno:25 baveja 3 rd edition)
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B i.e. Medial projection of middle ear cavity Tympanic nerve arises from the glossopharyngeal nerve, just below the jugular foramen. It passes through the floor of middle ear and reaches onto the mucous membrane covering the promontory(2, where it splits into branches and joint branches of internal carotid plexus to form tympanic plexus. Promontary is round bulging in the medial or labyrinthine wall of middle ear cavityQ produced by the first turn of cholea.
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First hea sound is a low, slightly prolonged lub caused by vibrations set up by the sudden closure of mitral or tricuspid valves at the sta or ventricular systole and it occurs during the period of Isovolumetric contraction. Ref: Medical Physiology: Principles for Clinical Medicine, 3rd Ed, Page 247 By Rodney Rhoades, David R. Bell, Ph.D
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Hormones secreted by Kidney
Renin
Erythropoietin
1,25 DHCC
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Governments have set a date of 2015 by which they would meet the MDGs I.e, eradicate extreme povey and hunger;achieve universal primary education;promotes gender equality;improve maternal health,ensure environmental sustainability and develop a global panership for development (refer pgno:893 park 23rd edition)
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Ans. is 'c' i.e., Put the dressing material directly in an appropriate bag and send for incineration o This waste category lies in category No. 6 o No.6 category of solid wastes consists of : Items contaminated with blood and fluid containing u Cotton dressings Soiled plaster casts o Linen o Beddings Other materials contaminated with blood o Treatment and disposal of this category of wastes o Incineration (There will be no chemical pretreatment prior to incineration) Autoclaving/microwaving
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Leukoplakia is a precancerous lesion that appears as a white, elevated, plaque-like growth. It usually has asymmetric borders and usually affects the oral mucosa. It cannot be wiped off. The lesions tend to occur on the lip, mouth, buccal mucosa, and vaginal mucosa. Those at risk are cigarette smokers, pipe smokers, smokeless tobacco users, and heavy alcohol users. Others at risk include those with chronic oral infections, chronic malocclusion, or chronic ultraviolet light exposure. If suspected, these lesions should be biopsied to rule out malignancy. Approximately 10% may show malignant transformation. Candida infections can resemble leukoplakia, but candida can be removed using a cotton swab.
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Posterior nares Nasal cavity: Nasal fossae are two irregular cavities extending from the mucocutaneous junction with the nasal vestibule in front(anterior nares) to the junction with the nasopharynx behind(posterior nares or choanae) Ref.Dhingra 5/e,p 150.6/e,p 135.
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Xanthogranulomatous pyelonephritis It is an unusual and rare form of chronic pyelonephritis associated with Proteus infections. MORPHOLOGY Gross: Cut surface shows large, yellowish-orange nodules, which may be confused with renal cell carcinoma. Microscopy: Interstitium shows foamy macrophages, plasma cells, and lymphocytes Clinical Features Chronic pyelonephritis associated with reflux may be a silent onset. Usual symptoms are back-pain, fever, pyuria, and bacteriuria Ref: RAM DAS NAYAK EXAM PREPARATORY MANUAL FOR UNDERGRADUATES 2nd ed. pg no: 619
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Ans. is 'd' i.e., Isotretinoin * Following is the risk category of the drugs to be used in pregnancy:Risk category of drugs during pregnancyCategoryExamplesA No riskAdequate studies in pregnant women have failed to demonstrate a risk to the foetusInj. Mag. sulfate, thyroxineB No evidence of risk in humansAdequate human studies are lacking, but animal studies have failed to demonstrate a risk to teh foetusorAdequate studies in pregnant women have failed to demonsirate a risk to the fectus, but animal studies have shown an adverse effect on the foetusPenicillin V. amoxicilin. cafactor, erythromycin, paracetamol, lidocaineC Risk cannot be ruled oldNo adequate studies in pregnant women and animal studies are lacking or have shown an adverse effect on foetus, but potential benefit may warrant use of the drug in pregnant women desplite potential riskMorphine, codeine, atropine, corticosteroids, adrenaline, thiopentone, bupivacaineD Benefit may out weight potential riskThere is evidence of human foetal risk, but the potential benefits from use of the drug may be acceptable despite the potential riskAspirin, phenytoin carbamazepine valproate, lorazepam, methotrexateX ContraindicatedStudies in animals of humans have demonstrated foetal abnormalities, and potential risk clearly outweighs possible benefitEstrogens, isotretinoin, ergometnne thalidomide* Category X drugs have proven fetal abnormalities and are teratogenic.
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In garotting, a loop of things string is thrown around the neck of victim, who is attacked from his back. The ligature is then rapidly tightened with the help of two sticks tied at the free ends of the string so as to constrict the neck strongly. Asphyxiation of the unaware victim ensues rapidly and ultimately death. Ref: TEXTBOOK OF FORENSIC MEDICINE AND TOXICOLOGY KRISHNAN VIJ FIFTH EDITION PAGE 134
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Abdominal aoic aneurysms can rupture anteriorly into the peritoneal cavity (20 per cent) or posterolaterally into the retroperitoneal space (80 per cent). The most common complications after open repair are cardiac (ischaemia and infarction) and respiratory (atelectasis and lower lobe consolidation)
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Ans. (C) Ketamine(Ref: Goodman and Gilman 12th/e p538-539)Ketamine increases all pressures (blood pressure, intracranial tension, intraocular pressure) in the body. It is therefore intravenous anesthetic of choice for shock (increases blood pressure).
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Ans. is'b'i.e., Sympathetic branchRef: Gray's Anatomy 39,/el'Median nerve supplies vascular branches to the brachial aery in the arm.These fibres are sympathetic fibres.Median nerve has no sensory or cutaneous branch in the arm.Only branches it gives off in the arm are sympathetic branches to the brachial aery.
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