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Ans. is 'd' i.e., Doxycycline
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Right mediastinal border is formed by right innominate (brachiocephalic) vein, SVC, right atrium, and IVC (IVC may not be visible in PA view).
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Ans. D: Phenylketonuria Common causes of diffuse hyperpigmentation: Addison's disease Porphyria cutanea tarda Cushing's syndrome Hemochromatosis Phaeochromocytoma Biliary cirrhosis High dose ACTH therapy Phenylketonuria results in hypopigmentation
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Superfemale (Triple X Chromosome)The possession of an extra X is not excessively rare since it is quite compatible with complete feminine normality. There is, however, a well-recognized triple X syndrome in which the patient, who is often mentally subnormal, suffers from scanty or irregular menstruation and infeility. Clinical examination may reveal hypoplasia of the genital tract.Reference: Shaw's textbook of gynecology; 16th edition; Page no 146
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Persistent reflexes: Reflexes that never disappears.
Walking and stepping reflex
Limb placement reflex
Parachute reflex
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Ans. is 'a' i.e Woodworkers Workers of wood industry develop - Adenocarcinomas of ethmoid & other nasal sinusesWorkers of Nickle refining industry - Sq. cell Ca & anaplastic Ca of nasal sinuses.
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Left surgical lobe * Couinaud Segment IX is a pa of caudate lobe (I) of the left surgical liver. * Left surgical liver contains segment number I, II, III & IV. * Left Anatomical lobe lies to the left of falciform ligament and contains only segment number III & IV. * Right surgical (functional) lobe contains segment no V, VI, VII & VIII.
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Membranous nephropathy Membranous nephropathy is the most common cause of nephrotic syndrome in Caucasian adults. It is caused by antibodies (usually autoantibodies) directed at antigen(s) expressed on the surface of podocytes, including the M-type phospholipase A2 receptor 1. While most cases are idiopathic, a propoion are associated withother causes, such as heavy metal poisoning, drugs, infections, lupus and tumours . Approximately one-third of patients with idiopathic membranous nephropathy undergo spontaneous remission, one-third remain in a nephrotic state, and one-third develop progressive CKD. High doses of glucocoicoids and cyclophosphamide may improve bboth the nephrotic syndrome and the long-term prognosis. However, because of the toxicity of these regimens, many nephrologists reserve such treatment for those with severe nephrotic syndrome or deteriorating renal function. Treatment of secondary membranous nephropathy is directed at the underlying cause. Ref Harrison20th edition pg 278
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In sickle cell anemia the hemolysis is due to structural defect in the B chain causing increased stickiness. It is not immune related.
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Ans. is 'd' i.e., Biliary atresia Most of the books are of the opinion that alkaline phosphatase and gamma glutamyl transpeptidase are two enzymes that are associated with biliary tract disease.Serum levels of these enzymes are usually increased in cholestasis or bile duct obstruction.But the problem in that, all of these books also add that they may also be increased in parenchymal disease or infiltrative or mass lesions of the liverIn the question only the value of Gamma glutamyl transpeptidase is given. Nothing is mentioned about the value of other enzymes.We cannot come to a conclusive diagnosis only by the level of Gamma glutamyl transpeptidaseBut still such a considerable elevation in the serum level of Gamma glutamyl transpeptidase i.e., 10 to 12 times its normal value points towards the diagnosis of biliary tract diseaseNote:- Normal value of serum Gamma glutamyl transpeptidase is - 10-40IU/L
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Ans. (d) Squamous cell carcinomaRef: Devita 9th edition, page 729* Most common site oral Cancer: Carcinoma Tongue > Carcinoma Lip* Most common histological type: Squamous Cell Cancer* Most common site of oral Cancer in India: Cancer of Buccal Mucosa* Max Risk of L.N. Metastasis: Carcinoma Tongue* Min Risk of L.N Metastasis: Carcinoma lip > hard palate* Most common age: 50-60 years
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Plasma levels of cholesterol and triglyceride are extremely low in this disorder, and chylomicrons. Abetalipoproteinemia usually presents in early childhood with diarrhea and failure to thrive. The neurological manifestations like decreased distal lower extremity vibratory and proprioceptive sense, dysmetria, ataxia, and the development of a spastic gait, often by the third or fouh decade. Patients also develop a progressive pigmented retinopathy presenting with decreased night and color vision. Ref: Harrisons Principles of Internal Medicine, 18th Edition, Page 3153
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Ans. is 'c' i.e., Increased hea rate Compensatory mechanisms in acute hemorrhage In acute hemorrhage there is compensatory sympathetic stimulation which causes :? 1) Generalized vasoconstriction with increased total peripheral resistance (TFR). 2) Increased hea rate (tachycardia). 3) Increased cardiac contractility. 4) Increased renin release causing sodium and water retention through RAA system. 5) Shift of fluid from intracellular and interstitial space into vascular space.
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LEVELS OF PREVENTION: Primordial prevention Prevention of emergence of development of risk factors Done by health education. Primary prevention Action taken prior to the onset of disease Done by health promotion & specific protection. Secondary prevention Action which halts the progress of a disease Done by early diagnosis & treatment Teiary prevention Action taken during the progression/ end of disease Done by diability limitation & rehabilitation. - Note: All vaccines comes under primary level of prevention - specific protection. All screening & diagnostic tests comes under secondary level of prevention.
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Ans. (d) Clip the towel* Towel clips are used to hold the sterile dressing after drape in position* Some surgeons use this to hold and retract the tongue outside for intra oral surgeries.
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A i.e. Water constitutes 60% of body weight
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Darier's disease is characterized by defect in Ca+2 pump that is necessary for desmosome function, due to mutation in ATP2A2 gene.
Both HHD and Darier's disease are characterized by acantholysis and suprabasal blister, but dysteratosis (premature keratinization in epidermis) is seen classically with Darier's disease.
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Answer- B. 2 - 3 Kg wt loss / monthRkk of gall stone formation in obese persons during active weight loss seems to increase in an exponential fasion. The data suggest that rates of weight loss should not exceed an average of 7.5 kg per week
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Lymphatic drainage of anal canal is through the mesorectal (also known as inferior rectal) nodes to the inguinal and femoral nodes. Anal cancers are more likely to produce inguinal adenopathy, with internal iliac adenopathy also occurring when the tissues near the anorectal junction are involved. ref : bailey and love
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Ans. is 'a' i.e., Man is an intermediate host
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Answer is A (Digoxin) Digoxin has no definitive role in the management of Acute Pulmonary Edema `Digitalis is not the initial drug of choice for management of patients with acute severe pulmonary edema (severe hea failure) because of its mild inotropic effect and because of the delay in time to peak action. It should not be used in the management of acute cases, in the absence of atrial arrhythmias as its use may complicate an already difficult management problem. Digoxin is only recommended if the patient is in atrial fibrillation and this is contributing to the cardiac failure - 'Circulation' Journal of American Hea Association Digoxin is not recommended in acute pulmonary edema unless there is associated rapid atrial fibrillation. Rapid atrial fibrillation in this situation is better treated with urgent cardioversion' - 'Coronary care manual by Thompson (Elsevier) 2"a/508 `Digoxin has no definitive role in the management of acute congestive hea failure (acute pulmonary edema) ' - Clinical Emergency Medicine (Cambridge University Press) 2005/499 `Once a mainstay of treatment because of their positive inotropic action digitalis glycosides are rarely used at present. However they may be useful for control of ventricular rate in patient with rapid atrial fibrillation or flutter with LV dysliinction' Initial Management of Acute Pulmonary Edema (Acute Hea Failure) Oxygentation with face mask or Positive Pressure Ventilation (Non invasive) Vasodilatation by Nitrates (or Nitroprusside) Diuretic therapy by Furosemide (or other loop diuretics) Morphine for relief of physical psychological stress and to improve haemodynamics. Ino ropes should be used based on clinical and haemodynamic parameters of the at ent who does not respond to initial treatment. Pulmonary Edema Oxygen and Ventilatory Suppo Morphine Vasodilators Diuretics Inotropic Agents * Supplemental oxygen Morphine diminishes Vasodilators are Diuretics are Inotropic agents are The maintenance of anxiety and decreases indicated in most recommended for indicated in the Sa02 within normal limits (95-98%) is sympathetic outflow, thereby reducing both patients with acute pulmonary edema initial management of acute severe management of Acute pulmonary edema in the impoant to maximize venous and aerial (AHF) as first line pulmonary edema presence of peripheral oxygen delivery to vasoconstriction therapy if especially in the hypoperfusion tissues resulting in decreases associated with presence of (hypotension/reduced renal * Non invasive in ventricular preload adequate blood symptoms function) with or without ventilatio n (without ( w and after load. pressure and signs secondary to fluid congestion or pulmonary endotrachial * Morphine is of congestion with retension (Reduce edema refractory to intubation) recommended for the low diuresis to Alveolar Edema) di iuretcs and vasodilators at CPAP or Non invasive treatment of Acute open the peripheral * Intravenous optimal doses. positive Pressure severe pulmonary circulation and to administration of * Dobutamine/Dopamine Ventilation (NIPPV) edema especially if lower preload. Loop Diuretics * Phosphodiesterase The use of CPAP and associated with * Nitrates (Furosemide, Inhibitors (Milrinone / NIPPV in Acute restlessness and (sublingual/Intrave Bumetonide or Enoximone) Cardiogenic dyspnea (effectively nous) (Agent of Torasemide) is the * Levosimenden Pulmonary Edema is ameliorates choice) preferred choice * Norepinephrine/ associated with a symptoms) * Nitroprusside due to their strong Epinephrine significant reduction (Associated and brisk diuretics in the need of tracheal intubation and mechanical ventilation. Hypeensive Crisis) * Nesiritide effect. Digoxin is not recommended as on inotrope for the management of Acute pulmonary Edema because of its mild inotropic effect and delay in time to peak action (slow action). Digoxin may be selectively considered for patients with Atrial Fibrillation where AF is contributing to cardiac failure / pulmonary edema.
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Theophylline is having a narrow margin of safety so therapeutic drug monitoring is essential If levels increase more than 20mg/L- side effects occurs ESSENTIAL OF MEDICAL PHARMACOLOGY SEVENTH EDITION KD TRIPATHI PGNO.226
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Rarely, Halothane can cause Malignant hypehermia, which is treated with dantrolene Inhalational anesthetic agents and Depolarising NM blockers like succinylcholine can precipitate malignant hypehermia.
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Chlamydiae possess group specific antigens. These are heat-stable lipopolysaccharides with 2-keto-3-deoxyoctanoic acid as an immunodominant component. Antibody to these genus-specific antigens are detected by complement fixation (CF) and immunofluorescence. Ref: Harrisons Internal Medicine, 18th Edition, Chapter 176; Jawetz, Melnick and Adelberg's Medical Microbiology, 25th Edition, Chapter 27
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Ref: Harrison's l8th editionExplanation:The clinical syndrome caused by the reactivation of VZV from sensory ganglia is herpes zoster.The commonly involved dermatomes are:The thoracic dermatomes, especially T4 to T12. are involved in about 50% of casesThe lumbosacral dermatomes in about 16%The cranial nerves in 14 to 20% ot patientso Opthalmic division of trigeminal in 10 to 15 percent ando Other cranial nerves causing 4 to 5 percentThere are two rather characteristic cranial herpetic syndromes are ophthalmic herpes and geniculate herpes.In ophthalmic herpes, which accounts for 10 to 15 percent of all cases of zoster, the pain and rash are in the distribution of the first division of the trigeminal nerve, and the pathologic changes are centered in the gasserian ganglion. The main hazard in this form of the disease is herpetic involvement of the cornea and conjunctiva, resulting in corneal anesthesia and residual scarring. Palsies of extraocular muscles, ptosis, and mydriasis are frequently associated, indicating that the third, fourth, and sixth crania] nerves are affected in addition to the gasserian ganglion.The less common but also characteristic cranial nerve syndrome called Ramsay Hunt syndrome - consists of a facial palsy in combination with a herpetic eruption of the external auditory meatus, sometimes with tinnitus, vertigo, and deafness. This is due to the reactivation of herpes from the geniculate ganglion.
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Ans. A: Tick Kyasanur forest disease is a tick-borne viral hemorrhagic fever endemic to South Asia. The disease is caused by a virus belonging to the family flaviviridae, which also includes yellow fever and dengue fever. There are a variety of animals thought to be reservoir hosts for the disease, including porcupines, rats, squirrels, mice and shrews. The vector for disease transmission is Haemaphysalis spinigera, a forest tick. Humans contract infection from the bite of nymphs of the tick. Estimated incubation period is between 3-8 days.
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Best natural source of iodine is - Sea foods.
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The most common cause of cervical insufficiency is idiopathicCervical incompetence may be congenital due to the following:Mullerian anomaliesCollagen disordersExposure to DES or the causes may be acquiredObstetric trauma like cervical laceration during deliveryMechanical dilatationCervical Conization
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Ans. c (Langerhan's cells/histiocytes). (Ref. Robbins, Pathology, 7th, 199, 1228)# Macrophages have role in inflammation and induction and effector phase of immune response.# Dendritic cells are important antigen presenting cells for initiating primary immune responses against protein ags.# Features which contribute to their function are location at right place to capture ags (under epithelia, in interstitia), expression of receptors for capturing and responding to microbes (TLRs and mannose receptors) and expression of same chemokine receptors as do naive T-and immature dendritic cells within epidermis are Langerhan's cells.Cell TypeMajor Role in Innate ImmunityMajor Role in Adaptive ImmunityPlasmacytoid dendritic cells (DCs) of lymphoid lineageProduce large amounts of IFN-alpha which has antitumor and antiviral activity, and are found in T cell zones of lymphoid organs; they circulate in blood.IFN-alpha is a potent activator of macrophage and mature DCs to phagocytose invading pathogens and present pathogen antigens to T and B cellsMyeloid dendritic cells are of two types; Interstitial and Langerhans-derived- Interstitial DCs are strong producers of IL-12 and IL-10 and are located in T cell zones of lymphoid organs, circulate in blood, and are present in the interstices of the lung, heart, and kidney;- Langerhans DCs are strong producers of IL-12; are located in- T cell zones of lymph nodes,- Skin epithelia, and- Thymic medulla;- and circulate in bloodInterstitial DCs are potent activators of macrophages and mature DCs to phagocytose invading pathogens and present pathogen antigens to T and B ceils
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Ans. is 'd' i.e., All of the above Preanaesthetic medication Premedication (Preanaesthetic medication) refers to the use of drugs before anaesthesia to make it more pleasant and safe. The aims are : Relief of anxiety and apprehension preoperatively and to facilitate smooth induction. Amnesia for preoperative and postoperative events. Supplement analgesic action of anaesthetics and potentiate them. Decrease secretions and vagal stimulation (undesirable reflex). Antiemetic effect extending into postoperative period. Decrease acidity and volume of gastric juice so that it is less damaging if aspirated. Drugs used in premedication 1. Sedative - antianxiety - Diazepam / Lorazepam / Midazolam. Lorazepam is used most commonly. Midazolam is used for day care surgery. 2. Opioids - Morphine / pethidine 3. Anticholinergics -. Atropine / Hyoscine / Glycopyrrolate. 4. Neuroleptics Haloperidol / chlorpromazine / triflupromazine. 5. H2 blocker or proton pump inhibitor Ranitidine / Famotidine, omeprazole / Pantoprazole. 6. Antiemitics - Metoclopramide / Domperidone / Ondansetron.
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Ans. is None
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Pyloric stenosis clinical presentation Infant is normal at bih, symptomatic between ages of 3-6 weeks Infants with HPS typically present with projectile nonbilious vomiting Visible gastric peristalsis may be seen as a wave of contraction from the left upper quadrant to the epigastrium The infants usually feed vigorously between episodes of vomiting Typical electrolyte abnormalities Hypochloremia Hypokalemia Metabolic acidosis with paradoxical aciduria Ref: Sabiston 20th edition Pgno : 1869
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Ans. C: Urethra Methylene blue 3 swab test is useful for diagnosing site of leakage. In this test, Catheter is introduced in to the bladder through the urethra. Vaginal cavity is packed with 3 sterile swabs 50-100 ml of dilute methylene blue dye is injected into the bladder through the catheter (methylene blue turns urine blue). If VVF is present, methylene blue will stain the uppermost swab. If lowermost swab gets stained, the leak is from the urethra If the swab do not take up the stain but gets wet, leak is from the ureter.
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When mother is suffering from syphilis, transmission occurs to fetus, but not before the 4th month of pregnancy; It is most likely to occur after 6th month, when Langhan&;s cell layer has completely atrophied. Infection of fetus is most likely to occur when mother has primary or secondary stages of syphilis than late syphilis. Clinical features include: Hutchinson&;s triad (deafness, Hutchinson&;s teeth- Central notched, widely-spaced peg-shaped upper central incisors and interstitial keratitis), snuffles (rhinitis) and Mulberry Molars (sixth year molars with multiple poorly developed cusps) Neurological damage with mental retardation is one of the most serious consequence of congenital syphilis. Ten daily injections of Procaine penicillin (600,000 Units) are also adequate. According to the CDC, 40% of bihs to syphilitic mothers are stillborn and 30% are infected. Ref: Park 25th edition Pgno: 563
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Type 2 diabetes mellitus results from a complex interplay between underlying resistance to the action of insulin in its metabolic target tissues (liver, skeletal muscle, and adipose tissue) and a reduction in glucose-stimulated insulin secretion, which fails to compensate for the increased demand for insulin. In obese persons, the release of inhibitory mediators from adipose tissue interferes with intracellular signaling by insulin. Hyperinsulinemia secondary to insulin resistance also downregulates the number of insulin receptors on the plasma membrane. The other choices have not been related to the pathogenesis of type 2 diabetes.Diagnosis: Diabetes mellitus, type 2
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Symptoms of keratitis: Pain and foreign body sensation occurs due to mechanical effects of lids and chemical effects of toxins on the exposed nerve endings Watering of the eye occurs due to reflex hyperlacrimation Photophobia, i.e., intolerance to light results from stimulation of nerve endings Blurred vision results from corneal haze Redness of eyes occurs due to congestion of circumcorneal vessels Ref: Comprehensive Ophthalmology by AK Khurana, 4th edition, Page 95.
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Colonic bacteria break down dietary fibers into short chain fatty acids - acetate, butyrate and propionate.
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Ans. is 'a' i.e., Decrease binding of O2 and hemoglobinDPG is an optional by-product of the glycolytic pathway . DPG binds with deoxygenated hemoglobin but not with oxygenated hemoglobin . Therefore raised DPG concentration releases oxygen from oxyhemoglobin by shifting thefollowing reversible reaction to the right : -HbO, + DPGHb - DPG + 02One molecule of DPG binds with one mole of deoxyhemoglobin.That is why in the presence of raised DPG concentration, less oxygen can combine with hemoglobin at a given PO2. Hence an increase in DPG concentration shifts the oxygen-hemoglobin dissociation curve to the right. Thus 2,3 DPG causes delivery (unloading) of O2 to the tissues.
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Ans. is 'b' i.e., Posterior urethral valve The informations provided in this question are ? i) Straining --> Sign of obstruction ii) Driblling --> Sign of obstruction and incomplete bladder emptying. iii) UTI --> May be due to urinary obstruction. o All these suggest the diagnosis of obstructive uropathy, and posterior urethral valve is most common cause of obstructive uropathy.
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"Foresight prevents blindness" was the slogan chosen by WHO for World Health Day in 1976, when effos were made around the world to raise public awareness about the problem of preventable blindness. Ref: Education Of Communicable And Non-Communicable Diseases By Sumer Lal Goel, 2009, Page 149.
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Glottie part is the most common sites for carcinoma larynx followed by supraglottic & subglottic pats respectively.
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Typical pneumoniae
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Circulatory disturbances
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Single-agent chemotherapy is used as palliative therapy in head and neck cancers with the recurrent or metastatic form of cancer. The drugs which are used are -
Cisplatin
Methotrexate
5 Fu
Paclitaxel
Docetaxel
Sometimes combinations of these drugs are used.
Remember these basic points about the t/t of head and neck cancers and one can apply them to all tumors of head and neck.
a) Treatment of localized head and neck cancers -
These tumors are treated with curative intent either with surgery or radiotherapy.
The choice of modality differs according to anatomic location and institutional expertise. In early laryngeal cancer generally, radiotherapy is done to preserve voice while in early oral cavity cancers, surgery is preferred to avoid the long-term complication of radiation such as xerostomia and dental decay.
b) Locally or advanced regional disease -
Combined modality therapy including surgery, radiation therapy, and chemotherapy is used. Concomitant chemotherapy and radiotherapy appear to be most effective.
c) Recurrent or metastatic disease -
chemotherapy is used.
Management of neck lymph nodes
The neck lymph nodes should be treated when there are clinically positive nodes or the risk for occult disease is high based on the location and stage of the primary lesion.
The decision to perform neck dissection or irradiate the neck is related to the treatment of the primary lesion.
If the primary tumor is being treated with radiation and the neck is N0 or N1, the nodes are usually treated with irradiation.
For surgically treated primary lesions, N0 or N1 neck disease may be treated surgically as well (Radical neck dissection/Modified neck dissection/Selective neck dissection). Negative prognostic factors such as extracapsular spread of tumor, perineural invasion, vascular invasion, fixation to surrounding structures, and multiple positive nodes are indicators for postoperative adjuvant radiation therapy.
For N2 or N3 neck disease, neck dissection with planned postoperative radiation therapy is performed.
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park's textbook of preventive and social medicine 23rd edition. *absolute contraindications: cancer of breast and genitals,liver disease,history of thromboembolism and abnormal uterine bleeding.
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Fox Fordyce disease is a disease of apocrine glands. It is an uncommon chronic disorder of sweat glands causing itchy lesions of the skin under the arms, in pubic area, around the nipple pas of genitalia and sometimes on chest and abdomen. It is characterized by by retention of apocrine sweat leading to the formation of yellow papules.
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A i.e. Sherrington's law
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Answer is B (PDA) Patent Ductus Aeriosus is not classified as a cyanotic congenital hea disease. PDA is an Acyanotic Hea disease with Left to Right shunt
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Hypomanic episode and cyclothymia have been classified under bipolar disorders
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Drug allergy (hypersensitivity)
It is an immunologically mediated reaction producing stereotype symptoms which are unrelated to the pharmacodynamic profile of the drug. The symptoms may appear even with much smaller doses and have a different time course of onset and duration. This is also called drug hypersensitivity; but does not refer to increased response, which is called super sensitivity. The target organs primarily affected in drug allergy are skin, airways, blood vessels, blood cells and gastrointestinal tract. Allergic reactions occur only in a small proportion of the population exposed to the drug and cannot be produced in other individuals at any dose.
Prior sensitization is needed and a latent period of at least 1- 2 weeks is required after the first exposure. However, the sensitizing exposure may go unnoticed or may be environmental.
Reference: Essentials of Medical Pharmacology Eighth Edition KD TRIPATHI page no 96
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External jugular vein is formed by posterior auricular vein and posterior division of retromandibular vein.
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Ans. is 'd' i.e., % of institutional deliveries Monitoring and Evaluation of ASHA's workGovernment of India has set up following indicators for monitoring ASHA (41).1. Process IndicatorsNumber of ASHAs selected by due processNumber of ASHAs trained; and% of ASH As attending review meeting after one year2.Outcome Indicators% of newborn who were weighed and families counseled.% of children with diarrhoea who received ORS.% of deliveries with skilled assistance.% of institutional deliveries.% of JSY claims made to ASHA% of completely immunized in 12 to 23 months age group.% of unmet need for spacing contraception among BPL.% of fever cases who received chloroquine with in first week in a malaria endemic area.3.Impact IndicatorsIMRChild malnutrition ratesNumber of cases of TB/leprosy detected as compared to previous year.
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Best indicator of protein quality: DIAAS (Digestible indispensable amino acid scores) > PDCAAS (Protein digestibility-corrected amino acid score) >NPU (Net protein utilization). DIAAS =100 x . NPU = 100 x (Nitrogen retained by the body) / (Nitrogen intake) Other indicators: Amino acid score, Biological value, Protein efficiency ratio. Amino acid score = 100x (mg of amino acid per gm of test protein)/(mg of same amino acid per gm of reference protein) Also remember, protein quantity is measured by protein energy ratio = 100 x energy from protein / total energy in diet.
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FUNCTIONAL HALLUCINATIONS Patient perceives a stimulus from one modality and perceives hallucination in same modality Ex. Whenever the patient hears water flowing from tap he hears auditory hallucinations REFLEX HALLUCINATION: Patient perceives a stimulus from one modality and perceives hallucination in another modality Ex. Whenever the patient sees blue color he hears auditory hallucinations EXTRACAMPINE AUDITORY HALLUCINATIONS Patient sits in Chennai and says that he could see things that are happening in Delhi Patient is perceiving things that is outside his normal visual ability Ref.Kaplon and sadock, synopsis of psychiatry, 11 th edition, pg No. 195
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DNA is cut into large fragments, using restriction enzymes. These fragments are then separated by gel electrophoresis (either agarose or polyacrylamide gel electrophoresis).
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Ans. is 'b' i.e. Osteosarcoma Repeated innumerable timesOsteosarcoma is least radiosensitive out of the four.Radiosensitivity of differenttumors A)Highly Sensitive C)Relatively resistant LymphomaSeminomaMyelomaEwing's Sq cell Ca of lung Hypernephroma Rectal Carcinoma Bladder carcinomaB)Wilms tumor Moderately sensitiveSmall cell Ca of lung Breast cancer Basal cell Ca D)Soft tissue sarcoma Carcinoma of the cervix Highly resistant Melanoma Osteosarcoma Pancreatic Medulloblastoma TeratomaOvarian cancer * About neuroblastoma, Devita's Oncology, 7/e, p 1907 writes - "Neuroblastoma is very sensitive to ionizing radiation".
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The fifth taste sense, umami, was recently added to the four classic tastes. This taste has actually been known for almost 100 years, and it became established once its receptor was identified. It is triggered by glutamate and paicularly by the monosodium glutamate (MSG) used so extensively in Asian cooking. The taste is pleasant and sweet but differs from the standard sweet taste.Ref: Ganong&;s review of medical physiology 23rd edition, Page no:224
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Vitamin A: - Role 1) Vision 2) Reproduction & growth 3) Maintenance of epithelial cell 4) Stabilization of cellular and intra Cellular membrane 5) Synthesis of glycoprotein 6) Antioxidant 7) Skin & Bone Metabolism
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The most common presentations of the lymphatic filariases are asymptomatic (or subclinical) microfilaremia, hydrocele , acute adenolymphangitis (ADL), and chronic lymphatic disease. If there is obstruction of the retroperitoneal lymphatics, increased renal lymphatic pressure leads to rupture of the renal lymphatics and the development of chyluria, which is usually intermittent and most prominent in the morning. (Harrison's Principles of internal medicine, 20th edition, page 1747)
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Rain : Is the prime source of all water and is the ‘purest form of water in nature.’
Chemically, it is very soft water : contains traces (0.0005%) of solids Gibraltar depends on rain water as a source of supply.
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Myoglobin is an iron-containing pigment found in skeletal muscle. It resembles hemoglobin but binds 1 rather than 4 mol of O2 per mole. Its dissociation curve is a rectangular hyperbola rather than a sigmoid curve. Because its curve is to the left of the hemoglobin curve (Figure 36-5), it takes up O2 from hemoglobin in the blood. It releases O2 only at low PO2 values, but the PO2 in exercising muscle is close to zero. The myoglobin content is greatest in muscles specialized for sustained contraction. The muscle blood supply is compressed during such contractions, and myoglobin may provide O2 when blood flow is cut off. Ref: Ganong's Review of Medical Physiology 23rd edition, Chapter 36.
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Answer- C. 8 timesPoiseuille Hagen FormulaF = (PA - PB) x (p /8) x (1/?) x (r4/L)Where,F= flowPA-PB = pressure difference between two ends of the tube? = viscosityr = radius of tubeL = length of tubeBecause flow is equal to pressure difference divided by resistance (R),R = 8?L/pr4
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Ans. D. Frontonasal processThe tongue is divided into two parts: oral part (anterior two third) and pharyngeal part (posterior one-third).a. The oral part of tongue develops from three swellings associated with first pharyngeal arch. These swellings are two lateral lingual swellings and one median swelling--the tuberculum impar.b. The pharyngeal part of tongue develops from a median swelling called hypobranchial eminence associated with third, and fourth pharyngeal arches.c. Muscles of tongue develop from occipital myotomes.
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The whole vagina epithelium is derived from the paramesonephric (Mullerian) duct with bone morphogenic protein 4 reshaping the intermediate mesoderm-derived Mullerian duct into the vaginalprimordium. Vaginal development is also under negative control of androgens. Ref - BDC 6e vol2 pg 395
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Half life of cobalt - 60 is 5.2 years.
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Female, weight loss in spite of appetite, amenorrhea, tremors, brisk reflexes are features of Thyrotoxicosis Option A- Pulses Paradoxus is feature of C. Tamponade it is ruled out Option B- Collapsing pulse- Rapidly rising pulse, which collapses suddenly as aerial pressure falls rapidly, during late systole and diastole (Corrigan's pulse). -Feature of aoic regurgitation & AR have Diastolic murmur. Option C- Thyrotoxicosis can be Associated with A. fibrillation. So, irregularly irregular pulse can be presentation of Thyrotoxicosis. Option D- Pulsus Alternans is feature of LVF.
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Aoic Stenosis is associated with a narrow pulse pressure. Patent Ductus Aeriosus (PDA), Aoic Regurgitation and AV Malformations (Aeriovenous shunting) are all associated with a wide pulse pressure. REF: Harrison book of internal medicine 21ST EDITION
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Ans. is 'a' i.e., L-asparginase o Leukemia cells are deficient in L-Asparagine synthase and depend on the supply of L-asparagine from medium. The enzyme L-asparaginase degrades L-asparagine to L-aspaic acid, depriving leukemic cells of essential metabolite-may cause cell death.
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A ureterocele is a cystic dilatation of the terminal ureter and is obstructive because of a pinpoint ureteral orifice. Ureteroceles are much more common in girls than in boys. In girls, ureteroceles are almost always associated with ureteral duplication, whereas in 50% of affected boys there is only one ureter. Ultrasonography is effective in demonstrating the ureterocele and whether the associated obstructed system is duplicated or single. VCUG usually shows a filling defect in the bladder, sometimes large, corresponding to the ureterocele, and often shows reflux into the adjacent lower pole collecting system with typical findings of a "drooping lily" appearance to the kidney. Nuclear renal scintigraphy is most accurate in demonstrating whether the affected renal moiety has significant function.
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Decreases Secretion of Ach
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21 a hydroxylase deficiency is the most common cause of androgenital syndrome and its clinical manifestations depends upon the extent of enzyme deficiency. In less severe cases there is only masculinization due to increased androgen production (17 ketosteroids and testosterone). In severe cases, due to mineralocoicoid deficiency they can also present with salt wasting if untreated leading to life threatening volume depletion and shock. 11 beta hydroxylase deficiency is marked by salt retention (increase in 11 DOC) leading to hypeension, masculinization and an increase in 11 deoxycoisol. 17 alpha hydroxylase deficiency is marked by increased production of mineralocoicoids and decreased production of 17 ketosteroids and 17 hydroxycoicoids. Ref: Rapid Review Biochemistry By John W. Pelley, page 91-2
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ANSWER: (A) CulexREF: Park 20th ed p. 676Also asked in June 2011See APPENDIX-43 below for list of medically important "Mosquitos" APPENDIX - 43Mosquito AnophelesCulexAedesMansoniaA.K.A Nuisance mosquitoTiger mosquito Egg layingSingly on waterIn small dusters of 200-300 on waterSingly on damp soilIn star shaped clusters/Rafts on under surface of aquatic plantsEgg shapeBoat shaped2 Lateral floats +Trabeculated surface +Raft shape No lateral floatsCigar shapedNo lateral floatsStar shapedNo lateral floatsDesiccationCannot surviveCannot surviveCan surviveCannot surviveLarva (Wrigglers) 5-7 daysHorizontal floating Surface feeders.Mo siphon tubeHead down at an angle of 45deg parallel to the surface of 'water.Bottom feeders. Siphon tube 8th segment of abdomenHead down at an angle of 45deg parallel to the surface of water.Bottom feeders. Siphon tube 8th segment of abdomenHead down at an angle of 45'' parallel to the surface of water. Bottom feeders. Siphon tube 8th segment of abdomenPupa/T umblers 1-2 daysTrumpet/siphon tube broad & shortTrumpet/ siphon tube long & narrowTrumpet/ siphon tube long & narrowTrumpet/ siphon tube long & narrowAdult (2 weeks)Body inclined with surface at rest. Wings spotted Long palpi in both sexes.Body parallel to surface at rest. Wings not spotted. Short palpi in females.Body parallel to surface at rest. Wings not spotted. Short palpi in females.Body parallel to surface at rest.Wings not spotted. Short palpi in females.Feeding habitNight bitersNight biters Biting peak at MidnightDay time bitersNight bitersBreeding habitClean waterDirty and polluted waterArtificial collection of waterAquatic vegetationVector ofMalariaFilaria (not in India)Bancroftianfllariasis, Japanese encephalitis, west Nile feverYellow fever (not in India), Dengue, Chikungunya, Rift valley fever, Filaria (not in India)Malayan (Brugianfllariasis),ChikungunyaEggs hatch in 48 hoursPupa is resting stage, moves actively but do not feed Eggs to adult = 7-10 daysDuring growth, the larva molts (sheds its skin) four times. The stages between molts are called instars Life span of mosquito varies from 8-34 days (2 weeks average), males are short lived.Males never bite (feed on nectar). Females need blood meals every 2-3 days for development of eggs
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Immunosuppressive agents have reduced the incidence of rejection of transplanted solid organs but have increased risk of opportunistic infection. Fungal infections, while not the majority of infections in these patients, carry a high risk of mortality. Candida and Aspergillus are responsible for most of these opportunistic infections that can occur within a month or after several months. A. fumigatus (most common species) infections are primary pulmonary infections that may be a rapidly necrotizing pneumonia with a potential to disseminate. The organism is a mold in the environment and in the host. The hyphae are septate with acute angle, dichotomous, branching. Candida infections generally start as candidemia, which may reach the blood stream by catheters or translocation from the gut. C. albicans is the most frequent Candida isolate. This component of normal flora is generally in the yeast form as a commensal and when infection occurs the additional presence of hyphae and pseudo-hyphae is observed. C. glabrata, which is seen with increasing frequency, does not form hyphae. Cryptococcus neoformans is an encapsulated yeast. Other fungi have been reported with less frequency.
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. There is no germ cells in this condition
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Refractory period is that time period after the first stimulus during which the nerve is "refractory" to another stimulus. Hence, maximum frequency of excitation can be 2500 times in a second, as each next stimulus can excite the nerve if applied immediately at the end of the refractory period (1/2500th of a second).
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Because gravity aids the delivery of arterial blood, classically, the patient with rest pain can obtain relief by simply hanging the leg over the side of the bed.
• Arterial insufficiency ulcers ischemic ulcers are mostly located on the lateral surface of the ankle or the distal digits.
• Most common on distal ends of limbs.
Etiology
• Caused by lack of blood flow to the capillary beds of the lower extremities.
• Most often endothelial dysfunction is causative factor in diabetic microangiopathy and macroangiopathy
Characteristic Features
• Punched-out appearance
• Intensely painful
• Pulses are not palpable
• Associated skin changes (thin shiny skin, absence of hair, brittle nails)
Diagnosis
• The lesion can be easily identified clinically.
• Arterial doppler and pulse volume recordings for baseline assessment of blood flow.
• Radiographs may be necessary to rule outosteomyelitis.
Treatment
• Vascular surgery to revascularize the area.
• In infection: Antibiotics + Debridement
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2 doses of HPV vaccine are recommended irrespective of age, gender, type of vaccine. Option 1: Bivalent vaccine- serotype 16,18 (cervarix). Option 2: Quadrivalent vaccine- serotype 6,11,16,18 (Gardasil,Merck). Option 3, 4: The first dose is recommended for most persons before 15 years of age and the second dose should be given 6 to 12 months after the first dose. A 3-dose schedule is recommended for people who get the first dose on or after 15 years of age, and for people with ceain immunocompromising conditions.
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Ans. is 'd' i.e., Pupillary asymmetry Cranioveebral anomalies Cranioveebral anomalies include congenital anomalies at the base of the skull and atlantooccipital region. It includes the occipito atlanto axial complex Symptoms and signs of cranioveebral junction anomalies Signs and symptoms of cranioveebral junction anomalies reflect the abnormalities and compromise of the following structures. a) Pons b) Medulla c) Cervicomedullary junction and upper cervical spinal cord d) Lower cranial nerves e) Cervical nerve roots f) Vascular supply to the neural structures o In cranioveebral anomalies there is involvement of so many neurological structures that it presents with confusing neurological picture. o A patient with congenital anomaly of cranioveebral junction usually presents with an abnormal physical appearance. Congenital anomalies included in cranioveebral anomalies also include Klippel-Feil syndrome and Down's syndrome. o Findings in Klippel -- Feil syndrome is Head cocked to one side Sho neck Abnormally low hairline posteriorly Limitation of neck movement Some more impoant facts about cranioveebral junction anomaly o Most common neurological symptom is posterior occipital headache, that worsens with neck flexion and extension. o Myelopathy with involvement of pyramidal tract is also very common symptom associated with cranioveebral anomaly. o Most common cranial nerve dysfunction is hearing loss o Pupillary asymmetry usually results due to abnormality of 2"d or 3rd nerve. o The 2"d nerve is coical and 3rd nerve is related to the mid brain so quiet obviously they will not get involved in cranioveebral junctional anomaly.
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Malignant hypehermia (MH) or malignant hyperpyrexia is a rare life-threatening condition that is usually triggered by exposure to ceain drugs used for general anesthesia -- specifically the volatile anesthetic agents and succinylcholine, a neuromuscular blocking agent. In susceptible individuals, these drugs can induce a drastic and uncontrolled increase in oxidative metabolism in skeletal muscleRef: Ganong&;s review of medical physiology; 24th edition; page no: 320
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Ans. is 'c' i.e., Mass t/t with mebendazole o No drug is suitable for effective mass treatment of Dracunculiasis. o The drugs effective for t/t of cases of Dracunculiasis Niridazole Mebendazoel Metronidazole
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Ans. is 'b' i.e., Gluteus mediusAttachments of greater trochanter (GT) All are inseionsPa of GTMuscle inseedApex (tip) of GTPiriformisAnterior surface (lateral pa)Gluteus minimusLateral surfaceGluteus mediusMedial surfaceObturator internus & two gemelliTrochanteric fossaObturator externus
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The total body radical burden can be estimated by measuring the products of lipid peroxidation:
FOX (Ferrous Oxidation in Xylenol) Assay
Lipid peroxides can be measured by the ferrous oxidation in xylenol orange (FOX) assay. Under acidic conditions, they oxidize Fe 2+ to Fe 3+, which forms a chromophore with xylenol orange.
Estimation of Dialdehydes
‒ The dialdehydes formed from lipid peroxides can be measured by reaction with thiobarbituric acid, when they form a red fluorescent adduct. The results of this assay are generally reported as total thiobarbituric acid reactive substances,TBARS.
Measurement of Pentane and Methane in Exhaled air
‒ Peroxidation of ω-6 polyunsaturated fatty acids leads to the formation of pentane, and of-ω3 polyunsaturated fatty acids to ethane, both of which can be measured in exhaled air.
Reference- Review of biochemistry by Rebecca James Perumcheril Pg-412
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Involution forms - phase of decline.
Sporulation - stationary phase.
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Ans. is 'a' i.e., Halothane All inhalational agent cause mild hepatotoxicity by decreasing hepatic blood flow. Isoflurane is the agent of choice in liver disease as it has least effect on Hepatic blood flow. Direct hepatotoxicity (Hepatitis,Hepatic necrosis) is caused by :- Halothane, Chloroform, trilene, methoxyflurane
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Ans. is a, i.e. FSHRef: Novaks p1143In males with oligospermia, pregnancy rates have been improved by administering exogenous FSH. Clomiphene citrate can also benefit to some extent but not as much as FSH.
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Loosely wound spiral forms on peripheral blood smear shows Borrelia. Diagnosis is relapsing fever. Louse-borne/Epidemic Relapsing fever Tick-borne/endemic relapsing fever Cause-Borrelia recurrentis At least 15 spp- B.duttonii, B.parkeri, B.hermsii B. turicata Tends to occur as epidemic Sporadic cases in endemic areas Vector-body louse Vector-soft tick Inoculation of louse feces into skin Transmitted by bite of soft tick No extra-human reservoir Rodents and other mammals Disease -severe. Disease -milder. CFR-4-40% CFR-1-4% Relapses-1/2 Frequent relapses
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D i.e. Malunion with gunstock deformity
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.Indications for thoracotomy * Haemothorax more than 1500 ml found when ICT is placed or hourly collection in ICT is 200- 300 ml * ICT placed shows persistent drainage of blood * Diaphragmatic injury * When associated with liver and spleen injuries * Bronchus and major vessel injuries * Haemopericardium * Oesophageal and thoracic duct injuries. ref:SRB&;s manual of surgery,ed 3,pg no 1061
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Testicular tumors MC presentation is a nodule or painless swelling of one gonad. 10% patients present with acute pain or manifestation due to secondaries like neck or abdominal masses, GI disturbances, respiratory or CNS symptoms, bone pain or lumbar backache due to nerve roots involvement by bulky retroperitoneal disease Secondary hydrocele is also seen in 5-10% cases 5% GCT may present with gynecomastia as a systemic endocrine manifestation Gynecomastia is more common seen with sex cord or gonadal stromal tumors (Leydig cell tumor, seoli cell tumor, Granulosa cell tumor/Theca cell tumor) Majority (2/3rd) of seminoma are confined to testis at the time of presentation, whereas majority of non-Seminomatous GCT have widespread metastasis at presentation Many patients would present with a history of trauma, but trauma merely draws the attention of the patients and has no etiological association with tumor Any patients with a solid form intra testicular mass must be considered to have testicular tumor unless otherwise proved Bilateral testicular tumors Bilateral testicular tumors are seen in 1-2% cases Primary bilateral testicular tumors have Tendency of same histology on both sides Seminoma is the MC histological finding in bilateral primary testicular tumor, whereas malignant lymphoma is the MC bilateral testicular tumor Ref: Bailey and love 27th edition Pgno : 1506
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Echinococcus granulosus is dog tapeworm. It is not an STD. Trichomonas is the only parasite causing STD. Molluscum contagiosum is a virus causing STD, whereas candida albicans is a fungus causing STD and T.pallidum is a bacteria causing STD Ref: Ananthanarayan& Paniker&;s textbook of microbiology, 9th edition.
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Biopsy can cause profuse bleeding, therefore should be avoided.
Investigations used for NFA are :-
Soft tissue lateral film of nasopharynx
X-ray paranasal sinus and base of skull
Contrast CT of skull (investigation of choice)
MRI
Carotid angiography
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There are two distinct goals of drug therapy in CHF:(a) Relief of congestive/low output symptoms and restoration of cardiac performance: Inotropic drugs--digoxin, dobutamine/ dopamine, amrinone/milrinone Diuretics--furosemide, thiazides Vasodilators--ACE inhibitors/AT1 antagonists, hydralazine, nitrate, nitroprussideb blocker--Metoprolol, bisoprolol, carvedilol (b) Arrest/reversal of disease progression and prolongation of survival:ACE inhibitors/AT1 antagonists (ARBs)b blockers Aldosterone antagonist--Spironolactone KD TRIPATHI ESSENTIALS OF MEDICAL PHARMACOLOGY 6TH EDITION : pg 519
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Placenta pre
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Exotoxins produces by C. Perfringens *Alpha toxin(lecithinase) - detroys RBC& WBC *phi toxin- myocardial depression *kappa toxin-destruction of connective tissue and blood vessels Ref:Bailey and love 27th edition Pg no :420
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(Refer: AK Khurana Comprehensive Ophthalmology, 6th edition, pg no. 67 - 71) Arlt's line is a conjunctival sign (not corneal)Signs of TrachomaConjunctival signs:- Congestion, conjunctival follicles (boiled sagograin like), Papillary hyperplasia, conjunctival scarring (Arlt's line), ConcretionCorneal signs:- superficial keratitis, Herbe follicles, pannus, Corneal ulcer, Herbe pits, corneal opacity Arlt's line is a thick band of scar tissue in the conjunctiva of the eye, near the lid margin, that is associated with eye infections. Arlt's line is a characteristic finding of trachoma, an infection of the eye caused by Chlamydia trachomatis.
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Cisplatin belongs to the group of medicines known as alkylating agents. It is used to treat cancer of the bladder, ovaries, and testicles. It is a platinum coordination complex that is hydrolysed intracellularly to produce a highly reactive moiety which causes cross linking ofDNA. Theoured siteis N&;ofguanineresidue. It can also react with -SH groups in proteins and has radiomimetic propey. It is bound to plasma proteins, enters tissues and is slowly excreted unchanged in urine with a tlh about 72 hrs. Negligible amounts enter brain.Leukemia is cancer of the body&;s blood-forming tissues, including the bone marrow and the lymphatic system. Alkylating agents are chemo drugs that interfere with a cell's DNA in a ceain way. These drugs can sometimes cause AML and MDS. Often MDS develops first, which then progresses to AML. The chemo drugs cisplatin and carboplatin are not an alkylating agents, but they attack cancer cells in much the same way. These drugs seem to increase the risk of leukemia (mainly AML), too, but the risk is not as great as with the alkylating agents. This leukemia is hard to treat and tends to have a poor outcome, much like the leukemia linked to the alkylating agents. The risk of leukemia rises as the amount of drug used gets higher. The risk of developing leukemia increases even more if radiation is given along with cisplatin or carboplatin. REFERENCE:ESSENTIALS OF MEDICAL PHARMACOLOGY(K.D.TRIPATHI,SIXTH EDITION,PAGE NO:827) www.mayoclinic.org
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Bronchogenic carcinoma accounts for 70-80% of all cases of superior vena cava (SVC) obstruction; primary mediastinal tumors are the second most common cause. The main bronchial lymphatics are located at the tracheal bifurcation and immediately to the right and left of the trachea. Tuberculosis and mycotic infections are the most likely causes of chronic fibrosing mediastinitis.
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In the fetus, the spinal cord and the veebral column are of the same length. Since the veebral column grows faster, the spinal cord retracts. It ascends upwards and reaches the level of lower border of L3 at bih and lower border of L1 in adults.
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Its life cycle begins when cysts rupture and release sporozoites, which mature into trophozoites that eventually form cysts. The diagnostic methods for P. carinii pneumonia (PCP) have progressed from open lung biopsy to bronchoalveolar lavage (BAL) and induced sputum analysis . Ref Harrison20th edition pg 1056
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Connections in Basal ganglia
Substantia nigra pars compacta (SNPC) to Striatum (Caudate nucleus & Putamen)- Dopaminergic
Striatum to Substantia nigra pars reticulata (SNPR)- GABA
Striatum to Globus pallidus inner segment & external segment- GABA
Globus pallidus external segment to subthalamic nucleus and internal segment- GABA
Subthalamic nucleus to Globus pallidus external segment and internal segment.- Glutamate
Within the striatum- Cholinergic interneurons.
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