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Refer Katzung 11/e p863 Unlike other protease inhibitors atazanvir6 does not appear to be associated with dyslipidemia ,fat redistribution or metabolic syndrome
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ANSWER: (B) Mastoid air cellsREF: Dhingra 4th ed p. 383Laws viewIt is the lateral oblique view of the mastoid.The patient lies in such a way that the sagittal plane of the skull is parallel to the film and X-ray beam is projected 15deg cephalocaudal Structures seen are:External auditory canal superimposed on the internal auditory canalMastoid air cellsTegmenLateral sinus plateTemporomandibular joint.(Key area of the mastoid, i.e. attic, aditus, and antrum are not well seen)Schuller's viewSimilar to Law's view but cephalocaudal beam makes an angle of 30deg to the sagittal.Structures seen are:External canal superimposed on the internal canalMastoid air cellsTegmenLateral sinus plateCondyle of mandibleSino-dural angleAntrum and upper part of the attic (i.e. key area).(This view is taken to see the extent of pneumatization, destruction of intercellular septa as in mastoiditis, the location of sinus plate and tegmen, cholesteatoma and longitudinal fracture of the petrous pyramid)
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Ans. a (Bicalutamide). (Ref. Bailey and Love 25th/108)BICALUTAMIDE# is an anti-androgenic drug used in prostatic cancer therapy for medical castration.# The addition of actual antagonists of androgens acting at the androgen receptor, including flutamide or bicalutamide, is of uncertain additional benefit in extending overall response duration, but it clearly prevents the activation of androgen receptors by adrenal androgens, and the combined use of orchiectomy or leuprolide plus flutamide is referred to as "total androgen blockade."# Other hormones that may be active include estrogens, progestins, ketoconazole, and glucocorticoids.TamoxifenBlocks oestrogen receptorsBreast cancerAnastrazoleAn aromatase inhibitor that blocks post-menopausal (non- ovarian) oestrogen productionBreast cancerExemestaneAn aromatase inhibitor that blocks post-menopausal (non- ovarian) oestrogen productionBreast cancerLetrozoleAn aromatase inhibitor that blocks post-menopausal (non- ovarian) oestrogen productionBreast cancerLeuprolideAnalogue of gonadotrophin-releasing hormone; continued use produces downregulation of the anterior pituitary with a consequent fall in testosterone levelsProstate cancerGoserilinAnalogue of gonadotrophin-releasing hormone; continued use produces downregulation of the anterior pituitary with a consequent fall in testosterone levelsProstate cancerBuserelinAnalogue of gonadotrophin-releasing hormone; continued use produces downregulation of the anterior pituitary with a consequent fall in testosterone levelsProstate cancerCabergolineBlocks prolactin release, a long-acting dopamine agonistProlactin-secreting pituitary tumorBromocriptineDopamine agonist, blocks stimulation of the anterior pituitaryPituitary tumoursCyproterone acetateBlocks the effect of androgensProstate cancerFlutamideBlocks the effect of androgensProstate cancerNilutamideBlocks the effect of androgensProstate cancerBicalutamideBlocks the effect of androgensProstate cancerEducational Points:# Prostate cancer is classically treated by diethylstilbesterol (DES) acting as an estrogen at the level of the hypothalamus to down-regulate hypothalamic LH production, resulting in decreased elaboration of testosterone by the testicle. For this reason, orchiectomy is equally as effective as moderate-dose DES.# In the event that orchiectomy is not accepted by the patient, testicular androgen suppression can also be effected by luteinizing hormone-releasing hormone (LHRH) agonists such as leuprolide and goserelin.# Primary hormonal manipulation in prostate cancer one can choose orchiectomy or leuprolide, not both.
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Rapid progression of disease with full-blown manifestation in AIDS occurs when CD4 T cell count falls below 200/µL.
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Ans. is 'd' i.e., Multipolar * All skeletal muscles are supplied by motor neurons which are multipolar neurons.* There are following types of neurons1) Unipolor neurons These neurons have one process, with different segments (of that one process) serving as dendrite (receptive surfaces) as well as axons (releasing terminals). It is found in invertebrates.2) Bipolar neurons These are neurons with a dendrite and an axon, e.g. bipolar cells of retina.3) Pseudounipolar neurons (subclass of bipolar neurons) The neuron develops, a single process splits into two, both of which functions as axons, - one going to skin or muscle and another to spinal cord, e.g. dorsal root ganglion.4) Multipolar neurons These have one axons and many dendrites, e.g. motor neuron, pyramidal cell of hippocampus and cerebellar purkinje cells.
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Cytochrome oxidase is a hemoprotein widely distributed in many tissues, having the typical heme prosthetic group present in myoglobin, hemoglobin, and other cytochromes.Ref: Harper Biochemistry; 30th edition; Chapter 12; Biologic Oxidation
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Refer kDT 6/e p 484 ACE inhibitors of the first choice drugs with diabetic patient with hypeension. These are however contraindicated in pregnancy and other conditions mentioned in the questions
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Persistent mood disorders are characterised by persistent mood symptoms which last for more than 2 years but are not severe enough to be labelled as even hypomania or mild depressive episode. If the symptom consists of persistent inability of mood between mild depression and mild elation, the disorder is called as cyclothymia (Ref: a sho textbook of psychiatry, Niraj Ahuja,7th edition, pg no73)
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The red nucleus is diagnostic of midbrain division at the level of the superior colliculus; it lies between the occulomotor nucleus (CN III) and the substantia nigra. fig:- crossection at the level of Superior colliculus Midbrain
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Clostridium tetani is a Gram-positive, slender bacillus. Spores are spherical and bulging, giving the bacillus characteristic drumstick appearance. It is non-capsulated and motile by peritrichate flagella. Reference: Textbook of Microbiology; Anathanarayan and paniker's; 10th edition; Page no: 264
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RLE in Haem Synthesis is - ALA Synthase ALA Synthase I : Expressed throughout the body. (Rate limiting step in liver) ALA Synthase II: Expressed in erythroid tissues
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Autoimmunity is the system of immune responses of an organism against its own healthy cells and tissues. Any disease that results from such an aberrant immune response is termed an autoimmune disease. Prominent examples include celiac disease, diabetes mellitus type 1, sarcoidosis, systemic lupus erythematosus (SLE), Sjogren's syndrome, eosinophilic granulomatosis with polyangiitis, Hashimoto's thyroiditis, Graves' disease, idiopathic thrombocytopenic purpura, Addison's disease, rheumatoid ahritis (RA), ankylosing spondylitis, polymyositis (PM), and dermatomyositis (DM). Autoimmune diseases are very often treated with steroids.
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B i.e. Pelvis
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Ans. is 'c' i.e., Antibodies appear in sho time Primary response Secondary response . Slow . Fast . Sluggish . Powerful . Sho lived . Prolonged (antibody persists for long) . Long lag phase . Sho or negligible lag phase (Antibody appears in sho time) . Predominant IgM . Predominant IgG * Antibody is more specific . Antibody is less specific . Antibody is less avid . Antibody is more avid . Qualitative response . Quantitative response
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Ans. (d) More common in males between 30-40 years of ageDiabetes mellitus and Gall stones:* Diabetes though not a direct risk factor for gall stones- the following factors in diabetes may increase the chance of getting Gall stones:# Increased Bile Cholesterol# Poor GB motility# Decreased Bile Acids
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Ans; B (Hallucination) Table 79-2 (Harrison 18th/638): Diagnostic Features of Anorexia NervosaRefusal to maintain body weight at or above a minimally normal weight for age and height. (This includes a failure to achieve weight gain expected during a period of growth leading to an abnormally low body weight.)Intense fear of weight gain or becoming fat.Distortion of body image (e.g... feeling fat despite an objectively low weight or minimizing the seriousness of low weight).Amenorrhea. [This criterion is met if menstrual periods occur only following hormone--e.g, estrogen--administration.)Table 79-l (Harrison 18th/637): Common Characteristics of Anorexia Nervosa, Bulimia Nervosa, and Binge Eating Disorder Anorexia Nervosa3Bulimia Nervos3Clinical characteristicsOnsetMid-adolescenceLate adolescence/ early adulthoodFemale: male10:110:1Lifetime prevalence1% of women1-3% of womenWeightMarkedly decreasedUsually normalMenstruationAbsentUsually normalBinge eatingh25-50%Required For diagnosisMortality~5% per decadeLowPhysical and laboratory findings1Skin/extremitiesLanugoCallus/abrasion on dorsum of hand AcrocyanosisEdema CardiovascularBradycardia Hypotension GastrointestinalSalivary gland enlargementSlow gastric emptyingConstipationElevated liver enzymesSalivary gland enlargementDental erosionHematopoieticNormochromic, normocytic anemiaLeukopenia Fluid/Electrolyteincreased BUN, creatinineHypokalemiaHypophosphatemia,HypomagnesemiaHypokalemiaHypochloremiaAlkalosisEndocrineHypoglycemiaLow estrogen or testosteroneLow LH and FSHLow-normalthyroxineNormal TSHIncreased cortisol BoneOsteopeniaPatients with anorexia nervosa who frequently induce purging may also exhibit the physical and laboratory findings associated with bulimia nervosa./Obese patients with binge eating disorder are at risk for complications of obesity,
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c. Promyelocytic leukemia(Ref: Nelson's 20/e p 2442-2443, Ghai 8/e p 605-607)This patient has complaints of bleeding along with thrombocytopenia, decreased fibrinogen & increased PT & APTT. This is consistent with DIC; DIC is most commonly seen with M3 AML
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* Initial Investigation in a patient with abdominal trauma is USG to detect hemoperitoneum * Investigation of choice to know the source of hemoperitoneum in a stable patient is CECT-Abdomen. Radiological evaluation of abdominal trauma in emergency:
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D i.e. Topical permethrin
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Ans. is 'a' i.e., Gonococcal Ophthalmia neonatorum:o Ophthalmia neonatorum, also called neonatal conjunctivitis, is the conjunctivitis in the first month of life. Infection may be acquired during birth from infected birth canal (most common) or after birtho The causative agents are: -i) Common organisms are:- Gonococcus, C. trachomatis, Herpes simplex virus. Other organisms are: - Staphylococcus aureus, pneumococcus, Streptococcus, Pseudomonas, Serratia, Klebsiella.ii) Chemical conjunctivitis :- Caused by use of silver nitrate or antibiotic prophylaxis.Clinical features:o Clinical features depend upon the type of ophthalmia neonatorum :i) Infective ophthalmia neonatorum: - Pain, tenderness, purulent or mucopurulent discharge, swollen lids, chemosis & conjunctival hyperaemia.ii) Chemical ophthalmia neonatorum: - Watery discharge, minimal or no edema or chemosis, self limited course of to 2 days postpartum.
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- for children between 4-8 years, the dose of chloroquine per day is 300 mg. - 2 tablets of chloroquine 150mg base is provided. Reference : Park's textbook of preventive and social medicine, 23rd edition pg no:264 <\p>
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Ans. is 'c' i.e., Topiramate o Use of topiramate is limited by its unwanted side effects paicularly weight loss, sedation and naming difficulties. Note - Other drug causing weight loss is Felbamate.
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In cocaine test - normal pupil dilates whereas Horner's pupil doesnot.
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Atropine is used for all the given four objectives (has been explained in previous explanations).
However, the primary objective of atropine is to relieve ciliary spasm and give rest to ciliary muscles.
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Ans. Dextrodepression
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Esophageal perforation Iatrogenic Spontaneous Most common type Caused by endoscopy MC site is cervical esophagus (cricopharyngeal area) Esophageal rupture after vomiting MC site: left posterolateral side of the distal esophagus
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Ans. c. Rat
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Ans. (a) Bladder cancer* The IVP cystogram shows a filling defect in left side of bladder.* It looks like a mass like filling defect in TCC bladder
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D i.e. Oblique view
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Danazol Isoxazole derivative of 17 - alpha ethinyl testosterone propeies Causes atrophy of endometrium It is strictly antigonadotropin but acts as an androgen agonist Mode of action Acting on the hypothalamo - pituitary - gonadal axis - depression of frequency of GnRh pulses - suppression of pituitary FSH and LH surge. There is however no change in the basal gonadotropin level Indication of danazol Endometriosis DUB Symptomatic fibroid Precocious pubey
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α - 1 Antitrypsin deficiency - Autosomal recessive.
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Ans. 5.4 to 7.9
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Ans. is 'a' i.e., Femur Splints Any material which is used to suppo a fracture is called splint. Splints are used for immobilizing fractures; either temporarily during transpoation or for definitive treatment. The most commonly employed splints is plaster of paris (POP) splint. Various POP splints are:- 1) Casts : - Here the POP roll completely encircles the limb. 2) Slab : - It is not completely encircles the limb, but only one half or one third circumference. 3) Spica : - This encircles a pa of the body; e.g., hip spica for fractures around hip.
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A i.e. Aldosterone
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Ans. B i.e. TSH dependent The rate of growth of papillary carcinoma thyroid may be stimulated by TSH Thyroid medullary Ca/ MTC 80% cases are sporadic, 20% are familial (MEN-Ha or MEN-Hb), MTC is the first abnormality expressed in MEN-Ha/ Ilb, Stroma of MTC shows material with staining propeies of amyloid, MTC can be diagnosed by demonstrating calcitonin within the MTC cells (on immuno-histochemical studies), Total thyroidectomy is the TOC
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Cancrum Oris (also k/a Noma and Gangrenous stomatitis) :
Cancrum Oris is now rarely seen in developed countries but is still not uncommon in many developing countries.
It is a gangrenous process of the mouth, which starts suddenly, rapidly involve the adjacent tissues of the face, quickly becomes well demarcated, and then spreads no further. It most often affects one or both sides of the jaw, and occasionally the front of the face (mouth, lips, nose & chin). The gangrenous process may spread to destroy the bones of the face.
This disease occurs primarily in a severely malnourished child less than 5 yrs of age. Often they have had a preceding illness such as measles, malaria, scarlet fever, tuberculosis, malignancy or immunodeficiency, which has weakened the general health of the child.
The exact cause is not known but may be bacterial. Fusiformis & Borrelia are largely responsible, but the ds. is not contagious.
Untreated Cancrum Oris is almost always quickly fat.: due to associated illness or a complication, such as a septicemia or aspiration pneumonia.
Management involves :
correction of the general condition.
antibiotics (Penicillin + Metronidazole).
Excision of the dead tissue.
Plastic surgery.
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Ans. 1% burns
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Lesions of psoriasis are non-pruritic or only mildly pruritic
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<p>. Developmental milestones:- GROSS MOTOR DEVELOPMENT: 2 months: Holds head in plane of rest of the body when held in ventral suspension. In prone position in bed, the chin lifts momentarily. 3 months:lift head above the plane of the body. Head control stas by 3 months and fully developed by 5 months. 4 months:Remain on forearm suppo if put in prone position, lifting the upper pa of the body off the bed. 5 months: Rolls over. 6 months:sit in tripod fashion. 8 months: sits without suppo., crawling 9 months: Takes a few steps with one hand held. Pulls to standing and cruises holding on to furniture by 10 months. 10 months: creeps 12 months:creeps well, walk but falls, stand without suppo. 15 months: walks well, walks backward/ sideways pulling a toy. May crawl upstairs. 18 months: Runs, walks upstair with one hand held. Explores drawers 2 years: walk up and downstairs, jumps. 3 years : rides tricycle, alternate feet going upstairs. 4 years: hops on one foot, alternate feet going downstairs. 5 years:skips FINE MOTOR DEVELOPMENT:- 2 months- eyes follow objects to 180 deg. 3 months-Grasp reflex disappears and hand is open most of the time. 4 months- Bidextrous approach( reaching out for objects with both hands). 6 months- Unidextrous approach( Reach for an object with one hand).transfer object from one hand to other. 8 months- radial grasp sta to develop. Turns to sound above the level of ear. 9 months- immature pincer grasp, probes with forefinger. 12 months-Unassisted pincer grasp. Releases object on request.Uses objects predominantly for playing, not for mouthing. Holds block on each hand and bang them together. 15 months- imitate scribbling , tower of two blocks 18 months- scribbles, tower of 3 blocks.turn pages of a book, 2-3 at a time. 2 years- tower of 6 blocks, veical and circular stroke. 3 years-Tower of 9 blocks, dressing and undressing with some help, can do buttoning. 4 years- copies cross, bridge with blocks 5 years- copies triangle, gate with blocks. SOCIAL AND ADAPTIVE MILESTONES: 2 months: social smile(smile after being talked to).watches mother when spoken to and may smile. 3 months:Recognizes mother, anticipates feeds. 4 months: Holds rattle when placed in hand and regards it . Laughs aloud. Excited at the sight of food. 6 months:recognizes strangers, stranger anxiety . Enjoy watching own image in mirror, shows displeasure when toy pulled off. 9 months:waves bye bye 12 months:comes when called, plays simple ball game.kisses the parent on request. Makes postural adjustments for dressing. 15 months:jargon, stas imitating mother. 18 months: copies parents in tasking, dry by day, calls mother when he wants potty, points to three pas of body on request. 2 years: ask for food, drink, toilet, pulls people to show toys. 3 years:shares toys, know fullname and gender, dry by night. 4 years:Plays cooperatively in a group, goes to toilet alone, washes face, brushes teeth. Role play . 5 years:helps in household task , dresses and undresses. LANGUAGE MILESTONES: 1 month: Ales to sound. 2 month:respond to sound by stale or quitening to a smooth voice. 3 months: babbles when spoken to. Makes sounds (ahh,coos, ) laughs. 4 months: laughs aloud. 6 months: monosyllables 9 months: understands spoken words, bisyllables. 12 months: 1-2 words with meaning. 18 months: vocabulary of 10 words. Can name one pa of body. 2 years: 3 word simple sentences 3 years:asks questions, knows full name and gender. 4 years: says songs or poem, tells story, knows three colours. 5 years: ask meaning of words. {Reference: GHAI Essential pediatrics, eighth edition}
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Ans. is 'a' i.e., Cerebral edema o Two ty pes of neurological disturbance are unique to patients on chronic dialysis.A) Dialysis dementiaQB) Dialysis disequilibriumQDialysis dementia -o It may occur in patients who have heen on dialysis for many years0 and is characterized by dyspraxia, myoclonus, dementia and eventually seizure and death.o The major contribution to this syndrome is Aluminium intoxicationQ.Dialysis disequilibrium -o This occurs during first few weeksQ of dialysis and is associated with rapid reduction in blood urea levels0. It manifests clinically with nausea, vomiting, drowsiness, headache and rarely seizures.o This syndrome has been attributed to cerebral edema & increased intracranial pressureQ due to the rapid (dialysis induced) shift of osmolality and pH between extracellular and intracellular fluids.
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- Since Infants are initially obligate nasal breathers- Bilateral choanal atresia can cause significant airway distress in newborn - With complete nasal airway obstruction in the newborn, cyanotic episodes are frequent and may be alleted during crying, a phenomenon known as cyclical cyanosis.
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Ans. C: Pernicious anemia Leukocyte alkaline phosphatase is a test how much alkaline phosphatase (ALP) is inside white blood cells. A. Higher-than-normal results may be due to: Leukemoid (leukemia-like) reaction Myelofibrosis Polycythemia vera. B. Lower-than-normal results may be due to: Aplastic anemia Chronic granulocytic leukemia Pernicious anemia.
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A seems to be better answer though even the liver cells can produce a small amount of von willibrand factor.(ref Robbins 8th/670-671,9/e661)
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Fistula- normal anion gap is seen CAUSES OF NON ANION GAP METABOLIC ACIDOSIS(NAGMA)
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Ans. (a) CNS(Ref: Harrison 18th/pg Chapter 189)Lymphoma in HIV90% of lymphomas in HIV are B cell in phenotype; more than half contain EBV DNA.Immunoblastic lymphomas account for 60% of the cases of lymphoma in patients with AIDS.Primary CNS lymphoma accounts for 20% of the cases of lymphoma in patients with HIV infection.Most common extranodal site involved in Lymphoma in HIV is the CNS, which is involved in one-third of all patients with lymphoma.
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Answer is B (vitamin Bp is Deficiency) Presence of anemia (Hb= 6gm%) Macrocytosis (MCV=104) and decreased vitamin B12 levels (B12=60 pg/ml) suggests a diagnosis of megaloblastic anemia due to vitamin B12 deficiency. Reference values from Harrison's Appendix A Parameter Normal Values Patient value Inference Hb 13-18 g/dl 6 gmldl Anemia HCV 79-93.3/L 104 fL Macrocytosis Vitamin B12 >250 pg/ml 60 pg/mI Vitamin B12 deficiency Folic Acid 5.4-18.0 ng/ml 8 ng/ml Normal folate levels Iron 30-160 ug/dl 160 ug/dl Normal The patient in question, thus has a macrocytic anemia due to vitamin B12 deficiency.
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B i.e. Seraline
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In any cell or tissue other than muscle, glycogen give rise to glucose which is phosphorylated by hexokinase to glucose-6-phosphate using ATP and then undergo fuher glycolysis. However, Muscle lacks glucose-6-phosphatase which conves glucose-6-P produced for glycogen to glucose in other cells. So, the glucose-6-phosphate formed in glycogen degradation in muscles can directly enter the glycolysis without the need for ATP-requiring hexokinase reaction (See fig above). Thus, one less ATP is required for the investment stage of glycolysis in muscles only. Hence, net yield of ATP increases by 1. If staing material is ATPs Obtained glucose 2 ATPs glucose-6-phosphate 3 ATPs
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Ans. (a) Inhibits plasminogenRef Lippincott's Pharmacology 4/e, p 265
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Ans. is 'c' i.e., Dopamine o Dopamine acts on dopamine (D1 & D2) and adrenergic (a1 + a2 + b1) receptors, with no action on b2 receptorso Dobutamine is a relatively selective b1 agonist. Though it acts on both a and b receptors, the only prominent action of clinically employed doses is its b1 action, i.e. an increase in force of cardiac contraction and output, without a significant change in HR., BP and Peripheral resistance.
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Ans. is 'c' i.e., M. Marinum * 'Fish tank granuloma', also called 'swimming pool granuloma', is caused by M. marinum.
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The markers for myeloid series are CD13, CD33, CD 11b, CD15, CD117 and cMPO. c MPO is the most lineage specific marker amongst these. Regarding other options, CD 34 - Myeloid and lymphoid blasts, stem cells, CD 45 - Leukocyte common antigen (nonerythroid hematopoietic cells), CD 99 - Ewing's sarcoma/primitive neuroectodermal cells.
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Naproxen: The anti-inflammatory activity is stronger and it is particularly potent in inhibiting leucocyte migration - may be more valuable in acute gout: dose 750 mg stat followed by 250 mg 8 hourly till attack subsides. It is also recommended for rheumatoid arthritis and ankylosing spondylitis. Because of longer t ½ , regular use can effectively suppress platelet function. Gastric bleeding is more common than with ibuprofen. Naproxen carries lower thrombotic risk than diclofenac, etoricoxib, etc. Dose should be reduced in the elderly.
Naproxen is marketed as active single S(-) enantiomer preparation, which poses less renal burden. However, some R(+) enantiomer is formed in vivo due to inversion.
Uricosuric drugs like probenecid and sulfinpyrazone are ineffective in the presence of renal insufficiency.
Allopurinol is a drug of choice for most cases of chronic gout. Renal impairment increases the incidence of rashes and other reactions to allopurinol.
Reference: Essentials of Medical Pharmacology Eighth Edition KD TRIPATHI page no 217
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Ans. is 'd' i.e., Adrenal glands
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Ans: c (Perisinus abscess) Ref: Dhingra, 3rd ed, 109; 4th ed, p. 77All the given abscess are extracranial location except perisinus abscess, which is located in relation to lateral sinus, an intracranial structure.Perisinus abscess: Abscess formed in relation to outer dural wall (sigmoid sinus/lateral sinus). Bony dural plate may remain intactOutcomes or It may be destroyed by coalescent bone erosion & cholesteatomaComplications of CSOMExtracranialIntracranialMastoiditisExtradural abscessPetrositisSubdural abscessLabrynthitisBrain abscessFacial nerve paralysisMeningitis Lateral sinus thrombosis Otitic hydrocephalausAbscess seen in relation to mastoid1. Post auricular abscess - commonest abscess over mastoid2. Zygomatic abscess3. Bezold abscess-following a/c coalescent mastoiditis when pus breaks through the thin medial side of tip of mastoid.4. Meatal abscess (Luc abscess) -Pus breaks through the bony wall between antrum and external osseous meatus.5. Citellis abscess-Behind the mastoid (Remember post auricular abscess is formed over the mastoid)6. Parapharyngeal abscess & retropharyngeal abscesses.
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Cause of Hashimoto thyroiditis,is autoimmune-mediated destruction of thyrocytes. A complex immunologic phenomenon results in the formation of immunecomplexes and complement in the basement membrane of follicular cells. These cellular reactions ultimately result in the infiltration of lymphocytes and resultant fibrosis, which decreases the number and efficiency of individual follicles. Thus leading to hypothyroidism Huhle cell (oncocytes) changes are seen in Hasimotos thyroiditis. Orphan annie eye nuclei are seen in papillary carcinoma thyroid. Source Sabiston 20th edition Pg : 891
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SPORE PRODUCING BACTERIA
• B. anthrax and subtilis
• Sporosarcina
• Clostridia
• Coxiella burnetti
Mnemonic = BSc Chemistry
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Ans. D: Gentamycin
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EXPOSURE TIME (s):
Changing the exposure time—typically measured in fractions of a second (s)—modifies the duration of the exposure and thus the number of photons generated. When the exposure time is doubled, the number of photons generated at all energies in the X-ray emission spectrum is doubled. The range of photon energies is unchanged.
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Ans. D. Female preponderance of 9:1Scleroderma or Systemic Sclerosis is an autoimmune rheumatic disease in which there is a 4:1 female predominance. A wide spectrum of clinical features are seen in Scleroderma:* Severe pruritus* Initially, scleroderma patients experience puffiness and non-pitting edema of fingers.* The skin later becomes indurated, thickened, and fixed to underlying structures resulting in sclerodactyly.* Vasospasm and Digital ulceration* Around 90% of patients suffering from scleroderma, have dysphagia, and GERD at the level of esophagus.* Mask like facies is seen due to the waxy nature of skin and lack of wrinkles.Typical facial features: note the expressionless facies, mat-like telangiectases, microstomia, perioral furrowing and beak-like nose.Digital UlcerationAdvanced-stage sclerodactyly with contractures and vasculopathic ulcers over the bony prominences
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Ans. is `c i.e., Liver Malignant melanoma mostly arise in uvea and uveal malignant melanoma is the most common primary intraocular tumor. The most common site for distant metastasis of uveal melanoma is liver. The liver is the most common site of metastasis of uveal melanoma" -- Clinical oncology The liver is the most common site of metastatis from primary ocular melanoma" -- Smith & Nesi's Uveal melanoma Uveal melanoma is the most common primary intraocular tumor in adults. Most of the (85%) uveal melanomas arise in the choroid. So, choroidal melanoma is the most common primary intraocular tumor in adults. Tumor arises from dendritic melanocytes (neural crest, neuroectodermal origin). Histologically choroidal melanoma can be divided into: - Spindle cell melanomas : - These melanomas contain predominantly spindle cells. These melanomas are fuher subdivided into Spindle A or Spindle B depending upon the type of cells. Epitheloid cell melanomas : - Contain epitheloid like cells. Mixed cell melanomas : - Contain both spindle cells and epitheloid cells. Choroidal melanoma presents as a sessile or dome shaped mass located deep to the sensory retina. A secondary non-rheugmatogenous retinal detachment frequently occurs. Involvement of voex vein by tumor results in glaucoma. With continued growth, a choroidal melanoma can rupture Bruch's membane and assume a mushroom shape. When that occurs, tumor has a tendency to bleed, and vitreal or subretinal hemorrhage may occur.
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Ans. Ophthalmic nerve
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The inheritance of a number of birth defects is multifactorial. Most normal human traits are inherited neither as dominant nor as recessive mendelian attributes, but rather in a more complex manner. For example, multifactorial inheritance determines intelligence, height, skin color, body habitus, and even emotional disposition. Similarly, most of the common chronic disorders of adults represent multifactorial genetic diseases and are well known to "run in families." Such maladies include diabetes, atherosclerosis, and many forms of cancer and arthritis, and hypertension. The inheritance of a number of birth defects is also multifactorial (e.g., cleft lip and palate, pyloric stenosis, hypospadias, and congenital heart disease). The concept of multifactorial inheritance is based on the notion that multiple genes interact with various environmental factors to produce disease in an individual patient. Such inheritance leads to familial aggregation that does not obey simple mendelian rules (see choices A, B, D, and E). As a consequence, the inheritance of polygenic diseases is studied by the methods of population genetics, rather than by the analysis of individual family pedigrees.Diagnosis: Hypospadias, multifactorial inheritance
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Ans. is 'b' i.e., Proctodaeum * 'The lower third of the anal canal is an ectodermal derivative and is derived from the proctodaeum.'* Part of anal canal above pectinate line develops from dorsal part of endodermal cloaca (primitive rectum) and part of anal canal below pectinate line develops from ectodermal proctodeum.
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Ans. is 'd' i.e., > 95% o WHO's measles elimination strategy comprises a three part vaccination strategy, i.e.:-i) Catch-up - One-time, nationwide vaccination campaign targeting usually all children aged 9 months to 14 years regardless of history of measles disease or vaccination status.ii) Keep-up - Routine services aimed at vaccinating more than 95% of each successive birth cohort.iii) Follow-up - Subsequent nationwide vaccination campaign conducted every 2-4 years targeting usually all children bom after catch-up campaign.
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Ans. is 'c' i.e., Louis Pasteure Louis Pasteur is associated with : Development of live vaccine (first was anthrax). Development of vaccine for rabies (hydrophobia). Introduction of technique of sterilization. Disprove the theory of spontaneous generation (abiogenesis). Established the different growth need of different bacteria (helped in complex media). Coined the term vaccine.
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Ans. is 'c' i.e., Manganese Major causes of dilated cardiomyopathy (with common examples)Inflammatory myocarditisMatabolicInfectiveViral (Coxsackie. adenovirus, HIV, hepatitis C)Parasitic (T. cruzi- Chagas1 disease, toxoplasmosis)Bacterial (diphtheria)Spirochetal (Borellia burgdorferi-Lyme disease)Rickettsial- (Q fever)Fungal (with systemic infection)NoninfectiveGranulomatous inflammatoiy diseaseSarcoidosisGiant cell myocarditisHypersensitivity myocarditisPolymyositis, dennaiomyositisCollagen vascular diseasePeripartum cardiomyopathyTransplant rejectionNutritional deficiencies: thiamine, selenium, carnitineElectrolyte deficiencies: calcium, phosphate, magnesiumEndocrinopathy:Thyroid diseasePheochromocytomaDiabetesObesityHemochromatosisInherited Metabolic Pathway DefectsFamilial*Skeletal and cardiac myopathyDystrophin-related dystrophy (Duchenne's, Becker's)Mitochondrial myopathies (e.g. Kearns-Sayre syndrome)Arrhythmogenic ventricular dysplasiaHemochromatosisAssociated with other systemic diseases ToxicSusceptibility to immune-mediated myocarditisAlcoholCatecholamines: amphetamines, cocaineChemotherapeutic agents: (anthracyclines, trastuzumab)InterferonOther therapeutic agents (hydroxychloroquine, chloroquine)Drugs of misuse (emetine, anabolic steroids)Heavy metals: lead, mercuryOccupational exposure: hydrocarbons, arsenicalsOverlap with restrictive cardiomyopathy"Minimally dilated cardiomyopathy"HemochromatosisAmyloidosisHypertrophic cardiomyopathy ("burned-out") ''Idiopathic"Miscellaneous (Shared elements of above etiologies)Arrythmogenic right ventricular dysplasia (may also affect left ventricle)*Left ventricular noncompaction*Peripartum cardiomyopathy
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a. Intussusception(Ref: Nelson's 20/e p 1812-1814, Ghai 8/e p 287)Discussing about the options one by one,Option a.Recurrent intussusception is noted in 5-8%Advancing intestine can prolapse through the anus in intussusception and is distinguished from rectal prolapse by separation between the protruding intestine and the rectal wall, which does not exist in rectal proplaseOption b.Rectal prolapse usually occurs during defecation and is usually painless or produces mild discomfortOption c.There is no diarrhea in rectal prolapse, hernia and hemorrhoidsOption d.External hemorrhoids are associated with extreme pain & itchingInternal hemorrhoids (those located above the dentate line) manifest primarily with bleeding, prolapse and occasional incarceration
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Severe hepatotoxicity associated with steatohepatitis, most likely a result of mitochondrial toxicity, is being recognized with increasing frequency with antiretroviral therapy with reverse transcriptase inhibitors (e.g., zidovudine, didanosine) or protease inhibitors (e.g., indinavir, ritonavir. Reference: Harrisons Principles of Internal Medicine, 18th Edition, Page 2560
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Baby friendly hospitals initiatives It was launched in USA by combined effos of WHO & UNICEF Since 1993 WHO's effos to improve infant and young child nutrition have focused on promoting breast feeding. It has been calculated that breast feeding could prevent deaths of at least one million children a year. A new "baby-friendly hospital initiative" (BFHI), created and promoted by WHO and UNICEF, has proved highly successful in encouraging proper infant feeding practices, staing at bih. BFHI is suppoed by the major professional medical and nursing bodies in India. The global BFHI has listed ten steps which the hospital must fulfil. This includes: (1) Have a written breast-feeding policy that is routinely communicated to all health care staff; (2) Train all health care staff in skills necessary to implement this policy; (3) Inform all pregnant women about the benefits and management of breast- feeding; (4) Help mothers initiate breast-feeding within one half-hour of bih; (5) Show mother, how to breast-feed and maintain lactation, even if they should be separated from their infants; (6) Give newborn infants no food or drink other than breast milk, not even sips of water, unless medically indicated; (7) Practice rooming-in that is, allow mothers and infants to remain together 24 hours a day; (8) Encourage breast-feeding on demand; (9) Give no aificial teats or pacifiers (also called dummies or soothers) to breast-feeding infants; and (10) Foster the establishment of breast-feeding suppo groups and refer mothers to them on discharge from the hospital or clinic. The "Baby friendly" hospitals in India are also expected to adopt and practice guidelines on other interventions critical for child survival including antenatal care, clean delivery practices, essential newborn care, immunization and O Ref: Park 25th edition Pgno : 568
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The rate of systemic absorption is propoionate to the vascularity of the site of injection: intravenous > tracheal > intercostal > caudal > paracervical > epidural > brachial plexus > sciatic > subcutaneous. Ref: Morgan, Jr. G.E., Mikhail M.S., Murray M.J. (2006). Chapter 14. Local Anesthetics. In G.E. Morgan, Jr., M.S. Mikhail, M.J. Murray (Eds), Clinical Anesthesiology, 4e.
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HEREDITARY FRUCTOSE INTOLERANCE Aldolase B deficiency Symptoms appear on intake of fructose Aversion to sweet food C/F: Hypoglycemia Hepatomegaly Jaundice Vomiting Reducing substance in urine: POSITIVE - BENEDICT'S TEST T/t- Avoid fructose
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Transvaginal sonography (TVS) is the investigation of choice and is superior to Transabdominal sonography(TAS) for detecting placental abnormalities. Approach to placenta pre after confirmation by TVS at anomaly scan. Bleeding present: Individual management. No Bleeding/Minor Pre: Repeat USG at 36 weeks No bleeding/Major Pre or accreta: USG at 32 weeks followed by elective CS at 37 to 38 weeks. Note: Transabdominal sonographic assessment (TAS) of placental location is one of the standard components of the basic obstetrical ultrasound examination, and thus can be considered a screening test for placenta pre, however according to recent studies TVS generally provides a clearer image of the relationship between the edge of the placenta and the internal cervical os than transabdominal ultrasound. Randomized trials and prospective comparative studies have established the superior performance of TVS over transabdominal sonography for diagnosis of placenta pre. Ref: Williams Obstetrics 24th edition Pgno: 802
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Asymmetrical inflammatory oligoahritis - seen in psoriatic ahritis. - Occurs mostly in hands and feet. Synovitis of the finger or toe along with tenosynovitis, enthesitis and inflammation of the intervening tissue causes sausage digits.
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Disturbed sleeps as a result of depression is associated with increased REM sleep and decreased REM latency. Although hypersomnia can occur in depressive illness, insomnia is more common. Therefore it is hard to identify whether disturbances in sleep due to depression increase or decrease total sleep time. More vivid dreams is not identified as an association. Ref: Singer C.M., Applebee G.A. (2008). Chapter 28. Sleep Disorders. In M.D. Feldman, J.F. Christensen (Eds), Behavioral Medicine: A Guide for Clinical Practice, 3e.
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Ans. is 'b' i.e., NREM stage 3, 4 Slow wave sleep (stage 3 & 4 of NREM sleep) disorders :- Sleep walking (somnambulism), night terror (sleep terror or pavornocturnus), Nocturnal enuresis, Bruxism (teeth grinding), and sleep talking (somniloquy). REM sleep events/disorder :- Nightmares, nocturnal penile tumescence, Narcolepsy.
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Ans. Fomepizole competitively inhibits aldehyde dehydrogenase
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Ans. is 'd' i.e., Epigastric veins o Venous drainage of breast is through axillary, internal mammary and intercostal veins providing three major routes of hematogenous metastasis.
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Verumontanum is midline elevation on the posterior wall of the prostatic urethra. It acts as a surgical landmark. It lies immediately proximal to the external urethral sphincter. It thus serves as a distal landmark for prostatic resection in TURP to prevent injury to the external urethral sphincter. "The verumontanum serves as a significant landmark to stop resection because the external urethral sphincter lies just distal to it." Ref - Reoperative Pelvic Surgery By Richard P. Billingham p225
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Setting time of Fast-setting alginate = 1.5 to 3 min
Setting time of Normal-setting alginate = 3 to 4.5 min
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C i.e. Psychosis For a patient to meet the diagnostic criteria for schizophrenia, the symptoms must have been present for at least 6 monthsQ. With same symptoms if - Duration of episode of disturbance is > 1 day but < 1 month, then the diagnosis is Brief psychotic disorder. - Duration episode of disorder is > 1 month but < 6 months then the diagnosis is Schizophreniform (psychotic) disorder.
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Bulb of posterior horn is present on medial wall of posterior horn of lateral ventricle and is formed by fibers of forceps major.
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Cytogenetic abnormalities in the tumor cells of Burkitt&;s lymphoma is t (8;14) ,and t (8;22) involving MYC gene on chromosome 8 witho overexpression of MYC protein having transforming activity. Reference textbook of Pathology 6th edition Author Harsha Mohan page number 378
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Triptans like sumatriptan, frovatriptan etc are 5HT1B/1D agonists. These are drug of choice for acute severe migraine. Ergot alkaloids like ergotamine can also be used for acute attack of migraine. These also stimulate 5HT1B/1D receptors. Two primary hypotheses has been proposed for their action- 1. Activation of 5HT1D/1B receptors on pre-synaptic trigeminal nerve endings to inhibit the release of vasodilating peptides and anti- seizure agents may suppress excessive firing of these nerve endings. 2.Vaso-constricting action of direct 5HT agonists ( triptans and ergot) may prevent vaso-dilation and stretching of pain nerve endings. DOC for prophylaxis of migraine is propranolol.
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Shower of golden rain is due to cholestrol crytals in vitreous cavity.
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Answer- A. Posteromedial soft tissue releaseIf treatment by manipulation and retention fails, operation should usually be undeaken before 9 months of age, mostly at 4- 6 months.The idea behind early operation is to set the tarsal bones in normal relationship to one another and to remove deforming forces, thus allowing the bones to develop in their normal shape from an early age. The procedure used is soft tissue release, i.e. postero-medial release (PMR).
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Calcium gluconate (Also see AIIMS May 2010) . Calcium gluconate is the fastest acting agent used in t/t of hyperkalemia. . In acts within nzinutes but an impoant point to note is that it does not cause transcellular movement of potassium, instead it acts on cell membrane. - It stabilizes the cardiac cell membrane and reduces chances of cardiac arryhthmia. - Thus it has no use when there are no E.C.G. features. NaHCO3 NaHCO3 has been routinely used in the treatment of hyperkalemia. It was believed that NaHCO3 caused movement of potassium inside the cells by causing alkalosis. But studies do not suppo this - They claim that NaHCO3 do not cause movement of potassium inside the cells in acute cases of hyperkalemia. - It only decreases potassium when there is coexisting acidosis. - NaHCO3 can decrease potassium level in chronic hyperkalemia. It increases potassium delivery to the kidney. But the use of NaHCO3 still continues in most hospitals and institutes across the world. - It is now hypothesized that NaHCO3 does not cause IC* entry inside the cell by mechanism earlier believed to be, but by another mechanism. The question does not say anything about acidosis. Don't think that acidosis occurs only in severe hyperkalemia. Most patients with C.R. F. present with acidosis and mild moderate hyperkalemia. In hyperkalemia with no E.C.G. feature, calcium prophylaxis is not indicated - Calcium gluconate is administered to stabilize the cardiac membrane - Instability of the cardiac membrane is indicated by E.C.G. changes - Absence of E.C.G. changes suggest that the cardiac membrane is stable. In these cases there is no use of calcium administration. Prophylactic calcium gluconate is of no use.
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Dietary sources of vitamin D: DISINFECTANT Mg/100 g Egg 1.25-1.5 butterl 10.5-1.5 Milk 0.1 Cod liver oil 200-750 Halibut liver oil 500-10,000 Ref: Park 22nd edition, page 572
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The most commonly used fluid worldwide is the University of Wisconsin solution. It contains lactobionate, raffinose, and hydroxyethyl starch. Lactobionate is impermeable and prevents intracellular swelling; it also lowers the concentration of intracellular calcineurin and free iron, which may be beneficial in reducing reperfusion injury. Hydroxyethyl starch, a synthetic colloid, may help decrease hypothermia-induced cell swelling of endothelial cells and reduce interstitial edema. Another solution that is now being used commonly is histidine-tryptophan-ketoglutarate solution Ref: Schwaz's principle of surgery 9th edition, chapter 11.
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Centre of Reflex is superior delivary complex in brainstem.
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P.falciparum Forms in peripheral blood-ring forms and gametocytes (crescent shaped) A) Most pathogenic B). No relapses in P.falciparum-exo-erythrocytic schizogony is absent C). Complications-pernicious malaria,black water fever D)pernicious malaria-1). Cerebral malaria-hyperpyrexia, coma,paralysis.Brain is congested.Capillaries of the brain are plugged with parasitised erythrocytes 2). Algid malaria-cold clammy skin leading to circulatory failure 3). Septicaemic malaria- high continuous fever with involvement of various organs Black water fever * Previously infected * Intravascular haemolysis fever and haemoglobinuria * Autoimmune mechanism * Bilious vomiting+prostration+black urine(refer pgno:60 baveja 3 rd edition)
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Testicular feminising syndrome karyotype is 46 XY normal breast development primary amenorrhea inherited as autosomal dominant/X linked recessive gene sex chromatin is negative D.C.DUTTA'S TEXTBOOK OF GYNAECOLOGY,Pg no:443,6th edition
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Fontana masson stains mainly used to detect melanin granules in cytoplasm of tumour cells of melanoma.
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Ans. is 'd' i.e., Diagnosis can be made with available techniques o The hidden pa of iceberg (i.e. submerged poion) constitutes latent, inapparent, presymptomatic and undiagnosed cases and carriers in the community. o Its detection and control is a challange to modern techniques in preventive medicine.
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Giardiasis Pulmonary diseases associated with tissue or blood eosinophilia are a heterogenous group of disorders. They are classified as : Loeffler's syndrome It is a benign acute eosinophilic pneumonia of unknown cause characterized by migrating pulmonary infiltrates and minimal clinical manifestations. These are usually secondary to parasites or drugs. Loeffler's syndrome reflects a hypersensitive response to an ingested or inhaled antigen from food, medication or an infectious agent. Causes of Loeffler's syndrome Parasitic infections Ascaris Schistosomiasis Strongyloides Ancyclostomiasis Trichomoniasis Clonorchiasis Visceral larva migrans Tapeworm Paragonimiasis
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- The given image is showing a sac of meninges with some neural component inside it. So it is a meningomyelocele. - Most common location of a meningomyelocele is lumbo-sacral region.
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Types of Drug Resistance In defining criteria for resistance to the aminoquinolineantimalarial drugs, the WHO has described three grades of resistance following treatment (Low grade) R1 : Recrudescence of infection between 7 and 28 days of completing treatment following initial resolution of symptoms and parasite clearance. (High grade) R2 : Reduction of parasitaemia by > 75% at 48 hours but failure to clear parasites<br />within 7 days. R3 : Parasitaemia does not fall by >75% within 48 hours. (www.slideshare.net)
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Ans-A Condyloma accuminata (Ref Shows, 13/e, p 112 (12/e, p. 80-81)).The diagnosis of condyloma should be considered in a patients with history of sexual exposure and growths on vulva. The findings of the patient are consistence with that of condyloma accuminata.Condyloma accuminata -It is a sexually transmitted disease caused by human papilloma virus 6, 11, 16 & 18.Warts are seen on the vulval area. These verrucous growths may coalesce to form large cauliflower growths.Before concluding my answer, let me exclude other choices -Verrucous plana -It can be easily excluded, as in it warts are not found in genital areaHands and face are the most common site.Moreover the age group is also different, it is usually seen in children.Sometimes it can also occur in young women, but then face is the most common site involved.Verruca vulgaris -Here also the site of warts are different usually affected areas are exposed part of the body, hand, feet, nails, arms and legs, face and scalp.Condyloma lata -These are growth seen on genitals in secondary syphilis*.The presence of these lesions without any other features of syphilis is very unlikely.
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Ans. is 'a' i.e., Decreased gluconeogenesisExcess intake of alcohol leads to excessive production of NADH with a concomitant decrease in NAD+.This causes following metabolic alterations :-i) The increase availability of NADH ours the reduction of pyruvate to lactate and oxaloacetate to malate and decreasing its availability for gluconeogenesis and decrease synthesis of glucose. This results in Hypoglycemia.ii) Increased ratio of NADH/Nad+ inhibits p-oxidation of fatty acids and citric acid cycle and promotes lipogenesis, triacylglycerol synthesis and cholesterol synthesis from acetyl CoA.iii) Increased lactic acid production causes lactic acidosis and hyperuricemia.iv) Accumulation of lipid in various tissues causes fatty liver, fatty myocardium etc.
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IgE is to identify and neutralize pathogens such as bacteria, parasite, and viruses Ref: Ananthanarayan & Parkers textbook of microbiology 9th edition pg:98
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