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The pyrimidine synthesis is a similar process than that of Purines(Purines Synthesis). In the de novo synthesis of Pyrimidines, the ring issynthesized first and then it is attached to a ribose-phosphate to for a pyrimidinenucleotide. Pyrimidine rings are assembled from bicarbonate, aspaate, and Ammoni
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C i.e. Left common carotid aery arising from brachiocephalic trunk
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Ans is 'a' i.e., Wear and tear Lipofuscin* It is an insoluble pigment, also known as lipochrome and wear or tear or aging pigment. Lipofuscin is not injurious to the cell or its functions.* Its importance lies in being the tell-tale sign of free radical injury and lipid peroxidation.* It is seen in cells undergoing slow, regressive changes and is particularly prominent in the liver and heart of aging patients or patients with severe malnutrition and cancer cachexia.* On electron microscopy, the granules are highly electron dense, often have membranous structure in their midst and are usually in perinuclear location. In tissue section it appears as yellow brown pigment.* Deposition of lipofuscin in the heart is referred as brown atrophy.
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Ans. D i.e. Infant of diabetic mother
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This woman has hypehyroidism. Thyroid hormone causes increased protein breakdown. Hence, she will not have decreased protein breakdown. Physiological effects of Thyroid hormone: Target Tissue Effect Mechanism Hea Chronotrophic and ionotrophic Increased number of b-adrenergic receptors Enhanced responses to circulating catecholamines Increased propoion of a-myosin heavy chain (with higher ATPase activity) Adipose Tissue Catabolic Stimulated lipolysis Muscle Catabolic Increased protein breakdown Bone Developmental Promote normal growth and skeletal development Nervous system Developmental Promote normal brain development Gut Metabolic Increased rate of carbohydrate absorption Lipoprotein Metabolic Formation of LDL receptors Other Calorigenic Stimulated oxygen comsumption by metabolically active tissues (exception: testes, uterus, lymph nodes, spleen, anterior pituitary) Increased metabolic rate Ref: Guyton and Hall 13th edition Pgno: 955, 957
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Ans. is "a' i.e.. Dilatation & curettage o It is a condition characterized by adhesions and/or fibrosis of the endometrium most often associated with dilation and curettage of the intrauterine cavity.o The history of a pregnancy event followed by a D&C leading to secondary' amenorrhea or hvpomenorrhea is typical,
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Low dietary vitamin C, and high salt and nitrate consumption predispose to gastric cancer, as does ingestion of smoked foods. Smoking is a risk factor, but alcohol is not. H. pylori is another important risk factor, since it causes gastritis that eventually leads to chronic atrophic gastritis, metaplasia, dysplasia, and then carcinoma.
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Ans. is b, i.e. Cesarean sectionRef. Dutta Obs 7/e, p 249, 250; Fernando Arias 3/e, p 337, 339The patient in the question:1. Has gestational age = 37 weeks i.e. fetus has attained maturity so immediate termination of pregnancy is recommended.2. Has central placenta previa Type IV i.e. vaginal delivery is contraindicated, cesarean section has to be done.3. Patient is having heavy bleeding.According to Fernando Arias 3/e, p 337"In patients with heavy bleeding an efficient management plan including life support measures and immediate operative intervention is the only way to avoid a maternal death."It further says - on p 339"Patients with placenta previa and severe bleeding should be delivered by cesarean section irrespective of the type of placenta previa."So, from the above discussion, it is very much clear that in this patient, immediate cesarean section is the best resort. Friends, here I want to point out that earlier it was said that for minor degrees of placenta previa, vaginal delivery can be tried, but now, irrespective of degree of placenta previa, cesarean section is done and recommended.
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Ans. b. 1-9 years
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Ans. is 'b' i.e., Aspergillus Otomycosiso Otomycosis, also called acute fungal otitis externa, describes a fungal or yeast infection of the external auditory meatus.o Saprophytic fungi potentially residing in the ear canal include Aspergillus, Candida albicans, Phycomycetes, Rhizopus, Actinomyces, and Penicillium.o Under certain conditions of increased heat, humidity, glucose concentration (diabetes), immunosuppression, or overuse of systemic or topical antibiotics and steroids, these saprophytic fungi can become pathogenic,o Aspergillus niger accounts for 90% of otomycosis infections.o Othercommon organisms are Candida albicans (2nd most common) and Aspergillus fumigatus.o Less common organisms are Phycomycetes, Rhizopus, Actinomyces and Penicillium.
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Dexmedetomidine is alpha 2 agonist, more sensitive than clonidine. It is used to produce conscious sedation.
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Ans. (d) Ileum & jejunumRef: Chatterjee 12th ed. /116* Tapeworm infection can also be caused by eating raw or undercooked meat from an animal or a fish that has the larval form of the tapeworm cysts in its muscle tissue.* Once ingested, the larvae then develop into adult tapeworms in the small intestine (jejunum and ileum).TAPEWORMS* Taenia saginata: The beef tapeworm* Taenia solium: The pork tape worm* The habitat of tapeworms: Small intestine (upper jejunum)* Definitive host: Man* Intermediate host: Cattle (cow or buffalo) for T. Saginata Pig for T. Solium.
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Ans. A. Severity'CURB - 65' score: To asses severity of pneumonia, CURB-65 score is useda. Confusion:b. Urea >7mmol/L(7x2.8=19.6mg%)c. Respiratory rate >30/mind. BP <90 systolic and/or <60mmHg diastolic).e. Age >65.Score:0-1 = home treatment possible0-2 = Hospital Therapy0-3 = Indicates severe pneumonia.
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Commonest cause of chronic renal failure is pyelonephritis.
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Ans. B. Bulimia nervosaAnorexia nervosa - Under weightBulimia nervosa - Normal WeightBinge eating disorder - Over weight.
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D i.e. Congenital cataract Rubiosis Iridis It is neovascularization of iris and may lead to neovascular glaucoma. Neovascularization develops following retinal ischemia, which is a common feature of Proliferative diabetic retinopathyQ CRVOQ Sickel cell retinopathy Eale's disease Other rare causes are Fuch's hetrochromic cyclitisQ, chronic intraocular inflammation, intraocular tumor, long standing retinal detachment & CRAO.
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Because small particle filled composite has highest filler loading.
And higher filler loading increases the mechanical property of composite.
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Non depolarising neuromuscular blocker are competitive blockers and when more than 80 -90 % receptor is blocked then only neuromuscular transmission fails. Characteristic of NDNB 1. Decreased twitch response to a simple stimulus. 2. Fade on tetanic stimulus 3. Train of four response is seen 4. TOF ratio <1 5. Post tetanic potentiation 6. Potentiation of other nondepolarising drugs Antagonism by anticholinesterase
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Examples of Halophilic Vibrio –V. alginolyticus, V. parahemolyticus, V. vulnificus & V. fluvialis
Examples of Non Halophilic Vibrio – V. cholerae and V. mimicus
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Ans. (a) Acute pancreatitisRef: Sabiston page 1525/20th edition* History of pain reduced on sitting with leaning forward is typical pancreatic pain.* Periumbilical discoloration = Cullen's signAll these favor more of acute pancreatitis
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Ans. Air embolism
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A i.e. Decreased Solubility
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In high small bowel obstruction there is rapid vomiting and dehydration.
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Pelvic postoperative radiotherapy (external) in a dose of 6000 cGy over a 6-week period is recommended in high-risk cases such as an undifferentiated tumor, myometrial infiltration, pelvic node involvement, and in serous, clear cell and adenosquamous carcinoma. The postoperative radiotherapy is required in Stages IA (Grade 3), IA2, IB and II. Whole-abdomen radiation is required when para-aoic lymph nodes are involved while protecting the liver and kidneys.The most impoant factors in considering the need for postsurgical radiotherapy are (1) histology; (2) grading as studied by biopsy and (3) depth of myometrial invasionas seen by ultrasound, MRI and at the time of surgery.Ref: Shaw&;s textbook of gynecology; 16th edition; Page no: 512
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Ans. is 'b' i.e., Middle 1/3* Esophageal Carcinoma is of two common histological typesi) Squamous cell Ca - the MC type in world (-95% according to Sabiston)ii) Adenocarcinoma - where incidence is increasing at a rapid rate and is now the MC type in USA (Ref: Harrison, Schwartz)* Distribution of Squamous Cell Ca.# Upper 1/3 - 10%# Middle 1/3 - 60%# Lower 1/3 - 30% * Adenocarcinoma is mainly located in lower 1/3.
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2 LT1 receptor antagonists is montelukast and zafir lukast, they competitively antagonize LT1 receptor zileuton- inhibits the synthesis of Leukotrienes ESSENTIALS OF MEDICAL PHARMACOLOGY SEVENTH EDITION KD TRIPATHI PG NO .228
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Ketamine
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S. epidermidis is still the most frequent early and late cause of endocarditis in patients with prosthetic heart valves. The other organisms are seen less frequently in late prosthetic valve endocarditis.
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CD la Histiocytosis is a disorder of the mononuclear phagocytic system. Mononuclear phagocytic system consists of monoblasts, promonocytes, monocytes and tissue macrophages, Macrophages are transformed monocytes i.e. monocytes present in the tissues. Moncytes emigrate continuously from peripheral blood into the tissues. Histiocyte The term histiocyte is synonymous with macrophage. In diseases of mononuclear phagocytic system the terms histiocyte and histiocytosis are used. Langern cell histiocytosis Langerhans cell is macrophage and plays impoant role in immunity. It processes antigen and present it to T cells. Langerhans cells histiocytosis (LCH) is a clonal histiocytosis and the lesions are characterized by the presence of Langerhans cells, eosinophils and Lymphocytes in a variable number. The various features of langerhans cells are : Presence of Birbeck granules (E/M - HX bodies) Presence of enzymes like - a Naphthyl acetate esterase - a Naplahyl butyrate esterase - Acid phosphatase Markers like - S-I00 positivity - CD-la positivity' - HCA-DR expression
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• Most common site for genital TB is fallopian tube (90% cases).
• Uterus is involved in 70% cases of genital tuberculosis.
• The infection to uterus descends from the tube, i.e. if TB endometritis is present, invariably tubes are involved.
• Most common symptom of Genital TB: Infertility (35 – 60%). Infertility is either due to blockage of fallopian tube or due to loss of tubal function even if tubes are patent.
Tubercular endometritis causes uterine scarring which destroys the endometrium leading to synechia formation (Asherman syndrome) and infertility.
“In developing countries, genital TB may account for 3% or more of patients with infertility. In these cases tubal damage and endometrial adhesions are the underlying cause.”
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Skin necrosis is not a side effect of heparin therapy. From medical pharmacology padmaja 4th edition Page no 335
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Ans. d (Denial). (Ref. Neeraj Ahuja, 5th/pg.231)Defence mechanism shown by drug addicts is denial.Defence mechanism Denialis a psychotic type of defence mechanism where there is involuntary exclusion of unpleasant or painful reality from conscious awareness.Repressionseemingly inexplicable naivete, memory lapse, or lack of awareness of physical status; the emotion is conscious, but the idea behind it is absent.Reaction Formationbehavior that is completely the opposite of what one really wants or feels (e.g, taking care of someone when what one really wants is to be taken care of; studying to be a pilot to coverup being afraid to fly). Note : this can work in the short term as an effective strategy to cope, but will eventually break down.Displacementseparation of emotion from its real object and redirection of the intense emotion toward someone or something that is less offensive or threatening in order to avoid dealing directly with what is frightening or threatening.Dissociationtemporary and drastic modification of one's personal identity or character to avoid emotional distress.Sublimationtransformation of negative emotions or instincts into positive actions, behavior, or emotion, art, sports, hobbies, or even one's choice of profession)RationalizationA defence mechanism, operating unconsciously, in which an individual attempts to justify or make consciously tolerable by plausible means, feelings or behavior that otherwise would be intolerable. Not to be confused with conscious evasion or dissimulation.
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Hydrocephalus most commonly in children because of abnormality of the aqueductal stenosis or obstruction of the 4th ventricles. Aqueductal stenosis results from an abnormally narrow aqueduct of sylvius that is often associated with branching or forking. Ref: Kligman, Behrman, Jenson, Stanton (2008), Chapter 592, "Congenital Anomalies of the Central Nervous System", In the book, "Nelson's Textbook of Pediatrics", Volume 2, 18th Edition, New Delhi, Page 2453
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MRI Thermography and ultrasonography (USG) contains no radiation risk because they use non-ionizing radiation.
CT scan is whit maximum radiation risk
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Cost accounting: A quantitative management technique which provides basic data on cost structure of any programme. Is based on: Cost control. Planning and allocation of people and financial services. Pricing of cost reimbursement.
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Blood supply- femoral head
Femoral artery
Profunda femoris artery
Medial circumflex femoral artery- Major supply
Lateral circumflex femoral artery
Obturator artery
Artery of ligamentum teres
Intramedullary vessels in femoral neck.
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Ans. is 'b' i.e., CD 8 o Helper T-cells -CD4 positive.o Cytotoxic T-cells and suppressor T-cells - CD 8 positive.
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Ans. is a i.e. Squamous cell Ca Vaginal carcinoma Primary cancer of vagina are very rare. Most common age group is Elderly females - 70 years. Most common histologic type is Squamous cell carcinoma Most common site is Upper third of Posterior wall of vagina. Mostly asymptomatic Patient may present with abnormal vaginal bleeding (including post coital bleeding). Foul smelling discharge per vaginum. P/S - Ulcerative/exophytic growth on vagina. Cervix appears normal. Lymphatic Drainage : Tumor arising in upper vagina : drain to pelvic lymph node. Tumor arising in lower pa : drain to inguinal lymph node. Management : Growth limited to middle third : Radiotherapy Growth limited to upper third and lower third : Surgery.
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Ans. Delayed healing of fractures
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(Pharmacodynamics): (37 KDT 7th edition)PHARMACODYNAMICS - is the study of drug effects* Thus it attempts to elucidate the complete action -effect sequence and the dose-effect relationship* Modification of the action of one drug by another drug is also as aspect of pharmacodynamicsPHARMACOGENETICS - The study of genetic basis for variability in drug response is called pharmacogenetics, It deals with genetic influence on drug action as well as on drug handling by the body.PHARMACOGENOMICS - is the use of genetic information to guide the choice of drug and dose on an individual basis.PHARMACOKINETICS - refers to movement of the drug in and alteration of the drug by the body; includes absorption, distribution, binding / localization / storage, biotransformation and excretion of the drugPHARMACOTHERAPEUTICS - is the application of pharmacological information together with knowledge of the disease for its prevention, mitigation or cure.IDIOSYNCRASY - is genetically determined abnormal reactions**
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The Gs alpha subunit (Gas, Gsa) is a subunit of the heterotrimeric G protein Gs that stimulates the cAMP-dependent pathway by activating adenylyl cyclase. Gsa is a GTPase that functions as a cellular signaling protein Ref-Harper 28/e p447
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.Necrotising enterocoilitis occurs among premature infants under stress in first week of life. pathogenesis:mucosal injury, bacterial infections of the injured gut with E.colli,,Klebsiella,Pseudomonas ,Clostridia, Salmonella,formula feeding clinical features: stage 1:unstable temperature,apnea,lethargy,mild abdominal distension,vomiting, in stage 1B ,blood is present in stools stage 2:clinical signs as above,bowel sounds are diminished,tenderness may be present.In 2B there may be metabolic acidosis and thrombocytopenia. Stage 3:above features+low BP,bradycardia,apnea,acidosis,DIC,even anuria ESSENTIAL PEDIATRICS,O.P.GHAI,PG NO:139, 7th edition
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Feilisation
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The chorda tympani branch of the facial nerve is responsible for carrying taste fibers from the anterior two thirds of the tongue and also provides secretory fibers to submandibular and sublingual salivary glands. The mandibular division of the trigeminal nerve (V3) provides sensory innervation for the anterior two-thirds of the tongue. The glossopharyngeal nerve provides both sensory innervation and taste sensation for the posterior third of the tongue.
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Child in the question is showing features of whooping cough. Definitive diagnosis of whooping cough can be made after isolating Bordetella peussis from the respiratory tract. Either nasopharyngeal swab or nasopharyngeal aspirate is taken for sampling. Ref: Whooping Cough By Patrick G. Guilfoile, David Heymann, Hilary Babcock page 56-65; Communicable disease control handbook By Jeremy Hawker page 238.
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Ans B Reference Sabiston Textbook of Surgery. 20th edition. Annular pancreas results from aberrant migration of the ventral pancreas bud which leads to circumferential or near-circumferential pancreas tissue surrounding the second portion of the duodenum This abnormality may be associated with other congenital defects, including Down syndrome, malrotation, intestinal atresia, and cardiac malformations If symptoms of obstruction occur surgical bypass through duodenojejunostomy is performed Axial image from an abdominal CT scan showing the annulus encircling the duodenum (arrow). Courtesy-
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Ans. is d i.e. 14 days after ovulation The first definitive sonographic finding to suggest early pregnancy is visualization of the gestational sac. Using transvaginal transducers with frequency of 5 MHz, the size threshold for sac detection is 2 - 3 mm, corresponding to 4 weeks + 1 day gestational age to 4 weeks + 3 days gestational age." To understand how many days after ovulation, you should first understand that gestational age is calculated from 1st day of last menstrual period. As is evident from above diagram gestational sac is visualised approximately 15-17 days after ovulation (or within 1-3 days of missed period) but since it is not given in options so the nearest possible answer is 14 days after ovulation.
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The axillary nerve innervates the deltoid muscle, as well as provides sensation over the lateral pa of the arm.The dorsal scapular nerve innervates the rhomboids and levator scapulae muscles.The long thoracic nerve innervates the serratus anterior. Injury to this results in winging of the scapula.The suprascapular nerve innervates the supraspinatus and infraspinatus muscle.
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Answer is C (Nephritic syndrome): Post infective glornerulonephritis are acute glomerulonephritis that usually present with Acute Iepitrotic syndrome. It is the classic presentation of Post-Streptococcal or Post-Infective glonierulonephritis.
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The diagnosis of congenital hypothyroidism is by testing a sample of blood is taken from the heel or from the umbilical cord at bih and analyzed for total T4 or TSH. A total T4 of less than 6 g/dL or a TSH more than 25 mU/L is usually indicative of congenital hypothyroidism. A low total T4 alone may be associated with low circulating thyroxine-binding globulin (TBG), but the significantly elevated TSH is diagnostic of primary hypothyroidism. The diagnosis may be accompanied by radiologic evidence of retarded bone age or epiphyseal dysgenesis (centers of ossification, especially of the hip, may show multiple small centers or a single stippled, porous, or fragmented center) in severe congenital hypothyroidism. Ref: Styne D. (2011). Chapter 6. Growth. In D.G. Gardner, D. Shoback (Eds), Greenspan's Basic & Clinical Endocrinology, 9e.
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Ans. is 'c' i.e., Weight loss Bulemia Nervosao Bulimia nervosa is characterized by episodes of uncontrollable excessive eating (binges) followed by vigorous weight-reducing measures like self-induced vomiting, purgative abuse, diuretics, or abuse of emetics; and less commonly severe dieting and stemous exercise.o Episodes of binge eating occur relatively frequently (twice a week or more) for at least 3 months.o As in anorexia nervosa, there is extreme preoccupation with the shape and weight of the body. However, bulimia nervosa differs from anorexia nervosa : -Patients of bulimia are slightly older than those with anorexia i.e., Late adolescence.Most of the patients with bulimia nervosa have a weight within their normal weight rangeAmenorrhea is usually not present and most are sexually active, compared with anorexia nervosa patients.Peculiar behavior about the food of anorexia nervosa is absent.Depressive symptoms are more common - Post-binge anquish.o Patient with bulimia nervosa may have dental caries/tooth decay, Sore throat, Swollen Salivary gland (parotitis), and internal bleeding due to vomiting.
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Ans. A. PhenobarbitoneThe drug of choice for treating neonatal seizures is phenobarbitone. Its initial IV dose is 20-40mg/kg IV, followed by maintenance dose of 3-5mg/kg/dayIV/IM or oral.
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(B) CMV # Cytomegalic cells in vivo (presumed to be infected epithelial cells) are two to four times larger than surrounding cells and often contain an 8- to 10-m intranuclear inclusion that is eccentrically placed and is surrounded by a clear halo, producing an "owl's eye" appearance.> Cytomegalic cells are found in a wide variety of organs, including the salivary gland, lung, liver, kidney, intestine, pancreas, adrenal gland, and central nervous system.> Viral inclusion bodies:A. Examples of viral inclusion bodies in animals are Intracytoplasmic eosinophilic:1. Negri bodies in Rabies2. Guarnieri bodies in Small pox3. Henderson-Peterson bodies in Molluscum contagiosumB. Intranuclear acidophilic:1. Cowdry type A in Herpes simplex virus and Varicella zoster virus and Torres bodies in Yellow fever2. Cowdry type B in PolioC. Intranuclear basophilic:1. Cowdry type B in Adenovirus2. "Owl eyes" in cytomegalovirusD. Both intranuclear and intracytoplasmic:1. Warthin fmkeldey bodies in Measles.
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Malignant hyperthermia is autosomal dominant disease. It is characterized by metabolic acidosis and hyperkalemia.
i.v dantrolene infusion is used for treatment.
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NEERI developed a technique for removing fluoride by chemical deflouridation of water called Nalgonda technique. REF. PARK'S TEXTBOOK OF PREVENTIVE AND SOCIAL MEDICAL 21ST EDITION. PAGE NO - 596
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ANSWER: (C) S. aureusREF: With textBacterial orbital cellulitis is a life-threatening infection of the soft tissues behind the orbital septum. It can occur at any age but is more common in children. The most common causative organisms are S. pneumoniae, S. aureus, S. pyogenes and H. Influenzae. (Ref: Khurana 4th ed page 385, Kanski 7th ed chapter 3)The major causes of orbital cellulitis are sinusitis (58%), lid or face infection (28%), foreign body (11%), and hematogenous (4%). Staphylococcus andStreptococcus are the most common causative organisms in adults, Haemophilus influenzae in children. Less common organisms are Pseudomonas and Escherichia coli. (Ref: Yanoff 2nd ed page 739)H. influenza type b has been the most common pathogen responsible for Orbital cellulitis prior to the advent of its vaccine. Currently Staphylococcus is the most common bacterial isolate. (Ref: Oculoplastics and Orbit: Aesthetic and Functional Oculofacial Volume 3 ByRudolf R Guthoff, James Katowitz page 151)Option (D); Rhino-orbital mucormycosis: Mucormycosis is a very rare opportunistic infection caused by fungi of the family Mucoraceae, which typically affects patients with diabetic ketoacidosis or immunosuppression. (Ref: Kanski 7th ed chapter 3)
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Behavioral therapy is learning given by BF Skinner , according to him all behaviors are learned phenomenon and thus can be unlearned Positive reinforcement a type of reinforcement when a behavior is rewarded there is more chance that the behavior is repeated Negative reinforcement is that when a behavior is done and an aversive response is removed, the behavior is repeated. When I go and meet my girlfriend, she checks my messages and picks up fight (aversive response) suddenly I delete all messages one day and that day there was no fight (no aversive response) then that behavior is repeated (delete all messages before meeting my girlfriend) Extinction is the type of reinforcement where a behavior is done and a rewarding response is removed the chance is that behavior will not be repeated A child likes to play with children( reward) but when the child fights with other children( undesirable behavior) the child will be removed from playing( removing a reward) , then the child stops fighting with other children( reduction of undesirable behaviour) Ref. kaplon and sadock synopsis, 11 th edition, pg no. 845
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Ans. is 'd' i.e., Alpo syndromeo Glomerulonephritis, deafness, corneal dystrophy with foam cells and attenuation of GBM suggest the diagnosis of Alpo syndrome.
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As on 31 st march 2014 ,5,363 community health centers were established by upgrading the primary health centers,each community health center covering a population of 80,000 to 1.20 lakh(one in each community development block) with 30 beds and specialists in surgery,medicine,obstetrics and gynecology and paediatrics with x-ray and laboratory facilities (refer pgno:907 park 23 rd edition)
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A chest tube is a flexible plastic tube that is inseed through the chest wall and into the pleural space or mediastinum. It is used to remove air, fluid, or pus from the intrathoracic space. It is also known as a Bulau drain or an intercostal catheter Ref Harrison 20th edition pg 1423
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Ans. a. Serum levels of factor VIII are decreasedRef: Robbins and Cotran Pathologic Basis of Disease 9th Ed; Page No- 662Hemophilia AIt is an X-linked recessive inheritance.Commonly Males are affected.Factor VIII deficiency is present.Symptoms vary depending on the degree of deficiency.Most common hereditary disease associated with life-threatening bleeding.There will be no petechiae or purpura.Newborns may develop bleeding at the time of circumcision. Other problems include spontaneous hemorrhage into joints (hemarthrosis), easy bruising and hematoma formation after minor trauma, and severe prolonged bleeding after surgery or lacerations.Laboratory studies typically show normal platelet count and normal bleeding time, normal PT and prolonged PTT.Treatment is factor VIII concentrate.
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Fothergill's operation(Manchester Repair) is done in women below 40 years, who want to retain their menstrual function.
In both questions 1 and 2 patient are less than 40 years and multiparous so, Fothergill's repair is the ideal management for them.
Fothergill's repair causes complications of pregnancy like incompetent os, habitual abortion and cervical dystocia therefore in a multipara who have completed their family we can do tubal ligation to prevent pregnancy.
"If the family is completed, vaginal sterilization is to be done."
— Dutta Gynae 6th /ed p 216
Thus in question 1 answer is Fothergill's repair with tubal ligation.
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Ans. A. maxillary nerveThe foramen ovale is situated in the posterior part of the sphenoid bone, posterolateral to the foramen rotundum.The following structures pass through foramen ovale:a. Mandibular nerveb. Motor root of the trigeminal nervec. Accessory meningeal arteryd. Lesser petrosal nervee. An emissary vein connecting the cavernous sinus with the pterygoid plexus of veins
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The lambdoid suture lies between the occipital bone and the two parietal bones. Sutural bones are common along this suture. Lambdoid sutures are usually visible clearly. The lambdoid suture traverses the posteriormost pa of the skull. Ref: BD Chaurasia's HUMAN ANATOMY, Volume 3, 4th edition.
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In red blood cells the pentose phosphate pathway provides NADPH for the reduction of oxidized glutathione catalyzed by glutathione reductase, a flavoprotein containing FAD. Reduced glutathione removes H2O2 in a reaction catalyzed by glutathione peroxidase, an enzyme that contains the selenium analogue of cysteine (selenocysteine) at the active site (Figure 21-3). The reaction is impoant, since accumulation of H2O2 may decrease the life span of the erythrocyte by causing oxidative damage to the cell membrane, leading to hemolysis Ref: Harper 28th edition, chapter 21.
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Pulled elbow or Nursemaid elbow or Babysitter's elbow or radial head subluxation is most commonly occurs in children aged 1-4 years. The etiology is slippage of the head of the radius under the annular ligament. The distal attachment of the annular ligament covering the radial head is weaker in children than in adults, allowing it to be more easily torn. As children age, the annular ligament strengthens, making the condition less common. The oval shape of the proximal radius in cross-section contributes to this condition by offering a more acute angle posteriorly and laterally, with less resistance to slippage of the ligament when axial traction is applied to the extended and pronated forearm. The patient resists supination/pronation as well as flexion/extension of the forearm. Axial traction is the most common cause of nursemaid elbow. A fall is the second most common mechanism of injury. Infants have been repoed with nursemaid elbow after rolling over or being assisted to roll over. The Monteggia fracture is a fracture of the proximal third of the ulna with dislocation of the head of the radius.
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Ans. (a) IodidesRef: Schwartz 9th Edition Page2599/E book* Excessively large doses of iodide may lead to initial increased organification, followed by suppression, a phenomenon called the Wolff-Chaikoff effect
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THORNWALDT'S DISEASE (PHARYNGEAL BURSITIS) It is infection of the pharyngeal bursa which is a median recess representing attachment of notochord to endoderm of the primitive pharynx. Pharyngeal bursa is located in the midline of posterior wall of the nasopharynx in the adenoid mass. CLINICAL FEATURES :- 1. Persistent postnasal discharge with crusting in the nasopharynx. 2. Nasal obstruction due to swelling in the nasopharynx. 3. Obstruction to eustachian tube and serous otitis media. 4. Dull type of occipital headache. 5. Recurrent sore throat. 6. Low-grade fever. Examination would reveal a cystic and fluctuant swelling in the posterior wall of nasopharynx. It may also show crusts in the nasopharynx due to dried up discharge. TREATMENT:- Antibiotics are given to treat infection and marsupialization of the cystic swelling and adequate removal of its lining membrane. Ref:- Dhingra; pg num:-245
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Pauci-immune type crescentic GN is defined by the lack of anti-GBM antibodies or significant immune complex deposition. Anti-neutrophil cytoplasmic antibodies (ANCA) typically are found in the serum, which, have a pathogenic role in some vasculitides. In some instances, therefore, crescentic GN is a component of systemic vasculitis such as microscopic polyangiitis or granulomatosis with polyangiitis. Ref: ROBBINS BASIC PATHOLOGY 10th ed Pg no: 563
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The Loss of Antithrombin III may be the reason for hypercoaguability in Nephrotic Syndrome. Thrombotic and thromboembolic compliactions are common in Nephrotic Syndrome due to loss of anticoagulant factor (Antithrombin III, Protein C and S) combined with increased platelet activation, hyperfibrinogenemia in liver and impaired fibrinolysis. Ref: Therapy of Renal Diseases and Related Disorders By Wadi N. Suki, Shaul G. Massry, Page 322; Harrison's Principles of Internal Medicine, 16th Edition, Page 1684.
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Agoraphobia - fear of places which is difficult to escape such as crowded, enclosed or open places Claustrophobia - fear of closed places Nyctophobia - fear of dark Thanatophobia - fear of death Xenophobia - fear of stranger Acrophobia - fear of heightsc Cynophobia - fear of dogs
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(C) Traumatic glaucoma# Traumatic Glaucoma: Atraumatic separation to the iris root and citiary body. Is not an uncommon cause of trauma by blunt object or by penetrating injury to globe.> Symptoms: Pain, blurred vision, history of blunt and penetrating injury.> Sings: Hyphaema, an irregular pupil in acute phase, slightly reduced IOP due to Iris/increased aquous.> Transient elevated IOP due to hyphema or anteriorly dislocated lens.> Signs in Chronic Phase: Chronic pressure elevation due to obstruction of aquous outflow system Optic disc cupping Visual field loss.
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Ans. is c, i.e. Perform suction evacuationSuction evacuation is the method of choice, for evacuation of a partial molar pregnancy.
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(Ref: Katzung 10/e p753) Streptogramins like quinpristin and dalfopristin possess microsomal enzyme inhibitory propey (NOT inducing). These are effective against MRSA and VRE infections.
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Eugenol and calcium hydroxide cannot be incorporated into the same formulation, because eugenol rapidly chelates calcium ions in a strongly exothermic reaction.
Therefore, the choice of a eugenol-based versus calcium hydroxide-based liner is based on the relative depth of the tooth preparation.
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Refer kDT 6/e p 497 Some drugs accumulate in ceain tissues (for example, digoxin accumulates in hea and skeletal muscles), which can also act as reservoirs of extra drug. These tissues slowly release the drug into the bloodstream, keeping blood levels of the drug from decreasing rapidly and thereby prolonging the effect of the drug. Some drugs, such as those that accumulate in fatty tissues, leave the tissues so slowly that they circulate in the bloodstream for days after a person has stopped taking the drug
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Ans: d (Good pasture s disease)Reference: Robbins, 8th ed pg. 912Renal InvolvementCharacteristic1. Post Streptococcal glomerulonephritis (PSGN)2. Membranous glomerulopathy3. IgA nephropathy4. Membrano proliferative glomerulo nephritis (MPGN)Enlarged hypercellular glomeruli Severe form - Crescent formation IF: Granular deposits of IgG, IgM, C3 along GBM E/M: "Subepithelial humps"Diffuse thickening of glomerular capillary wallE/M: electro denseSubepithelial deposit of IgSilver- "Spike like projection"Focal segmental or diffuseProliferation of mesangiumIF: IgA deposits in mesangiumE/M: Electron dense mesangial deposits Thickening of GBM with proliferation of glomerular cells & leukocytic infiltrationLight microscopy - Double contour or tram-track appearance - split basement membraneType 1 - Subendothelial depositsType 2 - Intramembranous deposits5. Lupus nephritis IF: Irregular mesangial & capillary loop deposits Subendothelial location6. Good Pasture Dense linear IgG staining of syndrome the GBM7. Diabetic Nephropathy Nodular Mesangial expansion "Kimmelstal Wilson Nodule" with increased mesangial matrix and cellularity & micro aneurysm formation.
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Ans. Descemet's membrane of cornea
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Bi-Hogg-Dube syndrome: Autosomal Dominant Defect in BHD gene which codes for folliculin Triad:- S:Skin manifestations (fibrofolliculomas, trichodiscomas, and acrochordons) R:Renal Cancer P:Pulmonary cysts or blebs
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ICRP recommends that genetic dose to population should not exceed 5 rems over a period of 30 years. Ref: Park's textbook of Preventive and Social Medicine, 21st edition, page-687
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Ans. Persistent depressive disorder
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Anterior division of internal iliac artery
A part of Umbilical artery persists as superior vesical artery and remaining artery becomes obliterated forming medial umbilical ligament.
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Ans. is 'a' i.e., Carcinoma pancreas
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In midpontine lesion, the pneumotaxic center is separated from the Apneustic center The apneustic center is inhibited by the pneumotaxic center and vagus. When both are cut there is prolonged inspiration which is called as Apneustic breathing Ref: Ganong 25th ed/page 655
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Ans. D. Progressive multiple encephalopathyProgressive Multifocal Leukoencephalopathya. PML is a rare demyelinating CNS disorder caused by the reactivation of JC virus.b. The virus stays latent in the kidneys and lymphoid organs until reactivation.c. PML mainly occurs in adults with impaired cell-mediated immunity, especially AIDS patients but also in those with lymphoproliferative and myeloproliferative disorders. Decreasing immunosuppression in non-AIDS patients with PML (e.g. Transplant patients).d. JCV causes lytic infection of oligodendrocytes in the white matter.e. Symptoms include altered mental status, aphasia, ataxia, hemiparesis or hemiplegia and visual filed disturbances, Seizures.f. Treatment: Risperidone and mirtazapine.Oligodendrocyte inclusion bodies are seen in PML
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GAMEKEEPER&;S THUMB/SKIER&;S THUMB The ulnar collateral ligament inses paly inyo the palmar plate. In PAIAL RUPTURE,only the ligament proper is torn and the thumb is unstable in flexion.Here the palmar plate is intact. In COMPLETE RUPTURE,both the ligament proper and the palmar plate are torn and the thumb is unstable in all positions. C/F:Tenderness and swelling precisely over the ulnar side of the thumb metacarpophalangeal joint. X-ray is essential,to exclude a fracture berfore carrying out any stress tests. TREATMENT: Paial tears can be treated by a sho period (2-4weeks)of immobilisation in a splint followed by icreasing movement. Complete tears need operative repair.Post operatively,the joint is immobilized in a thumb slint for 6 weeks,but can be moved early in the flexion-extension phase. Ref: Maheshwari and Mhaskar 9th ed pg 122
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Ans. (c) IIIRef: Inderbir Singh's Embroyology, 7th ed. /119-120* Lower part of hyoid and greater cornu of hyoid is derived from branchial arch III.* Upper part of hyoid and lesser cornu of hyoid is derived from branchial arch II
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Ans. is'b'i.e., 25 yearsTime of fusion of greater cornua of hyoid - 25 years with the bodyTime of fusion of lesser cornua = 35-40 years
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Randomization is a statistical procedure by which the study paicipants are allocated into groups usually called study and control groups; to receive or not receive an experimental preventive or therapeutic procedure, maneuver or intervention Ref: 25th edition, Park's Textbook of Preventive and Social Medicine, Page no. 90
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FOLIC ACID India has not yet adopted recommendation of foification of all wheat products in India with folic acid Preconceptionally given for prevention of neural tube defects It is present in leafy vegetables spinach, paneer Requirement perday in pregnancy is 500 mcg Ref: Park 25th edition Pgno : 658
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It includes Eliminate kala-azar Reduce moality by 50% on account of TB ,malaria and other vector and water borne diseases Reduce prevalence of blindness to 0.5% Reduce IMR to 30/1000 and MMR to 100/lakh (refer pgno:873 park 23 rd edition)
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Fibromuscular dysplasia (FMD) Abnormal development or growth of cells in the walls of aeries that can cause the vessels to narrow or bulge. Most common form- Medial fibrosis Young women and affects the distal 2/3 of the main renal aery. Bilateral. The iliac aeries are the limb aeries most likely to be affected by fibromuscular dysplasia. Gross: Alternating thickened and thinned aerial walls give rise to the characteristic "sausage-string" or "string of beads" appearance (especially as seen on angiography) Histology: fibromuscular thickening of the media alternating with areas of thinning and loss of the internal elastic lamina.
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Henoch-schonlein purpura is a small vessel vasculitis characterized by palpable purpura ahralgias, gastrointestinal signs and symptoms, glomerulonephritis. Gastrointestinal involvement is characterized by colicky abdominal pain, nausea, vomiting, diarrhea, or constipation and frequently associated with passage of blood and mucus per rectum. Ref: Harrisons Internal Medicine, 18th Edition, Chapter 326
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Dabigatran is an oral anticoagulant classified as a direct factor Xa inhibitor that does not require Coagulant profile Monitoring. When given in fixed doses, Dabigatran produces such a predictable anticoagulant response that routine coagulation monitoring is unnecessary. Heparin and Warfarin require close monitoring because of their narrow therapeutic index and increased risk for bleeding. Argatroban is a synthetic parenteral direct thrombin inhibitor that requires routine laboratory monitoring of their therapeutic effect while balancing the risk of bleeding with that of clinical efficacy. Anticoagulant Not requiring Coagulant Profile Monitoring: Parenteral Indirect Thrombin Inhibitors: Low molecule Weight Heparin (LMWH) (Enoxaparin, Dalteparin, Nadroparin, Tinzaparin, Ceoparin, Reviparin, Ardeparin, Parnaparin and Pemiparin) Indirect Factor Xa Inhibitors: Desirudin (Exception) Oral Direct Thrombin Inhibitors Dabigatran Direct Factor Xa Inhibitors Rivoraxaban Apixaban Betrixaban Edoxaban (Japan) Desirudin is a parenteral Direct thrombin Inhibitor given subcutaneously in low doses and doesnot require monitoring. Anticoagulants Requiring Caogulant Profile Monitoring: Parenteral: Parenteral Direct Thrombin Inhibitors Hirudin derivatives (Lepirudin) Hirudin analogues (Bivarudin) Argatroban Parenteral Indirect Thrombin Inhibitors Heparin Oral Coumarin derivatives (Vitamin K Antagonist) Warfarin Indanediones (Vitamin K Antagonists) Phenindone Ref: KDT 7th edition
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Ans. is 'a' i.e., Autosomal dominanto Otosclerosis (otospongiosis) is abnormal bone deposition in the middle ear about the rim of the oval window into which the footplate of stapes fit.o This results in conductive deafnesso In most instances it is familial, following autosomal dominant transmission with variable penetrance.
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Diagnostic Advantages of Hepatobiliary Ultrasound Hepatobiliary Diagnostic Limitations of Ultrasound Remarks Rapid evaluation of liver and bile ducts Accurate identification of dilated bile ducts Not limited by pregnancy Guidance for fine-needle Biopsy Bowel gas Ascites Poor visualisation of distal C.B.D Initial Procedure of choice in biliary tract obstruction
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Ans. is 'c' i.e., Hepcidin
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COPD presents with Hypoxic Hypoxia. Hypoxic hypoxia is the most common form of hypoxia seen clinically.
The diseases that cause it can be roughly divided into those in which the gas exchange apparatus fails, those such as congenital heart disease in which large amounts of blood are shunted from the venous to the arterial side of the circulation, and those in which the respiratory pump fails.
Lung failure occurs when conditions such as pulmonary fibrosis produce alveolar-capillary block, or there is ventilation-perfusion imbalance.
Pump failure can be due to fatigue of the respiratory muscles in conditions in which the work of breathing is increased or to a variety of mechanical defects such as pneumothorax or bronchial obstruction that limit ventilation.
It can also be caused by abnormalities of the neural mechanisms that control ventilation, such as depression of the respiratory neurons in the medulla by morphine and other drugs.
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Ans. is 'c' i.e., Burn wound
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Ans. is 'b' i.e., Morphine o Respiratory insufficiency after upper respiratory tract infection is the classic presentation of bronchiolitis. Treatment of Bronchiolitis ? Treatment is essentially symptomatic. The child should be nursed in humid atmosphere. O2 remains the mainstay of treatment. o Antibiotics - Though antibiotics have no role* but Ribavarin can sometime be used. o Iffever is present antipyretics can be used. Continuous positive airway pressure. 1-32 adrenergic drugs and Ipratropium bromide are also not recommended for infants < 6 months.
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