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Answer is C (Aneurysm): The most common cause of subarachnoid haemorrhage is rupture of a saccular aneurysm (Saccular aneurysms are synonymous with Berry Aneurysms or 'Circle of Willi's aneurysms' and most commonly occur in the anterior circulation on the Circle of Willis).
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Ref Robbins 8/e p276; 9/e p279 Ceain non neoplastic disorders _ the chronic atrophic gastric of pernicious Anemia, solar keratosis of skin, chronic ulcerative colitis and leukoplakia of the oral cavity, vulva and penis, have such a well defined association with cancer that they have been termed precancerous condition
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Neuroblastoma is the most common solid neoplasm outside the CNS. It arises from neural crest tissue of the sympathetic ganglia or adrenal medulla. It most commonly metastasize to bone, bone marrow, lymph nodes, liver and subcutaneous tissue. It has a predilection for metastasis to the skull, paicularly the sphenoid bone and retrobulbar tissue. Ref: Essential Pediatrics By O P Ghai, 6th Edition, Page 573; CURRENT Diagnosis and Treatment: Pediatrics, 20th Edition, Chapter 29.
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Bronchopulmonary sequestration can be differentiated from a bronchogenic cyst; in that it is composed of nonfunctioning lung tissue that is disconnected from the remaining lung; it has a separate blood supply. Glomus tumors are rare tumors that arise in the middle ear or jugular bulb. Patients complain of tinnitus and hearing loss.
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Ans. is 'b' i.e., Amorphous densities in mitochondrial matrixFormation of amorphous densities in the mitochondrial matrix is a feature of irreversible injury and not reversible injury.Features of reversible cell injuryFeatures of irreversible cell injuryo Cellular swellingo Loss of microvillio Formation of cytoplasmic blebso Endoplasmic reticulum swellingo Detachment of ribosomeso Myelin figureso Clumping of nuclear chromatino Large flocculent, amorphous densities in swollen mitochondria due to increased calcium influxo Swelling and disruption of lysosomes and leakage of lysosomal enzymes in cytoplasmo Decreased basophiliao Severe damage to plasma membranes o Nuclear changes include:y Pyknosis (Nuclear condensation)y Karyorrhexis (Nuclear fragmentation)y Karyolysis (Nuclear dissolution)
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Ans. is 'b' i.e., Modified radical mastectomy with axillary lymph node dissection * 55 yr old female patient with fungating breast mass of size 3 cm in diameter with palpable ipsilateral two axillary lymph nodes and no evidence of distant metastases - is a case of stage IIA breast carcinoma.* This patient comes under the category of early invasive breast carcinoma so management with modified radical mastectomy and axillary lymph node dissection is the appropriate treatment.Stage I & II breast cancers (Early invasive breast cancers) are managed by:1) Primary therapy for local management &2) Adjuvant therapy* Primary therapy consists of:# Mastectomy with assessment of axillary lymph node status (or modified radical mastectomy) or# Breast conservation (lumpectomy, wide local excision or quadrantectomy) with assessment of axillary lymph node status + radiotherapy.* Various trials have found both these methods to be equally effective. Breast conservation is the preferred form of treatment because of cosmetic advantages. However there are certain contraindications for conservative surgery (described in subsequent question).* Management of axillary lymph nodes :# Earlier dissection of axillary lymph nodes (level I and II) was performed to assess the lymph node status (i.e. presence or absence of occult metastasis)# Now Sentinel lymph node biopsy is considered the standard for evaluation of the axillary lymph nodes for metastasis in women who have clinically negative lymph nodes, (the sentinel lymph node is the first regional lymph node to receive tumor cells that metastasize along the lymphatic pathway from the primary breast cancer)# Axillary Lymph node dissection is performed for clinically palpable axillary lymphnodes or metastatic disease detected in sentinel lymph node biopsy.* Adjuvant chemotherapy is given to :# All node-positive cancers# Node negative cancers if > 1 cm in size# Node negative cancer > .5 cm in size with adverse prognostic factors such as :* Blood vessel or lymph vessel invasion* High nuclear grade* High histological grade* HER 2/neu overexpression* Negative hormone receptor status* Adjuvant hormone therapy (tamoxifen) is added to all those with estrogen receptor positive tumors# HER-2/neu expression is determined for all patients with newly diagnosed breast cancer and may be used to provide prognostic information in patients with node-negative breast cancer and predict the relative efficacy of various chemotherapy regimens. Trastuzumab is the HER-2/neu-targeted agent that is added to the adjuvant therapy is the tumor shows overexpression of HER-2/neu receptors.Advanced Local-Regional Breast Cancer (Stage III)(Neoadjuvant chemotherapy + MRM + adjuvant radiation therapy +chemotherapy + antiestrogen therapy)* Here the disease is advanced on the chest wall or in regional lymph nodes (or both), with no evidence of metastasis to distant sites. Such patients are recognized to be at significant risk for the development of subsequent metastases, and treatment addresses the risk for both local and systemic relapse.* In an effort to provide optimal local-regional disease-free survival as well as distant disease-free survival for these women, surgery is integrated with radiation therapy and chemotherapy.* Neoadjuvant chemotherapy (administration of therapeutic agents prior to the main treatment) should be considered in the initial management of all patients with locally advanced stage III breast cancer.* Surgical therapy for women with stage III disease is usually a modified radical mastectomy, followed by adjuvant radiation therapy and chemotherapy. Antiestrogen therapy (tamoxifen) is added for hormone receptor positive tumors.* Chemotherapy is used to maximize distant disease-free survival, whereas radiation therapy is used to maximize local-regional disease-free survival.* In selected patients with stage III A cancer, neoadjuvant (preoperative) chemotherapy can reduce the size of the primary cancer and permit breastconserving surgery.Distant Metastases (Stage IV)(mainly palliative treatment)* Treatment for stage IV breast cancer is not curative but may prolong survival and enhance a woman's quality of life.* Hormonal therapies that are associated with minimal toxicity are preferred to cytotoxic chemotherapy. Appropriate candidates for initial hormonal therapy include women with hormone receptor-positive cancers; women with bone or soft tissue metastases only; and women with limited and asymptomatic visceral metastases.* Systemic chemotherapy is indicated for women with hormone receptor-negative cancers, symptomatic visceral metastases, and hormonerefractory metastases.* Bisphosphonates, which may be given in addition to chemotherapy or hormone therapy, should be considered in women with bone metastases.
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Ans. C: Ivermectin Ivermectin is used as single oral dose of 200 microgram/ kg body weight It can be repeated after 2 weeks It is indicated in epidemics of scabies in orphanages and Norwegian scabies Scabies: Incubation period: 4 weeks Pathognomic lesion: Burrow, which lies in stratum corneum MC site in infants: Scalp, face Most severe form: Norwegian scabies Drug used orally: Ivermectin
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Orbito Frontal cortex, basal ganglia and head of caudate nucleus are involved in obsessive compulsive disorder.
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Lateral pterygoid is the only muscle of mastication, which is inserted into anterior margin of articular disc and capsule of TMJ by lower head and to pterygoid fovea of neck of mandible, by superior head.
It pulls the disk of TMJ downwards, depressing the mandible.
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Answer is B (COPD): The most common cause of chronic cor puhnonale is chronic. obstructive pulmonary disease - Rubin's pathology
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Aldosterone receptor antagonist Osmotic diuretics Carbonic anhydrase inhibitor Thiazides spironolactone, eplerenone inhibit the aldosterone channels located on the basal side cells of collecting tubule, so they are not secreted in lumen. They filter across the glomerulus and in the nephron it will attract water, so it needs to come in the lumen They are also filtered in the tubule and inhibit carbonic anhydrase They are also fitered in lumen and they inhibit the Na+ Cl- channels in the DCT So the answer is '4'.
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Neural differentiation is seen in Ewing's sarcoma due to which it is now being labeled as a tumor of neuroectodermal origin.
Ewing's sarcoma usually seen in the 1st and Find decades (10 to 15 yrs age group), is an aggressive tumor. Fundamental radiologic findings are osteolysis, cortical erosion, periosteal reaction and a soft tissue mass.
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Ans, a. Acts with the cardiovagal centre to maintain BPVasomotor centre (VMC) controlling sympathetic outflow acts along with cardiovagal centre (CVC) controlling parasympathetic out flow to maintain blood pressure."Vasomotor centre (VMC) controlling sympathetic outflow acts along with cardiovagal centre (CVC) controlling parasympathetic out flow to maintain blood pressure. Baroreceptors, chemoreceptors and cortico hypothalamic inputs influence VMCG. Baroreceptors are tonically active stretch receptors located in walls of aortic arch and carotid sinus. Discharge from baroreceptors cause inhibition of Cl neurons of vasomotor center (VMC) situated in upper (rostral) half of ventrolateral medullaQ andfacilitation of cardiovagal centre (CVC) or nucleus ambiguous. "Medullary Centres regulating Blood PressureVasomotor Centre (VMC)Cardiovagal Centre (CVC)* Collection of glutaminergic neurons in superficial medullary reticular formation, known as C1 neurons, serves as pressure area of VMC. Cell bodies of C1 cells lie in ventrolateral region of upper half of medulla.* These neurons are spontaneously active day and night, tonically discharging impulses (in rhythmic manner) to the heart and blood vessels through lateral reticulospinal tract* It refers to nucleus ambiguous which lies lateral to VMC (medullary reticular neurons)* It receives afferents via Nucleus tractus solitaries (NTS) and in turn sends parasympathetic impulses to heart via the vagus, so named cardiovagal centre* The neurons in CVC do not discharge rhythmically (i.e. are not tonically active) Medullary Centres regulating Blood PressureVasomotor Centre (VMC)Cardiovagal Centre (CVC)* These reticulospinal tracts synapse with preganglionic neurons of sympathetic nervous system located in intermediolateral grey column of spinal cord (thoraoo lumbar sympathetic out flow)* Post ganglionic sympathetic neuron secrete nor adrenaline thereby increasing sympathetic activity and causing tonic vasoconstrictor and cardio accelerator activity resulting in:* The discharge increases parasympathetic activity there by resulting in: * Vasodilation* BP* Cardiac output* Heart rate * Vasoconstriction* BP* Cardiac output* Stroke volume
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Ans. d Lichen nitidus (Ref: Mark Lebwohl 2nd/345)A young 8 years old boy with multiple, small, pin point, shiny, papular lesions on dorsal aspect of hand, forearms and his penis also. Diagnosis is Lichen nitidus.Grouped pinhead lesions on elbow. abdomen, penis and dorsum of hand in a child as shown in the picture is highly suggestive of lichen nitidus.Lie hen scrofulosorum is an uncommon asymptomatic lichenoid eruption of minute papule occurring in children and adolescents with strongly positive tuberculin reaction. It mainly involves perifollicular distribution on abdomen, chest, back and proximal limbs. A hallmark is that superficial epitheloid dermal granuloma surround hair follicles and sweat ducts and may occupy several dermal papillae. Lichen NitidusLesion and etiology are similar, but size is smaller 1.2 mm (pinhead sizeQ)Occurs as grouped lesions on elbow, abdomen, penis and dorsum of handQMucosal or nail changes are rareSelf limiting, non-itchyQHistopathology:Dense, circumscribed and distinctive infiltrate of histio-lymphocytic cells situated directly beneath thinned epidermis results in widening of papillary dermis with elongation and the appearance of embracement by neighboring rete ridges ( Ball in clutch appearanceQ).Thinned epidermis demonstrates central parakeratosisQ, variable /focal hyper keratosis without hypergranulosis, minimal hydropic degeneration and few dyskeratotic cellsTreatment:Antihistaminics particularly AstemazoleQ is effective. Lichen ScrofulosorumLichen scrofulosorum is a lichenoid eruption of minute papulesQOccurs in children and adolescents with tuberculosis.Pathogenesis:Usually associated with chronic tuberculous disease of the LNs and honesQClinical Features:Eruption is asymptomatic and is usually confined to the trunkQ.Lesions consist of symptomless, small, firm, follicular or parafollicular papules of a yellowish or pink color with flat-top or bear a minute homy spine or fine scales on their surfaceQ.It mainly involves perifollicular distribution on abdomen, chest, back and proximal limbsQ.Histopathology:A hallmark is that superficial epitheloid dermal granuloma surround hair follicles and sweat ducts and may occupy several dermal papillaeQ.Treatment:Antituberculous therapy results in complete resolution within a matter of weeksQ.FeatureLichen NitidusLichen planusSymptomsAsymptomaticItchy (marked)Cutaneous lesionMultiple, discrete (or closely grouped), minute, pinpoint to pinhead sizedQ (1- 2mm), flat/ round or dome shaped papule with a glistening (shiny surface)Q.Papules are flesh colored or pink or shiny hypopigmentedQ (in blacks)Larger, plain (flat) topped, polygonal, pruritic, pink/purple (violaceous) papuleQWickham's striaeAbsentPresentQGroupingPresentQUsually notMucous membrane involvementUncommonCommonQ (Variably present)SiteMost frequently on flexural surfaces of upper extremities i.e. arm. forearm, wrist and dorsal surface of hands, lower abdomen, breast, the glans and shaft of penis and other areas of genital regionQFlexures (wrist), extremities (shin), lower back and genitalsQ
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The low surface tension when the alveoli are small is due to the presence of surfactant in the fluid lining the alveoli. Surfactant is a mixture of dipalmitoylphosphatidylcholine (DPPC), other lipids, and proteins. If the surface tension is not kept low when the alveoli become smaller during expiration, they collapse in accordance with the law of Laplace. Ref: Barrett K.E., Barman S.M., Boitano S., Brooks H.L. (2012). Chapter 34. Introduction to Pulmonary Structure and Mechanics. In K.E. Barrett, S.M. Barman, S. Boitano, H.L. Brooks (Eds), Ganong's Review of Medical Physiology, 24e.
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Answer is A (Migraine): Episodic unilateral throbbing headache in a 30 year old female with associated nausea and vomiting suggests a diagnosis of migraine. Aura may or may not be present. Infact 80% of patients with migraine have migraine without aura and 15-20% have migraine with aura. Common Migraine (Migraine without aura) This is characterized by headache with autonomic system dysfunction ( eg. pallor & nausea, vomiting), but without stereotypical neurological or ophthalmic features as in classical migraine Premonitory features include changes in mood frequent yawning or nonspecific prodromal symptoms like loss of concentration Headache stas anywhere in the cranium and is pounding or throbbing It usually spreads to involve one half or even the whole head. During the attack which lasts from hours to a day or more patient is frequently photophobia and phonophobic and seeks relief in quiet dark environment, or through sleep. Classical Migraine (Migraine with aura) This is characterized by headache heralded by a visual aura which lasts about 20 minutes. Visual aura may consist of bright or dark spots, zig zags, heat haze distoions, fig san puzzle defects scintillating scotoma, tunnel vision or foification spectra which may progress to homonymous hemianopia. The headache follows the aura and is usually hemicranial opposite the hemianopia. During the attach patient has associated nausea and photophobia.
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Ans. is 'c' i.e., Ingestion
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D i.e. CyGMP
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Ans. D: Hepatic carcinomaThe human fetus has the highest amount of AFP levels found in humans. These AFP levels gradually decrease after bih down to the low, but detectable levels found in adults by the time a newborn reaches 8 to 12 months.AFP has no known function in healthy adults. In normal fetuses, AFP binds the hormone estradiol. AFP is measured in pregnant women, using maternal blood or amniotic fluid, as a screening test for a subset of developmental abnormalities; it is principally increased in open neural tube defects and omphalocoele and decreased in Down syndrome. In adults, raised levels of AFP are commonly seen in three situations: Hepatocellular carcinoma, Germ cell tumors, and metastatic cancer in the liver originating from other primary tumors elsewhere.
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True conjugate - 11cm Diagonal conjugate -12 cm Inteuberus diameter -11cm Interspinous diameter -10 cm Ref: Williams Obs 24e pg 32-33.
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Agglutination
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ILEUM:- Circular mucosal folds are smaller ,fewer and thin walled. Ileum has narrower lumen, as compared with jejunum. There are 3 or 6 aerial arcades with no windows. Lymphatics drain into the lymph nodes in the mesentery and finally drain into superior mesenteric nodes.
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Symptoms of Mendelson's syndrome generally occurs within 30 minutes of aspiration.
Critical pH is 2.5 and critical volume is 25 ml.
Use of corticosteroid is generally not recommended.
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Ans. C i.e. Anterior uveitis Acute anterior uveitis Associated with: - Juvenile rheumatoid ahritis & - Anklyosing spondylitis Miotic pupil, Treatment: - Steroids (DOC) followed by - Mydriatics, Steroids reduces inflammation & scarring; Dilation of the pupil by atropine: - Reduces pain & - Prevents synechiae formation
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The patient in question is presenting with charachteristic features of bronchiolitis obliterans. Fever, cough, and wheeze are common clinical features of bronchiolitis obliterans and a period of initial improvement may well be seen in cases of bronchiolitis obliterans (Initial sign of B.O). Hyperluscency or chest X-Ray and obstructive curve on pulmonary function tests fuhur suggest the diagnosis of bronchiolitis obliterans. Ref: Nelson 18th Edition, Page 1782
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Atherosclerosis is an inflammatory disease characterized by the deposition of cholesterol and cholesteryl ester from the plasma lipoproteins into the artery wall and is a major cause of heart disease.
Elevated plasma cholesterol levels (>5.2 mmol/L) are one of the most important factors in promoting atherosclerosis, but it is now recognized that elevated blood triacylglycerol is also an independent risk factor. Diseases in which there is a prolonged elevation of levels of VLDL, IDL, chylomicron remnants, or LDL in the blood (eg, diabetes mellitus, lipid nephrosis, hypothyroidism, and other conditions of hyperlipidemia) are often accompanied by premature or more severe atherosclerosis.
There is also an inverse relationship between HDL (HDL2) concentrations and coronary heart disease, making the LDL:HDL cholesterol ratio a good predictive parameter. This is consistent with the function of HDL in reverse cholesterol transport.
Susceptibility to atherosclerosis varies widely among species, and humans are one of the few in which the disease can be induced by diets high in cholesterol.
Key Concept:
Low LDL:HDL cholesterol ratio does not lead to arteriosclerosis.
Reference: HARPERS ILLUSTRATED BIOCHEMISTRY30th ed Page no 274
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Ans. b. 3 columns
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Propeies of Insulin PreparationsPreparationTime of Action (Hr)Onset PeakEffective durationSho actingAspa<0.250.5-1.52-4Glusiline<0.250.5-1.52-4Lispro<0.250.5-1.52-4Regular0.5-1.02-33-6Long actingDetemir1-4---12-24Glargine2-4---12-24NPH2-44-1010-16Ref: Harrison 19e pg: 2411
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Ans. (a) Myopic degeneration can lead to retinal detachmentRef: Kanski 7/e, p. 637; Parson's 22/e, p. 72"Rhegmatogenous retinal detachment (RD) is much more common in high myopia, the pathogenesis including increased frequency of posterior vitreous detachment, lattice degeneration, asymptomatic atrophic holes. Macular holes and occasionally giant retinal tears. The prevalence of retinal detachment appears to be related to the severity of myopia."Optic disc swelling (pseudopapillitis) seen in hypermetropia.
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Ans. is 'a' i.e., IgG IDOPATHICTHROMBOCYTOPENIC PURPURA There are two clinical subtypes of primary I.T.P, acute and chronic both are autoimmune disorders in which platelet destruction results from formation of antiplatelet antibodies. Pathogenesis Chronic ITP is caused by the formation of autoantibodies against platelet membrane glycoproteins most often or Ib-IX. In overwhelming majority of cases the antiplatelet antibodies are of the IgG class. The mechanism of platelet destruction is similar to that seen in autoimmune hemolytic anemias. Opsonized platelets are rendered susceptible to phagocytosis by the cells of the mononuclear phagocyte system. The spleen is the major site of the destruction of platelets. Pathology The principal morphologic lesions of thrombocytopenic purpura are found in the spleen and bone marrow but they are not diagnostic. The point to stress is that despite the increased destruction of platelets in spleen. the spleen size remains normal. On histological examination there is congestion of the sinusoids and hyperactivity and enlargement of the splenic follicles manifested by the formation of prominent germinal centres. Sometimes scattered megakaryocytes are found within the sinuses and sinusoidal walls. This represents a very mild form of extramedullary hematopoiesis. These splenic findings are not sufficiently distinctive to be considered diagnostic. Bone Marrow Bone marrow reveals a modestly increased number of megakaryocytes. These findings are not specific for autoimmune thrombocytopenic purpura, but merely reflect accelerated thrombopoiesis, being found in most forms of thrombocytopenia resulting from increased platelet destruction. The impoance of bone marrow examination is to rule out thrombocytopenias resulting from bone marrow failure. A decrease in the number of megakaryocytes goes against the diagnosis of I.T.P.
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Ans. Visual field
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Ans. C. ChylomicronsThe small intestine transports dietary triglyceride as chylomicrons in lymph. VLDLs are secreted by the small intestine during fasting. Although some dietary fatty acids are transported in the portal blood bound to albumin, it is not the predominant pathway for the transport of dietary lipids to the circulation by the small intestine. The intestine does not secrete LDLs, and although it does secrete HDLs, they are not used as a vehicle for transporting dietary lipids to the blood by the small intestine.
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Synarthrosis are immovable joints and include the fibrous joints.
Amphiarthrosis are slight mobile and include the cartilaginous joints.
Diarthrosis are freely mobile joints and include the synovial joints.
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Whenever the activity of osteoblasts increase, serum alkaline phosphatase is raised. Therefore, serum alkaline phosphatase acts as an index of osteoblastic activity.
The conditions in which osteoblastic activity is increased and hence the alkaline phosphatase in increased are : -
Rickets/osteomalacia
Primary hyperparathyroidism
Renal osteodystrophy (secondary hyperparathyroidism)
Chronic renal failure and secondary hyperparathyroidism
Paget's disease (osteitis deformans)
Osteoblastic secondaries
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When male and female are affected equally, this indicate there is no predilection for male or female, This indicates that mode of inheritance is autosomal. As question says the disease only affects homozygous person and it has early onset of symptoms, this indicate the mode of inheritance is recessive. Therefore, above disease is most likely autosomal recessive disease.
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Clinical features of Hemobilia Characterized by Quinck's triad (Sandblom's triad) : GI hemorrhage +biliary colic+ jaundice Presentation : Melena(90%), hemetemesis (60%), biliary colic(70%) and jaundice (60%) Tendency for delayed presentation(upto weeks) and recurrent brisk but limited bleeding over months and even years Ref : Sabiston 20th edition Pgno :1472-1474
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The microvascular complications of both type 1 and type 2 DM result from chronic hyperglycemia. Whereas, evidence implicating a causative role for chronic hyperglycemia in the development of macrovascular complications is less conclusive. Improvement of glycemic control reduce nonproliferative and proliferative retinopathy, albuminuria , clinical nephropathy, and neuropathy .Maximum reduction occurs in neuropathy but we cannot cpmpletely reverse microvascular or microvascular complication of diabetes. good glycemic control will slow down or prevent the complication but cannot reverse the disease once it occured.
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Ans. a. Genital tuberculosis (Ref: Shaw's 16/e p111)Most likely cause for beaded appearance of fallopian tubes with clubbed ends of fimbriae on HSG is genital Tuberculosis." Tubal occlusion in tuberculosis is considered the most common sign observed on an HSG and occurs most commonly in the region of isthmus and ampulla. Multiple constrictions along the course offallopian tube can also form from scarring and give rise to 'beaded' appearance to the tubes. Scarring can also lead to a 'rigid pipe stem' appearance of the tubes."Hysterosalpingographic presentation of tubal TB vary from non-specific changes such as hydrosalpinx to specific- pattern such as "beaded tube", "golf club tube, "pipestem tube", "cobble stone tube" and the "leopard skin tube".Genital TuberculosisGenital tuberculosis is almost always a secondary infectionQMC primary sites: Lungs >Lymph nodes >AbdomenQMC Route of spread: HematogenousQSites of Genital TB% InvolvementTubes90-100%QUterus50-60%QOvaries20-30%QVagina & Vulva1-2%QPathology :MC site: Bilateral fallopian tubesQIn Fallopian tubes: MC affected part: Ampulla; MC encountered pathology is endosalpingitisQ2nd MC site of involvement: UterusQCornu of the uterus is MC affected as it is in continuation with the fallopian tube & infection descends from the tubesQClinical Features:MC age group: 20-30 years (28 years specifically)MC symptom: InfertilityQUterine TB can manifest in the form of:Ashermairs syndrome (destruction of the endometrial lining of uterine cavity with the formation of intrauterine synechiae or adhesions)QPyometra (pus-filled uterine cavity)If patient conceives spontaneously, ectopic pregnancy is the most likely outcome.Menstrual abnormalities: Hypomenorrhea or amenorrhea due to Asherman's syndrome & polymenorrhea menorrhagiaQDiagnosis:Hysterosalpingography in TBHSG is contraindicated in patients of genital TB as it can lead to reactivation or spreading of diseaseQ.If unknowingly HSG is done in patients of TB, characteristic findings are* Lead pipe appearance of tubeQ* Beaded appearance of tubeQ* HydrosalpinxQ* Corneal blockQ* Intravasation of dyeQ* Golf club tubeQ* Tobacco pouch appearance of the fimbrial end of tube Q* Uterus: Honeycomb appearance due toAsherman syndromeQEndometrial biopsy: Best time is 1-2 days before or 12 hours after onset of menses. In unmarried girls, menstrual blood can be collected within 12 hours of onset of menstruation.PCR done on endometrium or menstrual blood is more sensitive than microscopy & bacteriological culture.Treatment:Genital tuberculosis falls in category 1. The treatment is ATT for 6 months Surgery for restoration of fertility (corrective tuboplasty ) is contraindicated in genital TBQIVF after completion of ATT is the treatment of infertility.
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Boyd's classification of claudication :
Grade I : Pian on walking, that improves with further walking.
Grade II : pain on walking, but patient continues to walk with pain.
Grade III : Pain on walking, that compels patient to take rest.
Grade IV : Rest pain.
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Ans. A. Poststreptococcal GNWorldwide, the most common type of glomerulonephritis is IgA nephropathy. It is also the most common cause of chronic glomerulonephritis in children. However, it is more commonly seen in the adolescents (peak age of occurrence being 10-20 years). In contrast, poststreptococcal GN is most common type of acute glomerulonephritis in children, its peak age of occurrence being 5-12 years of age.
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Ans. B: Methotrexate Dihydrofolate reductase inhibitor is a molecule that inhibits the function of dihydrofolate reductase, and is a type of antifolate. Since folate is needed by rapidly dividing cells to make thymine, this effect may be used to therapeutic advantage. For example, methotrexate is used as cancer chemotherapy because it can prevent neoplastic cells from dividing. Bacteria also need DHFR to grow and multiply and hence inhibitors selective for bacterial vs. host DHFR have found application as antibacterial agents Variety of drug act as inhibitors of dihydrofolate reductase: The antibiotic trimethoprim and its derivatives brodimoprim, tetroxoprim, and iclaprim. The antimalarial drug pyrimethamine. The chemotherapeutic agents methotrexate and pemetrexed. Methotrexate acts on this enzyme binding to it some 1000 times more tightly than folate itself.
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MUSCLES helping in looking down - Inferior rectus - primary function supplied by 3rd cranial nerve Superior oblique - secondary function-suppliecd by 4th cranial nerve
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Other causes:
Diabetes mellitus
Syringomyelia
Amyloidosis.
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The mechanism of enzyme catalysis is similar in principle to other types of chemical catalysis. By providing an alternative reaction route the enzyme reduces the energy required to reach the highest energy transition state of the reaction. The reduction of activation energy (Ea) increases the amount of reactant molecules that achieve a sufficient level of energy, such that they reach the activation energy and form the product. As with other catalysts, the enzyme is not consumed during the reaction (as a substrate is) but is recycled such that a single enzyme performs many rounds of catalysis.
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Lateral squint is also known as "Heterophoria" It is a condition in which tendency of the eyes to dete is kept latent by fusion. Therefore, when the influence of fusion is removed the visual axis of one eye detes away. Ref : A.K.Khurana; 6th edition;Page no: 344
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Ans. D. Microarray(Ref: Robbins 9/e page177,178)DNA microarray can be used to detect DNA sequence variationsRNA Microarray can detect Gene expression.
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Hyperkalemia, also spelled hyperkalaemia, is an elevated level of potassium (K+) in the blood serum. Normal potassium levels are between 3.5 and 5.0 mmol/L (3.5 and 5.0 mEq/L) with levels above 5.5 mmol/L defined as hyperkalemia. Typically this results in no symptoms. Occasionally when severe it results in palpitations, muscle pain, muscle weakness, or numbness. An abnormal hea rate can occur which can result in cardiac arrest and death. Refer kDT 6/e p499
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Methylphenidate is the drug of choice for ADHD in children. Dexamphetamine is a similar stimulant drug which is can be used as a second choice. Atomoxetine is also used as a second line drug for ADHD in children. Clonidine has anti-ADHD effects and is ideal if there are side effects from other drugs. E.g. Hypeension. Venalafaxine and Buproprion has similar anti-ADHD effects and can have a role in adults with ADHD. Ref: Kaplan & Sadock's Synopsis of Psychiatry, By Benjamin J Sadock, M.D., Harold I. Kaplan, Virginia A Sadock, M.D, 10th Edition, Page 1212 ; MTA Study on Stimulants, USA.
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Transfusions with FFP to replenish vitamin K-dependent clotting factors should be administered on call to the operating room. The timing of transfusion is dependent on the quantity of each factor delivered and its half-life. The half-life of the most stable clotting factor, factor VII, is 4 to 6 hours. Thus, transfusion of FFP on call to the operating room ensures that the transfusion is complete prior to the incision, with circulating factors to cover the operative and immediate postoperative period.
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He has left-sided heart failure with pulmonary edema and congestion. His reduced cardiac output leads to diminished renal blood flow that stimulates the renin-angiotensin mechanism to retain salt and water to increase plasma volume. He has prerenal azotemia with a high BUN-to-creatinine ratio and low fractional excretion of sodium. The other options do not explain his pulmonary edema. An aldosterone- secreting adrenal adenoma (Conn syndrome) would increase aldosterone, but decrease the plasma renin. In chronic adrenal failure (Addison disease), there should be hyperkalemia and hypoglycemia accompanying hyponatremia. Chronic glomerulonephritis with chronic renal failure would be associated with a BUN-to-creatinine ratio around 10:1. Pulmonary fibrosis would lead to cor pulmonale and a prominent right heart border with features of right-sided congestive heart failure. The syndrome of inappropriate antidiuretic hormone (ADH) is a paraneoplastic syndrome that can occur with pulmonary small cell carcinomas, and secretion of antidiuretic hormone (SIADH) would increase ADH and cause more severe hyponatremia, but would not have a major effect on the renin-angiotensin mechanism, and sodium excretion would be higher.
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Treatment of acute lymphangitis requires antibiotic and rest.
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Oligodendrocytes are responsible for myelination in the CNS. In the PNS, Schwann cells form the myelin sheath. The process of myelination begins before bih and is not complete until a year or more after bih. (Ref: Vishram Singh textbook of neuroanatomy, second edition, pg- 19)
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Among the given drugs only to drugs that is bosentan and amilodipine are indicated in pulmonary hypeension. Calcium channel blockers like amlodipine are indicated only in those patient who are positive for intravenous vasodilator challenge (less than 5% patient ). The patient is negative then endothelin drugs are indicated like ok Bosenton. Refer Harrison 19e p1659
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Ans. is `c' i.e., Leishmaniasis Disease common in Post-disaster Phase o Gastroenteritis (MC) o Acute respiratory tract infections (Pneumonia) o Leptospirosis Rickettsiosis Rabies Equine encephalitis
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Fasciotomy or fasciectomy is a surgical procedure where complete opening of all fascial envelope is done to relieve tension or pressure commonly to treat the resulting loss of circulation to an area of tissue or muscle. Fasciotomy is a limb-saving procedure when used to treat acute compament syndrome. REF : BAILEY AND LOVE 27TH ED
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Anthrax toxin is tripaite toxin It consist of Edema factor Protective factor Lethal factor Diphtheria toxin made up of A and B fragments Active fragment causes ADP ribosylation of EF leads to inhibition of protein synthesis Botulinum toxin - it has anticholinergic action Cholera toxin - two component
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"Target" or "Iris" or "Bull's eye" lesions on hands, wrists and ankles are characteristic of erythema multiformae.
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ANSWER: (B) NoseREF: Jawetz Microbiology, 24th Ed Ch. 14Staphylococci are ubiquitous human parasites. The chief sources of infection are shedding human lesions, fomites contaminated from such lesions, and the human respiratory tract and skin. Contact spread of infection has assumed added importance in hospitals, where a large proportion of the staff and patients carry antibiotic-resistant staphylococci in the nose or on the skin. Although cleanliness, hygiene, and aseptic management of lesions can control the spread of staphylococci from lesions, few methods are available to prevent the wide dissemination of staphylococci from carriers. Aerosols (eg, glycols) and ultraviolet irradiation of air have little effect.To diminish transmission within the hospital setting, high risk patients, such as those in intensive care units and patients transferred from chronic care facilities where prevalence is high, are frequently surveyed for anterior nares colonization. Patients who test positive by culture or PCR are placed upon contact precautions so as to minimize spread on the hands of health care workers. Health care workers should strictly adhere to infection control policies by wearing gloves and washing hands before and after patient contact.Rifampin coupled with a second oral antistaphylococcal drug sometimes provides long - term suppression and possibly cure of nasal carriage; this form of therapy is usually reserved for major problems of staphylococcal carriage, because staphylococci can rapidly develop resistance to rifampin.
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Ans. Greenish discoloration over right iliac fossa
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Othello Syndrome or Delusional jealousy is a psychiatric disorder in which a person holds a strong delusional belief that their spouse or sexual paner is being unfaithful without having any, very little, or insignificant proof to back up their claim. People who suffer from this disorder have a strong association with stalking, cyberstalking, sabotage, or even violence. It can be found in the context of schizophrenia and delusional disorder, such as bipolar disorder, but is also associated with alcoholism and sexual dysfunction and after neurological illness.
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Eugenics (Sir Francis Galton): Is a social philosophy which advocates the improvement of human hereditary traits through various forms of intervention (Genetic Manipulation).
Euthenics: Deals with human improvement through altering external factors such as education and the controllable environment, including the prevention and removal of contagious disease and parasites, environmentalism, education regarding home economics, sanitation, and housing (Environmental Manipulation).
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The term stillborn refers to the death of a fetus after 28 weeks of gestation or death of a fetus weighing 1000gms.
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Dysmenorrhea in endometriosis is usually congestive type that stas prior to onset of menstruation. All endometriosis lesions are associated with pelvic pain including minimal to mild endometriosis. IN regards to option 'b' , dysmenorrhea is less frequent in women with 'only ovarian endometrioma' compared with other locations. A strong association is found between pelvic pain, dyspareunia and posterior cul-de-sac ( POD) lesions. Distribution of pain is usually variable but its mostly bilateral.
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Ghrelin inhibits the satiety centre and is released from stomach and hypothalamus. It also stimulates the release of Growth hormone. The effect is that it increases appetite. It is also secreted in anorexia and induces lipolysis.
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Ans. is 'd' i.e., Medullary o Thyroid tumor is seen in MEN II, and is medullary carcinoma of thyroid.
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Gradenigo's syndrome/ Gradenigo-Lannois syndrome/ Petrous apicitis It is a complication of otitis media and mastoiditis involving the apex of the petrous temporal bone. It was first described by Giuseppe Gradenigo in 1904 when he repoed a triad of symptoms consisting of periorbital unilateral pain related to trigeminal nerve involvement, diplopia due to sixth nerve palsy and persistent otorrhea, associated with bacterial otitis media with apex involvement of the petrous pa of the temporal bone (petrositis).
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Composition of Bile Substance Liver Bile Gallbladder Bile Water 97.5 g/dl 92 g/dl Bile salts 1.1 g/dl 6 g/dl Bilirubin 0.04 g/dl 0.3 g/dl Cholesterol 0.1 g/dl 0.3 to 0.9 g/dl Fatty acids 0.12 g/dl 0.3 to 1.2 g/dl Lecithin 0.04 g/dl 0.3 g/dl Na+ 5 mEq/L 130 mEq/L K+ 5mEq/L 12 mEq/L Ca++ 5 mEq/L 23 mEq/L Cl- 100 mEq/L 25 mEq/L HCO3 28 mEq/L 10 mEq/L
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ANSWER: (A) Casoni's testREF: Paniker's 6th ed p. 149The Casoni test is a skin test used in the diagnosis of hydatid disease. The test involves the intradermal injection of 0.5 ml of sterilised fluid from hydatid cysts. A wheal response occurring at the injection site within 20 minutes is considered positive. The test is positive in about 90% of cases of hydatid disease affecting the liver, but positive in less than 50% of patients with hydatid disease elsewhere in the body; false positive results are also common. Consequently, serological tests are nowr generally used.Dick's test: Scarlet fever Schick's test: Diphtheria
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Lamellar or Zonular cataract It is a developmental cataract in which the opacity occupies a discrete zone in the lens. It is the most common type of congenital cataract presenting with visual impairment. Characteristic features. Typically, this cataract occurs in a zone of foetal nucleus surrounding the embryonic nucleus. The main mass of the lens internal and external to the zone of cataract is clear, except for small linear opacities like spokes of a wheel(riders) which may be seen towards the equator. Occasionally two such rings of opacity are seen. It is usually bilateral and frequently causes severe visual defects. Ref;A.K.Khurana; 6th edition; Page no:184
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Incubation period of staphylococcal food poisoning is 1-6 hours. As per question, consumption of food is within 6 hrs (3hrs). Food Poisoning Organism Incubation period Staphylococcal 1-6 hours Salmonella 12-24 hours Botulism 12-36 hours Clostridium perfringens 6-24 hours Bacillus cereus 1-6 hours E.coli 8-72 hours
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Ans. is 'd' i.e., Develops only in the cases of maternal hypertension HELLP Syndromeo It is an acronym for hemolysis (H) elevated liver enzymes (EL) and low platelets (LP) (<l,00,000/mm3).o This is a rare complication of pre eclampsia (10-15%).o It may also develop even in patients without maternal hypertension,o Patient have nausea, vomiting and epigastric or right upper quadrant pain.o Patient has elevated liver enzymes (AST/ ALT > 70IU/L), LDH (>600IU/L) and bilirubin >1[?]2 mg/di
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option c - Hyaluronic acid helps in wound healing Hyaluronic Acid Longest GAG Present in Extracellular Matrix (ECM) Present in both bacteria and animals No Sulfate Role in Cell Migration during Morphogenesis Role in Wound Healing
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Healthy glomerulus is responsible for repulsion of proteins like Albumin Any kind of inflammation affecting the glomerulus will lead to damage to glomerulus, thus glomerulus will not function properly, leading to proteinuria. This type of proteinuria is given the name "Sub-nephrotic proteinuria" Additional findings in patient with glomerulonephritis : 1. HTN 2. Hematuria 3. Oliguria
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Ans. B: ActinomycetesMycetoma is a chronic localized granulomatous inflammatory lesion common in the tropics and sub-tropics.Multiple siAuses, soft tissue swelling and discharge of coloured granules characterize a mycetoma foot. Chronic sinuses discharging granules are caused by (1) Eumycetes (true fungi), (2) Schizomycetes, which includesActinomycosis (aerobic higher filamentous bacteria) andBotryomycosis (bacterial infection).- Actinomycosis is often caused by Actinomadura or Nocardia species wherein it gains entry after penetrating trauma (splinter, gravel or thorn prick).Young males are commonly affected and 75% of the lesions occur in the lower limbs.The disease slowly progresses from a nodule to multiple sinuses discharging coloured granules. Involvement of bone is late following dermal and soft tissue spread.- Botryomycosis (a misnomer), a chronic suppurative infection is caused by bacteria involving skin or viscera . This rare condition mimics a deep mycotic infection and is often caused by Staphylococcus or Pseudomonas species of bacteria. The feet and hands are commonly affected and penetrating trauma may be a predisposing factor. It usually presents as a nodule, sinus or ulcer, which is initially localized.The diagnosis of actinomycosis is based on clinical findings, demonstration of characteristic granules and culture of the organism from a deep tissue biopsy.Immunological studies (counter immuno electrophoresis and ELISA) are also used. Botryomycosis is diagnosed based on a positive gram's stain and culture; negative fungal cultures and demonstration of the characteristic botryomycotic granules at histopathology from a deep biopsy.In endemic areas, subcutaneous swelling with sinuses should be considered as mycetoma unless proved otherwise. The differential diagnosis includes chronic osteomyelitis, tuberculosis and chronic abscesses.
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Ans. (b) Borrelia BurgdorferiRef.: Microbiology by Ananthanarayan and Paniker 8th ed. /377, 379, 381* Causal agent of lyme disease: Borrelia Burgdorferi (I.P. 3 to 30 days)# Vector: Ticks* Lyme disease occurs in 3 stages:# Stage 1: localized infection, appears an annular skin lesion (Erythema Migrans)# Stage 2: disseminated infection, now with headache, fever, arthralgia, myalgia and lymphadenopathy.# Stage 3: persistent infection, presents with chronic arthritis, encephalopathy, and acrodermatitis.Also Know* Borrelia vincenti: ulcerative gingivostomatitis or oropharyngitis (Vincents Angina)* Borrelia Recurrentis: louse borne relapsing I fever* Treponema carateum: causes Pinta* Treponema Pertenue: causes Yaws* Treponema Pallidum: Syphilis
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The light-cure process is activated when a diketone photosensitizer such as camphorquinone (CQ) absorbs a quantum of blue light and forms an excited-state complex (exciplex) with an electron donor such as an amine (e.g., dimethylaminoethyl methacrylate ).
While in this activated complex, CQ extracts a hydrogen atom from the α-carbon adjacent to the amine group, and the complex decomposes into amine and CQ free radicals. The CQ free radical is readily inactivated.
Thus, in photoinitiation only the amine free radicals act to initiate the addition polymerization reaction.
Reference: PHILLIPS’ SCIENCE OF DENTAL MATERIALS, 12th ed page no 289
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Ans. is `b' i.e., Epidemic disease Epidemic The unusual occurrence in a community or region of disease, specific health-related behaviour (e.g., smoking) or other related events clearly in excess of expected frequency (expected occurrence). o The key words in the definition of epidemic are "in excess of expected occurrence" (for expected occurence frequency see above explanation). o The amount of disease occuring in the past, in the absence of an epidemic, defines expected frequency. So, when disease occurs in expected frequency in the absence of epidemic --> Endemic disease. o When conditions are ourable for disease agent, it may occur in excess of expected occurrence, i.e., endemic disease bursts into epidemic. o If normal expectancy is zero, even one case is considered epidemics. That means occurence of new disease in a community is an epidemic. Similarly reoccurrence of an eradicated/eliminated disease is an epidemic. Statistically speaking, epidemic is said to occur when number of cases exceed 'twice the standard detion' Some times term outbreak is used. for a small, usually localized epidemic. o Diseases causing epidemics are measles, chickenpox, and cholera. o Besides these there is modern slow epidemic of non-communicable diseases like CHD. Pandemic o An epidemic usually affecting a large propoion of population over a large geographic area such as a nation, e.g., influenza, Cholera El Tor and acute hemorrhagic conjuctivitis. Ecdemic o Disease that originates outside the geographic area in which it occurs. Sporadic o The cases occur irregularly, haphazardly from time to time ,and generally infrequently. o The cases are so few and separated widely in space and time that they show little or no connection with each other, nor a recognizable common source of infection. o Examples - Polio, Tetanus, meningococcal meningitis, Herpes Zoster. For easy to remember Sporadic ---> Disease occuring irregularly from time to time. Endemic --> Disease occuring regularly in expected frequency. Epidemic --> Disease occuring in excess of expected frequency. Pandemic --> Epidemic affecting a large propoion of population over a wide geographic area.
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(b) Best seen on posterior rhinoscopy(Ref. Scott Brown, 6th ed., 4/10/14)EthmoidalAntrochoanalMainly allergic etiologyInfectiveCommonUncommonMiddle ageYoungMultipleSingleBilateralUnilateralSeen on anterior rhinoscopyPosterior rhinoscopySteroids and antihistaminics are used in t/tNo roleHighly recurrentRecurrence is uncommon
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A i.e. Bulb of hair follicleBulb of hair follicle has following layers- Fibrous connective tissueExternal root sheathInternal root sheath composed of epithelium stratum (Henle's layer)Q and granular stratum (Huxley's layer)QCuticle, coex & medulla of hair
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The action of extraocular muscles can be summarized as follows -
All the recti muscles are adductor except lateral rectus which is abductor.
Both oblique muscles are abductors
Both the superior muscles (superior oblique and superior rectus) are intortors.
Both the inferior muscles (Inferior oblique and inferior rectus) are extorters.
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GLUT 4 Is the insulin-regulated glucose transpoer. Responsible for insulin-regulated glucose storage. And the GLUT 4 is found in adipose tissues and striated muscle (skeletal muscle and cardiac muscle).Ref: Ganong&;s review of medical physiology;24th edition; page no-434
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ANSWER: (D) C8 T1REF: BDC 4th edition vol 1 Page 53See APPENDIX-7 for "BRACHIAL PLEXUS LESIONS -CHART 2"Repeat Anatomy December 2011 APPENDIX - 7Brachial Plexus Lesions-chart 1Nerve (Segment)Motor Deficit(s)Sensory DeficitsLong Thoracic (C 5, 6, 7)Winged Scapula- Serratus AnteriorNoneSuprascapular (C 5, 6 )Hard to start shoulder abduction - SupraspinatusNoneAxillary (C 5, 6 )Difficult abducting arm to horizontal - DeltoidLateral side of arm below point of shoulder Loss of shoulder roundness - DeltoidMusculocutaneous C 5, 6, (7)Very weak flexion of elbow joint- Biceps & BrachialisLateral forearm Weak supination of radioulnar joint -Biceps Radial (C 5 - Tl)Drop Wrist - Extensor carpi radialis iongus & brevis, Ext. carpi ulnarisPosterior lateral &arm; dorsum of hand Difficulty making a fist - synergy between wrist 1 extensors and finger flexors Median (EUR 5 - Tl) at ElbowPronation of radioulnar joints-Pronator teres & quadratusRadial portion of palm; palmar surface 8i tips of radial 3% Weak wrist flexion - FI. carpi radialisdigits Weakened opposition of thumb - thenar muscles "Ape Hand"- thumb hyper extended and adducted - thenar muscles "Papal Hand" Loss of flexion of I.P. joints of thumb & fingers 1 & 2 - Fl. pollices Iongus ; FL digit, superficialis, FL digit profundus Median (C 5 - Tl) at WristWeakened opposition of thumb - thenar musclesPalmar surface & tips of radial "Ape Hand"- thumb hyper extended and adducted - thenar muscles3% digitsUlnar (C 8, Tl) at Elbow"Clawing" of fingers 3 & 4- M.P. joints hyper extended: P.I.P. Flexed - Interossei& LumbricalsUlnar and dorsal aspect of palm and of ulnar VA digits Loss of abduction & adduction of M.P joints of fingers -Interossei Thumb - abducted and extended - adductor pollices Loss of flexion of D.I.P. joints of fingers 4 8t 5 - Fl. digit profund. Ulnar (C 8, Tl) at Wrist"Clawing" of fingers 3 & 4- M.P. joints hyper extended; P.I.P. Flexed - Interossei & LumbricalsUlnar and dorsal aspect of palm and of ulnar 1 xk digitsLoss of abduction & adduction of M.P joints of fingers - InterosseiThumb - abducted and extended - adductor pollicesUpper and Lower Root Lesions-chart 2LesionMotor DeficitsSensory DeficitsNervesErb s Palsy(C5,6)Loss of abduction, flexion and rotation at shoulder; Weak shoulder extension - deltoid, rotator cuffPosterior and lateral aspect of arm - axillary n.Axillary, Suprascapular, Upper and Lower subscapular Very weak elbow flexion and supination of radioulnar joint - biceps brachii & brachiaiisRadial side of Forearm- musculocutaneous n. Thumb and 1st finger - superficial hr. of radial; digital brs. - Median n.Musculocutaneous: Radial N. brs. to supinator & brachioradialis muscles Susceptible to shoulder dislocation - loss of rotator cuff muscles Suprascapular, Upper and Lower subscapular "Waiters Tip" position Klumke's Palsy (C8, Tl)Loss of opposition of thumb -Tnenar musclesUlnar side of forearm, hand & ulnar 1 Vi & digits - ulnar and medial antebrachial cutaneousThenar branch of Median nerve Loss of adduction of thumb - Adductor pollices Ulnar nerve Loss of following finger movements: abduction and adduction of M.P. joints; flexion at M.P. & extension of LP. joints. Lumbricals & interossei Deep branch of Ulnar & Median Very weak flexion of P.I.P. & D.I.P. joints FI Digit. Super. & Profund. Ulnar and Median
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The appendix is an immunologic organ involved in secretion of immunoglobulins. An inverse association between appendectomy and development of ulcerative colitis has been repoed. Routine resection of the normal appendix to improve the clinical course of ulcerative colitis is not generally indicated.
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Biotin (formerly known as anti-egg white injury factor Boas (1927) observed that rats fed huge quantity of raw egg white developed dermatitis and nervous manifestations & retardation in growth found that feeding cooked egg did not produce any of these symptoms It was shown that the egg white injury in rats and chicks (Boas experiment) was due to the presence of an anti-vitamin in egg white The egg-white injury factor was identified as a glycoprotein- avidin and biotin was called as anti-egg white injury factor. ref Satyanarayana 4th ed page 146
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Osteoporosis in menopause typically affects tracbecular bone.
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Large number of drugs follow first order kinetics of elimination i.e. a constant fraction of the drug is eliminated in unit time. Very few drugs e.g. alcohol, have zero order elimination pattern where in a constant amount of the drug is eliminated in unit time. For few other drugs the enzymes participating in the metabolic reactions are saturable hence at higher doses these drugs change their pattern from first order to zero order e.g. theophylline, phenytoin, etc.
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ERYTHROMYCIN It was isolated from Streptomyces erythreus in 1952. Since then it has been widely employed, mainly as alternative to penicillin. Water solubility of erythromycin is limited, and the solution remains stable only when kept in cold. Uses A . As an alternative to penicillin 1 . Streptococcal pharyngitis, tonsillitis, mastoiditis and community acquired respiratory infections caused by pneumococci and H. influenzae respond equally well to erythromycin. It is an alternative drug for prophylaxis of rheumatic fever and SABE. However, many bacteria resistant to penicillin are also resistant to erythromycin. 2. Diphtheria: acute stage as well as for carriers-7 day treatment. Some prefer it over penicillin. Antitoxin is the primary treatment. 3. Tetanus: as an adjuvant to antitoxin, toxoid therapy. 4. Syphilis and gonorrhoea: only if other alternative drugs, including tetracyclines also cannot be used: relapse rates are higher. 5. Leptospirosis: 250 mg 6 hourly for 7 days in patients allergic to penicillins. B. As a first choice drug for 1 . Atypical pneumonia caused by Mycoplasma pneumoniae: rate of recovery is hastened. 2. Whooping cough: a 1-2 week course of erythromycin is the most effective treatment for eradicating B. peussis from upper respiratory tract. However, effect on the symptoms depends on the stage of disease when treatment is staed. (a) Prophylactic: during the 10 day incubation period-disease is prevented. (b) Catarrhal stage: which lasts for about a week-erythromycin may abo the next stage or reduce its duration and severity. (c) Paroxysmal stage: lasting 2-4 weeks-no effect on the duration and severity of &;croup&; despite eradication of the causative organism. (d) Convalescent stage: during which &;croup&; gradually resolves (4-12 weeks)-is not modified. Azithromycin, clarithromycin, and chloramphenicol are the alternative antimicrobials. Cough sedatives are not very effective. Coicosteroids may reduce the duration of paroxysmal stage but increase the risk of superinfections and carrier stage; should be reserved for severe cases only. Adrenergic
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Granulomatosis with polyangiitis (formerly known as Wegener's granulomatosis) is characterised by granuloma formation, mainly affecting the nasal passages, airways and kidney. A minority of patients present with glomerulonephritis. The most common presentation of granulomatosis with polyangiitis is with epistaxis, nasal crusting and sinusitis, but haemoptysis and mucosal ulceration may also occur. Deafness may be a feature due to inner ear involvement, and proptosis may occur because of inflammation of the retro-orbital tissue. This causes diplopia due to entrapment of the extra-ocular muscles, or loss of vision due to optic nerve compression. Disturbance of colour vision is an early feature of optic nerve compression. Untreated nasal disease ultimately leads to destruction of bone and cailage. Migratory pulmonary infiltrates and nodules occur in 50% of patients (as seen on high-resolution CT of lungs). Patients with granulomatosis with polyangiitis are usually proteinase-3 (PR3) antibody-positive (ELISA).Pulmonary involvement may be manifested as asymptomatic infiltrates or may be clinically expressed as cough, hemoptysis, dyspnea,and chest discomfo. It is present in 85-90% of patients. Endobronchialdisease, either in its active form or as a result of fibrous scarring, maylead to obstruction with atelectasis . Renal disease (77% of patients) generally dominates the clinical picture and, if left untreated, accounts directly or indirectly for most of themoality rate in this disease. Although it may smolder in some casesas a mild glomerulitis with proteinuria, hematuria, and red blood cellcasts, it is clear that once clinically detectable renal functional impairment occurs, rapidly progressive renal failure usually ensues unlessappropriate treatment is institutedPatients with active disease usually have a leucocytosis with elevated CRP, ESR and PR3. Complement levels are usually normal or slightly elevated. Imaging of the upper airways or chest . Ref - Davidsons 23e p1041 , harrisons 20e p2578,2579
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Wounds do not begin to gain tensile strength from collagen immediately after the suturing . Wound stas achieving tensile strength around 20 % by 3 weeks, and increases by around 80 % by 12 weeks. The maximum scar strength is 80% of that of unwounded skin. Scar tissue continues to remodel for at least 6 - 12 months after an injury. Ref: Surgery of Bailey and love,26th edition.
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Serum ferritin levels is the most sensitive and specific test to diagnose iron deficiency anemia Under steady-state conditions, the serum ferritin level correlates with total body iron stores; thus, the serum ferritin level is the most convenient laboratory test to estimate iron stores. The normal value for ferritin varies according to the age and gender of the individual.As iron stores are depleted, the serum ferritin falls to <15 mg/L. Such levels are diagnostic of absent body iron stores. Adult males have serum ferritin levels that average ~100 mg/L, corresponding to iron stores of ~1 g. Adult females have lower serum ferritin levels averaging 30 mg/L, reflecting lower iron stores (~300 mg). Ferritin is also an acute-phase reactant and, in the presence of acute or chronic inflammation, may rise several-fold above baseline levels.
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Ans: a (NADP)Ref: Vasudevan Sreekumari, 6th edi., pg. 228NADPH is used for the reductive biosynthetic reactions e.g., de novo synthesis of fatty acid, synthesis of cholesterol and steroids. NADPH is mainly generated by the HMP shunt pathway.NADPH is not entering the ETC and NADPH will not generate ATP. NADH is used for reducing reactions in catabolic pathway e.g., pyruvate to lactate NADH enters the electron transport chain, and ATP is generatedETC is having four complexComplex one - NADH Co Qreductase or NADH dehydrogenase complex Complex two - succinate Q reductase Complex three - cytochrome reductase Complex four - cytochrome oxidaseSummary of electron flow in ETCComplex one - NADH-FMN-FeS-CoQ - 4 protons out of (ubiqunone) mitochondria Complex two -Succinate-FAD-FeS-CoQ (ubiqunone)Complex three -CoQ-FeS-Cytochromeb-cytochrome cl-cytochrome c -4 protons out Complex four -Cytochrome c-CuA-Cytochrome -2 protons out.a-Cytochrome a3-CuB -oxygen
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Winter bottom sign is enlargement of posterior cervical lymph nodes, seen in sleeping sickness. Sleeping sickness, also known as African trypanosomiasis is caused by Trypanosoma brucei gambiense and Trypanosoma brucei rhodesiense. T. brucei gambiense causes West African sleeping sickness manifested by fever, hepatosplenomegaly and posterior cervical lymphadenopathy with chronic central nervous system invasion. T. brucei rhodesiense causes East African sleeping sickness manifested by fever, early and acute central nervous system invasion, with loss of weight and myocarditis. South American trypanosomiasis (Chagas disease) is caused by T. cruzi
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Answer is A (Bronchoscopy, lavage and brushing) : The basic idea is to obtain a tissue biopsy. FNAC could he used, however it would ceainly not be the best. Bronchoscopy would allow, both, direct visualization and biopsy, and so is the best option here.
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Ans is 'a' i.e. difficulty in shrugging of shoulder Nerves in the posterior triangle of neck (only motor nerves)Spinal accessory nerveTwo small branches to levator scapulae(C3,4)Nerve to RhomboideNerve to serratus anteriorNerve to subclaviusSuprascapular nerveWhen a superficial incision is made in the post triangle, the nerve most likely to be injured is spinal accessory nerve, because it runs through a tunnel in the fascia forming the roof of triangle.Rest all nerves are either deep or have a very small course in the lower part of the triangleSpinal accessory nerve supplies 2 muscles -Trapezius andsternocleidomastoidAction of Trapezius* :Elevation of scapulaRetraction of scapulaRotation of scapulaAction of sternocleidomastoid* :Turns the face to opposite side *Tilts the head towards the same shoulder.When SCM of both sides contracts draws the head forwards.
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B i.e. 1% Atropine ointment
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Hydrofluoric acid causes Hypocalcemia. Calcium based therapies are main stay of treating Hydrofluoric acid burns. Topical application of calcium gluconate onto wounds and IV administration of calcium gluconate for systemic symptoms. Intra-aerial calcium gluconate infusion provides effective treatment of progressive tissue injury and intense pain.
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(Ref: Katzung Pharmacology, 14th ed. pg. 127-28)Organophosphates are irreversible Acetylcholinesterase inhibitor which is well absorbed from the skin, lung, gut, and conjunctiva--thereby making them dangerous to humans and highly effective as insecticides.Due to inhibition of acetylcholinesterase enzyme, acetylcholine levels are increased and the patient therefore presents with cholinergic symptoms: (Mn: SLUDGE-FB)Salivation, Lacrimation, increased urination, Diarreha, GI distress, Emesis, Faciculation, BradycardiaDOC for this poisoning: ATROPINEOXIMES (Pralidoximes, Di-Acetyl monoxime) are known as AchE enzyme reactivators. These are used only in organophosphate poisoning.Pin-point pupil is seen in poisoning with: (Mn: POMP)Pontine hemorrhage, Organophosphate, Morphine and Phenol poisoning
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openlifescienceai/medmcqa
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Ans. is 'a' i.e., Ileocaecal tuberculosis o Tuberculosis of the small intestine occurs in two forms :# Primary infection is usually due to bovine strain of mycobacterium tuberculosis and results from ingesting infected milk. In India the human strain may also cause such primary tuberculosis. This produces hyperplastic tuberculosis# Secondary infection occurs due to swallowing of tubercle bacilli in a patient with pulmonary tuberculosis. This leads to ulcerative tuberculosis, the more common form of intestinal tuberculosis.A) Hyperplastic tuberculosiso Caused by ingestion of Mycobacterium tuberculosis by pts with a high resistance to the organism. The infection established itself in lymphoid follicles and the resulting chronic inflammation causes thickening of the intestinal wall and narrowing of the lumen. There is early involvement of the regional lymph nodes which may caseate.o Untreated sooner or later subacute intestinal obstruction will supervene often together with the impaction of an enterolith in the narrowed lumeno It usually occurs in the ileocecal region.Clinical features# Attacks of acute abdominal pain with intermittent diarrhoea.# Sometimes the presenting picture is of a mass in the rt iliac fossa in a pt with vague ill health.# Features of blind loop syndrome may develop due to stasis, distention and chronic infection in the segment of ileum proximal to obstruction.Barium meal radiography will reveal# Persistent narrowing of the affected segment i.e. the terminal ileum and the caecum.# The caecum is pulled up * and may become subhepatic.# As the caecum is pulled up the ileo-caecal angle is widened. Normal ileo-caecal angle is 900. In ileocaecal tuberculosis this angle may increase upto 1500.*Treatment: This depends on the presence or absence of obstructive symptoms.# ATT is given in both cases.# If obstruction is present ileocaecal resection is best method of t/t (along with ATT)B) Ulcerative tuberculosiso It is usually secondary to pulmonary tuberculosis and results from swallowing tubercle bacilli in the sputum (cf. Hyperplastic tuberculosis is usually primary there is no pulmonary tuberculosis)o Usually longer parts of the terminal ileum is involved.o There are multiple ulcers in the terminal ileum lying transversely o Pt presents with diarrhoea and wt losso Barium meal shows absence of filling of the lower ileum, caecum and most of the ascending colon as a result of narrowing and hypermotility of the ulcerated segment.Treatment# A course of A TT is adequate# Operation is rarely required, in rare events of perforation or intestinal obstruction.
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openlifescienceai/medmcqa
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B i.e. Isocitrate dehydrogenase 2 molecules of carbon dioxide are released in TCA cycle. One before and one after a - ketoglatarate. Enzymes used are - isocitrate dehydrogenase and a ketoglutarate dehydrogenaseQ respectively.
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openlifescienceai/medmcqa
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