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The middle cerebral aeries are the most common site of occlusion resulting in cerebrovascular accident (CVA). The middle cerebral aeries supply the lateral surfaces of the frontal, temporal, and parietal lobes, and the inferior surfaces of poions of the frontal and temporal bones. MCA infarctions are the most common because the middle cerebral aery is essentially a direct continuation of the internal carotid aery. Contralateral hemiplegia affecting the arm and face more than the leg indicates an infarction in the territory of the middle cerebral aery. If the dominant hemisphere is affected, aphasia also occurs.
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Ans. A. PindololPindolol is beta blocker with intrinsic sympathomimetic activity. These drugs themselves activate beta 1/2 sub maximally.
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Our study confirmed that mitotic figures and nuclear pleomorphism are hallmarks of high-grade secondary peripheral chondrosarcoma. However, despite the substantial agreement, we demonstrated that histology alone cannot distinguish osteochondroma from low-grade secondary peripheral chondrosarcoma in the setting of multiple osteochondromas, since nodularity, the presence of binucleated cells, irregular calcification, cystic/mucoid changes and necrosis were not helpful to indicate malignant transformation of an osteochondroma. On the other hand, among the concordant cases, the cailage cap in osteochondroma was significantly less thick than in low- and high-grade secondary peripheral chondrosarcoma. Therefore, our study showed that a multidisciplinary approach integrating clinical and radio graphical features and the size of the cailaginous cap in combination with a histological assessment are crucial to the diagnosis of cailaginous tumors. REF <a href="
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. Ans : (c) Pain at exercise Intermittent claudication & rest pain are the cardinal symptoms of Peripheral aerial disease . Intermittent clarification refers to a pain, ache or sense of fatigue that occurs in affected muscle group with EXERCISE, paicularly walking & resolves with rest.
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The trigeminal ganglion lies on the trigeminal impression,on the anterior surface of the petrous temporal bone near its apex.It occupies a special space of duramater,called the trigeminal or Meckel's cave. REF.BDC VOL.3,Fifth edition.
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The main disability that follows the Classical Radical Neck Dissection is weakness and drooping of the shoulder due to paralysis of the trapezius muscle as a consequence of excision of the accessory Nerve. Reference : Bailey & Love, 27th Edition, page no = 758.
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A i.e. Propofol, Fentanyl, isoflurane
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Regression: Structure of exact relationship b/w two variables. Value of one variable in an individual case can be known from value of another variable. y= a + bx ;x= independent variable ; a=constant ; b= regression coefficient]. Types of regression: Simple linear regression - y= a + bx Simple curvilinear regression - y= a + bx3 Multiple linear regression - y = a + bx1 + cx2 + dx3 Multiple curvilinear regression - y = a + bx12 + Cx2 +dx39 Simple - only 1 independent variable. Multiple - >1 independent variable. Linear - independent variable has no power . Curvilinear - Atleast one independent variable has power.
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Clinical features: Progressive unilateral sensory neural healing loss often accompanied by tinnitus. Vestibular symptoms seen are unsteadiness and rarely veigo. Cranial nerve involvement: Vth cranial nerve: Reduced corneal sensitivity, numbness or paraesthesia of face. VIIth nerve: Hypoesthesia of posterior metal wall, loss if taste and reduced lacrimation. IX and X nerves: Dysphagia and hoarseness due to palatial, pharyngeal and laryngeal paralysis. XI and XII, III, IV and VI are affected. Brainstem involvement: Ataxia, weakness and numbness of the arms and legs with exaggerated tendon reflexes. Cerebellar involvement: Pressure symptoms. Finger-nose test, knee heel test, dysdiadochokinesia, ataxia gait and inability to walk along a straight line with the tendency to fall to the affected side. Raised intracranial tension: Headache, nausea, vomiting, diploma, papilloedema. Ref: Textbook of diseases of ENT, PL Dhingra, 7th edition, pg no. 125
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Cochlear implants are neural prostheses that conve sound energy to electrical signals and can be used to stimulate the auditory division of the eighth nerve directly. Bilateral cochlear implants are increasingly common and serve to enhance sound localization and improve understanding of speech in background noise.
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The ischial tuberosity gives attachment to the posterior femoral muscles. Quadratusfemoris is attached along the upper pa of its lateral border. The upper area of the tuberosity is subdivided by an oblique line into a superolateral pa for semimembranosus and an inferomedial pa for the long head of biceps femoris and semitendinosus. The lower area is subdivided by an irregular veical ridge into lateral and medial areas. The larger lateral area is for pa of adductor magnus.Ref: Gray's anatomy 40th edition, Chapter 111.
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Ans. is 'd' i.e., Vitellointestinal duct Meckel's diveiculum Meckel's diveiculum is the persistent proximal pa of the vitellointestinal duct which normally disappears during intrauterine life. It follows 'rule of 2' :- present in 2% subjects, 2 inches (5 cm) long and is situated 2 feet (60 cm) proximal to ileocoecal valve. It is attached to antimesenteric border of ileum. Its calibre is equal to that of the ileum. Its apex may be free or attached to umblicus or mesentery by a fibrous band. o Vitellointestinal duct posseses all three coats of intestinal wall.
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Metastatic orbital tumours in children neuroblastoma, nephroblastoma, Ewing's, testicular embryonal sarcoma and Ovarian sarcoma.
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A cherry-red colouration of the skin, mucous membranes, conjunctiva, nail beds, areas of hypostasis, blood, tissues and internal organs is seen in carbon monoxide (CO) poisoning. It is associated with 30-40% COHb. Ref: The Essentials of Forensic Medicine and Toxicology by Narayan Reddy, 27th edition, Page 555.
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<p> HEV causes large epidemics in Asia and Noh America. Park&;s textbook of preventive and social medicine,K.Park,23rd edition,page no:220. <\p>
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In the image on the left adenoma sebaceum is present, which looks like extensive acne in a butterfly distribution. The CT scan head shows a big lesion obliterating the ventricular system. It is a sub-ependymal nodule seen in tuberous sclerosis. A point against Sturge Weber is the absence of cutaneous lesion of Po wine stain. VHL is associated with cerebellar hemangioblastoma.
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Uterine contractions: Palpable when intensity exceeds 10 mm Hg Painful when exceeds 15 mm Hg
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Normally, the glomerular filtration system is extraordinarily permeable to water and small solutes and almost completely impermeable to molecules of the size and molecular charge of albumin (a 70,000-kDa protein).<p> Robbins book of pathology.
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Ans. C. Apply Mc Donald's StitchHistory of prior pregnancy losses in the second trimester with painless cervical dilatation is suggestive of cervical incompetence. The woman has now come in the 2nd trimester again with level II scan showing V shaped tunneling of internal os and the closed cervical length measuring 0.9cm ( as depicted in the figure) which is less than the cutoff of 2.5cm. This case will benefit from placement of cervical cerclage, best achieved by placing a vaginal Mc Donald's cervical cerclage.
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C i.e. LGV
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Ans. is 'a' i.e., CEA o Carcinoembryonic antigen is a marker in cancer of colon, pancreas, lung, breast, and ovary.
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Signs of Spina bifida on USG : Small biparietal diameter Ventriculomegaly Frontal bone scalloping or the so called Lemon sign. Elongation and downward displacement of the cerebellum, the so called Banana sign Effacement or obliteration of the cisterna Magna. Ref:Williams Obs 23e pg 354,355.
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Ans. is. 'b' i. e. B. cereus
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Ankylosing spondylitis and Reiters syndrome:
Both involve young males who are positive for HLA-B27.
Behcet's syndrome:
The disease typically affects the young men who are positive for HLA-B51.
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Average period in days a hospital bed remains vacant between one discharge and another admission is known as T interval. The value of T may be positive or negative. A negative T is indicative of scarcity of bed and overutilization. Ref: Textbook of community medicine, S. Lal, 3rd edition pg: 685.
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Fibrous pericardium base is broad and inseparably blended with the central tendon of the diaphragm.Ref: BD Chaurasia; Volume I; 6th Edition; Page no: 249
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Chorionic vinous biopsy at this stage will confirm presence or absence In a woman with a history of a previous child with Down syndrome the risk of recurrence of Down syndrome is increased These women need confirmatory diagnosis of Down's syndrome as early as possible. If would after them the advantage of first trimester aboion, if the .fetus is diagnosed with Down's syndrome. The definitive diagnosis of Down 's syndrome or any aneuploidy can only be provided by Karyotyping. - The fetal cells for Karyotyping can be obtained by two methods :- - Chrionic vinous sampling - Amniocentesis Chorionic vinous sampling would be the procedure of choice, because it is usually performed during first trimester i.e., between 9- 12 weeks so it offers the advantage of first trimetster aboion if the fetus is affected. Amniocentesis too provides definitive diagnosis, but, it is usually performed in the 2"d trimester (16-18 weeks). All other methods used to diagnose Down's syndrome i.e., ultrasound, biochemical markers, triple test, quadruple test etc are just screening methods. They would only suggest the presence of Down's syndrome, they do not provide definitive diagnosis.
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One of the most important requirements is that the darkroom be lightproof. If it is not, stray light can cause film fogging and loss of contrast. To make the darkroom lightproof, a light-tight door or doorless maze (if space permits) is used.
SAFELIGHTING
The processing room should have both white illumination and safelighting. Safelighting is low-intensity illumination of relatively long wavelength (red) that does not rapidly affect open film but permits one to see well enough to work in the area. To minimize the fogging effect of prolonged exposure, the safelight should have a frosted 15-watt bulb or a clear 7.5-watt bulb and should be mounted at least 4 feet above the surface where opened films are handled.
X-ray films are very sensitive to the blue-green region of the spectrum and are less sensitive to red wavelengths. The red GBX-2 filter is recommended as a safelight in darkrooms where either intraoral or extraoral films are handled because this filter transmits light only at the red end of the spectrum. Film handling under a safelight should be limited to about 5 minutes because film emulsion shows some sensitivity to light from a safelight with prolonged exposure. The older ML-2 filters (yellow light) are not appropriate for fast intraoral dental film or extraoral panoramic or cephalometric film.
Reference: White and Pharoah's Oral Radiology Principles and Interpretation 7th edition page no 70, 71
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The cerebral hemisphere is divided into several areas, called Brodmann Areas. Each cerebral hemisphere contains a total of &;47&; such areas. The area between central sulcus and precentral sulcus is called pre-central gyrus; the motor area of the brain (Brodmann area 4).Ref: Textbook of physiology, Dir. Prof. AK Jain, 5th edition
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Ans. is 'c' i.e. The patients do not know which treatment they are receivingRef. Park 20th/e, p 79, 18th/e, p. 77 (17th/e p 73)Blinding was introduced to prevent bias during randomized controlled trial.Single Blind TrialThe trial is so planned that the participant is not aware whether he/she belongs to the study group or the control groupDouble Blind TrialThe trial is so planned that neither the doctor nor the participant is aware of the group allocation and the treatment receivedTriple Blind TrialThis goes one step further. The participant, the investigator and the person analysing the data are all "blind."Ideally, of course, triple blinding should be used, but the double blinding is the most frequently used method when a blind trial is conducted.Remember, when the outcome such as death is being measured, blinding is not so essential.
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Corneal dystrophies are primary, bilateral and inherited disorder manifesting occasionally at bih but more usually during first or second decade and sometimes even later in life. Corneal dystrophies are of 3 types: anterior dystrophy, stromal dystrophy and posterior dystrophy.
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Medullary spaces of jaws are remarkably reduced in both forms.
Osteomyelitis and jaw fracture is common during tooth extraction.
Key concept:
Osteomyelitis of the mandible is common due to a deficient blood supply. Bones are fragile and can fracture easily.
Ref: Shafer's textbook of oral pathology 7th edition page 704
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Ans. A. LymphadenopathyJohns major criteria - Migratory flitting polyarthritis, Sydenham's chorea, pan carditis, subcutaneous nodules, erythema marginatum
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Gonococci is a gram-negative coccus. Chronic urethritis due to gonococci can lead to stricture formation. In men, the disease caused by gonococci stas as an acute urethritis with a mucopurulent discharge containing gonococci in large numbers. Infection extends along the urethra to prostrate, seminal vesicles and epididymis. Treatment involves ceftriaxone 125 mg single IM dose or ciprofloxacin 500 mg oral single dose. Reference: Textbook of Microbiology; Anathanarayan and panicker's; 10th edition; Page no: 230
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Crohn's disease (CD) can invade any pa of GIT from the oral cavity to the anus. Studies show that 70% of patients with CD will require a bowel resection in the first decade after diagnosis and 40% will require a fuher resection * Since surgery does not cure CD, the fundamental principle is to preserve healthy gut and to maintain adequate function. As the disease might recur after the surgery. Surgery is palliative in Crohn's disease whereas curative in Ulcerative colitis (UC). In UC disease stas from rectum and the fuher proceeds to the colon. Hence a single proctocolectomy is performed which is curative.
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Retinal detachment is not a complication of orbital cellulitis Orbital Cellulitis Inflammation of orbital septum Complications Exposure keratopathy Compression of optic nerve Central retinal aery occlusion Orbital Abscess Intracranial spread of infections Septicemia
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OxytocinIn general, oxytocin should be discontinued if the number of contractions persists with a frequency of more than five in a 10-minute period or more than seven in a 15-minute period or with a persistent nonreassuring fetal hea rate pattern.When oxytocin is stopped, its concentration in plasma rapidly falls because of the half-life is approximately 3 to 5 minutes.Ref: William&;s Obstetrics; 25th edition
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Age
US : LS Ratio
Birth
1.7 : 1
3 years
1.3 : 1
7 - 10 years
1 : 1
> 10 years
0.3 : 1
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Burns Marshall manoeuvre When the occiput is seen under the symphysis pubis,steady traction is given on the feet and the baby is swung in an arc towards the mother&;s abdomen.By simultaneous suprapubic pressure (refer pgno:380 sheila textbook of obstetrics 2 nd edition)
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Osteochondroma, also known as an exostosis, is the most common benign bone tumor; about 85% are solitary.It is a benign cailage-capped tumor that is attached to the underlying skeleton by a bony stalk. The cap is composed of benign hyaline cailage varying in thickness and is covered peripherally by perichondrium. The coex of the stalk merges with the coex of the host boneRef: Robbins Pathology; 9th edition; Page no: 1200
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NCCT head shows Hyderdense MCA sign of acute ischemic stroke. Hyperdense MCA sign- increased density within the middle cerebral aery on a non-contrast CT of the brain due to the presence of acute thrombus. This is one of the few signs that my be identified during the first few hours (hyperacute phase) of MCA territory infarction. Acute ischemic stroke: This sign indicates thrombus in the aery and is a early sign seen in cases of A.I.S. Before evolution of wedge shaped hypodensity . I/V Nicardipine & I/V Labetalol are not required as BP is not in range of Hypeensive crisis. Lowering this BP will reduce cerebral perfusion and worsen the patient. Rx- Mannitol is given when features of raised ICP are present. Best step is thrombolysis with Reteplase.
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Ans. is 'a' i.e., Spectrin deficiency Pathogensis of hereditary spherocytosis o Loss of membrane cytoskeleton proteins (ankyrin, spectrin, Band 3, 4.2) results in reduced membrane stability. Reduced membrane stability leads to spontaneous loss of membrane fragments during exposure to shear stresses in the circulation. The loss of membrane relative to cytoplasm forces the cells to assume the smallest possible diameter for a given volume --> Cells become microspherocytes. Because of their spheroidal shape and reduced membrane plasticity, red cells become less deformable and are trapped in to spleen as they are unable to pass through the interendothelial fenestrations of the venous sinusoids. In the splenic sinusoides, red cells are phagocytosed by RE cells --> Extravascular hemolvsis.
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Answer is A (Migraine) Migraine is a syndrome of episodic recurrent throbbing headache, more often unilateral, which is associated with nausea vomiting, photophobia or phonophobia. Parastheasis with tingling and numbness and focal neurological deficits are often associated. Aura may or may not be present.
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Behaviour therapy- most studied and most effective treatment for phobias. Ref- Synopsis of Psychiatry, 11e, pg 404.
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Appropriate antimicrobial therapy 2 weeks intravenous and 4 weeks oral Refer Maheshwari 6th/e p 168
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Hurler syndrome [Ref: Campbell's Ohopaedics 11/e Chapter 20 - Benign Bone Tumors and Nonneoplastic Conditions Simulating Bone Tumors p885.1 Following lesions have been mentioned to be non-neoplastic lesions resembling bone tumors (in Campbell's Ohopaedics Chapter 20 - Benign Bone Tumors and Nonneoplastic Conditions Simulating Bone Tumors). Nonneoplastic Conditions Simulating Bone Tumors Nonossifying fibromas (aka fibrous coical defects, and fibroxanthomas) Coical Desmoid Fibrous dysplasia Osteofibrous dysplasia (ossifying fibroma of long bones, aka Campanacci disease) Bone islands Unicameral bone cysts Aneurysmal bone cysts lntraosseous Ganglion Cyst Epidermoid Cyst Paget Disease "Brown Tumor" of Hyperparathyroidism Bone Infarct Osteornyelitis Stress Fracture Posttraumatic Osteolysis
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Nonenzymatic glycosylation refers to the chemical process whereby glucose attaches to proteins without the aid of enzymes. The degree of glycosylation is proportionate to the level of blood glucose. Many proteins, including hemoglobin, undergo nonenzymatic glycosylation. Because RBCs have a life span of about 120 days, the amount of glycosylated hemoglobin is a function of the blood glucose level over the previous 120-day period. The level of glycosylated hemoglobin is not appreciably affected by short-term changes in plasma glucose levels. Random glucose testing is an immediate way of monitoring short-term adjustments with diet and medications such as insulin and oral agents. Fasting glucose testing affords a better way to diagnose diabetes mellitus initially. Measurements of cholesterol and fructosamine have no value in managing diabetes mellitus. Microalbuminuria may presage the development of the diabetic renal disease. The "incretin effect" is diminished in patients with type 2 diabetes, and the use of GLP-1 receptor agonists can help to restore incretin function and lead to improved glycemic control and loss of weight via increased satiety.
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Thymoma is the most common Anterior mediastinal mass. Thymomas are seen to be associated with Myasthenia gravis Acquired hypogammaglobulinemia Pure red cell aplasia Grave's ds Pernicious anemia Dennatomyositis-polymyositis Cushing syndrome Ref : Robbins (big) 8/e p636
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The low modulus of elasticity of microfilled composites allow them to flex with tooth and protect the bonding interface. This is most useful in bruxism, clenching and stressful occlusion where flexure forces are high.
Reference- Sturdevant 4th ed P:257
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Umbilical cord separation usually takes place within first 2 weeks.
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Ans. is 'd' i.e., All of above Functional Neurological Disordero Transformation of inner psychological conflict into physical symptomso Two typesSomatoformDissociativeSomatoform disorder include-ConversionSomatizationPain disorderHypochondriasisBody dysmorphic disorderDissociative disorder - include-Dissociative amnesiaFugueo They are often associated with co-morbid mood & anxiehg disorder.
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Ans. b. Bacillus stearothermophilus (Ref: Ananthanarayan 7/e p28)Spores of Bacillus stearotherntophilus are used as control in autoclave."Sterilization control of autoclave: For determining the efficacy of moist heat sterilization, spores of Bacillus stearothermophilus are used as test organism. This is a thermophilic organism with an optimum growth temperature of 55-60 degree and its spores require an exposure of 12 minutes at 121 degree to be killed.""Plasma sterilization is a safe method to sterilize instruments at low temperature under vacuum. Vacuum is required to prevent large concentrations of species from absorbing the UV rays created by the plasma during the sterilization process. The bacterial organism most resistant to the sterilization technique was Bacillus stearothermophilus. The organism was then used in Survival Analysis Curve testing and was effectively sterilized to a level of <106 with 30 min of diffusion time using both survivor curve and fraction negative analysis. So that Bacillus stearothermophilus is used as control in plasma sterilization.""B. subtilis is used in Guthrie's test.""Sterilization control of Hot air oven: The spores of non-toxigenic strain of Clostridium tetani are used as a microbiological test of dry heat efficiency."ProcedureTest OrganismSteam cyclesSpores of Bacillus stearothermophilusQEthylene oxideSpores of Bacillus atrophaeusQPlasma sterilizationSpores of Bacillus stearothermophilusQDry heatSpores of Bacillus atrophaeusQParacetic acidSpores of Bacillus stearothermophilusQOzone cyclesSpores of Bacillus stearothermophilusQ
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Ans. is 'None'
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* SCHIZOTYPAL PERSONALITY DISORDER * Ideas of reference (not delusions) * Odd beliefs and magical thinking * Unusual perceptual disturbances * Paranoid ideation and suspiciousness * Odd thinking and speech without coherence * SUPERSTITIONS/TELEPATHY * ODD DRESSING * ODD SPEECH LACK OF EMOTIONS Ref.KAplon and Sadock, synopsis of psychiatry, 11 th edition, pg no.744
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CO2 is the major greenhouse gases which are mainly emitted from the combustion of fossil fuels Park's Textbook of Preventive and Social Medicine, 25th edition, Page No. 794
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Amiodarone-induced liver damage may present as Reye's syndrome in kids and may present as asymptomatic elevation of liver enzymes in adults. Asymptomatic liver enzyme elevation occurs in 25% of the population treated with amiodarone and is usually reversible upon discontinuation of therapy zidovudine-induced myopathy and hepatotoxicity in patients Valproic acid may cause serious or life-threatening damage to the liver that is most likely to occur within the first 6 months of therapy Chlorpropamide doesn't cause fatty liver Ref Davidson edition23rd pg774
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Cerebrospinal fluid (CSF)
CSF is present in the ventricular system of the brain and in the subarachnoid space around the brain and spinal cord.
The CSF is mainly formed by the choroid plexuses of lateral ventricles and lesser amounts by the choroid plexus of 3rd and 4th ventricles.
The total quantity of CSF is about 150ml. It is formed at the rate of about 200 ml / hr or 5000 ml / day. The normal pressure is 10-60 mm of H2O.
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(A) OCD # Obsessive-compulsive disorder (OCD) is a psychiatric anxiety disorder most commonly characterized by a subject's obsessive, distressing, intrusive thoughts and related compulsions (tasks or "rituals") which attempt to neutralize the obsessions.# Obsessions are defined by:> Recurrent and persistent thoughts, impulses, or images that are experienced at some time during the disturbance, as intrusive and inappropriate and that cause marked anxiety or distress.> Thoughts, impulses, or images are not simply excessive worries about real-life problems.> Person attempts to ignore or suppress such thoughts, impulses, or images, or to neutralize them with some other thought or action.> Person recognizes that the obsessional thoughts, impulses, or images are a product of his or her own mind, and are not based in reality.> Tendency to haggle over small details that the viewer is unable to fix or change in any way. This begins a mental pre-occupation with that which is inevitable.# Compulsions are defined by:> Repetitive behaviors or mental acts that the person feels driven to perform in response to an obsession, or according to rules that must be applied rigidly.> The behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation; however, these behaviors or mental acts either are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive.
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The duodenojejunal flexure is suppoed by a fibromuscular band called the suspensory ligament of the duodenum (ligament of Treitz), which is attached to the right crus of the diaphragm. C. - The pancreas is an endocrine and exocrine gland; is retroperitoneal in position and receives blood from the splenic, gastroduodenal, and superior mesenteric aeries. E - The spleen lies in the left hypochondriac region, is hematopoietic in early life, and later functions in worn-out red blood cell destruction. It filters blood, stores red blood cells, and produces lymphocytes and antibodies. D - The splenic aery is a branch of the celiac trunk, follows a touous course along the superior border of the pancreas, and divides into several branches that run through the lienorenal ligament. A -. The common hepatic aery is divided into the proper hepatic and gastroduodenal aeries.
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According to FDI, left lower canine is designated as 33. Ref: K.S.Narayan Reddy's synopsis of Forensic Medicine and Toxicology ,29 th edition Chapter4.page no -60
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Meningococcemia is a fulminant systemic rapidly progressing infection, which results in shock and is followed by death in 20% of children afflicted. The presence of meningitis has been shown to increase the survival rate to approximately 95%. Sensorineural deafness is the most common residual following bacterial meningitis. Penicillin, Ampicillin, or a third generation cephalosporin would be appropriate antibiotics to choose for treatment. Vancomycin spectrum of activity is limited to gram-positive organisms. Ref: Laumann A.E. (2005). Chapter 107. Dermatologic Conditions. In J.B. Hall, G.A. Schmidt, L.D. Wood (Eds), Principles of Critical Care, 3e.
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ANSWER: (C) 3DREF: Oxford American Handbook of Ophthalmology By James Tsai Pg 7, Ophthalmology at a glance by J.Olver Ch 8The pinhole (stenopeic slit upto 1.2 mm) can neutralize upto 3 Dioptres of refractive error.It is a useful method of finding out if the patient is suffering from refractive errors. If the vision improves with a pinhole test, it means that the patient has a refractive error. See the diagram below:In emmetropia every point in an object of regard is brought to point focus on the retina and the sum of all the points yields a clear image, i.e. point-to-point correspondenceIf there is a refractive error present, a blur circle is formed on the retina, which is dependent on the size of their pupil (smaller pupil = smaller blur circle)When a pinhole aperture is placed in front of the eye, it acts as an artificial small pupil and the size of the blur circle is abolished/reduced, producing a clearer image
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INDERBIR SINGH&;S TEXTBOOK OF HUMAN HISTOLOGY-PAGE NO:413 The tympanic membrane Structure:the tympanic membrane consists of the following three layers Outer epithelial layer:it is continuous with the eac skin Middle fibrous layer Inner mucosal layer
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(B) Acetylcholine > Sympathetic cholinergic system serves two important function.> Sweat gland: Secretion of sweat> Vasodilation in skeletal Muscles: A part of the neurons to blood vessels in skeletal muscles are anatomically sympathetic secrete acetylcholine. Simulation of this system of neurons produces vasodilatation in skeletal muscles.
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TnI and TnT normally are not found in the circulation; however, after acute MI, both are detectable within 2 to 4 hours, with levels peaking at 48 hours and remaining elevated for 7 to 10 days. Although cardiac troponin and CK-MB are equally sensitive markers of the early stages of an MI, persistence of elevated troponin levels for approximately 10 days allows the diagnosis of an acute MI long after CK-MB levels have returned to normal. With reperfusion, both troponin and CK-MB levels may peak earlier owing to more rapid washout of the enzyme from the necrotic tissue. (Robbins basic pathology,9th edition,pg no.383)
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It provides basic data on cost structure of any program.Financial records are kept in a manner permitting costs to be associated with the purpose for which they are incurred.Cost-accounting has three impoant purposes in health services Cost control Planning and allocation of financial resources Pricing of cost reimbursement (refer pgno:871 park 23 rd edition)
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PRECAUTIONS AND CONTRAINDICATIONS (a) Hypokalemia, hypomagnesemia, hypercalcaemia: enhances digitalis toxicity. (b) Elderly, renal or severe hepatic disease: patients are more susceptible to digoxin toxicity. (c) Myocardial ischaemia: severe arrhythmias are more likely. (d) Thyrotoxicosis: patients are more prone to develop digitalis arrhythmias. (e) Myxoedema: these patients eliminate digoxin more slowly; cumulative toxicity can occur. (f) Ventricular tachycardia: digitalis is contraindicated because it may precipitate ventricular fibrillation. (g) Paial A-V block: may be conveed to complete A-V block by digoxin. (h) Acute myocarditis: Diphtheria, acute rheumatic carditis, toxic carditis--inotropic response to digitalis is poor, more prone to arrhythmias. (i) Wolff-Parkinson-White syndrome: Digitalis is contraindicated because it decreases the ERP of bypass tract in 1/3 patients. In them rapid atrial impulses may be transmitted to ventricles - VF may occur. Digitalis can increase the chances of reentry by slowing conduction in the normal A-V bundle and accelerating it in the aberrant pathway. Ref:- kd tripathi; pg num:-516,517
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image showed above is rash in fibromyalgia major drug of choice in fibromyalgia is : snri = DULOXITINE MANAGEMENT Evidence-based guidelines by the American Pain Society (APS) for the optimal treatment of FMS. MEDICATIONS: Strong Evidence for Efficacy (Tricyclic Antidepressant Medications) Amitriptyline Cyclobenzaprine CNS agents, antidepressants, muscle relaxants, or anticonvulsants are the most successful pharmacotherapies. ref : kd tripathi 9th ed
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Active euthanasia or positive euthanasia is a positive merciful act, to end useless suffering or a meaningless existence. It is an act of commission. Example: By giving large doses of drugs to hasten death. Passive euthanasia means discontinuing or not using extraordinary life sustaining measures to prolong life. This includes acts of omission. Example: Failure to resuscitate a terminally ill or hopelessly incapacitated patient. Assisted suicide: A person providing information to another with information, guidance and means to take his own life with the intention that it will be used for this purpose is assisted suicide. Ref: The Essentials of Forensic Medicine and Toxicology 29th Ed Page 42.
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For recording the distolingual border, hold the tray in place with the fingers in each premolar region, while at the same time, asking the patient to place the tip of the tongue against the tray handle.
The action pulls forward the palatoglossal arches and conforms the impression material to its correct shape.
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Ans. a. Surgery should not be done unless patient becomes symptomatic (Ref: Sabiston 19/e p1120-1126; Schwartz 9/e p1318-1331; Bailey 25/e p972-976; Schackelford 7/e p568-579)Sabiston says "Most surgeons recommend operation on discovery of an inguinal hernia because the natural history of a groin hernia is that of progressive enlargement and weakening, with the potential for incarceration and strangulation."Bailey says " The basic operation is inguinal herniotomy, which entails dissectiong out and opening the hernial sac, reducing any content and then transfixing the neck of the sac and removing the remainder. It is employed either by itself or as the first step in a repair procedure (herniorrhaphy). By itself, it is sufficient for the treatment of hernia in infants, adolescents and young adults."Non-absorbable mesh is used in hernia surgery.Surgery can be done using laparoscopy (TFP or TAPP)Management of hydrocele of the hernia sac (congenital hydrocele) in a 3 years old child is herniotomy."A patent processus vaginalis may allow only peritoneal fluid to track down around the testis to form a hydrocoele. Hydrocoeles are unilateral or bilateral, asymptomatic, non-tender scrotal swellings. They may be tense or lax. but typically transilluminate. The majority resolve spontaneously as the processus continues to obliterate, but surgical ligation is recommended in boys older than three years of age. "--Bailey 26/e p111"In congenital hydrocele, the processus vaginalis is patent and connects with the peritoneal cavity. The communication is usually too small to allow herniation of intra-abdominal contents. Pressure on the hydrocele does not always empty it but the hydrocele fluid may drain into the peritoneal cavity when the child is lying down; thus, the hydrocele may be intermittent. Ascites should be considered if the swelling are bilateral. Congenital hydroceles are treated by herniotomy if they do not resolve spontaneously. " Bailey 26/e p1382HerniotomyLigation of hernial sacQHerniorrhaphyHerniotomy with posterior wall repair using in-situ structuresQHernioplastyHerniotomy with strengthening of posterior wall using exogenous material like meshQManagement of Inguinal HerniaObjectives of treatment: Treatment of hernia sac and Inguinal floor reconstructionManagement of Inguinal HerniaTreatment of Hernia SacInguinal Floor Reconstruction* Basic operation is inguinal herniotomy, which entails dissecting out & opening the hernial sac, reducing any contents and then transfixing the neck of the sac and removing the remainderQ.* Direct sacs are usually too broad for ligation and should not be opened but instead are simply inverted into peritoneal cavityQ.* Management of the hernia sac is sufficient for children and young adultsQ* Reconstruction (repair or strengthening) of the inguinal floor is necessary in all adult hernias to prevent recurrenceQ.* Types of repair:1. Primary tissue repairQ2. Anterior tension-free mesh repairQ3. Pre-peritoneal repairs: Open & laparoscopic approachQ Inguinal Floor ReconstructionPrimary Tissue RepairAnterior Tension-Free Mesh RepairLaparoscopic and Pre-Peritoneal Repairs* Posterior wall of inguinal wall is strengthened by approximation of tissues with suturesQ.* There is no use of prosthetic materialQ.* Advantages: Simplicity of the repair & absence of any foreign body in groin* Disadvantage: Higher recurrence rates due to tension on the repair and slower return to unrestricted physical activityQ.* Types:- Bassini repairQ- Haisled repair- McVayQ (Cooper ligament) repair Shouldice repairQ- Dam repair* Current practice in hernia management employ synthetic mesh to bridge the defect* Recurrence is very low* Types:* Lichtenstein repair0: Mesh is used to reconstruct the inguinal floor.* Patch and plug repair(r): Plug of mesh is inserted into the hernia defect and sutured in place. Then another piece of mesh is placed over the inguinal floor.* Pre-peritoneal space is reached by either trans-abdominal laparoscopy (TAPP) or by totally extra-peritoneal repair (TEP).* Both techniques are similar In actual repair but differ in the manner by which the preperitoneal space is accessed.* TAPP (Trans-abdominal Pre- PeritoneaI)(r): Peritoneal space is reached by conventional laparoscopy and pre-peritoneum overlying the inguinal floor is dissected away as a flap.* TEP (Totally Extra-Peritoneal) (r): Pre-peritoneal space is accessed without entering the peritoneal cavity Gibbon's hernia* Hernia with hydroceleQBerger's hernia* Hernia into pouch of DouglasQBedard's hernia* Femoral hernia through opening of saphenous veinQAmyand's hernia* Inguinal hernia containing appendixQOgilive's hernia* Hernia through the defect in conjoint tendon just lateral to where it inserts with the rectus sheathQStammer's hernia* Internal hernia occurring through window in the transverse mesocolon after retrocolic gastrojejunostomyQPeterson hernia* Hernia under Roux limb after Roux-en-Y gastric bypassQ
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The cause of sacrococcygeal teratomas is unknown. Sacrococcygeal teratomas are germ cell tumors. Germ cells are the cells that develop into the embryo and later on become the cells that make up the reproductive system of men and women. Most germ cell tumors occur in the testes or ovaries (gonads) or the lower back. When these tumors occur outside of the gonads, they are known as extragonadal tumors. Researchers do not know how extragonadal germ cell tumors form. One theory suggests that germ cells accidentally migrate during to unusual locations early during the development of the embryo (embryogenesis). Normally, such misplaced germ cells degenerate and die, but in cases of extragonadal teratomas researchers speculate that these cells continue to undergo mitosis, the process where cells divide and multiply, eventually forming a teratoma. Sacrococcygeal teratomas are thought to arise from an area under the coccyx called "Henson's Node". This is an area where primitive cells persist (germ cells) that can give rise to cells of the three major tissue layers of an embryo: ectoderm, endoderm, and mesoderm. These embryonic layers eventually give rise to the various cells and structures of the body. Sacrococcygeal teratomas can contain mature tissue that looks like any tissue in the body, or immature tissue resembling embryonic tissues. Ref- <a href="
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Ans. B i.e. 10
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Ideal requirements of denture cleanser:
Non-toxic
Easy to remove and should be harmless to patient.
Harmless to the denture base materials and denture teeth.
Able to dissolve all denture deposits such as calculus.
Exhibit bactericidal and fungicidal activity.
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Ans: b (Stroke volume.) Ref: Ganong, 22nd ed, p. 590Arterial pressure is the product of cardiac output and peripheral resistance. But remember cardiac output = stroke volume toeart rate.i.e., BP = stroke volume toeart rateperipheral resistance.BP a stroke volume.Systolic BP (SBP) = Is the highest pressure during cardiac cycle, occurs in systole.It depends on:Stroke volume (SV) - As SV increases, SBP increases.Compliance of vessel - As compliance decreases, SBP increases (windkessel effect, e.g.. old age)Diastolic BP (DBP) =is the lowest pressure during cardiac cycle: occurs during diastole.It depends on:Peripheral resistance- As PR increases, DBP increasesMean Arterial Pressure (MAP) =average pressure during cardiac cycle.MAP=SBP+ 3 23DBP(or)MAP= DBP + 1/3 PPPP=SBP-DBPSome important values from respiratory system
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Ans. D. PelvisSOME SPECIFIC NAMED LIGAMENTS IN THE BODY:Weitbrecht's ligamentThe oblique cord connecting the ulna and the radiusPoupart's ligamentInguinal ligamentPetits ligamentThickened portion of Pelvic fascia between the cervix and vagina. Passes posteriorly in the recto-Uterine fold to attach to the Ant. surface of sacrumGimbernat's ligamentLacunar ligament which forms the medial portion of the femoral ringMackenrodt's ligamentTransverse cervical ligament-important support of the uterusLisfranc's ligamentLigament joining the cuneiform bone of ankle to the 2nd metatarsal.Henle's ligamentThe conjoined tendon of the transverses abdominis muscleLockwood's ligamentSuspensory ligament of the eyeball
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Tyndallization or Intermittent sterilization: Sugar, Egg, Serum and Gelatin containing media are sterilized by heating at 100oC for 20 mins on three successive days, using moist heat First day all vegetative forms are killed. Second day germinating spores and remaining if present killed on final day. It is carried out in a Koch and Arnold steam sterilizer. Media which contain any ingredient/component not able to tolerate the temperature of an autoclave are sterilized by tyndallization. Eg. TCBS, XLD, DCA, sugar solutions for fermentation tests and gelatin containing media. Inspissation or Fractional sterilization: Heating at 80-85oC for 30 mins on three successive days.
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Hyperacute rejection is due to the presence in the recipient of preformed antibodies against HLA class I antigens expressed by the donor. Antibody mediated rejection generally occurs hours to days after transplantation. Kidney transplants are paicularly vulnerable to hyperacute graft rejection, whereas hea and liver transplants are relatively resistant. Bailey and love 27th edition Pg: 1535
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Option a,b,c are not considered pre-malignant lesions.
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Marrow is Normoblastic REF: APPENDIX-52 for TYPES OF ANEMIA_ "Bone marrow picture in iron deficiency anemia is normoblastic"
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Fetal growth is affected by maternal nutrition during any trimester in pregnancy.
Fetal growth is affected even by nutritional status of mother prior to pregnancy.
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The sudden onset of tachycardia and hypotension indicates an acute process. Since the patient is being mechanically ventilated with positive pressure, he is at increased risk of a bullous rupture from barotrauma, leading to a pneumothorax.Cardiac arrhythmia could lead to tachycardia and hypotension. Ventricular tachycardia and atrial fibrillation with a rapid ventricular response may cause this from decreased ventricular filling. An ECG would aid in this diagnosis. In the setting of mechanical ventilation, however, a pneumothorax must be excluded first. Bronchial secretions usually have a progressively worsening presentation. Fuhermore, the patient would exhibit desaturation, but not necessarily hypotension. Myocardial infarction may lead to cardiogenic shock from failure. However, this would most likely be a bit more progressive and less acute. Infarction must remain high on the differential diagnosis, and the patient may require vasopressors because of the shock. In the immediate setting, the pneumothorax is more likely, given the acuity of onset. Pulmonary embolus is on the differential diagnosis of electromechanical dissociation. This patient&;s risk of an embolus is increased because of prolonged immobilization. However, the subcutaneous heparin should be adequate prophylaxis against an embolism.
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Tension-type headache (TTH) is commonly used to describe a chronic head-pain syndrome characterized by bilateral tight, bandlike discomfo. The pain typically builds slowly, fluctuates in severity, and may persist more or less continuously for many days. The headache may be episodic or chronic (present >15 days per month). TTH are completely without accompanying features such as nausea, vomiting, photophobia, phonophobia, osmophobia, throbbing and aggravation with movement. The pain of TTH can generally be managed with simple analgesics such as acetaminophen, aspirin, or NSAIDs. Behavioral approaches including relaxation can also be effective. Ref: Harrison's Internal Medicine, 18th Edition, Pages 120-122, 114-120, 122, 3360-3361
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Amongst the given options, RA is the most common cause of tarsal tunnel syndrome.
Facts about etiology of tarsal tunnel syndrome
Most common origin of tarsal tunnel syndrome is idiopathic (21-36%).
When the cause is known, trauma is the most common cause.
Two most common systemic causes of tarsal tunnel syndrome are diabetes (m.c.) and RA (2nd m.c.)
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Chronic Crohn's: First stage--Mild diarrhoea, colicky pain, fever, anaemia, mass in right iliac fossa which is tender, firm, nonmobile along with recurrent perianal abscess. Second stage is either acute or chronic intestinal obstruction due to cicatrisation with narrowing. Third stage--Fistula formation--enterocolic, enteroenteric, entero-vesical, entero-cutaneous, etc. it is pre-cancerous condition but not as much as ulcerative colitis. ref:SRB&;s manual of surgery,ed 3,pg no 801
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Ans. is 'd' i.e., Hippocampus o Hippocampus is not involved in Wernicke 's korsakoff syndromeo The areas commonly affected include the:-# Medial dorsal thalamic nucleus# Mammillary bodies# Periaqueductal grey matter# Floor of the fourth ventricle which include the occular motor and vestibular nuclei.o The lesions of wernicke's encephalopathy occur in a characteristic symmetrical distribution in structures surrounding the third ventricle, aqueduct and the fourth ventricle.# Mamillary bodies are involved in virtually all cases and the dorsomedial thalamus, locus ceruleus, periaqueductal gray, occular motor nuclei and vestibular nuclei are commonly affected.
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Cu T 308A is approved for use for 10 years However, it is demonstrated to maintain its efficacy over at least 12 years of use Reference: Park&;s textbook of preventive and social medicine, 23rd edition, Page no: 497
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Ans. A. Anti-ds DNAAnti-ds DNA is present in 65% cases of SLE and is a marker of development of lupus nephritis.Anti Ro is present in 30% cases and is a marker of cutaneous lupus and development of congenital CHB in the baby of mother with SLE. Anti-phospholipid are present in 40% cases and are a marker of recurrent fetal loss and thrombosis.Anti-ribosomal P antibody is present in 20% cases only and is a marker of psychosis
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Ans. c (Left-to-right shunt). (Ref. Grainger's Diagnostic Radiology, 4th en., 492, 590, 600, 602, 667, 596, 597)# Left-to-right shunt produces hyperemic lung fields.# As Hyaline membrane disease (HMD) progresses, influx of plasma renders the lungs more radio-opaque, reticulogranular shadowing becomes more confluent and ground glass haziness is seen with loss of clarity of diaphragm and heart.# In staphylococcal pneumonia, later in disease more homogenous opacification of lung fields may occur, although pneumatoceles are classical of it.- Ground-glass appearance is also a feature of infracardiac TAPVC.- Ground-glass haziness, especially in adults is also seen in interstitial lung diseases.
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Neonate (Newborn)
From birth to under four weeks of age (< 28 days), the infant is called neonate.
The neonatal period has been further subdivided into -
Early neonatal period → the First week of life (< 7 days)
Late neonatal period → 7th to < 28th day
Term neonate (term baby)
Any neonate born between 37 and < 42 weeks (259 - 293 days) of pregnancy irrespective of the birth weight.
Preterm baby
Any neonate born before 37 weeks (<259 days) of pregnancy irrespective of the birth weight.
Post-term baby
Any neonate born at or after 42 weeks (294 days or more) of pregnancy irrespective of the birth weight.
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Ans. is 'a' i.e., Brain FunctionMajor sites of expressiono GLUT lBasal glucose uptakePlacenta, Blood-brain barrier, brain, RBC, Kidney, colono GLUT 2B-cell glucose sensorQ.Transport out of intestinal and renal epithelial cellsB cells of islets, liver, epithelial cells of small intestine & KidneyoGLUT3Basal glucose uptakeBrain, Placenta, Kidneyo GLUT4QInsulin-stimulating glucose uptakeQSkeletal and cardiac muscleQ. Adipose tissueo GLUTSQFructose transportQJejunum, spermo GLUT 6NonePseudogeneo GLUT 7G-6-P transporter in ERLiver
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MC cause of benign biliary stricture is laparoscopic cholecystectomy (operative trauma).
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ANSWER: (D) PinnaREF: Basic histology, Carlos & Jose, 11th edition, Chapter 7, Cartilage, Textbook of human histology 4th e p. 92-94See APPENDIX-2 below for ''Types of cartilage""Pinna or auricle is formed of elastic cartilage not fibrocartilage" APPENDIX - 2Types of Cartilages Hyaline CartilageElastic CartilageFibrocatilageCompositionType II collagenChondroitin sulfateType II collagenElastin fibersType I collagenPerichondriumPresentPresentAbsent Articular cartilageArytenoid cartilageThyroid cartilageCricoid cartilageEpiphyseal growth plateNasal septumCostal cartilage of ribsAuricleAuditory tubeEpiglottisCuneiform cartilage of larynxEpiglottisExternal auditory canalArticular discsIntervertebral discsMenisciPubic symphysisGlenoid labrumAcetabular labrum
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Ref Harrison 19 th ed pg 637-638 The diagnosis of b-thalassemia major is readily made during child- hood on the basis of severe anemia accompanied by the characteris- tic signs of massive ineffective erythropoiesis: hepatosplenomegaly, profound microcytosis, a characteristic blood smear ), and elevated levels of HbF, HbA2 , or both.
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Ans: c (Radiotherapy) Ref: Bailey, 24th ed, p. 793, Harrison, 16th ed, p. 2122, Davidson, 20th ed, p. 760Treatment of toxic nodule"Surgery or radioiodine treatment is appropriate. Resection is easy, and without morbidity. Radio iodine is a good alternative for people over 45 years of age because the suppressed thyroid tissue does not take up the iodine and thus there is no risk of delayed thyroid malignancy."- Bailey"A solitary autonomously functioning nodule is toxic adenoma. Treatment of solitary nodule is radioiodine ablation. Here the normal thyroid function is suppressed. I131 will concentrate in the hyperfunctioning nodule with minimal uptake and damage to the normal surrounding thyroid tissue."- Harrison"In toxic MNG the treatment of choice is Il31. The iodine uptake is lower than in Graves disease. So a higher dose is employed."- DavidsonFrom the above texts, it is clear that the treatment is radiotherapy.
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Activated fibroblasts, myofibroblasts, and capillary sprouts are abundant in healing wounds 3 to 5 days following injury. Activated fibroblasts change shape from oval to bipolar as they begin to form collagen and synthesize a variety of extracellular matrix proteins. -Neutrophils accumulate in the wound 12 to 24 hours after injury (choice B). -Mature scar tissue would be visible 2 weeks following injury. Diagnosis: Healing by primary intention
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Ans. is 'b' i.e., Vesicoureteric reflux o According to Nelson "The most common abnormality seen in a child with UTI in a voiding cystourethrogram is vescioureteric reflux. It is identified in approximately 40% of patients". Vesicoureteric reflux (VUR) o Retrograde flow of urine from the bladder to the ureter and renal pelvis is referred to as vesicoureteric reflux. o VUR is the source of UTI in 30 to 50% of children. o Recurrence occurs in about 309/0 of boys and 40% of girls. o Recurrences nearly always occur within the first six months after the first UTI. o Vesicoureteric reflex may be primary or secondary. 1) Causes of primary VUR a) Due to developmental ureterotrigonal weakness b) Associated with other ureteral anomalies such as ectopic orifice or ureterocele. 2) Causes of secondary VUR a) Bladder outlet obstruction c) Neuropathic dysfunction e) Inflammation b) Urethral obstruction d) Iatrogenic f) Tubercular infection
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Ans. is 'd' i.e.. All births Janani Suraksha Yojana o The National Maternity Benefit scheme has been modified into a new scheme called Janani Suraksha Yojana. o It was launched on 12th April 2005. o The objectives of the scheme are reducing maternal and infant mortality through encouraging delivery at health, institutions, and focusing on institutional care among women in below poverty- line, o Salient features of JSY: It is 100% centrally sponsored It combines 'benefit of cash assistance with institutional care' Eligibility for cash assistance. In low performing states (LPS) : All women undergoing institutional deliveries In high performing states (HPS) : Below poverty- line women aged 19 years and above; SC/ST pregnant women o Limitation of cash assistance In low performing states (LPS) : All births in institutions In high performing states (HPS) : upto 2 live births, o JSY package: Rural areas Urban areas Category Mother's package ASHA's package Total package Mother's package ASHA's package Total package LPS 1400 600 2000 1000 200 1200 HPS 700 - 700 600 - 600
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Both phenelzine and amitriptyline are used in the treatment of major depression. Phenelzine, an MAO inhibitor, augments available catecholamine neurotransmitters for release into the synaptic cleft by inhibiting the intraneuronal breakdown of norepinephrine, serotonin, and dopamine. The degree of enzyme inhibition appears to be directly related to the antidepressant effect. Amitriptyline, a tricyclic antidepressant, exes its therapeutic effect by means of inhibition of serotonin reuptake into the presynaptic neuron, thus enhancing the availability of neurotransmitter for action on the postsynaptic neuron. There is controversy surrounding the use of these medications for obsessive-compulsive disorder, phobic disorder, and panic attack, in which derangements in catecholamine neurotransmitters are also implicated. Clonazepam is a benzodiazepine used primarily as an anticonvulsant in the treatment of akinetic and myoclonic seizures. Haloperidol is a high potency antipsychotic agent with minimal anticholinergic propeies and maximal dopamine-blocking propeies; it is used in the treatment of schizophrenia, manic-depressive disorder, and other psychotic states. Benztropine is an anticholinergic used to manage the pseudoparkinsonian and extrapyramidal side effects of the higher potency antipsychotic agents like haloperidol. Ref: Olson K.R. (2013). Chapter 38. Poisoning. In M.A. Papadakis, S.J. McPhee, M.W. Rabow (Eds), CURRENT Medical Diagnosis & Treatment 2013.
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