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Patient because of positive biopsy findings and negative workup undergoes a radical prostatectomy. The pathology repo reveals Gleason score 9/10 and involvement of several pelvic lymph nodes. Which is the most likely site for prostatic cancer metastasis?
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Bone metastasis is a characteristic feature of prostatic cancer. The lesions are typically osteoblastic on x-ray, and the serum acid phosphatase level becomes elevated
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Ahus reaction is what type of hypersensitivity reaction
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Ahus reaction Localized area of tissue necrosis resulting from acute immune complex vasculitis, usually elicited in the skin. "SHARP" S- Serum sickness, Schick test, SLE H- HS pneumonitis (Farmers lung), HSP A- Ahus reaction R- Reactive ahritis, RA, Raji assay P - PAN, PSGN
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Investigation of choice for dysphagia for solids:
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Answer is D (Manometry) Esophageal manometry is the gold standard test for esophageal motility disorders. Esophageal Motility Disorders : Manometry is the test of choice Achalasia Cardia Diffuse Oesophageal Spasm (Discoordinated motility) Nutcracker Oesophagus (Hypercontractile motility) Hypeensive LES (Hypercontractile motility) Hypotensive LES(Hypocontractile motility) Ineffective Oesophageal motility (Hypocontractile motility)
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The following anticancer drug has high emetogenic potential
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PLATINUM COORDINATION COMPLEXES Cisplatin Mech of action:- It is hydrolysed intracellularly to produce a highly reactive moiety which causes cross linking of DNA. The oured site is N7 of guanine residue. Adverse effects:- It is a highly emetic drug. Antiemetics are routinely administered before infusing it. The most impoant toxicity is renal impairment which is dependent on total dose administered. Renal toxicity can be reduced by maintaining good hydration. Tinnitus,deafness, sensory neuropathy and hyperuricaemia are other problems. Ref:- kd tripathi; pg num:-861
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Spironolactone should not be given with
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Sprinolanctone is a potassium sparing diurectic It doesn't excrete potassium - increasing potassium levels in the blood ACE IN. also increases potassium levels in the blood Hence the combination is contraindicated Ref: KD Tripathi 8th ed
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A total of 5000 patients of glaucoma are identified and surveyed by patient interviews regarding family history of glaucoma. Such a study design is called-
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Case series repo: A case series repo is a descriptive study where in more than one patients having a paicular disease are studied. No cause related analysis or hypothesis testing is involved. Case control study: Backward looking/ retrospective study in which multiple risk factors are studied together. Odd's ratio can be calculated. Coho study: Forward / prospective study in which multiple outcomes can be studied together. Incidence & relative risk can be calculated.
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Based upon this PA ulnar detion view of the wrist, what is the MOST likely diagnosis?
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There is focal periostitis at the radial styloid. The radial styloid itself is normal. This is secondary to adjacent inflammation at the extensor pollicis brevis and abductor pollicis longus tendons (De Quervains tenosynovitis). The periosteal reaction of osteomyelitis is usually associated with abnormal underlying bone. The periosteal reaction of hyperophic osteoahropathy is more diffuse involving both the radius and ulna. New bone formation is not a feature of rheumatoid ahritis.
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Turbinate that aiculates with ethmoid is:
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Middle turbinate and superior turbinate are a pa of the ethmoidal bone where as inferior turbinate is an independant bone which aiculates with the ethmoid bone,completing the medial wall of Nasolacrimal duct. Ref. Scotts Brown 7/e,Vol 2 p 1329.
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An enzyme that recognizes a specific (palindromic) sequence and cuts within a DNA molecule is?
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ANSWER: (D) Restriction endonucleaseREF: Basic Genetics: Textbook and Activities by Ahmed Abouelmagd, Hussein M. Ageely page 117A palindromic sequence is a nucleic acid sequence {DNA or RNA) that is the same whether read 5' (five-prime) to 3' (three prime) on one strand or 5' to 3' on the complementary strand with which it forms a double helix.A restriction enzyme (or restriction endonuclease) is an enzyme that cuts DNA at specific recognition nucleotide sequences (with Type II restriction enzymes cutting double-stranded DNA) known as restriction sites. Such enzymes, found in bacteria and archaea, are thought to have evolved to provide a defense mechanism against invading viruses. Inside a bacterial host, the restriction enzymes selectively cut up foreign DNA in a process called restriction; host DNA is methylated by a modification enzyme (a methylase) to protect it from the restriction enzyme's activity. Collectively, these two processes form the restriction modification systemRestriction enzymes recognize a specific sequence of nucleotides and produce a double-stranded cut in the DNA. While recognition sequences vary betwreen 4 and 8 nucleotides, many of them are palindromic, wrhich correspond to nitrogenous base sequences that read the same backwards and forwards. In theory, there are two types of palindromic sequences that can be possible in DNA.The mirror-like palindrome is similar to those found in ordinary text, in which a sequence reads the same forward and backwards on a single strand of DNA strand, as in GTAATG.The inverted repeat palindrome is also a sequence that reads the same forward and backwards, but the forward and backward sequences are found in complementary DNA strands (i.e., of double-stranded DNA), as in GTATAC (GTATAC being complementary to CATATG). Inverted repeat palindromes are more common and have greater biological importance than mirror-like palindromes.Naturally occurring restriction endonucleases are categorized into four groups (Types I, II III, and IV) based on their composition and enzyme cofactor requirements, the nature of their target sequence, and the position of their DNA cleavage site relative to the target sequenceCategoryFunctionCofactors requiredCleavageType IMultifunctional protein with both restriction and DNA modify-cation (methylase) activityMg2+, ATP SAM (S- adenosylmethionine)Cleave DNA at non specific sites usually remote from recognition siteType IISingle function (restriction) en-zymes independent of methylaseOnly Mg2+Site specific 8t cleave writhin or at short specific distances from recognition siteType IIICombine restriction and DNA modification (methylase) activity in a single enzyme complex with different subunitsMg2+, SAM stimulates reaction but is not requiredCleave at sites a short distance from recognition siteHere are some restriction enzymes and the palindromic sequences which they recognizeEnzymeSourceRecognition SequenceCutEcoRlEscherichia coli5'GAATTC3'CTTAAG5---G AATTC---3'3---CTTAAG---5'BamH1Bacillus amylobquefaciens5'GGATCC3'CCTAGG5'---G GATCC---3'3'---CCTAG G---5'Taq1Thermus aquaticus5'TCGA3'AGCT5'---T CGA--3'3'---AGC T---5'Alul*Arthrobacter luteus5'AGCT3'TCGA5'---AG CT---3'3'---TC GA---5'* = blunt ends
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In pontaic fever, which antigen is seen in urine-
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Ans. is 'a' i.e., Group specific antigen of Legionella serogroup-1 (LP1) o The examination of urine for legionella antigen by ELISA is a rapid and specific method for identifying L pneumophila,o However, disadvantage of urine antigen test is that it only detects Legionella pneumophila serogroup 1 (LP-1) and negative urinary antigen test does not exclude infection with Iegionellae other than L pneumophila serogroup-1.o Only culture can detect non-LPl strains (strains other than serogroup-1).
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A patient with Hypeension presents with Hypokalemia. Aldosterone levels and Renin levels are both elevated. The most likely diagnosis is
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Answer- A. Renal Aery stenosisThe association of High aldosterone and High Renin levels in a hypeensive patient with hypokalemia suggests a diagnosis ofSecondary Hyperaldosteronism of from Renal Aery Stenosis.
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Mycosis fungoides: March 2013
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Ans. A i.e. Cutaneous T cell lymphoma Mycosis fungoides Mycosis fungoides is also known as: Cutaneous T cell lymphoma, Special features: - MC skin lymphoma, - Pautrier's microabscesses - Presents with diffuse erythroderma
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Me Callum patch is seen in the:(1988)
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Ans: b
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The main catabolic product/products of purine nuleotides in humans is which one of the following:
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Ans. (c) Uric AcidRef: Harper's Biochemistry, 30th edn. pg. 347-357Purines are metabolized by several enzymes:GUANINE* A nuclease frees the nucleotide* A nucleotidase creates guanosine* Purine nucleoside phosphorylase converts guanosine to guanine* Guanase converts guanine to xanthine* Xanthine oxidase (a form of xanthine oxidoreductase) catalyzes the oxidation of xanthine to uric acidADENINE* A nuclease frees the nucleotide# A nucleotidase creates adenosine, then adenosine deaminase creates inosine# Alternatively, AMP deaminase creates inosinic acid, then a nucleotidase creates inosine* Purine nucleoside phosphorylase acts upon inosine to create hypoxanthine* Xanthine oxidoreductase catalyzes the biotransformation of hypoxanthine to xanthine* Xanthine oxido-reductase acts upon xanthine to create uric acid
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Intraoperative Radiotherapy for treating pancreatic carcinoma mainly uses
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Electron Beam is preferred for intraoperative Radiotherapy. The Intraoperative radiotherapy (IO) appears to be an ideal therapeutic strategy for pancreatic cancer, Having the advantage of enabling the delivery of high doses of radiation to areas that are at risk for microscopic disease, saving critical organs and reducing the possibility of inducing radiotoxicity.
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Distally, Gubernaculum attaches to all except:-
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Gubernaculum is the fibro muscular band which helps in descent of testes. Proximally, it is attached to:- Lower pole of testis. Peritoneum of saccus vaginalis in front of testis. Mesonephric duct. Distally, it is attached to:- Bottom of scrotum. Superficial perineal pouch. Pubic symphysis above penis. Saphenous opening of thigh. Anterior superior iliac spine
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MMR (Measles, mumps, rubella) vaccine is an example of:
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Ans: a. Live attenuated.. LIVE ATTENUATEDKILLED WHOLE ORGANISMTOXOID PROTEINSPOLYSACCHARIDEGLYCOCONJUGATERCOMBINANTBCG, Yellow fever, OPV, Measles, Mumps, Rubella,Typhoid, Varicella,Rotavirus, Cholera,Cold-adapted influenza,Rotavirus reassoants.ZostTyphoid, Cholera, Plague,Peussis, Influenza,Typhus, lPV, Rabies, JE,Tickborne encephalitis, HAVDiphtheria, Tetanus,Acellular peussis,Anthrax, InfluenzasubunitPneumococcus,Meningococcus,Hib, Typhoid(Vi)Hib, Pneumococ-cus,MenACWY(Meningococcus)HBV Lymedisease, CholeraToxin B, HPV
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Which is the most common aerobic bacteria found in vagina?
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Normal vaginal flora is mostly aerobic with an average of six different species of bacteria, most common of which is hydrogen peroxide producing lactobacilli. Other commonly found aerobic bacteria found in the vagina are Diphtheroids, Streptococci, Staphylococcus epidermidis and Gardenella vaginalis. Most prevalent anaerobic bacteria which are detected are Peptococcus, Peptostreptococcus and Bacteroids.
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A 30 year old male presents with severe pain chest, breathlessness, hypotension and ECG shows ST elevation in V3, V4 V5 and V6 leads. He will be best treated with:
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Percutaneous transluminal coronary angioplasty (PCTA or angioplasty) is a procedure that is commonly performed on people with hea disease. This procedure is done to open up the blood vessel to allow the blood to pass through more easily PTCA is a minimally invasive procedure to open up blocked coronary aeries, allowing blood to circulate unobstructed to the hea muscle. The indications for PTCA are: Persistent chest pain (angina) Blockage of only one or two coronary aeries Ref Davidson edition23rd pg 460
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Which of the following-is the first sign of sexual maturity in boys?
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Ans. (d) Increase in testicular sizePlease refer explanation of question 40
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Thomsen friedensreich phenomenon is -
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Ans. is 'b' i.e., Red cell agglutination by all blood group sera Thomsen-Freidenreich Phenomenono Red cell suspensions contaminated with certain bacteria, e.g. pseudomonas aeruginosa, become aggluiinable by alt blood group sera and even by normal human sera,o This is known as Thomsen Friedenreich phenomenon and is due to unmasking of a hidden antigen normally present on all human erythryocytes, i.e. T-antigen.o Anti-T agglutinins are normally present in human sera.o Such panagglutinability of red cells has occasionally been observed in persons suffering from systemic bacterial infections.
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In mood disorder, rapid cyclers are defined as
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(A) 4 or more episodes per year# Rapid cycling:> Most people who meet criteria for bipolar disorder experience a number of episodes, on average 0.4 to 0.7 per year, lasting three to six months.> Rapid cycling, however, is a course specifier that may be applied to any of the above subtypes. It is defined as having four or more episodes per year and is found in a significant fraction of individuals with bipolar disorder. The definition of rapid cycling most frequently cited in the literature (including the DSM) is that of Dunner and Fieve: at least four major depressive, manic, hypomanic or mixed episodes are required to have occurred during a 12-month period.There are references that describe very rapid (ultra-rapid) or extremely rapid (ultra-ultra or ultradian) cycling. One definition of ultra-ultra rapid cycling is defining distinct shifts in mood within a 24-48-hour period.
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Best marker of SLE?
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Ans. (b) Anti-ds DNA antibodies(Ref: Harrison 18th/chapter 319)Anti dsDNA is specific for SLE, only in high titers;But still, anti ds DNA is the best marker for SLE because its prevalence in SLE is 70%;Whereas, Anti Sm antibody, which is specific for SLE, but is seen in only 25% patients with SLE
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Enzyme deficiency in Hurler syndrome?
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Disease name Abbretion Enzyme Defective GaG(s) affected Symptoms Hurler syndrome MPS I a-l-Iduronidase Dermatan sulfate, Heparan sulfate Mental retardation, coarse facial features, hepatosplenomegaly, cloudy cornea Reference: Harper; 30th edition; Page no:639; Table: 50-8
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Which of the following is a prodrug ?
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All ACE inhibitors are prodrugs except captopril and lisinopril.
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When the sympathetic nervous system is activated:
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Ans. C. Norepinephrine is released from axons onto the arteriolar wallNerve fibers, not vascular smooth muscle, release norepinephrine. The norepinephrine from the sympathetic nerves simply diffuses from the axons and binds to specific receptors on smooth muscle cells.
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Histological finding in Reye&;s syndrome is
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Reyes syndrome characterised by mitochondrial injury and decreased synthesis of mitochondrial enzymes in liver. Which leads to rise in blood ammonia and accumulation of triglycerides within hepatocytes. TEXTBOOK OF PATHOLOGY HARSH MOHAN 6TH EDITION PAGE 602
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All of the following play a significant role in bone resorption except:
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Pro-resorptive factors are hormones and cytokines are:-
PTH (Parathyroid hormone)
1,25dihydroxyvitamin D3,
IL-1
IL-6
TNF (Tumour necrosis factor)
LIF (Leukaemia inhibitory factor)
Corticosteroids, which activate osteoblasts and stroma cells to produce RANKL and depress OPG.
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Surgical treatment for asymptomatic uterine myoma is indicated if
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Management of myomas: Asymptomatic : observation with regular follow up Size < 12 weeks Uncomplicated pregnancy with fibroid Surgery: Size > 12weeks Cornual fibroid causing infeility Pedunculated cornual fibroid Pregnancy with torsion of pedunculated fibroid Symptomatic myoma: Medical: Hormones to shrink the fibroid _ surgery unterine aery embolization Myomectomy Lap myomectomy Lap myolysis MRI guided ablation Total / sub total abdominal hysterectomy Vaginal hysterectomy Total laproscopic hysterectomy Lap hysterectomy Lap assisted vaginal hysterectomy Cervical (1%): Vaginal polypectomy Myomectomy Lap myomectomy MRI guided myolysis Vaginal hysterectomy Total abdominal hysterectomy Ref Shaw 16th edition pg 409
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Tympanic membrane develops from?
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Ans. (d) All three germ layersRef: Longman's medical embryology 12th ed. / 326
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Mucoepidermoid carcinoma arises form
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Mucoepidermoid carcinomas are composed of variable mixtures of squamous cells, mucus-secreting cells, and intermediate cells. "The low-grade mucoepidermoid carcinoma is composed of largely mucin-secreting cells, whereas in high-grade tumors, the epidermoid cells predominate." They are the most common malignant tumors of the salivary glands. Treatment The primary t/t of all salivary malignancy is surgical excision: for parotid malignancies- Superficial parotidectomy with preservation of CN VII. Total parotidectomy with nerve preservation if deep lobe is involved. for other salivary gland - Enbloc removal of the involved gland Neck dissection for lymph nodes is done clinically palpable nodes for high grade malignancies Radiation therapy is used postoperatively for specific indications high grade histology presence of extraglandular disease perineural invasion direct invasion of regional structureregional metastasis
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Parasites causing lung infestation are -
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The worm lie in the lung parenchyma and are surrounded by a fibrous capsule formed by host tissue.Inflammatory reaction to the worms and their eggs lead to granuloma formation,cystic dilatation of bronchi,abscesses and pneumonitis.Patient present with cough,chest pain and haemoptysis (refer pgno:131 baveja 3 rd edition)
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Culex mosquito is a vector for:
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ANOPHELES CULEX AEDES MANSONIA Boat shaped Small in clusters Single ; Cigar shaped Star shaped ; in clusters Rest parallel to water surface Rest at an angle to water surface Rest at an angle to water surface Attached to roots of Aquatic plants - Sits by making an angle of 45o with surface - Have straight body & spotted wings - Hunchback posture - Hunchback posture 3-5 Km 11 km 100 m Clean water. Hence known as Sophisticated mosquito Diy water - Nuisance mosquito Aificial collection of rain water. - Tiger mosquito Aquatic plants Malaria Lymphatic filariasis Japanese Encephalitis West nile fever Dengue Chikungunya Yellow fever Zika virus Rift valley fever Brugian filariasis
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True statement about diphtheria toxin is
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Toxigenicity of the diphtheria bacilli depends on the presence in it of corynephages which acts as the genetic determinant controlling toxin production. The diphtheria toxin acts by inhibiting protein synthesis. Specifically, a fragment B heparin binding and fragment A inhibits polypeptide chain elongation in the presence of nicotinamide adenine dinucleotide by inactivating the elongation factor EF-2. Reference: Textbook of Microbiology; Anathanarayan and panicker&;s; 9th edition; Page no: 238
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All except one are formulas used to calculate fluid replacement in burns patient
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Holiday segar formula is not used to calculate fluid replacement in burns patient.
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Drug of choice for multidrug resistant staphylococcus aureus is:
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Ans: c (Vancomycin)Ref: Harrison 16 ed pg. 821, KDT 6 ed. Pg.732Vancomycin is the drug of choice for MRS A. Quinupristin and dalfopristin are both streptogramin antibiotics that act on MRSA and VRSA. They are used mainly for VRSA.Drugs useful against MRSA:Vancomycin Cotrimoxazole Doxycycline Minocycline Fluroquinolones - ciprofloxacin, levofloxacin Linezolid Streptogramins Quinipristine DalfopristineInvestigational Drugs for MRSA:Oritavancin Tigecycline
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A 26 year old female patient complains of discoloration with her upper front teeth. Intra-oral examination reveals intrinsic staining with maxillary incisors. Dentist prepares the tooth to receive veneers. This type of margin design is called as:
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The blending effect is predominantly related to smaller restorations, surrounded by hard dental tissues, such as composite restorations. It can reduce suboptimal shade matches due to operational error or lack of satisfactory match in the shade guide or restorative material. The veneers designed with “contact lens effect” margins before and after cementation are another example of blending effect.
Ref: Sturdevant's art and science of operative dentistry. 4th edition page - 205
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A 2 year old born out of consanguineous marriage, had a history of the collodion membrane. He had large, thick, plate-like brown scaling generalized distribution; no erythroderma and ectropion. Which disease is it?
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Ans. B. Lamellar ichthyosisLamellar ichthyosis (LI)* Collodion baby at birth as the baby is covered by a thickened collodion-like membrane which is then shed* Scaling occurs over the whole body, including creases and bends* The scale in LI is typically large, dark brown or grey and firmly adherent* Drooping of lower eyelids (ectropion), palmoplantar keratoderma and scarring alopecia may be seen in severe cases.* Limitation of joint movement, flexion contractures, and digital sclerodactyly may result. Nails may be small but hair shaft, mucous membranes and teeth are not affected.* May be associated with a mutation in transglutaminase 1 gene.
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Carey coombs murmur, which is false -
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A sho, mid-diastolic murmur is rarely heard during an episode of acute rheumatic fever (Carey-Coombs murmur) and probably is due to flow through an edematous mitral valve. An opening snap is not present in the acute phase, and the murmur dissipates with resolution of the acute attack. Complete hea block with dyssynchronous atrial and ventricular activation may be associated with intermittent mid- to late diastolic murmurs if atrial contraction occurs when the mitral valve is paially closed. Mid-diastolic murmurs indicative of increased tricuspid valve flow can occur with severe, isolated TR and with large ASDs and significant left-to-right shunting. Other signs of an ASD are present ( Chap. 236 ), including fixed splitting of S 2 and a mid-systolic murmur at the mid- to upper left sternal border. TTE is indicated for evaluation of a patient with a mid- to late diastolic murmur. Harrison principal of internal medicine,20edition,pg no.1432
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Tolvaptan is approved for use in-
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Tolvaptan is a vasopressor receptor antagonist used to correct hyponatremia in the treatment of syndrome of inappropriate water excretion or SIADH :-
Syndrome of inappropriate secretion of ADH is caused due to excesive secretion of antiduretic hormone.
Antidiuertic hormone (ADH) or arginine vasopressin is synthesized by the hypothalamus.
Its major effect is to prevent diuresis by promoting reabsorption of water in the kidneys.
- ADH is the primary physiological determinant of the rate of free water excretion.
- Its major renal affect is to augument the water permeability of the leminal membranes of the cortical and medullary collecting tubules thereby promoting water reabsorption.
The antidiuretic effect of ADH is mediated by "V2 receptors".
Tolvaptan is V2 receptor antagonist
- It can be used to correct hyponatremia due to excesive water retnetion caused by increased ADH secretion.
Randomized double blind trials have shown that oral or intravenous vasopressin antagonists are more effective than placebo in raising the serum sodium of hyponatremic patients.
"Tolvaptan" and "conivaptan" but not lixivaptan are approved for use in the united states.
Vasopressor receptor antagonist
There are three receptor for vasopressin (ADH).
- The V1 a, Vlb and V2 receptors.
The V2 receptors primarily mediate the antidiuretic response while V1 a and Vlb primarily cause vasoconstriction and adrenocorticotropic hormone (ACTH) release.
V2 → Mediate antidiuretic response
VlaVlb → Cause vasoconstriction and adrenocorticotropic hormone (ACTH) release.
The vasopressin receptor antagonist tolavaptan produces a selective water diuresis (aquaresis) without affecting sodium and potassium excretion.
- The ensuing loss of electrolyte free water will tend to raise the serum sodium in patients with SIADH and may improve mental status in patients with serum sodium under 130 meq/L.
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Organ most vulnerable to ischaemic due to shock?
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Ans. is 'd' i.e., Hea o The susceptibility of a tissue to hypoxia influences the likelihood of infarction. o Neurons are most sensitive to hypoxia (irreversible changes develop in 3-4 minutes) followed by myocardial cells (irrversible changes develop in 20-40 minutes). o Fibroblasts are amongst the most resistent cells to hypoxia.
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After premature delivery, mother's milk is low in
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Ans. a (Lactose) (Ref OP Ghai 6th/ p. 158; 7th/p. 131, 134)After premature delivery, mother's milk is low in:# Calcium # Phosphates # LactoseADVANTAGES OF BREAST MILK# Docosahexanoic acid (DHA, W3, 2:3) present in breast milk helps in brain development.# Maximum synthesis of breast milk occurs at 12 months.# Has better calcium than cow milk for baby to absorb.# Iron in breast has 70% availablity. # Prevents against infections by:- Human milk contains bacterial and viral antibodies, including secretory IgA. They probably account for the lower incidence of diarrhea, otitis media, pneumonia, bacteremia, and meningitis during the 1st yr of life.e- Macrophages in human milk may synthesize complement, lysozyme, and lactoferrin.- Lactoferrin has an inhibitory effect on the growth of Escherichia coli in the intestine.- The lower pH of the stool of breast-fed infants is thought to contribute to the favorable intestinal flora of infants fed human milk vs. formula (i.e., more bifidobacteria and lactobacilli; fewer E. coli), which also helps protect against infections caused by some species of E. coli.- Human milk also contains bile salt-stimulated lipase, which kills Giardia lamblia and Entamoeba histolytica.DISADVANTAGES OF BREAST MILK# Breast milk is balanced, will supply all the necessary nutrients except, perhaps, fluoride and, after several months, vitamin D.# The iron content of human milk is somewhat low. However, most normal infants have sufficient iron stores for the first 6 mo of life. Moreover, human milk iron is well absorbed.# The vitamin K content of human milk also is low and may contribute to hemorrhagic disease of the newborn. Parenteral administration of 1 mg of vitamin K, at birth is recommended for all infants, edpecially for those who will be breast- fed.# Cytomegalovirus (CMV), human T-cell lymphotropic virus type 1, rubella virus, hepatitis B virus, and herpes simplex virus also have been demonstrated in breast milk. Of these, the presence of CMV is the most troublesome.Nutritive value of milk compared BuffaloCowGoatHuman1Fat (g)6.54.14.53.42Protein (g)4.33.23.31.13Lactose (g)5.14.44.67.1Q4Calcium (mg)210120170285Iron (mg)0.20.20.3--6Vitamin C (mg)12137Minerals (g)0.80.80.80.18Water (g)81.08786.888
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Alkaline douch solution of nose does not contain:
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Ans. D Nasal irrigation and removal of crusts - warm normal saline or an alkaline solution made by Soda bicarbonate 1 pa Sodium biborate 1 pa Sodium chloride 2 pas in 280 ml of water Initially irrigation are done 2 or 3 times a day but later every 2 or 3 days is sufficient 25 % glucose in glycerine - nose is painted this inhibits the growth of proteolytic organisms which are responsible for foul smell.
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Shoest acting anticholinesterase is -
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Ans. is 'a' i.e., Edrophonium o Edrophonium is the shoest acting anti-ChE. o Why is it so, lets see : o When carbamates (other than edrophonium) and organophophates react with cholinesterase, they form covalent bond at esteratic site, which is considerably resistant to hydrolysis. o In contrast, edrophonium binds electrostatically and by hydrogen bonds at anionic site (not at esteratic site) of cholinesterase. The enzyme inhibitor complex does not involve a covalent bond and is correspondingly sho lived (2-10 minutes). o So edrophonium is also called as noncovalent inhibitor.
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Injury to the nerve originating from C5 in Brachial plexus leads to
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The question speaks of Dorsal scapular nerve on whose damage leads to winging of scapula.
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Which of the following features is not included in psychosis
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A i.e. Panic attack - Hypochondrial symptoms are commonly present in major depression. Panic attacksQ (generalized anxiety disorder) is a neurotic disorder Delusion & hallucinations are common in psychosis (MDP, Schizophrenia & delusional disorder).
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True about composition of hospital waste
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- the average composition of hospital wastes in India is; - 15% - 10% metals- 1% infectious wastes-1.5% -4% wastes-53.5% Reference : Park&;s textbook of preventive and social medicine, 23rd edition, pg no:790, table 2. <\p>
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Spring catarrah is -
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It is considered a hypersensitivity reaction to some exogenous allergen, such as grass pollens. VKC is thought to be an atopic allergic disorder in many cases, in which IgE-mediated mechanisms play an impoant role. Such patients may give personal or family history of other atopic diseases such as hay fever, asthma, or eczema and their peripheral blood shows eosinophilia and inceased serum IgE levels. Ref: A K KHURANA COMPREHENSIVE OPHTALMOLOGY,E4,page-74
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Most common histological type of thyroid carcinoma is
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(B) Papillary type # Morphological variants of thyroid carcinoma and their approximate frequencies are: Papillary carcinoma 75-85% Follicular carcinoma 10-20% Medullary carcinoma 5% Anaplastic carcinoma < 5%> Histology type Incidence Papillary 80% Follicular 10% Medullary 5% Anaplastic 1 %> Papillary carcinoma thyroid: Commonest carcinoma of thyroid gland (80%) Commonest carcinoma in iodine sufficient area. More common in patients with previous exposure to radiation (past childhood) Commonest age 30-40 year. Multifocal (more common) Lymph node metastases more common (i.e., lymphatic spread) Distant metastasis uncommon commonest site - lung followed by bone, liver, brain. Prognosis excellent -10 years survival (95%)
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Which vitamin deficiency may be observed in a patient on INH therapy: September 2012
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Ans: B i.e. Pyridoxine The main cause of pyridoxine deficiency is a lack of pyridoxine in the diet. Another cause of vitamin B6 deficiency is the use of the ATT medication isoniazid, and for this reason, it is usually replaced with vitamin B6 whilst using this drug.
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Hypersegmented neutrophils are seen in -
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Ans. is 'c' i.e.. Megaloblastic anemia Findings of megaloblastic anemiaPeripheral bloodo Macrocytosis i.e., megaloblastic RBC - Due to nuclear1 cytoplasmic asynchrony,o Macrocytes lack central pallor of normal RBC.o Anisopoikilocytosis - Marked variation in shape and size,o Majority of RBCs appear as macroovalcytes.o Few tear drop cells.o Low reticulocyte counto Some nucleated RBCs may appear (normally, during maturation of RBC, nucleus disappears),o Hyper-segmented neutrophils - First manifestation of megaloblastic anemia.o Large megakaryocytes with multilobate nuclei.o Evidence of erythropoiesis: - Basophilic stippling, Cabott Ring, Howell-jolly bodies,o As DNA synthesis is impaired in all proliferating ceils, pancytopenia (anemia, leukopenia, thrombocytopenia) may occur.Bone marrowo Hypercellular due to proliferation of erythroid precursors replacing fat - Decreased ration of fat cells to hematopoietic elements (normal is 1 : 1).o Reversal of myeloid to erythroid ratio (normal is 2 to 3 : 1) due to proliferation of erythroid precursors,o Megaloblastic erythropoiesisOtherso t MCV due to macrocytosiso T MCH due to increased hemoglobin content.o Normal MCHC because hemoglobin content in the cell is increased proportiante to increase in the size of RBC.
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A 20-year-old male presented with high-grade fever, groin pain and a swollen scrotum for 1 week and are worsening progressively. On examination, Tender inguinal lymphadenopathy Scrotal swelling with hydrocoele Lymphatic streaking Blood samples are taken and a parasite infection is suspected. Which of the following is the most likely organism: -
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This is a case of filariasis (acute lymphadenitis) due to Wuchereria bancrofti. Microfilariae are found in blood, hydrocoele and other body fluids. 1 Wuchereria bancrofti Sheath, no nuclei in the tip of the tail 2 Brugia malayi Sheath, 2 distinct nuclei in the tip of the tail 3 Loa loa Sheath, nuclei extending to the tip of the tail 4 Onchocerca volvulus (skin) No sheath, no nuclei in the tip of the tail 5 Mansonella perstans No sheath, nuclei extending to the tip of the tail 6 Mansonella ozzardi No sheath, no nuclei in the tip of the tail 7 Mansonella streptocerca (skin) No sheath, nuclei extending to the tip of the hooked tail
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All causes brain lesions except
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giardiasis is caused by Giardia lamblia. the parasite attaches itself to the epithelial surface of duodenum and jejunum and causes disturbance of intestinal function leading to malabsorption of fat. Patient presented with loose stool and mild steatorrhoea. .Baveja textbook of parasitology 3rd edition.
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All of the following metabolic pathways occur in both Cytoplasm and Mitochondria, except:
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Ans. (a) GlycolysisRef.: Harpers Biochemistry 30th edti. /142-144* Glycolysis occurs in cytoplasm.* There are two major sites for gluconeogenesis, the liver and the kidneys.* The liver accounts for 90% of gluconeogenesis in the body and the remaining 10% occur in the kidney and other tissues of the body.* The liver and kidneys maintain the glucose level in the blood so that the brain, muscle and red blood cells have sufficient glucose to meet their metabolic demands.Also KnowCycle occurs in both cytoplasm and mitochon- Idria-* Gluconeogenesis* Urea cycle* Heme synthesis
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Shailza, a 40-year-old female is having headache for the past 6 months. All her investigations were normal. She had several consultations and she had no relief of her symptoms. She still believes that she has some problem in her brain. Likely diagnosis could be: September 2010
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Ans. D: Hypochondriasis Hypochondriasis, hypochondria refers to excessive preoccupation or worry about having a serious illness. An individual suffering from hypochondriasis is known as a hypochondriac. Often, hypochondria persists even after a physician has evaluated a person and reassured them that their concerns about symptoms do not have an underlying medical basis or, if there is a medical illness, the concerns are far in excess of what is appropriate for the level of disease. Many hypochondriacs focus on a paicular symptom as the catalyst of their worrying, such as gastro-intestinal problems, palpitations, or muscle fatigue.
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Not a feature of acute aerial Occlusion ?
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Ans is 'a' ie Cyanosis
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Bajaj committee in 1986 proposed?
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<p> Manpower and planning. Reference:India health repo 2010,page no;132. <\p>
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Instrument of choice for diagnosing pediatric retinal disorders
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Retcam has been used to diagnose pediatric retinal disorders. It has a probe which is put over eye which captures the fundus photo. It can also do fluorescein angiography and is used for tele consultation too High Yield Facts *Factors responsible for ROP : Low GA is more impoant than LBW *WHO Vision 2020 program targets ROP as "avoidable disease" *Nd:Yag LASER is used in ROP Photocoagulation *30 Day Screening Strategy: ROP screening in NICU *Anti VEGF & Algae extracts: Experimentally evaluated for Rx *Lensectomy is done for cataract a/w ROP *Stage 5 ROP: Rx is Vitrectomy under poor prognosis *Retcam: Retinal wide field camera for diagnosis, training and angiography in Pediatric retinal anomalies
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Brunner's glands are seen in -
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The presence of mucous duodenal (Brunner’s) glands in the submucosa is indicative of upper duodenum. These submucosal glands are absent in the jejunum, ileum and the entire large intestine.
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All are seen in injury to common peroneal nerve except?
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A i.e. Loss of sensation ove soleSole is supplied by medial & lateral plantar and sural branches of tibial nerveQ anteriorly (from medial to lateral) and calcaneal branches of tibial nerveQ posteriorly (i.e. over heel). So it is not affected in common peroneal nerve injury.
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Haemoglobin can bind to all the following except
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Ans: c (SO2) Ref.Ganong 22nd ed/p.667.Hb does not bind to SO2.Functions of Hb:-It facilitates 02 transportIt facilitates C02 transportIt has an important role as a bufferIt transports NO.Hemoglobin binds NO in the lungs and releases it in the tissues, where it promotes vasodilation.In arterial blood,Total volume of C02 - 49ml/dlAmount of C02 transported as HC03- 43.8ml/dl ~ (90%)Amount of C02 transported as carbino compounds - 2.6ml/dl ~ (5%)Amount of C02 in dissolved state - 2.6ml/dl (5%)Note:-1 gm Hb can carry 1.39ml of oxygen, when fully saturated. 1,34ml oxygen in vivo.1 gm Hb carries 3.34mg Iron in it.Oxygen entering the body per minute = 250mlOxygen leaving the body per minute = 200ml (288L/day)pH of arterial blood = 7.4 and pH of venous blood = 7.36.Haematocrit of venous blood increase by 3%.Chloride shift takes about 1 second to occur.
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Cadaveric spasm -a) Immediate after deathb) After 2 hours of deathc) Affects voluntary musclesd) Affects involuntary muscle
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Cadaveric spasm occurs immediately after death and affects voluntary muscles.
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The treatment of acute myocardial infarction includes which of the following-
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Ref : harrisons-manual-of-medicine-16th-edition pg no: 622-623 TREATMENT Initial Therapy Initial goals are to: (1) quickly identify if patient is candidate for reperfusion therapy, (2) relieve pain, and (3) prevent/treat arrhythmias and mechanical complications. * Aspirin should be administered immediately (162-325 mg chewed at presentation, then 162-325 mg PO qd), unless pt is aspirin-intolerant. * Perform targeted history, exam, and ECG to identify STEMI (1 mmST elevation in two contiguous leads or new LBBB) and appropriateness of reperfusion therapy , which reduces infarct size, LV dysfunction, and moality. * Primary PCI is generally more effective than fibrinolysis and is preferred at experienced centers capable of performing procedure rapidly , especially when diagnosis is in doubt, cardiogenic shock is present, bleeding risk is increased, or if symptoms have been present for 3 h. * Proceed with IV fibrinolysis if PCI is not available or if logistics would delay PCI 1 h longer than fibrinolysis could be initiated (Fig. 123-1). Dooo- needle time should be 30 min for maximum benefit. Ensure absence of contraindications before administering fibrinolytic agent. Those treated within 1-3 h benefit most; can still be useful up to 12 h if chest pain is persistent or ST remains elevated in leads that have not developed new Q waves. Complications include bleeding, reperfusion arrhythmias, and, in case of streptokinase (SK), allergic reactions. Heparin should be initiated with fibrinolytic agents other than SK ; maintain aPTTT at 1.5-2.0 control (50-70 s). * If chest pain or ST elevation persists 90 min after fibrinolysis, consider referral for rescue PCI. Later coronary angiography after fibrinolysis generally reserved for pts with recurrent angina or positive stress test. The initial management of NSTEMI (non-Q MI) is different . In paicular, fibrinolytic therapy should not be administered.
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An 8 year old boy presented with fever and bilateral cervical lymphadenopathy with prior history of sore throat. There was no hepatomegaly. The peripheral blood smear shows > 20% lympho-plasmacytoid cells. The most likely diagnosis is -
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Ans. is 'b' i.e., Infectious Mononucleosis Infectious mononucleosis Infectious mononucleosis : Is the most characteristic disease produced by Epstein Barr Virus Clinical features : o Most infections are asymptomatic. o Headache, Abdominal pain, chills also seen in few casees. o Fever, malaise, sore throat, (exudative pharyngitis), loss of appetite o Generalized lymphadenopathy : Posterior and anterior cervical LN are almost always enlarged. Splenomegaly is found in 50-75% cases while hepatomegaly is found only in 30% cases. o Maculopapular rash. Laboratory findings : a. Atypical Lymphocytosis : Comprising over 10% of total lymphocytes at some time in the illness. b. Paul Bunnel test is positive c. Monospot test is the screening test
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In surgical anterolateral approach to tibia, incision is taken over the tibialis anterior muscle mass rather than over the shaft. What is/ are the advantages?
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Ans. is 'd' i.e., All the above * In surgical anterolateral approach to tibia, incision is taken over the tibialis anterior muscle mass rather than over the shaft. Following are the advantages :i) If required can be converted to an extensile approach. Entire tibia from knee to ankle can be exposed.ii) Open wound treatment of the fracture is possible with this incision with proper planning i.e. in cases where the fracture is compound and/ or there is excess tension while closing the wound, the surgical wound can be left open - with adequate planning the bones and implants will remain adequately covered by the medial flap.iii) Medially based flap - since the incision is lateral to the subcutaneous surface, the skin flap will be based medially, in an area of higher vascularity and skin sloughs will not normally occur.
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A young patient had a history of fall. The physician placed his hand on the patient's chin and instruct him to rotate his head to the opposite side against resistance. But he was unable to perform the action. Which of the nerve is injured in this patient?
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The sternocleidomastoid muscle creates the borders for both the anterior and the posterior triangles of the neck, and is innervated by the spinal accessory nerve (CN XI). To test the sternocleidomastoid muscle, the physician will place her hand on the patient's chin and instruct him to rotate his head to the opposite side against resistance. If acting normally, the patient's muscle can be seen and palpated. The physician next will instruct the patient to shrug his shoulders against resistance. Patients with damage to CN XI will have diminished shoulder strength while shrugging on the injured side.
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Most common cause of death in measles is
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.
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IQ in mild mental retardation is
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Ans. is 'a' i.e., 50-70
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Reticulocytosis is NOT a feature of:
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Answer is D (Anemia of chronic Renal Failure) Anemias of chronic renal failure and chronic disease are associated with low or normal reticulocyte counts. Elevated reticulocyle count is a feature of hyperproliferative anemias including PNH, hereditary spherocytosis and anemia after blood loss.
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Feline esophagus is seen in:
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- Feline esophagus is seen in both Eosinophilic Esophagitis>GERD. It is characteristic of Eosinophilic esophagitis so it serves as a better answer. - Eosinophilic Esophagitis: A barium swallow should be the first test obtained in the patient with dysphagia EE has a characterised finding often called the "Ringed esophagus" or the "feline esophagus" as the esophagus rings are felt to look like the strips on a housecat. The endoscopic appearance of EE is also characteristic and the appears as a series of rings. Feline Esophagus-BARIUM SWALLOW Normal Esophagus
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Lady with infeility with bilateral tubal block at cornua : best method of management is :
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IVF
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Local anesthetic action is a result of blockade of the movement of wof channels
|
LOCAL ANAESTHETICS MECHANISM OF ACTION The LAs block nerve conduction by decreasing the entry of Na+ ions during upstroke of action potential (AP). As the concentration of the LA is increased, the rate of rise of AP and maximum depolarization decreases causing slowing of conduction. Finally, local depolarization fails to reach the threshold potential and conduction block ensues. The LAs interact with a receptor situated within the voltage sensitive Na+ channel and raise the threshold of channel opening: Na+ permeability fails to increase in response to an impulse or stimulus. Impulse conduction is interrupted when the Na+ channels over a critical length of the fibre (2-3 nodes of Ranvier in case of myelinated fibres) are blocked. Ref:- kd tripathi; pg num:-361
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Odd pair -
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Ans. is 'd' i.e., Erythema chronicum migrans - malignancyo "Erythema gvratum repens" is a rare and characteristic rash strongly associated with malignancy .It consists of wavy erythematous concentric bands that can be figurate, gyrate or annular.These bands are arranged in parallel rings and lined by a fine trailing edge of scale pattern described as "wood grained"Erythema g}'ration repens can expand as fast as l cm/day. It is extremely pruritic and can involve large areas of the body but tends to spare hands, face and feet.Malignancies associated with Erythema gyratum repens :Bronchial carcinomaEsophageal cancerBreast cancerLess commonly it may also be seen in patients with genitourinary, gastrointestinal and hematological malig- nancies.o Erythema chromic urn nigranso Erythema chronicum migrans is the cutaneous hallmark of "h me disease "o One or more large erythematous patches appear anywhere on the skin. The lesion expands centrifugally. Sometimes with central clearing giving rise to annular patches.Ervthema Annulare centrifugumo Erythema annulare centrifugum is characterized by non indurated annular patches with associated trailing scale inside the erythematous bordere.o The annular lesions most commonly affects the tranks, bullocks, thighs and legs while sparing the hands feets and face.o The etiology and pathogenesis are unknown.It is believed that erythema annulare centrifugum represents a continuous manifestation of a hypersensitivity reation to a myriad of underlying conditions including infection by dermatophytes bacteria and viruses, malignancy and immunological disorders.Necrotizing acral ervthema is associated with Hepatitis C virusCutaneous manifatations associated with Hepatitis C virusUrticariaErthema multiformeErthema nodosumMixed cryoglobulinemiaUrticarial vasculitisHenoch schnolein purpuraNecrolytic acral erythemaPorphyria cutanea tardaLichen planusPntrigoErythema marginatumo It is a characteristic cutaneous manifestation of rheumatic fever.o Erythema marginatum are rash present on the trunk and proximal part of extremities.Face is spared.Never pruritic, never indurated andNever tender
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All of the following are true about rituximab except?
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Ans. d. Dose independent pharmacokinetics (Ref: Harrison 19/e p2147,18/e p2749; Katzung 12/e p646; htt[://www.isdbweb. org/documents/file/1442_2pdf)Pharmacokinetics of rituximab (monoclonal antibodies) is dose dependent.'The rate of uptake and elimination of antibodies by target-mediated pathways is a function of dose and the expression level of the target, as well as a function of the kinetics of receptor internalization and intracellular catabolism http:// www.isdbweb.org/documents/file/1442_2.pdfRituximabRituximab is a murine-human monoclonal IgG1 (human Fc) that binds to the CD20 molecule on normal and malignant B lymphocytesQMechanism of Action:The mechanism of action includes complement-mediated lysis, antibody-dependent cellular cytotoxicity, and induction of apoptosis in the malignant lymphoma cellsQ.Indications:Approved for relapsed or refractory low-grade or follicular B cell non-Hodgkin's lymphomaQ.Approved for the treatment of refractory RA in combination with methotrexate and has been shown to be more effective for patients with seropositive than seronegative diseaseQ.Side-effects:Associated with mild-to- moderate infusion reactions as well as an increased risk of infectionQ.Notably, there have been isolated reports of a potentially lethal brain disorder, progressive multifocal leukoencephalopathy (PML), in association with rituximab therapy.It has been also shown to cause Tuberculosis.Pharmacokinetics:The rate of uptake and elimination of antibodies by target-mediated pathways is a function of dose and the expression level of the target, as well as a function of the kinetics of receptor internalization and intracellular catabolism.Monoclonal antibodies marketed for therapeutic useAntibodyIsotype/structurePrimary indicationAbciximabChimeric mouse/human FabPrevention of cardiac ischemic complicationsAdalimumabHuman lgG1Rheumatoid arthritisAlemtuzumabCDR-grafted rat/human IgG1B-cell chronic lymphocytic leukemiaBasiliximabChimeric mouse/human IgG1Prophylaxis of acute organ rejectionBevacizumabCDR-grafted mouse/human lgG1Colorectal, lung, and breast cancerCertolizumab pegotPEGylated FabCrohn's diseaseCetuximabChimeric mouse/human lgG1Head and neck cancer, colorectal cancerDaclizumabCDR-grafted mouse/human lgG1Prophylaxis of acute organ rejectionEculizumabCDR-grafted mouse/human lgG2/lgG4Paroxysmal nocturnal hemoglobinuriaEfalizumabCDR-grafted mouse/human lgG1PsoriasisGemtuzumab ozogamicinCDR-grafted mouse/human lgG4Acute myeloid leukemiaIbritumomab tiuxetanMurine lgG1Non-Hodgkin's lymphomaInfliximabChimeric mouse/human lgG1Rheumatoid arthritis, Crohn's diseaseMuromonab-CD3Murine lgG2aAcute organ rejectionNatalizumabCDR-grafted mouse/human lgG4Multiple sclerosisOmalizumabCDR-grafted mouse/human lgG1AsthmaPativizumabCDR-grafted mouse/human lgG1Prevention of respiratory tract diseasePanitumumabHuman lgG2Colorectal cancerRanibizumabCDR-grafted human IgG1 FabMacular degenerationRituximabChimeric mouse/human IgG1Non-Hodgkin's lymphoma, rheumatoid arthritisTositumomabMurine lgG2aNon-Hodgkin's lymphomaTrastuzumabCDR-grafted mouse/human lgG1Breast cancerCDR, complementarity determining region: IgG, immunoglobulin G.
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NOT a constituent of embalming fluid: AIIMS 08
|
Ans. Ethanol
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Which of the following is true of mumps ?
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Ans. is 'c' i.e., Meningoencephalitis can precede parotitis "Aseptic meningitis may develop before, during, after or in the absence of parotitis." About other options o Mainly parotid glands are involved, but sublingual and submaxillary glands may also be involved. o Patient is infectious 4-6 days before the onset of swelling. Sterility after mumps orchitis is rare.
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Which of the following is not a characteristic finding in Henoch Schonlein Purpura?
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Henoch Schonlein Purpura is a small vessel vasculitis characterized by palpable purpura, ahralgia, gastrointestinal signs and symptoms and glomerulonephritis. Patients have a normal platelet count, other laboratory findings includes mild leukocytosis, occasional eosinophilia, normal serum complement and elevated IgA. Reference: Harrison's Principles of Internal Medicine 18th edition, chapter 326.
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False statement about selegeline is -
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Ans. is 'a' i.e., It is a MAO-A inhibitor o Selegeline (deprenyl) inhibitis MAO-B o Unlike nonselective MAO inhibitors, selegiline in low doses does not interfere with peripheral metabolism of dietary amine (tyramine), accumulation and hypeensive reaction (cheese reaction) does not develop, while intracerebral degradation of dopamine is retarded. o Adminstered with levodopa, it prolongs levodopa action, attenuates motor fluctuation and decreases "wearing off' and "on of' effects.
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Most common cause of ARDS in children is:
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c. Severe pneumonia with sepsis(Ref: Neonatal and Pediatric Respiratory Care 4/e By Brian K. Walsh p 564)Pneumonia, sepsis and aspiration are the most common cause of ARDS and ALI in children
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The most frequently implicated antibiotic among the causes of drug induced liver injury is:
|
Amoxicillin-clavulanic acid : The most frequently implicated antibiotic among cases of drug-induced liver injury. Reference: Harrisons Principles of Internal Medicine, 18th Edition, Page 2560
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Which of the following is a nonmodifiable risk factor for coronary hea disease?
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park's textbook of preventive and social medicine 23rd edition. *non modifiable risk factors for CHD :age,sex,ethnicity, genetic factors. *modifiable risk factors: obesity,alcohol,physical activity, saturated fat, socio-economic status.
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Families which lags behind rest of community, is known as
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Problem Family: Is a family which lags behind rest of the community; underlying factors in most problem families are those of personality, relationships, backwardness, povey, illness, mental and social instability, character defects and marital disharmony. Standards of life are generally far below the accepted minimum Parents are unable to meet the physical and emotional needs of children Home life is utterly unsatisfactory Ref: Park 25th edition Pgno: 723
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The serum concentration in which of the following human IgG subclasses is maximum?
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IgG 1 - 65%, IgG2- 23%. IgG3 -8% IgG4 - 4%
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29 year old female with history of Sjogren's syndrome presents with a 2 day episode of watery diarrhea 2 days ago. Physical examination is unremarkable. Because of her history, the physician decides to check her urine electrolytes. Urine chemistry: K = 31, Na = 100, Cl = 105. Her current diagnosis is?
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* The urine electrolytes are used to distinguish between A and diarrhea * UAG is an indirect measure of ammonium excretion * UAG = (Na + K) - Cl * UAG = ( 100 + 31 ) - 105 = 26 * A positive UAG suggest A because in the setting of diarrhea, ammonium chloride concentration in the urine would be high and the UAG would be negative. * A positive value suggests that the kidney is unable to adequately excrete ammonium, leading to a reduction in net acid excretion and thus metabolic acidosis. Hyperkalemia, acidemia is seen in type IV A Type IV A associated with Diabetes Mellitus
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Prolonged latent phase is seen in :
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In primi, the latent phase is often long (about 8 hours) during which effacement occurs; the cervical dilatation averaging only 0.35 cm/hr. In multi, the latent phase is sho (about 4 hours) and effacement and dilatation occur simultaneously. Latent phase is the preparatory phase of the uterus and the cervix before the actual onset of labor. A latent phase that exceeds 20 hours in primigravidae or 14 hours in multiparae is abnormal. The causes include--(1) unripe cervix (2) malposition and malpresentation (3) cephalopelvic dispropoion and (4) premature rupture of the membranes. Management: Expectant management is usually done unless there is any indication (for the fetus or the mother) for expediting the delivery. Rest and analgesic are usually given. When augmentation is decided, medical methods are preferred. Amniotomy is usually avoided. Prolonged latent phase is not an indication for cesarean delivery. Reference: D C Dutta's Textbook of Obstetrics 7th edition page no 403
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A 60-year-old female is having proximal muscle weakness with increased serum creatinine kinase. The probable diagnosis is:
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A. It is a subacute inflammatory myopathy affecting adults, without rash, involvement of eye, family history of neuromuscular disease B. Dermatomyositis is identified by a rash preceding muscle weakness. C. Inclusion body myositis has an asymmetrical muscle involvement. D. Limb girdle muscular dystrophy and would have pediatric presentation and not in old age. Even if it LGMD patient survives by 60 years of age severe muscle wasting with contractures would have occurred.
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You are in the causlity when a student, Kumar is brought in with a shoulder injury sustained while playing football. In comparing the symmetry of his two shoulders, you notice a marked elevation of the distal end of his clavicle with respect to the acromion on the injured side. X-ray exam reveals a grade III shoulder separation. In order for this to have occurred, which ligament must be torn?
|
A shoulder separation is an injury to the acromioclavicular joint. A first degree separation involves stretching the ligaments, but maintenance of the joint. A second degree separation involves tearing of the joint capsule and coracoclavicular ligament, but still continuity. A third degree separation involves total disruption of the joint and the coracoclavicular ligament. Since the patient has a third degree shoulder separation, you know he must have torn his coracoclavicular ligament. The coracoacromial ligament contributes to the stability of the acromioclavicular joint, but damaging this ligament is not the hallmark of a third degree shoulder separation. The costoclavicular ligament connects the first rib to the clavicle. The superior glenohumeral ligament contributes to the stability of the shoulder joint, but not to the stability of the acromioclavicular joint. The transverse humeral ligament holds the tendon of the long head of the biceps in place in the inteubercular groove.
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Hemolytic Uremic Syndrome is characterized by -a) Microangiopathic haemolytic anaemiab) ↓ed LDHc) Thrombocytopeniad) Renal failuree) Positive Coomb's test
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Hemolytic uremic syndrome
Hemolytic uremic syndrome is characterized by the triad of :
Anemia (microangiopathic hemolytic anemia).
Renal failure (microangiopathy of kidney involving glomerular capillaries and arterioles).
Thrombocytopenia (due to platelet consumption).
Hemolytic uremic syndrome is most common is children under 2 years of age.
It usually follows an episode of acute gastroenterities, often triggered by E coli.
The prodrome is usually of abdominal pain, diarrhoea and vomiting.
Shortly thereafter, signs and symptoms of acute hemolytic anemia, thrombocytopenia and acute renal failure ensue.
Sometimes neurological findings also occur. (But usually absent and differentiate HUS from TTP.)
Rarely HUS may follow respiratory tract infection.
Etiology
Gastrointestinal infection in infants with the following organism :
E coli, Shigella dysenteriae, Streptococouus pneumoniae
Hematological findings in a case of microangiopathic hemolytic anemia :
Presence of schistocytes (fragmented red cells). This is the hallmark of microangiopathic hemolytic anemia.
Neutrophil leukocytosis.
Thrombocytopenia.
Hemoglobinuria is mild to moderate with hemosiderinuria.
Blood urea and serum creatinine
Elevated serum LDH
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All of the following antihistaminic agents lack anticholinergic property EXCEPT :
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All the drugs listed in the question are second generation anti-histaminic agents except promethazine.
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Totipotency of embryonic stem cell is due to that they?
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Ans. is 'a' i.e., Can differentiate into all the tissues of embryonic or extraembryonic cell types Stem cells base on their potency* Potency refers to ability of stem cells to differentiate into specialized (mature) cell type:-A. Totipotent stem cells - These cells are produced from fertilization of sperm and ovum and cells that are produced by first few division after fertilization are also totipotent. These cell can differentiate into all the tissues of embryonic or extra embryonic cell types.B. Pluripotent stem cells - These are descendants of totipotent stem cells and can differentiate into cells derived from any of the three germ layers.C. Multipotent stem cells - These cells can differentiate only into cells of a closely related family, e.g. hematopoietic stem cells differentiate into RBC, WBC, platelets but not into other types.D. Unipotent stem cells - Can differentiate only in to one cell type (e.g. muscle stem cell), but have property of self-renewal which distinguiches them from non-stem cells.
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Copper -- T is preferably inseed postnatal after :
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8 weeks
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Pneumothorax of what size generally needs operative treatment?
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Small pneumothoraxes (<20%) that are stable may be monitored if the patient has few symptoms Moderate (20%-40%) and large (>40%) pneumothoraxes nearly always are associated with persistent symptoms that cause physical limitations and require intervention.
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Most Common extranodal site of Lymphoma in 14W is?
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Ans. is 'a' i.e., CNS
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Which one of the following stains is specific for Amyloid?
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Ans. is 'c' i.e., Congo Red "To differentiate amyloid from other hyaline deposits (eg. Collagen andfibrin), a variety of histochemical techniques are used, of which the most widely used is Congo Red " - Robbins 7th/e p. 259Staining for Amyloido Congo red : It is the most widely used specific stain for amyloid.o Iodine staining: It is used for unfixed specimen or histological section. Amyloid stains mahogany brown and if sulfuric acid is added, it turns violet.o Thioflavin 'T' and 'S' give secondary immunoflurescence with ultraviolet light. Thioflavin T is more useful for demonstrating juxtalomerular apparatus of the kidney,o Metachromatic stains like crystal violet and methyl violet give rose pink appearance,o Amyloid is PAS positive.
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Physiological uncoupler is ?
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Ans. is 'd' i.e., All of the above
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Type II hypersensitivity -
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autoimmune haemolytic anaemia, transfusion reactions,idiopathic thrombocytopenic purpura,graves disease,myasthenia gravis are the examples of type 2 hypersensitivity.Harshmohan textbook of pathology 7th edition
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Gas gangrene is caused by: March 2012
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Ans: A i.e. Clostridium welchii Conditions and pathogens Established pathogens (clostridium) for gas gangrene (group) includes Cl. Perfringens/ welchii, Cl. septicum & Cl. Novyi Established pathogen (clostridium) for tetnaus include Cl. Tetani Established pathogens (clostridium) for food poisoning (group) includes Cl. Perfringens type A (gastroenteritis), Cl. Perfringens type C (necrotising enteritis) and Cl. Botulinum (botulism) Established pathogens (clostridium) for acute colitis include Cl. difficile
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The main enzyme responsible for activation of xenobiotics is -
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Most important reaction in biotransformation of xenobiotics is oxidation reaction. The most important enzyme for oxidation reactions is cytochrome P450.
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ABC transpoer ?
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Ans. is'a' i.e., P. glycoproteinATP-binding cassette transpoers (ABCtranspoers) are integral transmembrane proteins that utilize ATP as an energy source to translocate a variety of substrates across membranes.P-glycoprotein is an ATP-binding cassette (ABC) transpoer and is an impoant factor to limit membrane permeability in several tissues and/or elimination pathways into urine (rend tubles) and bile (liver).
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Site where endolymph is seen:
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(b) Scala media(Ref. Scott Brown, 8th ed., Vol 2, page 545)Endolymph is present in the membranous labyrinth, whereas perilymph is present in the bony labyrinth.Hence scala vestibuli, scala tympani and their interconnection helicotrema, which are parts of bony labyrinth, are filled with perilymph.Scala media, utricle, saccule and semicircular canals, which are parts of membranous labyrinth, are filled with endolymph.
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