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Mucocelr is commonly seen in sinus:
|
A mucocele is an epithelial lined,mucus containing sac completely filling the sinus and capable of expansion: Mucocele are most commonly formed in frontal sinus followed by Ethmoid,sphenoid and maxillary sinuses. Mucocele of frontal sinus presents as a swelking in the floor of frontal sinus above the inner canthus.Itbdisplaces the eyeball forward,downward and laterally. Ref Dhingra 6/e,p 198;Tuli 1/e,p 196.
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ENT
|
Nose and paranasal sinuses
|
Frontal
|
Investigation of choice for Entrapment Neuropathy is?
|
ANSWER: (B) MRIREF: Surgical management of pain by Kim Burchiel Page 658, Neurology by Jon Brillman 8f Scott Khan page 110EMG and nerve conduction studies are done to identity the site of entrapment. Imaging is done to rule out any occult fracture and MRI for visualization of entrapped nerve in the tunnel. MRI is the imaging investigation of choice as it demonstrated soft tissue like nerve, muscle and tendon. MRJ is sensitive for changes in compressed or entrapped nerves
|
Radiology
|
Brain Imaging: Anatomy, Trauma, and Tumors
|
MRI
|
Graham Cole test refers to
|
Oral cholecystography (Graham Cole Test) Once considered the diagnostic test of choice for gallstones, oral cholecystography has been replaced by ultrasonography It involves oral administration of a Radiopaque compound that is absorbed, excreted by the liver, and passed into the gallbladder Successful visualisation of GB in oral cholecystography depends on Blood flow to liver Ability of the liver cells to excrete dye into the bile (functioning liver) Patency of hepatic and cystic duct system Ability of GB to concentrate to excreted dye (by absorbing water) Ref: schwaz's principle of surgery 10th edition Pgno : 1141
|
Anatomy
|
G.I.T
|
Oral cholecystography
|
Node of Ranvier is seen in -
|
Ans. is 'c' i.e., Axons o Nodes of Ranvier are periodic gaps in the myelin sheath on the axon.o Neuron is the functional unit (basic unit of nervous tissue).o It is specialized for the function of reception, integration and transmission of information in the body,o The basic structure of neuron is best studied in a spinal motor neuron,o This cell has a 'cell body (soma)' with 5-7 small processes called 'dendrites'.o There is a long process called 'axon' that originate from "axon hillock (A thickned area of cell body from which axon originates)".o The first portion of the axon is called "initial segment".o In a motor neuron, the axon hillock and the initial segment of axon have the low est threshold for excitation0o Functionally speaking, the neuron can be divided into four zones : -Dendrides and Soma (cell body) - Receptor zoneAxon hillock of body & initial segment of axon - Generator area (Nerve impulse is generated) QAxon (main length) : - Transmitter zone (Transmits nerve impulse).The nerve terminals (Terminal knobs or buttons) : - Release zone (release neurotransmitters).
|
Physiology
|
Nerve Physiology
|
Axons
|
Parasympathetic stimulation of nerves innervating the islets of the pancreas will:
|
The pancreatic islets receive innervation from both the sympathetic and parasympathetic nervous system. Stimulation of the parasympathetic system increases secretion of insulin from the B cells. Stimulation of the sympathetic system increases glucagon secretion from the A cells. Insulin is inhibited by sympathetic stimulation. Ref: Molina P.E. (2013). Chapter 7. Endocrine Pancreas. In P.E. Molina (Ed),Endocrine Physiology, 4e.
|
Physiology
| null |
Increase secretion of insulin from B cells
|
A 25 yr old man presents for a routine examination The patient is tall and on examination was found to have an early diastolic murmur Family pedigree given what is the mode of inheritance of the disease in this patient
|
HISTORY SUGGESTIVE OF MARFANS SYNDROME . WHICH IS AD. REF : ROBBINS 10TH ED
|
Pathology
|
All India exam
|
AD
|
Rhinophyma is a slow growing tumour with the following pathology:
|
Rhinophyma or potato tumour is a slow growing benign tumour due to hyperophy of the sebaceous glands of the tip of nose.
|
ENT
| null |
Hyperophy of the sebaceous glands
|
Best indicator of protein quality:-
|
Best indicator of protein quality: DIAAS (Digestible indispensable amino acid scores) > PDCAAS (Protein digestibility-corrected amino acid score) >NPU (Net protein utilization). DIAAS =100 x . NPU = 100 x (Nitrogen retained by the body) / (Nitrogen intake) Other indicators: Amino acid score, Biological value, Protein efficiency ratio. Amino acid score = 100x (mg of amino acid per gm of test protein)/(mg of same amino acid per gm of reference protein) Also remember, protein quantity is measured by protein energy ratio = 100 x energy from protein / total energy in diet.
|
Social & Preventive Medicine
|
Proteins, Fats, Rich Sources
|
DIAAS
|
Amniocentesis for aneuploidy detection is best done at:
|
AMNIOCENTESIS Amniocentesis is the most commonly performed procedure used to diagnose fetal aneuploidy and other genetic conditions. Indications Diagnosis of fetal genetic disorders Congenital infections Alloimmunization Assessment of fetal lung maturity Therapeutic for polyhydramnios The most common types of prenatal diagnostic tests are: Chromosomal Micro Array to assess copy-number gains or losses karyotype analysis to test for aneuploidy, Fluorescent In Situ Hybridization ( FISH ) to identify gain or loss of specific chromosomes or vchromosome regions It is ideally done at 16-18 weeks.Early amniocentesis can be done between 13-15 weeks.
|
Gynaecology & Obstetrics
|
Aboions, Spontaneous & Induced Emergency Contraception (Hey,whats the hurry !)
|
16-18 weeks
|
What is the treatment modality for the following fracture?
|
Image shows patellar fracture. Tension band wiring is also used for: Patellar fracture Olecranon fracture Medial malleolus fracture Tension band wire are loop of wires passed around two bony fragments and then tightened to compress the fragments together. External fixation is done by using screws and is applicable to the tibia and pelvis. Indications of TBW: Fracture patella Fracture olecranon Fracture medial malleolus Fracture greater tuberosity Fracture greater trochanter
|
Orthopaedics
|
Fracture Management
|
Tension band wiring
|
Which of the following is true for Klinefilter's syndrome?
|
Klinefelter syndrome Rare disorder, Karyotype 47 XXY, Externally resembles a male in general body conformity, Penis small or normal, Testes small, Gynaecomastia, Appearance eunuchoid, Mentally retarded, Azoospermia,Infeility, Tall stature, Testosterone may help in Rx Breasts may need surgical excision.
|
Gynaecology & Obstetrics
|
Mullerian Abnormalities
|
Tall stature
|
Isovolumetric relaxation ends immediately after
| null |
Physiology
| null |
When ventricular pressure falls below atrial pressure
|
Endometrial cancer involving 50% of endometrium, extending to vagina, lymph nodes negative with positive peritoneal cytology is staged as
|
3b FIGO STAGING OF ENDOMETRIAL CANCER STAGE I Cancer confined to corpus uteri IA --> Limited to endometrium IB --> < 1/2 myometrial thickness IC > 1/2 myometrial thickness STAGE II Tumour involves cervix but does not extend beyond uterus (la --> Cervical glandular involvement llb --> Cervical stromal involvement STAGE III Local and/or regional spread Ilia --> Uterine serosa, positive peritoneal washings Adnexal involvement Ilib -4 Vaginal involvement (lymph node absent) 111c --> Positive lymph node no pelvis and paraaoic lymph node STAGE IV Tumour widespread IVa - Bladder or bowel mucosa IVb --> Distant metastasis
|
Gynaecology & Obstetrics
| null |
3b
|
Mucopolysaccharide having anticoagulant action is?
|
Ans. is 'a' i.e., Heparin Heparin It is a parenteral indirect thrombin inhibitor. It is a on uniform mixture of straight chain polysaccharides with molecular weight 10, 000 - 20, 000. It contains polymers of two sulfated disaccharide units D glucosamine L iduronic acid and D glucosamine D glucuronic acid. Heparin is the strongest organic acid present in the body.
|
Pharmacology
| null |
Heparin
|
Patients suffering from multidrug resistant tuberculosis can be treated with all the following drugs EXCEPT:
|
Multidrug-resistant (MDR) TB: is defined as resistance to both H and R and may be any number of other(1ST LINE) anti-TB drugs. MDR-TB has a more rapid course (some die in 4-16 weeks). Treatment of these cases is difficult, because one or more second line drugs are to be given for 12-24 months. If sensitivity of the TB bacilli is known, the drug/ drugs to which they are resistant is /are excluded and other first line drugs are prescribed along with 1-3 second line drugs. A total of 5-6 drugs are given. One of the FQs is generally included. ln case streptomycin is not being given, one out of kanamycin/ amikacin/ capreomycin should be added, because they are tuberculocidal. TOBRAMYCIN It was obtained from S. tenebrarius in the 1970s. The antibacterial and pharmacokinetic propeies, as well as dosage are almost identical to gentamicin, but it is 2-4 times more active against Pseudomonas and Proteus, including those resistant to gentamicin. However, it is not useful for combining with penicillin in the treatment oi enterococcal endocarditis. It should be used only as a reserve alternative to gentamicin. Serious infections caused by Pseudomonas and Proteus are its major indications. Ototoxicity and nephro toxicity is probably lower than gentamicin. ESSENTIALS OF MEDICAL PHARMACOLOGY K.D.TRIPATHI SIXTH EDITION PAGE NO:724,748
|
Pharmacology
|
Chemotherapy
|
Tobramycin
|
A 19 year old boy fell from the motorbike on his shoulder. The doctor diagnosed him as a case of Erb's paralysis. All of the following signs and symptoms will be observed in this boy, EXCEPT:
|
Due to Erb's paralysis there is damage of biceps brachii and supinator due to which there is loss of pronation of forearm. It is associated with loss of abduction at shoulder joint, loss of lateral rotation and loss of flexion at elbow joint and is not associated with loss of pronation at radioulnar joint.Erb's paralysis occur from damage at the Erb's point which is the meeting point of 6 nerves such as ventral rami of C5 and C6, suprascapular and nerve to subclavius of upper trunk and two divisions of upper trunk. Muscles paralysed are supraspinatus, deltoid, teres minor, infraspinatus, biceps brachii, brachialis, brachioradialis and supinator. PositionParalysis ofOveraction of Adduction of armSupraspinatus and deltoidAdductors of the shoulderMedial rotation of the armTeres minor and infraspinatusMedial rotators of the shoulderExtension of forearmBiceps brachii, brachialis and brachioradialisExtensors of elbowPronation of forearmBiceps brachii and supinatorPronators of forearmRef: Clinical Anatomy for Students: Problem Solving Approach By Neeta V. Kulkarni page 20.
|
Anatomy
| null |
Loss of pronation at radioulnar joint
|
Cut off duration for diagnosis of Priaspism is:
|
Priapism: It is defined as a persistent painful erection lasting longer than 4 hours irrespective of any sexual stimulation & beyond reaching of orgasm. It is an emergency situation It is of two types: Ischemic priapism Non-ischemic priapism
|
Surgery
|
Urethra and penis
|
4 hours
|
Most common cause of biliary stricture is:-
|
MC cause of benign biliary stricture is laparoscopic cholecystectomy (operative trauma).
|
Surgery
|
Bile duct
|
Trauma
|
A patient gives history of recurrent episodes of pain and swelling in Mandibular posterior region.He is diagnosed to have pericoronitis.The partially erupted 3rd molar was vital.On radiographical examination a well defined radiolucency was found with distal aspect of the respected tooth. What could be the daignosis:
|
Paradental Cyst
Aka:
Baccal bifurcation Cyst
Craig’s cyst
Collateral cyst
Mandi 3rd molar – Association.
Associated with VITAL TOOTH and recurrent pericoronitis DISTAL Aspect of mandi 3rd molar
|
Pathology
| null |
Paradental cyst.
|
Warm antibody in autoimmune hemolytic anemia
|
Warm antibody is IgG.
|
Medicine
| null |
IgG
|
A 35-year-old coal worker presents with difficulty in breathing on exeion for last 2 years. CXR was performed. What does it show?
|
The CXR of Coal worker patient shows the presence of hyperinflation in lungs with a tubular appearance of the hea. Lungs appear relatively blacker with flattening of the diaphragm on both sides. The hea appears smaller as lungs are hyper-inflated. These findings are suggestive of emphysema.
|
Medicine
|
Interstitial Lung Disease
|
Emphysema
|
Which of the following is not a direct route for transmission of communicable diseases?
|
Ref. Foundations of Community medicine. Page. 393
|
Unknown
| null |
Droplet nuclei
|
Which is not associated with diabetes mellitus?
|
Coisol, growth hormone and catecholamines increase the blood sugar levels leading to impaired glucose tolerance or diabetes mellitus. whereas hypothyroidism is not associated with the blood sugar levels or diabetes mellitus
|
Medicine
|
Diabetes Mellitus
|
Hypothyroidism
|
Which of the following anaesthetic agents causes a rise in the Intracranial pressure –
|
All inhalational agents increase ICT.
Amongst intravenous agents only ketamine increases ICT. Propofol, etomidate, and barbiturates (thiopentone, methexitone) decrease ICT.
Lidocaine decreases ICT.
|
Anaesthesia
| null |
Sevoflurane
|
A study is looking at breast cancer of women compared cases with non-cases, and found that 75/100 cases used calcium supplements compared with 25/100 of the non-cases. Calculate Cross product ratio
|
Odds ratio = ad/bc Breast cancer cases Non-cases Used Ca supplements 75 (a) 25 (b) Did not use Ca supplements 25 (c) 75 (d) 100 100 Odds ratio = ad/bc = 75*75/25*25 = 9
|
Social & Preventive Medicine
|
Case Control Study, Combined Designs
|
9
|
Oculomotor nerve palsy show all of the following except -
|
Ans. is 'b' i.e., Inability of lateral gaze Features of 3rd (occulomotor) nerve palsy* Paralysis of superior rectus, inferior rectus, medial rectus and inferior oblique. Eye is down and out due to unopposed action of superior oblique and lateral rectus. Medial 8c upward gaze is not possible.* Paralysis of sphinctor pupillae - Loss of ipsilateral direct and consensual pupillary light reflex and there is mydriasis.* Paralysis of ciliary muscle - Paralysis of accommodation.* Two extraocular muscles are sparedi) Superior oblique :- Intorsion, abduction and depression remain active.ii) Lateral rectus :- Abduction remains active. So eye is deviated lateraly.* Paralysis of levator palpabrae superioris -> Ptosis.
|
Ophthalmology
|
Neuro-Ophthalmology
|
Inability of lateral gaze
|
True about tropomysin is?
|
ANSWER: (B) Lies on top of actinREF: Guyton 12th ed page 72-76SLIDING FILAMENT THEORY OF MUSCLE CONTRACTION:In resting muscle, the ends of the actin filaments extending from two successive Z discs barely begin to overlap one another. Troponin I is tightly bound to actin and tropomyosin covers the sites where myosin heads bind to actin i.e the tropomyosin molecules lie on top of the active sites of the actin strands, Thus, the troponin-tropomyosin complex constitutes a "relaxing protein" that inhibits the interaction between actin and myosin filaments to cause contractionIn contracted state, these actin filaments have been pulled inward among the myosin filaments, so their ends overlap one another to their maximum extent. Also, the Z discs have been pulled by the actin filaments up to the ends of the myosin filaments. Thus, muscle contraction occurs by a sliding filament mechanism.Actin filaments slide inward among the myosin filaments by forces generated by interaction of the cross-bridges from the myosin filaments with the actin filaments. Under resting conditions, these forces are inactive. But when an action potential travels along the muscle fiber, this causes the sarcoplasmic reticulum to release large quantities of calcium ions that rapidly surround the myofibrils. When the Ca2+ released by the action potential binds to troponin C, the binding of troponin I to actin is presumably weakened, and this permits the tropomyosin to move laterally. This movement uncovers binding sites for the myosin heads. ATP is then split and contraction occurs. Seven myosin-binding sites are uncovered for each molecule of troponin that binds a calcium ion. But energy is needed for the contractile process to proceed. This energy comes from high-energy bonds in the ATP molecule, which is degraded to adenosine diphosphate (ADP) to liberate the energy.Molecular Basis of ContractionThe process by which the shortening of the contractile elements in muscle is brought about is a sliding of the thin filaments over the thick filaments. The width of the A bands is constant, whereas the Z lines move closer together when the muscle contracts and farther apart when it is stretched. The sliding during muscle contraction occurs when the myosin heads bind firmly to actin, bend at the junction of the head with the neck, and then detach. This "power stroke" depends on the simultaneous hydrolysis of ATP. Myosin-II molecules are dimers that have two heads, but only one attaches to actin at a time. The process by which depolarization of the muscle fiber initiates contraction is called excitation-contraction coupling.Steps in contractionDischarge of motor neuron.Release of transmitter (acetylcholine) at motor end-plate.Binding of acetylcholine to nicotinic acetylcholine receptors.Increased Na+ and K+ conductance in end-plate membrane.Generation of end-plate potential.Generation of action potential in muscle fibers.Inward spread of depolarization along T tubules.Release of Ca2+ from terminal cisterns of sarcoplasmic reticulum and diffusion to thick and thin filaments.Binding of Ca2+ to troponin C, uncovering myosin-binding sites on actin.Formation of cross-linkages between actin and myosin and sliding of thin on thick filaments, producing movementSteps in relaxationCa2+ pumped back into sarcoplasmic reticulum.Release of Ca2+ from troponin.Cessation of interaction between actin and myosin.
|
Physiology
|
Skeletal Muscle: Contraction and Excitation
|
Lies on top of actin
|
A male neonate is born with an omphalocele. This entity can be distinguished from gastroschisis, because in an omphalocele, the protrusion is:
|
Abdominal wall defects Omphalocele- Intestine fails return to the intra-abdominal cavity- Covered by 2 layers* Amnion* Peritoneum- For Small defect - Protrusion of small amounts of bowel- For Large defect - Protrusion of small bowel along with liver- Associated with Trisomy 13, 18, 21- Associated with congenital malformations - CVS > Musculoskeletal system >Gastrointestinal system > Genito urinary system- MC cause of death - congenital malformations- Associated with BECKWITH - WEIDMAN SYNDROME (variant of Wilms tumour)* Hemi hyperophy* Macroglossia* Visceromegaly* Omphalocele* Hepatoblastoma- Poor prognosis (associated with congenital malformations) Gastroschisis- Splitting of abdominal wall from right side with herniation of bowel.- Bowel is exposed, not covered and becomes thickened,matted and edematous- Associated with Intestinal atresiaRisk factors- If mother has history of intake of* Alcohol* Smoking* Aspirin during first trimester* Ibuprofen* Pseudoephedrine- Age of mother - < 20 years age- Not associated with congenital anomalies - so good prognosis
|
Surgery
|
Hernia and abdominal wall
|
Associated with congenital malformations
|
Following grows in the cell free medium except -a) Rickettsiab) M lepraec) Bartonellad) Syphilis
|
Obligate intracellular organisms
To grow in a medium which does not contain cells (cell free medium), organism should be capable of ATP synthesis.
Obligate intracellular organisms are not capable of the metabolic pathways for ATP synthesis.
So, these organisms are dependent on the ATP of host cells.
As they require host cell ATP, they can not grow in the media which do not contain cells (cell free media).
Such organisms are -
Rickettsiae
Chlamydiae
Viruses
M.leprae
Pathogenic treponemes (syphillis)
|
Microbiology
| null |
abd
|
Stage X3B refers to the following in the classification of vitamin A deficiency:
|
d. Keratomalacia(Ref: Nelson's 20/e p 3 IB-320, Ghai B/e p 111-112)WHO classification of Vitamin A deficiency:IndicatorCategoryNight blindnessXNConjunctival xerosisX1ABitot's spotsX1BCorneal xerosisX2Corneal ulcerationX3AKeratomalaciaX3BXerophthalmia-related corneal scarsXS
|
Pediatrics
|
Nutrition
|
Keratomalacia
|
Clue cell is seen in aEUR'
|
Bacterial vaginosis Clue cells are seen in bacterial vaginosis -Clue cells are vaginal epithelial cells coated with coccobacillary organisms which have granular appearance and indistinct borders, on a wet mount prepared by mixing vaginal secretions with normal saline in a ratio of -1:1. Amsel criteria for the diagnosis of bacterial vaginosis Includes any three of the following four clinical abnormalities i) Objective signs of increased white homogenous vaginal discharge. ii) Vaginal discharge pH of >4.5 iii) Liberation of distinct .fishy odour (attributable to volatile amines such as trimethylamine) immediately after vaginal secretions are mixed with a 10% solution of KOH. iv) Microscopic demonstration of clue cells.
|
Gynaecology & Obstetrics
| null |
Bacterial vaginosis
|
Gold standard test for diagnosis of laryngopharyngeal reflux is -
| null |
ENT
| null |
24 hr double probe pH monitoring
|
When ICF and ECF of child becomes equal to adult person -
|
Ans. is 'a' i.e., 1 year o In fetus, ECF is much larger than ICF. o By the age of 1 year, ratio of ICF to the ECF volume approaches adult level.
|
Pediatrics
| null |
1 year
|
Which of the following antimalarial agents is most commonly associated with acute hemolytic reaction in patients with glucose–6–phosphate dehydrogenase deficiency
| null |
Pharmacology
| null |
Primaquine
|
The most important function of the microcirculation is:
|
Ans. A. The exchange of nutrients and wastes between blood and tissueEach of the choices is a function of the microcirculation, but its most important function by far is to provide tissue with nutrients and remove the wastes.
|
Physiology
|
Heart, Circulation, and Blood
|
The exchange of nutrients and wastes between blood and tissue
|
Altitudnal Field Defects are seen in
|
Non aeritic AION Impoant Points on Visual Pathway Lesions 1. Optic nerve lesion I/l direct and c/ L consensual reflex gone Causes *Optic atrophy/ optic neuritis, Avulsion optic nerve 2. Middle Chiasmal syndrome/ Central Chiasmal lesion Saggital chiasma lesion Bitemporal hemianopia
|
Ophthalmology
|
Squint
|
Non Aeritic Ischemic Optic Neuropathy
|
What is the treatment for headache in a case of peptic ulcer disease?
|
Propoxyphene binds primarily to opioid receptors and produces analgesia and other CNS effects that are similar to those seen with morphine-like opioids. It is likely that at equianalgesic doses the incidence of side effects such as nausea, anorexia, constipation, abdominal pain, and drowsiness are similar to those of codeine. All other choices produce gastric ulceration. Ref: Yaksh T.L., Wallace M.S. (2011). Chapter 18. Opioids, Analgesia, and Pain Management. In L.L. Brunton, B.A. Chabner, B.C. Knollmann (Eds), Goodman & Gilman's The Pharmacological Basis of Therapeutics, 12e.
|
Pharmacology
| null |
Propoxyphene
|
Which of the following is not estrogen dependant carcinoma
|
Refer Robbins page no 1095
|
Anatomy
|
Endocrinology
|
Follicular thyroid carcinoma
|
Vogt Koyanagi - Harada (VKH) syndrome is -
|
(Ref: Khurana 7th/e p.175 & 4th/e p.156) VKH syndrome is a multisystem disorder characterized by chronic granulomatous uveitsi with exudative retinal detachment that is often associated with neurological and cutaneous manifestations.
|
Anatomy
|
General anatomy
|
Chronic granulomatous uveitis
|
Gallstones do not contain:
|
Gallstones In the USA and Europe, 80% are cholesterol or mixed stones, whereas in Asia, 80% are pigment stones Cholesterol or mixed stones - 51-99% pure cholesterol Pigment stone contains <30% cholesterol Black stones - Insoluble bilirubin polymer + calcium phosphate + calcium bicarbonate Brown pigment stones- calcium bilirubinate+ calcium palmitate + calcium stearate+ cholesterol
|
Surgery
|
Gallbladder
|
Oxalate
|
Typical CECT finding to suggest the diagnosis of pseudomyxoma peritonei is:
|
CT-scan findings may be pathognomonic for pseudomyxoma peritonei, Typical CT appearance 1. Areas of low attenuation, with islands of higher attenuation due to solid elements within mucinous material. 2. Classically scalloping of visceral surfaces, paicularly of the liver and spleen Ref: World J Gastrointest Oncol 2010 January 15; 2(1): 44-50.
|
Surgery
| null |
Scalloping of the visceral surfaces of the liver and spleen
|
Pathologic migration of tooth occurs:
| null |
Dental
| null |
Towards the bone resorption area
|
Which is the most likely cause of protein - losing enteropathy
| null |
Medicine
| null |
Menetrier's disease
|
The given ECG shows
|
Ans. B. Pulmonary embolism* The given ECG shows changes corresponding with pulmonary embolism.* Changes are- Sinus tachycardia- S1Q3T3 pattern (T-wave inversion in III)- Incomplete RBBB- Right precordial T-wave inversions* Consistent with acute RV overload in a patient with pulmonary emboli
|
Medicine
|
C.V.S.
|
Pulmonary embolism
|
Which of the following is not an effect of cholinergic muscarinic receptor stimulation:
|
Stimulation of muscarinic receptors decreases BP.
|
Pharmacology
| null |
Rise in BP.
|
Branched chain aminoacid is used in:
|
Ans: d (Isolated hepatic failure)Ref: Various internet sitesBranched chain amino acids are used in hepatic encephalopathy to improve mental function and muscle control.They have been tried in burns, sepsis and trauma but without much success.Eg of branched chain amino acid -valine, leucine and isoleucine.
|
Pharmacology
|
Miscellaneous (Pharmacology)
|
Isolated hepatic failure
|
All are true about in pubey menorrhagia Except:
|
Endometrial biopsy confirms diagnosis REF: Novak's gynecology 13' edition - page 152 Causes of mennorhagia in adoloscese Anovulatory bleeding Pregnancy-related Bleeding Exogenous Hormones Hematologic Abnormalities Infections Anatomic Causes Obstructive or paially obstructive genital anomalies typically present during adolescence. mUllerian abnormalities, such as obstructing longitudinal vaginal septa or uterus didelphisolycystic ovarian syndrome Diagnosis Any adolescent with abnormal bleeding should undergo sensitive pregnancy testing, regardless of whether she states that she has had intercourse. Laboratory Testing In addition to a pregnancy test, laboratory testing should include a complete blood count with platelets, coagulation studies, and bleeding time. Thyroid studies also may be appropriate. A complete pelvic examination is appropriate if the patient has been sexually active, is having severe pain, or an anomaly is suspected. Cultures for gonorrhea and testing for chlamydia infection are appropriate if the patient has been sexually active. Some young teens who have a history that is classic for anovulation, who deny sexual activity, and who agree to return for follow-up evaluation may be managed with a limited gynecologic examination and pelvic ultrasonography Imaging Studies If the pregnancy test is positive, pelvic imaging using ultrasonography may be necessary to confirm a ble intrauterine pregnancy and rule out a spontaneous aboion or ectopic pregnancy. If a pelvic mass is suspected on examination, or if the examination is inadequate (more likely to be the case in an adolescent than an older woman) and additional information is required, pelvic ultrasonography may be helpful Management Management of bleeding abnormalities related to pregnancy, thyroid dysfunction, hepatic abnormalities, hematologic abnormalities, or androgen excess syndromes should be directed to treating the underlying condition. Oral contraceptives can be extremely helpful in managing androgen excess syndromes. After specific diagnoses have been ruled out by appropriate laboratory testing, anovulation or dysfunctional bleeding becomes the diagnosis of exclusion.
|
Gynaecology & Obstetrics
| null |
Endometrial biopsy confirms diagnosis
|
'Murphy sign' is associated with: March 2004
|
Ans. A i.e. Acute cholecystitis
|
Radiology
| null |
Acute cholecystitis
|
Schneiderian First rank symptoms are found in :
|
A >> B, C The presence of one of these Schneider's first rank symptoms (SFRS) in the absenc of intoxication, brain injury or clear affective illness, was sometimes taken as sufficient for making diagnosis of schizophrenia (Kaplan). SFRS are not specifc for schizophrenia and may be seen in other psychiatric disorders such as mood disorderQ and organic psychiatric disordersQ (Ahuja)/affective psychosis (New oxford) Schneider first rank symptoms, which he believed were pathognomic of schizophrenia (& became the forerunner of notion of positive signs & symptoms ), are now known not to be specific for schizophrenia, for they may also occur in mania, drug induced states, other disordersQ (CDTP) Classification of schizophrenia like disorders include cases that resemble schizophrenia in some respects and yet do not meet the criteria for diagnosis. These include ICD-10 DSM - IV Schizoaffective disorder Schizo affective disorder Persistent delusional disorders Induced delusional disorder Delusional disorder Shared psychotic disorder Acute & transient psychotic disorder Acute schizophrenia like psychotic disorder Brief psychotic disorders Schizophreniform disorder Unspecified non organic psychosis Psychotic disorder not otherwise specified Schizotypal disorder, Other non organic psychotic disorders ?
|
Psychiatry
| null |
All
|
A drug not effective in Multiple Myeloma is?
|
Hydroxyurea REF: Harrison 17th ed chapter 106 Drugs used in chemotherapy of multiple myeloma are: Melphan Thalidomide Lenalidomide Cyclophosphamide Vincristine Doxorubicin (Adriamycin) and liposomal doxorubici
|
Surgery
| null |
Hydroxyurea
|
Which of following is true about allodynia?
|
*Allodynia describes the situation in which a non painful stimulus ,once perceived ,is experienced as painful ,even excruciating . Allodynia refers to central pain sensitization (increased response of neurons) following normally non-painful, often repetitive, stimulation. Allodynia can lead to the triggering of a pain response from stimuli which do not normally provoke pain. Ref Harrison20th edition pg 2245
|
Medicine
|
C.N.S
|
Perception of non painful stimulus as pain
|
In pseudomyxoma peritonei, mucinous cyst-adenocarcinoma of which following organ is involved:
|
Pseudomyxoma Peritonei Mucinous ascites Caused by ruptured Appendiceal or Ovarian Adenocarcinoma MC primary cause - Appendix > ovary Incidence- male = female Usually seen in 4th - 5th decade Peritoneal cavity is filled with mucinous substances (JELLY like) creates pressure in abdomen compressing the bowel & simultaneously in Upright posture - Abdominal distension
|
Surgery
|
GIT
|
Ovary
|
Low serum haptoglobin in hemolysis is masked by ?
|
Ans. is 'c' i.e., Bile duct obstruction Haptoglobin o Haptoglobin is a transpo glycoprotein which binds free hemoglobin in plasma and carries it to the reticuloendothelial system. It is synthesized in the liver. o A decrease in haptoglobin levels (with normal liver function) occurs when there is excess of hemoglobin in the plasma due to intravascular hemolysis ---> free hemoglobin in plasma bound to haptoglobin and this complex is rapidly cleared by mononuclear phagocytic system. o In biliary obstruction the serum haptoglobin level is increased and this may mask the decrease in serum haptoglobin due to hemolysis.
|
Pathology
| null |
Bile duct obstruction
|
Disinfection frees the surface from
| null |
Microbiology
| null |
Vegetative forms
|
Right axis detion is seen In all except-
|
Right axis detion also may occur as a normal variant (paicularly in children and young adults), as a spurious finding due to reversal of the left and right arm electrodes, or in conditions such as right ventricular overload (acute or chronic), infarction of the lateral wall of the left ventricle, dextrocardia, left pneumothorax, and left posterior fascicular block. The ECG in severe pulmonary hypeension shows P pulmonale, right axis detion, and RV hyperophy. In ostium secundum ASD, electrocardiogram (ECG) usually shows right-axis detion and an rSr' pattern in the right precordial leads representing enlargement of the RV outflow tract. ( Harrison&;s principle of internal medicine,18th edition,pg no.1834 )
|
Medicine
|
C.V.S
|
Ostium primum ASD
|
Antral puncture is done through
|
Antral puncture and irrigation: Sinus cavity is irrigated with a cannula passed through the inferior meatus. Removal of pus and exudates helps the sinus mucosa to reve to normal. Ref: Dhingra 7e pg 219.
|
ENT
|
Diagnostic and operative ENT
|
Inferior meatus
|
Investigation of choice in whole body imaging in metastasis is -
|
Best investigation for bony metastasis is MRI. MRI has almost 100% sensitivity in detecting bony metastasis Investigation of choice for whole body screening for bony metastasis is Bone scan Intial investigation in symptomatic bone pain is Radiography CT is used in evaluation of focal abnormalities of bone scan and also for guided needle biopsy.
|
Radiology
|
Skeletal system
|
Bone scan
|
Treatment for achlasia associated with high rate of recurrence :
|
Ans. is 'd' i.e., Botulinum toxin Treatment of Achalasia The aim of treatment is to be relieve the functional obstruction at the cardia The two main methods to achieve this are I) Forceful dilatation or 2) Esophageal myotomy (Heller's myotomy) with or without an antireflux procedure 1) Forceful dilatation (pneumatic dilatation) - The aim is to weaken or rupture the circular muscle fibres of the LES by forceful stretch. - Perforation and bleeding are potential complications 2) Extramucosal cardiomyotomy (Heller's myotomy) this involves surgical division of the muscle fibres of the lower esophageal sphincter. this procedure can be performed through a laparoscopic or thoracoscopic approach (Open surgical procedure i.e. Laparotomy or thoractomy can also be done, but the videoscopic procedure is better) - major complication is gastro-esophageal reflux. - paial fundoplication is done to prevent reflux "modified laparoscopic Heller myotomy is the operation of choice"- Sabiston Other methods of treatment Drugs Nitrates and calcium channel bockers can be used, but are ineffective for long term use. They can be used for transient relief of symptoms and in patients unfit for surgery and pneumatic dilatation. Botulinum toxin Botulinum toxin is given by endoscopic injection into the LES. It reduces LES pressure by blocking the cholinergic excitatory nerves in the sphincter. Its effect is only sho-lived and repeated injections have to be given. Used only in patients unfit for surgery and pneumatic dilatation.
|
Surgery
| null |
Botulinum toxin
|
True regarding presentation of primary T.B. is -
| null |
Medicine
| null |
U/L hilar lymphadenopathy
|
Most potent stimulus for secretin secretion is
|
Protein / acid in duodenum is the most potent stimulus for secretion of secretin.
|
Physiology
| null |
Protein in duodenum
|
Standard treatment of whole-brain radiotherapy (WB) for brain Metastasis :
|
Ans. B, 30 grays (Gy) in 10 fractionsWhole-brain radiotherapy (WB) to 30 grays (Gy) in 10 fractions - Standard treatment in patients with multiple brain metastases.Current study investigated the potential benefit of dose escalation beyond 30 Gy.
|
Radiology
| null |
30 grays (Gy) in 10 fractions
|
Which of the following statement regarding Rota virus is false?
|
Rota virus is a double stranded RNA virus belonging to the family Reoviridae. The RNA is enclosed in a triple layered, non enveloped icosahedral capsid. It is one of the commonest cause for watery diarrhoea in children. Oral rehydration therapy is the most appropriate treatment of choice.
|
Microbiology
| null |
None of the above
|
Which of the following phospholipid is associated with apoptosis?
|
Lipid bilayer is asymmetric. Phosphatidylserine and phosphatidyl ethanolamine are located in the inner leaflet Lecithin and sphingomyelin are located in the outer leaflet. Flipping of phosphatidylserine to outer membrane is seen in apoptosis. This is the basis of annexin V assay
|
Biochemistry
|
Chemistry of Lipids
|
Phosphatidylserine
|
Which of the following malignancy is associated with invasion of Voex Vein?
|
Malignant melanoma of the choroid is the most common primary intraocular tumor of adults usually between the age group 40-70 years. It is rare in blacks and is more common in whites. It arise from the neural crest derived pigment cells of the uvea as a solitary tumor and is usually unilateral. This tumor during the stage of extraocular extension burst through the sclera at limbus. This extraocular spread occur through the perivascular spaces of voex veins or ciliary vessels. Ref: Comprehensive Ophthalmology By AK Khurana, 4th Edition, Pages 162-5.
|
Ophthalmology
| null |
Malignant melanoma
|
A Female health worker has to teach women in Urban slum about ORS preparation. Best method will be
|
Demonstration -Is a carefully planned presentation where idea is to show ' how to perform' a skill/procedure Two principles : 1. Seeing is believing 2. learning by doing
|
Social & Preventive Medicine
|
HC Methods, D-P Communication
|
Demonstration
|
Which of the following Inhalation anaesthesia agent is Hepatotoxic:
|
Side effects of inhalation anesthetics Halothane: Auto immune hepatitis Disrupts dual blood supply Respiratory depression Sevoflurane Produce Comp A (nephrotoxic) Day care surgery Inhalational induction agent of choice Pediatric population Isoflurane Coronary steel phenomenon Procaine Local anesthetic Used in cataract surgery
|
Anaesthesia
|
FMGE 2018
|
Halothane
|
Degenerated neurofilaments seen in patients with Alzheimer's disease are:
|
Neurofibrillary tanglesThe build-up manifests in two ways:Plaques- deposits of the protein beta-amyloid that accumulate in the spaces between nerve cells Tangles - deposits of the protein tau that accumulate inside of nerve cellsBoth amyloid plaques and neurofibrillary tangles are clearly visible by microscopy in brains of those afflicted by AD.Plaques are dense, mostly insoluble deposits of amyloid - beta peptides and cellular material outside and around neurons.Senile neural plaques correlates (increases) with ageTangles (neurofibrillary tangles) are aggregates of the microtubule-associated protein tau which has become hyperphosphorylated and accumulate inside the cells themselves & are associated with severe dementiaLateral geniculate body is resistant to neurofibrillary tangles.
|
Psychiatry
| null |
Neurofibrillary tangles
|
Pepsinogen is secreted by
|
Chief or zymogen or peptic cells secrete pepsiongens.Parietal or oxyntic cells secrete HCl and intrinsic factor.These cells are located in the body of stomach, including the fundus.(Ref: Ganong&;s Review of medical physiology, 23 rd edition, page 431)
|
Physiology
|
G.I.T
|
Chief cells
|
In the work of breathing, tissue resistance contributes ___% fraction:
|
Work done = load x displacement. In the context of lungs, load is analogous to pressure and displacement is volume expansion of lungs. Hence, work of breathing = DP X DV. Thus, work done can be calculated as area covered under the inspiratory curve in compliance diagram. Of the total inspiratory work, 65% work is elastic work or compliance work. Remaining 35% is non-elastic work - (28% is airway resistance work, 7% is tissue resistance work.)
|
Physiology
|
Respiratory System Pa 1
|
7%
|
Snow banking is typically seen in:
|
A i.e. Pars planitis Pars planitis (intermediate uveitis) presents with snow ball opacities Q which coalesce to form a grey white plaque called snow banking Q
|
Ophthalmology
| null |
Pars planitis
|
Non visualization of gastric fundic bubble with air-fluid level in retrocardiac region suggests:September 20003
|
Ans. C i.e. Achalasia cardia
|
Radiology
| null |
Achalasia cardia
|
Which of the ITIowing mosquitoes is invohed in the spread of-Japanese encephalitis ?
|
Ans. is 'c' i.e., Culex
|
Social & Preventive Medicine
| null |
Culcx
|
Which of the following is a content of dentinal tubules
|
Contents of Dentinal tubule
Odontoblastic process
Afferent Nerve terminal
Dendrites of antigen presenting cell
Dentinal fluid
intratubular dentin
|
Dental
| null |
All
|
Reducing sugar in urine can be detected by ?
|
Ans. is 'd' i.e., All of the aboveDetection of reducing sugars Reducing propey of sugars in alkaline solution is utilized for both qualitative and quantitative determination of sugars. Reagent containing Cu' ions are most commonly used. These are generally alkaline solution of cupric sulfate :-Benedict's quantitative reagent (CuSO4, Na2CO3, sodium citrate, potassium ferrocyanide, potassium thiocyanide) can detect any reducing sugar.Fehling solution contains CuSO4, Ruchelle Salt (sodium potassium taarate) and strong alkali (NaOH/ KOH). It is not used now.Glucose oxidase method : - This method is specific for glucose. Peroxidase and oxidase enzymes are used for estimation of glucose. These enzymes are the basis of highly specific test strips used for detction of glucose in urine or blood.
|
Biochemistry
| null |
All of the above
|
Ulcerative colitis what is seen?
|
Cryptitis The pathology in ulcerative colitis typically involves distoion of crypt architecture, inflammation of crypts (cryptitis), frank crypt abscess, and hemorrhage or inflammatory cells in the lamina propria. Pathology of ulcerative colitis. Macroscopic features Ulcerative colitis is a mucosal disease that usually involves the rectum and extends proximally to involve all or pa of the colon. The lesion is continuous and normal areas between the lesions (skip lesions) do not occur. With mild inflammation the mucosa is erythematous and has a fine granular surface that appears like sand paper. In severe cases mucosa is hemorrhagic. ulcerated and edematous. In long standing cases. inflammatory polyps (pseudopolyp) may be present as a result of epithelial regeneration. With many years of disease the mucosa becomes atrophic and featureless and entire colon becomes narrowed and shoened. Microscopic features :? The impoant pathological characteristic is that the process is limited to the mucosa and superficial submucosa with deeper layers unaffected except in fulminant disease. Two major features in ulcerative colitis suggests chronicity Distoion of the crypt architecture of the colon (cryptitits) - Crypts may be bifid and reduced in number often with a gap between crypt bases and musculoris mucosae. Diffuse predominantly mononuclear infiltrate in lanzina propria is universally present - Neutrophilic infiltration of epithelial layer produce collection of neutrophils in crypt (crypt abscess).
|
Pathology
| null |
Cryptitis
|
Parachute reflex disappears by: March 2013 (c, f)
|
Ans. D i.e. Persists Parachute (forward) reflex When:This occurs from about 9 months of age and persists. What:If the baby is held in a position where he is dropped forward, he will outstretch his hands. This is one of the baby milestones that is protective for falling.
|
Pediatrics
| null |
Persists forever
|
All are true regarding vitamin D, except ?
|
Ans. is 'b' i.e., 1-hydroxylation in liver
|
Physiology
| null |
1-hydroxylation in liver
|
Marjolin ulcer
|
.marjolin&;s ulcer is the name given to a malignancy ( usually a squamous cell carcinoma ) which arise in any long standing wound or a scar mostly scar of an old burn it grows slowly as it is avascular it is painless
|
Surgery
|
General surgery
|
Ca in marjolin's is squamous cell ca
|
Proprioception is carried by which fibers?
|
Ans. is'a'i.e., Fasciculus cuneatus and fasciculus gracilis(Ref: Guyton 12th/e p. 573)Posterior column (Dorsal column) (Fasciculus Gracilis and Fasciculus Cuneatus) carriesProprioception (Position of body or limb, position of joint)VibrationFine touch (two point discrimination, topognosis, stereognosis).Kinesthesia
|
Anatomy
| null |
Fasciculus cuneatus and fasciculus gracilis
|
Persistent bucconasal membrane result in
|
Ans. b (Choanal atresia). (Ref. Diseases of ENT, PL Dhingra, 3rd ed., 78, 210, 510)# Persistant bucconasal membrane leads to choanal atresia.Choanal atresia# Is a autosomal recessive trait in which the posterior choanae unilaterally or bilaterally fail to develop properly.# Persistent bucconasal membrane is the basic etiology.# Occurs in 1 in 5,000 births; more common among girls (2:1)# Unilateral > bilateral atresia.# Because newborns are obligate nose breathers, bilateral atresia is immediately apparent as respiratory distress.# Characteristics is the history or failure to pass a rubber catheter or nasogastric tube into the pharynx.# Symptoms of choanal atresia include failure to thrive due to poor feeding and mucoid nasal discharge.# The presence of choanal atresia can be confirmed with visualization of retention material in the posterior part of the nose on a lateral radiograph with the patient in the supine position.# Anatomic characterization of the deformity with CT can be important for planning surgical procedures.# Surgical treatment methods for membranous atresia include puncture of the choanal membrane and placement of a stent for 6 weeks.# If bony atresia is present, the bony wall can be taken down transnasally with microsurgical techniques followed by placement of a stent.# When suboptimal resection for atresia or choanal stenosis occurs, transpalatal repair at 3-4 years age is advised.# The septum usually deviates to the affected side; however, more posterior examination shows atresia.# Transpalatal repair is being replaced by endoscopic techniques of repair of atresia in children and adults.
|
ENT
|
Nose and PNS
|
Choanal atresia
|
Empirical treatment for meningococcal meningitis is:
|
Ans. (A) Ceftriaxone(Ref: Harrison 19/e p767)Drug of choice for treatment of meningococcal meningitis is Penicillin G. But for empirical treatment we need to cover other likely organisms too. So, ceftriaxone is preferred that will also cover H. influenzae. Vancomycin is usually added to cover other organisms also.
|
Pharmacology
|
Chemotherapy: General Principles
|
Ceftriaxone
|
Pheochromocytoma are tumours of:
|
Ans. B. Adrenal medullaPheochromocytoma are a type of tumor of the adrenal glands that can release high levels of epinephrine and norepinephrine. As the name implies, the "ad-renal" glands are located near the "renal" area. Someone with a pheochromocytoma usually has three classic symptoms, headache, sweating, and heart palpitations (a fast heart beat) in association with markedly elevated blood pressure (hypertension). Other conditions that may accompany these classic symptoms are as follows:a. Anxiety,b. Nausea,c. Tremors,d. Weakness,e. Abdominal pain, andf. Weight loss.
|
Biochemistry
|
Endocrinology
|
Adrenal medulla
|
Primary peritonitis is more common in females because :
|
Ans. is a i.e. Ostia of fallopian tubes communicate with abdominal cavity Primary peritonitis refers to inflammation of peritoneal cavity without a documented source of contamination. "It occurs more commonly in children than adults and in women than in men. The later distribution is explained by entry of organisms into the peritoneal cavity through the fallopian tubes."
|
Gynaecology & Obstetrics
| null |
Ostia of Fallopian tubes communicate with abdominal cavity
|
Rhomboid major is supplied by which type of neuron-
|
Ans. is 'd' i.e., Multipolar * All skeletal muscles are supplied by motor neurons which are multipolar neurons.* There are following types of neurons1) Unipolor neurons These neurons have one process, with different segments (of that one process) serving as dendrite (receptive surfaces) as well as axons (releasing terminals). It is found in invertebrates.2) Bipolar neurons These are neurons with a dendrite and an axon, e.g. bipolar cells of retina.3) Pseudounipolar neurons (subclass of bipolar neurons) The neuron develops, a single process splits into two, both of which functions as axons, - one going to skin or muscle and another to spinal cord, e.g. dorsal root ganglion.4) Multipolar neurons These have one axons and many dendrites, e.g. motor neuron, pyramidal cell of hippocampus and cerebellar purkinje cells.
|
Physiology
|
Nervous System
|
Multipolar
|
SIADH secretion is seen in all except -
|
Ref - geekymedics.com
|
Medicine
|
Endocrinology
|
Interstitial Nephritis
|
The most easily perforated tooth with a slight mesial or distal angulation of bur after a mandibular central incisor is:
| null |
Dental
| null |
Maxillary premolar
|
All of the following provisions are included in the primary health care according to the Alma Ata declaration except
|
Ans. c. Provision of free medicines Primary Health Care The Alma Ata Conference has defined primary health care as -- an essential health care made universally accessible to individuals and acceptable to them, through their full paicipation and at a cost the community and country can The Alma -- Ata Declaration has outlined 8 essential components of primary health care Education concerning prevailing health problems and the methods of preventing and controlling themQ Promotion of food supply and proper nutritionQ An adequate supply of safe water and basic sanitationQ Maternal and child health care, including family planningQ Immunization against major infectious diseasesQ Prevention and control of locally endemic diseasesQ Appropriate treatment of common diseases and injuriesQ Provision of essential drugsQ The principles of primary health care include Equitable distributionQ Community paicipationQ Intersectoral co-ordinationQ Appropriate technologyQ
|
Social & Preventive Medicine
| null |
Provision of free medicines
|
True about first order kinetics is:
|
Ans. d. The rate of elimination is proportional to the plasma concentration (Ref: Katzung 12/e p43-44: KDT 7/e p30-31, 6/e p31-32)Rate of elimination is proportional to plasma concentrationQ first order kinetics (Linear kinetics).First Order Kinetics (Linear kinetics)Zero Order Kinetics (Non linear Kinetics)* Constant fraction of drug is eliminated per unit of timeQ.* Rate of elimination is proportional to plasma concentrationQ.* Clearance remains constantQ.* Half-life remains constantQ.* Most of the drugs follow first order kineticsQ.* Constant amount of the drug is eliminated per unit timeQ.* Rate of elimination is independentQ of plasma concentration.* Clearance is more at low concentrations and less at high concentrationsQ.* Half-life is less at low concentrations and more at high concentrationsQ.* Very few drugs follow pure zero order kinetics e g. alcoholQ* Any drug at high concentration (when metabolic or elimination pathway is saturated) may show zero order kineticsQ.
|
Pharmacology
|
Pharmacokinetics
|
The rate of elimination is proportional to the plasma concentration
|
A 35-year-old female presents with recurrent renal stone. What is not advised?
|
Low-calcium diets increase the risk of the incident stone formation. Low-calcium diets lead to the stone formation by reducing the amount of calcium to bind oxalate in the intestine- | urine oxalate levels.
|
Medicine
|
Kidney Stones & Renal Tubular Acidosis
|
Restrict calcium
|
The tensile strength of wound after laparoscopic cholecystectomy in a 30 years old woman depends upon:
|
The recovery of tensile strength results from the excess of collagen synthesis over collagen degradation during the first 2 months of healing, and, at later times, from structural modifications of collagen fibers (cross-linking, increased fiber size) after collagen synthesis ceases.
'Recovery of Tensile Strength: Fibrillar collagens (mostly type I collagen) form a major portion of the connective tissue in repair sites and are essential for the development of strength in healing wounds. Net collagen accumulation, however, depends not only on increased collagen synthesis but also on decreased degradation. When sutures are removed from an incisional surgical wound, usually at the end of the first week, wound strength is approximately 10% that of unwounded skin.
Wound strength increases rapidly over the next 4 weeks, slows down at approximately the third month after the original incision, and reaches a plateau at about 70% to 80% of the tensile strength of unwounded skin. Lower tensile strength in the healed wound area may persist for life. The recovery of tensile strength results from the excess of collagen synthesis over collagen degradation during the first 2 months of healing, and, at later times, from structural modifications of collagen fibers (cross-linking, increased fiber size) after collagen synthesis ceases.'- Robbins 8/e p105-106
|
Pathology
| null |
Extensive crosslinking of tropocollagen
|
A 53-year-old woman with known kidney disease presents to a hospital because her pain has become increasingly more severe. A physician performing kidney surgery must remember that:
|
The left renal vein runs anterior to both the aoa and the left renal aery.. The right renal aery runs behind the IVC and is longer than the left renal aery. Because of the large size of the right lobe of the liver, the right kidney lies a little lower than the left kidney. 4 coverings around the kidney from inside to outside are as follows: True capsule (Renal capsule):Collagen-rich connective tissue. Perinephric fat (adipose capsule): It is present b/w renal capsule and renal fascia. Renal fascia- Lies external to the perirenal fat and internal to the pararenal fat, Surrounds the suprarenal gland. Paranephric fat
|
Anatomy
|
GIT 1
|
The left renal vein runs anterior to both the aoa and the left renal aery
|
The major role of 2,3 DPG in RBC includes
|
The normal BPG in the blood keeps the O2-hemoglobin dissociation curve shifted slightly to the right all the time. In hypoxic conditions that last longer than a few hours, the quantity of BPG in the blood increases considerably, thus shifting the O2-hemoglobin dissociation curve even faher to the right. This shift causes O2 to be released to the tissues at as much as 10 mm Hg higher tissue O2 pressure than would be the case without this increased BPG. Therefore, under some conditions, the BPG mechanism can be impoant for adaptation to hypoxia, especially to hypoxia caused by poor tissue blood flow.Ref: Guyton and Hall textbook of medical physiology 13th edition. Page:532
|
Physiology
|
Cardiovascular system
|
Release of O2
|
A lady on long term hemodialysis developed carpel tunnel syndrome. The cause was diagnosed to be amyloidosis by using a biopsy. What is the type of amyloid that is seen?
|
Ans. is 'a' i.e. Beta 2 microglobulin Dialysis-related amyloidosis (DRA) is a disorder caused by tissue deposition of beta2 microglobulin as amyloid fibrils.The clearance of beta2 microglobulin, a component of the major histocompatibility complex that is present on cell surfaces, normally occurs by glomerular filtration with subsequent reabsorption and catabolism in proximal tubules. Clearance therefore declines in patients with reduced kidney function, leading to plasma accumulation and slow tissue deposition.The tissue deposition of amyloid detected histologically occurs much earlier than any clinical or radiographic manifestations of the illness.In contrast to fragments of immunoglobulin light chains in primary amyloidosis and serum amyloid A in secondary amyloidosis, the amyloid protein in DRA is composed primarily of beta2- microglobulin.The amyloid found in the bone cysts and synovial tissue in patients with DRA is similar to other forms of amyloid in its staining properties with Congo red and in exhibiting apple-green birefringence under polarized light. It has been proposed that beta2- microglobulin has a high affinity for collagen, an effect that could explain the predominance of joint and bone diseaseClearance of beta2-microslobulinUnderlying the tissue deposition of beta2-microglobulin among patients with end-stage renal disease is the inability to adequately clear this substance, even with modem high flux hemodialysis and/or convective therapies. Bones and diseasesLess tendency to deposit in gastrointestinal organsRarely involvesp2 amyloid has preference for deposition in bones joints and synoviump2 amyloid has affinity for collagenCarpal tunnel syndromeScapulohumeral periarthritisEffusive arthropathySpondyloarthropathyBone diseasesColonStomachEsophagusSmall intestineCardiacPulmonarycutaneousTissue histologyIn contrast to fragments of immunoglobulin light chains in primary amyloidosis and serum amyloid A in secondary amyloidosis, the amyloid protein in DRA is composed primary of beta2-microglobulinThe amyloid found in the bone cysts and synovial tissue is similar to other forms of amyloid in its staining properties with Congo red and in exhibiting apple-green birefringence under polarized light - Biopsy remains the "gold standard" for the diagnosis of beta2- microglobulin amyloidosis. Despite this, the diagnosis of DRA is usually clinical and relies upon the combination of typical clinical features plus characteristic radiographic findings. Abdominal fat pad aspirates are not useful for the diagnosis of DRA.Type of AmyloidosisMajor Fibril proteinPrecursor proteinSystemic Amyloidosis Primary amyloidosisSecondary amyloidosisHemodialysis associated amyloidosisALAAAb2 microglobulinImmunoglobulin light chainSSAb2 microglobulinHereditary amyloidosis Familial Mediterranean feverFamilial amyloidotic neuropathiesSystemic senile amyloidosisAAATTRATTRSAATransthyretinTransthyretinLocalized amyloidosis Senile cerebral(Alzheimer's)Medullary ca thyroidIslet of LangerhansIsolated atrial amyloidosisAbAcalAIAPPAANIAPPCalcitoninIslet amyloid peptideAtrial natriuretic factor
|
Pathology
|
Histo Pathology
|
Beta 2 microglobulin
|
Contrast used for MRI –
|
Gadolinium is the most commonly used MR contrast agent.
|
Radiology
| null |
Gadolinium
|
True about diabetic mother is :
|
Ans. is b i.e. High incidence of congenital hea anomalies is common
|
Gynaecology & Obstetrics
| null |
High incidence of congenital hea anomalies is common
|
Earliest presentation of Friedrich's ataxia is?
|
Answer is A (Ataxia): In most patients ataxia of gait and stance is the first manifestation of the disease.- Clinical Neurology by Goetz 2"d/742 Friedreich's ataxia presents with progressive staggering gait, frequent falling and titubation- Harrison Note: The first pathological changes in Friendreich's Ataxia are thought to occur is dorsal root ganglia with loss of large sensory neurons.
|
Medicine
| null |
Ataxia
|
Laproscopic tubal ligation contraindication -
|
Ans. is 'a' i.e., Postpartum state "The operation is done in the interval period, concurrent with the vaginal termination of pregnancy or 6 weeks following delivery. Should not be done within 6 weeks following delivery."
|
Unknown
| null |
Post partum state
|
All are the Complication of CVP line except -
|
IMMEDIATE: Failure of procedure Pneumothorax Haemothorax Retroperitoneal haematoma Aerial puncture Local haematoma Guidewire-induced arrhythmia Thoracic duct injury Guide wire embolism Air embolism EARLY: catheter blockage chylothorax catheter knots LATE: Infection : 2.5 infections/ 1000 catheter days catheter fracture vascular erosion vessel stenosis thrombosis osteomyelitis of clavicle (sub clan access)
|
Anaesthesia
|
Preoperative assessment and monitoring in anaesthesia
|
Airway injury
|
which of the following is derived from surface ectoderm-
|
Ans. is 'c' i.e., Lens PrecursorDerivativesNeural ectodermSmooth muscle of the iris, opticle vesicle and cup, iris epithelium, ciliary epithelium, Part of the vitreous, Retina, Retinal pigment epithelium, fibres of the opric nerve.Surface ectodermConjunctiva] epithelium , Corneal epithelium. Lacrimal glands, Tarsal glands. Lens .MesodermExtraocular muscles, corneal stroma, sclera, iris. Vascular endothelium. Choroid, Part of the vitreous.Neural crestCorneal stroma, keratocytes and endothelium, Sclera, Trabecular meshwork endothelium. Iris stroma, Ciliary muscles, Choroidal stroma. Part of the vitreous, Uveal and conjunctival melanocytes. Meningeal sheaths of the optic nerve, Ciliary ganglion, Schwann cells, orbital bones, Orbital connective tissue, Connective tissue sheath and muscular layer of the ocular and orbital blood vessels.
|
Ophthalmology
|
Anatomy
|
Lens
|
Golden S is seen in
|
Golden "S" sign is a Reverse "S" sign seen on Frontal Chest Radiograph In patients with Bronchogenic Ca with Right Upper lobe collapse Lower convexity of the Reverse S is due to the mass Upper concavity of the "S" is due to Right UPPER LOBE atelectasis with the upward shifting of the horizontal fissure.
|
Radiology
|
Respiratory Radiology
|
Bronchogenic carcinoma
|
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