question
stringlengths 1
1.57k
| exp
stringlengths 1
22.5k
⌀ | subject_name
stringclasses 21
values | topic_name
stringlengths 3
135
⌀ | answer
stringlengths 1
287
⌀ |
|---|---|---|---|---|
The structure marked A begins to close by what time frame and due to what cause?
|
The structure marked is ductus aeriosus which begins to close 10-15 hours after bih due to withdrawal of prostaglandins and exhibits functional closure by 7 days and anatomical closure by 4 weeks after bih.
|
Anatomy
|
Pharyngeal arch and its derivatives, pharyngeal arch aeries
|
Begins to close at 10-15 hours after bih, due to withdrawal of prostaglandins
|
All are indicated in a 30-year-old patient with increased serum cystine and multiple renal stones except:
|
The clinical diagnosis of profile given in the question is CYSTINURIA . Cystinuria- AR,defect in re-absorptive transpo of cystine and the dibasic amino acids ornithine, arginine, and lysine from the luminal fluid of the renal proximal tubule and small intestine. Urinalysis- hexagonal shaped crystals: pathognomonic of cystinuria. The foundation of cystine stone prevention is adequate hydration and urinary alkalinization. When this conservative therapy fails, the addition of drugs, such as D-penicillamine and captopril. -The clinical profile should not be confused with Cystinosis which is treated with Cysteamine.
|
Medicine
|
Kidney Stones & Renal Tubular Acidosis
|
Cysteamine
|
A Ten year old boy presents to the pediatric emergency unit with seizures. Blood pressure in the upper extremity measured as 200/140 mm Hg. Femoral pulses were not palpable. The most likely diagnosis amongst the following is:
|
Answer is D (Coarctation of Aoa) Isolated upper extremity hypeension (200 / 140 mm Hg), together with absent/ diminished femoral pulses is a characteristic feature of coarctation of aoa. Although coarctation of aoa does not commonly present with seizures, these may be seen as a consequence of severe hypeension (BP = 200/140) or complications like intracranial haemorrhage (from Berry aneurysms which are more common in patients with coarctation. Coarctation of Aoa is the most likely diagnosis: Approach (Nelson/Hurst) The classic sign of coarctation of aoa is a disparity in pulsations and blood pressure in arms and legs. The femoral, popliteal, posterior tibial and dorsalis pedis pulses are weak (or absent in upto 40% of patients) in contrast to bounding pulses in the arms and carotid vessels. The blood pressure is the legs is lower than in the arms and 90% of patients with coarctation have hypeension in an upper extremity greater than 95" perecentile for age Age (yrs) 95th percentile (mm Hg) > 1 yrs 110 60 I -- 5 yrs 115 /75 6-10 yrs 125 /85 11 -- 18 yrs 140 /90 A blood pressure of 200 /140 mm Hg in a 10 year old boy suggests severe hypeension (95" percentile at 10 years -- 125/85) Severe hypeension may be seen as a consequence of persistant hypeension in an individual who has not undergone corrective surgery for coarctation, and this usually appears in the second or third decade of life (Hurst) Children with severe/malignant hypeension may develop headaches, seizures and stroke (haemorrhage from Berry aneurysms which are more common in patients with coarctation). Takayasu Aooaeritis may also present with severe hypeension and absent femoral pulses due to acquired midaoic coarctation but this is an uncommon presentation in Takavasu aooaeritis (and hence not the single best answer of choice) Takayasu aeritis (or non specific aooaeritis) is a chronic vasculitis disease of medium and large sized aeries with a strong predilection for aoic arch and its branches. This may lead to stenosis of the involved vessels and hence a picture of acquired coarctation. It may thus produce a clinical picture similar to that of coarctation with disparity in pulsations and blood pressure in arms & legs with hypeension depending on the site of the acquired stenosis. However, this condition is more common in women and most commonly affects the subclavican aery. Hence it more commonly presents with claudication, along with unequal and reduced pulses / BP in the upper extremity than the lower extremity. Also systemic symptoms are more common is Takayasu than in coarctation. Neveheless Takayasu aeritis may affect the Thoracic or Abdominal aoa and present with absent lower limb pulses and upper extremity hypeension like coarctation of aoa. Takayasu aeritis can be picked as the answer if Coarctation of aoa is not provided amongst the options
|
Medicine
| null |
Coarctation of Aoa
|
A 30 year-old male has jaundice. Blood examination shows total serum bilirubin 28 mg%, direct bilirubin 16 mg % and alkaline phosphatase 184 KA units. The Diagnosis is :
|
Answer is D (Obstructive jaundice): The patient in question has high conjugated bilirubin levels (direct bilirubin > 50% of total bilirubin), along with alkaline phosphatase levels more than 6 times normal. The answer of choice therefore is obstructive jaundice. Approach: If direct conjugated bilirubin is greater than 15O of the total bilirubin, it is termed as direct bilirubinemia.
|
Medicine
| null |
Obstructive jaundice
|
In differential diagnosis of lump in right fornix which is not true :
|
Submucosal fibroid
|
Gynaecology & Obstetrics
| null |
Submucosal fibroid
|
A patient presents with symptoms of Hypoglycemia. Investigations reveal decreased blood glucose and increased Insulin levels. C-peptide assay is done which shows normal levels of C- peptide. The most likely diagnosis is:
|
Answer is C (Accidental exogenous Insulin administration): Normal / Reduced levels of C- peptide in the presence of increased insulin suggest a diagnosis of exogenous insulin administration as the cause of hypoglycemia. Approach to a patient with Hypoglycemia and Increased Insulin levels: Role of C- peptide Assay Normally Endogemous Insulin is secreted from (3-cells of pancreas in the form of Pro-insulin This proinsulin is then broken down to Insulin and C- peptide such that for each molecule of endogenous insulin, one molecule of C-peptide is produced. C-peptide levels are thus increased whenever endogenous insulin is increased e.g. Insulinomas, Sulfonylureas, Autoimmune processes and in cases of Insulin resistance (type II DM).
|
Medicine
| null |
Accidental exogenous Insulin administration
|
Methemoglobinemia may be caused by all of the following drugs, EXCEPT:
|
Drugs causing methemoglobinemia are: Nitrous gases, chloroquine and primaquine, phenazopyridine, sulfonamides, sulfones, aniline dye derivatives, phenacetin, dapsone, local anesthetics, and nitrobenzenes. Hemoglobin becomes methaemoglobin when iron is oxidized from the ferrous to the ferric form. This conversion of hemoglobin to methaemoglobin result in tissue hypoxia by decreasing both delivery of oxygen and removal of carbon dioxide. When levels of methaemoglobin exceeds : 10% of total haemoglobin: cyanosis without any shoness of breath 15% of total haemoglobin: blood appears chocolate brown 25% of total haemoglobin: peripheral and perioral cyanosis 35-40% of total haemoglobin: patients experience lassitude, fatigue, and dyspnea 60% of total haemoglobin: coma and death may occur Ref: Morgan D.L., Borys D.J. (2011). Chapter 47. Poisoning. In R.L. Humphries, C. Stone (Eds), CURRENT Diagnosis & Treatment Emergency Medicine, 7e.
|
Pharmacology
| null |
Phenytoin
|
A patient came with abduction limitation of right eye and horizontal diplopia. Which nerve can possibly be paralyzed
|
Lateral rectus Palsy 1. Lesion of Abducens nerve 2. Abduction limitation due to paralysis of lateral rectus 3. Convergent squint and diplopia (horizontal) on long standing palsy. 4. Patient present with turn towards the side of affected muscle Associations Millard Gubler syndrome: Ipsilateral 6th nerve palsy with contralateral hemiplegia Mobius Syndrome O Expressionless face O Facial palsy O 6th and 7th cranial Nerve involved O Lateral rectus paralyzed O Missing fingers & Bone abnormalities O The muscle weakness also causes problems with feeding that become apparent in early infancy. O Hypotonia O Intelligence is normal O Cleft palate O Missing and misaligned teeth
|
Ophthalmology
|
Squint
|
6th Nerve
|
Most common cause of acute parotitis -
|
Ans. is 'a' i.e., Staph Aureus o MC organism is staph aureus >> str. viridans >> pneumococcus.
|
Surgery
|
Miscellaneous (Salivary Gland)
|
S. Aureus
|
The most commonly affected tissues in neurocysticercosis is -
|
Larvae penetrate the intestine -MC sites of deposition in- CNS (60-90%)> Eye > muscle. in CNS - subarchanoid >parenchymal Option 1, 2, 3, 4 Cysticercosis: Caused by T. solium (Pork tapeworm) Potentially dangerous systemic disease. Neurocysticercosis (NCC) NCC: MC parasitic CNS infection of man and MC cause of adult onset epilepsy in world. MC site: Sub-arachnoid space followed by parenchyma.
|
Microbiology
|
Parasitology Pa 2 (Helminthology)
|
Brain
|
Which scientific principle is the basis for thermodilution method used in measurement of cardiac output by pulmonary catheter?
|
Ans. b. Stewart-Hamilton equation (Ref: Ganong 23/e p513; Guyton 11/e p244)Stewrt-Hamilton equation is the basis for thermodilution method used in measurement of cardiac output by pulmonary catheter.Stewart Hamilton equationThe thermodilution technique has become the de-facto clinical standard for measuring cardiac output because of its ease of implementation and the long clinical experience using it in various settings.It is a variant of the indicator dilution methodQ, in which a known amount of a substance is injected into peripheral vein and its concentration change measured over time in serial arterial samples.As its name implies, the thermodilution method uses a thermal indicator, whereas other indicator dilution methods use various substances, such as indocyanine green dye.The fundamental physical basis for the indicator dilution method is given by the Stewart-Hamilton equationQ, named after the two investigators who were instrumental in the development of this technique.
|
Physiology
|
Circulation: Cardiac Output, Venous Return
|
Stewart-Hamilton equation
|
Which of the following muscle lies between superficial and deep pas of submandibular salivary gland?
|
Submandibular gland is a large salivary gland situated in the anterior pa of the digastric triangle. It is roughly J-shaped,being indented by the posterior border of the mylohyoid which divides into a larger pa superficial to the muscle,and a small pa lying deep to the muscle. Reference: B D Chaurasia's human anatomy; 5th edition, page.166.
|
Anatomy
|
Head and neck
|
Mylohyoid
|
Inhibition of protein synthesis in translation phase is: due to
| null |
Biochemistry
| null |
Isoniazide
|
Most common cause of chronic pancreatitis:
|
Ref. API Textbook of Medicine. Pg. 815
Chronic pancreatitis is a chronic inflammatory disease in which there is irreversible progressive destruction of pancreatic tissue
Its clinical course is characterized by severe pain and in the later stages, exocrine and endocrine pancreatic insufficiency .
High alcohol consumption is the most frequent cause accounting for 60-70% of case, but only 5-10%of people with alcoholism develop chronic pancreatitis . The exact mechanism remains unclear; genetic and metabolic factors may be at play.
|
Unknown
| null |
Alcohol
|
Compliance curve of the lung given below. Curve A signifies which of the followings:
|
Compliance is defined as the change in volume for a unit change in pressure. It measures the distensibility or, stretchability of lung The total compliance of both lungs together in the normal adult human averages about 200 milliliters of air per centimeter of water transpulmonary pressure. The compliance of the combined lungthorax system is almost exactly one half that of the lungs alone-- 110 milliliters of volume per centimeter of water pressure. Types of compliance measurements: Static compliance: This is the measurement made without taking into account the effect of the different phases of respiration. Dynamic compliance: Compliance measurement during the difference phases of respiratory. So it's a measure of static compliance (lungs and chest wall stiffness) plus airway resistance = impedance of lung Specific compliance = Compliance/FRC Reduced compliance is caused by: Increased fibrous tissue in the lung (pulmonary fibrosis) Decreased surfactant or increased surface tension Presence of air (pneumothorax), excess fluid (pleural effusion), or blood (hemothorax) in the intrapleural space Alveolar edema, which prevents the inflation of some alveoli Atelectasis (collapse) Increased pulmonary venous pressure a lung becomes engorged with blood An increased compliance occurs in pulmonary emphysema normal aging lung In both instances, an alteration in the elastic tissue in the lung is probably responsible. Aging cause changes in the structure of lung collagen and elastin rather than changes in the amount or propoion of the two molecules. In emphysema, the alveolar septal tissue that normally opposes lung expansion are destroyed. Increased compliance also occurs during an asthma, but the reason is unclear.
|
Physiology
|
Respiratory System
|
Emphysema
|
Which of the following nerves carries taste sensation from posterior one-third of the tongue:
|
The Glossopharyngeal nerve is the nerve for both general sensation and taste sensation for the posterior 1/3rd of the tongue including the circumvallate papillaeNerve supply of tongueMotor supply: All the intrinsic muscles, except the palatoglossus are supplied by the hypoglossal nerve (The palatoglossus is supplied by the cranial pa of accessory nerve through the pharyngeal plexus)Sensory supply :- Anterior 2/3rd of the tongue - Lingual nerve is the nerve of general sensation and the chorda tympani is the nerve of taste for the anterior two-thirds of the tongue.- Posterior 1/3rd of tongue - The glossopharyngeal nerve is the nerve for both general sensation and taste sensation for the posterior 1/3rd of the tongue.The posterior most pa of the tongue is supplied by the vagus nerve through the internal laryngeal branch
|
Anatomy
| null |
Glossopharyngeal nerve
|
All of the following are true about the Right Coronary Aery (RCA) except___
|
The right coronary aery arises from the anterior aoic sinus (Right coronary sinus) of the ascending aoa. (Option B) It passes anteriorly and descends veically in the coronary sulcus between the right atrium and the right ventricle. On reaching the inferior margin, it turns posteriorly and continues in the sulcus on to the diaphragmatic surface and the base of the hea. The diameter of the right coronary aery is less than that of the left coronary aery (option A) The right coronal aery is, usually the first branch of the coronary aery. (Option D) The circumflex coronary aery is a branch of the left coronary aery and is the exclusive supplier to the right bundle branch. Ref: Gray's Anatomy 41st edition Pgno: 1016
|
Anatomy
|
All India exam
|
RCA gives rise to circumflex coronary branch
|
Most common malignant lesion of the eyelid is
|
Basal cell carcinoma This is usually a slow-growing, locally-invasive, malignant tumour of pluripotential epithelial cells arising from basal epidermis and hair follicles; hence, it affects the pilo-sebaceous skin. EPIDEMIOLOGY The strongest predisposing factor to BCC is UVR. It occurs in the elderly or the middle-aged after excessive sun exposure, with 95% occurring between the ages of 40 and 80 years. The incidence of BCC rises with proximity to the equator, although 33% arise in pas of the body not usually sunexposed. Other predisposing factors include exposure to arsenical compounds, coal tar, aromatic hydrocarbons, ionising radiation and genetic skin cancer syndromes. White- skinned people are almost exclusively affected. BCC is more common in men than women. PATHOGENESIS BCCs have no apparent precursor lesions and their development is propoional to the initial dose of the carcinogen, but not duration of exposure. The most likely model of pathogenesis for BCCs involves mesodermal factors as intrinsic promoters coupled with an initiation step. BCCs metastasise extremely rarely. MACROSCOPIC BCC can be divided into localised (nodular; nodulocystic; cystic; pigmented and naevoid) and generalised (superficial: multifocal and superficial spreading; or infiltrative: morphoeic, ice pick and cicatrizing). Nodular and nodulocystic variants account for 90% of BCC. MICROSCOPIC Twenty-six histological subtypes have been described. The characteristic finding is of ovoid cells in nests with a single 'palisading' layer. It is only the outer layer of cells that actively divide, explaining why tumour growth rates are slower thantheir cell cycle speed would suggest, and why incompletely excised lesions are more aggressive. Morphoeic BCCs synthesize type 4 collagenase and so spread rapidly Ref: Bailey and love 27th edition Pgno : 604
|
Surgery
|
Urology
|
Basal cell carcinoma
|
ANA seen in SLE is directed against?
|
“Antibodies to double-stranded DNA and the Smith (Sm) antigen are virtually diagnostic of SLE" ---------- Robbins
Antinuclear antibodies in SLE
1) Generic antinuclear antibodies (ANA)
□ These are most common (93-100% of patients), thus are most sensitive antibodies for SLE (best screening test).
2) Anti-dsDNA and Anti-smith (Sm) antibodies
□ These are the most specific antibodies for SLE.
3) Antihistone antibodies
□ Particularly seen in drug-induced SLE.
4) Anti-RNP SS-A (Ro), SS-B (La)
□ These are seen in neonatal lupus with congenital heart block and in subacute cutaneous lupus. These antibodies are associated with decreased risk of lupus nephritis.
5) Other less common types of ANAs in SLE
□ Anti-U1 RNP
□ Anti-DNA topoisomerase (Scl-70)
□ Anticentromere
□ Anti-histidyl t-RNA synthase
|
Pathology
| null |
dsDNA
|
In cellular event of acute inflammation all are seen except -
|
. PECAM &; Activation of leukocytesExplanation :- PECAM 1 (platelet endothelial adhesion molecule) or CD31 &; involved in migration of leukocytes
|
Pathology
| null |
PECAM - Activation of leukocytes
|
A 76 year old male with a history of dyspnoea on exeion was subjected to x-ray chest by the treating physician. The findings on the chest X-ray are given below. There is a history of fever with significant loss of weight and occasional bloody diarrhoea for the past 3 months. What is the most likely diagnosis?
|
This is an X-ray film showing multiple cannonball metastasis in the lung. The following neoplasms are most likely to spread to the lungs. Given the history it is likely to be a colorectal carcinoma. Melanoma Thyroid cancer Breast cancer Colorectal cancer Head and neck cancer Renal cell cancer Choriocarcinoma Testicular cancer Osteosarcoma Ewing sarcoma Wilms tumor Rhabdomyosarcoma Prostate cancer
|
Radiology
| null |
Colon cancer with lung metastasis
|
A 21 years female of 143 cm height present primary amenorrhea, absent breast, Cubitus valgus. Most probable diagnosis is?
|
Individuals with Turner's syndrome are phenotypic females with primary amenorrhea, absent secondary sexual characteristics, sho stature, multiple congenital anomalies, and bilateral streak gonads. Characteristic Findings in Women with Turner Syndrome: Height 142-147cm Micrognathia Epicanthal folds Low-set ears Sensorineural hearing loss Otitis media leading to conductive loss High-arched palate Webbing of the neck Chest square and shield-like Lack of breast development Areolae widely spaced Coarctation of the aoa Sho fouh metacarpal Cubitus valgus Renal abnormalities Autoimmune disorders Autoimmune thyroiditis Diabetes mellitus Ref: Hoffman B.L., Schorge J.O., Schaffer J.I., Halvorson L.M., Bradshaw K.D., Cunningham F.G., Calver L.E. (2012). Chapter 18. Anatomic Disorders. In B.L. Hoffman, J.O. Schorge, J.I. Schaffer, L.M. Halvorson, K.D. Bradshaw, F.G. Cunningham, L.E. Calver (Eds), Williams Gynecology, 2e.
|
Gynaecology & Obstetrics
| null |
Turner's syndrome
|
WHO ORS contains -
|
Ans. is 'b' i.e., Potassium chloride-1.5 gm Because of the improved effectiveness of reduced osmolarity ORS solution, WHO and UNICEF are recommending that countries manufacture and use the following formulation in place of the previously recommended ORS solution.
|
Pediatrics
| null |
Potassium chloride 1.5 g
|
DNA replication and transcription occurs in which direction -
|
Ans. is 'a' i.e., 51 - 31 Elongation in DNA synthesiso Once the RNA primer has been synthesized at each of the replicating forks, a DNA polymerase III initiates the synthesis of new DNA strand by adding deoxyribonucleotides to the 31 end of RNA primer. Thus, both new strands are synthesized always in 51- 31 direction. Both the DNA strands are synthesized simultaneously, but in opposite direction.o During synthesis of RNA primer and synthesis of DNA strands, the nucleotides are added according to the sequence of base in the template strand, i.e. 'base pairing rule'. For example, an adenine nucleotide would enter at a thymine nucleotide.Elongation in transcriptiono The process of elongation proceeds after the formation of the first phosphodiester bond. After formation of approximately 10 phosphadiester bonds of new RNA, sigma (a) factor dissociates from the core enzyme. RNA polymerase utilize ribnucleotide triphosphate (ATP, GTP, CTP and UTP) for the formation of RNA.o RNA synthesis occurs in 51-3' direction (similar to DNA synthesis), i.e. genetic information is read in 31-51direction on template DNA and complementary base sequence is synthesized in 51-31 direction for RNA strand.o The selection of nucleotide is according to base-pairing rule, (e.g. U opposite to A and G opposite to C)o The process of elongation continues until a termiantion point is reached.
|
Biochemistry
|
DNA Replication
|
51-31
|
Sympathetic ophthalmitis is due to
|
Sympathetic Ophthalmitis* Bilateral granulomatous panuveitis after penetrating trauma with prolapsed of uvea* Injured eye - exciting eye; normal fellow- sympathizing eye* Causes: penetrating injury, intraocular surgeries, cyclophotocoagulation, cyclocryotherapy* Site of injury: involving CB, iris and lens capsule* Pathogenesis: Autoimmunity against uveal pigments * Dalen Fuchs Nodules - granulomas between Bruchs and RPE* Earliest Symptom: Loss of accommodation* Earliest Sign: Retrolental flare and cells, KPs at the back of cornea* Enucleation of the injured eye within 10 days only in eyes with a hopeless visual prognosis* Treatment: Topical and systemic steroids
|
Ophthalmology
|
Ocular Trauma
|
Penetrating trauma
|
Best test to quantify' feto-maternal haemorrhage in Rh isoimmunisation is -
|
Ans. is 'c' i.e., Kleinhauser test Kleiheaur betke testo It is quantitative test which is used to calculate the approx volume of the fetal blood entering into the maternal circulation. Based on the principle of acid elution technique and is done by using citric acid phosphate buffer. Fetal red cells (dark refractile bodies) are calculated as per 50 low power fields. If there are 80fetal erythrocytes in 50 low power fields in maternal peripheral blood films, it is estimated as transplacental haemorrhage to the extent of 4 ml of fetal blood.o Though more accurate tests are flow cytometry and immunofluorescence.o Apt test (Singer alkali denaturation test) is another test by which is used to detect the presence of fetal blood in maternal blood. But it is qualitative test. It uses KOH as reagent and is based on alkali denaturation.o Bubble test (shake test) is a bedside test to detect the fetal lung maturity.
|
Gynaecology & Obstetrics
|
Pregnancy in Rh-negative Women
|
Kleinhauser test
|
Collagen found in hyaline cailage is
|
Collagen present in cailage are chemically distinct from those in most other tissues.They are described as type 2 collagen Inderbir Singh&;s textbook of human Histology Seventh edition Pg no 82
|
Anatomy
|
General anatomy
|
Type II
|
A 60 year old male patient complains of food lodgment in upper right back teeth region. Patient gives h/o RCT with 16 and extraction with 15. Ceramic crown and bridge was planned. Which of the following is not a method for strengthening this restoration?
|
-DEVELOPMENT OF RESIDUAL COMPRESSIVE STRESSES
The fabrication of metal-ceramic and all-ceramic prostheses usually involves sintering the ceramic at high temperature or hot-pressing a veneering ceramic onto the metal or core ceramic. The process of cooling to room temperature offers the opportunity to take advantage of mismatches in coefficients of thermal contraction of adjacent materials in the ceramic structure.
-MINIMIZING THE NUMBER OF FIRING CYCLES
The purpose of porcelain firing procedures is to densely sinter the particles of powder together and produce a relatively smooth, glassy layer (glaze) on the surface. In some cases a stain layer is applied for shade adjustment or for characterization, such as stain lines or fine cracks.
-ION EXCHANGE
The technique of ion exchange is an effective method of introducing residual compressive stresses into the surface of a ceramic.
-THERMAL TEMPERING
Perhaps the most common method for strengthening glasses is by thermal tempering, which creates residual surface compressive stresses by rapidly cooling the surface of the object while it is hot and in the softened (molten) state. This rapid cooling produces a skin of rigid glass surrounding a soft (molten) core. As the molten core solidifies, it tends to shrink, but the outer skin remains rigid. The pull of the solidifying molten core, as it shrinks, creates residual tensile stresses in the core and residual compressive stresses within the outer surface.
Philips’ Dental Material, pg- 440, 441
|
Dental
| null |
Maximizing the number of firing cycles
|
A 23-year-old female presents with an itchy, linear rash on her foot. She returned from a camping trip 4 days ago and denies using any new makeup, clothing, or jewelry. True about this skin pathology:
|
Diagnosis - Contact dermatitis. Foot lesions are erythematous papules and vesicles with serous weeping. Lesions localized to areas of contact with the offending agent (the foot ware in this case). Treatment: Topical or systemic coicosteroids & cool, wet compresses
|
Dental
|
Eczema and related disorders
|
Treatment is with coicosteroids
|
Treatment of choice of Kawasaki disease ?
|
Kawasaki disease is a vasculitis that mostly involves the coronary vessels. It presents as an acute systemic disorder, usually affecting children under 5 years.Kawasaki's disease is an acute, febrile, multisystem disease of children. Some 80% of cases occur prior to the age of 5, with the peak incidence occurring at <=2 years. It is characterized by nonsuppurative cervical adenitis and changes in the skin and mucous membranes such as edema; congested conjunctivae; erythema of the oral cavity, lips, and palms; and desquamation of the skin of the fingeips. Although the disease is generally benign and self-limited, it is associated with coronary aery aneurysms in ~25% of cases, with an overall case fatality rate of 0.5-2.8%.Presentation is with fever, generalised rash, including palms and soles, inflamed oral mucosa and conjunctival congestion resembling a viral exanthema. The cause is unknown but it is thought to be an abnormal immune response to an infectious trigger These complications usually occur between the third and fouh weeks of illness during the convalescent stage. Vasculitis of the coronary aeries is seen in almost all the fatal cases that have been autopsied. There is typical intimal proliferation and infiltration of the vessel wall with mononuclear cells. Beadlike aneurysms and thromboses may be seenalong the aery. Other manifestations include pericarditis, myocarditis,myocardial ischemia and infarction, and cardiomegaly . It occurs mainly in Japan and other Asian countries, such as China and Korea, but other ethnic groups may also be affected. Treatment is with aspirin (5 mg/kg daily for 14 days) and IV Ig (400 mg/kg daily for 4 days) . Ref Davidsons 23e p1041 ,Harrisons 20e p2588
|
Medicine
|
Immune system
|
IV immunoglobulin
|
When restoring a tooth with resin material, acid etching can do all of the following except
| null |
Dental
| null |
Permit chemical bonding between resin and enamel
|
A 35 year old female, hospitalized after a motor vehicle accident, develops acute gastric stress ulcers. Increases in which of the following normal physiological parameters may have contributed to this condition?
|
Pepsin production is a normal physiologic activity of the stomach that, in conditions of stress, may overwhelm the stomach's weakened defenses and result in gastric ulceration. Gastric acid production is another condition that may increase and cause acute ulceration. Fuhermore, these two factors may remain unchanged and still result in gastric ulcers if the gastric defenses are weakened by stress. All of the other choices represent normal defensive forces in the stomach. Increased bicarbonate transpo would protect the gastric epithelium from the potentially harmful acidity of the gastric contents. The adherent mucus is relatively alkaline, providing local protection to the superficial mucosa. Gastric epithelial cells can normally replicate rapidly, allowing mucosal defects to be rapidly repaired. Increasing the regenerative capacity of the epithelium would have a protective effect against ulceration. The gastric mucosa is richly supplied with blood, providing the epithelial cells with an ample supply of nutrients, oxygen, and bicarbonate to contend with the harsh gastric microenvironment. Stress ulcers are associated with compromised gastric blood flow, not increased flow. Ref: Mills J.C., Stappenbeck T.S., Bunnett N. (2010). Chapter 13. Gastrointestinal Disease. In S.J. McPhee, G.D. Hammer (Eds), Pathophysiology of Disease, 6e.
|
Physiology
| null |
Pepsin production
|
Which of these is characteristic of amyloidosis-
|
Robbins and Cotran pathologic basis of disease South Asia edition. *by electron microscopy all types amyloid consist of continuous non branching fibrills.X Ray crystallography and infrared spectroscopy demonstrate a characteristic cross-beta-pleated shear conformation .this conformation is responsible for distinctive Congo red staining and birefringence of amyloid.
|
Pathology
|
General pathology
|
Beta pleated, fibrillary, congophilic
|
What is the intermediate host of the organism shown here?
|
organism-Guinea worm/medina worm/serpent worm habitat- subcutaneous nodules DH-humans IH- cyclops(lobsters, crabs shrimps) MOI-ingestion of drinking water containing cyclops infested with L3Larvae
|
Microbiology
|
Parasitology Pa 2 (Helminthology)
|
Cyclops
|
Following is true about longitudinal studies
|
Longitudinal studies are useful in: To study the natural history of disease and it's future outcome For identifying risk factors of disease For finding out incidence rate or rate of occurrence of new cases of disease in the community Ref: 25th edition, Park's Textbook of Preventive and Social Medicine, Page no. 78
|
Social & Preventive Medicine
|
Epidemiology
|
Used to study the natural history of the disease
|
What is the indication for therapeutic thoracocentesis?
|
Therapeutic thoracocentesis- Indication - Free fluid separates the lung from chest wall by 10 mm Measured radiographically Preferred site of thoracocentesis -7th ICS Scapular line. For Recurrent pleural effusion - pleurodesis. In pleurodesis we inject a sclerosing agent in pleural space which causes obliteration of pleural cavity
|
Medicine
|
Pleural effusion & Pulmonary alveolar proteinosis
|
Free fluid separates the lung from chest wall by 10 mm
|
The major difference between X-Rays and Light is:
|
The main difference between an X-ray photon and a visible light photon lies in the energy of each photon. Xray photon has approximately 5000 times the energy of an ordinary light photon, allowing the Xray photon to pass through materials more readily than a regular light photon. Ref: Techniques in Microscopy for Biomedical Applications By Terje Dokland, Page 289
|
Radiology
| null |
Energy
|
Structure NOT passing through esophageal opening
|
At T8 - IVC hiatus in central tendon through which IVC and few branches of Rt. phrenic nerve passes At T10 - Oesophageal opening is present through which passes: Esophagus Esophageal branch of left gastric aery Anterior and posterior vagal trunk At T12 - Aoic hiatus posterior to diaphragm formed by median arcuate ligament through which passes: Aoa Thoracic duct Azygous vein
|
Anatomy
|
Umblicial cord and diaphragm
|
Phrenic nerve
|
Waist Hip Ratio in men that indicate obesity
| null |
Social & Preventive Medicine
| null |
> 1
|
Notching of the ribs is seen in man
|
Coarctation of aoa
|
Radiology
| null |
Coarctation of aoa
|
Baezomib is -
|
Ans. is 'a' i.e., Proteosome inhibitor Proteosome inhibitors o Transcription factor NFKB is associated by an inhibitor IKB. o IKB is degraded by proteosomes. o Inhibition of proteosome prevents degradation of IKB which inhibits the overactivity of NFKB. o Proteosome inhibitor (Baezomib) is used in multiple myeloma.
|
Pharmacology
| null |
Proteosome inhibitor
|
Superior rib notching is/are caused by:
|
A, B, C, i.e. Hyperparathyroidism, Poliomyelitis, Marfan syndome
|
Radiology
| null |
All
|
Destruction of fat in acute pancreatitis is due to -
|
An enzyme activated by trypsin is phospholipase A2. This enzyme splits a fatty acid off lecithin, forming lysolecithin. Lysolecithin damages cell membrane. It has been hypothesized that in acute pancreatitis phospholipase A2 is activated in the pancreatic ducts, with the formation of lysolecithin from lecithin that is a normal constituent of bile. This cause disruption of pancreatic tissue and necrosis of surrounding fat.
|
Pathology
| null |
Lipase and trypsin
|
The very first step in investigation of Epidemic
|
INVESTIGATION OF AN EPIDEMIC The occurrence of an epidemic always signals some significant shift in the existing balance between the agent, host and environment. It calls for a prompt and thorough investigation of the cases to uncover the factor(s) responsible and to guide in advocating control measures to prevent fuher spread. Emergencies caused by epidemics remain one of the most impoant challenges to national health administrations. Epidemiology has an impoant role to play in the investigation of epidemics. The objectives of an epidemic investigation are a. to define the magnitude of the epidemic outbreak or involvement in terms of time, place and person. b. to determine the paicular conditions and factors responsible for the occurrence of the epidemic. c. to identify the cause, source(s) of infection, and modes of transmission to determine measures necessary to control the epidemic; and d. to make recommendations to prevent recurrence. Steps of investigations of epidemic Verification of diagnosis Confirmation of existence of epidemic Defining population at risk Rapid search for all cases and their characteristics Data analysis Formulation of hypothesis Testing of hypothesis Evaluation of ecological factors Fuher investigation of population at risk Writing the repo Ref : Park 23rd edition Pgno : 132
|
Social & Preventive Medicine
|
Epidemiology
|
Verification of diagnosis
|
Orally administered anti kala-azar drug is
|
Ans. is 'b' i.e., Miltefosine o Drugs used for kala-azar :- o Parentral : Amphotericin-B (iv), Paromomycin (im), sodium stibogluconate (iv or im). Oral : Miltefosine
|
Pharmacology
| null |
Miltefosine
|
Which DNA segments in the lactose operon of E. coli is a trans-acting regulatory element?
|
Regulatory sequences in DNA are classified as cis- or trans-acting elements, depending on the mechanism of action. Cis-acting elements function only when located on the strand of DNA being regulated, relatively close to the regulated gene. The operator (0), the promoter (P), and the CAP binding site all are located just upstream from the regulated structural genes of the operon, and do not function if placed at other locations. The -galactosidase gene is one of the regulated structural genes of this operon. Trans-acting elements can function from long distances, and can even be on a different DNA molecule in the cell. The gene, which encodes the repressor protein, is an example of a trans-acting regulatory element. Because the gene encodes a diffusible product, it doesn't matter where it is placed relative to the regulated genes. Ref : Biochemistry by U. Satyanarayana 3rd edition Pgno : 567
|
Biochemistry
|
All India exam
|
I gene
|
Comment on the diagnosis for an individual serum alkaline phosphatase normal, PTH normal, Vitamin D3 normal with elevated serum Calcium values?
|
Multiple myeloma is a plasma cell neoplasm commonly associated with lytic bone lesions, hypercalcemia, renal failure, and acquired immune abnormalities. Clinical Features. The clinical features of multiple myeloma stem from (1) the effects of plasma cell growth in tissues, paicularly the bones (2) the production of excessive Igs, which often have abnormal physicochemical propeies; and (3)The suppression of normal humoral immunity. Bone resorption often leads to pathologic fractures and chronic pain. The attendant hypercalcemia can give rise to neurologic manifestations, such as confusion, weakness, lethargy, constipation, and polyuria, and contributes to renal dysfunction. Decreased production of normal Igs sets the stage for recurrent bacterial infections. Cellular immunity is relatively unaffected. Of great significance is renal insufficiency, which trails only infections as a cause of death. The pathogenesis of renal failure (Chapter 20), which occurs in up to 50% of patients, is multifactorial. However, the single most impoant factor seems to be Bence-Jones proteinuria, as the excreted light chains are toxic to renal tubular epithelial cells. Ceain light chains (paicularly those of the l6 and l3 families) are prone to cause amyloidosis of the AL type, which can exacerbate renal dysfunction and deposit in other tissues as well.
|
Pathology
|
FMGE 2019
|
Multiple myeloma
|
"Gold standard" study for diagnosis of pulmonary embolic episode is:
|
Ans. B. Pulmonary angiographyAlthough pulmonary angiography is supposed to be the definitive and gold standard means of diagnosing PULMONARY EMBOLISM with the decreasing availability of pulmonary arteriography and increasing use of other non-invasive tests like spiral CT, the exact role of pulmonary arteriography is now less clear and there are only few indications for it, especially in absence of spiral CT or MRI.
|
Radiology
|
Respiratory System
|
Pulmonary angiography
|
Tryptophan is
|
During metabolism Tryptophan, pa of carbon skeleton enters ketogenic pathway and rest glucogenic pathway. Alanine is glucogenic and Acetoacetyl CoA is ketogenic.
|
Biochemistry
|
Metabolism of protein and amino acid
|
Both glucogenic & ketogenic
|
A 3–month old male child with normal genitalia presents to the emergency department with severe dehydration, hyperkalemia and hyponatremia. The measurement blood levels of which of the following will be helpful?
|
This is a case of congenital adrenal hyperplasia due to deficiency of 21 - hydroxylase deficiency.
Because of the enzyme block ,there is increased formation of 17- hydroxyprogesterone, which is then shunted into the production of testosterone.
Levels of cortisol and aldosterone are reduced.
|
Pediatrics
| null |
17–hydroxy progesterone
|
Refeeding Syndrome - Lab values to be monitored are all except
|
Ans. (d) AmmoniumRef: Bailey and Love 27th edition Page 288, Surgery Sixer 3rd Edition Page 6Refeeding Syndrome* Characterized by severe fluid and electrolyte shifts in malnourished patients undergoing refeeding.* It can occur with Enteral and Parenteral nutrition (MC with TPN)* Lab values: Hypophosphatemia, Hypocalcemia, Hypomagnesemia(Mneumonic-CPM Low)* Risk factors: Alcohol, Severe malnutrition, Anorexia, Prolonged fasting* Treatment: Avoid Overfeeding* Deliver calories slowly* Electrolyte imbalance needs to corrected
|
Surgery
|
Fluid & Electrolyte
|
Ammonium
|
Mucormycosis of paranasal sinus is most common in
|
MUCORMYCOSIS: Caused by - rhizopus , rhizomucor , cunninghamella Moulds with non septate hyphae The higher prevalence of mucormycosis in India turned out to be statistically significant (p < 0.0001) in comparison with all other countries Predisposing factors - Organ transplant recipients - Long term desferroxamine therapy - Immunosuppression due to steroids or cytotoxic drugs Hematological malignancy - Diabetics - Chronic renal failure Five forms Rhinocerebral (most common site) Pulmonary mucormycosis (2' most common) Cutaneous Gastrointestinal Disseminated Diagnosis: Microscopy and biopsy show organisms that appears as broad ribbon like usually non septate hyphae which branch at right angles
|
ENT
| null |
Diabetes
|
Spironolactone is most useful in _________ syndrome:
| null |
Medicine
| null |
Conn's syndrome
|
Which of the following supplies the pineal gland?
|
Pineal gland is present posterior to midbrain so if tumor is in pineal gland ,it may l/t dorsal mid brain syndrome as it would press on the midbrain from behind. * MCA(Middle Cerebral Aery) not a pa of Circle of Willis * PCA (Posterior Cerebral Aery) P1,P2 and 10-11 Post choroidal aeries P1 supplies- Midbrain P2 supplies -PCA Post choroidal aeries supplies -Pineal gland
|
Medicine
|
Raised ICP and Brain death
|
Posterior choroidal aeries
|
A 54-year-old man is admitted to the hospital due to severe headaches. A CT examination reveals an internal carotid artery aneurysm inside the cavernous sinus. Which of the following nerves would be typically affected first?
|
The abducens nerve would be affected first due to aneurysmal dilation of the internal carotid artery (ICA) because the nerve runs in closest proximity to the artery within the cavernous sinus. The other nerves running in the wall of the cavernous sinus are the oculomotor nerve, trochlear nerve, and both the maxillary and ophthalmic branches of the trigeminal nerve. Each of these nerves, however, courses along, or within, the lateral walls of the cavernous sinus and may not be immediately affected by an aneurysm of the ICA.
|
Anatomy
|
Head & Neck
|
Abducens nerve
|
Coenzyme required for tissue respiration is
|
Coenzyme Q (CoQ) is a quinone derivative with a long, hydrophobic isoprenoid tail. It is also called ubiquinone because it is ubiquitous in biologic systems. CoQ is a mobile carrier and can accept hydrogen atoms both from FMNH2, produced on NADH dehydrogenase (Complex I) and from FADH2, produced on succinate dehydrogenase (Complex II).Ref: Harpers Biochemistry; 30th edition
|
Biochemistry
|
Respiratory chain
|
Coenzyme Q
|
Cause of death in Carcinoma penis is usually -
|
Inguinal lymph nodes erode the skin of the groin and the death of the patient may be due to involvement of the femoral or external iliac artery with torrential hemorrhage.
|
Surgery
| null |
Erosion of Femoral blood vessels
|
All are true about levamisole EXCEPT:
|
Levamisole- Active against many nematodes, but use is restricted to ascariasis and ancylostomiasis because the action on other worms is poor. The ganglia in worms are stimulated causing tonic paralysis and expulsion of live worms. Interference with carbohydrate metabolism (inhibition of fumarate reductase)may also contribute. It is an immunostimulant, used for slow spreading vitiligo to be used for at least 6 weeks ESSENTIALs of MEDICAL PHARMACOLOGY SIXTH EDITION -KD TRIPATHI Page 812
|
Pharmacology
|
Immunomodulators
|
Single dose is sufficient for the treatment of psoriasis
|
In patients with osteoahritis of knee joint, atrophy occurs most commonly in which muscle :
|
Quadriceps only Met Maheshwari 3/e, p 253;Apley's 8/e, p 472] In osteoahritis of knee joint, the quadriceps muscle is usually wasted.
|
Surgery
| null |
>Qudriceps only
|
All of the following are pyrogenic cytokines, Except-
|
Ans. is 'a' i.e., Interleukin 18 (IL-18) Interleukin 18 is not a pyrogenic cytokine.
|
Pathology
| null |
Interleuken 18 (IL-18)
|
All of the following are known causes of recurrent aboion, except:
|
SLE is associated with antiphospholipid syndrome (anti cardiolipin antibodies) and is known to cause recurrent aboions. RH incompatibility is a known cause for spontaneous aboion and may lead to recurrent aboions if it remains unrecognized. Syphilis has also lead to recurrent aboion. TORCH is thus the single best answer of exclusion. Ref: Gynaecology for Postgraduates and Practitioners By Sengupta, Pages 187-92; Textbook of High Risk Pregnancy By Hemant Deshpande, Hemant, Pages 248-49
|
Gynaecology & Obstetrics
| null |
TORCH infections
|
Pontaic, fever is caused by -
|
Ans. is 'a' i.e., Legionella
|
Microbiology
| null |
Legionella
|
A patient presents with fever, cough with sputum and weight loss. He has a history of not completing treatment for tuberculosis thrice in the past. XDR-TB is suspected. How is XDR-Tb defined?
|
XDR-TB (Extensively drug-resistant TB) is defined as MDR TB (Resistant to rifampicin and isoniazid) + Resistant to one fluoroquinolone (eg. ofloxacin) + resistance to one injectable second line drug (Amikacin or kanamycin or capreomycin). Reference: Ananthanarayan and Paniker&;s Textbook of Microbiology Tenth edition
|
Microbiology
|
Bacteriology
|
Resistant to INH + Rifampicin + Amikacin + Ofloxacin
|
False about acute aluminium phosphate poisoning:
|
D i.e. Oesophageal stricture Aluminium (zinc) phosphide or celphos poisoning liberates phosphine gas which inhibits mitochondrial cytochrome oxidase, respiratory chain enzymes and electron transpo systemQ. It is a systemic poison and kills most of patients with in 24 hours secondry to cardiovascular collapse d/t direct myocardial toxic effect( 2. Oesophageal strictures and fistula occur in few survivors (which are already very few) in late stages. So this is late complication of least occurance (among other options)
|
Forensic Medicine
| null |
Oesophageal stricture
|
The vertical fracture of root seen with gutta percha obturation is due to:
| null |
Dental
| null |
The vertical compression of warm GP points
|
Alzheimers disease, true is all except -
| null |
Medicine
| null |
Dysdiadochokinesia
|
Injury occurs at C7 root, in what pa of arm, sensation will be lost ?
|
Ans. is 'd' i.e., None of the above
|
Anatomy
| null |
None of the above
|
A child having delayed separaion of umbilical cord with leukocytosis with Downs syndrome and recurrent infections. Diagnosis ?
|
Leukocyte adhesion deficiency (LAD) is a rare primary immunodeficiency. The clinical picture is characterized by marked leukocytosis and localized bacterial infections that are difficult to detect until they have progressed to an extensive level secondary to lack of leukocyte recruitment at the site of infection. Thus the infections in patients with leukocyte adhesion deficiency act similarly as those observed in patients with neutropenia. See the images below. Reference: GHAI Essential pediatrics, 8th edition
|
Pediatrics
|
Genetic and genetic disorders
|
Leucocyte Adhesion deficiency
|
False regarding Cytochrome P 450 is ?
|
Ans. is d i.e., They are non heme proteins CYTOCHROME P450 They CYP450 are essential for the production of cholesterols, steroids, prostacyclins and thromboxane A2. They are also essential for the metabolism of foreign chemicals and detoxification of drugs. CYP 450 enzymes are so named because they are bound to membranes within a cell (cyto) and contain a heme pigment (chrome and P) that absorbs light at a wavelength of 450 nm when exposed to carbon monoxide. There are more than 50 CYP450 enzymes, but the CYP1A2, CYP2C9, CYP2C19, CYP2D6, CYP3A4, and CYP3A5 enzymes metabolize 90 percent of drugs.
|
Pharmacology
| null |
They are non heme proteins
|
The mode of inheritance of Incontinentia pigmenti is -
|
Ans- C X-linked dominant
|
Skin
|
Autoimmune Skin Disorders
|
X-linked dominant
|
Ramu, presents with recurrent attacks of cholelithiasis, U/S examination shows a dilated CBD of 1 cm. The next line of management is ?
|
Ans. is A ie. ERCP The first inv. for any pt. with cholelithiasis or jaundice is U/S. Next inv. depends on U/S findings, If the intrahepatic ducts are dilated without any extrahepatic dilatation then the preferred inv. is ----> PTC* If the dilatation is in CBD ---> ERCP*. ERCP may provide direct diagnosis of the distal CBD pathology and may be therapeutic as well for a CBD stone or stricture.
|
Surgery
| null |
ERCP
|
A 50 year old male patient came with the complaint of palpitations. Examination of pulse revealed irregular heabeat and advised ECG recording. Spread of cardiac impulse is fastest in which of the following structure
|
Conduction speed in cardiac tissue: Tissue Conduction Rate SA node 0.05 Atrial pathways 1 AV node 0.05 Bundle of His 1 Purkinje system 4 Ventricular muscle 1 Purkinje fibers also have the ability of firing at a rate of 15-40 beats per minute if upstream conduction or pacemaking ability is compromised. In contrast, the SA node in normal state can fire at 60-100 beats per minute. In sho, they generate action potentials, but at a slower rate than sinoatrial node. This capability is normally suppressed. Thus, they serve as the last reso when other pacemakers fail. When a Purkinje fiber does fire, it is called a premature ventricular contraction or PVC, or in other situations can be a ventricular escape. It plays a vital role in the circulatory system. Reference: Ganong's Review of Medical Physiology; 25th edition; Page no: 522
|
Physiology
|
Cardiovascular system
|
Purkinje fibre
|
Golgi tendon apparatus conveys message to CNS, depends upon:
|
Golgi tendon organs are in series with the muscle fibers, they are stimulated by both passive stretch and active contraction of the muscle, when tension increases inside muscle.
|
Physiology
| null |
Tension in muscle
|
Best stimuli for secretin is-
|
B i.e. Acid
|
Physiology
| null |
Acid
|
Drugs used in congestive hea failure are All except
|
As a medication, adrenaline is used to treat a number of conditions including anaphylaxis, cardiac arrest, and superficial bleeding. Inhaled adrenaline may be used to improve the symptoms of croup. It may also be used for asthma when other treatments are not effective. It is given intravenously, by injection into a muscle, by inhalation, or by injection just under the skin. Common side effects include shakiness, anxiety, and sweating. A fast hea rate and high blood pressure may occur. Occasionally it may result in an abnormal hea rhythm. While the safety of its use during pregnancy and breastfeedingis unclear, the benefits to the mother must be taken into account Refer kDT 6/e p502
|
Pharmacology
|
Cardiovascular system
|
Adrenaline
|
All are transmitted by blood except -
|
Ans-CEpstein Barr Virus??? Viruses associated with blood transfusion:Hepatitis C virus:Hepatitis G virus:Hepatitis B virusHIV type IHTLV Type ICytomegalovirusParvovirus B-19HGVA recently discovered and identified non A-E hepatitis virus has been designated the name Hepatitis G virus (HGV) which is a member of Flaviviridae family.HGV is distinct from hepatitis C virus (HCV) and the newly discovered GBV-A and GBV-B agents.The structure of the HGV genome resembles that of HCV.HGV replicates in peripheral blood cells I while replication in liver cells has not been observed till date. It does not appear to cause liver disease.Epidemiological data indicates that virus is prevalent throughout the world and has clearly reestablished transmission modes which are: -Blood and Blood productsSexual transmissionEBV can also be transmitted by blood transfusion.- EBV os present in the transfused WBC.The leucocyte associated viruses are: -CMVEBVHHV-8 (Human herpes virus type 8)HTLV-1 &HTLV-IIHIVWe are not sure of the answer.Now we should look for the virus which is least commonly transmitted.There is confusion in this too because both EBV and Parvovirus are rare with transfusion.An important point * All the viruses mentioned in the question are not routinely screened for blood transfusion.The American Red Cross performs laboratory tests for multiple infectious disease markers on every unit of donated blood.These tests includes: -Chagas diseaseHepatitis B virus (HBV)Hepatitis C virus (HCV)HIV (1,2)HTLV-ISyphilisWest Nile virus (WNV)
|
Unknown
| null |
Epstein Bar virus
|
An adult patient presents with leg pain. On examination there is gangrene of his toe. What would be the ankle to brachial aerial pressure ratio in this patient ?
|
Since this patient has developed gangrene of the toe ankle to brachial presure ratio should be less than 0.3. Ratio of ankle to brachial systolic pressure (ankle brachial index) is obtained to determine the presence and magnitude of occlusive disease. The ankle brachial index of 0.9 - 1.0 indicates normalcy or minimal aerial occlusive disease. ABI of 0-5 -0.9 signifies claudication level. ABI less than 0.5 signifies presence of ischemic rest pain or severe occlusive aerial disease. ABI less than 0.3 is compatible with trophic changes over the lower extremity.
|
Surgery
| null |
0.3
|
The infection that is spreading to the newborn by caregivers?
|
Ans is (c) i.e Candida Paraspilosis Ref Clin MicroHol Rev. Oct 2008: 21(4): 606-625 Candida parapsilosis is an emerging major human pathogen that has dramatically increased in significance and prevalence over the past 2 decades, such that C. parapsilosis is now the second leading causes of invasive candidal disease. Individuals at the highest risk for severe infection include neonates and patients in intensive care units. C. parapsilosis infections are especially associated with hyperalimentation solutions, prosthetic devices, and indwelling catheters, as well as the nosocomial spread of disease through the hands of health care workers. Factors involved in disease pathogenesis include the secretion of hydrolytic enzymes, adhesion to prosthetics, and biofilm formation. Impoant Points about Candida parapsilosis Candida species are presently the fouh leading cause of nosocomial bloodstream infection. Candida albicans is the most frequent isolate from blood cultures followed by Candida parapsilosis C. parapsilosis does not form true hyphae and exists in either a yeast phase or a pseudohyphal form. C. parapsilosis is notorious for its capacity to grow in total parenteral nutrition and to form biofilms on catheters and other implanted devices, for nosocomial spread by hand carriage. C. parapsilosis is of special concern in critically ill neonates, causing more than one-quaer of all invasive fungal infections in low-bih-weight infants. Additionally, it is the predominant fungal organism isolated in many neonatal intensive care units (NICUs), where it is often associated with neonatal moality C. parapsilosis is also a normal human commensal, and it is one of the fungi most frequently isolated from the subungal space of human hands C. parapsilosis fungemia can lead to seeding of tissues, resulting in deep-seated infections, and has a moality rate ranging from 4% to 45% Compared to C. albicans, C. parapsilosis more frequently caused fungemia among neonates, in patients with intravenous lines or vascular catheters, who had received prior antifungal agents, were on parenteral nutrition, or had undergone transplantation.
|
Microbiology
| null |
Candida parapsilosis
|
Hepatotoxic drugs are
|
Refer KDT 6/e p372 Massive liver necrosis following Halothane anaesthesia is seen in some cases If chloroform cos given for long period liver damage occurs
|
Pharmacology
|
Anesthesia
|
Both are above
|
Which of the following statement is false regarding phenobarbitone: September 2011
|
Ans. D: N significant interaction with warfarin Barbiturates stimulates hepatic microsomal catabolism of warfarin Phenobarbital/ Phenobarbitone It is a barbiturate It is the most widely used anticonvulsant worldwide, and the oldest still commonly used. The World Health Organization recommends its use as first-line for paial and generalized tonic-clonic seizures (those formerly known as grand mal) in developing countries. It is still commonly used to treat neonatal seizures. Phenobarbital is indicated in the treatment of all types of seizures except absence seizures. Sedation and hypnosis are the principal side effects (occasionally, they are also the intended effects) of phenobarbital. Central nervous system effects like dizziness, nystagmus and ataxia are also common. In elderly patients, it may cause excitement and confusion while in children, it may result in paradoxical hyperactivity. Another very rare side effect is amelogenesis imperfecta Contraindication: Acute intermittent porphyria, oversensitivity for barbiturates, prior dependence on barbiturates, severe respiratory insufficiency and hyperkinesia in children The principal mechanism of action of barbiturates is believed to be their affinity for the GABAA receptor (Acts on GABA : BDZ receptor Cl- channel complex). GABA is the principal inhibitory neurotransmitter in the central nervous system (CNS). Barbiturates bind to the GABAA receptor at the alpha subunit, which are binding sites distinct from GABA itself. Like benzodiazepines, barbiturates potentiate the effect of GABA at this receptor. In addition to this GABA-ergic effect, barbiturates also block the AMPA receptor, a subtype of glutamate receptor. Phenobarbital has an oral bioavailability of approximately 90%. Peak plasma concentrations are reached 8 to 12 hours after oral administration. It is one of the longest-acting barbiturates available - it remains in the body for a very long time (half-life of 2 to 7 days) and has very low protein binding (20 to 45%). Phenobarbital is metabolized by the liver, mainly through hydroxylation and glucuronidation, and induces many isozymes of the cytochrome P450 system. Cytochrome P450 2B6 (CYP2B6) is specifically induced by Phenobarbital It is excreted primarily by the kidneys Phenobarbital markedly reduces effect of warfarin
|
Pharmacology
| null |
No significant interaction with warfarin
|
Optic tract fibers project to the superior colliculi for
|
Optic tract fibers project to the superior colliculi for reflex gazesPretectal area for the light reflexSuprachiasmatic nucleus of the anterior hypothalamus for generation of circadian rhythms
|
Microbiology
|
All India exam
|
Reflex gazes
|
Traid of Bulgar urethral injury includes all except
|
Pelvic hematoma occurs in membranous urethral injury not bulbar urethral injury.
|
Surgery
| null |
Pelvic hematoma
|
Which of the following deals with section 377, I.P.C?
|
Voluntary sexual intercourse against the order of nature with any man, woman, or animal is an unnatural sexual offence (Section 377 I.P.C). Penetration is sufficient to constitute the offence. These offences are punishable with imprisonment for life or upto ten years and also with fine. Ref: The Essentials of Forensic Medicine and Toxicology, 27th edition, Page 363.
|
Forensic Medicine
| null |
Unnatural sex offences
|
A 60-year man had undergone cardiac bypass surgery 2 days back. Now he staed forgetting things and was not able to recall names and phone numbers of his relatives. What is the probable diagnosis?
|
The history of cardiac surgery 2 days prior followed by behavioral changes is suggestive of delirium. The question here is stressing on "disturbances of memory" which can be seen in delirium, however are usually restricted to sho term memory loss. The other impoant features such as clouding of consciousness and attention impairment have not been provided. Nonetheless, the most likely diagnosis appears to be delirium. As delirium has prominent cognitive dysfunction, that is the correct answer. Alzheimer disease does not have such sudden onset.
|
Psychiatry
|
Organic Mental Disorders
|
Cognitive dysfunction
|
Striatum damage affects priming
|
Implicit memory is subdivided into 4 types. Procedural memory includes skills and habits, which one acquired become unconscious and automatic. Priming is facilitation of recognition of words or objects by prior exposure to them. Ganong&;s review of medical physiology; 23rd edition; pg: 290
|
Physiology
|
Nervous system
|
Procedural memory
|
In facial palsy, food accumulated in the mouth due to paralysis of
|
(D) Buccinator > The facial nerve contributes to the oropharyngeal phase of deglutition via the buccinator, perioral, digastricus posterior, and stylohyoid muscles. The gustatory and salivatory functions of the facial nerve are also known to contribute to swallowing.> The relation between peripheral facial nerve palsy (PFP) and swallowing dysfunction has never been studied systematically
|
Medicine
|
Miscellaneous
|
Buccinator
|
Glycogen phosphorylase coenzyme associated is?
|
ANSWER: (D) Pyridoxal phosphateREF: Lehninger Principles of Biochemistry 4th edition page 562Pyridoxal phosphate is an essential cofactor in the glycogen phosphorylase reaction; itsphosphate group acts as a general acid catalyst, promoting attack by Pi on the glycosidic bond. (This is an unusual role for this cofactor; its more typical role is as a cofactor in amino acid metabolism)Flavin mononucleotide (FMN), or riboflavin-5'-phosphate, is a biomolecule produced from riboflavin (vitamin B2) by the enzyme riboflavin kinase and functions as prosthetic group of various oxidoreductases including NADH dehydrogenase as well as cofactor in biological blue- light photo receptors
|
Biochemistry
|
Glycogen Metabolism and Glycogen Storage
|
Pyridoxal phosphate
|
The minimum number of feeding days in a year recommended, under Mid-day meal programme is
|
Recommended norms of 450 Kcal and 12 g protein for a minimum of 200 days Ref : Park 23rd edition Pgno :661
|
Social & Preventive Medicine
|
Health programmes in India
|
250
|
Most characteristic eye lesion in diabetes is
|
Most characteristic - Capillary aneurysm.
|
Ophthalmology
| null |
Capillary aneurysm
|
A 24-year-old female complains of suicidal ideation. She lost her family in a car accident earlier this year. Since then, she had problems with focusing on her work. She was laid off from her work as she was making many errors due to false judgment. She was rescued from suicidal attempts a couple of times. She was prescribed electroconvulsive therapy. The intravenous anesthetic of choice for electroconvulsive therapy is:
|
Answer: c) MethohexitalMethohexital has minimum interference with therapeutic induction of seizures. Hence, it is the drug of choice for electroconvulsive therapy (ECT).Propofol can be used as an alternative if methohexital is contraindicated.Therapeutic seizures induced by ECT typically last for 15-70s.The steps involved in the anesthesia for ECT are as follows:Pre-oxygenation: Should be maintained at near 100%. It decreases post-seizure hyperventilation and prevents increased intensity of seizures.Anesthetic medication: Drug of choice is methohexital.Anticholinergic medication: It prevents vagally mediated bradycardia and reduces excess respiratory and oral secretions.Skeletal muscle relaxant: It prevents musculoskeletal injury.
|
Psychiatry
|
Treatment
|
Methohexital
|
40 yr old with koilonychias, iron deficiency & dysphagia, diagnosis is -
|
Ans. is 'a' i.e., Plummer Vinson syndrome Plummer-Vinson syndromeo Plummer-Vinson syndrome, also known as Brown-Kelly-Paterson syndrome or sederopenic dysphagia, seen in middle aged edentulous women.o The plummer Vinsion Paterson Brown Kelly Syndrome is characterized by: -DysphagiaChronic iron deficiency anemiaAtrophic oral mucosa and glossitisBrittle, spoon-shaped fingernails (Koilonychia)o The cause of dysphagia is usually a cervical esophageal web, but abnormal pharyngeal and esophageal motility may play a role.o The syndrome characterstically occurs in middle aged edentulous (without teeth) women, o It is a premalignant lesion. Approximately 10% of patient develop squamous cell Ca of esophagus, oral cavity or the hypopharynx.o As iron-deficiency anemia is a common finding, it is also known as sideropenic dysphagia. o Carcinoma develops in post-cricoid region.
|
ENT
|
Oesophagus
|
Plummer Vinson syndrome
|
The most common site of perforation in tympanic membrane is
|
Perforations. They may be central, attic or marginal and are associated with chronic otitis media The most common site of Tympanic membrane perforation is antero-inferior quadrant. Ref : Diseases of ENT by Dhingra 6th edition Pgno : 56,71
|
ENT
|
Ear
|
Antero inferior
|
A carrier who gets infected from another carrier is known as:-
|
Paradoxical carrier - A person gets infected from another carrier and himself becomes Carrier. Carriers are of 6 major types: Content carrier - Carrier gets infection from a case Paradoxical carrier - Carrier gets infection from another carrier Chronic carrier - Carrier for duration of more than 6 months Incubatory carrier - can transmit the agent during the incubation period before clinical illness begins. Convalescent carrier - can transmit the agent during recovery phase Pseudo carrier - asymptomatic carrier with avirulent organismsm.( no need to worry about it)
|
Social & Preventive Medicine
|
Other Key Definitions & Concepts
|
Paradoxical carrier
|
Which is the treatment of choice for CA head of pancreas
|
Answer- C. Whipple's SurgeryWhipples operation (Pancreaticoduodenectomy) is the most commonly performed operation for carcinoma of head of Pancreas.
|
Surgery
| null |
Whipple's Surgery
|
Kartagener's syndrome increase risk of -
|
Ans. is 'c' i.e., Bronchieactasis
|
Pathology
|
Respiration
|
Brochieactasis
|
An accused in a case of sodomy is brought for Medical Examination. On detailed questioning, he reveals that he is an active agent and is a regular participant. Which of the following will not be seen during the examination of the accused -
|
Presence of thick uniform coating of smegma under prepuce and around corona glandis is suggestive of absence of inter course (vaginal or anal) within the last 24 hours since it gets rubbed off during the sexual act.
However, its an unreliable sign with no medicolegal value as its presence or absence depends on personal hygiene.
|
Forensic Medicine
| null |
Presence of smegma
|
30 yea raid female comes with acute breathelessness, neck vein distension, absent breath sounds and mediastinal shift. Which of the following should be done immediately: (PGI June 2008)
|
Ans.: D {Large bore needls puncture of thorax) (Ref Harrison 17th/1660; Oxford Textbook of Surgery'/1932}The young lady from the case history is suffering from tension pneumothorax.The immediate management of such patient should be large bore neelds punctureQ of thorax through second anterior intercostals space to save the life- Oxford Textbook of Surgery/1932X-ray is used for confirmation of diagnosis, but urgent order is not requiredABC & HRCT is not necessaryFig.: Needle Insertion & thoracostomy tubeTension Pneumothorax Harrison I7th/1660# This condition usually occurs during mechanical ventilation or resuscitative efforts.The positive pleural pressure is life-threateningQ both because ventilation is severely compromised and because the positive pressure is transmitted to the mediastinum, which results in decreased venous return to the heart and reduced cardiac output.Difficulty in ventilation during resuscitation or high peak inspiratory pressures during mechanical ventilation strongly suggests the diagnosis.The diagnosis is made by physical examinationQ showing an enlarged hemithorax with no breath sounds, hvperresonance to percussion, and shift of the mediastinum to the contralateral side.Tension pneumothorax must be treated as a medical emergencyQIf the tension in the pieural space is not relieved, the patient is likely to die from inadequate cardiac output or marked hypoxemia.A large-bore needleQ should be inserted into the pleural space through the second anterior intercostal space. If large amounts of gas escape from the needle after insertion, the diagnosis is confirmed. The needle should be left in place until a thoracostomy tube can be inserted
|
Medicine
|
Pulmonary Diagnostic Procedures
|
Large bore needle puncture of pleura
|
All are true statements about Conversion disorder except
|
Conversion Disorder Conversion disorder is characterised by the following clinical features: 1. Presence of symptoms or deficits affecting motor or sensory function, suggesting a medical or neurological disorder. 2. Sudden onset. 3. Development of symptoms usually in the presence of a significant psychosocial stressor(s). 4. A clear temporal relationship between stressor and development or exacerbation of symptoms. 5. The patient does not intentionally produce the symptoms. 6. There is usually a ' secondary gain' (though not required by ICD-10 for diagnosis). 7. Detailed physical examination and investigations do not reveal any abnormality that can explain the symptoms adequately. 8. The symptom may have a 'symbolic' relationship with the stressor/conflict. There can be two different types of disturbances in conversion disorder; motor and sensory. Autonomic nervous system is typically not involved, except when the voluntary musculature is involved, e.g. vomiting, globus hystericus. Ref: A Sho Textbook of Psychiatry, Niraj Ahuja, 7th Edition, pg. no. 99
|
Psychiatry
|
Somatoform disorders
|
Autonomic nervous system involved
|
HLA gene for abacavir hypersensitivity is?
|
Drug allergies are the most significant allergic reactions occurring in HIV-infected patients and appear to become more common as the disease progresses. Anaphylaxis is extremely rare in patients with HIV infection, and patients who have a cutaneous reaction during a single course of therapy can still be considered candidates for future treatment or prophylaxis with the same agent. The one exception to this is the nucleoside analog abacavir, where fatal hypersensitivity reactions have been repoed with rechallenge. This hypersensitivity is strongly associated with the HLA-B5701 haplotype, and a hypersensitivity reaction to abacavir is an absolute contraindication to future therapy. Ref: Harrison&;s Principles of Internal Medicine; 19th edition; Chapter 226; Human Immunodeficiency Virus Disease: AIDS and Related Disorders; Page no: 1260
|
Medicine
|
Immune system
|
B57
|
Major Pyrogenic cytokine:
|
Ans. D. IL-1. (Ref Robbins Basic Pathology 8th/ Table 2-6).IL-1: fever.IL-2: stimulates T cells.IL-3: stimulates bone marrow.IL-4: stimulates IgE production.IL-5: stimulates IgA production.IL-6: stimulates acute-phase protein production.IL-8: recruites Neutrophils. Tumor Necrosis Factor and Interleukin-1# TNF and IL-1 are producedby activated macrophages, as well as mast cells, endothelial cells, and some other cell types.# Their secretion is stimulatedby microbial products, such as bacterial endotoxin, immune complexes, and products of T lymphocytes generated during adaptive immune responses.# The principal role of these cytokines in inflammation is in endothelial activation.# Both TNF and IL-1 stimulate the expression of adhesion molecules on endothelial cells, resulting in increased leukocyte binding and recruitment, and enhance the production of additional cytokines (notably chemokines) and eicosanoids.# TNF also increases the thrombogenicity of endothelium and causes aggregation and activation of neutrophils, and# IL-1 activates tissue fibroblasts, resulting in increased proliferation and production of ECM.- Although TNF and IL-1 are secreted by macrophages and other cells at sites of inflammation, they may enter the circulation and act at distant sites to induce the systemic acute-phase reaction that is often associated with infection and inflammatory diseases.- Components of this reaction include fever, lethargy, hepatic synthesis of various acute-phase proteins, metabolic wasting (cachexia), neutrophil release into the circulation, and release of adrenocorticotropic hormone (inducing corticosteroid synthesis and release). Role of Mediators in Different Reactions of InflammationVasodilationProstaglandins. Nitric oxide, HistamineIncreased vascular permeabilityHistamine and serotonin, C3a and C5a (by liberating vasoactive amines from mast cells, other cells), Bradykinin, Leukotrienes C4, D4, E4, PAF, Substance PLeukocyte recruitment and activationTNF, IL-1, Chemokines, C3a, C5a, Leukotriene B4 (Bacterial products, e.g., N-formyl methyl peptides)Fever0IL-1, TNF, ProstaglandinsPainProstaglandins, Bradykinin, NeuropeptidesTissue damageLysosomal enzymes of leukocytes, Reactive oxygen species, Nitric oxide CytokineCellular sourceTraget cellsBiologic effectsIL-1Monocytes and macrophagesT cells, B cells neuronsCostimulator pyrogenIL-2Tumor cells T cells (TH1)Endothelial cells T cellsB cellsNK cellsGrowthActivation and antibody productionActivation and growthIL-3T cellsImmature hemopoietic stem cellGrowth and differentiationIL-4T cells (TH2)B cellsActivation and growth; isotype switch to IgE; increased MHCII expression T cellsGrowthIL-6Monocytes and macrophages T cells, B cells Ovarian cancer cells Other tumors tumor cellsB cellsT cellsHepatocytesStem cell Autocrine/paracrine growth and viability-enhancing factorDifferentiation, antibody productionCostimulatorInduction of acute-phase responseGrowth and differentiationIL-10T cells (TH2)Monocytes and macrophagesT cells (Th1)Monocytes and macrophagesInhibition of cytokine synthesisInhibition of Ag presentiation and cytokine production B cellsAcivationIL-12MonocytesNK cells, T cells (TH1)InductionIL-13T cells (TH2), mast cells, NK cellsBcells, TH2 cells, macrophagesRegulates IgE secretion by B cell TH2developmentMacrophage activityIL-15Dendritic cells, monocytes, placenta, kidney, lung, heart, TcellsMast cellsNK cell development and functionMast cell proliferation11-16CD4+ and CD8+ T cells, eosinophils, mast cells, dendritic cellsT cells, monocytes, dendritic cells, eosinophilsPrevent antigen-induced T-cell death, chemotactic factor for CD4= T cells, monocytes, eosinophils, dendritic cellsIL-17Acivated CD4+ T cellsT cell, fibrobiastsT-cell activation Induces secretion ofcytokiness by fibroblastsIL-27Monocytes, macrophagesCD4+ T cellsProliferation of naive CD4+ T cells, synergizes with IL-12IFN-YT cells (TH1) NK cellsMonocytes/ macrophagesNK cells, T cells, B cellsActivationAcivation Enhanves responsesTNF-aMonocytes and macrophages T cellsMonokine productionCostimulator pyrogenMonocytes/ macrophages T cells, B cells Neurons Endothelial cells Muscle and fat cellsActivation, inflammationCatabolism/cachexiaAdditional Educational points:# The major cytokines in acute inflammation are TNF and IL-1, as well as a group of chemoattractant cytokines called chemokines. Other cytokines that are more important in chronic inflammation include interferon-? (IFN-?) and IL-12.# Chemokines are classified into four groups based on the arrangement of highly conserved cysteine residues. The two major groups are the CXC and CC chemokines:- CXC chemokines have one amino acid separating the conserved cysteines and act primarily on neutrophils.* IL-8 is typical of this group; it is produced by activated macrophages, endothelial cells, mast cells, and fibroblasts, mainly in response to microbial products and other cytokines such as IL-1 and TNF.- CC chemokines have adjacent cysteine residues and include:* monocyte chemoattractant protein 1 (MCP-1) and macrophage inflammatory protein 1? (MIP-1?) (both chemotactic predominantly for monocytes),* RANTES (regulated on activation normal T expressed and secreted) (chemotactic for memory CD4+ T cells and monocytes), and* eotaxin (chemotactic for eosinophils).
|
Pathology
|
Cellular Pathology
|
IL-1
|
Subsets and Splits
No community queries yet
The top public SQL queries from the community will appear here once available.