JIPMER November 2014 exam held on Sunday 23rd November 2014
- it is a very interesting paper with challenging MCQs .
- The JIPMER November 2014 MCQs recalled by students of onlinembbs.com are published here with explanatory answers.
- The discussion on the paper will be held at 5 pm online on Tuesday Nov 25 at Nampally centre Hyderabad and also you can attend free online at http://anatomy2medicine.com/watch-online-video-class/
- Don’t forget to visit our other page http://news4medico.com/jipmer-pg-medical-entrance/ which has JIPMER 2014 Feb MCQs and JIPMER 2010 video discussion. Also you can go to download section and download 4000 pages of pdf notes for PG Medical entrance prep .
- We keep uploading MCQs with explanations as and when they get ready . Hence keep revisiting this page .
- JIPMER 2014 November discussion by Dr Murali Bharadwaz Sir at 5 pm Tuesday 25 th November at news4medico dot com.JIPMER 2014 November discussion by Dr Murali Bharadwaz Sir at 5 pm Tuesday 25 th November at news4medico dot com.AnatomyJIPMER 2014 November discussion by Dr Murali Bharadwaz Sir at 5 pm Tuesday 25 th November at news4medico dot com.
JIPMER 2014 November discussion by Dr Murali Bharadwaz Sir at 5 pm Tuesday 25 th November at news4medico dot com.
1. Gray ramus communicans contains? (JIPMER November 2014)
a) Preganglionic sympathetic fibres
b) Postganglionic sympathetic fibres
- Each spinal nerve receives a branch called a gray ramus communicans from the adjacent paravertebral ganglion of the sympathetic trunk. The gray rami communicantes contain postganglionic nerve fibres of the sympathetic nervous system.Preganglionic sympathetic fibres from the intermediolateral cell column (lateral grey horn) of the spinal cord are carried in the white ramus communicans to the paravertebral ganglia of the sympathetic trunk. Once the preganglionic nerve has traversed a white ramus communican, it can do one of three things.The preganglionic neuron can synapse with a postganglionic sympathetic neruron in the sympathetic paravertebral ganglion at that level. From here, the postganglionic sympathetic neuron can travel back out the grey ramus communican of that level to the mixed spinal nerve and on to the effector organ.
The preganglionic neuron can travel up (towards the head) or down (towards the feet) to a sympathetic paravertebral ganglion of a higher/lower level where it can synapse with a postganglionic sympathetic neruron. From here, the postganglionic sympathetic neuron can travel back out the grey ramus communican of that level to the mixed spinal nerve and on to an effector organ.
The preganglionic neuron can pass through the paravertebral ganglion without synapsing, and therefore continue as a preganglionic nerve fibre until it reaches a distant collateral ganglion anterior to the vertebral column. At the distal ganglion, it can synapse with postganglionic nerve fibres responsible for innervation of the pelvic viscera. From here, the postganglionic sympathetic neuron can travel out the grey ramus communican of that level to its visceral effector organ.
JIPMER 2014 November discussion by Dr Murali Bharadwaz Sir at 5 pm Tuesday 25 th November at news4medico dot com.
@ Which of the following is not a tributary of hepatic portal vein (JIPMER November 2014)
a) Superior mesenteric vein
b) Splenic vein
c) Cystic vein
d) inferior phrenic vein
In most individuals, the hepatic portal vein is formed by the union of the superior mesenteric vein and the splenic vein.
For this reason, the hepatic portal vein is occasionally called the splenic-mesenteric confluence.
Occasionally, the hepatic portal vein also directly communicates with the inferior mesenteric vein, although this is highly variable. Other tributaries of the hepatic portal vein include the cystic and gastric veins
JIPMER 2014 November discussion by Dr Murali Bharadwaz Sir at 5 pm Tuesday 25 th November at news4medico dot com.
@ Which of the following structure does not cross the root of mesentery (JIPMER November 2014)
a) Abdominal aorta
b) second part of duodenum
c) Right Ureter
d) Right gonadal vessels
The root of the mesentery (or mesenteric root)—the part connected with the structures in front of the vertebral column—is narrow, about 15 cm. long, and is directed obliquely from the duodenojejunal flexure at the left side of the second lumbar vertebra to the right sacroiliac articulation.
Structures crossed by root of mesentery:
1. Horizontal (3rd) and Ascending (4th) part of duodenum.
2. Abdominal aorta.
4. Right Ureter.
5. Right Psoas major.
6. Right gonadal vessels
@ Deep inguinal ring is present in (JIPMER November 2014)
a) internal oblique aponeurosis
b) transverse abdominis
c) aponeurosis of the external oblique
Deep inguinal ring
- it is at the layer of the transversalis fascia.
- It is bounded, above and laterally, by the arched lower margin of the transversalis fascia; below and medially, by the inferior epigastric vessels.
- It transmits the spermatic cord in the male and the round ligament of the uterus in the female.
Superficial inguinal ring
- The superficial inguinal ring (subcutaneous inguinal ring or external inguinal ring) is an anatomical structure in the anterior wall of the human abdomen. It is a triangular opening that forms the exit of the inguinal canal, which houses the ilioinguinal nerve, the genital branch of the genitofemoral nerve, and the spermatic cord (in men) or the round ligament (in women). At the other end of the canal, the deep inguinal ring forms the entrance.
- It is found within the aponeurosis of the external oblique, immediately above the crest of the pubis, 1 centimeter above and lateral to the pubic tubercle. It has medial and lateral crura. It is at the layer of the aponeurosis of the obliquus externus abdominis
@The following are branches of Popliteal artery branches except (JIPMER November 2014)
a) Genicular artery
b) Anterior tibial artery
c) Posterior tibial artery
- The popliteal artery is a deeply placed continuation of the femoral artery after it passes through the adductor hiatus, or opening in the distal portion of the adductor magnus muscle. It courses through the popliteal fossa and ends at the lower border of the popliteus muscle, where it branches into the anterior and posterior tibial arteries.
- The branches of the popliteal artery are:
o anterior tibial artery
o posterior tibial artery
o sural artery
o medial superior genicular artery
o lateral superior genicular artery
o middle genicular artery
o lateral inferior genicular artery
o medial inferior genicular artery
- Muscular branches of the popliteal artery supply the hamstring, gastrocnemius, soleus, and plantaris muscles. The superior muscular branches of the popliteal artery have clinically important anastomoses with the terminal part of the deep femoral and gluteal arteries
@Myelination begins at which week in fetal development (JIPMER November 2014)
In humans, myelination begins in the 14th week of fetal development, although little myelin exists in the brain at the time of birth
@ A patient came with breathlessness to emergency opd..Doctor advised an X-ray..The patient told that he has azygous lobe .Azygous lobe is seen in which view?
a.right upper lobe
b.right lower lobe
C.left upper lobe
D.left lower lobe
An azygos lobe is created when a laterally displaced azygos vein makes a deep fissure in the upper part of the lung during embryological development. It is therefore not a true accessory lobe, but rather a normal variant appearance of the right upper lobe, which results from invagination of the azygos vein
@Adduction of wrist is more than abduction because (JIPMER November 2014)
A) radial styloid is lower than ulnar styloid
Adduction of the hand is considera- bly greater than abduction perhaps due to more proximal site of ulnar styloid process and it occurs mostly at the radiocarpal joint; whereas the abduction from the neutral position occurs at the midcarpal joint, the prox- imal carpal row is not moving considerably. The ad- duction / abduction movements occur around an AP axis perpendicular to the axis of the 3rd metacarpal bone if extended through the distal radius. In abduction much of the proximal articular surface of the scaphoid becomes subcapsular beneath the radial collateral liga- ment and forms a smooth, convex, palpable promi- nence in the floor of the anatomical snuff box
Being a carpal bone scaphoid has an important role in wrist movements. Wrist joint is a synovial modified ellipsoid joint where movements like flexion, extension and adduction, abduction take place around two xes (transverse and antero-posterior).
The wrist is more stable in flexion than in extension more because of the strength of various capsules and ligaments than the interlocking parts of the skeleton
Mechanically the wrist is the most complex joint in hu- man body and is generally considered as ellipsoid variety of biaxial joint. It has a large arc of motion, incremental adjustment capabilities and substantial resistance to forces and torques.
@ Level of Facial nerve. lesion with Intact lacrimation on schrimer test and loss of taste in anterior 2/3 of tongue is
a Horizontal canal
c.Internal auditory canal
- Pontine leision : Facial palsy+ Strabismus + Contralateral hemiplegia + Facial sensory loss
- Cerebellopontine leision : VIII Nerve paralysis+ loss of taste in anterior 2/3 of tongue + loss of lacrimation (involvement of petrosal nerves) + Facial palsy
- Facial canal Leisions :
o Between internal auditory meatus and geniculate ganglion : loss of taste in anterior 2/3 of tongue + loss of lacrimation (involvement of petrosal nerves) + Facial palsy
o At geniculate ganglion : Herpetic vescicles at external ear + loss of taste in anterior 2/3 of tongue + loss of lacrimation (involvement of petrosal nerves) + Facial palsy
o Below geniculate ganglion to stylomastoid foramen : loss of taste in anterior 2/3 of tongue + intact lacrimation +hyperacusis + Facial palsy
o At Stylomastoid foramen : only Facial palsy without other neurologic signs
The facial nerve has six named segments:
- intracranial (cisternal) segment
- meatal segment (internal auditory canal) – 8mm – zero branches
- labyrinthine segment (IAC to geniculate ganglion) – 3-4mm – 3 branches (from geniculate ganglion)
- tympanic segment (from geniculate ganglion to pyramidal eminence) – 8-11mm – zero branches
- mastoid segment (from pyramidal eminence to stylomastoid foramen) – 8-14mm – 3 branches
- extratemporal segment (from stylomastoid foramen to division into major branches) 15-20mm – 9 branches
The facial canal is a Z-shaped canal running through the temporal bone from the internal acoustic meatus to the stylomastoid foramen. In humans it is approximately 3 centimeters long, which makes it the longest human osseous canal of a nerve.It is located within the middle ear region, according to its shape it is divided into three main segments: the labyrinthine, the tympanic, and the mastoidal segment. It contains Cranial Nerve VII, also known as the facial nerve.
- Labyrinthine segment
- As the facial nerve and nervus intermedius pass through the anterior superior quadrant of the internal acoustic meatus it enters the Fallopian canal, passing anterolaterally between and superior to the cochlea (anterior) and vestibule (posterior), and then runs back posteriorly at the geniculate ganglion (where the nervus intermedius joins the facial nerve and where fibers for taste synapse – see function below).
- It is here that three branches originate:
o greater superficial petrosal nerve
o lesser petrosal nerve
o external petrosal nerve
- The labyrinthine segment is the shortest only measuring 3-4 mm.
- It is also the narrowest and the most susceptible to vascular compromise
- Tympanic segment
- As the nerve passes posteriorly from the geniculate ganglion it becomes the tympanic segment (8-11 mm in length) and is immediately beneath the lateral semicircular canal in the medial wall of the middle ear cavity. The bone of the Fallopian canal is often dehiscent in the area of the oval window in 25-55% of postmortem specimens, having mucosa in direct contact with the nerve. The nerve passes posterior to the cochleariform process, tensor tympani and oval window. Just distal to the pyramidal eminence the nerve makes a second turn (second genu) passing vertically downwards as the mastoid segment.
- The tympanic segment has no branches.
- The mastoid segment, measuring 8-14mm in length, extends from the second genu to the stylomastoid foramen, through what is confusingly referred to as the Fallopian canal.
- It gives off three branches:
o nerve to stapedius
o chorda tympani – terminal branch of the nervus intermedius carrying both secretomotor fibres to the submandibular gland and sublingual gland and taste to the anterior two thirds of the tongue
o nerve from the auricular branch of the vagus nerve (CN X) – pain fibers to the posterior part of the external acoustic meatus hitchhike from the jugular foramen
@ Compression of hook of hamate with hyperextended hand causes damage to
a) superficial cutaneous branch of ulnar nerve
b) dorsal sensory branch branch of ulnar Nerve
c) deep motor branch of ulnar Nerve
d) Median Nerve
Ulnar nerve :
- dorsal sensory branch:
o the nerve emerges from the medial border of the FCU about 5 cm proximal to the pisiform;
o supplies dorsoulnar aspect of the hand and the ulnar 1 1/2 fingers
- terminal branches in the hand:
o guyon’s canal:
o superficial cutaneous branch to ulnar portion of palm & volar surfaces of ulnar 1 1/2 fingers,
o deep motor branch passes adjacent to hook of hamate
If there is a history of trauma, hook of the hamate fracture is the most common cause of compression in zones 1 and 2.
At the level of the wrist, the ulnar nerve and artery enter the ulnar tunnel. The ulnar tunnel is 4 cm long and begins at the proximal edge of the volar carpal ligament, a continuation of the antebrachial fascial
Zone 1 is the level that includes the sensory and motor fascicles. It is bound ulnarly by the FCU and the pisiform. The motor fascicles lie deep (dorsal-ulnar) to the sensory fascicles within the nerve at this level
Zone 2 is the region that involves the deep motor branch. It is bounded superficially by the palmaris brevis muscle and the fibrous arch of the hypothenar muscles; radially by the hook of the hamate, the transverse carpal ligament, and the flexor digiti minimi muscle; deeply by the pisohamate and pisometacarpal ligaments, with the triquetrohamate joint as the floor; and ulnarly by the superficial branch of the ulnar nerve and the abductor digiti minimi muscle. The deep motor branch passes through zone 2, around the hook of the hamate, and then between the pisohamate ligament and the fibrous arch of the flexor digiti minimi. Within zone 2, the deep motor branch innervates the abductor digiti minimi, the flexor digiti minimi, and the opponens digiti minimi from ulnar to radial. Distal to zone 2 and the hook of the hamate, the deep motor branch innervates the ring- and small-finger lumbricals, the palmar and dorsal interosseous muscles, the adductor pollicis, and the deep portion of the flexor pollicis brevis.
Zone 3 is the area that involves the superficial sensory branch. It is bound superficially by the palmaris brevis and the ulnar artery, radially by the deep motor branch (zone 2), ulnarly by the abductor digiti minimi muscle, and deeply by the flexor digiti minimi, with the hypothenar fascia acting as the floor. Within zone 3, the superficial sensory branch gives off branches to the palmaris brevis
The hamate is the medial bone in the distal row of carpal bones, located beneath the base of the little finger. Fractures at the hook of the hamate most often are a diagnostic problem in patients who sustain a direct blow against the hamate from the handle of a tennis racket or golf club during an unbalanced swing. Radiation of pain to the dorsum of the hand is common, and the patient will have point tenderness over the hook of the hamate, located at the ulnar aspect of the palm near the base of the fourth metacarpal. The mechanism of injury can provide a clue to the diagnosis, but the injury could also be a stress injury with a less obvious initiating event.
@ In a supracondylar fracture ,pointing index finger is due to the damage to
a) anterior interosseus branch of median Nerve
b) posterior interosseous nerve
@N acetyl cysteine NAC replenishes intracellular levels of
NAC replenishes intracellular levels of the natural antioxidant glutathione
@Hydrochlorthiazide effect on Lithium
What happens to lithium levels in blood when used with hydrochlorothiazide
a) Blood levels of lithium rise
b) Blood levels of lithium decrease
c) Blood levels of hydrochlorothiazide rise
d) Blood levels of hydrochlorothiazide decrease
- Drugs that alter renal function can increase the risk for chronic lithium toxicity Among these, ACE inhibitors, NSAID, and thiazide diuretics increase the reabsorption of lithium and result in increased serum lithium concentration
- Factors that increase the risk for lithium toxicity
- Cystic fibrosis
- Decreased effective circulating volume
o congestive heart failure
o nephrotic syndrome
- Decreased dietary sodium intake
o Diabetes insipidus
o Diabetes mellitus
o angiotensin-converting enzyme inhibitors
o diuretics: loop diuretics and thiazides
o nonsteroidal anti-inflammatory drugs
- Renal insufficiency
- Volume depletion
@ Mechanism of action of Alendronate
a) inhibit osteoclast activity
- Alendronate inhibits osteoclast-mediated bone-resorption. Like all bisphosphonates, it is chemically related to inorganic pyrophosphate, the endogenous regulator of bone turnover. But while pyrophosphate inhibits both osteoclastic bone resorption and the mineralization of the bone newly formed by osteoblasts, alendronate specifically inhibits bone resorption without any effect on mineralization at pharmacologically achievable doses. Its inhibition of bone-resorption is dose-dependent and approximately 1,000 times stronger than the equimolar effect of the first bisphosphonate drug, etidronate. Under therapy, normal bone tissue develops, and alendronate is deposited in the bone-matrix in pharmacologically inactive form. For optimal action, enough calcium and vitamin D are needed in the body in order to promote normal bone development. Hypocalcemia should, therefore, be corrected before starting therapy.
- Etidronate has the same disadvantage as pyrophosphate in inhibiting mineralization, but all of the potent N-containing bisphosphonates including Alendronate and also risedronate, ibandronate, and zoledronate, do not.
@ Mechanism of action of metformin
a) increase peripheral glucose uptake
b) stimulate release of insulin
Metformin may also increase glucose utilization in peripheral tissues, and possibly reduce food intake and intestinal glucose absorption
Which of following drugs act as a fusion inhibitor
HIV drugs mnemonic
- FUsion inhibitors – EnFUvirtide
o Fu – four – gp four one – binds gp 41 inhibiting viral entry.
- Maraviroc – You rock when you are 5, you rock when you are 12 and you rock when you are 20.
o Binds CCR 5 inhibiting in interaction with gp 120.
- InTEGRAse inhibitors – RalTEGRAvir
o Inhibits HIV genome integration into host cell chromosome by inhibiting HIV integrase.
- Have you dined with my nuclear family?
o Drugs that end in “-vudine” are Nucleoside Reverse Transcriptase Inhibitors!
- Never tease a pro-tease.
o Drugs that end in “-navir” are Protease Inhibitors!
Enfuvirtide works by disrupting the HIV-1 molecular machinery at the final stage of fusion with the target cell, preventing uninfected cells from becoming infected. A biomimetic peptide, enfuvirtide was designed to mimic components of the HIV-1 fusion machinery and displace them, preventing normal fusion. Drugs that disrupt fusion of virus and target cell are termed entry inhibitors or fusion inhibitors.
HIV binds to the host CD4+ cell receptor via the viral protein gp120; gp41, a viral transmembrane protein, then undergoes a conformational change that assists in the fusion of the viral membrane to the host cell membrane. Enfuvirtide binds to gp41 preventing the creation of an entry pore for the capsid of the virus, keeping it out of the cell
@ Which of the following is not a cause of drug induced hepatitis
d) Methyl dopa
Isoniazid, pyrazinamide, sulphonamides, ketoconazole, methyldopa, phenytoin and others may produce acute hepatocellular necrosis
@ A 35yr old male taking methotrexate 7.5mg /wk.His wife with no significant past medical history is on Oral contracptive pills.Now the couple want to conceive.What is your advice?
a) methotrexate should be stopped before 3months in males with effective contraception till then
b) methotrexate should be stopped before 4 weeks in males with effective contraception till then
Methotrexate can cause birth defects and should be stopped before trying to conceive. Just how long the drug should be stopped for is under debate – some say six months, some three months. It is also recommended by the manufacturers that TNF inhibitors are also discontinued prior to conception but the evidence that these drugs cause birth defects is not anywhere near as strong –
People taking methotrexate, both male and female, are advised to discontinue taking the drug at least three months prior to conception because there is a chance that the drug may cause birth defects. The period of time off the drug used to be six months but has recently been reduced to three, much to our relief. In people who have arthritis some other way of controlling the disease must be found during this period. For men, once pregnancy is conﬁrmed they can go straight back on to methotrexate. Women, however, are advised to stay off the drug throughout pregnancy. Fortunately the pregnancy itself often helps rheumatoid arthritis but not until about 12 weeks. In the period of time between stopping the methotrexate and the pregnancy associated relief some other ‘safer’ drug is used or a short period of time on steroids is recommended
@When patient is on isotretinoin therapy , monitoring of which of the following is done
a) liver function test
b) lipid profile
c) renal function tests
As part of the monitoring, patients’ blood is periodically re-tested throughout treatment for blood lipids, pregnancy, and several other factors. Women, diabetics, and patients with liver problems are particularly at risk and will be monitored especially closely.
@At low dose,linear increase in plasma drug concentration and at higher dose, steep increase in drug concentration is what type of kinetics?
c. Psuedo Zero order
- First-order processes by which a constant fraction of drug is transported/metabolised in unit time.
- Zero-order processes by which a constant amount of drug is transported/metabolised in unit time.
For some drugs it is observed that the elimination of the drug appears to be zero order at high concentrations and first order at low concentrations. That is ‘concentration’ or ‘dose’ dependent kinetics are observed. At higher doses, which produce higher plasma concentrations, zero order kinetics are observed, whereas at lower doses the kinetics are linear or first order.
As the amount of drug in the body rises, metabolic reactions or processes that have limited capacity become saturated. In other words, the rate of the process reaches a maximum amount at which it stays constant, e.g. due to limited activity of an enzyme, and any further increase in rate is impossible despite an increase in the dose of drug. In these circumstances, the rate of reaction is no longer proportional to dose, and exhibits rate-limited or dose-dependent5 or zero-order or saturation kinetics. In practice, enzyme-mediated metabolic reactions are the most likely to show rate limitation because the amount of enzyme present is finite and can become saturated.
@ The incorrect match of antidote among following
- cyanide poisoning – methylene blue
- N-acetyl-l-cysteine –paraquat
- isopropyl alcohol – ethanol
- oxime -sarin
Administration of N-acetyl-l-cysteine (NAC), an antioxidant, prior to paraquat may attenuate the paraquat toxicity both in vivo and in vitro
Like other nerve agents, sarin attacks the nervous system by interfering with the re-absorption of neurotransmitters at neuromuscular junctions. Death will usually occur as a result of asphyxia due to the inability to control the muscles involved in breathing function.
Specifically, sarin is a potent inhibitor of acetylcholinesterase, an enzyme that degrades the neurotransmitter acetylcholine after
- Ethanol and isopropyl alcohol have no specific antidote
- Ethanol and fomepizole are for ethylene glycol and methanol poisoning
Isopropyl alcohol (isopropanol, 2-propanol, propan-2-ol) is commonly used as a disinfectant, antifreeze, and solvent, and typically comprises 70 percent of “rubbing alcohol.” People ingest isopropyl alcohol to become intoxicated (ie, ethanol substitute) or to harm themselves. When ingested, isopropyl alcohol functions primarily as a central nervous system (CNS) inebriant and depressant, and its toxicity and treatment resemble that of ethanol.
Fomepizole competitively inhibits ADH and is an effective and safe antidote for both ethylene glycol and methanol toxicity.
Supportive measures are generally sufficient if patient is not comatose or hypotensive. Some studies suggest that isopropanol levels between 150 and 200 mg/dL are associ- ated with increased mortality,6,42 whereas in others, blood levels of
- Supportive measures are generally sufficient if patient is not comatose or hypotensive. Some studies suggest that isopropanol levels between 150 and 200 mg/dL are associ- ated with increased mortality,6,42 whereas in others, blood levels ofSupportive measures are generally sufficient if patient is not comatose or hypotensive. Some studies suggest that isopropanol levels between 150 and 200 mg/dL are associ- ated with increased mortality,6,42 whereas in others, blood levels of
It is reasonable to initiate hemodialysis if the patient presents with hypotension and coma or blood isopropanol levels of > 200 mg/dL
The nitrites oxidize some of the hemoglobin’s iron from the ferrous state to the ferric state, converting the hemoglobin into methemoglobin.
Cyanide binds avidly to methemoglobin, forming cyanmethemoglobin, thus releasing cyanide from cytochrome oxidase
Treatment with nitrites is not innocuous as methemoglobin cannot carry oxygen, and methemoglobinemia needs to be treated in turn with methylene blue.
Oxime compounds are used as antidotes for nerve agents
@ Lenalidomide co administration with which drug increases risk of deep vein thrombosis
Lenalidomide has demonstrated a significantly increased risk of deep vein thrombosis (DVT) and pulmonary embolism (PE), as well as risk of myocardial infarction and stroke in patients with multiple myeloma who were treated with Lenalidomide and dexamethasone therapy
@ You can prevent spread of MRSA in ICU by
a) Redoing culture
b) Simple handwashing by all medical personnel
c) Mopping floor with chlorohexidine
d) Test staff for nasal swab test and isolating positive ones
@ The mechanism of cholera toxin is activation of
a) adenylate cyclase
b) guanylate cyclase
c) protein synthesis
Cholera toxin acts by the following mechanism: First, the B subunit ring of the cholera toxin binds to GM1 gangliosides on the surface of target cells. Once bound, the entire toxin complex is endocytosed by the cell and the cholera toxin A1 (CTA1) chain is released by the reduction of a disulfide bridge. The endosome is moved to the Golgi apparatus, where the A1 protein is recognized by the endoplasmic reticulum chaperon, protein disulfide isomerase. The A1 chain is then unfolded and delivered to the membrane, where the ER-vcoxidase – ER oxidoreductin triggers the release of the A1 protein by oxidation of protein disulfide isomerase complex. As the A1 protein moves from the ER into the cytoplasm by the Sec61 channel, it refolds and avoids deactivation as a result of ubiquitination.
CTA1 is then free to bind with a human partner protein called ADP-ribosylation factor 6 (Arf6); binding to Arf6 drives a change in the shape of CTA1 which exposes its active site and enables its catalytic activity. The CTA1 fragment catalyses ADP-ribosylation of the Gs alpha subunit (Gαs) proteins using NAD. The ADP-ribosylation causes the Gαs subunit to lose its catalytic activity in hydrolyzing GTP to GDP + Pi so it remains activated longer than normal. Increased Gαs activation leads to increased adenylate cyclase activity, which increases the intracellular concentration of cAMP to more than 100-fold over normal and over-activates cytosolic PKA. These active PKA then phosphorylate the cystic fibrosis transmembrane conductance regulator (CFTR) chloride channel proteins, which leads to ATP-mediated efflux of chloride ions and leads to secretion of H2O, Na+, K+, and HCO3- into the intestinal lumen. In addition, the entry of Na+ and consequently the entry of water into enterocytes are diminished. The combined effects result in rapid fluid loss from the intestine, up to 2 liters per hour, leading to severe dehydration and other factors associated with cholera, including a rice-water stool.
Interestingly, the pertussis toxin (also an AB5 protein) produced by Bordetella pertussis acts in a similar manner with the exception that it ADP-ribosylates the Gαi subunit, rendering it inactive and unable to inhibit adenylyl cyclase production of cAMP (leading to constitutive production)
@ Example of meta zoonoses is?
Classification of zoonoses.
The World Health Organization Expert Committee on Zoonoses recommends the following categories:
1) Direct Zoonoses. Transmitted from infected vertebrate host to a susceptible vertebrate host by direct contact, fomented, or by a mechanical vector. No developmental change or propagation of the organism occurs during the transmission. Examples: Rabies, trichinosis, and brucellosis.
2) Cyclozoonoses. Requires more than one vertebrate host, but no invertebrate host.
Examples: Human taeniasis and echinococcosis infections.
3) Metazoonoses. Agent multiplies, develops, or both in an invertebrate host before transmission to a vertebrate host is possible. (A definite incubation period must be completed before transmission.)
Examples: arboviruses, plague, and schistosomiasis.
4) Saprozoonoses. To transmit these infections a non-animal development site or reservoir is required, such as food plants, soil, or other organic material. Examples: larva migrants and some of the mycotic diseases
@ infection with neisseria occurs in deficiency of which of the following components of immune system
a) terminal complement components
@Diagnosis of respiratory viral infection is best done with
D) Nucleic acid amplification tests
In the past decade, there has been a marked improvement in the availability of laboratory and point-of-care tests for the diagnosis of respiratory virus infections. Commercial manufacturers have introduced new rapid respiratory virus culture methods, pooled antibody reagents, rapid antigen direct tests (RADTs), and improved specimen collection devices. Most important among these is the development of commercial, Food and Drug Administration (FDA)-approved, and laboratory-developed nucleic acid amplification tests (NAATs).
@ Inspite of Pretransfusion testing, post transfusion hepatitis continues to spread in blood transfusions because
a) Hepatitis B Antigen test is poor
b) Donor in window period don’t produce Hepatitis B Antigen
c) Hepatitis C is not tested
d) hepatitis is caused by CMV
.In spite of meticulous testing one can not detect the infections in “Window Phase”.
During the window period (or equivalence zone) of hepatitis B, both serological markers HBsAg (Hepatitis B surface antigen) and Anti-HBs (antibody against HBsAg) are negative (which is due to the fact that, although there are Anti-HBs antibodies present, they are actively bound to the HBsAg). Other serological markers, IgM (antibody) against HBc can be positive at this point.
In spite of technological advancements, the problems of ‘window period’, false- negative results, prevalence of asymptomatic carriers, genetic variability in viral strains and technical errors to be considered.
Post-transfusion hepatitis B continues to be the most common cause of post-transfusion hepatitis in India. Screening of donor units for HBsAg by ELISA does not exclude all blood units infectious for hepatitis B virus
Hepatitis B is one of the common TTI. In most of the blood banks the diagnosis of HBV infection is based on the presence of Hepatitis B Surface Antigen in the Blood stream which does not confirm the absence of HBV infection. The occult HBV infection can only be diagnosed by HBc and HBV DNA. Many workers had shown a significant numbers of HBsAg negative blood donors were anti HBc positive and exposed to HBV infection. These donors are potential for transmitting HBV contaminated blood
Cytomegalovirus (CMV) can be transmitted by WBCs in transfused blood. It is not transmitted through fresh frozen plasma. Because CMV does not cause disease in immunocompetent recipients, routine antibody testing of donor blood is not required. However, CMV may cause serious or fatal disease in immunocompromised patients, who should probably receive CMV-negative blood products that have been provided by CMV antibody-negative donors or by blood depleted of WBCs by filtration.
@ False about staphylococcus aureus
b) coagulase positive
c) oxidase negative
d) DNAse positive
S. aureus is catalase-positive (meaning it can produce the enzyme catalase). Catalase converts hydrogen peroxide to water and oxygen. Catalase-activity tests are sometimes used to distinguish staphylococci from enterococci and streptococci. Previously, S. aureus was differentiated from other staphylococci by the coagulase test. However it is now known that not all S. aureus are coagulase-positive
@ A diabetic presented with cellulitis of middle finger. Most likely organism is
b) Pseudomonas aeruginosa
By far the most common causes of SSTIs are Staphylococcus aureus and streptococcal species like S. pyogenes and S. agalactia. In diabetics, infections of foot ulcers are frequently polymicrobial involving gram positive organisms, gram negatives like the enterobacteriacea group or pseudomonas and anaerobes. But, in cases of cellulitis in diabetics and also non- diabetics who do not have open wounds, staphylococcus and streptococcus cause almost all cases
@ Resistance to streptococcus pneumonia is most commonly acquired through
b) altered pencillin binding protein
c) efflux pump
d) extended spectrum beta lactamase
The mechanism of penicillin resistance with S. pneumoniae is alterations of the targets of penicillin action, penicillin binding proteins (PBPs).
@ 13. All are properties of exotoxin except
a) heat stable
@ A person with 5 litres of blood and heart rate of of 72/minute . Calculate stroke volume
a) 70 ml
b) 50 ml
c) 110 ml
d) 90 ml
@pulmonary system is unique from rest of circulation due to..
a) low pressure , high flow ,low compliance system
b) high pressure , high flow ,high compliance system
c) high pressure , low flow ,low compliance system
d) low pressure , high flow ,high compliance system
The pulmonary circulatory system handles the same cardiac output as the systemic circulation but in a very different way. The systemic circulation is a high-pressure system. This high pressure is necessary to pump blood to the top of the brain while standing or even to a maximally elevated fingertip. The systemic circulation also needs to be a high-pressure system because it is a high-resistance system. It uses this high resistance to control the distribution of blood flow. Thus, at rest, a substantial fraction of the systemic capillaries are closed, giving the system the flexibility to redistribute large amounts of blood (e.g., to muscle during exercise). The mean pressure of the aorta is ∼95 mm Hg
In contrast, the pulmonary circulation is a low-pressure system. It can afford to be a low-pressure system because it needs to pump blood only to the top of the lung. Moreover, it must be a low-pressure system to avoid the consequences of Starling forces which would otherwise flood the lung with edema fluid. The mean pressure in the pulmonary artery is only ∼15 mm Hg.
Thus, the total resistance of the pulmonary circulation is less than one tenth that of the systemic system, which explains how the pulmonary circulation accomplishes its mission at such low pressures. Unlike in the systemic circulation, where most of the pressure drop occurs in the arterioles (i.e., between the terminal arteries and beginning of the capillaries), in the pulmonary circulation almost the entire pressure drop occurs rather uniformly between the pulmonary artery and the end of the capillaries. In particular, the arterioles make a much smaller contribution to resistance in the pulmonary circulation than in the systemic circulation.
Thus, the total resistance of the pulmonary circulation is less than one tenth that of the systemic system, which explains how the pulmonary circulation accomplishes its mission at such low pressures. Unlike in the systemic circulation, where most of the pressure drop occurs in the arterioles (i.e., between the terminal arteries and beginning of the capillaries), in the pulmonary circulation almost the entire pressure drop occurs rather uniformly between the pulmonary artery and the end of the capillaries. In particular, the arterioles make a much smaller contribution to resistance in the pulmonary circulation than in the systemic circulation.
The walls of pulmonary vessels have another key property: thinness, like the walls of veins elsewhere in the body. The thin walls and paucity of smooth muscle give the pulmonary vessels a high compliance, which has three consequences. First, pulmonary vessels can accept relatively large amounts of blood that shift from the legs to the lungs when a person changes from a standing to a recumbent position. Second, as we discuss later, the high compliance also allows the vessels to dilate in response to modest increases in pulmonary arterial pressure. Third, the pulse pressure in the pulmonary system is rather low (on an absolute scale).
@ most fenestrated capillaries are present in
c) skeletal muscle
• Fenestrated capillaries have pores in the endothelial cells (60-80 nm in diameter) that are spanned by a diaphragm of radially oriented fibrils and allow small molecules and limited amounts of protein to diffuse
In the renal glomerulus there are cells with no diaphragms called podocyte foot processes or “pedicels,” which have slit pores with an analogous function to the diaphragm of the capillaries. Both of these types of blood vessels have continuous basal lamina and are primarily located in the endocrine glands, intestines, pancreas, and glomeruli of kidney.
o Continuous capillaries, which are continuous in the sense that the endothelial cells provide an uninterrupted lining, and they only allow smaller molecules, such as water and ions to diffuse through tight junctions, leaving gaps of membranes called intercellular clefts.
o Tight junctions can be further divided into two subtypes:
• Those with numerous transport vesicles that are primarily found in skeletal muscles, finger, gonads, and skin.
• Those with few vesicles that are primarily found in the central nervous system. These capillaries are a constituent of the blood brain barrier
o Sinusoidal capillaries are a special type of fenestrated capillaries that have larger openings (30-40 μm in diameter) in the endothelium. These types of blood vessels allow red and white blood cells (7.5μm – 25μm diameter) and various serum proteins to pass aided by a discontinuous basal lamina. These capillaries lack pinocytotic vesicles, and therefore utilize gaps present in cell junctions to permit transfer between endothelial cells, and hence across the membrane. Sinusoid blood vessels are primarily located in the bone marrow, lymph nodes, and adrenal gland. Some sinusoids are special, in that they do not have the tight junctions between cells.
o They are called discontinuous sinusoidal capillaries, and are present in the liver and spleen where greater movement of cells and materials is necessary
@Parameter not depending on preload or afterload
a) cardiac output
b) stroke volume
c) ejection fraction
The ideal indicator of myocardial contractility should not be affected by preload or afterload. Ejection fraction (an indicator of contractility) is less dependent of loading conditions as compared to SV. However, the EF is afterload dependent and is depressed in situations with a high afterload. EF is measured in the ICU in three ways
CO is dependent upon loading conditions and is inferior to hemodynamic parameters defined by the PV plane.
EF is also dependent on loading conditions and inferior to hemodynamic parameters defined by the PV plane.
The stroke volume is affected by changes in preload, afterload, and inotropy (contractility). In normal hearts, the SV is not strongly influenced by afterload, whereas, in failing hearts, the SV is highly sensitive to afterload changes
dP/dtmin & dP/dtmax
These represent the minimum and maximum rate of pressure change in the ventricle. Peak dP/dt has historically been used as an index of ventricular performance. However, it is known to be load-dependent and inferior to hemodynamic parameters defined by the PV plane.
An increase in contractility is manifested as an increase in dP/dtmax during isovolumic contraction. However, dP/dtmax is also influenced by preload, afterload, heart rate, and myocardial hypertrophy. Hence, the relationship between ventricular end-diastolic volume and dP/dt is a more accurate index of contractility than dP/dt alone.
Although ejection fraction is highly dependent upon preload and afterload in addition to contractility, in the most common causes of cardiac dysfunction (coronary disease and dilated cardiomyopathy), loading conditions are usually “nor mal,” and ejection fraction reliably reports at least gross abnormalities in contractility. In some specific instances, however, ejection fraction causes a significant misinterpreta- tion of the actual pathophysiology. In aortic stenosis, excess afterload may cause the ejection fraction to be reduced in the face of relatively normal contractility.21 In such cases, the ejection fraction would mislead the clinician into thinking that severe muscle dysfunction was present when it was not. In mitral regurgitation, augmented preload increases ejection fraction and may cause an overestimation of contractility, falsely leading the clinician to believe that because ejection fraction is “normal,” contractility is also normal, which would ultimately lead to an untimely delay in correction of the lesion.22,23 Perhaps the most common misuse and misun- derstanding of ejection fraction, however, occurs in the case of concentric left ventricular hypertrophy. Here, a normal ejection fraction may be maintained by the subnormal func- tion of sarcomeres laid down in parallel.5 Subnormal short- ening of extra parallel sarcomeres leads to the same thicken- ing and to the same displacement of blood as would normal shortening of fewer sarcomeres. Thus, in the many cases of concentric left ventricular hypertrophy, an ejection fraction of 0.55 indicates substantial muscle dysfunction.24 This dys- function can be detected by the use of afterload-corrected mid wall-mechanics, but unfortunately difficulty of application has led only a few investigators to use this concept productively.
@ Correct about Spinothalamic tracts
a) it carries contralateral pain
b) it carries contralateral light touch.
c) It crosses over in medial lemniscus
d) It crosses to opposite side from thalamus to parietal lobe
Axons carrying pain and temperature sensation synapse in the dorsal horn of the cord, cross within the cord and pass in the spinothalamic tracts to the thalamus and reticular formation
Axons in the posterior columns whose cell bodies are in the ipsilateral gracile and cuneate nuclei in the medulla carry sensory modalities of vibration, joint position (proprioception), light touch and two-point discrimination. Axons from second-order neurones then cross in the brainstem to form the medial lemniscus, passing to the thalamus
@True about gall bladder?
a) supplied completely by sympathetic
b) it store 1.5-2 litres of bile secreted by liver concentrate in gall bladder
c) Common bile duct diameter is 10 mm
d) Right and Left bile ducts unite to form CBD
The mean diameter of the normal common duct was 4.1 mm.
The common bile duct (ductus choledochus) is a tube-like anatomic structure in the human gastrointestinal tract. It is formed by the union of the common hepatic duct and the cystic duct (from the gall bladder). It is later joined by the pancreatic duct to form the ampulla of Vater. There, the two ducts are surrounded by the muscular sphincter of Oddi.
The bile that is secreted by the liver and stored in the gallbladder is not the same as the bile that is secreted by the gallbladder. During gallbladder storage of bile, it is concentrated by removal of some water and electrolytes. This is through the active transport of sodium ions across the epithelia of the gallbladder, which creates an osmotic pressure that also causes water and other electrolytes such as chlorine to be reabsorbed
@ Function of pseudouridine arm of tRNA
a) help in initiation of translation
It is commonly found in tRNA, associated with thymidine and cytosine in the TΨC arm and is one of the invariant regions of tRNA.The function of it is not very clear, but it is expected to play a role in association with aminoacyl transferases during their interaction with tRNA, and hence in the initiation of translation. Recent studies suggest it may offer protection from radiation
@What is the method by which noradrenaline is removed from synaptic cleft in peripheral nervous system
In the peripheral nervous system, neuronal reuptake is the major mechanism for terminating noradrenaline’s action at the synapse. Things are different in the central nervous system , where a degradative enzyme is pretty important in dealing with noradrenaline. The enzyme is monoamine oxidase (MAO). Hence the previous importance of MAO inhibitors in management of depressive disorders in man.
There is yet another enzyme, catechol O-methyl transferase (COMT) that is widespread both inside and outside neuronal tissue. It inactivates both noradrenaline and adrenaline.
@ vitamin for which RDA is based on protein intake
Vitamin B6 requirement is increased when high-protein diets are consumed, since protein metabolism can only function properly with the assistance of pyridoxine
@In PKU which is true
a) Tyrosine level decreases
b) increase in phenylalanine products
Phenylketonuria (PKU) is an autosomal recessive metabolic genetic disorder characterized by homozygous or compound heterozygous mutations in the gene for the hepatic enzyme phenylalanine hydroxylase (PAH), rendering it nonfunctional.:541 This enzyme is necessary to metabolize the amino acid phenylalanine (Phe) to the amino acid tyrosine (Tyr). When PAH activity is reduced, phenylalanine accumulates and is converted into phenylpyruvate (also known as phenylketone), which can be detected in the urine
@ Rate limiting step in purine de novo synthesis?
a) Glutamate PRPP amidotransferase
De novo purine nucleotide synthesis occurs actively in the cytosol of the liver where all of the necessary enzymes are present as a macro-molecular aggregate. The first step is a replacement of the pyrophosphate of PRPP by the amide group of glutamine. The product of this reaction is 5-Phosphoribosylamine. The amine group that has been placed on carbon 1 of the sugar becomes nitrogen 9 of the ultimate purine ring. This is the commitment and rate-limiting step of the pathway.
The enzyme is under tight allosteric control by feedback inhibition. Either AMP, GMP, or IMP alone will inhibit the amidotransferase while AMP + GMP or AMP + IMP together act synergistically. This is a fine control and probably the major factor in minute by minute regulation of the enzyme. The nucleotides inhibit the enzyme by causing the small active molecules to aggregate to larger inactive molecules
@ Enzyme involved in both cholesterol synthesis and ketone body synthesis?
a) HMG CoA reductase
b) HMG CoA lyase
c) HMG CoA synthase
d) Acetyl CoA carboxylase
HMG-CoA synthase is an enzyme which catalyzes the reaction in which Acetyl-CoA condenses with acetoacetyl-CoA to form 3-hydroxy-3-methylglutaryl-CoA (HMG-CoA). It is the second reaction in the mevalonate-dependent isoprenoid biosynthesis pathway. HMG-CoA is an intermediate in both cholesterol synthesis and ketogenesis
@ glucose intolerance is caused by deficiency of
The symptoms of chromium deficiency caused by long-term total parenteral nutrition are severely impaired glucose tolerance, a loss of weight, and confusion
@Function of Glucagon like peptide (GLP 1)
a) Secreted from beta cells of pancreas
b) post prandial glucose reduction is the function
c) Decrease glucose mediated insulin release
Glucagon-like peptide-1 (GLP-1) is an incretin derived from the transcription product of the proglucagon gene. The major source of GLP-1 in the body is the intestinal L cell that secretes GLP-1 as a gut hormone.
The known physiological functions of GLP-1 include:
• increases insulin secretion from the pancreas in a glucose-dependent manner.
• decreases glucagon secretion from the pancreas by engagement of a specific G protein-coupled receptor.
• increases insulin-sensitivity in both alpha cells and beta cells
• increases beta cells mass and insulin gene expression, post-translational processing and incretion.
• inhibits acid secretion and gastric emptying in the stomach.
• decreases food intake by increasing satiety in brain.
• promotes insulin sensitivity.
@ Which of the following is not a Single gene disorder?
A Mitral Valve Proplase
B Hypertrophic Cardiomyopathy
C Dilated Cardiomyopathy
D Arrhythmogenic Right Ventricular Cardiomyopathy
ARVC can result from mutations in at least eight genes. Many of these genes are involved in the function of desmosomes, which are structures that attach heart muscle cells to one another. Desmosomes provide strength to the myocardium and play a role in signaling between neighboring cells.
Mutations in the genes responsible for ARVC often impair the normal function of desmosomes. Without normal desmosomes, cells of the myocardium detach from one another and die, particularly when the heart muscle is placed under stress (such as during vigorous exercise). These changes primarily affect the myocardium surrounding the right ventricle, one of the two lower chambers of the heart. The damaged myocardium is gradually replaced by fat and scar tissue. As this abnormal tissue builds up, the walls of the right ventricle become stretched out, preventing the heart from pumping blood effectively. These changes also disrupt the electrical signals that control the heartbeat, which can lead to arrhythmia
@Pyridoxine is associated with?
PLP, the metabolically active form of vitamin B6, is involved in many aspects of macronutrient metabolism, neurotransmitter synthesis, histamine synthesis, hemoglobin synthesis and function, and gene expression. PLP generally serves as a coenzyme (cofactor) for many reactions including decarboxylation, transamination, racemization, elimination, replacement, and beta-group interconversion. The liver is the site for vitamin B6 metabolism
@Insulin dependent glucose transport occurs in all except
glucose transport into the liver is not dependent on the GLUT4
@ Lipoprotein A shows homology with
Lipoproteln(a) (Lp[a]> Is a complex plasma llpoproteln In which apollpoprotein (apo) B-100 Is covalerrtty linked by a dlsulfide bridge to a unique apollpoprotein, apo(a). The cDNA of apo(a) has recently been Isolated and sequenced, and a remarkable homology to human plasminogen has been noted.
@After giving heparin which among the following is released
a) lipoprotein lipase
Heparin releases both LPL and HL from their tissue binding sites
@ which membrane defect causes severe form of hereditary spherocytosis
@ Enzyme increased in fed state is
A) Acetyl CoA carboxylase
@ Entero hepatic circulation occurs at level of
c) Terminal ileum
d) sigmoid colon
@Zinc is present in
a) salivary amylase
b) pancreatic lipase
c) alkaline phosphatase
A class of catalytic zinc sites, called cocatalytic zinc sites, has been defined in which two or more zinc atoms are in close proximity to one another This group of enzymes includes alkaline phosphatase (with two zinc ions and one magnesium ion), phospholipase C (three zinc ions), nuclease P1 (EC 188.8.131.52; three zinc ions) and leucine aminopeptidase (two zinc ions)
@27.uronic acid doesnt seen in KERATAN sulfate
8. Mucopolysaccharide that doesn’t contain Uronic acid residue is?
A Heparan Sulfate
C Chondroitin Sulfate
D Keratan Sulfate
Glycosaminoglycans (GAGs) or mucopolysaccharides are long unbranched polysaccharides consisting of a repeating disaccharide unit. The repeating unit (except for keratan) consists of an amino sugar (N-acetylglucosamine or N-acetylgalactosamine) along with a uronic sugar (glucuronic acid or iduronic acid) or galactose. Glycosaminoglycans are highly polar and attract water. They are therefore useful to the body as a lubricant or as a shock absorber.
Chondroitin sulfate (CS) is a glycosaminoglycan consisting of repeating (HexA-GalNAc sulfate) disaccharides, the functions of which depend on patterns of sulfation and uronic acid epimerization
L-Iduronic acid (IdoA) is the major uronic acid component of the glycosaminoglycans (GAGs) dermatan sulfate, and heparin
It is also present in heparan sulfate
Uronic acids are a class of sugar acids with both carbonyl and carboxylic acid functional groups. They are sugars in which the terminal carbon’s hydroxyl group has been oxidized to a carboxylic aci
Some of these compounds have important biochemical functions; for example, many wastes in the human body are excreted in the urine as their glucuronate salts, and iduronic acid is a component of some structural complexes such as proteoglycans.
@ Northern blotting done for
Antigen recognition site for group typing of RBC is
Fucose at the non-reducing termini linked α-1,2 to galactose forms the H antigen, the substructure of the A and B blood group antigens
@the mediators of inflammation not derived from cell
• A kinin is any of various structurally related polypeptides, such as bradykinin and kallikrein. They are members of the autacoid family
• They act locally to induce vasodilation and contraction of smooth muscle
• It is a component of the kinin-kallikrein system.
• Their precursors are kininogens
@. Mechanism of growth of bone is
long bones lengthen at the epiphyseal plate with the addition of bone tissue and increase in width by a process called appositional growth
# Forensic medicine
@Male pelvis differ from female pelvis by all except
a) sides of the male pelvis converge from the inlet to the outlet
b) The iliac crests are higher and more pronounced in males
c) preauricular sulcus prominent in male pelvis
The principal differences between male and female true and false pelvis include:
• The female pelvis is larger and broader than the male pelvis which is taller, narrower, and more compact.
• The female inlet is larger and oval in shape, while the male sacral promontory projects further (i.e. the male inlet is more heart-shaped).
• The sides of the male pelvis converge from the inlet to the outlet, whereas the sides of the female pelvis are wider apart.
• The angle between the inferior pubic rami is acute (70 degrees) in men, but obtuse (90-100 degrees) in women. Accordingly, the angle is called subpubic angle in men and pubic arch in women
• Additionally, the bones forming the angle/arch are more concave in females but straight in males.
• The distance between the ischia bones is small in males, making the outlet narrow, but large in females, who have a relatively large outlet. The ischial spines and tuberosities are heavier and project farther into the pelvic cavity in males. The greater sciatic notch is wider in females.
• The iliac crests are higher and more pronounced in males, making the male false pelvis deeper and more narrow than in females.
• The male sacrum is long, narrow, more straight, and has a pronounced sacral promontory. The female sacrum is shorter, wider, more curved posteriorly, and has a less pronounced promontory
• The acetabula are wider apart in females than in males In males, the acetabulum faces more laterally, while it faces more anteriorly in females. Consequently, when men walk the leg can move forwards and backwards in a single plane. In women, the leg must swing forward and inward, from where the pivoting head of the femur moves the leg back in another plane. This change in the angle of the femoral head gives the female gait its characteristic (i.e. swinging of hips)
@ Hanging causes maximum injury to?
A Carotid Artery
D Vertebral Artery
In the absence of fracture and dislocation, spinal cord damage may have a role but occlusion of blood vessels becomes a major cause of death. Obstruction of venous drainage of the brain via occlusion of the internal jugular veins leads to cerebral oedema and then cerebral ischemia. Other processes that have been suggested to contribute are vagal collapse (via mechanical stimulation of the carotid sinus), and compromise of the cerebral blood flow by obstruction of the carotid arteries, even though their obstruction requires far more force than the obstruction of jugular veins, since they are seated deeper and they contain blood in much higher pressure compared to the jugular veins. Only 7 lb of pressure may be enough to constrict the carotid arteries to the point of rapid unconsciousness (this varies from individual to individual).
@According to MTP act, abortion can be done till
A) 20 weeks
In case of pregnancies exceeding 12 weeks but less than 20 weeks, termination needs opinion of two doctors.[
@ A man hit by car is thrown up and hits road divider falls on the ground sustains head injury then run over by another car. Head injury is classified under
a) Secondary impact injury
b) Secondary injury
c) Primary impact injury
@Dribbling of saliva is feature of
a) antemortem hanging
b) postmortem hanging
Dribbling of Silva
Dribbling of saliva occurs from the angle of the mouth which is at a lower level i.e., from theangle opposite the side of the knot. When the knot is on the nape of the neck it occurs acrossthe middle of the lower lip. When the knot is under the chin, then it occurs through either or both angles of the mouth. The saliva drops down in front of the chest when the body is bareor it stains the clothes in front, when the deceased is dressed. When dried or partly dried, it becomes quite fixed and cannot be easily removed or rubbed out. Dribbling of the saliva isconsidered a very important phenomenon in support of death due to ante-mortem hanging, as because, excessive salivation is an ante-mortem reaction which occurs due to irritation of thesubmandibular salivary glands during life, due to the pressure and friction caused by theligature material.
@ In India, magistrate inquest is done in the following cases, EXCEPT:
A Exhumation cases
B Dowry deaths within 5 years of marriage
C Murder cases
D Death of a person in police custody
Magistrate Inquest (S. 174, S. 176 CrPC) is conducted by DM, SDM, Executive Magistrate, empowered by the state govt, such as deputy collector or Tehsildar (Executive Magistrate), it is done in cases of
a. death in prison,
b. death in police custody, while under police interrogation,
c. death due to police firing,
d. dowry death, S. 304B IPC
f. death in psychiatric hospital.
@ Among the following organs, putrefaction first starts at
c) Below the liver.
Order of putrefaction in various organs
Larynx and trachea > stomach, intestine > liver > lung > brain, heart > kidney > bladder, uterus > skin, muscles, tendons > bones.
@ Child with adenoids hypertrophy and blockage of eustachian tube has future risk for
a) primary accquired cholestatoma
b) Secondary accquired cholestatoma
c) congenital cholestatoma
Primary-acquired cholesteatoma results from ET dysfunction
@maternal mortality rate reduction by 2015 by —– % is goal in millenium developmnt goals (MDG)
A) 75% reduction
Millennium Development Goals by 2015:
• To eradicate extreme poverty and hunger
• To achieve universal primary education
• To promote gender equality and empower women
• To reduce child mortality
• To improve maternal health
• To combat HIV/AIDS, malaria, and other diseases
• To ensure environmental sustainability
• To develop a global partnership for development
MDG 5 target of a 75% reduction in their 1990 maternal death rate by 2015.
@ ratio of sodium and glucose in ors ?
d) 1: 3
Efficacy of ORS solution for treatment of children with acute non-cholera diarrhoea is improved by reducing its sodium concentration to 75 mEq/l, its glucose concentration to 75 mmol/l, and its total osmolarity to 245 mOsm/l.
@ Preventing childhood obesity is
a) primordial prevention
b) primary prevention
c) secondary prevention
d) teritiary prevention
@ In acute severe malnutrition , Z score is
a) < -2 but > -3
b) < -1 but > -2
c) < -3
@ Color of bag for discarding sharp waste
a) blue /white translucent
Category 4 : Waste Sharps (needles, syringes, scalpels blades, glass etc. that may cause puncture and cuts. This includes both used & unused sharps)
@ Management of open fracture in a child is
b) external fixation
c) open reduction and internal fixation
d) Intramedullary nail
Perhaps the most important aspect in the treatment of open fractures is the initial surgical intervention with irrigation and meticulous debridement of the injury zone
@ What is the best management in a CTEV newborn
a) Manipulation alone
b) Manipulation with corrective splint
c) Corrective surgery
d) Wait and watch
• In a newborn, the mother is taught to manipulate the foot after every feed.
• The foot is dorsiflexed and everted (MCQ)
• While manipulating, sufficient pressure should be applied by the person so as to blanch her own fingers.
• This pressure should be maintained for about 5 seconds, and this is repeated several times, over a period of roughly 5 minutes.
• Minor deformities are usually corrected by this method alone.
• For major deformities, further treatment by corrective plaster casts is required.
@ light bulb sign is seen in
a) anterior dislocation of shoulder
b) posterior dislocation of shoulder
The lightbulb sign refers to the abnormal AP radiograph appearance of the humeral head in posterior shoulder dislocation.
When the humerus dislocates it also internally rotates such that the head contour projects like a lightbulb when viewed from the front.
Pediatric advanced life support initial impression doesnt include
Ans:Airway… ABCDE in primary evaluation
Pediatric Advanced Life Support (PALS) is a 2 day (with an additional self study day) American Heart Association training program. The goal of the course is to aid the pediatric healthcare provider in developing the knowledge and skills necessary to efficiently and effectively manage critically ill infants and children, resulting in improved outcomes.
@ Parotid enlargement is considered which stage of HIV in children
a) Stage 1
b) Stage 2
c) Stage 3
d) Stage 4
WHO CLINICAL STAGING OF HIV FOR INFANTS AND CHILDREN WITH ESTABLISHED HIV INFECTION
• Clinical stage 1
o Persistent generalized lymphadenopathy
• Clinical stage 2
o Unexplained persistent hepatosplenomegaly
o Papular pruritic eruptions
o Extensive wart virus infection
o Extensive molluscum contagiosum
o Recurrent oral ulcerations
o Unexplained persistent parotid enlargement
o Lineal gingival erythema
o Herpes zoster
o Recurrent or chronic upper respiratory tract infections (otitis media, otorrhoea, sinusitis, tonsillitis)
o Fungal nail infections
• Clinical stage 3
o Unexplained moderate malnutrition not adequately responding to standard therapy
o Unexplained persistent diarrhoea (14 days or more)
o Unexplained persistent fever (above 37.5 °C, intermittent or constant, for longer than one month)
o Persistent oral Candidiasis (after first 6 weeks of life)
o Oral hairy leukoplakia
o Acute necrotizing ulcerative gingivitis/periodontitis
o Lymph node TB
o Pulmonary TB
o Severe recurrent bacterial pneumonia
o Symptomatic lymphoid interstitial pneumonitis
o Chronic HIV-associated lung disease including bronchiectasis
o Unexplained anaemia (1 cm in size
• Usually in mid-zone or periphery of upper lobes
• Compensatory emphysema occurs in lower lung fields
• Nodules tend to disappear from rest of lung when PMF develops
• Progressive Massive Fibrosis (PMF) may cavitate from tuberculosis or ischemic necrosis
@Multiple myeloma on radionuclide scanning presents as
a) cold nodule
b) hot nodule
c) diffuse increased uptake
d) diffuse decreased uptake
Bone scintigraphy is of limited use in multiple myeloma. Detection of bone involvement using technetium 99-m (99mTc) labelled diphosphonates relies on the osteoblastic response and activity of the skeletal system for uptake. Multiple myeloma, however, is primarily an osteolytic neoplasm. Lesions that are well defined on isotope bone scans are the result of complications of multiple myeloma, namely, osteoblastic response to a compression fracture of a vertebral body or pelvic insufficiency fracture. Bone scintigraphy may be helpful in evaluating areas not well demonstrated in plain radiography, such as ribs and sternum . In a report comparing the skeletal survey with isotope bone scans, uptake of the radioisotope in radiographically abnormal regions occurred in 44% of cases, normal findings were seen in 48%, and diminished uptake was seen in 8%
@ patient with head injury , BP 90/60 mmhg , all are contraindicated for induction except ?
Thiopentone coma remains a standard treatment when ICP is difficult to manage
Ketamine has many unique attributes making it well suited to certain applications in the emergency department (ED), including pediatric procedural sedation, and as an induction agent in patients with asthma and exacerbation of chronic obstructive pulmonary disease. However, ketamine has been historically contraindicated for induction use in patients with head injury because of a concern that it may increase intracranial pressure (ICP)
CI for halothane are:
a. Previous history of halothane induced hepatitis.
b. Head injury and intracranial lesions (as it raises ICT significantly).
c. Pheochromocytoma as it sensitizes myocardium to adrenaline.
d. Fixed cardiac output lesions like AS and MS.
Preexisting liver disease is not considered as CI as the main cause of halothane hepatitis is outside the liver (immunologic basis).
@pt with mitral stenosis in labour, wants analgesia for normal delivery…which form of anesthesia to be used for her?
a) inhalational anesthesia
b) spinal anesthesia
c) epidural anesthesia
Most reports have recommended vaginal delivery under epidural anaesthesia, unless obstetrically contraindicated
Tachycardia, secondary to labour pain, increases flow across the mitral valve, producing sudden rises in left atria . pressure, leading to acute pulmonary oedema. This tachycardia is averted by epidural analgesia without significantly altering the patient haemodynamics
Combined spinal–epidural analgesia during labour using intrathecal fentanyl 25 μg produces good analgesia without major haemodynamic changes during the first stage of labour. During the second stage of labour, only the uterine contractile force should be allowed rather than the maternal expulsive effort that is always associated with the valsalva . maneuver. Therefore, the second stage of delivery should be cut short by instrumentation. Supplementary analgesia for instrumentation with slow epidural boluses of fentanyl and a low concentration of bupivacaine reduces SVR and the cardiac pre-load. Low spinal anaesthesia for vaginal instrumental delivery has also been used with good results in these patients.
One of the major advantages of epidural analgesia is that it can be administered in incremental doses and that the total dose could be titrated to the desired sensory level. This, coupled with the slower onset of anaesthesia, allows the maternal cardiovascular system to compensate for the occurrence of sympathetic blockade, resulting in a lower risk of hypotension and decreased uteroplacental perfusion. Moreover, the segmental blockade spares the lower extremity “muscle pump,” aiding in venous return, and also decreases the incidence of thromboembolic events. Invasive haemodynamic monitoring, judicious intravenous administration of crystalloid and administration of small bolus doses of phenylephrine maintain maternal haemodynamic stability.
@ least dangerous in pregnancy
c)cyanotic heart disease
• Pregnant women with Marfan syndrome are considered high risk cases
• Pregnancy is usually well tolerated unless cyanosis or arrhythmia develops in Ebstein’s anomaly
@ DOC for Chlamydia.trachomatis in pregnancy?
The recommended treatment during pregnancy is erythromycin base or amoxicillin.
@ Female treated for Urinary tract infection now has vaginal discharge. Most likely organism is ?
a) Ureaplasma urealyticum
Vaginal yeast infections occur when new yeast is introduced into the vaginal area, or when there is an increase in the quantity of yeast already present in the vagina relative to the quantity of normal bacteria. For example, when the normal, protective bacteria are eradicated by antibiotics (taken to treat a urinary tract, respiratory, or other types of infection) or by immunosuppressive drugs, the yeast can multiply, invade tissues, and cause irritation of the lining of the vagina
@ 18-20wks Level II scan is done for
a) diagnosis of fetal anomaly
b) lung maturity
c) sex determination
Level II – anomaly, targeted or dating scan
• At the second trimester scan they check that your baby is developing normally, they assess the gestational age by measuring the crown-rump length and will also look for any major problems. This is a routine ultrasound examination performed at 18 to 20 weeks of gestation.
• During the examination, the fetus is seen by abdominal ultrasound. The fetus is now large enough for an accurate survey of the fetal anatomy. With multiple pregnancies, they can be firmly diagnosed and dates and growth can also be assessed. Placental position is also determined. Further scans may be necessary if abnormalities are suspected
@ 33. Hypothermia during anesthesia treated by
a) warm saline
• Volume depletion is a common clinical finding in the severely hypothermic patient, and IV fluids are indicated. The usual parameters for fluid assessment may be difficult to use in a hypothermic victim, due to large quantities of fluid in the “third space” and the clinical difficulty of obtaining orthostatic blood pressures and weight. It should be emphasized that peripheral access may be quite limited due to vasoconstriction, and a central line may need to be placed upon arrival in the ED. IV infusion sets, urinary catheters, suction tubes, and endotracheal tubes may become stiff and break if not pre-warmed prior to pre-hospital use. IV solutions also should be prevented from freezing. but standard formulations of saline and dextrose solutions can be used safely after thawing if no visible precipitates are present and the bags are intact.
• IV fluids should be warmed to approximately 43°C prior to administration in the pre-hospital setting to prevent further core cooling. Methods to warm fluids include using standard blood warmers adapted for saline bag use or portable battery, operated IV line warmers, preheating saline IV bags and storing them in heated carrying packs, and micro waving liter bags of saline with insulation during administration. The use of an insulation barrier around all IV tubing and solutions can help prevent heat loss from warmed solutions in cold environments.
@ Inhalational agent of choice for Pediatric anesthesia in a child with congenital heart disease
• Halothane or sevoflurane is the anesthetic of choice for induction of anesthesia by mask
• Halothane has enjoyed popularity as the inhalational agent of choice for paediatric anesthesia
• Sevoflurane is the inhalation agent of choice for pediatric anesthesia due to low pungency
• Sevoflurane may be a better choice in children with congenital heart disease
• For neonates undergoing open heart surgery, opioidrelaxant inductions are most prevalent, whereas older children with sufficient cardiac reserve typically receive inhalation inductions with either halothane or sevoflurane
• Sevoflurane offers a more tolerable aroma without the magnitude of myocardial depression that accompanies halothane. 75 In addition, its blood gas solubility is nearly as low as desflurane. Hemodynamically, sevoflurane tends to produce some tachycardia, particularly in older children, and preserve systemic arterial pressure. 76 Reductions in heart rate and systemic arterial pressure are more modest in infants anesthetized with sevoflurane than in control subjects anesthetized with halothane, and the former exhibit echocardiographic evidence of normal contractility and cardiac index
@ A depressed farmer attempted suicide . On examination , pupils wer dilated. Most likely agent used for poisoning is
a) organophosphate poisoning
b) tricyclic antidepressant overdose
@- A girl with a lesion but no family h/o of lesions in parents . Most likely mode of inheritance
a) Autosomal dominant
b) Autosomal recessive
c) X linked recessive
d) X linked dominant
The characteristics of traits with an autosomal recessive inheritance pattern (usually)
• Show a “horizontal” pattern (as opposed to vertical seen in AD). This means that if the condition is rare, siblings may be affected but rarely are their parents or children
• Both sexes can be affected
• The parents of an affected child are both carriers but themselves unaffected
• If the trait is rare, one may suspect consanguinity
• The recurrence risk for each sib of an affected person is 1/4 (25%).
• The probability of a normal sib being a carrier is 2/3.
The characteristics of autosomal dominant inheritance are (usually)
• Vertical pattern in a pedigree (multiple generations affected). The phenotype appears in every generation except when cases originate by new mutations in a phenotypically unaffected parent or when the disorder is non penetrant or is expressed very mildly. With these exceptions, unaffected family members will not transmit the trait.
• Males and females affected equally frequently and severely. Exceptions are sex limited or sex influenced dominant traits.
• If the trait is rare, each affected person is heterozygous; s/he inherits the gene from only one parent.
• When an affected person mates with an unaffected person, each offspring has a 50% chance of inheriting the affected phenotype regardless of the sex of the affected parent. This reflects the fact that for rare AD traits each affected person is heterozygous. Male to male transmission occurs.
• Variable expressivity and Incomplete penetrance are common in AD traits.
• New AD sporadics occurs and are often correlated with paternal age
@ Apoptosis is associated with
a) activation of Caspase
Caspase activation plays a central role in the execution of apoptosis.
@ Reagent used in Apt test
• The alkali denaturation test, also known as Apt–Downey test or Apt test, is a medical test used to differentiate fetal or neonatal blood from maternal blood found in a newborn’s stool or vomitus
• The Apt test is most commonly used in cases of vaginal bleeding late during pregnancy (antepartum haemorrhage) to determine if the bleeding is from the mother or the fetus.
• A positive test would indicate that blood is of fetal origin, and could be due to vasa previa.
• A negative test indicates that the blood is of maternal origin.
• In practice, the Apt test may not be done when there is suspicion of vasa previa, because the time to fetal collapse with bleeding from vasa previa is often very short.
• The Apt test can also be used to detect the presence of fetal blood in the maternal circulation in cases of suspected fetal-maternal hemorrhage. Since the test is only a qualitative determination of the presence of fetal hemoglobin in maternal blood, the quantitative Kleihauer-Betke test is more commonly used.
• The blood is mixed with a small amount of sterile water to cause hemolysis of the RBCs, yielding free hemoglobin. The sample is next centrifuged for several minutes.
• The pink hemoglobin-containing supernatant is then mixed with 1 mL of 1% NaOH for each 5 mL of supernatant. The color of the fluid is assessed after 2 minutes. Fetal hemoglobin will stay pink and adult hemoglobin will turn yellow-brown since adult hemoglobin is less stable and will convert to hematin which has a hydroxide ligand
@ Negri bodies are not seen in
a) Purkinje cells
b) basal ganglia
c) cerebral cortex
Neuropathologic specimens in rabies show intraneuronal Negri inclusion bodies. Classic Negri bodies are round or oval, discrete, sharply demarcated eosinophilic intracytoplasmic bodies. They are most commonly seen in the pyramidal cells of the hippocampus, cerebral cortex, and Purkinje cells of cerebellar cortex. They may be anywhere in the cytoplasm or in its dendrite, and there may be more than one in a single cell
@ Carcinoid Tumor of lung originates from?
a) Type 2 Alveolar cell
b) Clara cell
c) Mucus (Goblet) cell
d) Kulchitsky cell
• Enterochromaffin (EC) cells, or “Kulchitsky cells”, are a type of enteroendocrine and neuroendocrine cell occurring in the epithelia lining the lumen of the digestive tract and the respiratory tract that release serotonin.
• Another population of chromaffin cells is found only in the stomach wall, called enterochromaffin-like cells (ECL). They look like EC cells but do not contain 5-HT.
• ECL cells respond to gastrin released by G-cells and they release histamine, which will stimulate the parietal cells to produce gastric acid.
• The neuroendocrine progenitors to enterochromaffin cells in the bronchial epithelium have been implicated in the origin of small cell lung cancer
@ Mutation of STK 11 and LKB1 gene is associated with?
A Familial Adenomatous Polyposis
B Hereditary nonpolyposis colorectal cancer
C Peutz-Jeghers syndrome (PJS)
• Serine/threonine kinase 11 (STK11) also known as liver kinase B1 (LKB1) or renal carcinoma antigen NY-REN-19 is a protein kinase that in humans is encoded by the STK11 gene
• Germline mutations in this gene have been associated with Peutz-Jeghers syndrome, an autosomal dominant disorder characterized by the growth of polyps in the gastrointestinal tract, pigmented macules on the skin and mouth, and other neoplasms. However, the LKB1 gene was also found to be mutated in lung cancer of sporadic origin, predominantly adenocarcinomas. Further, more recent studies have uncovered a large number of somatic mutations of the LKB1 gene that are present in cervical, breast, intestinal, testicular, pancreatic and skin cancer
@ In acute pancreatits which of the following is not seen?
b. raised amylase
Acute pancreatitis is characterized by fasting hyperglycemia and hyperglucagonemia, associated with relative hypoinsulinemia
@ Which of the following is not a symptom of thyrotoxicosis (Hyperthyroidism)
@Males have more bulky voice with lower pitch because of
a) longer cords
b) more vibration of cords
c) larger cricoid cartilage
d) inferiorly placed glottis
• Adult men and women have different sizes of vocal fold; reflecting the male-female differences in larynx size. Adult male voices are usually lower-pitched and have larger folds.
• The male vocal folds (which would be measured vertically in the opposite diagram), are between 17 mm and 25 mm in length. The female vocal folds are between 12.5 mm and 17.5 mm in length.
The difference in vocal folds size between men and women means that they have differently pitched voices.
@ In a child with serous otitis media ,hearing loss is typically
a) 10 -20 db
b) 20-40 db
c) 40 -60 db
d) 60-80 db
@ A teacher with tirednes of voice, hoarsness .on laryngoscopic examination , keyhole glottis is present. Which of the following is true regarding management
a) Treated with voice rest and hygiene
b) Weakness of thyroarytenoid interarytenoid treated with repositioning of arytenoid
@ A patient with bilateral hilar lymphadenopathy on CXR, clinically diagnosed as sarcoidosis , what is the next step?
a) CT thorax
b) Lymph Node biopsy
c) Serum calcium
• Diagnosis of sarcoidosis is a matter of exclusion, as there is no specific test for the condition. To exclude sarcoidosis in a case presenting with pulmonary symptoms might involve chest X-ray, CT scan of chest, PET scan, CT-guided biopsy, mediastinoscopy, open lung biopsy, bronchoscopy with biopsy, endobronchial ultrasound, and endoscopic ultrasound with FNA of mediastinal lymph nodes (EBUS FNA).
• Diagnosis requires biopsy in most cases. If therapy is to be given for sarcoidosis, tissue confirmation is essential. Watchful waiting is indicated only for patients who exhibit a classic presentation, are asymptomatic, and with whom one can ensure close follow-up.
• Transbronchial biopsy via fiberoptic bronchoscopy has a high diagnostic yield. Results may be positive, even in the setting of normal chest radiography findings.
• Standard transbronchial needle aspiration allows successful lymph node sampling in nearly all patients with sarcoidosis and is associated with high diagnostic yield regardless of disease stage.
• Endobronchial biopsy is performed during bronchoscopy and increases the yield of the procedure. In a study of 34 subjects, endobronchial biopsy findings were positive in 61.8% of patients with a yield comparable to transbronchial biopsy, which showed nonnecrotizing granulomas in 58.8% of subjects. The addition of endobronchial biopsy increased the yield of fiberoptic bronchoscopy by 20.6%.
• At least one study has shown that the diagnostic yield of endobronchial ultrasound-guided transbronchial needle aspiration for stage I and II sarcoidosis is even higher than standard transbronchial lung biopsy
• Tissue from biopsy of lymph nodes is subjected to both flow cytometry to rule out cancer and special stains (acid fast bacilli stain and Gömöri methenamine silver stain) to rule out microorganisms and fungi.
Serum markers of sarcoidosis, include: serum amyloid A, soluble interleukin 2 receptor, lysozyme, angiotensin converting enzyme, and the glycoprotein KL-6. Angiotensin-converting enzyme blood levels are used in the monitoring of sarcoidosis. A bronchoalveolar lavage can show an elevated (of at least 3.5) CD4/CD8 T cell ratio, which is indicative (but not proof) of pulmonary sarcoidosis
@ A obese lady ,BMI=35. FBG is normal .PPBG is slightly elevated. Ideal management is ?
@Extrapulmonary intrathoracic involvement include all except?
d) Chest indrawing
When taking functional differences into consideration, the airway is broken into 3 physiological segments: intrathoracic intrapulmonary, intrathoracic extrapulmonary, and extrathoracic extrapulmonary.
Under normal conditions, during inspiration, the intrathoracic airways tend to expand, because negative extraluminal pressure is greater than intraluminal pressure, and the extrathoracic airways, being exposed only to negative intraluminal pressure, tend to contract. The opposite process occurs with expiration.5 Thus, in a patient with extrathoracic obstruction, airway narrowing is more pronounced during inspiration. Likewise, in a patient with intrathoracic obstruction, airway narrowing worsens during expiration
Wheeze is generally caused by intrathoracic obstruction, whereas stridor usually results from extrathoracic obstruction.
@A 55 yr old man with MI has elevated Serum.creatinine, urea and oliguria .After treatment blood urea came down with polyuria
a) patchy tubular necrosis
In acute tubular necrosis due to poor perfusion of kidney leading to patchy tubular necrosis..once you hav adequately replenished the blood flow to kidney, it normalizes
@Steroid is not used in which form of TB ?
a) Endobronchial tuberculosis
b) primary progressive tuberculosis
• Corticosteroids are often used as an adjunct in the treatment of various forms of tuberculosis (TB) and for the prevention of complications, such as constrictive pericarditis, hydrocephalus, focal neurological deficits, pleural adhesions, and intestinal strictures.
• Corticosteroid therapy may not influence the outcome of endobronchial tuberculosis
• Anecdotal reports suggest that corticosteroids might be beneficial in patients with endobronchial TB. However, in one trial 32 of 34 patients with endobronchial TB, corticosteroids had no appreciable effect on bronchoscopic healing rate, radiological findings, and pulmonary functions
@Which of the following drugs is not known to prolong life in Ischemic heart disease
b) ACE inhibitors
Drugs known to prolong life in Ischemic heart disease
• β-adrenoceptor blocker
• ACE inhibitor
• Lifestyle factors
@ Normal asymptomatic looking girl came to emergency with central cyanosis . Cause is
a) Lead poisoning
b) severe chronic anemia
c) Increased peripheral resistance
d) carbon monoxide poisoning
• Pseudocyanosis is a bluish tinge to the skin and/or mucous membranes that is not associated with either hypoxemia or peripheral vasoconstriction.
• Most causes are related to metals (eg, silver nitrate, silver iodide, silver, lead) or drugs (eg, phenothiazines, amiodarone, chloroquine hydrochloride).
• One report describes blue-gray discoloration in a man who for years ingested colloidal silver for a urinary tract infection ; his oxygen levels were normal.
• One report describes a girl with intensely blue skin from food coloring.
• Consider pseudocyanosis when the patient has no cardiopulmonary symptoms and the skin does not blanch under pressure. To be sure of the diagnosis, obtain a pulse oximetry or arterial blood gas measurement.
@Right sided murmer that dereases in intensity on inspiration.
a) Pulmonary ejection click of Pulmonic stenosis
b) Tricuspid stenosis
• Pulmonary stenosis evokes hypertrophy of the right ventricle, stiffening that chamber. When blood is drawn into the right ventricle during inspiration, the thickened right ventricle does not distend normally, so pressure in that chamber rises, and the pulmonary valve is partially opened. Because the pulmonary valve is partially open when the right ventricle contracts, its excursion is less, and the ejection click associated with its maximal opening is softer and earlier
With severe valvular pulmonary stenosis, the right ventricle may be so stiff and atrial contraction so vigorous that right atrial contraction actually opens the pulmonary valve completely and produces a click in late diastole.
• Ejection clicks are high-pitched sounds that occur at the moment of maximal opening of the aortic or pulmonary valves. They are heard just after the first heart sound.
• The sounds occur in the presence of a dilated aorta or pulmonary artery or in the presence of a bicuspid or flexible stenotic aortic or pulmonary valve
• Systolic ejection clicks occur in early systole and may result from either the abrupt opening of the semilunar valves or the rapid distention of the proximal aorta or pulmonary artery at the onset of ejection.
• Pulmonary ejection clicks frequently decrease in intensity or merge with the first heart sound during inspiration, whereas aortic ejection clicks are not affected by respiration
• Clicks were associated with sudden “doming” of the valve demonstated by cineangiography
• Inspiratory increase in venous return causes the valve leaflets to move to an open or “domed” position. Ventricular systole at this time produces no sound since there is no slack.
• With expiration pulmonary artery pressure exceeds RVEDP. Ventricular systole at this time produces an opening motion of the closed, slack leaflets. The click occurs when the opening motion is suddenly checked.
• An ejection click in close proximity to the S1 is heard along the left sternal border and second left intercostal space, which decreases in intensity with inspiration
@Electrical shooting pain down back and arm few months after radiotherapy is called
a) Lhermitte sign
• Lhermitte’s sign or the Lhermitte sign ,sometimes called the barber chair phenomenon, is an electrical sensation that runs down the back and into the limbs. In many patients, it is elicited by bending the head forward.
• It can also be evoked when a practitioner pounds on the posterior cervical spine while the neck is flexed; this is caused by involvement of the posterior columns.
• The sign suggests a lesion of the dorsal columns of the cervical cord or of the caudal medulla. Although often considered a classic finding in multiple sclerosis, it can be caused by a number of conditions, including transverse myelitis, Behçet’s disease,trauma, radiation myelopathy, vitamin B12 deficiency (subacute combined degeneration), and compression of the spinal cord in the neck from any cause such as cervical spondylosis, disc herniation, tumor, and Arnold-Chiari malformation. Lhermitte’s Sign may also appear during or following high dose chemotherapy. Irradiation of the cervical spine may also evoke it as an early delayed radiation injury, which occurs within 4 months of radiation therapy.
• Delayed onset Lhermittes’s sign has been reported following head and/or neck trauma.This occurs ~2 1/2 months following injury, without associated neurological symptoms or pain, and typically resolves within 1 year.
• This sign is also sometimes seen as part of a “discontinuation syndrome” associated with certain psychotropic medications, such as serotonin reuptake inhibitors, particularly Paroxetine and Venlafaxine. Typically, it only occurs after having taken the medication for some duration, and then stopped or withdrawn rapidly. Fluoxetine, given its very long half-life, can be given as a single small dose, and often avoid Lhermitte’s sign and other withdrawal symptoms
@ Test for viable myocardium after myocardial ischemia
a) Thallium scan
b) MUGA scan
@ In a child with pharyngitis, to prevent developing Acute Rheumatic fever, within how many days penicillin has to be given , for it to be effective as secondary prophylaxis?
a) 6 days
b) 7 days
c) 8 days
d) 9 days
• AHA Guidelines on Prevention of Rheumatic Fever and Diagnosis and Treatment of Acute Streptococcal Pharyngitis
• Prophylaxis should be initiated as soon as acute rheumatic fever or rheumatic heart disease is diagnosed.
• Even when started as long as 9 days after the onset of acute illness, penicillin effectively prevents primary attacks of rheumatic fever
@ vwF deficiency child came for dental extraction .next step is to administer prophylactically
a) Blood transfusion
General Management of VWD Patients
• Long-term prophylaxis is rarely required, but should be considered for recurrent joint bleeding or excessive mucocutaneous bleeding not adequately controlled by other treatments.
• Avoid aspirin, other NSAIDs, and other platelet-inhibiting drugs.
Notes on Treatment of Minor Bleeding and Prophylaxis for Minor Surgery
• Minor bleeding should be treated with intravenous or nasal DDAVP, if
supported by results of a DDAVP trial.
• If response to DDAVP is inadequate, VWF concentrate should be used,
with dosing primarily based on VWF:RCo units and secondarily on FVIII
• For minor surgery, prophylaxis should achieve VWF:RCo and FVIII activity
levels ≥30 IU/dL, and preferably >50 IU/dL, for 1-5 days.
• Management of minor bleeding with DDAVP and proper fluid restriction can be performed without electrolyte monitoring unless DDAVP is used
>3 times in 72 hours.
• For mild to moderate VWD, antifibrinolytics combined with DDAVP are
generally effective for oral surgery.
Notes on Treatment of Major Bleeding and Prophylaxis for Major Surgery
• All treatment plans should be based on objective laboratory
determinations of response of VWF:RCo and FVIII activity levels to
DDAVP or VWF concentrate.
• For severe bleeding (e.g. intracranial, retroperitoneal) or prophylaxis of
major surgery, initial target VWF:RCo and Factor VIII activity levels should be >100 IU/dL, and levels >50 IU/dL should be maintained for at least 7-10 days.
• In all patients receiving VWF concentrate, clinicians should perform proper thrombotic-risk assessment and institute appropriate strategies to prevent thrombosis.
• To decrease risk of perioperative thrombosis, VWF:RCo levels should not exceed 200 IU/dL, and FVIII activity should not exceed 250 IU/dL.
@ A pregnant lady on antenatal checkup has family history of sister developing thromboembolism has factor 5(leiden) deficiency in heterozygous state. Next step of management
a)observation and if any calf pain and immediate reporting
C) Start aspirin
D) Start heparin
Factor V Leiden increases the risk of developing a DVT during pregnancy by about 7-fold. Women with factor V Leiden who are planning pregnancy should discuss this with their obstetrician and/or hematologist. Most women with factor V Leiden have normal pregnancies and only require close follow-up during pregnancy. For those with a history of DVT or PE, treatment with an anticoagulant during a subsequent pregnancy can prevent recurrent problems.
@ Number Connection test is done to detect ?
A Cerebral Ataxia
D Hepatic Encephalopathy
• The number connection tests A and B are regarded as sensitive psychometric measures for the assessment of early hepatic encephalopathy.
• Older tests include the “numbers connecting test” A and B (measuring the speed at which one could connect randomly dispersed numbers 1–20), the “block design test” and the “digit-symbol test”.
• In 2009 an expert panel concluded that neuropsychological test batteries aimed at measuring multiple domains of cognitive function are generally more reliable than single tests, and tend to be more strongly correlated with functional status. Both the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and PSE-Syndrom-Test may be used for this purpose.
• The PSE-Syndrom-Test, developed in Germany and validated in several other European countries, incorporates older assessment tools such as the number connection test
@ pathognomonic sign retina is seen in
a) Wilson disease
b) Infective endocarditis
c) Primary vitreoretinal lymphoma
d) Sickle cell disease
The hallmark of primary vitreoretinal lymphoma is the presence of vitreous cells and white subretinal pigment epithelial deposits. Retinal, choroidal or chorioretinal infiltrates may be present, in which case they may be focal, multifocal or diffuse and are essentially pathognomonic for the disease
▪ Although common, it is not pathognomonic of sickle cell disease.
Venous tortuosity is due to decreased perfusion/circulation (ie, venous stasis, arteriolar-venous shunting)
Roth spots are white-centred retinal haemorrhages, previously thought to be pathognomonic for subacute bacterial endocarditis. A number of other conditions can be associated with Roth spot . Roth spots have been described in a number of autoimmune conditions. The association with leukaemia, anoxia, hypertensive retinopathy, diabetic retinopathy, intracranial haemorrhage, prolonged intubation, neonatal birth trauma, complicated delivery and battered children have also been describe
@ Ideal Rehabilitation for patients with Aphakia is?
A Anterior Chamber IOL
B Posterior Chamber IOL
C Contact Lens