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JIPMER 2014 MCQ Recall
1. Drug causing hypothyroidism – amiodarone
2. Stratosphere sign in usg –pneumothorax
3. Increased vocal resonance -bronchial ca
4. Pointing index – ain injury
5. Alendronate hip pain – invst –xray
6. Fusion inhibitor –enfuvirtide
7. Ketone bodies not utilised by – rbc
8. Muscle not contain – glucose6phosphatase
9. Most metabolised inhalational anaesthetic –halothane
10. No cns penetration – glycopyrrolate
11. Incresed cerebral blood flow by and ci in epilepsy- ketamine
12. Potent la –bupivacaine
13. Psychiatry coined by -reil
14. Wandering acetabulm –tb hip
15. Mallet finger – extensor tendon avulsion
16. Fruit bite mark preserved in………meta bisulphate
17. Negri body not found in –
18. Chronic mild depression for two year or more- dysthymia
19. Magistrate inquest not in -homicide
20. Espundia caused by – leishmania
21. Post.cricothyroid – abductor of vocal cord
22. Globoid bodies – krabbes disease
23. Mansonia transmits –chickungunya
24. Hinge fracture –skull #
25. Drug used in monotherapy of juvenile myoclonic epilepsy in pregnancy -lamotrigine
26. Drug which does not affect retina? – amiodarone
27. Non motile- klebsiella
28. Spontaneous breathing -mapelson a
29. Hyperkalemia s/e – succinylcholine
30. Capillary leak syndrome (cls) seen with -gmcsf
31. Pco2 in the expired air – 32
32. Medullary ca all are true except- it is usually familial (sporadic is more common)
33. March fracture – second metatarsal shaft
34. Montagia # – ulna # wit sup ru jt dislocation
35. Ateral condyle fracture – cubitus valgus
36. Maffuci enchondroma wit hemangioma
37. Light bulb sign – post dislocation humerus
38. Hill sach lesion -post sup lesion in humeral head
39. Tom smith – septic arthritis of infancy
40. Meralgia paresthetica- lat cut nerve of thigh
41. Hpe of osteosarcoma- malignant cells wit osteoid formation
42. Mdg to reduce mmr by 0.75
43. Metazoonosis- plague
44. International food standards- codex alimentarius
45. Case control study -rare disease
46. Not a test of significance – sd
47. Point source not true – many secondry waves
48. Killed vaccine- salk
49. Endoscope sterilisation – glutraldehyde
50. Waste sharps -blue/white bag
51. Nrhm asha – community participation
52. Childhood obesity prevention- primordial prevention
53. Lithium stopped before surgery- 48 hrs
54. For post puncture headache–wrong statement – stylet kept inside and needle removed
55. Retina gas- sf6
56. Salmonella common to all species – indole negative
57. Painless ulcer labia majora – treponema pallidum
58. Freis test -lgv
59. Whiff test – bacterial vaginosis
60. Koch’s postulates not true – antibiotics cures the disease
61. Transmitted through pilus – conjugation
62. Not a fungal infection -mycosis fungoides
63. Craige tube – diff b/w motile and nonmotile
64. Exotoxin not true – heat stable
65. Staphylococcus not true -catalase negative
66. Hot spot on t99m—adenolymphoma
67. Nerve damage by sentinel node biopsy in breast ca–intercostobrachial nerve
68. Follicular ca.–hematogenous route
69. Mc blunt trauma injury–spleen
70. Abdominal desmoid to screen for – colonic ca
71. Good pasture syndrome- type four collagen
72. Burkitt -ebv
73. Lepra 2 rxn – type3 hs
74. Allograft rejection – delayed hs
75. Ig in alternate pathway – iga
76. Rhabdomyosarcoma marker- desmin
77. Alziemer – a beta amyloid
78. Inflammatory mediator not from cells -kinin
79. Whorled epithelium in asthma- curschman spiral
80. M/c benign tumor of esophagus –leiomyoma
81. Ct for ca esophagus –cisplatin
82. Ileostomy complication – necrosis
83. Intussusception -submucus lipoma
84. Secondaries neck mass grade – t0 n2a mx
85. M/c melanoma – superficial spreading
86. Osteoblastic metastasis -prostate
87. Damage control surgery- minimum intervention definitive surgery later
88. Not a complication of tpn -neutrohil dysfunction
89. Marker for contrast nephropathy -creatinine
90. Symptomatic spinal injury wit normal radiology –children
91. Agent for tinea capitis – t.violaceum
92. Contact dermatitis most effective treatment -moist compress
93. Thiazide diuretic in rf-metolazone
94. Betablocker with antioxidant property – carvidilol
95. Membrane stabilising agent maximum -propanolol
96. Azole -ergosteron synthesis inhibitor
97. Not used in chf – clopidogrel
98. Not a prodrug –ticagrelor
99. 8 yrs familial hyper cholestrelemia trt – pravastatin
100. Iodine not true- ci in hypothyroidism
101. Not a cell adhesion molecule……spectrin
102. Fetal and maternal blood diff by – apt test
103. Apt test uses – naoh
104. Active management of third stage oxytocin =10 u im
105. Cin2 in pap smear next step- colposcopy
106. Dysmenorrhea wit uniformly enlarged uterus 14 wks –adenomyosis
107. Most accurate method of dignosis of pregnancy at 6 wks – usg fetal cardiac activity
108. Asymptomatic bacteriuria- trt not needed in pregnancy
109. Hrt not given for- cad prevention
110. Secretory phase – progesterone
111. 11 wks method of termination- suction evacuation
112. M/c progestrone metabolite in urine – pregnanediol
113. Not a stimuli for insulin- hypokalemia
114. Mmse for…….dementia
115. Increased anion gap acidosis a/e -diarrhea
116. Hyerkalemia a/e – u wave
117. Bmr decreased in hypothyroidism
118. Not a feature of thyrotoxicosis hair loss
119. Alkaline diuresis – phenobarbitone
120. Mi first marker- myoglobin
121. Peanut eating tongue swelling -angioneurotic edema
122. Takayasu mc involved -subclavian artery
123. Acute pancreatitis not seen -hypoglycemia
124. Obst sleep apnea next step – wt reduction
125. Edema in nephritic syndrome due to – reduced oncotic pressure
126. Alert not responding – stupor
127. Least sensitive to muscle relaxant- diaphragm
128. Celiac plexus block- diarrhea and hypotension
129. Ci for epidural and spinal all except – hyper tension
130. Red velvetty mucosa – arsenic
131. Lead poisoning-sideroblasts
132. Rta – secondary injury
133. Viper resembles- abrus
134. Last organ to putrify- prostate
135. Vision not affected in – papilledema
136. Visualise angle – gonioscope
137. Rosette- traumatic cataract
138. Not seen in vitreous hemorrhage – metamorphopsia
139. Horner syndrome- miosis
140. Vertically oval pupil – angle congestive glaucoma
141. Soft contact lens – hema
142. Iridotomy -yag laser
143. Not a part of ethmoid – inferior turbinate
144. Claudius cells- organ of corti
145. Mucormycosis – amphotericin
146. Sinus at birth – maxillary and ethmoid
147. Ca larynx wit vocal cord fixation- t3
148. Auditary tube – ant wall of middle ear
149. Otosclerosis – as curve
150. Reverse transcriptase – telomerase
151. Subs level phosphorylation not seen in -pfk
152. Heparin releases – lpl
153. Lyase -aldolase b
154. Insulin dependent glucose transport not in – liver
155. Low km – high affinity
156. Immediate change after lying down -increased venous return
157. Proprioception – a alpha
158. Electrical synapse- gap junction
159. Neuropraxia – physiological interruption
160. Diastolic murmur – pathologic
161. Mr child wit flank mass and liver swellings -tuberous sclerosis
162. Adrenaline dose in a neonate- 0,01 mg/kg or .1 mg /kg of 1 /10000
163. Imp sign in resp disease – retraction
164. Widened epiphysis wit bow legs – rickets
165. Erythema of cheek -pure red cell aplasia
166. Blood nerve barrier formed by perineurium
167. Collecting duct is derived from metanephros
168. Null cells or nk cells 5 -10%
169. Retropharyngeal space extend frm skull base to the level of diaphragm
170. Hypocalcemia not seen in turniquet application
171. Best treatment to prolong life in copd- oxygen
172. Not a sign of increased pulmonary blood flow -kerley b lines
173. Hypothermia during anaesthesia… Warm saline prevention
174. Loading dose – to attain the target concentrationrapidly ..
175. All are associated with sudden death in hocm except? – mr
176. Avg.threshold of hearing at 500,1000,1500 is 45db then % of hearing loss is? 30
177. Icd 10 for psychiatric illnesses :
178. Atypical lymphocytes in infectious mononucleosis cd8t cells
179. Aseptic meningitis- intrathecal methotrexate
180. Not a pleotropic effect of statins – ldl lowering
181. Plasma osmolality 285-295
182. Efficacy of phototherapy not depend on level of bilirubin
183. Osteogenesis imperfecta type 1collagen
184. Disease transmitted by virus mumps and rabies
185. Field h2 of forel =lenticular fasciculus
186. Receptors not true???? Meissner in hairy skin
187. Receptors not true???? Meissner in hairy skin
188. In which pneumoconiosis there is snow-storm appearance on c-xr –silicosis
189. 14 yr old child with abnormal movements with hyperintensity and inv of thalamus pons striatum ? Wilson’s disease
190. Radiation in cervical ca 80-85 -85-90 at point a
191. Amt of iron req by lactating women-38mg
192. L:s ratio for – fetal lung maturity
193. Photoelectric effect -low energy photon nd inner shell electron
194. Abundant element –flourine
195. Lung neuroendocrine cells – carcinoids
196. Urinary catheterised individual no need of any rx
197. Spider leg -polycystic kidney
198. Multiple myeloma…..m spike..35% blast
199. It is not possible to apply koch’s postulates to leprosy
200. M/c mucocele in pns? Frontal
201. Regarding trigeminal nerve, false option is arises from midbrain
202. Melanoma marker s100
203. %percentage of burn in child wid burn in buttocks ,thigh , head n neck ? 37
204. Mc form of vaginitis –senile
205. A patients relative gives a h/o tattoo however it wasnt found on autopsy,wht should b dissected to prove ? Ans = lymph node
206. Vaginal adenosis precedes clear cell ca vagina
207. Eye muscle not supplied by occulomotor? Ans= so
208. Tonsillectomy? Grisler syndrome is not common
209. Hepatitis after blood transfusion is c
210. Anastomosis in arteries except ans = uterine and ovarian artery
211. Extensor hallucis palsy: l5 palsy
212. Inferior tympanic artery is is branch of ascending pharyngeal artey
213. Content of mesorectum except?? – inf rectal arterty
214. Aortic opening–t12
215. Lenalidomide and dexamethasone increased risk of thrombo embolism
216. Earliest serum marker in downs- pappa
217. The difference between hus & ttp is–fever(not found in hus)
JIPMER 2010 February paper Recall of MCQs with discussion
1. In Phenol poisoning urine colour is
Phenol poisoning can lead to green or black urine due to carboluria
2. Methotrexate – is
Anti cancer antibiotic
DNA gyrase inhibitor
3. In early stage meniere’s disease
High frequency SNHL
Low frequency SNHL
High frequency conductive hearing loss
Low frequency conductive hearing loss
Physical distention caused by the increase in endolymphatic pressure leads to mechanical disturbance of the otolithic organs. Because the utricle and saccule are responsible for linear and translational motion detection, rather than angular and rotational acceleration, irritation of these organs may produce nonrotational vestibular symptoms.
This physical distention causes mechanical disturbance of the organ of Corti as well. Distortion of the basilar membrane and the inner and outer hair cells may cause hearing loss and tinnitus.
Because the apex of the cochlea is wound much tighter than the base, the apex is more sensitive to pressure changes than is the base. This explains why hydrops affects low frequencies (located at the apex) more than high frequencies (located at the relatively wider base of the cochlea
4. Post residual paralysis of limb –
Flexion, abduction, external rotation
Flexion, adduction, external rotation
Flexion, abduction, internal rotation
extension, abduction, internal rotation
The common surgeries performed were Soutter’s hip release operation for the hip flexion abduction and external rotation deformity, Yount’s release for flexion deformity of knee and TA lengthening for equinus at ankle.
5. Diaphysial origin of bone tumor is seen with
Primitive neuro ectodermal tumor
Giant cell tumor
6. Bone to bone metastasis is present in
Reticular cell ca
7. IV fluid requirement in < 10kg infant 40ml/hr 30 ml/hr 20 ml/hr 10 ml/hr A # orthopaedics 8. Decrease bone mass density per unit of bone mass known as Osteo malacia Osteoporosis Osteolysis Osteo petrosis B # medicine 9. Least common joint involved in ankylosing spondylitis Sacro iliac Costochondral joint TMJ Intervertrebral B The classic initial site of involvement of ankylosing spondylitis is the sacroiliac joint, followed by the thoracolumbar and lumbosacral junctions. As the disease progresses, the mid lumbar, upper thoracic, and cervical vertebrae are affected. Although considered characteristic, the disease does not always ascend up the spine. In general, atypical patterns occur more frequently in women; spinal disease without sacroiliac joint involvement is unusual in either sex. Peripheral joint involvement tends to occur more frequently in cases of chronic ankylosing spondylitis. Radiographic changes are seen in more than 50% of patients with long-standing ankylosing spondylitis. The hip joint is affected most often; the glenohumeral and knee joints are involved in approximately 30% of patients. With time, diffuse articular disease occurs, with involvement of the hands, wrists, and feet. Radiographic changes are seen at the pubic symphysis, often in combination with sacroiliitis. Other involved cartilaginous sites in the axial skeleton include the manubriosternal, acromioclavicular, and sternoclavicular joints. Enthesopathic changes are frequently seen at sites of tendinous and ligamentous attachments such as the ischial tuberosity, iliac crest, trochanters of the femur, and the inferior calcaneum. temporomandibular joint (TMJ) involvement is frequent in ankylosing spondylitis # orthopaedics 10. Which is not present in More dorsiflexion Cavus deformity c. Small hypoplastic heel A Presentation Seek a detailed family history of clubfoot or neuromuscular disorders, and perform a general examination to identify any other abnormalities. Examine the feet with the child prone, with the plantar aspect of the feet visualized, and supine to evaluate internal rotation and varus. If the child can stand, determine if the foot is plantigrade, if the heel is bearing weight, and if it is in varus, valgus, or neutral. Similar deformities are seen with myelomeningocele and arthrogryposis. Therefore, always examine for these associated conditions. The ankle is in equinus, and the foot is supinated (varus) and adducted (a normal infant foot usually can be dorsiflexed and everted, so that the foot touches the anterior tibia). Dorsiflexion beyond 90° is not possible. The navicular is displaced medially, as is the cuboid. Contractures of the medial plantar soft tissues are present. Not only is the calcaneus in a position of equinus but also the anterior aspect is rotated medially and the posterior aspect laterally. The heel is small and empty. The heel feels soft to the touch (akin to the feel of the cheeks). As the treatment progresses, it fills in and develops a firmer feel (akin to the feel of the nose or of the chin). The talar neck is easily palpable in the sinus tarsi as it is uncovered laterally. Normally, this is covered by the navicular, and the talar body is in the mortise. The medial malleolus is difficult to palpate and is often in contact with the navicular. The normal navicular-malleolar interval is diminished. The hindfoot, as shown below, is supinated, but the foot is often in a position of pronation relative to the hindfoot. The first ray often drops to create a position of cavus. The Ponseti method of closed management of clubfeet through manipulations and casting describes the elevation of the first metatarsal as a first step, even if it means seemingly exacerbating the supination of the foot Bone Tibia: Slight shortening is possible. Fibula: Shortening is common. Talus: In equinus in the ankle mortise, with the body of the talus being in external rotation, the body of the talus is extruded anterolaterally and is uncovered and can be palpated. The neck of the talus is medially deviated and plantar flexed. All relationships of the talus to the surrounding bones are abnormal. Os calcis: Medial rotation and an equinus and adduction deformity are present. Navicular: The navicular is medially subluxated over the talar head. Cuboid: The cuboid is medially subluxated over the calcaneal head. Forefoot: The forefoot is adducted and supinated; severe cases also have cavus with a dropped first metatarsal. Muscle Atrophy of the leg muscles, especially in the peroneal group, is seen in clubfeet. The number of fibers in the muscles is normal, but the fibers are smaller in size. The triceps surae, tibialis posterior, flexor digitorum longus (FDL), and flexor hallucis longus (FHL) are contracted. The calf is of a smaller size and remains so throughout life, even following successful long-lasting correction of the feet. Tendon sheaths: Thickening frequently is present, especially of the tibialis posterior and peroneal sheaths. Joint capsules: Contractures of the posterior ankle capsule, subtalar capsule, and talonavicular and calcaneocuboid joint capsules commonly are seen. Ligaments: Contractures are seen in the calcaneofibular, talofibular, (ankle) deltoid, long and short plantar, spring, and bifurcate ligaments. Fascia: The plantar fascial contracture contributes to the cavus, as does contracture of fascial planes in the foot @ orthopaedics 11. Fracture of base of First metacarpal Boxer # Bennets # Chauffers # Bartons # B Fractures of the thumb (first metacarpal) are fairly rare, because the bone is quite mobile. Bennett's fracture and Rolando's fracture, however, are two noteworthy first metacarpal fractures. Rolando's fracture is an intra-articular fracture of the base of the first metacarpal where the bone is crushed into several pieces at the fracture site (comminuted); Bennett's fracture is a noncomminuted fracture in the same location Fractures of the fifth metacarpal neck (boxer fractures) @ Mediicne 12 In Hypokalemia , ECG changes include Tall T waves Inverted T waves ST interval prolonged QT prolongation B Electrocardiography T-wave flattening or inverted T waves Prominent U wave that appears as QT prolongation ST-segment depression Ventricular arrhythmias (eg, premature ventricular contractions [PVCs], torsade de pointes, ventricular fibrillation)5 Atrial arrhythmias (eg, premature atrial contractions [PACs], atrial fibrillation Prominent U waves after T waves in hypokalemia. @ anatomy 13. Joint b/w epiphysis and diaphysis Syndesomosis Synchondrosis Plain Synovial joint Fibrous joint B commonest synchondroses are the epiphyseal (or growth) cartilages between the diaphysis (main shaft) and epiphyses (bony ends) of a long bone @ Orthopaedics 14. Medial border of Antomical snuff box is formed by extensor pollicis longus extensor pollicis brevis abductor pollicis longus Abductor pollisis brevis Ans a The boundaries The medial border of the snuffbox is the tendon of the extensor pollicis longus. The lateral border is a pair of parallel and intimate tendons, of the extensor pollicis brevis and the abductor pollicis longus. (Accordingly, the anatomical snuffbox is most visible, having a more pronounced concavity, during thumb extension.) The proximal border is formed by the styloid process of the radius The distal border is formed by the approximate apex of the schematic snuffbox isosceles triangle. The floor of the snuffbox varies depending on the position of the wrist, but both the trapezium and primarily the scaphoid can be palpated. Orthopaedics @15. Superficial branch of Ulnar nerve supplying hand muscle Adductor pollisis Abductor digiti minimi palmaris brevis Opponans pollisis C The superficial branch of the ulnar nerve is a terminal branch of the ulnar nerve It supplies the palmaris brevis and the skin on the ulnar side of the hand, and divides into a proper palmar digital nerve and a common palmar digital nerve. The proper digital branches are distributed to the fingers in the same manner as those of the median nerve. @ orthopaedics 16. Clergy man’s bursitis is Supra patellar Pre patellar Intra patellar Olecrenon C Infrapatellar bursitis or clergyman's knee @ Medicine 17. L4-L5 disc prolapse present with A/E Absent Ankle jerk Loss of sensation over dorsum of foot Extensor Hallucis .Longus paralysis S.L.R positive A # Medicine 18. Posterior column injury, A/E ankle jerk knee jerk c. Abdominal jerk d. propriception C @ Orthopaedics 19. most reliable symptom for determining a rotator cuff tear is Pain in the anterolateral aspect of the shoulder loss of abduction intolerance to overhead activity unable to lift a gallon of milk from the refrigerator Ans b Symptoms associated with rotator cuff tears The most reliable symptom for determining a rotator cuff tear is probably the least common and is found when there is a complete rupture with detachment of the rotator cuff leading to the complaint of complete loss of function, such as, loss of the ability to actively move the arm away from the side of the body (loss of abduction). Fortunately this finding is rare and when tears are symptomatic, most tears present as pain with limitation of function, a non-specific complaint that cannot distinguish between tendinitis, bursitis or arthritis. The clinical picture of a completely detached tear is more clear-cut, while the more common shoulder problems greatly overlap in their clinical presentation. Pain in the anterolateral aspect of the shoulder can be due to many causes, symptoms may reflect pathology outside of the shoulder which cause referred pain to the shoulder from sites such as the neck, heart or gut. Patient history will often include pain or ache over the front and outer aspect of the shoulder, pain aggravated by leaning on the elbow and pushing upwards on the shoulder (such as leaning on the armrest of a reclining chair), intolerance to overhead activity, pain at night when lying directly on the affected shoulder, pain when reaching forward (e.g. unable to lift a gallon of milk from the refrigerator). Weakness may be reported, but is often masked by pain and is usually found only through examination. With longer standing pain, the shoulder is favored and gradually loss of motion and weakness may develop which, due to pain and guarding are often missed by the patient and are only brought out during the examination. Primary shoulder problems may cause pain over the deltoid muscle that is made worse by abduction against resistance, called the impingement sign. Impingement reflects pain arising from the rotator cuff but cannot distinguish between inflammation, strain, or tear. Patients may report their experience with the impingement sign when they report that they are unable to reach upwards to brush their hair or to reach in front to lift a can of beans up from an overhead shelf. Some areas of the rotator cuff tendons have poor blood supply. @ Physiology 20. Gamma motor neurons present in which part of spinal cord Rubro spinal tract Cortico spinal Vertibral spinal Tecto spinal A The rubrospinal tract influences limb muscle function The red nucleus of the mesencephalon receives major input from both the cerebellum and the cerebral cortical motor areas. Output via the rubrospinal tract is directed predominantly to contralateral spinal motor neurons that are involved with movements of the distal limbs. The axons of the rubrospinal tract are located in the lateral spinal white matter. Rubrospinal action enhances the function of motor neurons innervating limb flrxor muscles while inhibiting extensors. This tract may also influence gamma motor neuron function. Electrophysiological studies reveal that many rubrospinal neurons are active during iocomotion, with more than one half showing increased activity during the swing phase of stepping, when the flexors are most active. This system appears to be important for the production of movement, espicially in the distal limbs. Experimental lesions that interrupt rubrospinal axons produce deficits in distal limb flexion, with little change in more proximal muscles. In higher animals, the corticospinal tract supersedes some of the function of the rubrospinal tract. Gamma-motoneurons regulate the gain of the stretch reflex by adjusting the level of tension in the intrafusal muscle fibers of the muscle spindle. This mechanism sets the baseline level of activity in α-motoneurons and helps to regulate muscle length and tone. For example, stimulation of a γ-motoneuron from higher centers contracts the ends of the intrafusal fibres and consequently stretches the middle part of the muscle spindle (where Type Ia sensory fibers are located). These afferent neurons are therefore innervated and go on to synapse with alpha-motoneurons. @ Radiology 21. gamma-knife contains Cs 130 Co 60 Gallium Iridium 92 B The Gamma Knife contains up to 201 cobalt-60 sources of approximately 30 curies each, placed in a circular array in a heavily shielded unit @ SPM 22. Which is a killed vaccine Yellow JE HBV Measles C Hepatitis B vaccine is an inactivated (killed) vaccine @ spm 23. Primary prevention + secondary prevention denotes Control Elimination Eradication Surveillance A # radiology 24. string’s sign of Kanter chron’s disease Ulcerative disease Achalsia cardia TB A Kantor's string sign is seen when a barium meal and follow through shows a typical stricture in the affected segment, usually the terminal ileum. In some cases the ulcerated small bowel may show a 'cobble-stone' appearance. @ Radiology 25. Spider leg appearance seen in ADPKD Hydro nephosis Wilm’s tumor Renal TB A ADPKD presents in the fourth or fifth decade, and in all patients by age 60. Presenting features are hypertension, renal failure, haematuria, proteinuria, abdominal pain and renal mass. A plain X – ray can show calcifications or calculi and enlarged renal contours. On IVU, kidneys are enlarged and renal pelvis is compressed and elongated. The calyces are stretched over the cyst may cause the typical spider leg deformity. Ultrasound shows bilaterally enlarged kidneys, with multiple cysts of varying sizes. CT scan shows the cysts, which may be calcified. Normally they are hypodense. Hyperdense cysts indicate haemorrhage or infection. A Swiss – cheese nephrogram refers to the appearance of multiple small cysts with smooth margins. The kidneys become smaller with onset of renal failure. Associated renal cell carcinoma can detected. On MRI scan, the cysts are hypointense in T1 and hyperintense in T2. @ SPM 26. MC complication of mumps in children Orchitis parotitis Meningo Enchephalitis myocarditis B The most common presentation is a parotitis, which occurs in 30-40% @ pATHOLOGY 27. Skip lesion seen in chron’s disease Ulcerative ds Ischemic colitis Celiac dis A @ pATHOLOGY 28. Auer rods are Leukocytic progenitor Calcification of rods in retina Abnormal condensation of intra cytoplasmic granules Dead cells C @ GOB 29. Inhibin secreted by Graffian follicle Corpus lueteum Decidua Theca cells Ans b Inhibin In both females and males, inhibin inhibits FSH production and GnRH release from the hypothalamus. However, the overall mechanism differs between the genders: In females Inhibin is produced in the gonads, pituitary gland, placenta and other organs. In women, FSH stimulates the secretion of inhibin from the granulosa cells of the ovarian follicles in the ovaries. In turn, inhibin suppresses FSH. Inhibin is secreted by granulosa cells of growing follicles and by the corpus luteum of the ovary. It inhibits secretion of FSH and to a lesser extent, LH. Inhibin B reaches a peak in the early- to mid-follicular phase, and a second peak at ovulation. Inhibin A reaches its peak in the mid-luteal phase. Inhibin secretion is diminished by GnRH, and enhanced by insulin-like growth factor-1 (IGF-1). In males In men, it is a hormone that inhibits FSH by negative feedback. It is secreted from the Sertoli cells, located in the seminiferous tubules inside the testes. Androgens stimulate inhibin production; this peptide may also help to locally regulate spermatogenesis In the primary ovarian follicle and later in follicle development (folliculogenesis) granulosa cells advance to form a multilayered cumulus oophorus surrounding the oocyte in the preovulatory or Graafian follicle. The major functions of granulosa cells include the production of sex steroids, as well as a myriad of growth factors thought to interact with the oocyte during its development. Also FSH stimulates granulosa cells to convert androgens (coming from the thecal cells) to estradiol by aromatase. However, after ovulation the granulosa cells produce progesterone. The progesterone may maintain a potential pregnancy and causes production of a thick cervical mucus that inhibits sperm entry into the uterus. @ Surgery 30. Primary Rx of sqamous anal canal carcinoma is APR Excision f/b chemoradiation Chemoradiation Only chemotherapy C Anal cancer is most effectively treated with surgery, and in early stage disease (i.e., localised cancer of the anus without metastasis to the inguinal lymph nodes), surgery is often curative. The difficulty with surgery has been the necessity of removing the anal sphincter, with concomitant fecal incontinence. For this reason, many patients with anal cancer have required permanent colostomies. In more recent years, physicians have employed a combination strategy including chemotherapy and radiation treatments to reduce the necessity of debilitating surgery. This "combined modality" approach has led to the increased preservation of an intact anal sphincter, and therefore improved quality of life after definitive treatment. Survival and cure rates are excellent, and many patients are left with a functional sphincter. Some patients have fecal incontinence after combined chemotherapy and radiation. Biopsies to document disease regression after chemotherapy and radiation were commonly advised, but are not as frequent any longer. Current chemotherapy active in anal cancer includes cisplatin and 5-FU. Mitomycin has also been used, but is associated with increased toxicity. @ Physiology 31. Androgen is secreted by Leydig cell Sertoli cell Seminiferous tubules Granulosa cells A Leydig cells release a class of hormones called androgens (19-carbon steroids). They secrete testosterone, androstenedione and dehydroepiandrosterone (DHEA) @ dermatology 32. In Dermatomyositis all are seen except Caclinosis cutis Butterfly malar rash Shawl sign Heliotrope rash Ans b RASHES OF DERMATOMYOSITIS Heliotrope rash – eyelids Gottron’s sign – hands and phalangeal joints Mechanic’s hands – palms radial aspect of fingers Shawl sign – posterior neck and shoulders V – sign – anterior neck and chest Poikiloderma vasculare atrophicans - torso Calcinosis cutis is a term used to describe a group of disorders in which calcium deposits form in the skin Generalized tissue damage Connective tissue diseases: Examples are dermatomyositis1,2 ; lupus erythematosus3,4,5,6 ; systemic sclerosis; and calcinosis cutis, Raynaud phenomenon, esophageal dysfunction, sclerodactyly, telangiectasias (CREST). In dermatomyositis, calcification occurs 3 times more commonly in juvenile dermatomyositis than the adult-onset form and may be seen in 30-40% of patients. Calcification is accentuated over joints, sparing the digits. Aggressive corticosteroid therapy decreases the incidence of calcification. In lupus erythematosus, calcification is rare and usually an insignificant incidental radiologic finding. Calcification occurs most frequently with long-standing systemic disease, and though calcification may develop in lesions of lupus profundus, it usually is not associated with panniculitis. However, an associated myositis may be present. Lesions characteristically are on the extremities.Regarding scleroderma, systemic scleroderma and CREST syndrome are related diseases frequently associated with the late development of tissue calcification # anatomy 33. Mesonephric duct derivatives are A/E Rete testis Seminiferous tuberlus Ejaculate duct The Wolffian duct (also known as archinephric duct, Leydig's duct, mesonephric duct, or nephric duct) is a paired organ found in mammals including humans during embryogenesis. It connects the primitive kidney Wolffian body (or mesonephros) to the cloaca and serves as the anlage for certain male reproductive organs. In both the male and the female the Wolffian duct develops into the trigone of urinary bladder, a part of the bladder wall. However, further development differentiates between the sexes in the development of the urinary and reproductive organs Male development In a male, it develops into a system of connected organs between the testis and the prostate, namely the rete testis, the efferent ducts, the epididymis, the vas deferens,and the seminal vesicle. The prostate forms from the urogenital sinus. For this it is critical that the ducts are exposed to testosterone during embryogenesis. Testosterone binds to and activates androgen receptor, affecting intracellular signals and modifying the expression of numerous genes. In the mature male, the function of this system is to store and mature sperm, and provide accessory semen fluid. Female development In the female, in the absence of testosterone support, the Wolffian duct regresses, and inclusions may persist. The epoophoron and Skene's glands may be present. Also, lateral to the wall of the vagina a Gartner's duct or cyst could develop as a remnant. The derivatives can be remembered using the mnemonic, "Gardener's SEED" for Gartner's duct, Seminal vesicles, Epididymis, Ejaculatory duct and Ductus deferens Derivatives of mesonephros are a appendix testis f b efferent ductules of the testis t c Gartner duct cyst f d gubernaculum testis f e prostatic utricle f # psychiatry 34. Anxiety is a Fear to known threat of external stimulus Unlike a fear Seems to be fear like emotion C Fear is an emotional response to a perceived threat. It is a basic survival mechanism occurring in response to a specific stimulus, such as pain or the threat of danger. Some psychologists such as John B. Watson, Robert Plutchik, and Paul Ekman have suggested that fear is one of a small set of basic or innate emotions. This set also includes such emotions as joy, sadness, and anger. Fear should be distinguished from the related emotional state of anxiety, which typically occurs without any external threat. Additionally, fear is related to the specific behaviors of escape and avoidance, whereas anxiety is the result of threats which are perceived to be uncontrollable or unavoidable @ Psychiatry 35. In Bipolar disorder Rx ,drugs used are all except Gabapentine Lithium Volproate Carbamazepine A The mainstay of treatment is a mood stabilizer medication such as lithium carbonate or lamotrigine. Lamotrigine has been found to be best for preventing depressions, while lithium is the only drug proven to reduce suicide in bipolar patients. These two drugs comprise several unrelated compounds which have been shown to be effective in preventing relapses of manic, or in the one case, depressive episodes. The first known and "gold standard" mood stabilizer is lithium, while almost as widely used is sodium valproate, also used as an anticonvulsant. Other anticonvulsants used in bipolar disorder include carbamazepine, reportedly more effective in rapid cycling bipolar disorder, and lamotrigine, which is the first anticonvulsant shown to be of benefit in bipolar depression. Treatment of the agitation in acute manic episodes has often required the use of atypical antipsychotic medications, such as quetiapine, olanzapine and chlorpromazine. More recently, olanzapine and quetiapine have been approved as effective monotherapy for the maintenance of bipolar disorder. A head-to-head randomized control trial in 2005 has also shown olanzapine monotherapy to be as effective and safe as lithium in prophylaxis. The use of antidepressants in bipolar disorder has been debated, with some studies reporting a worse outcome with their use triggering manic, hypomanic or mixed episodes, especially if no mood stabiliser is used. However, most mood stabilizers are of limited effectiveness in depressive episodes. Rapid cycling can be induced or made worse by antidepressants, unless there is adjunctive treatment with a mood stabilizer. One large-scale study found that depression in bipolar disorder responds no better to an antidepressant with mood stabilizer than it does to a mood stabilizer alone. Recent research indicates that triacetyluridine may help improve symptoms of bipolar disorder.Clinical studies have shown that Omega 3 fatty acids may have beneficial effects on bipolar disorder. Also, topiramate is an anticonvulsant often prescribed as a mood stabilizer. It is an off-label use when used to treat bipolar disorder. Unfortunately, its efficacy is likely minimal and side effects, such as significant cognitive impairment, limit its usefulness (Kushner, et al. 2006 Bipolar Disorders 8; Chengappa, et al. 2006 J Clin Psych; 6). When medication causes a reduction in symptoms or complete remission, it is important for someone with a bipolar disorder to understand they should continue to take the medicine. This can be complicated, as effective treatment may result in the reduction of manic symptoms and/or the medicine can be mood blunting or sedative, resulting in the person feeling they are stifled or that the medicine isn't working. Either way, relapse is likely to occur if the medicine is discontinued. @ Anaesthesia 36. Hemato toxicity causing anaesthetics N20 Halothane Sevoflorane Desflorane A Patients who are deficient in cytochrome b5 reductase are particularly prone to methemoglobinemia, especially when exposed to oxidizing medications and other chemicals, including nitrates, nitrites, prilocaine and lidocaine, nitric oxide, and aniline dyes @ Paediatrics 37. Pinser grasp seen at 4-6 m 7-8 m 9-10 m 12 m C @ SPM 38. MC cause of mortality in 1-4 yr child Malnutrition Respiratory infections Diarrheal diseases Prematurity B In 1-4 years', pneumonia forms the leading causes @ Radiology 39. Kerly – b lines are seen in Pneumonia Pulmonary. Edema ARDS Pnuemothorax B @ Forensic 40. Spinal cord preserved in which poisoning Strychnine Hg Lead Arsenic A Entire length of spinal cord is collected when strychnine poisoning is suspected. # forensic 41. doctor’s civil suit claimed with in-duration 3 months 6 months 1 year 2 yr @ forensic 42. Cotton swab forgotten in peritoneum during surgery is a Civil negligence Criminal negligence Doctrine of Res Ipsa Loquitur Vicarious liability C The Doctrine of Res Ipsa Loquitur: Ordinarily, the professional negligence of a physician must be proved in Court by the expert evidence of another physician. The patient need not prove negligence in case where the rule of res ipsa loquitur applies, which means “the thing or fact speaks for itself. The rule is applied when the following conditions are satisfied: (1) that in the absence of negligence the injury would not have occurred ordinarily; (2) that the doctor had exclusive control over the injury producing instrument or treatment; (3) that the patient was not guilty of contributory negligence. This enables the patient’s lawyer to prove his case without medical evidence. Some of the examples are: (1) failure to give anti-tetanic serum in cases of injury causing tetanus, (2) burns from application of hot water bottles or from X-ray therapy, (3) prescribing an overdose of medicine producing ill-effects, (4) giving poisonous medicine carelessly, (5) breaking of needles, (6) blood transfusion misadventure, (7) failure to remove the swabs during operation which may lead to complications or cause death, (8) loss of use of hand due to prolonged splinting. This doctrine is applied both to civil and criminal negligence. It does not apply where common knowledge or experience is not sufficiently extensive to know that the patient’s condition would not have existed but for the doctor’s negligence. It cannot be applied against several defendants only one of whom, who cannot be identified could have caused patient’s injury. @ Pharmacology 43. Ivermectin used in A/E Malaria Filariasis Ascariasis Oncerciasis A Ivermectin (22,23-dihydroavermectin B1a + 22,23-dihydroavermectin B1b) is a broad-spectrum antiparasitic medication. It is traditionally used against worms, but more recently found to be effective against mites and some lice too. Ivermectin has already been found to be highly effective in treating strongyloidiasis and ascariasis Ivermectin, under the brand name Mectizan, is currently being used to help eliminate river blindness (onchocerciasis) in the Americas and stop transmission of lymphatic filariasis and onchocerciasis around the world.   Currently, large amounts of Ivermectin are donated by Merck to fight river blindness in countries that are unable to afford the drug . The disease is endemic in 30 African countries, 6 Latin American countries and Yemen, according to studies conducted by the World Health Organization.  The drug rapidly kills microfilariae but not the adult worms. A single oral dose of ivermectin, taken annually for the 10-15 year life span of the adult worms, is all that is needed to protect the individual from onchocerciasis @ gob 44. All are ovarian epithelial cell tumors except Hilius cell tumor Brenners cell tumor Endometriad cell tumor Clear cell ca A Clear cell tumors Clear cell tumors are characterized by large epithelial cells with abundant clear cytoplasm and may be seen in association with endometriosis or endometrioid carcinoma of the ovary, bearing a resemblance to clear cell carcinoma of the endometrium. They may be predominantly solid or cystic. If solid, the clear cells tend to be arranged in sheets or tubules. In the cystic variety, the neoplastic cells make up the cyst lining. Prognosis These tumors tend to be aggressive, the five year survival rate for tumors confined to the ovaries is approximately 65%. If the tumor has spread beyond the ovary at diagnosis, the prognosis is poor Brenner tumor Brenner tumors are uncommon surface-epithelial stromal cell tumors in which the epithelial cell (which defines these tumors) is a transitional cell. These are similar in appearance to bladder epithelia. The tumors may be very small to very large, and may be solid or cystic. Histologically, the tumor consists of nests of the aforementioned transitional cells within surrounding tissue that resembles normal ovary. Brenner tumors may be benign or malignant, depending on whether the tumor cells invade the surrounding tissue. Ovarian cancer classified according to the histology of the tumor, obtained in a pathology report. Histology dictates many aspects of clinical treatment, management, and prognosis. Surface epithelial-stromal tumour, also known as ovarian epithelial carcinoma, is the most common type of ovarian cancer. It includes serous tumour, endometrioid tumor and mucinous cystadenocarcinoma. Sex cord-stromal tumor, including estrogen-producing granulosa cell tumor and virilizing Sertoli-Leydig cell tumor or arrhenoblastoma, accounts for 8% of ovarian cancers. Germ cell tumor accounts for approximately 30% of ovarian tumors but only 5% of ovarian cancers, because most germ cell tumors are teratomas and most teratomas are benign (see Teratoma). Germ cell tumor tends to occur in young women and girls. The prognosis depends on the specific histology of germ cell tumor, but overall is favorable. Mixed tumors, containing elements of more than one of the above classes of tumor histology. @ gob 45. Tumor marker for dysgerminoma LDH CEA CA-19 All of above A The standard workup for suspected GCTs requires alpha-fetoprotein (AFP) and beta-human chorionic gonadotropin (bHCG) levels because these agents have endocrine activity. Dysgerminomas (a germ cell subtype) are an exception to this rule. The absence of an elevated AFP or bHCG does not exclude the diagnosis of dysgerminomas because they rarely produce hormones. In extremely rare cases, dysgerminomas can become infiltrated with syncytiotrophoblastic giant cells, which produce human chorionic gonadotropin. Regardless, if the differential diagnosis includes dysgerminoma, AFP and bHCG levels are highly recommended. •Useful tumor markers for dysgerminomas bHCG AFP Lactate dehydrogenase (LDH) Cancer antigen 125 (CA-125) These markers can also be used for postoperative follow-up care or for tracking the success of adjuvant therapy # gob 46. Mc ovarian tumor in pregnancy Dermoid Dysgerminoma Granulosa cell tumor Hilus cell tumor A Ovarian tumors with pregnancy Incidence 1:1000 pregnancy Benign tumors are common e.g. luteal cyst and Dermoid cyst Malignant tumors 5% -Ovarian malignancy has no effect on pregnancy and pregnancy has no effect on prognosis of ovarian cancer -Benign cyst may undergo torsion causing acute abdomen commonly in puerperium 47. After IUCD memorrhagia Rx Progestin pill Ocp Aspirin Tranexamic acid Levonorgestrel intrauterine system Reduces menstrual blood loss by as much as 97%17 Comparable to transcervical resection of the endometrium for reduction of menstrual bleeding18 The FDA approved a new indication for the levonorgestrel intrauterine device, Mirena, for the treatment of menorrhagia in women who use intrauterine conception. Approval was granted subsequent to a randomized, open-label, active-control (medroxyprogesterone) clinical trial of women (n=160) with established heavy menstrual bleeding. The results demonstrated that Mirena reduced menstrual blood loss significantly compared with medroxyprogesterone (p<0.001). Adverse effects of Mirena include uterine bleeding or spotting, headache, ovarian cysts, vaginitis, dysmenorrhea, and breast tenderness 48. Superficial inguinal ring is defect of a. Ext. oblique aponeurosis b. Fascia transversalis c. ext. oblique muscle d. Int. oblique aponeurosis A The superficial 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 also called the subcutaneous inguinal ring or external inguinal ring. 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 49. OCP protects A/E Endometrial ca Cervical ca Colon ca Ovarian B 50. ½ kg wt reduction in 1wk, how much calories decrease per day 250 k.cal 500 k.cal 750 k.cal 775 k.cal 51. Adductor canal contents A/E F. artery F. vein Sephanous. N. Nerve to vastus lateralis D The canal contains the femoral artery, femoral vein, and branches of the femoral nerve (specifically, the saphenous nerve, and the nerve to the Vastus medialis).[ 52. Scarpas fascia attached to Inguinal ligament Conjoined ligament C. Superficial ing.ring A The deep layer (fascia of Scarpa) is a layer of the anterior abdominal wall. It is thicker and more membranous in character than the superficial fascia of Camper, and contains a considerable quantity of orange elastic fibers. It is loosely connected by areolar tissue to the aponeurosis of the Obliquus externus abdominis, but in the middle line it is more intimately adherent to the linea alba and to the symphysis pubis, and is prolonged on to the dorsum of the penis, forming the fundiform ligament; above, it is continuous with the superficial fascia over the rest of the trunk; below and laterally, it blends with the fascia lata of the thigh a little below the inguinal ligament; medially and below, it is continued over the penis and spermatic cord to the scrotum, where it helps to form the dartos. From the scrotum it may be traced backward into continuity with the deep layer of the superficial fascia of the perineum (fascia of Colles). In the female, it is continued into the labia majora and thence to the fascia of Colles. 53. Tensor fascia lata nerve supply is Femoral Superior glutial Infe. Glutial Sciatic B Tensor fascia lata 54. Nitric oxide MOA cGMP cAMP P53 DAG A 55. Vaginal metastasis least with Choreo ca Primary vaginal carcinoma Cervix ca Endometrial carcinoma B Endometrial carcinoma is surgically staged using the FIGO cancer staging system. Although the FIGO staging has recently been updated, the older staging described below is still commonly used. Stage IA: tumor limited to the endometrium Stage IB: invasion of less than half the myometrium Stage IC: invasion of more than half the myometrium Stage IIA: endocervical glandular involvement only Stage IIB: cervical stromal invasion Stage IIIA: tumor invades serosa or adnexa, or malignant peritoneal cytology Stage IIIB: vaginal metastasis Stage IIIC: metastasis to pelvic or para-aortic lymph nodes Stage IVA: invasion of the bladder or bowel Stage IVB: distant metastasis, including intraabdominal or inguinal lymph nodes 56. MC cause of psuedocyst pancreas Pancreatitis Trauma Surgery Pancreatic ca A Pancreatic pseudocysts are usually complications of pancreatitis,[although in children they frequently occur following abdominal trauma. Pancreatic pseudocysts account for approximately 75% of all pancreatic masses. Pseudocysts most commonly result from an acute or chronic inflammatory process involving the pancreas. Pancreatic trauma also can result in pseudocyst formation. In this process, the common etiologic insult that causes leakage of pancreatic juice and pseudocyst formation is pancreatic ductal disruption. 57. Vitiligo commonly associated with Addison’s disease DM DI Thyroid disease D Vitiligo is an acquired pigmentary disorder of the skin and mucous membranes, and it is characterized by circumscribed depigmented macules and patches. Vitiligo is a progressive disorder in which some or all of the melanocytes in the affected skin are selectively destroyed Autoimmune destruction of melanocytes The autoimmune theory proposes alteration in humoral and cellular immunity in the destruction of melanocytes of vitiligo. Thyroid disorders, particularly Hashimoto thyroiditis and Graves disease; other endocrinopathies, such as Addison disease and diabetes mellitus; and alopecia areata; pernicious anemia; inflammatory bowel disease; psoriasis; and autoimmune polyglandular syndrome are all associated with vitiligo. The most convincing evidence of an autoimmune pathogenesis is the presence of circulating antibodies in patients with vitiligo.2 The role of humoral immunity is further supported by the observation that melanocytes are destroyed in healthy skin engrafted onto nude mice injected with vitiligo patient sera.3 In addition to the involvement of humoral immune mechanisms in the pathogenesis of vitiligo, strong evidence indicates involvement of cellular immunity in vitiligo. Destruction of melanocytes may be directly mediated by autoreactive CD8+ T cells. Activated CD8+ T cells have been demonstrated in perilesional vitiligo skin. In addition, melanocyte-specific T cells have been detected in peripheral blood of patients with autoimmune vitiligo 58. All are present at birth except Malleus Incus Stapes Petrous temporal D 59. Mc motility disorder of oesophagus a. Achalasia cardia b. Nut craker esophagus c. Diffuse esophagal spasm d. Ineffective peristallis B Nutcracker esophagus is the most common motility disorder (>40% of all motility disorders diagnosed),
60. Plummer vinson syndrome all are seen except
Hypertrophic oral mucosa
atrophy of lingual papillae produces a smooth, shiny red tongue dorsum
61. All are cause primary amenorrhea except
62. Leukonychia seen in
Types of Leukonychia
This condition is a whitening of the entire nail. This may be due to hypoalbuminaemia (low albumin), which is caused by the nephrotic syndrome (a form of kidney failure), liver failure, protein malabsorption and protein-losing enteropathies. A genetic condition, and a side effect of sulphonamides, a family of antibiotics can also cause this appearance.
This condition is whitening of parts of the nail. There are several types of this condition.
Leukonychia Striata or Transverse Leukonychia
Also called Muehrcke’s lines, this is a whitening or discoloration of the nail in bands or “stria”. It may be caused by cirrhosis, chemotherapy, or physical injury to the nail matrix. (e.g. excessive nail “tapping” or slamming in a car door).
This condition looks similar to Mee’s lines, a condition caused by Arsenic, Lead, or other heavy metal poisoning.
Also known as ‘True’ Leukonychia. This is the most common form of Leukonychia, small white spots on the nails. Picking and biting of the nails are a prominent cause in young children and nail biters. In most cases, when white spots appear on a single or a couple of fingers or toes, the most common cause is injury to the base (matrix) of the nail.
When this is the case, white spots disappear after around eight weeks, which is the amount of time necessary for nails to regrow completely.
White spots showing up on all or nearly all nails for longer periods of time (months and years) can be due to one of several reasons. One common explanation is zinc deficiency.
63. In cocaine poisoning seen A/E
Amantidine is a treatment
Emotional distress can exacerbate dystonic reactions, whereas relaxation may reduce the intensity of such attacks. Using a calm reasoned approach in a quiet room markedly complements the effectiveness of pharmacologic interventions.
Dopamine and acetylcholine have mutually antagonistic functions in the nigrostriatal system. Although diphenhydramine, with its anticholinergic properties, is the drug of choice for most dystonic reactions, it should be used with caution in cocaine toxicity. Antihistamines cause hyperthermia by central (eg, hypothalamic) and peripheral (inhibition of sweating and muscular rigidity) effects; cocaine also causes hyperthermia. Antihistamines and cocaine are sodium channel blockers. Therefore, coadministration of an antihistamine in the setting of cocaine use may potentiate a molecular pathophysiological cascade that exacerbates end-organ dysfunction.
Benzodiazepines, with their anxiolytic and muscle relaxant properties, are alternative drugs for the treatment of dystonia. Although they only treat the manifestations of dystonias and not the pathophysiology underlying their development; the advantage of using benzodiazepines lies in their safety.
Approximately 30-50% of cocaine is metabolized by hepatic esterases and plasma pseudocholinesterase, resulting in the formation of ecgonine methyl ester. Spontaneous nonenzymatic hydrolysis of another 30-40% results in benzoylecgonine. Both products are water-soluble, metabolically active, and capable of increasing blood pressure (BP). Benzoylecgonine, which has a half-life of 7.5 hours, can induce seizures, perhaps even hours to days after the last use.
Cocaine-induced seizure is a severe manifestation of toxicity. Cocaine may cause generalized tonic and clonic convulsions as well as focal seizures. Intense stimulation of sigma and muscarinic receptors by cocaine and increased synaptic concentration of serotonin have been proposed as causal. Cocaine lowers the threshold for seizures and may produce a kindling effect on neurons that promotes convulsions.
The frequency of seizures ranges from a low as 1% to as high as 29%, perhaps a reflection of an increase in cocaine use from one time period to another or the concurrent use of other drugs. Of 474 patients with medical complications of cocaine abuse, 8% experienced first-time seizures and, of these, 85% had seizures during administration of the drug.
Cocaine-associated seizures may occur in naive and long-term users and are mostly single tonic-clonic, resolving without intervention. However, status epilepticus may occur. The first stage of status epilepticus is manifested by generalized tonic-clonic seizures associated with hypertension, hyperpyrexia, and diaphoresis. After approximately 30 minutes, the second stage may occur, in which cerebral autoregulation fails, cerebral blood flow diminishes, and systemic hypotension occurs. During this phase, the only clinical manifestations may be minor twitching, though cerebral electrical seizure activity continues.
64. Rheumatic chorea A/E
Increased during sleep
4-10 weeks present
Sudden jerky extermeties
Sydenham’s chorea or Chorea minor (also known as “Saint Vitus’ Dance”) is a disease characterized by rapid, uncoordinated jerking movements affecting primarily the face, feet and hands. SC results from childhood infection with Group A beta-hemolytic Streptococci and is reported to occur in 20-30% of patients with rheumatic fever (RF). The disease is usually latent, occurring up to 6 months after the acute infection, but may occasionally be the presenting symptom of RF. SC is more common in females than males and most patients are children, below 18 years of age. Adult onset of SC is comparatively rare and most of the adult cases are associated with exacerbation of chorea following childhood SC.
SC is characterised by the acute onset (sometimes a few hours) of motor symptoms, classically chorea, usually affecting all limbs.
Other motor symptoms include facial grimacing, hypotonia, loss of fine motor control and a gait disturbance. Fifty percent of patients with acute SC spontaneously recover after 2 to 6 months whilst mild or moderate chorea or other motor symptoms can persist for up to and over 2 years in some cases.
Sydenham’s is also associated with psychiatric symptoms with obsessive compulsive disorder being the most frequent manifestation. The PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infections) syndrome is similar, but is not characterized by Sydenham’s motor dysfunction, but presenting with tics and/or with psychological components (OCD) and much sooner, days to week after GABHS infection rather than 6-9 months. It is related to other illnesses such as Lupus and Tourette’s.
Movements cease during sleep, and the disease usually resolves after several months. It is associated with post-streptococcal rheumatic fever, pregnancy, hyperthyroidism, and systemic lupus erythematosus.
Neurologic symptoms of SC include behavior change, dysarthria, gait change, loss of fine and gross motor control with resultant deterioration of handwriting, headache, slowed cognition, facial grimacing, fidgetiness and hypotonia. Nonneurologic manifestations of ARF are carditis, arthritis, erythema marginatum, and subcutaneous nodules
65. Attachment of biceps tendon
Proximally, the short head of the biceps attaches to (originates from) the coracoid process of the scapula. The tendon of the long head passes along the intertubercular groove of the humerus into the joint capsule at the head of the humerus, and attaches to the scapula at the supraglenoid tubercle.
Distally, biceps attaches to (inserts into) the radial tuberosity. Because the ulnar and radial bones can rotate about each other the biceps can powerfully supinate the forearm. The biceps also connects with the fascia of the medial side of the forearm via the bicipital aponeurosis.
Two additional muscles lie underneath the biceps brachii. These are the coracobrachialis muscle, which like the biceps attaches to the coracoid process of the scapula, and the brachialis muscle which connects to the ulna and along the mid-shaft of the humerus
66. Mc cause of acute otitis media in child
Otitis media is most commonly caused by infection with viral, bacterial, or fungal pathogens. The most common bacterial pathogens are Streptococcus pneumoniae, nontypable Haemophilus influenzae, and Moraxella catarrhalis. Among older adolescents and young adults, the most common cause of ear infections is Haemophilus influenzae. Viruses such as respiratory syncytial virus (RSV) and those that cause the common cold may also result in otitis media by damaging the normal defenses of the epithelial cells in the upper respiratory tract.
67. Quadrivalent HPV vaccine
Human Papillomavirus Quadrivalent (Types 6, 11, 16, and 18) Vaccine
68. Spore destroyed by
69. The largest bacteria is
The largest bacteria, such as Bacillus megaterium, can also be seen at 400X.
70. Which is not freezed before inoculation
CSF samples should not be frozen while storing or transporting
. It should be transported in cold box with ice packs. Ensure that the samples do not come into direct contact with the icepacks to avoid freezing of the CSF
71. Indication for surgery in bronchietasis
Surgery is an important adjunct to therapy in some patients with advanced or complicated disease.112 Surgical resection for bronchiectasis can be performed with acceptable morbidity and mortality in patients of any age.
In general, surgery should be reserved for patients who have focal disease that is poorly controlled by antibiotics. The involved bronchiectatic sites should be completely resected for optimal symptom control
Other indications for surgical intervention may include the following:
Reduction of acute infective episodes
Reduction of excessive sputum production
Massive hemoptysis (Alternatively, bronchial artery embolization may be attempted for the control of hemoptysis.)
Foreign body or tumor removal
Consideration in the treatment of MAC or Aspergillus species infections
bilateral bronchiectasis are not a contraindication to surgery and even incomplete resection often results in considerable benefit to the patient
72. Postoperative nausea and vomiting seen least with
PONV is least when propofol is used for maintenance and induction of anaesthesia
73. IV, oral, IM, nasal route anaesthetic
Diazepam is not recommended for i.m. injection because of soft-tissue irritation
Diazepam, midazolam most commonly used
PO, PR, IM, IV, nasal (midazolam)
Time to effect depends on route of administration
Diazepam works well for muscle spasms
Midazolam has excellent amnestic effects
74. Anti che drug used in Rx of alzeimers disease
Donepezil, galantamine and rivastigmine are recommended as options for the treatment of moderate Alzheimer’s disease
75. Circadian rythym seen with
Supra optic nucleus
Supra chiasmatic nucleus
76. The excision of Pitutary stalk all are seen except
Growth hormone (GH) deficiency (GHD) due to damage to the hypothalamic-pituitary region by lesions, surgery and/or radiation is said to be “organic”. In other circumstances, GHD is readily diagnosed when magnetic resonance imaging (MRI) shows pituitary stalk interruption syndrome (PSIS)  and/or if there is microphallus, hypoglycemia, other hypothalamic-pituitary deficiencies, or genetic causes. GHD is difficult to diagnose when none of these conditions apply, the GHD is then said to be “idiopathic”.
Pituitary stalk compression can cause diabetes insipidus and may increase prolactin levels causing — galactorrhea
77. Not a glycoprotein
Hormones that are glycoproteins include:
Human chorionic gonadotropin
78. Cardiac tamponade A/E
Cold and clammy extremities from hypoperfusion are also observed in some patients
79. Hyperkalemia causing muscle relaxant
80. Dicrotic pulse seen in
Hypertrophic cardio myopathy
Dialated cardio myopathy
A dicrotic pulse is a type of pulse that is associated with low cardiac output.
It can be an indication of dilated cardiomyopathy.
It has a systole peak and a diastole peak (in contrast to pulsus bisferiens, which has two peaks in systole.)
81. Sensitive indicator of Severely malnourished child–
Loss of buccal pad of fat
Prominent gluteal folds
Loss of skin laxicity
Clinical features of Marasmus:
Initially, there is failure to gain weight followed by progressive loss of weight until emaciation results. There is loss of subcutaneous fat, this is lost first from the abdominal wall, then the limbs and finally the buccal pad of fat with loss of turgor in skin that becomes wrinkled and loose. The abdomen may be distended or flat, and the intestinal pattern may be readily visible. There is muscle wasting with resultant hypotonia.
82. Not seen in massive blood transfusion
hypocalcemia — Citrate binding of ionized calcium can lead
83. Symptoms of rabies encephalitis A/E
Trunk muscle spasm
There are two forms of human rabies, the wellknown encephalitic (furious) form and the paralytic (dumb) form. The encephalitic form starts with fever, malaise, pharyngitis and paraesthesia at the site of the bite followed by the classical neurologic symptoms of hydrophobia, aerophobia, agitation, hypersalivation and seizures. This is followed by paralysis and coma. Death is usually due to respiratory failure.
Paralytic rabies accounts for 20% of rabies.
Hydrophobia and aerophobia are present only in half of these patients and it closely resembles Guillian Barre Syndrome.
The diagnosis of rabies encephalitis is usually
unmistakable and is based on the unique clinical
symptoms. Hydrophobia, which is the most
characteristic and widely known feature of rabies, was not present in our case.
In a study by Chabra,
5% of patients with rabies did not have
hydrophobia(3). In an earlier study, Krishna and
Dutta reported 24.4% of patients with neurological
symptoms without hydrophobia(4). Such nonclassical
presentations may require laboratory
investigations and neuroimaging to arrive at a
Rabies progresses over 7-14 days, and the mean time between initial presentation and death is 16.2 days.
Patients have presented to EDs with nonspecific fevers and pharyngitis.
Most prodromes last from 2-10 days.
Initial symptoms of pain or paresthesias at the site of bite or scratch begin during the prodrome. These are the only symptoms that specifically may raise the red flag of a rabies diagnosis.
Fever, headache, and anorexia also may be present.
Neurologic stage (2-7 d)
Mental status changes
Disseminated intravascular coagulation (DIC)
84. Mc appendix tumor
Musinous adeno ca
Serous adeno ca
Carcinoid is the most common tumor of the appendix, and the appendix is the most common site of carcinoid tumors
85. Psuedomyxoma peritonii is associated. with
Granulosa cell tumor
Mucous cystedenoma of ovary
Hilus cell tumor
86. Not a cox-2 selective inhibitor
C & D
Classification of non-steroidal anti-inflammatory drugs (NSAIDS):
A- Non-selective cyclo-oxygenase inhibitors(COX1 and COX2 )
Salicylic acid derivatives: Aspirin, aloxiprin, benorylate, diflunsial,
Oxicams: Piroxicam, tinoxicam, meloxicam
a. Carbocyclic and heterocyclic acetic acids: Indomethacin, sulindac, tolmetin,etodolac, ketorolec
b. Phenyl acetic acids: Diclofenac, fenclofenac
4. Propionic acid derivatives: Ibuprofen, fenoprofen,
flurbiprofen naproxen, ketoprofen
5. Fenamic acid, flufenamic acid
6. Pyrazolone derivatives: Phenylbutazone, azapropazone,
B- Selective COX-2 inhibitors: Celecoxib, Rofecoxib
87. Falx cerebri contains
The falx cerebri, also known as the cerebral falx, so named from its sickle-like form, is a strong, arched fold of dura mater which descends vertically in the longitudinal fissure between the cerebral hemispheres.
It is narrow in front, where it is attached to the crista galli of the ethmoid; and broad behind, where it is connected with the upper surface of the tentorium cerebelli.
Its upper margin is convex, and attached to the inner surface of the skull in the middle line, as far back as the internal occipital protuberance; it contains the superior sagittal sinus. Its lower margin is free and concave, and contains the inferior sagittal sinus.
The falx cerebri is known to calcify with age.
88. Non motile clostridia
C. perfringens produces large rectangular spores and is non-motile
89. Mgso4 is contraindicated in pregnancy
90. POEM syndrome A/E
Multi organ involve
Polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes (POEMS) syndrome
91. Cachectin-1 also known as
92. All are mitochondrial inheritence A/E
Lebers heriditory optic atrophy
93. Age of cleft lip surgery
Within the first 2–3 months after birth, surgery is performed to close the cleft lip. While surgery to repair a cleft lip can be performed soon after birth, the often preferred age is at approximately 10 weeks of age, following the “rule of 10s” coined by surgeons Wilhelmmesen and Musgrave in 1969 (the child is at least 10 weeks of age; weighs at least 10 pounds, and has at least 10g hemoglobin).
94. Which thyroid tumor is associated with amyloid deposits
Medullary thyroid. Ca
Papillary thyroid. Ca
Follicular thyroid ca
Anaplastic thyroid ca
95. Mesangial IgA diposited in which disease
Biopsy of the kidney may be performed both to establish the diagnosis or to assess the severity of already suspected kidney disease. The main findings on kidney biopsy are increased cells and Ig deposition in the mesangium (part of the glomerulus, where blood is filtered), white blood cells, and the development of crescents. The changes are indistinguishable from those observed in IgA nephropathy.
96. Most common site of carcinoma . stomach
The stomach consists of the cardia (adjacent to the gastroesophageal junction), the fundus, the body, the antrum, and the pylorus. The fundus is dome-shaped and extends above and to the left of the cardia, toward the left hemidiaphragm. The body extends from the fundus to the lower end of the lesser curve, known as the incisura angularis. The antrum extends from the incisura to the pyloric canal.
Before 1950, most gastric tumors detected were located in the antrum. Since then, the location has gradually shifted from the antrum to the body and fundus because of the rapidly increasing incidence of carcinoma in the gastric cardia and lower esophagus. Today, 30% of gastric lesions are found in the antrum, 30% are in the body, and 40% are in the fundus and cardia.
97. Female child multiple fractures generalised osteoporosis, wormian bones on radiological examination Dx
Battered baby syndrome
Wormian bones are a feature of osteogenesis imperfecta (“brittle bone disease
98. True about DOTS
80% cure rate, 70% case detection
70% case detection, 85% cure rate
75 % case detection, 85% cure rate
80% case detection, 85% cure rate
DOTS is the only strategy which has proven effective in controlling TB on a mass basis. To date, 148 countries are implementing the DOTS strategy. India has adapted and tested DOTS in various parts of the country since 1993, with excellent results, and the RNTCP now covers more than 1 billion populations in over 564 districts in 29 states and union territories. The entire Country now covered by Revised National Tuberculosis Control Programme, making it the second largest such programme in the World. The programme has developed a ‘strategic Vision for TB Control for the Country up to 2015; under which it aims to achieve and maintain a Cure Rate of at least 85% in New Sputum Positive Pulmonary TB Patients, and detection of at least 70% of such cases.
99. landmark for low, medium, high Tracheostomy
Second tracheal ring
high tracheostomy (placed at or just inferior to the cricoid cartilag
100. Middle ear cavity anteriorly communicates with
There is no well-defined anterior or posterior wall. The anterior portion of the cavity is continued forward into the Eustachian tube; the canal for the tensor tympani muscle is immediately above it. Posteriorly the cavity of the attic is continuous through the aditus with the mastoid antrum and the cells beyond. Posterior to the opening of the Eustachian tube is an elevation on the internal wall called the promontory, formed by one of the semicircular canals. Above the promontory is the fenestra ova/is, which lodges the stapes bone and communicates with the vestibule. Below and behind is the fenestra rotunda, closed by a membrane separating the cochlea from the middle ear. Above the fenestra ovalis is a ridge of bone marking the aqueduct of Fallopius, in which runs the facial nerve.
101. Marker for peroxisomes
Catalase and urate oxidase were chosen as marker enzymes for peroxisomes
102. Most common Natural radiator on half of general population causing substance
Pottasium – 40
Background radiation is constantly present in the environment and is emitted from a variety of natural and artificial sources. Primary contributions come from:
Sources in the earth. These include sources in food and water, which are incorporated in the body, and in building materials and other products that incorporate those radioactive sources;
Sources from space, in the form of cosmic rays;
Sources in the atmosphere. One significant contribution comes from the radon gas that is released from the Earth’s crust and subsequently decays into radioactive atoms that become attached to airborne dust and particulates. Another contribution arises from the radioactive atoms produced in the bombardment of atoms in the upper atmosphere by high-energy cosmic rays.
103. Pneumoconiosis associated with paper mill workers
Recognized bagassosis as a ‘chronic, slowly progressive bronchopulmonary dis- order’ afflicting paper mill workers
104. Cell wall synthesis inhibiting drug A/E
D-cycloserine interferes with bacterial cell wall synthesis by competitively inhibiting two enzymes, L-alanine racemase and D-alanine:D-alanine ligase
105. In vestibular outer hair cells stimulated by
Inner hair cells – from sound to nerve signal
Section through the organ of corti, showing inner and outer hair cellsThe deflection of the hair-cell stereocilia opens mechanically gated ion channels that allow any small, positively charged ions (primarily potassium and calcium) to enter the cell. Unlike many other electrically active cells, the hair cell itself does not fire an action potential. Instead, the influx of positive ions from the endolymph in Scala media depolarizes the cell, resulting in a receptor potential.
This receptor potential opens voltage gated calcium channels; calcium ions then enter the cell and trigger the release of neurotransmitters at the basal end of the cell. The neurotransmitters diffuse across the narrow space between the hair cell and a nerve terminal, where they then bind to receptors and thus trigger action potentials in the nerve. In this way, the mechanical sound signal is converted into an electrical nerve signal. The repolarization in the hair cell is done in a special manner. The perilymph in Scala tympani has a very low concentration of positive ions. The electrochemical gradient makes the positive ions flow through channels to the perilymph.
Hair cells chronically leak Ca+2. This leakage causes a tonic release of neurotransmitter to the synapses. It is thought that this tonic release is what allows the hair cells to respond so quickly in response to mechanical stimuli. The quickness of the hair cell response may also be due to that fact that it can increase the amount of neurotransmitter release in response to a change as little as 100 μV in membrane potential.
Outer hair cells – acoustical pre-amplifiers
In mammalian outer hair cells, the receptor potential triggers active vibrations of the cell body. This mechanical response to electrical signals is termed somatic electromotility and drives oscillations in the cell’s length, which occur at the frequency of the incoming sound and in a stable phase relation. Outer hair cells have evolved only in mammals. They have not improved hearing sensitivity, which reaches similarly exquisite values also in other classes of vertebrates. But they have extended the hearing range from about 11 kHz in some types of bird to about 200 kHz in some marine mammals. They have also improved frequency selectivity (frequency discrimination), which is of particular benefit for humans, because it enabled sophisticated speech and music.
The molecular biology of hair cells has seen considerable progress in recent years, with the identification of the motor protein (prestin) that underlies somatic electromotility in the outer hair cells. Santos-Sacchi et al. have shown that prestin’s function is dependent on chloride channel signalling and that it is compromised by the common marine pesticide tributyltin (TBT). Because this class of pollutant bioconcentrates up the food chain, the effect is pronounced in top marine predators such as Orcas and toothed whales
106. Most common site of mandibular #
The most common sites of mandibular fracture are at the body (21-40%), condyles (15-20%), and angle (20-31%). In addition, 10-15% affect the parasymphysis; 3-9%, the ramus; 3-5%, the alveolar ridge; and 1-2%, the coronoid process.
107. In katrageners syndrome seen A/E
Kartagener syndrome is characterized by the clinical triad of chronic sinusitis, bronchiectasis, and situs inversus.
Nose: Patients may exhibit chronic, thick, mucoid rhinorrhea from early in childhood. Examination usually reveals pale and swollen nasal mucosa, mucopurulent secretions, and an impaired sense of smell. Nasal polyps are recognized in 30% of affected individuals.
Sinuses: The recurrent chronic sinusitis typically produces sinus pressure headaches in the maxillary and periorbital region. Symptoms usually improve with antibiotic therapy but have a propensity for rapid recurrence.
Ears: Recurrent otitis media is a common manifestation of primary ciliary dyskinesia. Examination may reveal a retracted tympanic membrane with poor or absent mobility and a middle-ear effusion. Other associated otologic disorders may include tympanosclerosis, cholesteatoma, and keratosis obturans.
Lower respiratory tract
Chronic bronchitis and recurrent pneumonia are common conditions in patients with primary ciliary dyskinesia. Thus, upon physical examination of the patient’s chest, increased tactile fremitus, rhonchi, crackles, and, occasionally, wheezes may be present.
Obstructive lung disease may be another component of Kartagener syndrome symptomatology. It probably results from elevated levels of local inflammatory mediators in a chronically irritated airway. Therefore, wheezing may occur. The lung examination may be normal during intercurrent periods when the airway is not actively inflamed.
Cardiovascular examination of a patient with KS demonstrates a point of maximal impulse, and the heart sounds are heard best on the right side of the chest.
Extremities may exhibit digital clubbing.
108. EBV causes A/E
109. TB otitis media true is
Blood stained discharge
110. Most common tumor of orbit
b. Embryonal Rabdomyosarcoma
c. Neuro blastoma
Children: The common pediatric malignant tumors include rhabdomyosarcoma and metastatic lesions related to leukemia or neuroblastoma. If rhabdomyosarcoma is resectable, then surgery is done, followed by chemotherapy and orbital radiation therapy. Leukemic disease is usually managed by orbital radiation therapy, chemotherapy, or both.
Adults: The most common benign tumors are meningiomas, mucoceles, and cavernous hemangiomas. Sphenoid wing meningiomas are treated with debulking via craniotomy when symptomatic, sometimes followed by a course of radiation therapy.
Because meningioma cells infiltrate bone of the skull base, complete resection usually is not possible. Mucoceles are treated by draining the offending lesion into the nose, because they most commonly arise from the ethmoid or frontal sinus. Cavernous hemangiomas are excised.
111. Ansa cervicalis supply all except
Branches from the ansa cervicalis innervate three of the four infrahyoid muscles, including the sternohyoid muscle, the sternothyroid muscle, and the omohyoid muscle.
112. Hypocalcemia ECG changes seen
PR intervel prolong
EKG changes include:
Prolonged ST interval
113. First sinus developed at birth
Maxillary sinus is the first of the paranasal sinuses to develop in the human fetus
114. CSF drains from scala vestibuli and scala tympanic to subarchanoid space
Medial to the opening for the carotid canal and close to its posterior border, in front of the jugular fossa, is a triangular depression; at the apex of this is a small opening, the aquaeductus cochleae (or cochlear aqueduct, or aqueduct of cochlea), which lodges a tubular prolongation of the dura mater establishing a communication between the perilymphatic space and the subarachnoid space, and transmits a vein from the cochlea to join the internal jugular
At the hinder part of the medial wall of the vestibule is the orifice of the vestibular aqueduct, which extends to the posterior surface of the petrous portion of the temporal bone.
It transmits a small vein, and contains a tubular prolongation of the membranous labyrinth, the ductus endolymphaticus, which ends in a cul-de-sac between the layers of the dura mater within the cranial cavity.
115. In carotid sheath all are present except
Cervical Sympathetic plexus
Internal jugular vein
The three major structures contained in the carotid sheath are:
the common carotid artery
internal jugular vein
the vagus nerve
The carotid artery lies medial to the internal jugular vein, and the vagus nerve is situated posteriorly between the two vessels.
The carotid sheath also contains the deep cervical lymph nodes.
In the upper part, the carotid sheath also contains the glossopharyngeal nerve (IX), the accessory nerve (XI), and the hypoglossal nerve (XII), which pierce the fascia of the carotid sheath.
The ansa cervicalis is embedded in the anterior wall of sheath. It is formed by “descendens hypoglossi” (C1) and “descendens cervicalis” (C2-C3).
116. charcot’s triad is a
pain, fever, jaundice
Pain fever, vomiting
Pain jaundice, vomiting
Pain jaundice, diarrhoea
Charcot’s triad II: The combination of jaundice; fever, usually with rigors; and upper quadrant abdominal pain.
117. Clue cells present
118. Schiller duval bodies seen in
Granulosa cell tumor
Endo dermal sinus
Hilus cell tumor
Schiller-Duval body is a cellular structure seen by microscope in endodermal sinus tumors (yolk sac tumors) which are the most common testicular cancer
119. Not a sex cord stromal tumor
Leydig cell tumor
Sertoli cell tumor
Yolk sac tumor
Sex cord-gonadal stromal tumour (or sex cord-stromal tumour) is a group of tumours of sex cord-derived tissues of the ovary and testis. In humans, this group accounts for 8% of ovarian cancers and under 5% of testicular cancers. Their diagnosis is histological: only a biopsy of the tumour can make an exact diagnosis. They are often suspected of being malignant prior to operation, being solid ovarian tumours that tend to occur most commonly in post menopausal women.
120. Immuno complex seen with which hsn reaction
Type – I hyper sensitivity reaction
Type – II HS
Type – III HS
121. Photosensitivity seen in
Photosensitive systemic lupus erythematosus (SLE) rashes typically occur on the face or extremities, which are sun-exposed regions
122. In pathological myopia seen A/E
Shallow ant. Chamber
What are the FINDINGS IN CLINICAL PATHOLOGY? (I) Anterior segment shows
(1) Large prominent eyeball.
(2) Cornea flatter
(3) Anterior chamber deep.
(4) Pupil larger.
(II) Fundus findings in pathological myopia
= Large optic disc
(1) Temporal myopia erescent.
(2) Nasal supertraction erescent
(3) Foster fuch’s flacks (FFF).
(4) White patches of choroidal atrophy
(5) Lattice Degeneration
(6) cyestoid Degeneration
= Vitreous opacities, degeneration.
123. Tractional detachment seen in
Causes OF TRACTIONAL retinal detatchment
Proliferative sickle retinopathy
Retinal venous occlusions
124. Selective oral alpha agonist used for Rx of adrenal insufficiency and postural hypotension
Midodrine is an investigational alpha agonist with a longer duration of action
Midodrine is a vasopressor/antihypotensive agent
Mechanism of Action
Midodrine hydrochloride forms an active metabolite, desglyMidodrine, that is an alpha1-agonist, and exerts its actions via activation of the alpha-adrenergic receptors of the arteriolar and venous vasculature, producing an increase in vascular tone and elevation of blood pressure. DesglyMidodrine does not stimulate cardiac beta-adrenergic receptors. DesglyMidodrine diffuses poorly across the blood-brain barrier, and is therefore not associated with effects on the central nervous system.
125. Which drug C/I in severe hypertriglyceridemia
Because bile acid sequestrants are not systemically absorbed, they may be preferred to statins in patients with diabetic nephropathy and renal insufficiency and in those with liver function abnormalities. However, bile acid sequestrants probably are contraindicated in patients with NIDDM who have autonomic neuropathy and constipation but may relieve diarrhea of diabetic autonomic neuropathy. Bile acid sequestrants, however, cannot be recommended for patients with NIDDM and hypercholesterolemia whose fasting plasma triglyceride levels exceed 3.4 mmol/L or 300 mg/dL, for those in poor glycemic control, and for morbidly obese patients.
Bile acid sequestrants block intestinal bile acid reabsorption, forcing up-regulation of hepatic LDL receptors to recruit circulating cholesterol for bile synthesis. They are proven to reduce cardiovascular mortality. Bile acid sequestrants are usually used with statins or with nicotinic acid (see Lipid Disorders: Low HDL) to augment LDL-cholesterol reduction and are the drugs of choice for children and women who are or are planning to become pregnant. Bile acid sequestrants are safe, but their use is limited by adverse effects of bloating, nausea, cramping, and constipation. They may also increase TGs, so their use is contraindicated in patients with hypertriglyceridemia. Cholestyramine, interfere with absorption of other drugs—notably thiazides, β-blockers, warfarin, and thyroxine—an effect that can be decreased by administration 4 h before or 1 h after other drugs.
Indications of Fenofibrate
Adjunct to dietary therapy for the treatment of adults with elevations of serum triglyceride levels (types IV and V hyperlipidemia); adjunct to dietary therapy for the reduction of low density lipoprotein cholesterol (LDL-C), total cholesterol (total-C), triglycerides, and apolipoprotein B (apo B) in adult patients with primary hypercholesterolemia or mixed dyslipidemia (Fredrickson types IIa and IIb)
Contraindications of Fenofibrate
Hypersensitivity to fenofibrate or any component of the formulation; hepatic dysfunction including primary biliary cirrhosis and unexplained persistent liver function abnormalities; severe renal dysfunction; pre-existing gallbladder disease; breast-feeding
126. Mechanism of action of Pioglitazone and rosiglitazone?
Increase insulin secretion
Increase insulin receptor
Increase glucose uptake in adipose tissue
Retard absorption of carbohydrates
Thiazolidinediones or TZDs act by binding to PPARs (peroxisome proliferator-activated receptors), a group of receptor molecules inside the cell nucleus, specifically PPARγ (gamma). The ligands for these receptors are free fatty acids (FFAs) and eicosanoids. When activated, the receptor migrates to the DNA, activating transcription of a number of specific genes.
Genes upregulated by PPARγ can be found in the main article on peroxisome proliferator-activated receptors.
By activating PPARγ:
Insulin resistance is decreased
Adipocyte differentiation is modified
VEGF-induced angiogenesis is inhibited
Leptin levels decrease (leading to an increased appetite)
Levels of certain interleukins (e.g. IL-6) fall
Adiponectin levels rise
127. Sucralfate interfere absorption of A/E
Phenoxy methyl pencillin
Sucralfate treatment is known to interfere with the bioavailability of phenytoin (20% decrease in absorption
Simultaneous administration may interfere with the absorption of ranitidine. Consider administering ranitidine two hours before sucralfate
sucralfate may decrease the absorption of digoxin.
128. Insulin MOA A/E
Inhibits na+ k+ atpase
The sodium-potassium ATPase (Na+/K+-ATPase or Na+/K+-pump) is an enzyme present at the surface of all eukaryotic cells, which actively extrudes Na+ from cells in exchange for K+ at a ratio of 3:2, respectively. Its activity also provides the driving force for secondary active transport of solutes such as amino acids, phosphate, vitamins and, in epithelial cells, glucose. The enzyme consists of two subunits (alpha and beta) each expressed in several isoforms. Many hormones regulate Na+/K+-ATPase activity and in this review we will focus on the effects of insulin
129. Brucellosis false
Ankylosing. Spondilitis like clinical picture
Inflammatory low back pain, spinal involvement and sacroiliitis are key features of both brucellosis and ankylosing spondylitis (AS
Antibiotics like tetracyclines, rifampicin and the aminoglycosides streptomycin and gentamicin are effective against Brucella bacteria. However, the use of more than one antibiotic is needed for several weeks, because the bacteria incubate within cells.
The gold standard treatment for adults is daily intramuscular injections of streptomycin 1 g for 14 days and oral doxycycline 100 mg twice daily for 45 days (concurrently). Gentamicin 5 mg/kg by intramuscular injection once daily for 7 days is an acceptable substitute when streptomycin is not available or difficult to obtain. Another widely used regimen is doxycycline plus rifampin twice daily for at least 6 weeks. This regimen has the advantage of oral administration. A triple therapy of doxycycline, together with rifampin and cotrimoxazole has been used successfully to treat neurobrucellosis. Doxycycline is able to cross the blood–brain barrier, but requires the addition of two other drugs to prevent relapse.
Ciprofloxacin and co-trimoxazole therapy is associated with an unacceptably high rate of relapse. In brucellic endocarditis surgery is required for an optimal outcome. Even with optimal antibrucellic therapy relapses still occur in 5–10 percent of patients with Malta fever. The main way of preventing brucellosis is by using fastidious hygiene in producing raw milk products, or by pasteurizing all milk that is to be ingested by human beings, either in its unaltered form or as a derivate, such as cheese. Experiments have shown that cotrimoxazol and rifampin are both safe drugs to use in treatment of pregnant women who have Brucellosis.
130. Not a facial nerve branch
Nerve to stylohyoid
The lingual nerve is a branch of the mandibular nerve (CN V3), itself a branch of the trigeminal nerve, which supplies sensory innervation to the tongue
Facial Nerve Branches
Greater petrosal nerve – provides parasympathetic innervation to lacrimal gland, sphenoid sinus, frontal sinus, maxillary sinus, ethmoid sinus, nasal cavity, as well as special sensory taste fibers to the palate via the Vidian nerve.
Nerve to stapedius – provides motor innervation for stapedius muscle in middle ear
Chorda tympani – provides parasympathetic innervation to submandibular gland and sublingual gland and special sensory taste fibers for the anterior 2/3 of the tongue.
Outside skull (distal to stylomastoid foramen)
Posterior auricular nerve – controls movements of some of the scalp muscles around the ear
Branch to Posterior belly of Digastric and Stylohyoid muscle
Five major facial branches (in parotid gland) – from top to bottom:
Temporal (frontal) branch of the facial nerve
Zygomatic branch of the facial nerve
Buccal branch of the facial nerve
Marginal mandibular branch of the facial nerve
Cervical branch of the facial nerve
131. All nerves originated from post. Cord of brachial plexus except
Long thoracic. Nerve
132. 1 cm coin lesion seen in right apical lobe of lung x-ray FNAC shows adeno carcinoma Rx?
Complete resection of f/b chemo radiation
Neoadjuvant chemo f/b surgery
Surgery and observation
Embolisation f/b surgery
Adenocarcinoma of the lung is currently the most common type of lung cancer in lifelong non-smokers. Adenocarcinomas account for approximately 10% of lung cancers. This cancer usually is seen peripherally in the lungs, as opposed to small cell lung cancer and squamous cell lung cancer, which both tend to be more centrally located, although it may also occur as central lesions. By unknown reasons, it often arises in relation to peripheral lung scars. The current theory is that the scar probably occurred secondary to the tumor, rather than causing the tumor.The adenocarcinoma has an increased incidence in smokers, and is the most common type of lung cancer seen in non-smokers and women.
The peripheral location of adenocarcinoma in the lungs is due to the use of filters in cigarettes which prevent the larger particles from entering the lung. Generally, adenocarcinomas grow more slowly and form smaller masses than the other subtypes. However, they tend to form metastases widely at an early stage. Adenocarcinoma is a non-small cell lung carcinoma, and as such, it is not as responsive to radiation therapy as is small cell lung carcinoma, but is rather treated by surgically, for example by pneumonectomy or lobectomy
133. Benign meningioma Rx
Excision with dural sheath
Excision f/b chemo
Observation with close imaging follow-up can be used in select cases if a meningioma is small and asymptomatic. In a retrospective study on 43 patients, it was found that 63% of patients had no growth on follow-up, and the 37% found to have growth grew at an average of 4 mm / year.In this study, younger patients were found to have tumors that were more likely to grow on repeat imaging, thus are poorer candidates for observation.
Observation is not recommended in tumors that are already causing symptoms. Furthermore, close follow-up with imaging is required with an observation strategy to rule out an enlarging tumor.
Meningiomas can usually be surgically resected with permanent cure if the tumor is superficial on the dural surface and easily accessible. Transarterial embolization has become a standard preoperative procedure in the preoperative management. If invasion of the adjacent bone occurs, total removal is nearly impossible. Malignant transformation is rare.
The probability of tumor recurrence or growth after surgical resection can be estimated by the tumor’s WHO Grade and by the extent of surgery by the Simpson Criteria
Radiation therapy may include Gamma Knife, proton beam treatment, or fractionated external beam radiation. Gamma Knife radiosurgery can be used in lieu of surgery in small tumors located away from critical structures. Fractionated external beam radiation can also be used as primary treatment for tumors that are surgically unresectable, or for patients who are inoperable for medical reasons.
Radiation therapy is often considered for WHO Grade I meningiomas after subtotal (incomplete) tumor resections. The clinical decision to irradiate after a subtotal resection is somewhat controversial as no class I randomized controlled trials exists on the subject. Numerous retrospective studies, however, have strongly suggested that the addition of post-operative radiation to incomplete resections improves both progression free survival (i.e. prevents tumor recurrence) and improves overall survival.
In the case of a Grade II or Grade III meningioma, the current standard of care involves post-operative radiation treatment regardless of the degree of surgical resection.This is due to the proportionally higher rate of local recurrence for these higher grade tumors.
Current chemotherapies are likely not effective. Antiprogestin agents have been used, but with variable results. Recent evidence that hydroxyurea has the capacity to shrink unresectable or recurrent meningiomas is being further evaluated
134. Most specific features of increased ICT in adult
Erosion of dorsum sella
Erosion of tunica sella
d. Copper beaten skull
The appearance of copper beaten skull is associated with raised intracranial pressure in children
135. Female with galactorrhea, amenorrhea on examination B/L temporal hemianopia Dx?
Prolactin secreting pitutary micro adenoma
Prolactin secreting pitutary macro adenoma
136. 760 mm Hg at atmosphere pressure Po2
38 mm Hg
76 mm Hg
160 mm Hg
228 mm Hg
If the percentage of oxygen in the atmosphere is 20.9% and the total barometric pressure of the atmosphere is 760 mmHg, then:
PO2 = 0.209 X 760 mmHg.
This gives an oxygen partial pressure (PO2) of:
158.84 (159 rounded) mm Hg
137. Maximum HCO3- loss seen in
138. Thiazide diuretic causes except
Side effects include hypokalemia, increased serum cholesterol, triglyceride, impaired glucose tolerance, diabetes mellitus and impotence. The side effect of hypokalemia has motivated combining thiazides with potassium chloride supplements, potassium sparing diuretics (e.g., with amiloride in co-amilozide) and with the newer ACE inhibitors, which also lower blood pressure but cause hyperkalemia as a side effect.
Long-term usage of thiazides is also linked to increased levels of homocysteine, a toxic amino acid byproduct that has been associated with atherosclerosis. However, there is no evidence that people receiving long-term thiazide treatments should also receive folic acid supplements. Thiazides have been known to cause a paradoxical effect in diabetes insipidus, where they may reduce the volume of urine, possibly due to their capability to inhibit urate secretion
Thiazides also lower urinary calcium excretion, making them useful in preventing calcium-containing kidney stones. This effect is associated with positive calcium balance and is associated with an increase in bone mineral density and reductions in fracture rates attributable to osteoporosis. By a lesser understood mechanism, thiazides directly stimulate osteoblast differentiation and bone mineral formation, further slowing the course of osteoporosis.
Because of their promotion of calcium retention, thiazides are used in the treatment of Dent’s Disease or idiopathic hypercalciuria.
Thiazide may be combined with ACE inhibitors to increase diuresis without changing plasma potassium concentrations. While ACE inhibitors cause diuresis with potassium retention, thiazide increases potassium excretion. Their combined effects on potassium cancel each other out. Thiazides have no major effect on renal blood flow, but are likely to decrease glomerular filtration rate.
139. Spectrascopic colour of metha hemoglobin
put 5-6 blood drops in 20 ml water.
add 8-10 drops of saturated potassium fericianide solution. The solution gets dark brown due
to the formed methemoglobin.
it has 4 absorption bands:
A narrow red one (620-630 nm) – specific for methemoglobin.
2 pale yellow green bands
a wide blue one (486-578 nm)
methemoglobin is improper for oxygen
deoxyhemoglobin (HbO) is converted into methemoglobin (MetHb), which is evident by the color change from red to brown
140. Brownish discoloration on immunoflorosence and yellow discoloration of teeth due to
Intrinsic tooth discoloration — This is when the inner structure of the tooth (the dentin) darkens or gets a yellow color. Fluorosis or tetracycline stains are examples of common intrinsic stains. Intrinsic stains are best removed through the use of whitening products that can bleach the tooth and change the natural tooth color.
141. Hypercalcemia seen in A/E
Hyperparathyroidism and malignancy account for about 90% of cases of hypercalcemia.
abnormal parathyroid gland function
solitary parathyroid adenoma
primary parathyroid hyperplasia
multiple endocrine neoplasia (MEN)
familial isolated hyperparathyroidism (Online ‘Mendelian Inheritance in Man’ (OMIM) 146200)
familial hypocalciuric hypercalcemia/familial benign hypercalcaemia
solid tumor with metastasis (e.g. breast cancer or classically squamous cell carcinoma, which can be PTHrP-mediated)
solid tumor with humoral mediation of hypercalcemia (e.g. lung or kidney cancer, pheochromocytoma)
hematologic malignancy (multiple myeloma, lymphoma, leukemia)
vitamin-D metabolic disorders
hypervitaminosis D (vitamin D intoxication)
elevated 1,25(OH)2D (see calcitriol under Vitamin D) levels (e.g. sarcoidosis and other granulomatous diseases)
idiopathic hypercalcemia of infancy
rebound hypercalcemia after rhabdomyolysis
disorders related to high bone-turnover rates
vitamin A intoxication
Paget’s disease of the bone
severe secondary hyperparathyroidism
142. Explict memory
Awareness of one’s own perception
Recalling of past memories
Rememorisation of habits and skills
Explicit memory is the conscious, intentional recollection of previous experiences and information. We use explicit memory throughout the day, such as remembering the time of an appointment or recollecting an event from years ago.
Explicit memory involves conscious recollection, compared with implicit memory which is an unconscious, nonintentional form of memory. Remembering a specific driving lesson is an example of explicit memory, while improving your driving skills during the lesson is an example of implicit memory.
Implicit memory is a type of memory in which previous experiences aid in the performance of a task without conscious awareness of these previous experiences. Evidence for implicit memory arises in priming, a process whereby subjects show improved performance on tasks for which they have been subconsciously prepared. Implicit memory also leads to the illusion-of-truth effect, which suggests that subjects are more likely to rate as true statements those that they have already heard, regardless of their veracity. In daily life, people rely on implicit memory every day in the form of procedural memory, the type of memory that allows people to remember how to tie their shoes or ride a bicycle without consciously thinking about these activities. Research into implicit memory indicates that implicit memory works through a different mental process from explicit memory.
143. Delirium is a
Seems like dementia
Derangement of wide cerebral metabolism
144. Dyslexia involves
Dominant temporal lobe
Non dominant temporal
Non dominant parietal
Dyslexia affects the development of the left temporal lobe in the brain
145. Non ketotic hyperosmolar coma
Hyper ventilation f/b coma
146. Aksin’s tumor is a
PNET on Chest wall
Merkel’s ca of skin
Askin’s tumor (PNET of the chest wall)
147. H. pylori infection causes
About 65% of patients with gastritis and H pylori infection are AGPA positive
148. Most common site of sterilization of tubes
149. Most common site of fertilization
Ampulla It is an intermediate dilated portion, which curves over the ovary. It is the most common site of human fertilization
150. Complications of vasectomy A/E
loss of libido
Antisperm antibody formation
151. Acute emphytematous cholecystitis is caused by
The organism commonly isolated in specimen cultures is Clostridium sp (2). Other organisms frequently detected are Klebsiella sp., Escherichia Coli, Enterobacter sp.
152. ritter’s disease mc caused by
Staphylococcal scalded skin syndrome, SSSS, also known as Pemphigus neonatorum or Ritter’s disease
153. Toxic shock syndrome of staphylo cocci by mechanism of
In both TSS (caused by Staph. aureus) and TSLS (caused by Strep. pyogenes), disease progression stems from a superantigen toxin that allows the non-specific binding of MHC II with T cell receptors, resulting in polyclonal T cell activation.
In typical T cell recognition, an antigen is taken up by an antigen-presenting cell, processed, expressed on the cell surface in complex with class II major histocompatibility complex (MHC) in a groove formed by the alpha and beta chains of class II MHC, and recognized by an antigen-specific T cell receptor. By contrast, superantigens do not require processing by antigen-presenting cells but instead interact directly with the invariant region of the class II MHC molecule. In patients with TSS, up to 20% of the body’s T cells can be activated at one time. This polyclonal T-cell population causes a cytokine storm, followed by a multisystem disease. The toxin in S. aureus infections is Toxic Shock Syndrome Toxin-1, or TSST-1.
154. Basophilic inclusion bodies seen in
Viral Inclusion Bodies
Rabies Negri bodies
Small pox Gaurnier bodies
Molluscum Contagiosum Henderson Roterson bodies
Fowl pox Bollinger bodies
Trachoma Halberstaedter- Prowazek Bodies
B)Intra Nuclear Inclusions
Cowdry type A Herpes Virus( Lipschutz Inclusions) Yellow fever ( Torres Bodies)
Cowdrey Type B
Adeno Virus ( Basophilic) Poliovirus ( acidophilic) C)Both Intra Nuclear and Cytoplasmic 1) Measles Virus
155. Beefy red recurrent bleeding foul smelling granulomatous single genital ulcer
Granuloma Inguinale or Donovanosis – Etiologic agent: Calymmatobacterium granulomatis
Clinical manifestations This disease begins as single or multiple small subcutaneous lesions which erode through the skin. The lesions continue to expand outward with destruction of normal tissue. They heal slowly over months with scarring and deformity.
Ulcer characteristics These are sharply demarcated, painless, and friable with a beefy red granulation tissue appearance. The appearance is similar to cancer in some cases
156. Confounding decreases by A/E
157. Complication of longstanding use of topical steroids
Topical steroids may cause or worsen glaucoma and result in cataracts with long-term use
158. Naloxone used as a antidote for A/E
The partial agonist activity means that opioid receptor antagonists (e.g., an antidote such as naloxone) only partially reverse the effects of buprenorphine
Naloxone (Narcan) is a specific antidote to pethidine (and morphine) and will reverse the effects of the drug
If adverse reactions occur while using fentanyl, the antidote is a drug called naloxone
The antidote for morphine, and most other opioids, is a medication called naloxone
159. Vestibulo occular reflex is a function of
Foculo nodular lobe
The vestibulo-ocular reflex (VOR) or oculovestibular reflex is a reflex eye movement that stabilizes images on the retina during head movement by producing an eye movement in the direction opposite to head movement, thus preserving the image on the center of the visual field. For example, when the head moves to the right, the eyes move to the left, and vice versa. Since slight head movement is present all the time, the VOR is very important for stabilizing vision: patients whose VOR is impaired find it difficult to read using print, because they cannot stabilize the eyes during small head tremors. The VOR does not depend on visual input and works even in total darkness or when the eyes are closed.
Role of cerebellum
The cerebellum is essential for motor learning to correct the VOR in order to ensure accurate eye movement. Motor learning in the VOR is in many ways analogous to classical eyeblink conditioning, since the circuits are homologous and the molecular mechanisms are similar.
Functions of the spino-cerebellum
• Sensory afferents from the spinal cord (direct or via the brainstem) reach the vermis and intermediate zone (somatotopic maps)
• Purkinje cells from the vermis project onto fastigial nucleus; this innervates brainstem nuclei and vestibular nuclei, which project to the spinal cord
– Regulation of head, neck, proximal limb movement (balance and postural control during voluntary movements)
• Purkinje cells from the intermediate zone project to intercalate and dentate nuclei, which innervate the red nucleus and the ventrolateral thalamus (indirectly the motor cortex)
– Control of limb movements and axial musculature
– Lesions of intercalate nuclei cause hypotonia and disrupt
160. Creamasteric reflex afferent
Genito femoral nerve
The cremasteric reflex is a superficial reflex observed in human males.
This reflex is elicited by lightly stroking the superior and medial (inner) part of the thigh
The normal response is a contraction of the cremaster muscle that pulls up the scrotum and testis on the side stroked.
More specifically, the reflex utilizes sensory and motor fibers of the genitofemoral nerve, formed by fibers from both the L1 and L2 spinal nerves. When the inner thigh is stroked, sensory fibers of the femoral branch of the genitofemoral nerve and the ilioinguinal nerve are stimulated. These synapse in the spinal cord and activate the motor fibers of the genital branch of the genitofemoral nerve which causes the cremaster muscle to contract and elevate the testis.
161. Most common cause of congenital hypothyroidism
Meternal thyroid antibody
Around the world, the most common cause of congenital hypothyroidism is iodine deficiency,
162. Wernicks pupil seen in which lesion
A reaction seen in hemianopsia in which the pupil constricts when light is directed to the normal side of the retina, but fails to constrict when light is directed to the retina’s blind side. Also called hemiopic pupillary reaction, Wernicke’s sign.
Wernicke’s hemianopic pupil
Wernicke’s hemianopic pupil indicates the lesion in the optic tract. In this condition, light reflex is absent when light is thrown on the temporal half of the retina of the affected side and nasal half of the retina of the opposite side. Light reflex is present when the light is thrown on the nasal half of the affected side and temporal half of the opposite side. The patient also has homonymous hemianophia as the lesion is in the optic tract.
163. Dopamine causes A/E
Increase cardiac out put
Increase splanchinic blood glow
peripheral vasoconstrictive effect is seen with catecholamine adrenergic agents, notably epinephrine, norepinephrine, and dopamine
164. On increase in arterial bp
a. Inhibition of sympathetic system
B.dysInhibition of sympathetic system
Reflex reduction in muscle sympathetic nerve activity (MSNA) per unit increase in diastolic arterial blood pressure.
165. True about inhaled glucocorticoids in asthma
Better than Beta 2 agonist
Dysphonia is most common side effect
EFFECTS OF LOCAL DEPOSITION
Side effects due to the local deposition of inhaled glucocorticoid in the oropharynx and larynx may occur. The frequency of complaints depends on the dose, frequency of administration, and on the delivery system used.
Dysphonia — The most common complaint is of hoarse voice (dysphonia) and may occur in over 50 percent of patients using metered dose inhalers (MDIs). Dysphonia is not usually reduced by using spacers, but the incidence may be lower with dry powder devices. Dysphonia is believed to be due to myopathy of laryngeal muscles and is reversible when treatment is withdrawn . Dysphonia may be disabling in singers and lecturers, although it is not troublesome for many patients.
Thrush — Oropharyngeal candidiasis (thrush) may be a problem in some patients, particularly elderly patients, patients taking concomitant oral glucocorticoids, and patients inhaling glucocorticoids more often than twice daily . Large volume spacer devices can be used with metered dose inhalers (MDIs) and protect against thrush by reducing the amount of drug that deposits in the oropharynx. In addition, the mouth should be rinsed and the rinse discarded after administration with all devices.
166. True about hepatocellular ca. A/E
P53 suppressor gene mutation
Over use of ocp
FNH highly malignant
Malignant transformation of FNH has not been reported. FNH must be differentiated from a fibrolamellar variant of hepatocellular carcinoma, with which it shares imaging and gross features
167. PUVA used in A/E
Cutaneous T.cell lymphoma
PUVA is a Psoralen + UVA treatment for Eczema, Psoriasis and Vitiligo, and mycosis fungoides
168. Follicular ca. thyroid is a mutation of
Ras is one such oncogene product that is found on chromosome 11.
Activating point mutations in the ras oncogene are well known in patients with follicular adenoma and carcinoma,2,3,4 especially in poorly differentiated (55%) and anaplastic carcinoma (52%).
As a result of such mutations, p21-RAS becomes locked in its active conformation, leading to the constitutive activation of the protein and tumor development.5 The biochemical pathways that this process follows may be therapeutic targets for FTC.6
The incidence of RAS oncogene mutations ranged from 0–50% in papillary cancer, 0–85% in adenomas 14–62% in follicular carcinomas, and 0–60% in anaplastic carcinomas (10, 18). Although some investigators found no correlation between the mutated RAS oncogene isoform and tumor pathology (19), others reported a higher frequency of mutations in the codon 61 of H-RAS and N-RAS in follicular tumors and poorly differentiated carcinomas (15, 17). Mutations involving K-RAS or codons other than codon 61 in H-RAS and N-RAS, and mutations in other types of thyroid tumors proved uncommon
169. All retinoretinoic acid used as a Rx for
170. Lepidic cells seen in
The diagnosis of cardiac myxoma is primarily dependent on the identification of the stellate to plump, cytologically bland mesenchymal cells, so-called “myxoma” or “lepidic” cells described in the WHO definition above. Myxoma cells are frequently stellate with eosinophilic cytoplasm and indistinct cell borders. Their ovoid nuclei are typically pale with open chromatin. Nucleoli may be prominent
The lepidic cells were often seen as single cells and had more cytoplasm and round, bland nuclei in atrial myxoma
This microscopic image shows a so-called “myxoma cell.” Myxoma cells are frequently stellate with eosinophilic cytoplasm and indistinct cell borders. Their ovoid nuclei are typically pale with open chromatin.
171. Parkland formula of burns
% of burn surface area x 4 mg/kg/wt
% of burn surface area x 3 mg/kg/wt
% of burn surface area x 2 mg/kg/wt
% of burn surface area x 1 mg/kg/wt
The Parkland formula is used to guide initial fluid resuscitation during the first 24 hours. The formula calls for 4 cc/kg/TBSA burn (second and third degree) of lactated Ringer’s solution over the fast 24 hours
Half of the fluid should be administered over the first eight hours post burn, and the remaining half should be administered over the next 16 hours. The volume of fluid given is based on the time elapsed since the burn.
Urine output should be used as a measure of renal perfusion and to assess fluid balance. In adults, a urine output of 0.5-1.0 mL/kg/h should be maintained. Patients with significant burns should have a Foley catheter inserted in order to monitor urine output.
172. Membrane receptor mutation is seen in
The LDL receptor locus in familial hypercholesterolemia: Multiple mutations disrupting the transport and processing of a membrane receptor
173. Allelic hyper heterogenicity seen with
A single disorder, trait, or pattern of traits caused by different mutations within a gene
In genetics, heterogeneity refers to multiple origins causing the same disorder in different individuals. If a number of different mutations occurring within the same gene produce disorders, it is said to manifest allelic heterogeneity. This term has been used when a number of different alleles cause a similar phenotype or different phenotypes.
Different FBN1 mutations causing Marfan’s syndrome
Cystic fibrosis is caused by mutations in 136 different alleles
Alpha-Thalassemia or sickle cell anemia can be caused by different mutations in alpha-globin gene.
174. Increased osmotic fragility seen in
increased osmotic fragility is characteristically associated with hereditary spherocytosi
175. Splenic sequestration seen in A/E
Increase Splenic size
What are the symptoms of splenic sequestration?
Large spleen or bulge on the left side of belly
More tired than usual
Dizziness or headache
Pale skin, nails or lips
Shortness of breath
Pain on the left side of the belly
176. Myeloproliferative disorders seen in A/E
Although not a malignant neoplasm like other cancers, MPDs are classified within the hematological neoplasms.
There are four main myeloproliferative diseases, which can be further categorized by the presence of the Philadelphia chromosome:
In 2001, the World Health Organization classified “chronic eosinophilic leukemia / hypereosinophilic syndrome” and chronic neutrophilic leukemia under “Chronic myeloproliferative diseases
The lymphoid lineage may produce similar diseases, the lymphoproliferative disorders (acute lymphoblastic leukemia, lymphomas, chronic lymphocytic leukemia and multiple myeloma).
177. Cortisol increases A/E
Cortisol induces a migration of eosinophil leukocytes from the blood to several lymphoid organs
178. Atheroma includes A/E
Smooth muscle cells
an atheroma (plural: atheromata) is an accumulation and swelling (-oma) in artery walls that is made up of cells (mostly macrophage cells), or cell debris, that contain lipids (cholesterol and fatty acids), calcium and a variable amount of fibrous connective tissue. In the context of heart or artery matters, atheromata are commonly referred to as atheromatous plaques. It is an unhealthy condition, but is found in most humans.[
These anatomic lesions usually begin in some children younger than age 1 year and all children older than age 10 regardless of geography, race, sex or environment. Veins do not develop atheromata, unless surgically moved to function as an artery, as in bypass surgery. The accumulation (swelling) is always between the endothelium lining and the smooth muscle wall central region (media) of the arterial tube, see IMT. While the early stages, based on gross appearance, have traditionally been termed fatty streak by pathologists, they are not composed of fat cells, i.e. adiopose cells, but of accumulations of white blood cell, especially macrophages that have taken up oxidized low-density lipoprotein (LDL). After they accumulate large amounts of cytoplasmic membranes (with associated high cholesterol content) they are called foam cells.
When foam cells die, their contents are released, which attracts more macrophages and creates an extracellular lipid core near the center to inner surface of each atherosclerotic plaque. Conversely, the outer, older portions of the plaque become more calcific, less metabolically active and more physically stiff over time.
179. Neutropenia caused by A/E
Glucocorticoids are powerful anti-inflammatory agents, often used in the treatment of this autoimmune disease. They exert significant inhibitory effects on neutrophil activation and functions, such as chemotaxis, adhesion, transmigration, apoptosis, oxidative burst, and phagocytosis
Acquired neutropenia caused by drugs and chemicals, excluding cytotoxic chemotherapy
The highest risk categories are antithyroid medications, macrolides, and procainamides.
Antimicrobials include penicillin, cephalosporins, vancomycin, chloramphenicol, gentamicin, clindamycin, doxycycline, flucytosine, nitrofurantoin, novobiocin, minocycline, griseofulvin, lincomycin, metronidazole, rifampin, isoniazid, streptomycin, thiacetazone, mebendazole, pyrimethamine, levamisole, ristocetin, sulfonamides, chloroquine, hydroxychloroquine, quinacrine, ethambutol, dapsone, ciprofloxacin, trimethoprim, imipenem/cilastatin, zidovudine, fludarabine, acyclovir, and terbinafine.
Analgesics and anti-inflammatory agents include aminopyrine, dipyrone, phenylbutazone, indomethacin, ibuprofen, acetylsalicylic acid, diflunisal, sulindac, tolmetin, benoxaprofen, barbiturates, mesalazine, and quinine.
Antipsychotics, antidepressants, and neuropharmacologic agents include phenothiazines (chlorpromazine, methylpromazine, mepazine, promazine, thioridazine, prochlorperazine, trifluoperazine, trimeprazine), clozapine, risperidone, imipramine, desipramine, diazepam, chlordiazepoxide, amoxapine, meprobamate, thiothixene, and haloperidol.
Anticonvulsants include valproic acid, phenytoin, trimethadione, mephenytoin(Mesantoin), ethosuximide, and carbamazepine.
Antithyroid drugs include thiouracil, propylthiouracil, methimazole, carbimazole, potassium perchlorate, and thiocyanate.
Cardiovascular drugs include procainamide, captopril, aprindine, propranolol, hydralazine, methyldopa, quinidine, diazoxide, nifedipine, propafenone, ticlopidine, and vesnarinone.
Antihistamines include cimetidine, ranitidine, tripelennamine (Pyribenzamine), methaphenilene, thenalidine, brompheniramine, and mianserin.
Miscellaneous drugs include allopurinol, colchicine, aminoglutethimide, famotidine, bezafibrate, flutamide, tamoxifen, penicillamine, retinoic acid, metoclopramide, phenindione, dinitrophenol, ethacrynic acid, dichlorodiphenyltrichloroethane (DDT), cinchophen, antimony, pyrithyldione, rauwolfia, ethanol, chlorpropamide, tolbutamide, thiazides, spironolactone, methazolamide, acetazolamide, IVIG, and levodopa.
Heavy metals include gold, arsenic, and mercury
180. Hyaline membrane seen in
181. Inherited thrombophilias A/E
Factor V Leiden deficiency
Protein – c deficiency
Anti phospholipid antibody syndrome
182. Iodine deficiency sensitive indicator
in Neonatal hypothyroidism
Urinary thyroxin levels
Serum thyrotropin (TSH) concentration remains the most sensitive screening test for hypothyroidism and for establishing the diagnosis of primary hypothyroidism.
183. Cyclical trend of influenza due to
Low herd immunity
influenza virus shows minor short term antigenic drift and major long term antigenic shift that are respectively typified by epidemics and pandemics
184. Drugs used in advanced life support A/E
Notes on using the ACLS algorithm
The most common reason that defibrillation is unsuccessful is the failure of providers to recognize and treat the underlying cause of the arrhythmia.
Search for and correct potentially reversible causes of arrest, brady/tachycardia.
Exercise caution before using epinephrine in arrests associated with cocaine or other sympathomimetic drugs.
Give atropine 1mg dose (IV) for asystole or slow PEA (rate<60/min) In PEA arrests associated with hyperkalemia, hypocalcaemia. or Ca2+ channel blocking drug overdose, give 10mL 10% calcium chloride (IV) (6.8mmol/L) Consider amiodarone for ventricular fibrillation/pulseless ventricular tachycardia after 3 attempts at defibrillation. For torsades de pointes, refractory VF in patients with digoxin toxicity or hypomagnesaemia, give IV magnesium sulphate 8mmol (4mL of 50% solution) 185. Fishnet appearance on immunoflorosence seen in Pemphigus Bullous pemphigoid Dermatitis herperiform’s Contact dermatitis Pemphigus Immunofluorescence Features Direct immunofluorescence shows binding of IgG and C3 between epithelial cells, forming a “chicken wire” or “fish net” appearance. There is no staining in the basement membrane zone (BMZ). Indirect immunofluorescence is positive in the same pattern in almost all cases indicating the presence of circulating autoantibodies. 186. Pul. HTN in VSD true is Cyanosis Ejection systolic murmer Resolution of heart failure A 187. Nocturnal angina with diaphoresis seen in Chronic AS Acute AS Chronic AR Chronic MS C Chronic severe aortic valve insufficiency Gradual enlargement of the left ventricle (LV) and gradual increase of stroke volume in most cases No symptoms for many years in most patients with chronic aortic valve insufficiency No symptoms for decades in most patients with chronic moderate aortic valve insufficiency Exertional dyspnea (common) Orthopnea (common) Paroxysmal nocturnal dyspnea (common) Angina pectoris (less common) Abdominal discomfort (less common) Syncope (rare) Nocturnal angina with diaphoresis (rare) 188. Ubiquitin involves Intra cellular protein degradation ETC Protein Synthesis A 189. Reverse split first Heart. sound Severe AS Severe TS Severe MS Severe PS C There is normal asynchrony in the closure of mitral (M1) and tricuspid (T1) valves, the mitral closure preceding tricuspid closure by 20 to 30 msec (0.02 to 0.03 sec.). This produces two audible components (M1-T1) referred to as normal or physiologic splitting of the first heart sound. Such narrow splitting is usually best heard at the lower left sternal border with the stethoscope diaphragm. The tricuspid component, which may increase with inspiration, is best heard in this location but is poorly transmitted to the apical region. The mitral component, in contrast, is best heard at the apex but is intense enough to be heard throughout the precordium Wide splitting of the first sound is almost always abnormal. The split may be increased to 60 msec in patients with right bundle branch block, Ebstein's anomaly, or other conditions in which there is electrical delay in activitation of one of the two ventricles (e.g., ventricular ectopic beats, ventricular tachycardia, AV block with idioventricular rhythm, and left ventricular pacing). Splitting of the first sound is not characteristic of left bundle branch block because there is no significant delay in onset of left ventricular contraction. Mechanical delays in closure of the mitral valve (e.g., mitral stenosis and left atrial myxoma) or the tricuspid valve (e.g., right atrial myxoma) may cause abnormal splitting of the first heart sound. 190. Wilke’s syndrome (superior mesentric art. Syn) ass with A/E Sudden wt. Loss Lordosis Long mesentry High ligament treitz C Important etiologic factors that may precipitate narrowing of the aortomesenteric angle and recurrent mechanical obstruction include the following: Constitutional factors Thin body build Exaggerated lumbar lordosis Visceroptosis and abdominal wall laxity Depletion of the mesenteric fat caused by rapid severe weight loss due to catabolic states such as cancer, surgery, burns, or psychiatric problems Severe injuries, such as head trauma, leading to prolonged bedrest Dietary disorders Anorexia nervosa Malabsorption Spinal disease, deformity, or trauma: Use of body cast in the surgical treatment of scoliosis or vertebral fractures. Superior mesenteric artery syndrome cases after corrective spine surgery are due to the result of spinal elongation, which decreases the superior mesenteric/aortic angle. Postoperative weight loss is an important factor for development of superior mesenteric artery syndrome. Although use of Harrington rods for corrective surgery commonly used in the 1950s and 1960s was an important contributory factor for development of superior mesenteric artery syndrome, newer derotation/translation corrective techniques can also rarely be associated with this disease entity.4 •Rapid linear growth without compensatory weight gain, particularly in adolescents Anatomic anomalies, rarely Abnormally high and fixed position of the ligament of Treitz with an upward displacement of the duodenum Unusually low origin of the superior mesenteric artery Unusual causes Traumatic aneurysm of the superior mesenteric artery after a stab wound Familial superior mesenteric artery syndrome Recurrent superior mesenteric artery syndrome 191. Decreased erythropoitin levels in end stage disease seen in Hepatitis Chronic renal failure Gastric ca B 192. Short period starvation features A/E Brain uses ketone bodies Increased hepatic gluconeogenesis When food intake ceases, the body's glycogen stores are used up in about 24 hours. The level of insulin in circulation is low and the level of glucagon is very high. The main means of energy production is lipolysis. Gluconeogenesis converts glycerol into glucose and the Cori cycle converts lactate into usable glucose. Two systems of energy enter the gluconeogenesis, proteolysis provides alanine and lactate produced from pyruvate. Acetyl CoA produces dissolved nutrients (Ketone bodies), which can be detected in urine and are used by the brain as a source of energy. In terms of insulin resistance, starvation conditions makes more glucose available to the brain. 193. Surfactant secreted by Type-II pneumocyte Type-I pneumocyte Alveolar epithelial cells A 194. True about Case fatality rate A/E It is a ratio To know interval time Not used in acute infectious disease Epidemic variation C 195. Bladder injury most commonly occur in Vaginal hysterectomy Hysteroscopy Abdominal hysterectomy Laproscopic C Bladder injuries are caused by either blunt or penetrating trauma to the lower abdomen, pelvis, or perineum. Blunt trauma is the more common mechanism, usually by a sudden deceleration, such as in a high-speed motor vehicle collision or fall, or from an external blow to the lower abdomen. The most frequently accompanying injury is a pelvic fracture, occurring in > 95% of bladder ruptures caused by blunt trauma. Other concomitant injuries include long bone fractures and CNS and chest injuries. Penetrating injuries, most often gunshot wounds, account for about 25% of bladder injuries.
The bladder is the most frequently injured organ during pelvic surgery. Such injuries can occur during transurethral surgery, colon resection, or gynecologic procedures (most commonly abdominal hysterectomy, cesarean section, pelvic mass excision). Predisposing factors include scarring from prior surgery or radiation, inflammation, and extensive tumor burden.
Bladder injury may occur during a vaginal or abdominal hysterectomy.
196. Cranial part wolffian duct
n the female, in the absence of testosterone support, the Wolffian duct regresses, and inclusions may persist. The epoophoron and Skene’s glands may be present.
epoophoron. a vestigial structure associated with the ovary; originates from the cranial mesonephric tubules and cysts of it may resemble ovarian cysts
197. Non invasive BP measured by
Beer lambarts law
The principle of the inventive method is derived from the Beer-Lambert law of analytical chemistry. The Beer-Lambert law gives the relationship between the absorption of monochromatic light by a concentration of a material in a solution as a function of the path length through the solution
oscillometric non-invasive blood pressure devices in this study have a repeatability of approximately 1 mmHg
198. Male DM patient came with joint swelling, painless joint with looser bodies found
Loose bodies are fragments of bone and/or cartilage that freely float in the joint space. They may occur singly or in groups and typically affect only one joint.
Loose bodies are classified as either stable or unstable. Stable loose bodies are in a fixed position and are generally well tolerated by the individual. Unstable loose bodies are free to move about the joint and cause symptoms.
Loose bodies are classified into three types: fibrinous, cartilaginous, and osteocartilaginous. Fibrinous loose bodies result from bleeding within the joint or from the death of the tissue lining of joints (synovial membrane) associated with tuberculosis, osteoarthritis, and rheumatoid arthritis. Cartilaginous loose bodies are fragments of cartilage and are caused by injury (trauma) to the joint and osteoarthritis. Osteocartilaginous loose bodies are fragments of cartilage and bone caused by fractures, bone and cartilage inflammation (osteochondritis dissecans), osteoarthritis, and benign tumors of the synovial membrane (synovial chondromatosis). Cartilage is nourished by the fluid within the joint (synovial fluid) so loose bodies often increase in size and become smoother over time.
199. Wermick’s enchepalopathy caused by
200. Hyper vitaminosis – A seen in A/E
Psuedo tumor cerebri
reduced bone mineral density that may result in osteoporosis
coarse bone growths
excessive skin dryness/peeling (desquamation)
idiopathic intracranial hypertension
Signs of acute toxicity include nausea and vomiting, headache, dizziness, blurred vision, and loss of muscular coordination.
201. Intra partum anaesthetic with least depression
Spinal anaesthesia offers the least drug transfer for the degree of anaesthesia achieved
Ketamine dose greater than 2 mg/kg is associated with neonatal depression
202. Cardio thoracic ratio at 2yr age
203. Ca cervix involved with lower 1/3rd of vagina without parametrium involvement stage is
Tumor extends to the pelvic wall and/or involves the lower third of the vagina and/or causes hydronephrosis or nonfunctioning kidney
Tumor involves lower third of vagina; no extension to pelvic wall
Tumor extends to pelvic wall and/or causes hydronephrosis or nonfunctioning kidney
Cervical carcinoma has extended beyond the true pelvis or has involved (biopsy proven) the bladder mucosa or rectal mucosa. Bullous edema does not qualify as a criteria for stage IV disease.
204. Papillary changes in diabetic retinopathy
Pallar of disc
Disc edema with telengectasia
Ruptured microaneurysms (MA) result in retinal hemorrhages either superficially (flame-shaped hemorrhages) or in deeper layers of the retina (blot and dot hemorrhages).
205. Least recurrence seen with incisional hernial repair
Peritonial mesh repair
Inlay mesh repair
Outlay mesh repair
Kelly’s mesh repair
206. Hurtnup’s disease false (hurtnup’s)
Defect in neutral aminoacid transport
Mental retardation common
Most children are asymptomatic