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What is What are the characteristics of the primary (initial) bacterial colonizers of the tooth in dental plaque formation? and explain in detail?

Streptococcal and Actinomyces species are initial colonizers of dental plaque. They are grampositive, facultative micro-organisms.

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What is Reversible Dementia Is a feature of ? and explain in detail?

Ans. is 'b' i.e., Hypothyroidism Causes of reversible dementiao Hypothyroidismo Normal pressure hydrocephaluso Depressiono Drugso Alcoholo Vitamin B12 deficiency

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What is Hormone involved in regulation of BP ? and explain in detail?

Ans. is 'b' i.e., Angiotensin- II

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What is Which of the following is False regarding H.Pylori infection : and explain in detail?

Answer is A (With chronic infection urease breath test becomes negative) Urease breath test detects H. pylon infection by 'bacterial urease activity' and remains positive till the bacteria has not been eradicated with treatment. Thus urease breath test becomes negative only after eradication of organism following treatment and not with chronic Mfection. Despite a substantial humoral antibody response infection persists indefinitely (persists life long if untreated) Invasive diagnostic test are based on Endoscopic, endoscopy is a diagnostic application. H. pylori produces several virulence factors that have been implicated in the damage of mucosa.

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What is A patient with Lefort-II, Lefort-III and nasoethmoidal fracture with intermaxillary fixation done is best intubated by: and explain in detail?

None

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What is Motor march is seen in ? and explain in detail?

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What is A case of solitary thyroid nodule, Investigation of choice is - and explain in detail?

"FNAC is the investigation of choice in discrete thyroid swellings"-Bailey & Love

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What is The ideal treatment for fracture of the angle of mandible is and explain in detail?

None

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What is The drug which is not suitable for patients with acute porphyria for intravenous induction is – and explain in detail?

All barbiturates (including thiopentone) are absolutely contraindicated. There is controversy regarding etomidate because some text books (miller) consider it safe, while other (Lee, Wylie), consider it unsafe :- Miller (7th/e 1115) has given etomidate amongst the safe drugs. Lee and Wylie have opinion different to Miller :- "Etomidate is potentially porphyriogenic in animal models and at least one crisis has followed its use in human subjects, although its safe use has also been reported, on balance, etomide should be considered unsafe". ─ Wylie "Etomidate should probably be avoided because it is potentially porphyrinogenic in animals, although reports in humans are conflicting". ─ Lee Anyways, whatever opinion about etomidate, the answer of this question is thiopentone for sure as there is no confusion about contraindication of barbiturates in porphyria.

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What is Maximum amount of incisor retraction achieved is: and explain in detail?

None

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What is Which line of death ceificate represent major antecedent cause of death - and explain in detail?

Ans. is 'c' i.e., Ic International death ceificate The basis of moality data is death ceificate. For ensuring national and international comparability, it is necessary to have a uniform and standardized system of recording and classifying deaths. For this purpose WHO has recommended international death ceificate. Consist of four lines: Line Ia: Disease or condition directly leading to death Line Ib: Antecedent/ underlying cause Line Ic: Main antecedent / underlying cause Line II: Other significant conditions contributing to death but not related to disease/ condition causing it Example of a death ceificate: Line Ia: Renal failure Line Ib: Diabetic nephropathy Line Ic: Diabetes mellitus Line II: Hypeension Concept of underlying cause, Line Ic is the most impoant line in death ceificate, thus also known as `Essence of Death Ceificate'.

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What is A 25 year old male after road traffic accident was brought to emergency depament. On examination, the patient was moaning with inability to speak but patient was able to understand what he wanted to speak. Which of the following marked area of brain is involved in this? and explain in detail?

Inability to speak - Motor aphasia Stroke of superior division of MCA i.e. Broca's area affected. A = Contraversive eye center B = Broca's area- inferior frontal gyrus - MCA: sup. division C = Wernicke's area -superior Temporal gyrus - MCA: inf division D = Occipital coex

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What is MAC stands for? and explain in detail?

Ans. is 'a' i.e., Minimum alveolar concentration Minimal alveolar concentration (MAC)* Most important measure of potency is minimal alveolar concentration (MAC). MAC is the lowest concentration of the anesthetic in pulmonary alveoli needed to produce immobility in response to a painful stimulus (surgical incision) in 50% individuals. Higher the MAC, less potent the anesthetic agent.* Methoxyflurane has minimum MAC (0.16%) - The most potent inhalational agent.* N2O has maximum MAC (105) - The least potent inhalational agent.* Order of potency in decreasing order (MAC in increasing order): -* Methoxyflurane (MAC = 0.16 %) > Trilene (MAC = 0.2%) > Halothane (MAC = 0.74%) > Chloroform (MAC = 0.8 %) > Isoflurane (MAC = 1.15 %) > Enflurane (MAC = 1.68%) > Ether (MAC = 1.92 %) > Sevoflurane (MAC = 2.0 %)> Desflurane (MAC = 6.0%) > Cyclopropane (MAC = 9.2%) > N20 (MAC 104%).Factor affecting MAC1. Age: - Young age increases and old age decreases MAC.2. Alcohol: - Chronic intoxication increases and acute intoxication decreases MAC.3. Temperature: - Both hypothermia and hyperthermia decrease MAC.4. Electrolyte: - Hypercalcemia, Hypermagnesemia & Hyponatremia decrease. Whereas hypernatremia increases MAC.5. Anemia : - Decrease MAC6. Hypoxia (pO2 < 40), and hypercarbia (pCO2 > 95) decrease MAC.7. Pregnancy: - Decreases MAC8. Drugs: -A. Decreasing MAC - Local anaesthetics (except cocaine) Opioids, Ketamine, Barbiturates, Benzodiazepines, Verapamil, Lithium, Sympatholytics (Methyldopa, reserpine, Clonidine, Dexmedetomidine), Chronic amphetamine use.B. Increasing MAC: - Acute amphetamine intake, Cocaine, ephedrine.

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What is Which of the following phase is absent in action potential of pacemaker cells? and explain in detail?

None

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What is Which of the following Human papilloma virus subtypes are not covered by Quadrivalent Anti-cervical cancer vaccine? and explain in detail?

b. Type 7(Ref: Nelson's 20/e p, Ghai 8/e p 200-201)Quadrivalent HPV vaccine contains serotypes 16, 18, 6 & 11 with aluminium containing adjuvant.

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What is Which of the following is best for diagnosing genital TB? and explain in detail?

Ans. (c) LJ mediumRef: Harrison 19th ed. /1110* Harrison states: "In genitourinary TB - culture of 3 morning urinary specimen yields a definitive diagnosis in 90% cases. LJ medium is most common solid medium used for culture.* Prevalence of GU TB= 10-15%* MC c/o- Urinary frequency, dysuria, nocturia, hematuria, and flank or abdominal pain.* Diagnosis- Culture of three morning urine specimens- definitive diagnosis in nearly 90% patient.* Other test- IV pyelography, abdominal CT, MRI-may show deformities and obstructions* Suggestive findings- calcifications and ureteral strictures-* Complication-# Female- affects the fallopian tubes and the endometrium and may cause infertility, pelvic pain, and menstrual abnormalities.# Diagnosis requires biopsy or culture of specimens obtained by dilation and curettage.# Male- affects the epididymis, producing a slightly tender mass that may drain externally through a fistulous tract; orchitis and prostatitis may also develop.* Rx: Genitourinary TB responds well to chemotherapy.

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What is Following are components of District mental Health program except:- and explain in detail?

Screening is not a component of District mental Health program. DISTRICT MENTAL HEALTH PROGRAMME (DMHP):- Launched under NMHP in 1996. (IX five year plan) DMHP was based on 'Bellary Model' with the following components: Early detection & treatment. Training: impaing sho term training to general physicians for diagnosis and treatment of common mental illnesses with limited number of drugs under guidance of specialist; health workers are being trained in identifying mentally ill persons. IEC: Public awareness generation. Monitoring: the purpose is for simple record keeping.

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What is The drug of choice for chemoprophylaxis in contacts of a patient of penumonic plague is - and explain in detail?

Ans. is 'd' i.e., Tetracycline Chemoprophylaxis o Chemoprophylaxis refers to the administration of a drug for the purpose of preventing disease or infection. Indications for chemoprophylaxis Disease Chemoprophylaxis Cholera Tetracycline or furazolidone for house-hold contacts Conjuncitivitis Erythromycin ophthalmic ointment Diphtheria Erythromycin (and first dose of vaccine) Influenza Amantadine (effective only for type A) for contacts suffering from chronic diaeases Malaria Chloroquine Meningitis Sulphadiazine for 4 days only meningococcal if the strain is shwon to be non-resistant, for household and close community contacts; immunization should be initiate in all cases (against serogrops A, and C). However, now rifampicin is the DOC for chemoprophylaxis. Plague Tetracycline for contacts of pneumonic plague

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What is All of the following are true regarding after pains except: and explain in detail?

Ans. is c, i.e. Decreases in intensity by 5th dayRef. Williams 24/e, p 670After pains - In primiparous women, uterus tends to remain tonically contracted following delivery. In multiparas, however, it often contracts vigorously and gives rise to after pains.After pains are similar to uterine contractions but milder than them.More pronounced as parity increases.Worsen with suckling of breast by infant.Decrease in intensity and become mild by 3rd day following delivery.

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What is En-coup-de sabre is a form of and explain in detail?

Systemic sclerosis Systemic sclerosis, or scleroderma, is a generalised disorder of connective tissue affecting the skin, internal organs and vasculature. It is characterised by sclerodactyly in combination with Raynaud's and digital ischaemia It is subdivided into diffuse cutaneous systemic sclerosis (DCSS: 30% of cases) and limited cutaneous systemic sclerosis (LCSS: 70% of cases). Many patients with LCSS have features that are phenotypically grouped into the 'CREST' syndrome (Calcinosis, Raynaud's, oEsophageal involvement, Sclerodactyly and Telangiectasia). . Features that associate with a poor prognosis include older age, diffuse skin disease, proteinuria, high ESR, a low TLCO (gas transfer factor for carbon monoxide) and pulmonary hypeension. REF:DAVIDSON&;S PRINCIPLES AND PRACTICE OF MEDICINE 22nd EDITION PAGE NO 1112

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What is DENOSUMAB a monoclonal antibody against RANKL receptor is used in the treatment of and explain in detail?

Ans. is 'b' i.e. Osteoporosis Osteoclast is a cell responsible for bone resorption.Osteoclasts express RANK receptors on its surface (RANK receptor activator for nuclear factor)When RANK receptor combine with their ligands (RANKL), osteoclastogenesis is a initiated and bone resorption occurs.Denosumab is a fully humanized monoclonal antibody against RANK ligand.It prevents the activation of the osteoclasts by these ligand.Note:Osteoporosis is a disease characterized by decrease in the bone massIn osteoporosis there is increase in the osteoclast activity and there is increased expression of RANK and RANKL.

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What is Sputum can be disinfected by all except - and explain in detail?

None

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What is A boy comes with complains of vomiting, bloated abdomen and abdominal pain. He has history of attending ice-cream eating competition last night. He also past history of similar episodes following ingestion of milk and milk products. The likely cause : and explain in detail?

Ans. is 'b' Lactase deficiency (Ref. : O.P. Ghai, Pediatrics, 6/e, p 110, 281 (5/e, p. 256), Nelson 17/e, p 1268).History of ice cream ingestion and subsequent symptoms of vomiting, bloated abdomen, are characteristic findings of lactase deficiency.About lactase deficiency.Lactase is a disaccharidase present on intestinal epithelium (brush border)*. It is used to digest lactose (disaccharide).Lactase Deficiency (Symptoms)Symptoms arise after ingestion of food containing lactose (e.g. milk).Symptom - Diarrhoea, vomiting, bloated abdomen.DiagnosisPresence of more than 1/2 percent of reducing substrate in fresh stool.Acidic stools*Abnormal oral sugar tolerance test* (blood glucose rise of less than 20mg/dl above fasting level with a disaccharide load of 2g/kg)Breath H2 excretion of more than 11 ppm*.Enzyme assay on mucosal biopsies showing low levels of disaccharidases.Treatment - low lactose diet.

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What is The pain around the hip with flexion, adduction & internal rotation of lower limb in a young adult after a road traffic accident is suggestive of - and explain in detail?

Ans. is 'c' i.e., posterior dislocation of hip Attitude of lower limbDiagnosisAdduction, Internal rotation, FlexionAbduction, Ext. rotation, FlexionAdduction, Ext rotation, FlexionPost, dislocation of hip Ant. dislocation of hip Fracture neck femur

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What is IUCD is absolutely contraindicated in all the following except and explain in detail?

Absolute contraindications for IUD use include the following: Pregnancy. Significantly distoed uterine anatomy. Unexplained vaginal bleeding concerning for pregnancy or pelvic malignancy. Gestational trophoblastic disease with persistently elevated beta-human chorionic gonadotropin levels. Ongoing pelvic infection

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What is Cyanide poisoning causes and explain in detail?

Anoxia According to Gordon (1944) the stoppage of vital functions depend upon tissue anoxia. Anoxia means "lack of oxygen". It may be: (1) Anoxic anoxia: In this type, oxygen cannot reach the blood, because of lack of oxygen in the lungs. This occurs: (a) from breathing in a contaminated atmosphere, e.g., from exposure to the fumes in wells and tanks, or from exposure to sewer gas, (b) from mechanical interference with the passage of air into or down the respiratory tract, e.g., in smothering, choking, hanging, strangulation, drowning, traumatic asphyxia and ceain forms of acute poisoning. (2) Anaemic anoxia: In this type, oxygen-carrying capacity of the blood is reduced, e.g., acute massive haemorrhage, poisoning by carbon monoxide, chlorates, nitrates, coaltar derivatives. (3) Stagnant anoxia: In this type, impaired circulation results in a reduction of oxygen delivery to the tissues, e.g., hea failure, embolism and shock. ( 4) Histotoxic anoxia: In this type, the enzymatic processes by which the oxygen in the blood is used by the tissues are blocked, e.g., acute cyanide poisoning. Ref:- k s narayan reddy; pg num:-137

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What is Glomerular filtration rate stas declining at what age? and explain in detail?

Glomerular filtration rate (GFR) is the volume of fluid filtered from the renal (kidney) glomerular capillaries into the Bowman&;s capsule per unit time.The normal range of GFR, adjusted for body surface area, is 100-130 ml/min/1.73m2 in men and women. In children, GFRmeasured by inulin clearance is 110 ml/min/1.73m2 until 2 years of age in both sexes, and then it progressively decreases. After age 40, GFR decreases progressively with age, by about 0.4 - 1.2 mL/min per yearRef: Ganong&;s review of medical physiology; 24th edition; page no; 679

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What is Examples of periodontal dressing packs: and explain in detail?

None

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What is All of the following are signs of Pulmonary Hypeension, except: and explain in detail?

Answer is A (Right Parasternal Heave): Pulmonary Hypeension is associated with Right Ventricular Hyperophy which presents as Left Parasternal Heave (Not Right Parasternal Heave). The Right Ventricle is situated just beneath the left 3rd ,4th, and 5th intercostal spaces close to the sternum and is palpable as a Left Parasternal Heave in cases of Pulmonary Hypeension.

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What is Hyperosmolarity of renal medulla is due to- and explain in detail?

Ans. is 'b > a & d' i.e., Na > K & Cl o A countercurrent system is a system in which inflow runs parallel to, counter to, and in close proximity to the outflow for some distance. In the kidney there are two countercurrent mechanisms : - i) Countercurrent multiplier at the loop of Henle which generate high medullary osmotic pressure gradient; and ii) Countercurrent exchanger at vasa recta of medullary capillaires, which helps to maintain the medullary osmotic pressure gradient.Countercurrent multipliero The loop of Henle gives the nephron a peculiar shape. The descending limb, in which the tubular fluid flows towards the hairpin bend (downwords) and the ascending limb, in which the tubular fluid flows 'upwards' lie close to each other. Two such tubes with fluid flowing through them in opposite directions provide an opportunity for the countercurrent multiplication.o The thick ascending limb of loop of Henle is impermeable to water but it actively reabsorbs NaCl. The thin descending limb of loop of Henle is relatively impermeable to solutes but highly permeable to water. The most important cause of the high medullary osmolarity is active transport of sodium0 and co-transport of potassium, chloride and other ions out of the thick ascending limb of loop of Henle0 into the medullary interstitium. Most important among all these is NaCl0, for maintenance of high medullary interstitium.o Consider the Na* is continuously flowing in from glomerulus into the tubule. However, most of the Na+, instead of flowing out, gets trapped in a circular path and recycles between the ascending and descending limbs of the loop of Henle. Consequently, the Na* concentration becomes very high at the tip of the loop.Role of ureao Urea also contributes to the osmalority of medullary interstitium0, especially when the kidney is forming maximally concentrated urine. The medullary region ofthe collecting duct is permeable to urea. Diffusion ofurea from these ducts into the medulla increases the osmolarity of medullary' interstitium. Under the influence of ADH, the permeability of medullary collecting ducts to urea further increases. Moreover. ADH makes these collecting ducts also permeable to water and outward diffusion of wrater. That increases the urea concentration within the duct. That leads to further diffusion of more urea out of duct along concentration gradient. Thus urea makes an important contribution to the genesis of high osmolarity in the renal medulla.Countercurrent exchangero If the blood flowrs through the hyperosmolar medulla as shown in figure A below', it would equilibrate with medullary interstitium and carry away the solutes concentrated in the medulla. However, what actually happens is shown in figure 'BT below. Vasa recta is U shaped (as is the loop of Henle). As the vasa recta dips into the hyperosmolar medulla, the blood equilibrates with the surrounding interstitium and becomes hyperosmolar. Thereafter, as the vasa recta loops around and ascends towards the cortex, the osmolarity of the blood keeps decreasing as it equilibrates with the surrounding interstitium. By the time vasa recta leaves the medulla, the blood in it has the same osmolarity as when it entered the medulla. In other words, the solutes concentrated in the medulla are not wrashed away by the blood flowing through the medulla,o Since the blood flowing through the medulla equilibrates completely with the medullary' inerstitium, the amount of solutes carried away by the blood is flow limited. Hence, the slow rate of blood flow through the vasa recta contributes to the conservation of medullary hyperosmolarity. Conversely, a high blood flow rate through the medulla reduces the medullary hyperosmolarity'.

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What is True about Dizygotic twins and explain in detail?

Dizygotic twins : There are two placentae, either completely separated or more commonly fused Fetus surrounded by a separate amnion and chorion Ref: Dutta Obs 9e pg 189.

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What is Allergic BPA which kind of hypersensitivity reaction - and explain in detail?

Ans. is 'a' i.e., Type I {Ref: Robbia's 9th/ep. 683]

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What is A 40 year old male was brought to the hospital with acute pain in the upper abdomen. Pateint was in shock with feeble pulse and tachycardia. There was tenderness present in the epigastrium. There is no blood in the gastric aspirate and thepatient felt better after aspiration. X-ray abdomen showed no free gas under the diaphragm. Investigations revealed TLC 13500 serum bilirubin 2.0 mg and serum amylase 800 I.U. The most likely diagnosis is - and explain in detail?

Ans. is 'b' i.e., Acute pancreatitis

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What is In Klippel-Feil syndrome, the patient has all of the following clinical features, EXCEPT: and explain in detail?

Bilateral shoness of sternomastoid is not included in Klippel-Feil syndrome. Ref:Harrison's Principles of Internal Medicine, 14th Edition, Page 2120 and 15th Edition, Page 2174

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What is In a lacerated wound the hair bulb is: and explain in detail?

Lacerated

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What is All the following are features of Tropical Pulmonary Eosinophilia except - and explain in detail?

None

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What is External auditory canal exostosis occurs due to? and explain in detail?

Ans. is 'd' i.e., Recurrent proplonged cold water exposure Ear canal exostoses are bilateral, usually symmetric multiple bony growths occurring in the medial poion of the external auditory canal. Also known as surfer's ear, exostosis is thought to be a reactive process from repeated stimulation by cold water and is much more common than external auditory osteoma

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What is Dengue hemorrhagic fever is caused by - and explain in detail?

Hypersensitivity or enhancement response to sequintial dengue virus infection in person sensitised by prior exposure to other serotupes of the viru REF:\p> ANATHANARAYANAN MICROBIOLOGY NINTH EDITION PAGE.523

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What is A 4 yr. old boy was brought by his mother to the OPD regarding complaints of cola coloured urine for 8 days. The mother has noticed repeated attacks earlier too. Associated history reveals SNHL and slit lamp examination reveals All of the statements regarding the disease are true EXCEPT? and explain in detail?

Presence of haematuria with SNHL with anterior lenticonus as shown in the slit lamp suggests the diagnosis of Alpo's syndrome. Alpo's syndrome is and X linked disorder characterized by defect in alpha 5 chain of type IV collagen. Electron microscopy reveals thinning of basement membrane (<150nm) as the earliest feature and 'basket weave appearance' is characteristic on EM.

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What is Cock up splint is used in - and explain in detail?

Cock- up splint is used for RADIAL NERVE PALSY. Knuckle- bender splint for Ulnar nerve palsy. Aeroplane splint for Brachial plexus palsy. REF:Essential ohopaedics- Maheshwari - 9th edn- pg no 25.

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What is Microscopical appearance of cervical mucus after ovulation is: and explain in detail?

The fern test can determine the presence or absence of ovulation or the time of ovulation. When cervical mucus is spread on a clean, dry slide and allowed to dry in air, it may or may not assume a frondlike pattern when viewed under the microscope. The fern frond pattern indicates an estrogenic effect on the mucus without the influence of progesterone; thus, a non-frondlike pattern can be interpreted as showing that ovulation has occurred. Progesterone makes the mucus thick and cellular. Ref: Kawada C., Hochner-Celnikier D. (2013). Chapter 35. Gynecologic History, Examination, & Diagnostic Procedures. In A.H. DeCherney, L. Nathan, N. Laufer, A.S. Roman (Eds), CURRENT Diagnosis & Treatment: Obstetrics & Gynecology, 11e.

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What is Most common cause of respiratory disease after thyroidectomy is? and explain in detail?

Laryngeal edema is the most common cause of post - operative respiratary distress after thyroidectomy.

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What is Locally invasive gastric cancer. Investigation of choice to know depth of cancer invasion and explain in detail?

EUS is useful to detect the involvement of layers of the stomach, nodal status and to define whether the tumour is early or advanced. All 5 layers are visualised as alternate hypo - hyperechogenic areas Reference SRB edition :5 page : 851

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What is True regarding vascularity of lung is: and explain in detail?

D i.e. Distended pulmonary veins in the lower lobes

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What is Factors affecting sickling in sickle cell anemia are? and explain in detail?

Ans. is 'a' i.e., HbS concentration; 'b' i.e., HbA; 'c' i.e., pH Factors affecting sickling Amount of HbS and interaction with other hemoglobins. o Most impoant factor for sickling is the amount of HbS and its interaction with other types of hemoglobin. o In homozygous individuals, all the hemoglobin in red blood cell is HbS, and undergo sickling. o In heterozygous, only 40% of hemoglobin is HbS --> Sickling does not occur because HbA (remaining 60% of normal hemoglobin) has an inhibitory effect on polymerization of HbS. o Fetal hemoglobin HbF also has inhibitory effect on sickling of HbS ----> Newborns do not manifest the disease until they are 5 to 6 months of age, when the amount of HbF in the cells falls close to the adult level. o HbC has a greater tendency to copolymerize with deoxygenated HbS. 2. Hemoglobin concentration o The rate of HbS polymerization is strongly dependent upon the hemologbin concentration per cell i.e., MCHC. o Higher HbS concentration increase the probability that aggregation and polymerization will occur during any given period of time. o Thus, intracellular dehydration, which increases the MCHC, faciliatates sickling. o Conversly, conditions that decrease MCHC reduce disease severity e.g., when sickle cell anemia occurs with athalassemia 3. Deoxygenation with HbS o Polymerization of HbS occurs only in deoxygenated state. o A decrease in pH reduces the oxygen affinity of hemoglobin, thereby increasing the fraction of deoxygenated HbS at any given oxygen tension and augmenting the tendency of sickling. 4. The length of time red cell are exposed to low oxygen tension. o Normal transient times for red cells passing through capillaries are not sufficient for significant aggregation of deoxygenated HbS to occurs. o Hence, sickling of red cells is confined to microvascular beds where blood flow is sluggish. o This is normally the case in spleen and bone marrow which are predominantly affected by sickle cell disease.

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What is mRNA is a complimentary copy of ? and explain in detail?

D i.e. A single strand of DNA

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What is Bilateral parotid enlargement is seen in:- and explain in detail?

Causes of Bilateral Parotid Enlargement Viral infections: Mumps Influenza Epstein - Barr virus Coxsackie virus Cytomegalovirus HIV Sarcoidosis Amyloidosis Kimura's Disease Wegner's granulomatosis Sjogren's syndrome Metabolic Diabetes mellitus Hyperlipoproteinemia Chronic pancreatitis Hepatic cirrhosis Endocrine Acromegaly Gonadal hypofunction

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What is Which of the following material is not applied for root conditioning after placement of MTA? and explain in detail?

Based on periodontal research, it would appear that if a root surface conditioning agent were to be used during periradicular surgery, EDTA might be the most appropriate solution. However, the manufacturer (personnel communication, Dr.  Torabinejad)  has  advised  against  the  use  of  EDTA  when mineral trioxide aggregate (MTA) is used as a root-end filling material,  because  it  may  interfere  with  the  hard  tissue–producing effect of MTA. Reference: Cohen Pathways of pulp 11th ed page no 416

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What is Reversal lepra reaction shown no response to : and explain in detail?

D. i.e. Thalidomide Appearance of new skin lesions or signs of inflammation (e.g. redness and swelling etc.) in prevous lesions, neuritis (e.g. nerve pain) and low grade fever in borderline forms of leprosy suggest the diagnosis of Jopling's type I (delayed type IV hype/sensitivity) reaction. If type I lepra reaction preceeds the initiation of appropiate antimicrobial therapy it is k/a down grading reaction & the case becomes histologically more lepromatous. When it occurs after initiation of therapy, it is termed as reversal reaction & the case becomes more tuberculoid. - This is presentation of lepra reaction (type I - reversal) & in any case of lepra reaction antileprotic drug is not stopped. Thalidomide is ineffective and has no role in type I lepra (downgrading and reversal) reactionsQ.

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What is Back pain and explain in detail?

Back pain is pain felt in the back. It may be classified as neck pain (cervical), middle back pain (thoracic), lower back pain (lumbar) or coccydynia (tailbone or sacral pain) based on the segment affected. The lumbar area is the most common area affected. An episode of back pain may be acute, subacute or chronic depending on the duration. The pain may be characterized as a dull ache, shooting or piercing pain or a burning sensation. Discomfort can radiate to the arms and hands as well as the legs or feet, and may include numbness or weakness in the legs and arms. The majority of back pain is nonspecific and idiopathic. Common underlying mechanisms include degenerative or traumatic changes to the discs and facet joints, which can then cause secondary pain in the muscles and nerves and referred pain to the bones, joints and extremities. Diseases and inflammation of the gallbladder, pancreas, aorta and kidneys may also cause referred pain in the back. Tumors of the vertebrae, neural tissues and adjacent structures can also manifest as back pain. Back pain is common; approximately nine of ten adults experiencing it at some point in their lives, and five of ten working adults experience back pain each year. Some estimate that as many of 95% of people will experience back pain at some point in their lifetime. It is the most common cause of chronic pain and is a major contributor to missed work and disability. For most individuals, back pain is self-limiting. Most people with back pain do not experience chronic severe pain but rather persistent or intermittent pain that is mild or moderate. In most cases of herniated disks and stenosis, rest, injections or surgery have similar general pain-resolution outcomes on average after one year. In the United States, acute low back pain is the fifth most common reason for physician visits and causes 40% of missed work days. It is the single leading cause of disability worldwide. Classification Back pain is classified in terms of duration of symptoms. Acute back pain lasts <6 weeks Subacute back pain lasts between 6 and 12 weeks. Chronic back pain lasts for greater than 12 weeks. Causes There are many causes of back pain, including blood vessels, internal organs, infections, mechanical and autoimmune causes. Approximately 90 percent of people with back pain are diagnosed with nonspecific, idiopathic acute pain with no identifiable underlying pathology. In approximately 10 percent of people, a cause can be identified through diagnostic imaging. Fewer than two percent of cases are attributed to secondary factors, with metastatic cancers and serious infections, such as spinal osteomyelitis and epidural abscesses, accounting for approximately one percent. Nonspecific In as many as 90 percent of cases, no physiological causes or abnormalities on diagnostic tests can be found. Nonspecific back pain can result from back strain or sprains, which can cause peripheral injury to muscle or ligaments. Many patients cannot identify the events or activities that may have caused the strain. The pain can present acutely but in some cases can persist, leading to chronic pain. Chronic back pain in people with otherwise normal scans can result from central sensitization, in which an initial injury causes a longer-lasting state of heightened sensitivity to pain. This persistent state maintains pain even after the initial injury has healed. Treatment of sensitization may involve low doses of antidepressants and directed rehabilitation such as physical therapy. Spinal disc disease Spinal disc disease occurs when the nucleus pulposus, a gel-like material in the inner core of the vertebral disc, ruptures. Rupturing of the nucleus pulposus can lead to compression of nerve roots. Symptoms may be unilateral or bilateral, and correlate to the region of the spine affected. The most common region for spinal disk disease is at L4–L5 or L5–S1. The risk for lumbar disc disease is increased in overweight individuals because of the increased compressive force on the nucleus pulposus, and is twice as likely to occur in men. A 2002 study found that lifestyle factors such as night-shift work and lack of physical activity can also increase the risk of lumbar disc disease. Severe spinal-cord compression is considered a surgical emergency and requires decompression to preserve motor and sensory function. Cauda equina syndrome involves severe compression of the cauda equina and presents initially with pain followed by motor and sensory. Bladder incontinence is seen in later stages of cauda equina syndrome. Degenerative disease Spondylosis, or degenerative arthritis of the spine, occurs when the intervertebral disc undergoes degenerative changes, causing the disc to fail at cushioning the vertebrae. There is an association between intervertebral disc space narrowing and lumbar spine pain. The space between the vertebrae becomes more narrow, resulting in compression and irritation of the nerves.Spondylolithesis is the anterior shift of one vertebra compared to the neighboring vertebra. It is associated with age-related degenerative changes as well as trauma and congenital anomalies. Spinal stenosis can occur in cases of severe spondylosis, spondylotheisis and age-associated thickening of the ligamentum flavum. Spinal stenosis involves narrowing of the spinal canal and typically presents in patients greater than 60 years of age. Neurogenic claudication can occur in cases of severe lumbar spinal stenosis and presents with symptoms of pain in the lower back, buttock or leg that is worsened by standing and relieved by sitting. Vertebral compression fractures occur in four percent of patients presenting with lower back pain. Risk factors include age, female gender, history of osteoporosis, and chronic glucocorticoid use. Fractures can occur as a result of trauma but in many cases can be asymptomatic. Infection Common infectious causes of back pain include osteomyelitis, septic discitis, paraspinal abscess and epidural abscess. Infectious causes that lead to back pain involve various structures surrounding the spine.Osteomyelitis is the bacterial infection of the bone. Vertebral osteomyelitis is most commonly caused by staphylococci. Risk factors include skin infection, urinary tract infection, IV catheter use, IV drug use, previous endocarditis and lung disease. Spinal epidural abscess is commonly caused by severe infection with bacteremia. Risk factors include recent administration of epidurals, IV drug use or recent infection. Cancer Spread of cancer to the bone or spinal cord can lead to back pain. Bone is one of the most common sites of metastatic lesions. Patients typically have a history of malignancy. Common types of cancer that present with back pain include multiple myeloma, lymphoma, leukemia, spinal cord tumors, primary vertebral tumors and prostate cancer. Back pain is present in 29% of patients with systemic cancer. Unlike other causes of back pain that commonly affect the lumbar spine, the thoracic spine is most commonly affected. The pain can be associated with systemic symptoms such as weight loss, chills, fever, nausea and vomiting. Unlike other causes of back pain, neoplasm-associated back pain is constant, dull, poorly localized and worsens with rest. Metastasis to the bone also increases the risk of spinal-cord compression or vertebral fractures that require emergency surgical treatment. Autoimmune Inflammatory arthritides such as ankylosing spondylitis, psoriatic arthritis, rheumatoid arthritis and systemic lupus erythematosus can all cause varying levels of joint destruction. Among the inflammatory arthritides, ankylosing spondylitis is most closely associated with back pain because of the inflammatory destruction of the bony components of the spine. Ankylosing spondylitis is common in young men and presents with a range of possible symptoms such as uveitis, psoriasis and inflammatory bowel disease. Referred pain Back pain can also be referred from another source. Referred pain occurs when pain is felt at a location different than the source of the pain. Disease processes that can present with back pain include pancreatitis, kidney stones, severe urinary tract infections and abdominal aortic aneurysms. Risk factors Heavy lifting, obesity, sedentary lifestyle and lack of exercise can increase the risk of back pain. Cigarette smokers are more likely to experience back pain than are nonsmokers. Poor posture and weight gain in pregnancy are also risk factors for back pain. In general, fatigue can worsen pain.A few studies suggest that psychosocial factors such as work-related stress and dysfunctional family relationships may correlate more closely with back pain than do structural abnormalities revealed in X-rays and other medical imaging scans. While back pain physical effects can range from muscle aching to a shooting, burning, or stabbing sensation. It can radiate pain down the legs and have pain increased by bending, twisting, lifting, standing, or walking. While the physical effects of back pain are always at the forefront back pain also has other psychological effects. Back Pain has been linked to depression, anxiety, stress, and avoidance behaviors due to mentally not being able to cope with the physical pain. “Both acute and chronic back pain can be associated with psychological distress in the form of anxiety (worries, stress) or depression (sadness, discouragement). Psychological distress is a common reaction to the suffering aspects of acute back pain, even when symptoms are short-term and not medically serious [35]’( (IASP, 2021) Diagnosis Initial assessment of back pain consists of a history and physical examination. Important characterizing features of back pain include location, duration, severity, history of prior back pain and possible trauma. Other important components of the patient history include age, physical trauma, prior history of cancer, fever, weight loss, urinary incontinence, progressive weakness or expanding sensory changes, which can indicate a medically urgent condition.Physical examination of the back should assess for posture and deformities. Pain elicited by palpating certain structures may be helpful in localizing the affected area. A neurologic exam is needed to assess for changes in gait, sensation and motor function. Determining if there are radicular symptoms, such as pain, numbness or weakness that radiate down limbs, is important for differentiating between central and peripheral causes of back pain. The straight leg test is a maneuver used to determine the presence of lumbosacral radiculopathy, which occurs when there is irritation in the nerve root that causes neurologic symptoms such as numbness and tingling. Non-radicular back pain is most commonly caused by injury to the spinal muscles or ligaments, degenerative spinal disease or a herniated disc. Disc herniation and foraminal stenosis are the most common causes of radiculopathy.Imaging of the spine and laboratory tests is not recommended during the acute phase. This assumes that there is no reason to expect that the patient has an underlying problem. In most cases, the pain subsides naturally after several weeks. People who seek diagnosis through imaging are typically less likely to receive a better outcome than are those who wait for the condition to resolve. Imaging Magnetic resonance imaging (MRI) is the preferred modality for the evaluation of back pain and visualization of bone, soft tissue, nerves and ligaments. X-rays are a less costly initial option offered to patients with a low clinical suspicion of infection or malignancy, and they are combined with laboratory studies for interpretation. Imaging is not needed for the majority of patients with back pain. In cases of acute back pain, MRI is recommended for those with major risk factors or clinical suspicion of cancer, spinal infection or severe progressive neurological deficits. For patients with subacute to chronic back pain, MRI is recommended if minor risk factors exist for cancer, ankylosing spondylitis or vertebral compression fracture, or if significant trauma or symptomatic spinal stenosis is present.Early imaging studies during the acute phase do not improve care or prognosis. Imaging findings are not correlated with severity or outcome. Laboratory studies Laboratory studies are employed when there are suspicions of autoimmune causes, infection or malignancy. Laboratory testing may include white blood cell (WBC) count, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). Elevated ESR could indicate infection, malignancy, chronic disease, inflammation, trauma or tissue ischemia. Elevated CRP levels are associated with infection. Red flags Imaging is not typically needed in the initial diagnosis or treatment of back pain. However, if there are certain "red flag" symptoms present, plain radiographs (X-ray), CT scan or magnetic resonance imaging may be recommended. These red flags include: History of cancer Unexplained weight loss Immunosuppression Urinary infection Intravenous drug use Prolonged use of corticosteroids Back pain not improved with conservative management History of significant trauma Minor fall or heavy lift in a potentially osteoporotic or elderly individual Acute onset of urinary retention, overflow incontinence, loss of anal sphincter tone, or fecal incontinence Saddle anesthesia Global or progressive motor weakness in the lower limbs Prevention Moderate-quality evidence exists that suggests that the combination of education and exercise may reduce an individuals risk of developing an episode of low back pain. Lesser-quality evidence points to exercise alone as a possible deterrent to the risk of the condition. Management Nonspecific pain Patients with uncomplicated back pain should be encouraged to remain active and to return to normal activities. The management goals when treating back pain are to achieve maximal reduction in pain intensity as rapidly as possible, to restore the individuals ability to function in everyday activities, to help the patient cope with residual pain, to assess for side effects of therapy and to facilitate the patients passage through the legal and socioeconomic impediments to recovery. For many, the goal is to keep the pain at a manageable level to progress with rehabilitation, which then can lead to long-term pain relief. Also, for some people the goal is to use nonsurgical therapies to manage the pain and avoid major surgery, while for others surgery may represent the quickest path to pain relief.Not all treatments work for all conditions or for all individuals with the same condition, and many must try several treatment options to determine what works best for them. The present stage of the condition (acute or chronic) is also a determining factor in the choice of treatment. Only a minority of people with back pain (most estimates are 1–10%) require surgery. Nonmedical Back pain is generally first treated with nonpharmacological therapy, as it typically resolves without the use of medication. Superficial heat and massage, acupuncture and spinal manipulation therapy may be recommended. Heat therapy is useful for back spasms or other conditions. A review concluded that heat therapy can reduce symptoms of acute and subacute low-back pain. Regular activity and gentle stretching exercises is encouraged in uncomplicated back pain and is associated with better long-term outcomes. Physical therapy to strengthen the muscles in the abdomen and around the spine may also be recommended. These exercises are associated with better patient satisfaction, although they have not been shown to provide functional improvement. However, one review found that exercise is effective for chronic back pain but not for acute pain. Exercise should be performed under the supervision of a healthcare professional. Massage therapy may provide short-term pain relief, but not functional improvement, for those with acute lower back pain. It may also offer short-term pain relief and functional improvement for those with long-term (chronic) and subacute lower pack pain, but this benefit does not appear to be sustained after six months of treatment. There do not appear to be any serious adverse effects associated with massage. Acupuncture may provide some relief for back pain. However, further research with stronger evidence is needed. Spinal manipulation appears similar to other recommended treatments. "Back school" is an intervention that consists of both education and physical exercises. There is no strong evidence supporting the use of back school for treating acute, subacute, or chronic non-specific back pain. Insoles appear to be an ineffective treatment intervention. While traction for back pain is often used in combination with other approaches, there appears to be little or no impact on pain intensity, functional status, global improvement or return to work. Medication If nonpharmacological measures are ineffective, medication may be administered. Non-steroidal anti-inflammatory drugs (NSAIDs) are typically attempted first. NSAIDs have been proven more effective than placebo, and are usually more effective than paracetamol (acetaminophen). Long-term use of opioids has not been tested to determine whether it is effective or safe for treating chronic lower back pain. For severe back pain not relieved by NSAIDs or acetaminophen, opioids may be used. Opioids may not be better than NSAIDs or antidepressants for chronic back pain with regard to pain relief and gain of function. Skeletal muscle relaxers may also be used. Their short-term use has been proven effective in the relief of acute back pain. However, the evidence of this effect has been disputed, and these medications do have negative side effects. For patients with nerve root pain and acute radiculopathy, there is evidence that a single dose of steroids, such as dexamethasone, may provide pain relief. Epidural corticosteroid injection (ESI) is a procedure in which steroid medications are injected into the epidural space. The steroid medications reduce inflammation and thus decrease pain and improve function. ESI has long been used to both diagnose and treat back pain, although recent studies have shown a lack of efficacy in treating low back pain. Surgery Surgery for back pain is typically used as a last resort, when serious neurological deficit is evident. A 2009 systematic review of back surgery studies found that, for certain diagnoses, surgery is moderately better than other common treatments, but the benefits of surgery often decline in the long term.Surgery may sometimes be appropriate for people with severe myelopathy or cauda equina syndrome. Causes of neurological deficits can include spinal disc herniation, spinal stenosis, degenerative disc disease, tumor, infection, and spinal hematomas, all of which can impinge on the nerve roots around the spinal cord. There are multiple surgical options to treat back pain, and these options vary depending on the cause of the pain. When a herniated disc is compressing the nerve roots, hemi- or partial- laminectomy or discectomy may be performed, in which the material compressing on the nerve is removed. A mutli-level laminectomy can be done to widen the spinal canal in the case of spinal stenosis. A foraminotomy or foraminectomy may also be necessary, if the vertebrae are causing significant nerve root compression. A discectomy is performed when the intervertebral disc has herniated or torn. It involves removing the protruding disc, either a portion of it or all of it, that is placing pressure on the nerve root. Total disc replacement can also be performed, in which the source of the pain (the damaged disc) is removed and replaced, while maintaining spinal mobility. When an entire disc is removed (as in discectomy), or when the vertebrae are unstable, spinal fusion surgery may be performed. Spinal fusion is a procedure in which bone grafts and metal hardware is used to fix together two or more vertebrae, thus preventing the bones of the spinal column from compressing on the spinal cord or nerve roots.If infection, such as a spinal epidural abscess, is the source of the back pain, surgery may be indicated when a trial of antibiotics is ineffective. Surgical evacuation of spinal hematoma can also be attempted, if the blood products fail to break down on their own. Pregnancy About 50% of women experience low back pain during pregnancy. Some studies have suggested that women who have experienced back pain before pregnancy are at a higher risk of experiencing back pain during pregnancy. It may be severe enough to cause significant pain and disability in as many as one third of pregnant women. Back pain typically begins at approximately 18 weeks of gestation and peaks between 24 and 36 weeks. Approximately 16% of women who experience back pain during pregnancy report continued back pain years after pregnancy, indicating that those with significant back pain are at greater risk of back pain following pregnancy.Biomechanical factors of pregnancy shown to be associated with back pain include increased curvature of the lower back, or lumbar lordosis, to support the added weight on the abdomen. Also, the hormone relaxin is released during pregnancy, which softens the structural tissues in the pelvis and lower back to prepare for vaginal delivery. This softening and increased flexibility of the ligaments and joints in the lower back can result in pain. Back pain in pregnancy is often accompanied by radicular symptoms, suggested to be caused by the baby pressing on the sacral plexus and lumbar plexus in the pelvis.Typical factors aggravating the back pain of pregnancy include standing, sitting, forward bending, lifting and walking

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What is 20 permanent teeth and 8 temporary teeth are seen at the age of : and explain in detail?

A i.e. 10 years

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What is True about gene library -a) Also known as chromosomeb) Library that contains books on genec) Computer base with all gene knowledged) DNA nucleotide or fragmente) Complete collection of gene copies of one organism and explain in detail?

Gene library is a collection of cloned DNA fragments. In the genomic library entire genome of an organism is subjected to a restriction enzyme. Each & every fragment is cloned with a suitable vector.

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What is Acrodermatitis enteropathica is due to deficiency of and explain in detail?

None

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What is Bright red color on postmortem staining found in - and explain in detail?

In cyanide (HCN) poisoning, postmortem staining is pink or bright red.

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What is Inspiratory stridor is found in what kind of lesions: and explain in detail?

Answer A. SupraglotticGenerally, an inspiratory stridor suggests airway obstruction above the glottis.While an expiratory stridor is indicative of obstruction in the lower trachea.A biphasic stridor suggests a glottic or subglottic lesion.

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What is Inspiratory stridor is obstructive lesions of: and explain in detail?

STRIDOR 1. Inspiratory stridor - obstructive lesion of supraglottis of pharynx. 2. Expiratory stridor - lesion of thoracic trachea, primary and secondary bronchi 3. Biphasic stridor - lesion of glottis sub glottis and cervical trachea

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What is Schedule of intradermal rabies vaccine is? and explain in detail?

In 8 site intradermal method human diploid vaccine is given intradermally .on day 0 -0.1ml given at 8sites,on day 7-0.1 ml at each of 4 sites.on days 28 and 90-0.1 ml is given at one site.Ref.PARK'S TEXTBOOK OF PREVENTIVE AND SOCIAL MEDICINE 21st edition page no 256

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What is Arteritic anterior ischemic optic neuropathy and explain in detail?

Arteritic anterior ischemic optic neuropathy (AAION or arteritic AION) is the cause of vision loss that occurs in temporal arteritis (aka giant-cell arteritis). Temporal arteritis is an inflammatory disease of medium-sized blood vessels that happens especially with advancing age. AAION occurs in about 15-20 percent of patients with temporal arteritis. Damage to the blood vessels supplying the optic nerves leads to insufficient blood supply (ischemia) to the nerve and subsequent optic nerve fiber death. Most cases of AAION result in nearly complete vision loss first to one eye. If the temporal arteritis is left untreated, the fellow eye will likely suffer vision loss as well within 1–2 weeks. Arteritic AION falls under the general category of anterior ischemic optic neuropathy, which also includes non-arteritic AION. AION is considered an eye emergency, immediate treatment is essential to rescue remaining vision. An exhaustive review article published in March 2009 described the latest information on arteritic and non-arteritic ischemic optic neuropathy, both anterior (A-AION and NA-AION) and posterior (A-PION, NA-PION, and surgical). Symptoms There are several constitutional symptoms of temporal arteritis that may aid in diagnosis of AAION such as jaw claudication (spasms of the jaw muscle), scalp tenderness, unintentional weight loss, fatigue, myalgias and loss of appetite

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What is A 3-year-old boy has had progressive developmental delay, ataxia, seizures, and inappropriate laughter since infancy. The child has a normal karyotype of 46, XY, but DNA analysis shows that he has inherited both of his number 15 chromosomes from his father. These findings are most likely to be indicative of which of the following genetic mechanisms? and explain in detail?

This child has features of Angelman syndrome, and the DNA analysis shows uniparental disomy. The Angelman gene encoded on chromosome 15 is subject to genomic imprinting. It is silenced on the paternal chromosome 15, but is active on the maternal chromosome 15. If the child lacks maternal chromosome 15, there is no active Angelman gene in the somatic cells. This gives rise to the abnormalities typical of this disorder. The same effect occurs when there is a deletion of the Angelman gene from the maternal chromosome 15. The other listed options do not occur in uniparental disomy.

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What is Sensorimotor neuropathy may be caused by all, except: and explain in detail?

Answer is B (Lead poisoning): Inorganic lead poisoning is not associated with a sensorimotor neuropathy Inorganic lead poisoning is primarily associated with a pure motor neuropathy. Selective motor neuropathy with wrist drop is characteristic of lead poisoning. Conditions that may cause Sensorimotor Neuropathies Polyneuropathy associated with Sensorimotor neuropathies (Harrison) Systemic Disease Diabetes mellitus Sensory, Sensorimotor, Motor Uremia Sensorimotor Porphyria (3 types) Sensorimotor Vitamin deficiency excluding B12 Sensorimotor Chronic liver disease Sensory or Sensorimotor Primary systemic amyloidosis Sensorimotor Chronic obstructive lung disease Sensory or Sensorimotor Malabsorption (sprue, celiac disease) Sensory or Sensorimotor Carcinoma (sensorimotor) Sensorimotor Carcinoma (demyelinating) Sensorimotor Multiple Myeloma, lytic type Sensory, Motor or Sensorimotor MGUS IgA Sensori motor IgG Sensorimotor 1gM Sensorimotor or Sensory Cryoglobulinemia Sensorimotor Drugs Amiodarone (antiarrhythmic) Sensorimotor Aurothioglucose (antirheumatic) Sensorimotor Isoniazid Sensorimotor Metronidazole (antiprotozoal) Sensory or Sensorimotor Misonidazolc (radioscnsitizer) Sensory or Sensorimotor Environmental Toxins Arsenic (herbicide; insecticide) Sensorimotor Diptheria toxin Sensorimotor y-Diketone hexacarbons (solvents) Sensorimotor Organophosphates Sensorimotor Thallium (rat poison) Sensorimotor

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What is Patient with recurrent aboion diagnosed to have antiphospholipid syndrome. What will be the treatment? and explain in detail?

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What is The other name for reverse transcriptase is : and explain in detail?

None

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What is A child transfers objects from one hand to other. What does it imply? and explain in detail?

GROSS MOTOR MILESTONE DEVELOPMENTAL IMPLICATION Holds head steady while sitting Allows more visual interaction Sits without suppo Increasing exploration Walks alone Exploration, controls proximity to parents FINE MOTOR MILESTONE DEVELOPMENTAL IMPLICATION Hand regard Self discovery of hands Reaches for objects Visuomotor coordination Palmar grasp gone Voluntary release Transfers object hand to hand Comparison of others Thumb -finger grasp Able to explore small objects Scribbles Visuomotor coordination Builds tower of 2 cubes Uses objects in combination SOCIAL MILESTONE DEVELOPMENTAL IMPLICATION Social smile More active social paicipation Follows 1 step command with gestures Non -verbal communication Points to objects Interactive communication Uncovers toy(after seeing it hidden) object permanence Pretends to drink from cup Symbolic thought Uses stick to reach toy Links actions to solve problems LANGUAGE MILESTONE DEVELOPMENTAL IMPLICATION Monosyllabic babble Experimentation with sound 1-step command without gesture Verbal receptive language Says "mama "or "dada" Expressive language Speaks first real world Beginning of labelling Speaks 4-6 words Acquisition of object and personal names Speaks 2-word sentences Beginning grammatization

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What is Which of the following anti-Parkinson drugs has the potential to cause retro peritoneal fibrosis: and explain in detail?

None

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What is In 2 years old child gallows traction is applied. Child is suffering from fracture OHMS 'Vov 201? if and explain in detail?

Ans. c. Fracture shaft of femur Russel's traction or Thomas splint is used for fracture shaft femur in older children. Gallow's Traction Gallow's traction is used for treatment of fracture shaft of femur, in infants and children <2 years of ageQ. Weight must not be >12 kgs Both the fractured and the normal femur are placed in skin traction and infant is suspended by these from a special frame. The buttocks should be lifted just off the bed so that the weight of the body provides counter traction and the fracture is reduced.

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What is Sling Psychrometer is used to measure- and explain in detail?

Ans. is 'd' i.e., Humidity Instruments MeasureSling psychrometer} Assmann psychrometerHumidityDry & wet bulb hygrometer Kata thermameter-Cooling power and air velocityGlobe thermameter-Radiant tempratureAnemometer-Air velocityWind vane-Wind (air) directionSound level meter-Intensity of soundBond frequency analyzer-Characteristic (pitch) of sound

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What is HLA* 1502 is a genetic marker of and explain in detail?

The HLA allele B*1502 as a marker for carbamazepine-induced Stevens-Johnson syndrome and toxic epidermal necrolysis .This allele is seen in high frequency in many Asian populations other than Han Chinese, but there are few data on whether the allele is a marker for this severe outcome in anyone other than Han Chinese. In fact, the association has not been found in Caucasian patients. Carbamazepine is an impoant treatment for seizure disorders, bipolar disorder, trigeminal neuralgia and chronic pain. However, carbamazepine is also associated with hypersensitivity reactions that range from benign uicaria to life-threatening cutaneous disorders, including Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) . Ref - harrison's internal medicine 20e p368

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What is In the presence of a drug that blocks all effects of norepinephrine and epinephrine on the heart, the autonomic nervous system can: and explain in detail?

Ans. B. Lower the heart rate below its intrinsic rateActivation of parasympathetic nerves to the heart would lower the heart rate below its intrinsic rate. However, with all effects of norepinephrine and epinephrine blocked, the sympathetic nervous system cannot raise the heart rate above its intrinsic rate. The withdrawal of parasympathetic nerve tone could only raise the heart rate to the intrinsic rate.

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What is What would be the race of individual if skull bone having following feature rounded nasal opening, horseshoe shaped palette. Round orbit & cephalic index above 80: and explain in detail?

B i.e. Mongols

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What is Amino acid required for formation of thyroxine and explain in detail?

Metabolic role of Tyrosine * Synthesis of thyroid hormones: Thyroxine (T4) and triiodothyronine (T3) * Synthesis of catecholamines * Synthesis of melanin pigment * Formation of tyramine * Formation of phenol and cresol * Formation of tyrosine-O-sulphateRef: Textbook of medical biochemistry, MN Chatterji, 8th edition, page no: 497

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What is All of the following skin infections are caused by S aureus, EXCEPT: and explain in detail?

Erysipelas is caused almost exclusively by Streptococcus pyogenes. It is characterized by abrupt onset of fiery red, swelling of face or extremities. It has well defined margins along the nasolabial fold, and has rapid progression with intense pain. It usually affects the face and legs. Bacterial infections and associated organisms: Infection Organism Folliculitis S. aureus, Pseudomonas aeruginosa Furuncle/Carbuncle S. aureus Abscess Polymicrobial , S. aureus in one quaer Erysipelas Streptococcus pyogenes Cellulitis S. aureus, Streptococcus pyogenes Ecthyma S. aureus, Streptococcus pyogenes Impetigo S. aureus, Streptococcus pyogenes Ref: Skin Infections: Diagnosis and Treatment edited by John C. Hall page 19.

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What is The best treatment for fracture neck femur is a 65-year-old lady is - and explain in detail?

Here, closed reduction and internal fixation have not been provided as an option. So, the best option is semi-replacement arthroplasty.

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What is A protaper F2 series Gutta Percha when cut 1 mm in apical position of canal. The preparation as per in apical region is? and explain in detail?

None

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What is Congenital toxoplasmosis, all are true, except and explain in detail?

Congenital toxoplasmosis is a disease that occurs in fetuses infected with Toxoplasma gondii, a protozoan parasite, which is transmitted from mother to fetus.  It can cause miscarriage or stillbirth.  It can also cause serious and progressive visual, hearing, motor, cognitive, and other problems in a child.  Most infected infants appear healthy at birth. They often do not develop symptoms until months, years, or even decades later in life. Infants with severe congenital toxoplasmosis usually have symptoms at birth or develop symptoms within the first six months of life. Symptoms may include: Premature birth — as many as half of infants with congenital toxoplasmosis are born prematurely, abnormally low birth weight, eye damage, jaundice, yellowing of the skin and whites of the eyes, diarrhea, vomiting, anemia, difficulty feeding, swollen lymph nodes, enlarged liver and spleen, macrocephaly, an abnormally large head, microcephaly, an abnormally small head, skin rash, vision problems, hearing loss, motor and developmental delays, hydrocephalus, a buildup of fluid in the skull, intracranial calcifications, evidence of areas of damage to the brain caused by the parasites, seizures, mild to severe mental retardation. Ref : https://www.healthline.com/health/congenital-toxoplasmosis#risks

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What is The inhibitory neurotransmitter in CNS neurons is and explain in detail?

GABA and Glycine are the chief inhibitory neurotransmitters in CNS.

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What is Right bundle branch block and explain in detail?

A right bundle branch block (RBBB) is a heart block in the right bundle branch of the electrical conduction system.During a right bundle branch block, the right ventricle is not directly activated by impulses travelling through the right bundle branch. The left ventricle, however, is still normally activated by the left bundle branch. These impulses are then able to travel through the myocardium of the left ventricle to the right ventricle and depolarize the right ventricle this way. As conduction through the myocardium is slower than conduction through the Bundle of His-Purkinje fibres, the QRS complex is seen to be widened. The QRS complex often shows an extra deflection that reflects the rapid depolarisation of the left ventricle followed by the slower depolarisation of the right ventricle. Incomplete right bundle branch block Incomplete right bundle branch block (IRBBB) is an conduction abnormality in the right bundle branch block. While a complete RBBB has a QRS duration of 120 ms or more, an incomplete block has a wave duration between 110 and 120 ms

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What is A 3 week old child presented to the pediatrician with meningitis. A presumptive diagnosis of late onset of a perinatal infection was made. The CSF culture was positive for gram positive bacilli. Which of the following characteristic of this bacteria would be helpful in differentiating it from other bacteria agents? and explain in detail?

(D) Motility at 25degC # Common causes of Meningits according to age are;> First 2 months of life: Group B and D streptococci (Streptococcus agalactiae) Gram negative enteric bacilli (Escherichia coli) Listeria monocytogenes H. influenzae (type b & non-encapsulated strain) - Rare> 2 months to 12 years of age: S. pneumoniae N. meningitidis H. influenzae type b> Subsequent to the implementation of universal immunization against the H. influenzae (beginning at 2 months of age), the incidence of H. influenzae dropped precipitously.> Meningitis (2 months -12 years) now is most commonly caused by S. pneumoniae & N. meningitidis.> T-lymphocyte defect (congenital or acquired by chemotherapy, AIDS or malignancy): t risk of L. monocytogenes infection.> Peak incidence of H. influenzae type B: 6-9 months of age.> Possible diagnosis in this 3 week old child.> Streptococci (Ruled out cause CSF shows gram positive bacilli).> E. coli - (Ruled out gram Negative)

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What is A child develops non-blanching macules and papules on lower extremities, mild abdominal pain and skin biopsy showed IgA deposition. Most appropriate diagnosis is: and explain in detail?

b. Henoch Schonlein purpura(Ref: Nelson's 20/e p 1612, Ghai 8/e p 632)Classification criteria for H.S. purpura according to Pediatric Rheumatology European Society:Palpable purpura (in absence of coagulopathy or thrombocytopenia) and 1 or more of the following criteria:Diffuse abdominal painArthritis or arthralgiaBiopsy of affected tissue demonstrating predominant IgA depositionRenal involvement (proteinuria, hematuria or red cell casts)Hence, it is a typical case presentation of Henoch-Schonlein purpura.

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What is A lady who is 9 weeks pregnant comes with a 2.5 cm mass in the upper outer quadrant of left breast. Ultrasound failed to show any abnormality. The ideal management will be to: and explain in detail?

Ans. b. Finger guided core biopsy (Ref: Schwartz 9/467; Sabiston19/2035-2037; Bailey 26/818, 25/846)Most breast lesions in pregnancy are benign but biopsy should be done to rule out malignancy. Core-needle biopsy with or without ultrasound guidance is a safe and reliable method for obtaining tissue."Fewer than 25% of the breast nodules developing during pregnancy and lactation will be cancerous. Ultrasonography and needle biopsy are used in the diagnosis of these nodules. Open biopsy may be required. Mammography is rarely indicated because of its decreased sensitivity during pregnancy and lactation; however, the fetus can be shielded if mammography is needed. --Schwartz 9/467"Because of the changes in the breast tissue with pregnancy, imaging modalities may be difficult to interpret. If used with appropriate shielding, mammography carries a limited risk to the fetus. Mammography has a high false-negative rate due to the increased density of the fibroglandular breast tissue, however.: so it has limited usefulness in the evaluation of the pregnant patient. Ultrasonography can safely be performed as an initial evaluation or in conjunction with mammography. Ultrasound is able to distinguish solid from cystic lesions in 97% of patients and is helpful in guiding fine-needle aspiration or biopsy Although MRI does not use ionizing radiation, the two main risks to the fetus from the magnetic field and electromagnetic radiation are heating and cavitation. With other reliable imaging modalities available, MRI is not currently recommended for breast imaging in the pregnant patient. Tissue diagnosis is essential.Core-needle biopsy with or without ultrasound guidance is a safe and reliable method for obtaining tissue. Fine-needle aspiration may be a reliable alternative to core-needle or open biopsy. "--Sabiston 19/2035Breast Career during PregnancyOccurs in 1 of every 3000Q pregnant womenMC non-gynecologic malignancy associated with pregnancyQ.Ductal carcinoma is MC type, accounting for 75-90%Q of breast cancer in pregnancy.Clinical Features:Presents as painless palpable massQ with or without nipple discharge Axillary LN metastases in upto 75% patientsApprox. <25% nodules developing during pregnancy and lactation will he cancerousQPresent at a later stage of disease because breast changes occurring in hormone-rich environment of pregnancy obscure early cancer.Diagnosis:USG and needle biopsyQ are used for diagnosisMammography is rarely indicated due to its decreased sensitivity during pregnancy & lactationTreatment: Mainstay of therapy is surgical resection.Stage I & IIMastectomy with axillary dissectionQLABCNACT after 1st trimester + MRM in 2nd trimester + RT after deliveryQLABC in PregnancyMRM can be performed during first and second trimester (increased risk of spontaneous abortion after first-trimester anesthesia), chemotherapy after first trimester & radiotherapy after delivery.Chemotherapy during first trimester carries a risk of spontaneous abortion & 12% risk of birth defects, given after first trimester.No evidence of teratogenecity by chemotherapy during second and third trimester.Breast cancer in pregnancy have prognosis stage by stage similar to that of non-pregnant patientElective termination of pregnancy to receive appropriate therapy without the risk for fetal malformation is no longer routinely recommended because no improvement in survival has been demonstrated.=

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What is In burnt bones, the following can be detected : and explain in detail?

A i.e. Arsenic

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What is Methylene blue reduction test is done for estimating - and explain in detail?

<p> Methylene blue reduction test:- Indirect method of detecting microorganisms in milk. The test is carried out on the milk accepted for pasteurization. It is based on the observation that bacteria growing in milk bring about a decrease in colour impaed to the milk. In conducting the tests definite quantities of methylene blue are added to 10 ml of milk and the sample is held at a uniform temperature of 37 deg C until the blue colour has disappeared. The milk which remains blue the longest is considered to be the best quality milk. The test thus serves as s confirmation of heavy contamination and compared with direct counts of bacteria, it saves time and money. {Reference: Park&;s textbook of community medicine 23 rd edition. Pg no. 655}

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What is Investigation of choice for screening of proximal internal carotid aery stenosis is : and explain in detail?

Answer is A (Doppler flow USG): 'Stenosis at the origin of the internal carotid Aery can be identified and quantified reliably by ultrasonography that combines B mode ultrasound image with a Doppler ultrasound assessment of flow velocity.'

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What is The drug used to treat acyclovir resistant Herpes Simplex Virus (HSV) and Varicella Zoster Virus (VZV) infection is : and explain in detail?

None

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What is Alcoholism leads to deficiency of which vitamin ? and explain in detail?

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What is Obesity Index defined as Height (cm) - 100 and explain in detail?

None

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What is Aery forming anastomosis around the surgical neck of humerus is a branch of:- and explain in detail?

Aeries forming anastomosis around the surgical neck of humerus are anterior circumflex humeral aeries posterior circumflex humeral aeries Both are branches of 3rd pa of axillary aery.

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What is The earliest immunoglobulin to be synthesized by the fetus is - and explain in detail?

Option 1, 3, 4 IgM: IgM is the first immunoglobulin to be synthesized by a neonate in about 20 weeks of age. IgM is not transpoed across the placenta; hence, the presence of IgM in the fetus or newborn indicates intrauterine infection. The first immunoglobulin produced in response to an antigen is IgM. after 3 monts of bih class switching is staed and then other class of immunoglobulins are synthesised. IgM is secreted as a pentamer and is composed of five H2L2 units (similar to one IgG unit) and one moleculeof a J chain.. It is the most efficient Because its interaction with antigen can involve all 10 binding sites, it has the highest binding capacity and cross-linking of all the immunoglobulins. Option 2 IgG is the only immunoglobulin class to cross the placenta and therefore is the most abundant immunoglobulinin newborns.( this is not the the first to be synthesised in newborn)

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What is 62-year-old woman has postmenopausal bleeding after 13 years of menopause. She has hypeension and type 2 diabetes mellitus. An endometrial biopsy is performed that shows grade I endometrial adenocarcinoma. Which of the following is the most appropriate next step in management? and explain in detail?

The patient has been diagnosed endometrial adenocarcinoma on biopsy The next step is to perform a staging laparotomy which involves the following Total abdominal hysterctomy + bilateral salpingo-oophorectomy Peritoneal cytology Omentectomy + appendicectomy + peritoneal biopsy: for non endometroid cancer Selective pelvic and para aoic lymphadenectomy

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What is Paget's disease of nipple is stained positive for: and explain in detail?

Paget's disease may be confused with superficial spreading melanoma. Differentiation from pagetoid intraepithelial melanoma is based on the presence of S-100 antigen immunostaining in melanoma and carcinoembryonic antigen immunostaining in Paget's disease. Surgical therapy for Paget's disease may involve lumpectomy, mastectomy, or modified radical mastectomy, depending on the extent of involvement and the presence of invasive cancer. Ref: Schwaz's principle of surgery 9th edition, chapter 17.

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What is Protein daily requirement is: and explain in detail?

Ans. (a) lgm/kgRef: K. Park 21sted. 1563* According to Indian medical council recommendation the daily protein requirement is lgm/kg body weight.* Assessment of protein nutritional status is done by: arm muscle circumference, the creatinine-height index, serum albumin and transferrin, total body nitrogen etc.* BEST MEASURE of the state of protein nutrition is: SERUM ALBUMIN CONCENTRATION (should be more than 3.5gm/dl)

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What is All are true regarding Plummer Vinson syndrome, EXCEPT: and explain in detail?

Ans. is 'd' Common in elderly male Plummer Vinson (Paterson Kelly) syndrome is seen in middle aged women*.Syndrome consists ofIron deficiency anemia*Oesophageal web* (Upper esophagus*)Koilonychia* (Spoon shaped nails)Glossitis*Plummer vinson syndrome is a pre-malignant condition for esophageal carcinoma.

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What is Development of national blindness control program is assisted by and explain in detail?

DANIDA (Danish international development agency) is providing assistance for the development of services under National Blindness Control Programme.Park 23e pg: 924

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What is Betamethasone and explain in detail?

Betamethasone is a steroid medication. It is used for a number of diseases including rheumatic disorders such as rheumatoid arthritis and systemic lupus erythematosus, skin diseases such as dermatitis and psoriasis, allergic conditions such as asthma and angioedema, preterm labor to speed the development of the babys lungs, Crohns disease, cancers such as leukemia, and along with fludrocortisone for adrenocortical insufficiency, among others. It can be taken by mouth, injected into a muscle, or applied to the skin topically in cream, lotion, or liquid forms.Serious side effects include an increased risk of infection, muscle weakness, severe allergic reactions, and psychosis. Long-term use may cause adrenal insufficiency. Stopping the medication suddenly following long-term use may be dangerous. The cream commonly results in increased hair growth and skin irritation. Betamethasone belongs to the glucocorticoid class of medication. It is a stereoisomer of dexamethasone, the two compounds differing only in the spatial configuration of the methyl group at position 16 (see steroid nomenclature).Betamethasone was patented in 1958, and approved for medical use in the United States in 1961. The cream and ointment are on the World Health Organizations List of Essential Medicines. It is available as a generic medication. In the United States, the pills and injectable solutions are more expensive than the cream. Medical uses Betamethasone is a corticosteroid that is available as a pill, by injection, and as an ointment, cream, lotion, gel, or aerosol (spray) for the skin, and a foam for the scalp. When given by injection, anti-inflammatory effects begin in around two hours and last for seven days.It is used as a topical cream to relieve skin irritation, such as itching and flaking from eczema. It is used as a treatment for local psoriasis, as betamethasone dipropionate and salicylic acid, or as the combination calcipotriol/betamethasone dipropionate. Betamethasone sodium phosphate is used orally and via injection with the same indications as other steroids. Many betamethasone-based pharmaceuticals include the steroid as the valerate ester. In a randomized controlled trial betamethasone was shown to reduce some of the ataxia (poor coordination) symptoms associated with ataxia telangiectasia (A-T) by 28-31%.Betamethasone is also used to stimulate fetal lung maturation in order to prevent infant respiratory distress syndrome (IRDS) and to decrease the incidence and mortality from intracranial hemorrhage in premature infants. A cream with 0.05% betamethasone appears effective in treating phimosis in boys, and often averts the need for circumcision. It has replaced circumcision as the preferred treatment method for some physicians in the British National Health Service. Side effects Euphoria Depression Adrenal suppression Hypertension Groupings of fine blood vessels becoming prominent under the skin, petechiae Excessive hair growth (hypertrichosis) EcchymosesProlonged use of this medicine on extensive areas of skin, broken or raw skin, skin folds, or underneath airtight dressings may on rare occasions result in enough corticosteroid being absorbed to have side effects on other parts of the body; for example, by causing a decrease in the production of natural hormones by the adrenal glands. Betamethasone is also used prior to delivery of a preterm baby to help prepare the lungs for breathing. However, because betamethasone crosses the placenta, which is required for its beneficial effects, it may also be associated with complications, such as hypoglycemia and leukocytosis in newborns exposed in utero. When injected into the epidural space or the spine, it may cause serious side effects like loss of vision, stroke, and paralysis. Forms Betamethasone is available in a number of compound forms: betamethasone dipropionate (branded as Diprosone, Diprolene, Celestamine, Procort (in Pakistan), and others), betamethasone sodium phosphate (branded as Bentelan in Italy) and betamethasone valerate (branded as Audavate, Betnovate, Celestone, Fucibet, and others). In the United States and Canada, betamethasone is mixed with clotrimazole and sold as Lotrisone and Lotriderm. It is also available in combination with salicylic acid (branded as Diprosalic) for using in psoriatic skin conditions

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What is Which of the following is not a bizarre delusion? and explain in detail?

Ans. C. My wife is definitely having affair with a colleagueDSM treats the presence of bizarre delusions (BD) as the heaviest-weighted clinical criterion of schizophrenia and define bizarre delusion as "clearly implausible and not understandable and not derived from ordinary life experiences".

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What is Annual blood smear examination rate is an indicator of- and explain in detail?

None

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What is An unconscious 50 year old known case of diabetes mellitus is brought to the ER. His medical records show he is on warfarin for atrial fibrillation. Which of the following investigations will not be done in this patient for work up? and explain in detail?

Option A- Always C/I in bleeding diathesis & in |ICT Option B- Known case of D.M so RBS should be done. Option C- Since he is unconscious may be d/t warfarin toxicity so CT scan is a probable investigation. Option D- patient on warfarin for atrial fibrillation so ECG monitoring is mandatory.

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What is Intracranial pressure is not raised during and explain in detail?

Ans. is 'a' i.e., Hyperventilation * Hyperventilation is used as a treatment with raised intracranial pressure.* Hyperventilation causes decreased PaCO2 which subsequently leads to arterial vasoconstriction thus lowering cerebral blood flow (CBF), cerebral blood volume, and intracranial pressure.Causes of ICTi) Intracranial mass (tumor)ii) Intracranial bleed (e.g. subdural hematoma, intraventricular or intracerebral)iii) Subarachnoid hemorrhage (aneurysm rupture)iv) Encephalitis/meningitsv) Head injuryvi) Status epilepticusvii) Strokeviii) Hydrocephalus

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What is Li-fraumani syndrome occurs due to mutation in gene? and explain in detail?

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What is Pitavastatin and explain in detail?

Pitavastatin (usually as a calcium salt) is a member of the blood cholesterol lowering medication class of statins.Like other statins, it is an inhibitor of HMG-CoA reductase, the enzyme that catalyses the first step of cholesterol synthesis. It was patented in 1987 and approved for medical use in 2003. It is available in Japan, South Korea and in India. In the US, it received FDA approval in 2009.Kowa Pharmaceuticals, a subsidiary of Kowa Company, is the owner of the American patent to pitavastatin. Medical uses Like the other statins, pitavastatin is indicated for hypercholesterolaemia (elevated cholesterol) and for the prevention of cardiovascular disease. A 2009 study of the 104-week LIVES trial found pitavastatin increased HDL cholesterol, especially in patients with HDL lower than 40 mg/dL, who had a 24.6% rise, in addition to greatly reducing LDL cholesterol 31.3%. HDL improved in patients who switched from other statins and rose over time. In the 70-month CIRCLE observational study, pitavastatin increased HDL more than atorvastatin.It has neutral or possibly beneficial effects on glucose control

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What is In pyloric stenosis, the following changes are seen: March 2011 and explain in detail?

Ans. A: Hypokalemic hyponatremic alkalosis The vomiting of hydrochloric acid results in hypochloraemic alkalosis but, initially sodium and potassium levels may be relatively normal, but later on bicarbonate is excreted along with sodium and so, with time, the patient becomes progressively hyponatremic and more profoundly dehydrated. Because of dehydration, a phase of sodium retention follows and potassium and hydrogen are excreted in preference. This results in the urine becoming paradoxically acidic and hypokalemia ensues