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Which of the following condition is necessary prerequisite for this change?

Ans. (C). Adequate liquor amniiThe photograph shows maceration, a sign of intrauterine death.Conditions favoring maceration: Intact membranes; adequate liquor amnii & NO air.

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Savita is 32 weeks pregnant presents in causality and diagnosed as a case of APH. Vitals are unstable with BP 80/60 which of the following is next step in M/n

Ans. is b i.e. Blood transfusion

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All are true about Cancer breast, except:

Ans. (d) Increased incidence with prolonged breast feeding* Paget's Disease is a superficial manifest of an underlying Intra ductal carcinoma breast

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Which of the following vitamin reduces the risk of insulin resistance, obesity, and the metabolic syndrome?

Higher Intakes of Vitamin D May Be Beneficial There is evidence that Vitamin D intake considerably higher than that required to maintain calcium homeostasis reduce the risk of insulin resistance, obesity, and the metabolic syndrome, as well as various cancers. There is growing evidence that higher vitamin D status is protective against various cancers, including prostate and colorectal cancer, and also against prediabetes and the metabolic syndrome. Desirable levels of intake may be considerably higher than current reference intakes, and ceainly could not be met from unfoified foods. While increased sunlight exposure would meet the need, it carries the risk of developing skin cancer. Reference: Harper; 30th edition; Page no: 552, 553

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The following drugs have significant drug interactions with digoxin except:

Ref:KDT 6/e p499 Cholestyramine inhibits itestinal absorption of digoxin. Thiazides result in hypokalemia and thus make precipitate digitalis toxicity by pharmacodynamic interaction. Quinidine and verampil reduces the exceion of digoxin and does make precipitate toxicity (pharmacokinetic interaction)

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Antiboiotic Prophylaxis for infective endocarditis is indicated in:

Answer is D (Coarctation of Aoa) Coarctation of Aoa is a high risk cardiac lesion fior the development of infective endocarditis and an indication fir antibiotic prophyloxis.

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Adder Head" appearance is found in:

VP

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Ortolani's test is done for

B. i.e. (Congenital dislocation of hip joints) (410 - Apley 8th)Important Tests**Ortolani's and Barlow's test Galeazzi test (604 CDT 4th)Congenital dislocation of hip joints** Apprehension testRecurrent dislocation of shoulder joints* Bryant's Call ways Hamilton ruler testHamilton ruler testAnterior dislocation of shoulder joints* **Pivot-shift testAnterior cruciate ligament* Lachman testAnterior cruciate ligament* Drawer testCruciate ligament (Ant & Post)* **Mc-Murray's testMeniscus injury* Appley's grinding testMeniscus injury* **Thomas testHip flexion deformity* ** Ankle joint has LEAST chances for recurrent dislocations

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A 50 year old female patient complains of difficulty in swallowing. Patient gives h/o multiple diagnostic CT-scans of the head and neck region. This patient may be predominantly susceptible to which of the following?

The incidence of thyroid carcinomas, predominantly papillary thyroid carcinomas, increases in humans after radiation exposure. There is strong dependence on age at exposure—susceptibility to radiation-induced thyroid cancer is higher in children than adults. There is little evidence for a dose response for individuals exposed during adulthood. Females are 2 to 3 times more susceptible than males to radiogenic and spontaneous thyroid cancers. Reference: White and Pharoah, Oral radiology, ed 8th, pg-92

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Which of the following may be seen in second degree Hea block (select three options):

Answer is A, B, and C Second degree AV block (Type I and /or Type II) may be associated with prolonged conduction time (prolonged PR interval), Atrial rate more than ventricular rate and change in QRS complex morphology (Tipe II). Name Rhythm Rate (beats/minute) P waves (lead II) PR Interval QRS complex First-degree atrio- ventricular (AV) block Regular That of underlying sinus rhythm; both atrial and ventricular rates will be the same Sinus origin: one P wave to each QRS complex Prolonged (more than 0.20 second); remains constant Normal (0.10 second or less) Second-degree AV Atrial: regular Atrial: that of Sinus origin Varies; progressively Normal (0.10 block, Mobitz I Ventricular: irregular underlying sinus rhythm lengthens until a P wave isn't conducted second or less) Ventricular: depends on number of impulses conducted through AV node: will he less than atrial rate (P wave occurs without the QRS cmplex); a pause follows the dropped QRS complex Second-degree AV Atrial: regular Atrial: that of Sinus origin: two or Normal or Normal if block at block, Mobitz II ventricular: usually underlying sinus three P waves prolonged; remains level of bundle of regular, but may be rhythm (sometimes more) constant His; irregular if Ventricular: depends before each QRS conductions ratios vary on number of Impulses conducted through AV node; will be less than atrial rate complex bundle branches Third-degree AV block Atrial: regular Atrial: that of Sinus P waves with Varies greatly Normal if block at Ventricular: regular underlying sinus rhythm Ventricular:40 to 60 if paced by AV junction; 30 to 40 (sometimes less) if paced by ventricles; will be less than atrial rate no constant relationship to the QRS complex; P waves found hidden in QRS complexes and T waves level of AV node or bundle of His; wide if block in bundle branches No constant Relationship between P wave and QRS complex is a feature of Third degree or complete hea block. One P wave to each QRS complex is a feature of First degree block

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An ill 16 days old baby girl is brought to the emergency. On examination pallor and dyspnoea present with a respiratory rate of 85 per minute. Her HR is 200 bpm, hea sounds are distant and a gallop is heard. X-ray showed cardiomegaly. An echocardiogram shows dilated ventricles and dilation of the left atrium. An ECG shows ventricular depolarization complexes that have low voltage. Which of the following is the most likely diagnosis?

In CHF pallor, dyspnoea, tachypnoea, tachycardia and cardiomegaly are common regardless of the cause.The most common causes of CHF in children include myocarditis caused by adenovirus and coxsackievirus B.The echocardiogram shows ventricular and left atrial dilatation as well as poor ventricular function. With glycogen storage disease of the hea muscle thickening would be expected. With pericarditis- pericardial effusion is seen. On ECG, the voltages of the ventricular complexes seen with aberrant origin of the left coronary aery are not diminished, and a pattern of myocardial infarction can be seen. *

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In inversion of the foot, the sole will face:

Ans: d (Medially) Ref: BDC, Vol. II, 4th ed, p. 155; Kieth L. Moore, 4th ed, p. 638Inversion is the movement in which the medial border of the foot is elevated, so that the sole faces medially.Eversion is the movement in which the lateral border of the foot is elevated. So that the sole faces laterally.Joints of the foot and the Movements taking place there:JOINTTYPE OF JOINTMOVEMENTSAnkle jointHinge jointPlantar flexion, dorsiflexionSubtalar joint (talocalcaneal)Plane synovialInversion, eversionT alocalcaneonavicularBall and socketGliding and rotator movementsCalcaneocuboidPlane synovialInversion, EversionTarsometatarsalPlane synovialGliding or slidingIntermetatarsalPlane synovialLittle movement possibleMetatarsophalangealCondylarFlexion, extension, adduction, abduction and circumductionInterphalangealHinge varietyFlexion, Extension

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Where does the "knot" is put in the neck during judicial hanging?

In judicial hanging, a rope to allow a drop of five to seven metres according to the weight, build and age of the person, is looped round the neck, with the knot under the angle of the jaw. This causes fracture-dislocation usually at the level of the second and third, or third and fouh cervical veebrae. Ref: The essentials of forensic medicine and toxicology by Dr K S Narayan Reddy, 27th edition, Page 306.

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Seal finger and whale finger are associated with -

Ans. is 'b' i.e., Erysipelothrix

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Which of the following muscle acts as unlocker of knee?

Popliteus rotates the tibia medially on the femur or, when the tibia is fixed, rotates the femur laterally on the tibia. At the beginning of flexion of the fully extended knee, lateral femoral rotation by popliteus muscle unlocks the joint.Must know:Locking of knee joint is due to the the action of quadriceps femoris, that brings about medial rotation of femur on tibia in later stages of extension. Ref: Snells, Clinical anatomy, 7th Edition, Page 650.

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A 60 yr old chronic smoker presents with painless gross hematuria of 1 day duration. Which is the investigation of choice to know the cause of hematuria?

A chronic smoker with painless gross hematuria should be suspected as having bladder cancer. The most common form of bladder cancer is transitional cell carcinoma (TCC). Tobacco use, followed by occupational exposure to various carcinogenic materials such as automobile exhaust or industrial solvents are the most frequent risk factors. Hematuria is the presenting symptom in 85-90% of patients with bladder cancer. It may be gross or microscopic, intermittent rather than constant. Exfoliated cells from both normal and neoplastic urothelium can be readily identified in voided urine. Ref: Scher H.I., Motzer R.J. (2012). Chapter 94. Bladder and Renal Cell Carcinomas. In D.L. Longo, A.S. Fauci, D.L. Kasper, S.L. Hauser, J.L. Jameson, J. Loscalzo (Eds), Harrison's Principles of Internal Medicine, 18e.

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The most sensitive method for detecting cervical Chlamydia trachomatis infection is:

Ans. is 'c' i.e., Polymerase chain reactionRef: Harrison, 17th/e, p. 1074,19th/e, p. 1165 and Ananthanarayan, 9th/e, p. 415Amplification assays such as ligase chain reaction and polymerase chain reaction are the most sensitive chlamydial diagnostic method.Other methods are:(a) Cell culture: Sensitivity (60-80%).(b) Direct immunofluorescent antibody test: Sensitivity 70-80% and quite specific.(c) ELISA: 60-80%.

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Congestive hea failure in an infant is characterized by all except

Congestive Cardiac Failure in InfantsSymptomsSignsuFeeding difficultyuTakes less volume per feeduDiaphoretic while suckinguForehead sweating.uSuck-rest-suck cycle.uPoor weight gainuPeriorbital edema uClothes no longer fituIncreasing cloth sizeuRapid breathing/nasal flaring/cyanosis/chest retractions.uTachycardia.uHepatomegaly.uOccasionally Splenomegaly.uPeriorbital edemauEdema in flanks. uDependent edema (Refer: Nelson's Textbook of Paediatrics, 19thedition, pg no:1530)

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Congenital hydrocele is best treated by

Congenital hydrocele is best treated with herniotomy if they do not resolve spontaneously. Established acquired hydrocele often have thick walls. They are treated by subtotal excision of the sac. If the sac is small, thin walled and contains clear fluid, Lord's operation is done. Jaboulay's operation where the sac is eveed with placement of testis in a pouch created by dissection in the fascial planes of the scrotum, is an alternative. Reference : page 1328 Bailey and Love's sho practice of surgery 25th edition and page 1072 SRB's manual of surgery 5th edition

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Rate limiting step in cholesterol synthesis is catalysed by which of the following enzyme?

Conversion of HMG CoA to mevalonate by HMG CoA reductase is the rate limiting step in the synthesis of cholesterol. Cholesterol is an allosteric inhibitor of HMG CoA reductase Statin drugs acts as competitive inhibitors with mevalonate for binding to HMG CoA reductase. Insulin ors the active form of HMG CoA reductase and increases cholesterol synthesis. Glucagon ours the inactive form and decreases cholesterol synthesis. Ref: Biochemistry By John W. Pelley, page 89.

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Vaccine administered by following route is

Hlnl live (Intranasal route)

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Coloured urine is not seen in :

Answer is A (Quinine) Quinine is not associated with discoloured urine.

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Schizophrenia is treated by

Ans. is 'b' i.e., Anti psychotics

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Fries test is used in the diagnosis of:

Granuloma venereum

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A 45-year-old woman complains of severe headaches and difficulty in swallowing. Over the past 6 months, she has noticed small, red lesions around her mouth as well as thickening of her skin. The patient has "stone facies" on physical examination. Which of the following antigens is the most common and most specific target of autoantibody in patients with this disease?

Scleroderma (refer to the image below) Autoimmune disease of connective tissue. Antinuclear antibodies are common but are usually present in a lower titer than in patients with SLE. Antibodies viually specific for scleroderma include:- Nucleolar autoantibodies (primarily against RNA polymerase) Antibodies to Scl-70, a non-histone nuclear protein topoisomerase; Anticentromere antibodies (associated with the "CREST" variant of the disease). The Scl-70 autoantibody is most common and specific for the diffuse form of scleroderma and is seen in 70% of patients. -Autoantibodies to double-stranded DNA (choice B) are seen in patients with SLE. -Autoantibodies to SS-A/SS-B are seen in patients with Sjogren syndrome. (Fig: A fibroblastic focus is present at the arrows.) Diagnosis: Scleroderma

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Grave's ophthalmopathy mostly presents as September 2010

Ans. A: Proptosis Graves' ophthalmopathy (also known as thyroid eye disease (TED), dysthyroid/thyroid-associated orbitopathy (TAO), Graves' orbitopathy) is an autoimmune inflammatory disorder affecting the orbit around the eye, characterized by upper eyelid retraction, swelling (edema), redness (erythema), conjunctivitis, reduce dpower convergence and bulging eyes (proptosis).

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Earliest lesion seen in atherosclerosis is:

Ans: A (Fatty streaks) Ref: Robbins Pathologic Basis of Disease, 8th edition.Explanation:Fatty streaks are the earliest lesions in atherosclerosis " Ref: RobbinsMorphology of AtherosclerosisFatty StreaksThese are the earliest lesions in atherosclerosis.They are composed of lipid-filled foamy macrophages.Beginning as multiple minute flat yellow spots, they eventually coalesce into elongated streaks 1 cm or more in length.These lesions are not significantly raised and do not cause any flow disturbanceAortas of infants less than 1 year old can exhibit fatty streaks, and such lesions are seen in virtually all children older than 10 years, regardless of geography, race, sex, or environment.The relationship of fatty streaks to atherosclerotic plaques is uncertainThey may evolve into precursors of plaques, not all fatty streaks are destined to become advanced lesions.Atherosclerotic PlaqueThe key processes in atherosclerosis are intimal thickening and lipid accumulationAtheromatous plaques impinge on the lumen of the artery and grossly appear white to yellow: superimposed thrombus over ulcerated plaques is red-brown.Plaques vary from 0.3 to 1.5 cm in diameter but can coalesce to form larger massesAtherosclerotic lesions are patchy, on cross- section, the lesions appear "eccentric"Local flow disturbances (e.g., turbulence at branch points) leads to increased susceptibility to plaque formation.In descending order, the most extensively involved vessels are theLower abdominal aorta (MC)The coronary arteries (Second MC)The popliteal arteriesThe internal carotid arteriesVessels of the circle of WillisVessels of the upper extremities are usually spared, as are the mesenteric and renal arteries, except at their ostia.Atherosclerotic plaques have three principal components:Cells, including smooth muscle cells, macrophages, and T cellsECM, including collagen, elastic fibers, and proteoglycansIntracellular and extracellular lipidSuperficial fibrous cap composed of smooth muscle cells and dense collagen.Beneath and to the side of the cap (the "shoulder") is a more cellular area containing macrophages, T cells, and smooth muscle cells.Deep to the fibrous cap is a necrotic core, containing lipid (primarily cholesterol and cholesterol esters), debris from dead cells, foam cells (lipid-laden macrophages and smooth muscle cells), fibrin, variably organized thrombus, and other plasma proteins and cholesterolThe periphery of the lesions show neovascularization (proliferating small blood vessels;Plaques generally continue to change and progressively enlarge due to cell death and degeneration, synthesis and degradation (remodeling) of ECM, and organization of thrombus.Atheromas often undergo calcificationAtherosclerotic plaques are susceptible to the following clinically important changes* Rupture, ulceration, or erosion of the intimal surface of atheromatous plaques exposes the blood to highly thrombogenic substances and induces thrombosis.* Such thrombosis can partially or completely occlude the lumen and lead to downstream ischemia.* If the patient survives the initial thrombotic occlusion, the clot may become organized and incorporated into the growing plaque.* Hemorrhage into a plaque. Rupture of the overlying fibrous cap, or of the thin-walled vessels in the areas of neovascularization, can cause intra-plaque hemorrhage; a contained hematoma may expand the plaque or induce plaque rupture.* Atheroembolism. Plaque rupture can discharge atherosclerotic debris into the bloodstream, producing microemboli* Alienism formation. Atherosclerosis-induced pressure or ischemic atrophy of the underlying media, with loss of elastic tissue, causes weakness resulting in aneurysmal dilation and potential rupture.

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Flipped LDH indicating Myocardial Infarction is represented by:

When LDH-1 is greater than LDH-2, it is referred to as flipped LDH and is indicative of MI. LDH-1 isoenzyme is found primarily in hea muscle and is lesser in concentration than the LDH-2 Isoenzyme which is primarily found in RBC. When the concentration of LDH-1 is observed to be greater than LDH2. It is referred to as flipped LDH and is indicative of Myocardial infarction. LDH has five isoenzymes: LDH-1 LDH-1 is found primarily in hea muscle 17% to 27% LDH-2 LDH-2 is primarily found in Red blood cells 27% to 37% LDH-3 LDH-3 is highest in the lung 18% to 25% LDH-4 LDH-4 is highest in the kidney, placenta, and pancreas 3% to 8% LDH-5 LDH-5 is highest in the liver and skeletal muscle 0% to 5% The LDH test helps determine the location of tissue damage. Thus in Normal ratios LDH-1 is less than LDH-2 and LDH-5 is less than LDH-4. When LDH-1 is greater than LDH-2: It is referred to as flipped LDH. It is indicative of MI. When your LDH-5 is greater than your LDH-4: It could mean damage to the liver or liver disease. This includes cirrhosis and hepatitis. Ref: Harrisons 19th edition

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Blood supply of stomach is/are:

A. i.e. Left gastric aery; B. i.e. Sho gastric aery; C. i.e. Left gastroepiploic aery

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Which of the following ultrasound finding has the highest association with aneuploidy?

All the above mentioned are ultrasound findings associated with increased risk of aneuploidy although the highest association is seen with cystic hygroma Nuchal translucency and cystic hygroma are both measured in the first trimesterTrisomy 21 is the most common aneuploidy associated with increased NT and cystic hygroma While monosomy X presents as second-trimester hygroma.

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Which of the following is not a component of transpo system?

Functions: Transpo Systems An essential role of biomembranes is to allow movement of all compounds necessary for the normal function of a cell across the membrane barrier. These compounds include a vast array of substances like sugars, amino acids, fatty acids, steroids, cations and anions to mention a few. These compounds must enter or leave the cells in an orderly manner for normal functioning of the cell. A. 1. Ion Channels Ion channels are transmembrane channels, pore-like structures composed of proteins. Specific channels for Na+, K+, Ca++, and Cl- have been identified. Cation conductive channels are negatively charged within the channel and have an average diameter of about 5 to 8 nm. All ion channels are basically made up of transmembrane subunits that come together to form a central pore through which ions pass selectively. All channels have gates and are controlled by opening and closing. Types of Gates Two types of gated channels. They are a. Ligand-gated channels: In this, a specific molecule binds to a receptor and opens the channel. Example: Acetylcholine receptor is present in the postsynaptic membrane. It is a complex of five subunits, having a binding site for acetylcholine. Acetylcholine released from the presynaptic region binds with the binding site of the postsynaptic region, which triggers the opening of the channel and influx of Na+. b. Voltage-gated channels: These channels open or close in response to changes in membrane potential. Some propeies of ion channels * Composed of transmembrane protein subunits. * Highly selective. * Well regulated by the presence of "gates". * Two main types of gates: Ligand-gated and voltage-gated. * Activities are affected by ceain drugs. * Mutations of genes encoding transmembrane proteins can cause specific diseases. 2. Ionophores Ceain microorganisms can synthesize small organic molecules, called ionophores, which function as shuttles for the movement of ions across the membrane. Structure: These ionophores contain hydrophilic centres that bind specific ions and are surrounded by peripheral hydrophobic regions. Types: Two types: (a) Mobile ion carriers: Like valinomycin (Refer uncouplers of oxidative phosphorylation). (b) Channel formers: Like gramicidin. 3. Water Channels (Aquaporins) In ceain cells, e.g. in red blood cells, and cells of the collecting ductules of the kidney, the movement of water by simple diffusion is enhanced by movements of water through water channels, composed of tetrameric transmembrane proteins called aquaporins. About five distinct types of aquaporins have been recognised. CLINICAL ASPECT Recently mutations in the gene encoding AP-2 (Aquaporin 2) protein, have been shown to be the cause of one type of nephrogenic diabetes insipidus. 4. Gap Junction Ceain cells develop specialized regions on their membranes for intercellular communications which are in close proximity. Function: They mediate and regulate the passage of ions and small molecules upto 1000 to 2000 mol wt, through a narrow hydrophilic core connecting the cytosol of adjacent cells. Structure: They are primarily composed of protein, called connexon which contains four membrane-spanning a-helices. the mitochondrial membrane also has paicularly energy coupling mechanism.Ref: MN Chatterjea Textbook of Medical Biochemistry, 8th edition

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Burst supression pattern on EEG is typically seen in:

Ref: Ref: Harrisons 18/e p e-45 chapter  As the depth of coma increases, the EEG becomes nonreactive and may show a burst-suppression pattern, with bursts of mixed-frequency activity separated by intervals of relative cerebral inactivity. In other instances there is a reduction in amplitude of the EEG until eventually activity cannot be detected. Such electrocerebral silence does not necessarily reflect irreversible brain damage, because it may occur in hypothermic patients or with drug overdose. The prognosis of electrocerebral silence, when recorded using an adequate technique, depends upon the clinical context in which it is found. In patients with severe cerebral anoxia, for example, electrocerebral silence in a technically satisfactory record implies that useful cognitive recovery will not occur.

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To feel comfoable and cool in a factory the conrrected effective temperature ( in degree Farenheit) should be -

Comfo zones: In deg C of corrected effective temperature Pleasant and cool 20 Comfoable and cool 20-25 (69-76F) Comfoable 25- 27 (77-80F) Hot and uncomfoable 27-28 Extremely hot 28+ Intolerably hot 30+. Park's Textbook of Preventive and Social Medicine, 25th Edition, Pg 792

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Test used for factor VIII deficiency identification is-

Ans. is 'b' i.e., APTT o Factor VIII is a part of the intrinsic pathway of coagulation. The test used to identity1 the defects in the intrinsic and common pathways of coagulation is PTT. Thus prolonged PTT is a feature of patient with factor VIII deficiency.o Patients with hemophilia have deficiency of factor VIII that results in prolonged PTT.o Tests used to evaluate different aspects of hemostasis.Bleeding timeo It is not a test for coagulation rathers it tests the ability of the vessels to vasoconstrict and the platelets to form a hemostatic plug.o It is the time taken for a standardized skin puncture to stop bleeding,o Normal reference value is between 2-9 minutes.o Prolongation generally indicates the defect in platelet number or function.Prothrombin time (PT)o This assay tests the extrinsic and common coagulation pathway.o So, a Prolonged PT can result from deficiency of factor V, VII. X, prothrombin or fibrinogen.Partial thromboplastin time (PTT)o This assay tests the intrinsic and common coagulation pathways.o So, a prolonged PTT. can results from the deficiency of factor V, VHI, IX, X, XI, XII, prothrombin or fibrinogen.Thrombin timeo It is the time taken for clotting to occur when thrombin is added to the plasma,o It tests the conversion of fibrinogen to fibrin and depends on adequate fibrinogen level,o Prolonged thrombin time results from decreased level of fibrinogen.Defective coagulation pathwayPTAPTTExtrinsicIntrinsicCommonIncreasedNormalIncreasedNormalIncreasedIncreased

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A 19 year old female presents with pain in the neck for 5 days. She is not able to wear tie for her job because of neck pain. H/O fatigue and lethargy for 10 days. She had flu like symptoms 20 days ago which resolved spontaneously. BP 110/80 mmHg, Pulse 48/min. Extremities are cold and dry. Neck is very tender. ECG normal. TSH is elevated. ESR 30 mm/hr. Next appropriate step

Answer: c) Aspirin (SCHWARTZ 19TH ED, P-1525; SABISTON 19TH ED, P-895)Granulomatous or Subacute or De Quervain's thyroiditisMost commonly occurs in 30- 40 year-old womenStrong association with the HLA-B35Fever with Sudden or gradual onset of neck painH/o preceding URI; Viral etiologyGland - enlarged, tender, firmClassically progresses through four stages: Hyperthyroid-Euthyroid-Hypothyroid-EuthyroidA few patients develop recurrent diseaseEarly stages: | ESR, Tg, T4, and T3 levels are elevated, TSH decreasedDuring Hypothyroid stage: elevated TSHLow radio-iodine uptakeFNAC - multinucleated giant cells of an epithelioid foreign body type and aggregates of lymphocytes activated macrophages, and plasma cellsSelf-limiting diseaseAspirin and NSAIDs are used for pain reliefPrednisolone for severe casesShort-term thyroid replacement may be needed and may shorten the duration of symptoms

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Headache, apathy and deteriorating level of consciousness occurring weeks after head injury suggests;

Chronic subdral haematoma

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A 27-year female wearing high heels stumbled and sustained inversion injury at ankle. Which ligament is most likely to be injured in the given case?

Ans. A. (A)A. Anterior Talofibular ligamentAnkle sprains: Usually caused by the falls from height or twists of ankle. When the plantar-flexed foot is excessively inverted, the anterior and posterior talofibular and calcaneofibular ligaments are stretched and torn. The anterior talofibular ligament is most commonly torn.

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Asymmetric tonic neck reflex (ATNR) disappears at ______

Asymmetric tonic reflex (ATNR) diappears by 6-7 months postnatally The tonic neck reflex is produced by manually rotating the infant&;s head to 1 side and observing for the characteristic fencing posture (extension of the arm on the side to which the face is rotated and flexion of the conralateral arm) An obligatory tonic neck response, in which the infant becomes "stuck" in the fencing posture, is always abnormal and implies a CNS disorder Ref: Nelson 21st edition pgno: 3059

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Ligament teres is a remnant of ?

Umbilical vein

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Sho structured primi gravida has height less then

140 cm

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Which of the following is the most specific and sensitive screening test for renovascular hypeension?

Hypeension due to an occlusive lesion of a renal aery is renovascular hypeensionIn the initial stages, the mechanism of hypeension generally is related to activation of the renin-angiotensin system. Obstruction of the renal aery leads to decreased renal perfusion pressure, thereby stimulating renin secretion. Over time, possibly as a consequence of secondary renal damage, this form of hypeension may become less renin-dependent.As a screening test, renal blood flow may be evaluated with a radionuclide -ohoiodohippurate (OIH) scan, or glomerular filtration rate may be evaluated with a - diethylenetriamine pentaacetic acid (DTPA) scan before and after a single dose of captopril (or another ACE inhibitor).Contrast aeriography remains the "gold standard" for evaluation and identification of renal aery lesions.Harrison 19e pg: 1618

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Role of egg lecithin in propofol formulation is?

Propofol is an insoluble drug that requires a lipid vehicle for emulsification. Current formulations of propofol use a soybean oil as the oil phase and egg lecithin as the emulsifying agent.

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A 63 year old man presents with a triad of angina, syncope and congestive hea failure. Which of the following valvular hea lesion can be suspected-

Even severe AS may exist for many years without producing any symptoms because of the ability of the hyperophied LV to generate the elevated intraventricular pressures required to maintain a normal stroke volume. Most patients with pure or predominant AS have gradually increasing obstruction over years, but do not become symptomatic until the sixth to eighth decades. Exeional dyspnea, angina pectoris, and syncope are the three cardinal symptoms. Dyspnea results primarily from elevation of the pulmonary capillary pressure caused by elevations of LV diastolic pressures secondary to reduced left ventricular compliance and impaired relaxation. Angina pectoris usually develops somewhat later and reflects an imbalance between the augmented myocardial oxygen requirements and reduced oxygen availability. Exeional syncope may result from a decline in aerial pressure caused by vasodilation in the exercising muscles and inadequate vasoconstriction in nonexercising muscles in the face of a fixed CO, or from a sudden fall in CO produced by an arrhythmia. ( Harrison&;s principle of internal medicine,18th edition,pg no.1939 )

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An athelete presented with red coloured urine after 2 days of history of severe exeion. The most probable cause is?

Myoglobinuria REF: Harrison's Internal Medicine 17th edition chapter 382, Physiology and pathology of the urine by john dixon p. 49 Red color urine may be due to hemoglobin or myoglobin. In the question clue is given that patient is an athlete who competed in an event which lead to sternous exercise and hence increased myoglobin in the urine. "The states of energy deficiency cause activity-related muscle breakdown accompanied by myoglobinuria, appearing as light-brown- to dark-brown-colored urine"

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Which of the following is released from hypothalamus?

There are 6 established hypothalamic releasing and inhibiting hormones : Corticotropin-releasing hormone (CRH), Thyrotropin releasing hormone (TRH), Growth hormone releasing hormone (GRH), Growth  hormone inhibiting hormone (GIH), Luteinizing hormone releasing hormone (LHRH) and Prolactin inhibiting hormone(PIH).

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Vestibulo-Ocular Reflex Mediated by:

Ans:A (Flocculonodular Lobe) Ref: Pal GK. Cerbellurn. In: Textbook of Medical Physiology. Ahuja Publishing House. 2007: 116: 871.Explanation:Functional Division of CerebellumVestibulo cerebellum/Arch-cerebellum (Flocculonodular lobe)Connections with vestibular apparatusConcerned with equilibrium and learning induced changes in vesiihulo-occular reflexSpino cerebellumVermis - controls muscle movements of axial bodyIntermediate zone - controls muscle movements of limbsCerbrocerbellum (Ponto cerebellum/Neo cerbellurn) Overall planning programming of motor activities

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Which statement best describes the cranial fossa?

The floor of the middle cranial fossa is made up of the body and greater wing of the sphenoid as well as the squamous temporal bone. The cribriform plate forms pa of the floor of the anterior cranial fossa The middle cranial fossa contains the pituitary gland. The internal acoustic meatus lies in the posterior cranial fossa.

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Which of the following vitamin enhances intestinal absorption of calcium?

Vitamin Functions Deficiency Disease D Maintenance of calcium balance Enhances intestinal absorption of Ca2+ and mobilizes bone mineral Regulation of gene expression and cell differentiation Rickets = poor mineralization of bone Osteomalacia = bone demineralization Reference: Harper; 30th edition; Page no: 550

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Which of these is the most impoant indication for Strassmans Metroplasty done for a bicornuate uterus?

Habitual aboion is the most impoant indication for surgical treatment of women who have a double uterus. The aboion rate in women who have a double uterus is to three times greater than that of the general population. Best diagnosis of the condition is made by laparohysteroscopy. Strassmans Metroplasty

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A 2-year-old child had burns on buttocks, both legs, face, neck and singeing of hair. Total surface area burnt: JIPMER 14

Ans. 37%

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Which test helps to differentiate between concomitant squint and paralytic squint

This procedure causes breakdown of binocular fusion mechanism thus helpful to differentiate.

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Best disinfectant of cholera stool is-

Cresol is an excellent coal-tar disinfectant. It is 3 to 10 times as powerful as phenol, yet no more toxic. Cresol is best used in 5 to 20 percent strength for disinfection of farces and urine. Cresol is an all-purpose general disinfectant. (refer pgno :128 park 23 rd edition)

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Black eye is a type of -

The synopsis of forensic medicine & toxicology ; Dr k.s.narayan reddy ; 28th edition ; Pg .no . 107 Black eye is the most common example for ectopic bruising or percolated contusion .

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In a patient with a type of familial dyslipidemias he presented with palmar Xanthomas and he ias at increased risk of atherosclerosis and CAD.In Lipid profile there was elevation of triacylglycerols and cholesterol.And the IDL and chylomicrons were elevated.What is the pathophysiology of the condition?

Reference: Harpers illustrated biochemistry 30th edition page 275

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Endolymphatic duct drains into :

Ans:A.)Subdural Perilymph drains into subarachnoid space through the aqueduct of cochlea... Endolymph is absorbed in subdural space.

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Usually associated with parvovirus B19 infection in those with hereditary spherocytosis-

Ans. is 'b' i.e., Aplastic crisis o Parvovirus B19 selectively infects erythroidprecursors and is the most common aetiological agent that induces aplastic crisis in patients with hereditary spherocytosis (and other Hemolytic disorders).Transient aplastic crisiso Persons with decreased erythrocytes caused by conditions such as iron deficiency anemia, human immunodeficiency virus sickle cell disease, spherocytosis or thalassemia are at risk of transient aplastic crisis if infected with parvovirus B19.o The virus causes a cessation of erythrocyte production,o Parvovirus infection may be the first manifestation in HS.o It begins with reticulocytosis and thrombocytosis.

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A patient with cushinoid features presents with hemoptysis; he shows no response to dexamethasone suppression test; most likely diagnosis here is:

Answer is C (Ca lung with ectopic ACTH production); Lack of suppression to dexamethasone challenge (ACTH producing tumor) and presence of hemoptysis (Carcinoma lung) in a patient with Cushinoid features suggests a diagnosis of Carcinoma lung with ectopic ACTH secretion. As a method of diagnostic workup of any patient with suspected Cushings we screen the patient with plasma coisol levels at 8:00 a.m. in the morning. Those with increased coisol levels are subjected to a dexamethasone supression test. In the given question there is lack of suppression to dexamethasone challenge so option (d) is out. Out of the choices remaining the presence of hemoptysis points towards the diagnosis of carcinoma lung with ectopic ACTH.

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Symptomatic treatment is not required in withdrawal of:

Since cannabis causes very mild withdrawal symptoms hence, no symptomatic treatment is required. LSD and other hallucinations also do not cause any withdrawal symptoms .

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Following death of a person, what happens to potassium level in the vitreous.

Potassium concentration raises at the rate of 0.17-0.25 mmol per hour following death. It helps in determination of time since death.

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Under transplantation of humans organs act, the punishment for the doctor involved is

The Transplantation of Human Organs Act 1994, amended in 2011, and 2012 Chapter VI and VII deals with the trial and punishment of offences under this act. Under this act, doctors involved will be punished for a period of 2-5yrs. Ref: FORENSIC MEDICINE AND TOXICOLOGY Dr. PC IGNATIUS PAGE NO: 389

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Staphylococcus aureus does not cause which of the following skin infection:

Ans. is. a. Ecthyma gangrenosum

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A young lady with symptoms of hypehyroidism with elevated T4 and TSH levels. On examination, patient was not experiencing Tachycardia or excessive sweating.Fuher examination reveals bitemporal hemianopia. Next step of management

Hypehyroidism with elevated levels of T4 and TSH levels and bitemporal hemianopia is highly suggestive of TSH secreting adenoma. Urgent MRI should be done to confirm the diagnosis of TSH secreting pituitary adenoma along with antithyroid drugs. Thyrotropin-secreting pituitary tumors (TSH-omas) are a rare cause of hypehyroidism and account for less than 1% of all pituitary adenomas. - Origin - anterior pituitary- MC cause of hyper pituitarism - Pituitary adenoma C/F Functional (Secreting) Non-Functional (Non-Secreting)Early Presentation due to physiologic Delayed presentation (Big enough toeffect cause neurological deficit) | Bitemporal Hemianopia Seen on 3rd / 4th Decade- M = F- MC type of pituitary adenoma is Prolactinoma IOC for diagnosis - MRIOther work-up done Full Endocrinologic ProfileFormal visual field testing TreatmentBromocriptine (Dopamine agonist) -Prolactinoma- Shrink prolactinoma in 6 to 8 weeks- Growth hormone security tumors - shrinkage occur < 20% Pts | Agent Octreotide | GH level in 70% Pts , | Tumor volume in 30% Indications of Sx in pituitary adenoma- GH Secreting tumors- Primarily Cushing Disease- Adenoma causing acute visual deterioration- Non-Prolactin secreting macroadenoma causing symptoms by mass effect Surgical ApproachIntranasal Trans-Sphenoidal , Sub labial Indications of Radiosurgery in pituitary adenoma- Used as primary therapy- Adjuvant therapy after subtotal resection- Recurrent disease

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Statuary rape is -

Ref:Textbook of Forensic medicine and toxicology (V.V.Pillay) 17th edition, page no.388 Minimum age at which female can give consent for sex by what age is 18 years. As per Sec.375IPC unlawful sexual intercourse by man with a woman with or without her consent when she is under 18 years of age. The criminal law (Amendment) Act,2013 has increased the previous recomended age of consent from 16 to 18 years, which means any sexual activity irespective of presence of consent with a woman below the age of 18 will constitute statutory rape.

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A patient on amiodarone is diagnosed to have cornea verticillata. What should be management –

Cornea Verticillata This is a whorl-like opacity in the corneal epithelium seen in patients on long-term treatment with medication such as amiodarone, chloroquine, phenothiazines and indomethacin. It is also seen in patients with Fabry disease and its carrier state. The condition is generally asymptomatic, harmless and reversible on stopping the drug. The whorl-like pattern shows the direction of migration of corneal epithelial cells. Occasionally the condition had been known to cause glare and surface discomfort which response to topical lubricants.

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Most aggressive lung CA:

Ans. (c) Small cell lung CARef: Robbings 9th ed./ 717* Small cell carcinoma is a highly malignant tumor with a strong relationship to cigarette smoking.* Around 1% occurs in nonsmokers.* They are the most aggressive of lung tumors, metastasizing widely and are always fatal.

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Chemoprophylaxis is indicated for all except-

Chemoprophylaxis There is no role of Chemoprophylaxis in Typhoid. For chemoprophylaxis in meningococcal meningitis, Rifampicin, Ciprofloxacin & Ceftriaxone is used. Tetracycline is used in Cholera and Plague.

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In pontaic fever, which antigen is seen in urine?

Ans. is 'a' i.e., Lipopolysaccharide-1 Legionella are classified into serogroup on the basis ofgroup specific lipopolysaccharide (somatic antigen or 'O' antigen). Legionella pneumophila sero-group-1 (LP-1) is the most common infecting organism. Urine test detect LP-1.

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Mediastinal lymph node calcification is seen in which one of the following-

Ref:Robbins Basic Pathology (9th Edition),page no.478,479 Sarcoidosis Although sarcoidosis is considered here as an example of a restrictive lung disease, it is impoant to note that sarcoidosis is a multisystem disease of unknown etiology characterized by noncaseating granulomas in many tissues and organs. MORPHOLOGY The diagnostic histopathologic feature of sarcoidosis is the noncaseating epithelioid granuloma, irrespective of the organ involved. This is a discrete, compact collection of epithelioid cells rimmed by an outer zone of largely CD4+ T cells. The epithelioid cells are derived from macrophages and are characterized by abundant eosinophilic cytoplasm and vesicular nuclei. It is not uncommon to see intermixed multinucleate giant cells formed by fusion of macrophages. A thin layer of laminated fibroblasts is present peripheral to the granuloma; over time, these proliferate and lay down collagen that replaces the entire granuloma with a hyalinized scar. Two other microscopic features are sometimes seen in the granulomas: (1) Schaumann bodies, laminated concretions composed of calcium and proteins; and (2) asteroid bodies, stellate inclusions enclosed within giant cells. Their presence is not required for diagnosis of sarcoidosis--they also may occur in granulomas of other origins. Rarely, foci of central necrosis may be present in sarcoid granulomas, suggesting an infectious process. Caseation necrosis typical of tuberculosis is absent The lungs are involved at some stage of the disease in 90% of patients. The granulomas predominantly involve the interstitium rather than air spaces, with some tendency to localize in the connective tissue around bronchioles and pulmonary venules and in the pleura ("lymphangitic" distribution). The bronchoalveolar lavage fluid contains abundant CD4+ T cells. In 5% to 15% of patients, the granulomas eventually are replaced by diffuse interstitial fibrosis, resulting in a so-called honeycomb lung. Intrathoracic hilar and paratracheal lymph nodes are enlarged and calcification in 75% to 90% of patients, while a third present with peripheral lymphadenopathy. The nodes are characteristically painless and have a firm, rubbery texture. Unlike in tuberculosis, lymph nodes in sarcoidosis are "nonmatted" (nonadherent) and do not ulcerate.

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"Candle-wax spots" in the retina are present in

(A) Sarcoidosis # OCULAR MANIFESTATIONS OF SARCOIDOSIS:> Anterior segment: Conjunctival involvement has been reported in patients with ocular sarcoidosis.> Sarcoidosis granulomas are solitary, yellow "millet-seed" nodules.> Anterior uveitis occurs in 22%- 70% of patients with ocular sarcoidosis, and is usually granulomatous & chronic.> Iris nodules have been reported in up to 12.5% of patients with sarcoidosis associated uveitis.> Exacerbations of granulomatous uveitis are often associated with an appearance of fresh iris or fundus nodules.> Posterior synechiae, cataract and glaucoma are common complications.> Corneal band keratopathy develops in a few patients and is usually associated with hypercalcemia.> Posterior segment: The most common manifestations at the posterior segment are vitritis, intermediate uveitis, panuveitis, posterior uveitis, retinal vasculitis & optic nerve involvement. Other manifestations include choroidal nodules & exudative retinal detachment.> Overall, patients with chronic posterior uveitis and panuveitis have significantly more complications than do patients with anterior uveitis.> "Candle wax drippings" and "punched-out" lesions can be seen in patients with uveitis secondary to sarcoidosis.

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The number of doses recommended for oral Ty21a typhoid vaccine is:

The Ty21a vaccine is licensed for use in individuals > 5 years. A three dose regimen is recommended. Vaccine is administered on alternate days: 0n days 1, 3 and 5. Ref: Park 21st edition, page 215.

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The drug used in petit mal seizures and has a narrow spectrum of antiepileptic activity is

Ethosuximide and valproate are the drugs of choice for absence seizures and are more effective than lamotrigineReference: Katzung Pharmacology; 12th edition; Page no: 418

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Which test is not useful in a patient with history of Syncopal attack?

Answer is C (PET Scan) : PET scan has- not been mentioned as a test to investigate syncope in Harrisons text. It is the single best answer of exclusion. Electrophysiological tests and 24 hour ECG Holter monitoring are indicated in patients where history suggests a cardiac disease. Upright tilt table testing is indicated for suspected neurogenic / vasodepressor syncope in patients with normal history / examination. Invasive Cardiac Electrophysiologic testing : provides diagnostic and prognostic information regarding Sinus Node function, AV conduction and Supraventricular and Ventricular arrhythmia. Holter monitor : provides 24 - 48 hours monitoring of ECG rhythm on an outpatient basis and is indicated for detection of conduction abnormalities. Upright tilt table testing : Is a test for vasodepressor / neurogenic syncope in patients with normal history / examination. In susceptible patients upright tilt at an angle between 60deg to 80deg for 30 to 60 minutes induces a vasovagal episode. Indications for Table Tilt test include : Recurrent syncope - Single syncope episode that caused injury - Single syncope event in high risk setting (pilot, commercial vehicle driver) Syncope The choice of diagnostic test should be guided by the history and physical examination For All patients Serum electrolytes Glucose Haematocrit

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Magic syndrome is seen in:

“MAGIC syndrome” (Mouth and Genital ulcers with Inflamed Cartilage) has been proposed to describe patients with clinical features of both relapsing polychondritis and Behcet disease.

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Acute hemorrhagic conjunctivitis is caused by ?

Ans. is 'a' i.e., Enterovirus 70 Acute hemorrhagic conjunctivitis (AHC) may be caused by adenoviruses, but two enteroviruses, enterovirus 70 and coxsackie A24 variant, are the major causes.

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In a 24 year old man weight of the upper limb is transmitted to the axial skeleton by:

The axial skeleton shapes the longitudinal axis of the human body. Coracoclavicular ligament suspends the scapula from the lower one third of the clavicle and forms a strong bond between them. The weight of the upper limb is transmitted to the axial skeleton through this ligament. A fracture of the clavicle, medial to the attachment of this ligament leads to drooping of upper limb. Ref: TB of Anatomy and Physiology PR Ashalatha, 1st Ed, Page 110

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Primary health care was proposed in 1978 at:

Answer: A. Alma ata. (Ref Park's Textbook of PSM 22nd/Pg.832)The new approach to health care came into existence in 1978 following an international conference at Alma Ata (USSR).The Alma-Ata conference defines the primary health care as follows: Primary health care is essential health care made universally accessible to individuals and acceptable to them, through their full participation and at a cost the community and the country can afford.Millennium Development Summit was held in New York in 2000 where MDG are formulated.World Health Assembly is held in Geneva, which is a head quarter of WHO.Note: The term "comprehensive health care" (womb to tomb) was first used by Bhore committee in 1946.

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Gene involved in Cowden syndrome is

(B) PTENo"Phosphatase and Tensin'' homolog (PTEN) - protein in humans encoded by the PTEN gene. Gene mutations promotes development of cancers.[?]Cowden's disease/Multiple Hamartoma Syndrome:-Part of PTEN hamartoma tumor syndrome-An autosomal dominant syndrome-Trichilemmomas - Numerous tumors of hair follicles in face-Multiple hamartomatous polyps in GI tract, Lipomas, Granulomas-Very high risk of breast, Follicular endometrail carcinoma & thyroid carcinomaoTreatment: Bilateral mastectomies recommended-Contraindicated are mammography & other radiation exposure of breast tissue.-Mean age at presentation <10 years-Very high risk of breast, follicular carcinoma of thyroid & Endometrial carcinomaoPTEN (phosphatase and tensin homologue) is a membrane-associated phosphatase encoded by a gene on chromosome 10q23 that is mutated in Cowden syndrome, an autosomal dominant disorder marked by frequent benign growths, such as skin appendage tumors, and an increased incidence of epithelial cancers, particularly of the breast, endometrium, and thyroid.oPTEN acts as a tumor suppressor by serving as a brake on the PI3K/AKT arm of the receptor tyrosine kinase pathway.oPTEN gene function is lost in many cancers through deletion, deleterious point mutations, or epigenetic silencing.SELECTED TUMOR SUPPRESSOR GENES & ASSOCIATED FAMILIAL SYNDROMES & CANCERS, SORTED BY CANCER HALLMARKS*Gene (Protein)Familial SyndromesAssociated CancersInhibitors of Mitogenic Signaling PathwaysAPC (Adenomatous polyposis coli protein)Familial colonic polyps and carcinomasCarcinomas of stomach, colon, pancreas; melanoma*. NF1 (Neurofibromin-1)Neurofibromatosis type 1 (neurofibromas and malignant peripheral nerve sheath tumors)Neuroblastoma, juvenile myeloid leukemia*. NF2 (Merlin)Neurofibromatosis type 2 (acoustic schwannoma and meningioma)Schwannoma, meningioma*. PTCH (Patched)Gorlin syndrome (basal cell carcinoma, medulloblastoma, several benign tumors)Basal cell carcinoma, medulloblastoma*. PTEN (Phosphatase and tension homologue)Cowden syndrome (variety of benign skin, GI, and CNS growths; breast, endometrial, and thyroid carcinoma)Diverse cancers, particularly carcinomas and lymphoid tumors*. SMAD2, SMAD4 (SMAD2, SMAD4)Juvenile polyposisFrequently mutated (along with other components of TGFb signaling pathway) in colonic & pancreatic CaInhibitors of Ceil Cycle Progression*. RB Retinoblastoma (RB) proteinFamilial retinoblastoma syndrome (retinoblastoma, osteosarcoma, other sarcomas)Retinoblastoma; osteosarcoma carcinomas of breast, colon, lung*. CDKN2A p16/INK4a & pU/ARFFamilial melanomaPancreatic, breast, and esophageal carcinoma, melanoma, certain leukemiasInhibitors of "Pro-growth" Programs of Metabolism and Angiogenesis*. VHL (Von Hippel Lindau (VHL) protein)Von Hippel Lindau syndrome (cerebellar hemangioblastoma, retinal angioma, renal cell carcinoma)Renal cell carcinoma*. STK11 (Liver kinase B1 (LKB1) or STK11)Peutz-Jeghers syndrome (GI polyps, GI cancers, pancreatic carcinoma and other carcinomas)Diverse carcinomas (5%-20% of cases, depending on type)*. SDHB, SDHD (Succinate dehydrogenase complex subunits B & D)Familial paraganglioma, familial pheochromocytomaParaganglioma

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Supraventricular crest lies between-

Ans. is 'a' i.e., Pulmonary orifice and atrioventricular orifice Interior of right ventricle* It is anteroinferior chamber and projects to the left of right atrium. It is in contact with the sternum.* It is divided into -i) Rough inflowing part (ventricle proper)# It is developed from right half of primitive ventricle.# Its interior is rough due to the presence of muscular ridges known as trabeculae carneae, which are more prominent in apical region.# Trabeculae carneae are of 3 types: -1. Ridges - Linear elevations.Supraventricular crest - a ridge present between the pulmonary and atrioventricular orifices, extends downwards in the posterior wall of the infundibulum.2. Bridges -'Muscular elevations with fixed ends on ventricular walls, the center being free.Septomarginal trabecula: It is a specialized bridge which extends from the right of ventricularseptum to the base of anterior papillary muscle. It contains the right branch of atrioventricular bundle.3. Papillary muscles are conical projections of muscle fiber bundles. Their base is attached to the ventricular wall and the apex is attached to the chordae tendinae, which are further attached to the cusps of atrioventricular (AV) valves. There are three papillary muscles in the right and two in the left ventricle. They regulate closure of atrioventricular valves.ii) Smooth outflowing part (infundibulum or conus arteriosus)# Smooth outflowing part develops from mid portion of bulbus cordis and surrounds pulmonary valveSupraventricular crest (crista supraventriculars) or infundibuloventricular crest separates tricuspid (AV) orifice and pulmonary orifice, i.e. inlet and outlet parts.

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Which of the following is freely filtered by kidney across glomerular capillariesa) Albumin (across glomerular capillaries)b) Globulinc) Creatinined) HCO3 e) Glucose

Freely filterable substances by glomerulus -        Water -        Na+ -        Cl- -        HCO3- -        Inulin -        Glucose -        Creatinine   -        Free Calcium or phosphate

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Antibodies associated with GTCS in SLE :

Ans.A Anti neuronal ab (Ref: Harrison's Internal medicine 18th/Table 319-1; 17th edition, P. 2076). Autoantibodies in Systemic Lupus Erythematosus (SLE) Antibody Prevalence, % Antigen Recognized Clinical Utility Antinuclear antibodies 98 Multiple nuclear Best screening test; repeated negative tests make SLE unlikely Anti-dsDNA 70 DNA (double-stranded) High titers are SLE-specific and in some patients correlate with disease activity, Anti-Sm 25 Protein complexed to 6 species of nuclear U1 RNA Specific for SLE; no definite clinical correlations; most patients also have anti Anti-RNP 40 Protein complexed to U1 RNA Not specific for SLE; high titers associated with syndromes that have overlap blacks than whites Anti-Ro (SS-A) 30 Protein complexed to hY RNA, primarily 60 kDa and 52 kDa Not specific for SLE; associated with sicca syndrome, predisposes to subacute cutaneous with decreased risk for nephritis Anti-La (SS-B) 10 47-kDa protein complexed to hY RNA Usually associated with anti-Ro; associated with decreased risk for nephritis Antihistone 70 Histones associated with DNA (in the nucleosome, chromatin) More frequent in drug-induced lupus than in SLE Antiphospholipid 50 Phospholipids, 2 glycoproteins 1 cofactor, prothrombin Three tests available ELISAs for cardiolipin and 2G1, sensitive prothrombin Antierythrocyte 60 Erythrocyte membrane Measured as direct Coombs' test; a small proportion develops overt hemolysis Antiplatelet 30 Surface and altered cytoplasmic antigens on platelets Associated with thrombocytopenia but sensitivity and specificity are not good; Antineuronal (includes anti-glutamate receptor) 60 Neuronal and lymphocyte surface antigens In some series a positive test in CSF correlates with active CNS lupus. Antiribosomal P 20 Protein in ribosomes In some series a positive test in serum correlates with depression or psychosis Also remember: Antibody Best screening test for Antibody ANA SLE Anti-Histone Drug-induced lupus Antinuclear antibodies SLE, nonspecific Anti-dsDNA; Anti-Sm Specific for SLE Anti-sm (Nelson's Paediatric Textbook) Marker of CNS lupus Anti-DNA Level of which correlates with disease activity Anti-Ro (SS-A) SACL, neonatal lupus Anti-Ro and Anti-La ie risk of nephritis (protective against nephritis) Antiphospholipid Hematological and Fetal Loss Antiribosomal protein Depression and Psychosis Anti-basement membrane Goodpasture syndrome Anticardiolipin, lupus anticoagulant SLE, antiphospholipid syndrome Anticentromere Limited scleroderma (CREST syndrome) Anti--Scl--70 (anti--DNA topoisomerase 1) Scleroderma (diffuse) Anti--SSA, anti--SSB (anti-Ro, anti--La) Sjogren syndrome Anti--Jo--1, anti--SRP, anti--Mi--2 Polymyositis, dermatomyositis Anti--TSH receptor Graves disease Anti--U1RNP (ribonucleoprotein) Mixed connective tissue disease c-ANCA (PR3-ANCA) Granulomatosis with polyangiitis (Wegener) IgA antiendomysial, IgA anti--tissue transglutaminase Celiac disease p-ANCA (MPO--ANCA) Microscopic polyangiitis, Churg--*JStrauss syndrome Anti--ACh receptor Myasthenia gravis Rheumatoid factor (antibody, most commonly IgM, specific to IgG Fc region), anti--CCP Rheumatoid arthritis Anti--glutamate decarboxylase Type 1 diabetes mellitus Anti--desmoglein Pemphigus vulgaris Anti--hemidesmosome Bullous pemphigoid Antimicrosomal, antithyroglobulin Hashimoto thyroiditis Antimitochondria! 1*< biliary cirrhosis Anti--smooth muscle Autoimmune hepatitis ALSO KNOW: LE cells Neutrophils with LE bodies seen in SLE, RA Penicillamine drug induced Hematoxilin bodies SLE endocarditis (Libmann-Sack) 'Wire-loop' lesions SLE type IV nephritis

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Tonsillar fossa is bounded anteriorly by

Tonsilar fossa is bounded by Anterior - Palatoglossal fold containing palatoglossal muscle Posterior - Palatopharyngeal fold containing palato pharyngeal muscle Apex - Soft palate, where both arches meet Base - Dorsal surface of posterior one-third of tongue. (Ref: Anatomy of head, neck and brain. Vishram Singh. P 227 )

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"Castration anxiety" is seen in which phase of Sigmond Freud's psychosexual stages of development

Phallic phase (3-5years): Male child develops Oedipus complex (sexual feeling towards mother) and will be afraid that father may castrate him for this termed as "Castration anxiety".

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Shock causes:

Ans: A (Stagnant hypoxia)Ref: Pat GK, Hypoxia and Oxygen Therapy, In: Textbook of Medical Physiology, 2nd ed, Abuja Publishing House 2011: 94: 754-55Explanation:Refer the explanation of previous question

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Calcium silicate based material is:

Mineral trioxide aggregate was developed by Dr Torabinejad in 1993.  It contains tricalcium silicate, dicalcium silicate, tricalcium aluminate, bismuth oxide, calcium sulfate and tetracalcium aluminoferrite. pH of MTA is 12.5. Textbook of Endodontics Nisha Garg 3rd Ed

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Which of the following statements about Total Infra–Venous Anaesthesia (TIVA) is true –

Total intravenous anaesthesia refers to a technique in general anaesthesia using a compination of agents given solely by IV route and in the absence of all inhalation agents. TIVA (Total intravenous anaesthesia) is produced by IV propoful. Propofol decreases the cerebral metabolic rate. Propofol does not impair renal function, does not trigger malignant hyperthermia and does not inhibit hypoxic pulmonary vasoconstriction.

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In Profound MR, IQ is

IQ range for categoriesICD-10DSM-IVMild50-6950-55 to 70Moderate35-4935-40 to 50-55Severe20-3420-25 to 35-40ProfoundBelow 20Below 20-25Reference: Oxford Textbook of Psychiatry; 3rd edition; Chapter 18; Learning Disability

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Which of the following iodinated compound is present in a maximum concentration in the thyroid?

THYROID HORMONE SYNTHESIS AND SECRETIONThyroid hormones are synthesized in the colloid, near the apical cell membrane of the follicular cells. Catalyzed by the enzyme thyroidal peroxidase, iodide in the thyroid cell is oxidized to iodine.The iodine enters the colloid and is rapidly bound at the 3 position to tyrosine molecules attached to thyroglobulin, forming monoiodotyrosine (MIT).MIT is next iodinated at the 5 position, forming diiodotyrosine (DIT).Two DIT molecules then condense in an oxidative process ("coupling reaction") to form one thyroxine (T4) molecule.Some T3 is probably formed within the thyroid gland by condensation of MIT with DIT. A small amount of reverse T3 (rT3) is also formed.In the normal thyroid, the average distribution of iodinated compounds is 23% MIT, 33% DIT, 35% T4, 7% T3, and 2% reverse T3.

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Silicosis caused by ?

Ans. is 'd' i.e., Silica

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Human development index includes -

Ans. is 'c' i.e., Life expectancy at bih According to 22nd/e of Park, options 'd & e' are not the components of HDI. o Expected years of schooling (not adult literacy rate) and GNI per capita (not GDP) are the components of HDI.

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H. capsulatum, a dimorphic fungus, is found in soil heavily contaminated with bird droppings. Which of the following statements best describes the presence of the organism in tissue biopsies?

Histoplasma capsulatum is a dimorphic fungus that forms two types of spores: tuberculate macroconidia and microconidia. Inhalation of the microconidia transmits infection. Inhaled spores (microconidia) are engulfed by macrophages and develop into yeast forms. Most infections remain asymptomatic; small granulomatous foci heal by calcification. However, pneumonia can occur. The heterophile antibody test is useful for early diagnosis of infectious mononucleosis. The figure below illustrates the oval budding yeasts.

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Budding reproduction in tissue is seen in

Cryptococcus is a yeast, candida is a yeast-like fungus. Both are reproduced by budding Histoplasma is a dimorphic fungus Mucor and Rhizopus are produced by asexual means sporangiospores Reference: Textbook of Microbiology; Baveja; 4th edition

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True about polio:

False 90-95% of polio infections are asymptomatic False Acute flaccid paralysis is seen in Polio & not spastic paralysis True Risk of paralytic polio is increased by tonsillectomy, strenous physical exercise, tooth extraction,Injection (intramuscular) False OPV drops are given to all children less than 5 yr age in pulse polio immunisation

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The retention of dowel in a pin retained crown is increased by

Post should be at least 2/3 the root length, parallel sided and serrated for increased retention in the canal

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Which of the following drugs can be administered by subcutaneous route?

terbutaline can be given as s.c (0.25mg) in asthma.

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Mycosis fungoides which is not true:

Mycosis Fungoides: Mycosis fungoides is synonymous with Cutaneous T cell lymphoma.

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Bacterial pyogenic parotitis affecting the parotid gland is most common after: March 2008

Ans. C: Debilitation after major surgery Acute bacterial parotitis is now infrequent, but its historical impoance. Mumps and bacterial parotitis were differentiated by 1800, but neither was effectively treated. The moality rate for bacterial parotitis was 80%. Before antibiotics and intravenous administration of fluids were available, bacterial parotitis occurred in postoperative patients or other severely ill patients who became dehydrated and contributed to their demise as an incurable sepsis.

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Patient diagnosed as squamous cell intraepithelial lesion which of the following has the highest risk for progression to carcinoma;

High grade squamous intraepithelial lesion have a propensity to progress and become invasive, therefore need investigations and treatment Ref: Shaw Gynecology 17 e pg 410.

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Autosomal recessive polycystic kidney disease features include:

Ans. A. Can be diagnosed intrauterineExplanationClinical features of ARPKD (Autosomal recessive polycystic kidney disease) are:Classic ARPKD is generally diagnosed in utero or within the neonatal period and characterized by greatly enlarged echogenic kidneys in diseased fetuses. (Option a)Reduced fetal urine production may contribute to oligohydramnios and pulmonary hypoplasia.About 30% of affected neonates die shortly after birth due to respiratory insufficiency. Close to 60% of mortality occurs within the first month of life.In the classic group, most patients are bom with renal insufficiency and ESRD (End stage renal disease). (Option b)However, infants often have a transient improvement in their GFR; death from renal insufficiency at this stage is rare.Some patients are diagnosed after the neonatal stage and form the older group. Morbidity and mortality in this group often involve systemic hypertension, progressive renal insufficiency, and liver manifestations.The hallmarks of ARPKD liver disease are biliary dysgenesis due to a primary ductal plate malformation with associated periportal fibrosis, namely congenital hepatic fibrosis (CHF) and dilatation of intrahepatic bile ducts (Caroli's disease). CHF and Caroli's disease can then lead to portal hypertension exhibiting hepatosplenomegaly, variceal bleeding, and cholangitis.Some patients with the diagnosis of ARPKD at 1 year of age with nephromegaly exhibit slowly declining renal function over 20 years with only minimally enlarged kidneys at ESRD (Option c and e) and markedly atrophic kidneys following renal transplantation.The slow progression of renal disease is likely due to increasing fibrosis rather than the development of cysts.Systemic hypertension is common in all ARPKD patients, even those with normal renal function. (option d)

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You are the medical officer in charge of the immunisation programme at a sub-centre and you are informed by the local ASHA worker that one of the children who was immunised has has been dizzy. On fuher investigation it was confirmed that the symptoms were due to anxiety of pain of the injection and not as a result of the vaccine. You would consider the incidence as:

The following are the adverse effect following immunisation: Vaccine reaction - Here the event is caused by the inherent propeies of the vaccine when given correctly. Programme error - In this case the event is as a result of error in preparation, handling or administration of the vaccine. Coincidental - The event after immunisation is not caused by the vaccine but by a chance association. Injection reaction - The anxiety of the pain an injection itself may cause hyperventilation, dizziness etc. This is not a result of the vaccine and is called injection reaction. Ref: Park, 21st Edition, Page 103, 107.

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Bicipital aponeurosis lies over which structure in cubital fossa:-

Bicipital aponeurosis lies superficial to the brachial aery and median nerve. -lies deep to superficial veins. -provides protection for the deeper structures during venepuncture at cubital fossa. -routinely released to decompress the median nerve

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