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Nerve supply to stylohyoid is from?

The stylohyoid is supplied by the facial nerve, which is the nerve of the second pharyngeal arch. Ref: BD Chaurasia's HUMAN ANATOMY, Volume 3, 4th edition.

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Hyponatremia is seen in

Hypothyroidism is one of the causes of hyponatremia, thus thyroid-stimulating hormone determination is mandatory during the evaluation of patients with reduced serum sodium levels. .Patients with moderate to severe hypothyroidism and mainly patients with myxedema may exhibit reduced sodium levels (<135 mmol/L) Ref Davidson 23rd edition pg 370

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Threonine, while metabolism is conveed to which amino acid:

Threonine aldolase cleaves threonine to acetaldehyde and glycine. Ref: Harper 28th edition, chapter 29.

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In a child, non - functioning kidney is best diagnosed by-

Ans. is 'c' i.e., DTPA renogram o The most convenient method of estimation of renal function is by isotope renography. Kumar/85] o Two types of isotope renography is there ? 1) Renogram, DTPA scan or MAG3 DTPA and MAG3 are rapidly excreted by the kidney and are therefore used as radiopharmaceutical agents for dynamic scan. This scan is preferred for the information ? i) About the blood flow of kidney ii) How well each kidney is functioning iii) It there is any obstruction to urine output 2) DMSA scan DMSA is concentrated in the renal parenchyma for a time and is therefore used as static scan. This scan is preferred to lood at structure of kidney, i.e. size, shape and position.

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Ground glass hepatocytes are seen in which of the viral hepatitis -

HBV-infected hepatocytes may show a cytoplasm packed with spheres and tubules of HBs Ag, producing a finely granular cytoplasm ("ground-glass hepatocytes").

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Example of Dimorphic fungus -

Ans. is 'b' i.e., Blastomyces Dimorphic fungio Fungi that have two growth forms, such as mold (filaments) and a yeast, which develop under different growth conditions.o In host tissues or cultures at 3 / C they occur as yeasts, while in the soil and in cultures at 22 C they appear as moulds.o Most fungi causing systemic infections are dimorphic fungi.Examples:# Coccidioides# Histoplasma# Blastomyces# Paracoccidioides# Sporothrix (Sporotrichum)# Candida albicans# Penicillium mameffiNote - Candida albicans is a dimorphic fungus, while other species of Candida are not dimorphic.

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First cell of RBC development:

a. Proerythroblast(Ref: Nelson's 20/e p 2304-2308, Ghai 8/e p 330)Stage of RBC development are: Proerythroblast - Basophillic - polychromatic - Orthochromatic erythroblast - Nucleated RBC - Reticulocyte - Mature RBC.

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Hair on end appearance is seen in:

Ans. Thalassemia

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A patient with multiple hypopigmented & hypesthetic patches on lateral aspect of forearm with abundance of AFB and granulomatous inflammation on histology. The diagnosis is

C i.e. Border line leprosy

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Gartners duct cyst lies in

Gartners duct cyst lies in anterolateral wall of vagina.

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A child can laugh aloud at the age of:-

A child laughs aloud at the age of 4 month. 1 month - ales to sound 2 months - Vocalizes 3 months - Coos 4 months - Laughs aloud

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In which of the following conditions of malabsorption, an intestinal biopsy is diagnostic-:

Answer is C (Whipple's Disease): An intestinal biopsy is diagnostic/specific for malabsorption due to Whipple's disease. Three most commonly asked forms of Malabsorption Syndromes Whipple's Disease Tropical Sprue Coeliac Disease Malabsorption syndrome with systemic Malabsorption syndrome of infectious Malabsorption syndrome of non infectious features with infectious etiology etiology without systemic features etiology without systemic features Etiology Etiology Etiology Gram negative actinomycetee Caused by some strains of E.coli Caused by intolerance to 'gliadin' gluten a Tropheryma whippelii protein found in wheat rye, barley . Biopsy Biopsy Biopsy Biopsy is Abnormal and Biopsy is abnormal but not Biopsy is abnormal but not specific/diagnostic specific/diagnostic specific/diagnostic Lamina Propria is infiltrated with Shoened, thickened villi increased Blunting and flattening surface with villi macrophages containing PAS positive crypt depth infiltration by either absent or broad and sho glycoproteins and rod shaped bacilli mononuclear cells Crypts are elongated

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Constrictions in esophagus are seen at all the levels except:

The esophagus has four constrictions.Where the pharynx joins the upper end - 15 cm from incisor teethThe second is at the where the aoic arch - 22.5 cm from incisor teethThe left bronchus cross its anterior surface - 27.5 cm from incisor teethWhere the esophagus passes through the diaphragm into the stomach - 37.5 cm from incisor teeth These constrictions are of considerable clinical impoance because they are sites where swallowed foreign bodies can lodge or through which it may be difficult to pass an esophagoscope.Because a slight delay in the passage of food or fluid occurs at these levels, strictures develop here after the drinking of caustic fluids. Those constrictions are also the common sites of carcinoma of the esophagus.

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. Immunity by vaccine of yellow fever is provided for:

10 years staing from 10 days after vaccination

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Only Hepatitis virus which can be cultured is:

HAV

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All muscles are useful in Supination and Pronation of Hand EXCEPT

(A) Anconeus # Supination & Pronation are rotatory movements of forearm (and hand) around a vertical axis.> In a semiflexed elbow, the palm is turned upwards in supination, and downwards in pronation Remember: Kings pronate, Beggars supinate> The movements are permitted at the superior and inferior radioulnar joints, there is no middle radioulnar joint, and so no role. The radius is pronated by the pronator teres and pronator quadratus muscles. Pronation is performed by pronator quadratus and pronator teres muscle. Brachioradialis puts the forearm into a midpronated/supinated position from either full pronation or supination. Hand is supinated by the brachioradialis, supinator (brevis), and biceps muscles. The hand is supine in the anatomical position (i.e., palms facing up during autopsy).This action is performed by the Biceps brachii and the Supinator muscle

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Vitamin required for collagen synthesis

The active form of vitamin C is ascorbic acid (Figure 28.8). The main function of ascorbate is as a reducing agent in several different reactions. Vitamin C has a well-documented role as a coenzyme in hydroxylation reactions, for example, hydroxylation of prolyl and lysyl residues of collagen (see p. 47). Vitamin C is, therefore, required for the maintenance of normal connective tissue, as well as for wound healing. Vitamin C also facilitates the absorption of dietary iron from the intestine.Deficiency of ascorbic acid A deficiency of ascorbic acid results in scurvy, a disease characterized by sore and spongy gums, loose teeth, fragile blood vessels, swollen joints, and anemia (Figure 28.9). Many of the deficiency symptoms can be explained by a deficiency in the hydroxylation of collagen, resulting in defective connective tissue.Ref: Lippincott, 5th edition, page no: 377

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Global removal of disease agent refers to

Disease control : Is decrease in incidence of disease, so that it is no more public health problem. Disease elimination : Complete reduction in incidence of disease in defined geographical area, but organism persists. Disease Eradication : Global removal of organism.

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The drug of choice in mycoplasma pneumonia in children is –

Treatment of pneumonia in children For mildly ill patient (not require hospitalization) Empirical treatment → Amoxicillin is the DOC. Atypical (mycoplasma) pneumonia → macrolides (Azithromycin, Erythromycin). For Hospitalized patients IV cefuroxime or cefotaxime or ceftriaxone. If clinical features suggest staphylococcal pneumonia, vancomycin or clindamycin are also added.

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All of the following are advantages of paralleling technique except:

Advantage of Long Cone Technique: 1. Accuracy: The paralleling technique produces an image that has dimensional accuracy (A profile view of the tooth with buccal and lingual roots projected in their normal respective lengths as buccal and lingual cusps correctly related on the same plane); the image is very representative of the actual tooth. The radiographic image is free of distortion and exhibits maximum details and definition. There is no overlap of related structures (eg. the zygomatic shadow), all shadows of anatomical structures are cast in their proper anatomic position. This accuracy is due to: Increased source film distance. Object and film are parallel to each other. Central ray strikes perpendicular to the long axis of the tooth and film. Though the object film distance is increased, it is compensated by increased source film distance and therefore, there is decreased enlargement. The increased kVp, to reduce exposure time, as the source film distance is increased, helps by reducing secondary and unwanted, short wavelength radiations. 2. Simplicity: This technique is simple and easy to learn and use. The film holder with a beam alignment device eliminates the need for all dental surgeons to determine horizontal and vertical angulations and also eliminates chances of dimensional distortion and coning off. 3. Duplication: This technique is easy to standardize and can be accurately duplicated or repeated, when serial radiographs are indicated. As a result, comparison of serial radiographs exposed using this technique have great validity. 4. Facial screens can be used. 5. There is decreased secondary radiation. 6. The radiographs produced give, An excellent bone level assessment. No elongation or foreshortening seen in the periapical region. Interproximal caries is clearly indicated. 7. The shadow of the zygomatic bone appears above the apices of the molar teeth. 8. The periodontal bone levels are well represented. 9. The periapical tissues are accurately shown with minimal foreshortening or elongation. 10. The crowns of the teeth are well shown enabling detection of proximal caries. 11. The relative positions of the film packet, teeth and X-ray beam are always maintained, irrespective of the position of the patient’s head. This is useful for handicapped and compromised patients.

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Which muscle is attached to intra-articular disc of temporomandibular joint ?

Ans. is 'd' i.e., Lateral pterygoid Temporomandibular jointo It is a synovial, bicondylar joint between the mandibular fossa and articular tubercle of temporal bone above and the head of mandible below. The joint is completely divided into two compartments (upper and lower) by a fibro cortilaginous articular disc. Ligaments of TM joints are fibrous capsule, Lateral temporomandibular ligament, and stylomandibular ligament.o The articular disc is a fibrocartilaginous disc which divides joint cavity into an upper and a lower compartment. The upper compartment permits gliding movement and the lower compartment permits rotatory as well as gliding movements. The articular disc represents the degenerated premitive insertion of lateral pterygoid: Central portion of articular disc is least vascular. Articular disc acts as shock absorber, prevents friction between articular surfaces and also has proprioceptive function. Articular disc also increases the area of contact and hence helps in distribution of weight across the joint, o There are following movements in TM joints1) Protrusion (protraction of chin):- Lateral and medial pterygoid of both sides acting together, assisted by superficial fibers of masseter.2) Retraction (Retraction of chin):- Posterior fibers of temporalis assisted by deep fibers of masseter.3) Elevation (Closing of mouth):- Masseter, temporalis, and medial pterygoid, of both sides.4) Depression (opening of mouth):- Both lateral pterygoids assisted by digastric, mylohyoid and geniohyoid.5) Side to side (lateral) movement:- Lateral and medial pterygoid of one side acting alternately with each other.o Dislocation of mandible occurs when mouth is opened too widely by excessive contraction of lateral pterygoid. Head of the mandible slips anteriorly into infratemporal fossa, o TM joints is supplied by auriculotemporal nerve and masseteric nerve.

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Flowing wax appearance on anterior and posterior borders of veebrae is seen in -

Radiological features of DISH (Diffuse Idiopathic skeletal hyperostosis) : Flowing calcification and ossification along the anterolateral aspect of veebral bodies. - Flowing wax appearance Preserved disc space. Absence of bony ankyosis of facet joints,absence of sacroiliac bony erosion,sclerosis or bony fusion.

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A 4-year-old child presented with a palpable abdominal mass in the right flank region which was painless and slowly increasing in size along with some episodes of fever and hematuria. On examination, hypeension was noted. CT scan of the abdomen was done. The patient was operated and the mass was resected. The gross specimen and the HPE examination are given below. All of the following drugs are approved for the above condition except: -

This is a case of Wilm's tumour. Wilms tumor is often associated with mutations in the WT1 gene, CTNNB1 gene, or AMER1 gene CT image shows a mass in the right kidney. Gross nephrectomy specimen shows a Wilms tumor pushing the normal renal parenchyma to the side. HPE image shows the characteristic three components: Malignant small round (blue) cells ~ 2x the size of resting lymphocyte (blastema component) Tubular structures/rosettes (epithelial component) Loose paucicellular stroma with spindle cells (stromal component) The median age at diagnosis of this kidney tumor (see the image below) is approximately 3.5 years. Clinical findings include the following: Asymptomatic abdominal mass (in 80% of children at presentation) Abdominal pain or hematuria (25%) Urinary tract infection and varicocele (less common) Hypeension, gross hematuria, and fever (5-30%) Hypotension, anemia, and fever (from hemorrhage into the tumor; uncommon) Respiratory symptoms related to lung metastases (in patients with advanced disease; rare) Drugs approved for chemotherapy are: - Cyclophosphamide Vincristine Doxorubicin Dactinomycin

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Which hormone increases with age ?

Ans. is 'c' i.e., FSHIncreasing age affects the hormonal secretion of body.

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Most common genetic mutation in Ca pancreas

MC genetic mutation in Ca pancreas/ Cholangiocarcinoma - KRAS > p-16 MC genetic mutation in Ca- GB - P53 > K-RAS MC genetic mutation in Ca stomach - P53 > COX - II

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Leukocyte alkaline phosphate is increased in all, except

Answer is B (CML): Leucocyte Alkaline phosphatase is decreased in CML (chronic myeloid leukemia) PNH (Paroxysmal nocturnal hemoglobinuria)

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The protein synthesis is soed out at/by

Main function of Golgi apparatus is protein soing, packaging, and secretion. Mitochondria are the powerhouse of cell. Detoxification of various drugs is an impoant function of ER. Ribosomes are involved in protein synthesis.Ref: DM Vasudevan - Textbook of Biochemistry for Medical Students, 7th edition, page no: 12

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The below mentioned fundus shows presence of:

Ans. (a) Forster-Fuchs spots.

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Open fracture is treated by

C i.e. Debridement

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A 59 yr old man with severe myxomatous mitral regurgitation is asymptomatic,wi wia left ventricular ejection fraction of 45% and an endsystollic diameter index of 2.9cm/m2 . The most appropriate treatment is

Ref Harrison 19 th ed pg 1545 Valve repair for ischemic MR is associated with lower periopera- tive moality rates but higher rates of recurrent MR over time. In patients with ischemic MR and significantly impaired LV systolic function (EF <30%), the risk of surgery is higher, recovery of LV per- formance is incomplete, and long-term survival is reduced.

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Pregnant and lactating mothers need_____ mg of dietary calcium per day

Ans. d (1000 mg) (Ref. Park Textbook of PSM 22nd/pg.590; table 29)PREGNANCYLACTATION# Extra calories - 300,# Extra calories - 550 (0 to 6 months) 400 (6 to 12 months),# Extra proteins - 15 g,# Extra proteins - 25 gm (0 to 6 months) 18 gm (6 to 12 months),# Calcium 1000 mg/day,# Calcium 1000 mg/day, iron - 30 mg/day,# Iron - 38 mg/day,# Folic acid - 150 mg/day.# Folic acid - 400 mg/day.

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Most common malignancy in children is

Leukemia is most common malignancy in the pediatric age groupLeukemia/lymphoma =40% (ALL is more common than AML)CNS Tumor=30%Embryonal & Sarcoma=10%2nd most common is CNS Tumor (30%)(Refer: Nelson's Textbook of Pediatrics, SAE, 1st edition, pg no. 2437-2445)

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Blood loss in class III hemorrhagic shock

Class I - < 750 mL Class II - 750 - 1500mL Class III - 1500 - 2000mL Class IV - 2000mL.

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Which of the following agents is recommended for treatment of Gastrointestinal Stromal Tumors (GIST) -

Ans. is 'b' i.e., Imatinib Tyrosine kinase inhibitors imatinib and sunitinib are approved for the treatment of Gastrointestinal Stromal Tumors (GIST)

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Drug causing impaired taste is

antibiotics, such as ACE inhibitors like <a class="content-link" style="-webkit-font-smoothing: antialiased; box-sizing: inherit; background-color: transparent; cursor: pointer; text-decoration-line: none; border-color: currentcolor; color: ;" href=" anhydrase inhibitors, such as methazolamide etc</li> ESSENTIALS of medical PHARMACOLOGY SIXTH EDITION-KD TRIPATHI Page:688,689

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Down syndrome is due to non-disjunction of?

Ans. is 'a' i.e., 21 Chromosome In 95% of cases of Down syndrome-trisomy of 21:? Extra chromosome is of maternal in origin. 1% have mosaic with some all have 46 chromosome. 4% have robesonian translocation. t (13 21) o t (14 : 21) t (15 : 21) Very rarely long arm of chromosome 21 is triplicate (Paial trisomy).

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Secretin stimulation test used for -

Ans. is 'a' i.e., Gastrinoma Gastrin Provoking tests* Gastrin provocative tests have been developed in an effort to differentiate between the causes of hypergastrinemia.* The tests are the secretin stimulation test and the calcium infusion study.* The most sensitive and specific gastrin provocative test for the diagnosis of gastrinoma is the secretin study. An increase in gastrin of >120 pg within 15 minutes of secretin injection has a sensitivity and specificity of >90% for ZES. PPI induced hypochlorhydria or achlorhydria may lead to a false-positive secretin test, thus this agent must be stopped for 1 week before testing.* The calcium infusion study is less sensitive and specific than the secretin test, which coupled with it being a more cumbersome study with greater potential for adverse effects, relegates it to rare utilization in the cases where the patient's clinical characteristics are highly suggestive of ZES, but the secretin stimulation is inconclusive.

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A patient has Bullous Lesion; on Tzank smear

B i.e. Acantholysis

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Klatskin tumor: (Repeat)

Ans: B (Cholangiocarcinoma arising from bifurcation of bile duct) Ref: Benbrahim Z et al. Askin's tumor: a case report and literature review. World J Surg Oncol. 2013: 11: 10.Explanation:Cholangiocarcinoma arising from bifurcation of bile duct - Klatsin tumorLung adenocarcinoma involving apical region - Pancoast tumorAskin tumors - Primitive neuroectodermal tumors (PNET) arising from the chest wallOther named TumorsBuschke-Lowenstein tumor-- Giant condyloma acuminatumAckerman tumor - Subtype of Verrucous Carcinoma (Carcinoma cuniculatum)Grawitz tumor - Renal cell carcinomaKrukenberg tumor - Metastatic secondaries in GIT from an ovarian primaryKuttner's stumor - Sialadenitis (sialoadenitis) - Inflammation of a salivary glandPotts puffy tumor - Frontal osteomyelitis with subperiosteal abscess e:Wilms tumor - Nephroblastoma affecting children

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TRUE about Vein of Labbe:

Superficial Middle Cerebral Vein communicates with the transverse sinus inferior anastomotic vein of Labbe. The Vein of Labbe is inferior (not superior) anastomotic vein, which crosses and anastomoses at its two ends with the Middle Cerebral Vein and the transverse sinus (not superior sagittal sinus). It drains its adjacent coical regions gathering tributaries from minor veins of the temporal lobe (not superior cerebral veins).

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Aldosterone regulates extracellular volume and potassium homeostasis by binding to its receptors present in all, EXCEPT:

Aldosterone regulates extracellular volume and potassium homeostasis by binding to renal coical collecting duct principal epithelial cell mineralocoicoid receptors. The mineralocoicoid receptor -- a member of the nuclear receptor family and also found in the hea, colon, and hippocampus -- is localized to the cytoplasm prior to activation, undergoes a conformational change on binding to aldosterone, and translocates into the nucleus where it functions as a transcription factor. Aldosterone is rapidly inactivated to tetrahydroaldosterone in the liver. Ref: Young, Jr W.F. (2011). Chapter 10. Endocrine Hypeension. In D.G. Gardner, D. Shoback (Eds), Greenspan's Basic & Clinical Endocrinology, 9e.

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Disorders of phagocytosis are all, except:

Ans. (d) Wiskott-Aldrich syndrome Ref. Anantlumarayan 9/e, p 172 Disorders of phagocytosis Chronic granulomatous disease Myeloperoxidase deficiency Chediak-Higashi syndrome Leukocyte G6PD deficiency Job's syndrome Tuftsin deficiency Lazy leukocyte syndrome Hyper-IgE syndrome Actin binding protein deficiency Shwachman's disease

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Consider the following characteristics of vaginal discharge in bacterial vaginosis :

Whiff test positive

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Which among the following is ANCA negative?

Ans: c (PAN) Ref: Robbins, 7th ed, p. 539 & Harrison, 16th ed, p. 2002"PAN has no association with ANCA"More about PAN:* Vasculitis of medium sized/small muscular arteries sparing pulmonary circulation* Characteristic -- All stages of inflammation coexist in different vessels.Microaneurysms (< 1 cm) - but not pathognomonic* 30% patients have hepatitis B Ag in their serum* MC organ system involved -- musculoskeletal > renal* MC cause of death -- gastrointestinal* Involvement of venules is suggestive of microscopic polyangitis

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Unmet need for contraception in a 35 years female is for ?

Ans. is 'b' i.e., Limiting bih Many women who are sexually active would prefer to avoid pregnancy, but neveheless are not using any method of contraception.These women are considered to have 'unmet need' for family planning.The concept is usually applied to married women.According to the National Family Health Survey-3, Unmet need for family planning is highest (27.1%) among women below 20 years age and is almost entirely for spacing the bihs rather than for limiting the bihs.It is also relatively high for women in age group 20-24 years (21-1%) with 75% need for spacing and 25% for limiting the bih.Unmet need for contraception among women aged 30 years and above are mostly for limiting

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While shaving, a 45-year-old teacher notices a marble-sized mass beneath his left ear. The mass is eventually excised, revealing which of the following benign parotid gland lesions?

Papillary cystadenoma lymphomatosum /Wahin's tumor/Adenolymphoma Exclusively seen in parotid gland Derived from salivary tissue inclusion in lymph node More common in males Associated with smoking Only tumor to show hot spot on TC99m-Peecnate Histopathology Papillary cystic pattern lined with columnar oncocytes and cuboidal cells with marked lymphoid component. Lined by a double layer of neoplastic epithelial cells resting on a dense lymphoid stroma sometimes bearing germinal centers =Mikulicz's disease involves chronic inflammation and swelling of the salivary glands, which is benign and usually painless

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Substrate for gluconeogenesis include?

Only 5 amino acids are both glucogenic and ketogenic. Mnemonic - TTT I P Both glucogenic and ketogenic amino acids: Tryptophan Tyrosine Threonine, Isoleucine, Phenylalanine Note: there is a controversy regarding Lysine, some book says it is purely ketogenic some say it is both Ketogenic and glucogenic serine is only glucogenic amino acid.

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Langerhans cells in skin are

Ans. is 'a' i.e., Antigen presenting cells

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Black eye is a type of-

Ans. is 'c' i.e., Ectopic bruise [Ref: Reddy 30th/ep. 167-168\o Site of bruise is at the site of impact most of the time however it may be away from the site of impact due to gravity shifting of blood, i.e., ectopic bruise. So, site of bruise does not always indicate site of violencet.o Example of ectopic bruise are : -Black eye (or spectacle hematoma in eyes & eyelids) may be due to fracture of floor of anterior cranial fossa or trauma of forehead (and rarely due to direct trauma),Bruise behind ear indicates basal fracture (rather than a direct blow).Jaw fracture may produce bruise in neck; fracture pelvis my produce bruise in thigh; fracture femur may produce bruise in lowrer thigh or above knee; Calf injury may produce bruise in ankle.

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Umbilical cord attached to the margin of placenta:

Ans. (b) Battledore placentaRef. William's Obstetrics 23rd ed. Ch: 27* Normally, the cord usually is inserted at or near the center of the fetal surface of the placenta.* Cord insertion at the placental margin is sometimes referred to as a Battledore placenta. It is found in about 7% of term placentas.* Velamentous insertion: This type of insertion is of considerable clinical importance. The umbilical vessels spread within the membranes at a distance from the placental margin, which they reach surrounded only by a fold of amnion. As a result, vessels are vulnerable to compression, which may lead to fetal anoxia. Incidence: 1%

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Cataracts in a newborn is:

a zonular refkhurana 3rd/e p. 187

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The causative agent of Lyme's disease:

Borrelia burgdorferi

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A patient presented with vomiting and ataxia. There were oxalate crystals in the urine. The patient was given ethanol and 4 methyl pyrazole for treatment. The likely diagnosis of the patient was?

Ans. (C) Ethylene glycol poisoning(Ref: Harrison 19/e p319)Symptoms of alcohol overdose along with oxalate crystalluria points towards ethylene glycol poisoning. It is confirmed because the patient is being treated with antidotes like ethanol and fomepizol (4 methyl pyrazole).

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Loeffler's syndrome is seen with all except :

Giardiasis Pulmonary diseases associated with tissue or blood eosinophilia are a heterogenous group of disorders. They are classified as : Loeffler's syndrome It is a benign acute eosinophilic pneumonia of unknown cause characterized by migrating pulmonary infiltrates and minimal clinical manifestations. These are usually secondary to parasites or drugs. Loeffler's syndrome reflects a hypersensitive response to an ingested or inhaled antigen from food, medication or an infectious agent. Causes of Loeffler's syndrome Parasitic infections Ascaris Schistosomiasis Strongyloides Ancyclostomiasis Trichomoniasis Clonorchiasis Visceral larva migrans Tapeworm Paragonimiasis

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A 60-year-old woman presents with symptoms of weight loss, anxiety, and palpitations. On examination, she has a thyroid goiter. Which of the following is the most likely cardiac finding?

Thyroid disease may affect the heart muscle directly or there may be excessive sympathetic stimulation. Common symptoms of thyrotoxic heart disease include palpitations, exertional dyspnea, and worsening angina. Atrial fibrillation is particularly common in older individuals.

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Pedigree analysis - Analyze the following pedigree and give the mode of inheritance ?

Ans. is 'c' i.e., Mitochondrial inheritance i) Disease is manifesting in both males and females. ii) But, the disease is transmitting to next generation only by females (mother). Both these are characteristics of mitochondrial diseases. Mitochondrial diseaes o Mitochondria' DNA is the only non-chromosomal DNA in human cells DNA in humans may be found either in the Nucleus (Nuclear DNA) or in the Mitochondria (Organelle DNA) o Mitochondria' DNA,is always maternally inherited. Mitochondrial and nuclear DNA are located in different places in the cell. During feilization, the sperm and egg cell nuclei fuse to form an embryo. The egg cell is very large compared to the sperm, so although the cells' nuclei fuse, the rest of the cell mass in the embryo comes from the egg only. Nuclear DNA is therefore co-inherited but the mitochondrial DNA, which is located outside of the nucleus, is always maternally inherited because all mitochondria in a foetus and later adult are derived from the mitochondria in the mother's egg. All children from affected mother will inherit the disease but it will not be transmitted from an affected father to his children.-

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Term cafe coronary was coined by -

Ans. is 'a' i.e., Roger Haugen "A popular term 'cafe coronary * was coined by Dr. Roger Haugen, Medical Examiner of Broward County, Florida for such impaction of food in the respiratory passage ".-- Krishan Vij

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Demyelinating disorder among the following is

Multiple sclerosis is a autoimmune disorder It leads to demyelination of myelinated nervefibers Ref:Guyton and Hall textbook of medical physiology 12th edition,page number:72,73

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IL1 antagonist is -

Ans. is 'a' i.e., Anakinra Drugs used for Rheumatoid arthritisDisease modifying antirheumatic drugs (DMARDs)Biologic response modifier (BRMs)Adjuvant drugs1. Immunosuppresants - Methotrexate, azathioprine, cyclosporine2. Sulfasalazine3. Choloroquine or hydroxychloroquine4. Leflunomide5. Gold sod. thiomalate, Auranofin6. d - Penicillamineo TNF a - inhibitors Etanercept, Infliximab, Adalimumabo IL-1 antagonist Anakinrao CorticosteroidsNote- Other immunosuppressants like cyclosporine, chlorambucil, cyclophosphomide are reserved for cases not responding to other DMARDs.

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Direct filling gold formed by electrolytic precipitation is called by all the terms, EXCEPT:

Electrolytic Precipitate Gold Another form of direct filling gold is microcrystalline gold powder formed by electrolytic precipitation, which is sandwiched between sheets of gold foil and formed into strips. It is also called mat or sponge gold. Granular (Powdered) Gold Gold powders in agglomerated form can also be prepared by chemical precipitation or atomization from molten gold. Direct filling gold is supplied in three basic forms: Foil (also known as fibrous gold) Electrolytic precipitate (also called crystalline gold) Granular gold (also called powdered gold) Phillips 12 Ed, page no. 413

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Predominant blood supply to the supraduodenal bile duct is from vessels:

Approximately 60% of the blood supply to the supraduodenal bile duct originates from the pancreaticoduodenal and retroduodenal aeries, whereas 38% of the blood supply originates from the right hepatic aery and cystic duct aery and 2 percent is non-axial.Ref: Gray's Anatomy (40th Edition), Pages 1177, 1185; Essentials of Human Anatomy A.K.Datta 8th Edition, Page 259

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Which of the following is not involved in intrinsic pathway?

Factor VII is required for the activation of Factor X in extrinsic pathway Ref: Ganong's Review of Medical Physiology Twenty-Third Edition Page No:533

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General feility rate is a better measure of feility than the crude bih rate because the denominator includes

General feility rate is the number of live bihs per 1000 women in the reproductive are group ( 15-44 or 49 years) in a given year GFR = number of live bih in an area during the year X 1000/ mid year female population age group 15-44 (or 49) in the same area in same year General feility rate is a better measure of feility than the crude bih rate because the denominator includes the number of women in the child bearing age rather than the whole population Reference : Park&;s textbook of preventive and social medicine, 23rd edition, Page no: 488

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Not a feature of Hartnup's disease:

c. Mental retardation(Ref: Nelson's 20/e p 636-642, Ghai 8/e p 653-655)Clinical features of Hartnup disease:Most children with Hartnup defect remain asymptomaticMajor clinical manifestation in symptomatic patient is cutaneous photosensitivity: pellagra-like rash on sun exposureSome patients may have intermittent ataxia & Psychological disturbances, but mental development is usually normal.

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A 65-year-old chronic smoker presents with a rapidly enlarging large hilar mass on a chest film associated with significant adenopathy. He also experiences recurrent hypoglycemic spells these days. A provisional diagnosis of Lung carcinoma being considered which of the following subtype will most commonly lead to this spectrum?

Small cell - Mediastinal adenopathy, - Hilar mass, - Small or invisibleftlung nodule, - High metastatic potential, - Rapid growth. - May be associated with Hypoglycemia, Cushing's syndrome, Inappropriate secretion of ADH, excessive gonadotropin secretion.

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Which is not a feature of non cirrhotic poal HT?

.

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Giardiasis is best diagnosed by:

Presence of both cysts and trophozoites in stools

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Biopsy of the parotid gland in Sjogren’s shows:

"The earliest histologic finding in both the major and the minor salivary glands is periductal and perivascular lymphocytic infiltration." (Ref: Robbins) Sjogren Syndrome It is an immune-mediated destruction of the lacrimal and salivary glands characterized by dry eyes {keratoconjunctivitis sicca) and dry mouth (xerostomia) It occurs as an isolated disorder (primary form), also known as the sicca syndrome, or more often in association with another autoimmune disease (secondary form). Associated diseases Rheumatoid Arthritis (Me) SLE Polymyositis Systemic sclerosis Vasculitis Thyroiditis The ductal epithelial cells of the exocrine glands are the primary target for autoantibodies. There is also systemic B-cell hyperactivity, as evidenced by the presence of ANAs and RF. Autoantibodies to the RNP antigens SS-A (Ro) and SS-B (La) (also present in SLE) Other secretory glands like nasopharynx, upper airway, and vagina, may also be involved Involved tissues show an intense lymphocyte (primarily activated CD4+ T cells) and plasma cell infiltrate. Lacrimal gland destruction results in a lack of tears, leading to drying of the corneal epithelium, with subsequent inflammation, erosion, and ulceration (keratoconjunctivitis). Similar changes may occur in the oral mucosa as a result of the loss of salivary gland output, giving rise to mucosal atrophy, with inflammatory Assuring and ulceration (xerostomia). Dryness and crusting of the nose may lead to ulcerations and even perforation of the nasal septum. When the respiratory passages are involved, secondary laryngitis, bronchitis, and pneumonitis may appear. Approximately 25% of the patients (especially those with anti-SS-A antibodies) develop extra-glandular disease affecting the CNS, skin, kidneys, and muscles. Renal lesions take the form of mild interstitial nephritis associated with tubular transport defects: Unlike in SLE. glomerulonephritis is rare. 90% of cases occur in women between 35 and 45 years Extraglandular manifestations include synovitis, pulmonary fibrosis, and peripheral neuropathy. There is a 40-fold increased risk of developing non-Hodgkin B-cell lymphoma.

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The disease for which vaccination ceificate is required for international travel is -

All travellers including infants exposed to the risk of yellow fever or passing through an endemic zones of yellow fever should possess a valid international ceificate of vaccination against yello fever before they are allowed to enter yellow fever receptive areas. Reference; Park&;s Textbook of preventive and social medicine, 24th edition.Pg no. 301

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24 hours after fever, maculopapular rash and erythema appears on the face of infant. This organism can also cause

It’s caused by Parvo B19 virus, and it causes the following diseases Erythema infectiosum Fifth disease. Slapped cheek appearances. Arthropathy. Transient Aplastic crisis. Hydrops fetalis (most sensitive period 2nd trimester) Myocarditis. PPGSS Papular - Purpuric Gloves & Stock Syndrome.   Transient Aplastic Crisis The transient arrest of erythropoiesis and absolute reticulocytopenia. RBC aplasia or transient aplastic crisis in patients with chronic hemolytic conditions, including: Sickle cell disease. Thalassemia. Hereditary spherocytosis. Pyruvate kinase deficiency. In contrast to children with erythema infectiosum only, patients with aplastic crisis are ill with fever, malaise, and lethargy and have signs and symptoms of profound anemia, including pallor, tachycardia and tachypnea. The incubation period tor transient aplastic crisis is shorter than that for erythema infectiosum because the crisis occurs coincident with the viremia. Children with sickle cell disease may also have a concurrent vasoocclusive pain crisis.

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Which of the following is not a bronchodilator

Classification: bronchodilators: beta 2 agonists anticholinergics and methylxanthines like caffeine and theophylline ref KD Tripathi 8th ed

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Difference between contusion and post-moem lividity is that post-moem lividity-

The synopsis of forensic medicine & toxicology;Dr k.s narayan reddy; 28th edition;pg.no. 88; Contusion or bruises are not washable but postmoem lividity is washable. Also refer page no.106

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Fomepizole acts as antidote for ?

Ans. is 'a' i.e., Methanol poisoning Methanol is highly toxic alcohol. It is metabolized to formaldehyde (by alcohol dehydrogenas) and formic acid (by acetaldehyde dehydrogenase). It is the accumulation of formic acid which causes toxic effects in methanol poisoning. Accumulation of formic acid results in lactic acidosis/high anion gap metabolic acidosis with low plasma bicarbonates, blindness due to retinal damage, papilledema. Methanol poisoning can be treated by suppoive measures, gastric lavage and sodium bicarbonate (to treat acidosis). Ethanol is useful because it competitively inhibits the conversion of methanol to formic acid. Fomepizole can also be used as it is a specific inhibitor of alcohol dehydrogenase. Folic acid or folinic acid. Enhance the metabolism formic acid to CO2. Hemodialysis may also be used.

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Chancroid is caused by?

Ans:A.)H. Ducrei CHANCROID (SOFT SORE) This venereal infection is caused by the Gram-negative bacillus Haemophilus ducreyi. One to 5 days post-infection, a soft sloughy ulcer appears on the penis or vulva. The treatment of choice is erythromycin (500 mg 6-hourly for 14 days).

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Pentavalent immunoglobin is -

Ans. is 'c' i.e., IgiMValency of antibodyo The valency of antibody refers to the number of antigenic determinants that an individual antibody molecule can bind.o The valency of all antibodies is at least two and in some instances more.AntibodyValencyIgG2IgA2,4IgM10IgD2IgE2Though the theoretical valency of Ig M is ten, this is observed only with small haptens. With larger antigens, the effective valency falls to five, probably due to steric hindrance. Physical, chemical, and Biologic Properties of Human ImmunoglobulinsPropertyIgGIgAIgMIgDIgEUsual molecular formMonomerMonomer, dimerPentamer, hexamerMonomerMonomerOther chainsNoneJ chain, SCJ chainNoneNoneSubclassesG1G2, G3, G4Al, A2NoneNoneNoneHeavy chain allotypesGm (=30)No Al, A2m (2)NoneNoneNoneMolecular mass, kDa150160, 400950, 1150175190Sedimentation constant, Sw206.6S7S, 11S19S7S8SCarbohydrate content, %3710913Serum level in average adult, mg/mL9.5-12.51.5-2.60.7-3.70.040.0003Percentage of total serum Ig75-857-155-100.30.019Serum half-life, days236532.5Synthesis rate, mg'kg per day3 365'0.40.016Antibody valency22, 430, 12O Classical complement activation+ (G1, 2?, 3)----Alternate complement activation-(G4)+-+-Binding cells via FcMacrophages neutrophils, large granular lymphocytesLymphocytesLymphocytesNoneMast cells, basophils, B cellsBiologic propertiesPlacental transfer, secondary Ab for most antipathogen responsesSecretory immunoglobulinPrimary Ab responsesMarker for mature B-cellsAllergy, antipaTasite responses

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BCR ABL gene mutation is seen in ?

ANSWER: (A) CMLREF: Robbins 7th ed p. 697BCR gene on chromosome 9 gets translocated to ABL gene on chromosome 22 leading to the formation of a fusion protein with a tyrosine kinase activity.

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T helper cells recognizes -

MHC restriction T cells (in contrast to B cells) cannot be activated by soluble antigens. Therefore, presentation of processed antigen by antigen presenting cells is required for induction of cell mediated immunity. T cell receptors recognizes peptide antigens that are displayed by major histo compatibility complex (MHC) molecules on the surface of antigen presenting cells. T cells develop MHC restriction so that :- Helper (CD4) T cells respond only to foreign antigens presented along with HLA class II (MHC class II). CD8 T cells respond to antigens presented along with HLA class I (MHC class I). MHC restriction refers to the fact that a given T cell will recognize a peptide antigen only when it is bound to a particular MHC molecule.

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Most sensitive test for detection of argemone oil?

Ans. is 'b' i.e., Paper chromatography o Paper chromatography is the most sensitive test. o Note : In previous question, paper chromatography was not there in options, therefore the answer was nitric acid test.

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Prostaglandin inhibiting action of Aspirin is useful in the treatment of all of the following conditions except

Inhibition of prostaglandin synthesis is responsible for analgesia, antipyretic, anti-inflammatory and antiplatelet action of aspirin. this action is also utilised in the treatment of PDA. high doses of Aspirin causes uricosuria various therapeutic doses result in hyperuricemia these effects are and related to its action on prostaglandin synthesis Ref kdt 6/e p188

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Dermatological sign of carcinoma stomach is?

ANSWER: (C) Acanthosis NigransREF: Fitz Patricks Dermatology 6th Edition Page 1612, Harrison's 18th ed chapter 53Indirect repeat Dermatology 2008,2003 (See table of TYPES AND CAUSES OF ACANTHOSIS NIGRICANS) 8t Surgery June 2009

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Which one of the following statements best describe pseudoaneurysm

Pseudoaneurysm Wall is not formed by all the three layers Pseudoaneurysms can arise from Primary defects in the aoic wall (e.g -After trauma or contained aneurysm rupture) Anastomotic or cannulation site leaks that occur after cardiovascular surgery. Anastomotic pseudoaneurysms can be caused by Technical problems Deterioration of the native aoic tissue, graft material, or suture. Associated with Marfan syndrome, Loeys-Dietz syndrome Progressive degenerative disease Infection. Saccular aneurysm: affect only one pa of aerial circumference

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'Brush burn' is

Ans. a (An abrasion) (Ref. FMT by Reddy. 27th/ Pg. 145 & FMT by Krishan Vij 4th/Pg. 282-283).# An abrasion (or a graze) is a superficial injury involving only the outer layers of the skin and not penetrating the full thickness of the epidermis.# A graze is an injury, which is produced when a broad surface of the skin slides or scrapes against a rough surface.# It is also k/a 'brush burn' as it is caused by the frictional force of rubbing against a surface causes it; resembles a bum.ABRASIONS (GRAZES, SCRATCHES, BRUSH BURNS)# Loss/crushing of outer skin layer due to impact with a rough surface- Tangential impact produces a moving abrasion:# Indicates direction.# Trace material (e.g., grit).- Direct impact produces an imprint abrasion:# Pattern of causative object.# All abrasions reflect site of impact (contrast bruises).# Assessment of age difficult.# Postmortem abrasion - Brown, leathery.- Patterned Abrasions:o Patterned abrasions occur when the force is applied at or around right angle to the surface of skin. The classical example of this is seen in traffic accidents when tyre of a motor car passes over the skin leaving the pattern when the skin has been squeezed into the grooves of the rubber thread.- Pressure Abrasions (Crushing Abrasions / Imprint Abrasions):o When the impact is vertical to the skin surface, the epidermis gets crushed and pressure type of abrasions result and the imprint of the impacting object may be produced. These may be seen in manual strangulation (abrasions produced by fingernails) and in hanging, where weave of the ligature material may be reproduced.

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Characteristic feature of nephritic syndrome in children -

Ans. is 'c' i.e., RBC casts in urine Acute nephritic syndrome o Nephritic syndrome is a collection of signs associated with disorders affecting the kidneys, more specifically glomerular disorders and is characterized by haematuria, protenuria, hypeension, edema and oliguria. 1. Haematuria The haematuria is slight giving the urine smok appearance. Erythrocytes are detectable by microscopy or by chemical testing for hemoglobin. Presence of RBC casts in urine is classical feature of nephritic syndrome. 2. Proteinuria Proteinuria is mild (< 3 gm/day) also called nephritic range proteinuria or subnephrotic range proteinuria. Proteinuria is nonselective. Edema --> Usually mild and results from sodium and water retention. Liguria --> Reflects the severity of glomerular involvement. Note ? Edema and proteinuria are not as severe as in nephrotic syndrome.

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A 24-year old woman notices increasing shortness of breath after recent treatment for right lower lobe pneumonia. She has no fever, cough, or sputum production. On examination, the pertinent findings are decreased fremitus, dullness on percussion, and absent breath sounds of the right lower lung. In addition, the trachea has shifted to the left.For the above patient with abnormal pulmonary physical findings, select the most likely diagnosis.

Careful physical examination can be very useful in diagnosing many common pulmonary disorders. Atelectasis and large pleural effusions both can present with decreased fremitus, dullness or flatness to percussion, and absent breath sounds. In atelectasis, tracheal shift, if present, is toward the affected side, and the opposite for a large pleural effusion. Asthma's most typical manifestations are prolonged expiration and diffuse wheezing. However, impaired expansion, decreased fremitus, hyperresonance, and low diaphragms can also be found. A complete pneumothorax results in absent fremitus, hyperresonance or tympany, and absent breath sounds. Lobar pneumonia is characterized by consolidation with increased fremitus, dullness, and auscultatory findings of bronchial breathing, bronchophony, pectoriloquy, and crackles.

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6 years old girl with vaginal spotting. Diagnosis is –

A foreign body is commonly responsible for vaginal bleeding in pediatric patients.

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McNaughton's rule is related to:

- Mc Naughton's rule is related to Criminal responsibility of Insane person - Sec. 84 IPC also deals with the Criminal responsibility of Insane person Section 84 IPC embodies McNaughton rules as follows: "Nothing is an offence which is done by a person who, at the time of doing it, by reason of unsoundness of mind, is incapable of knowing the nature of the act or that he is doing what is either wrong or contrary to the law."

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How many vascular segments are present in each kidney?

Ans. is 'c' i.e., 5o Renal artery Right renal artery is longer and passes behind I VC. Renal artery divides into : -Posterior division :- Supplies posterior segment.Anterior division :-Divides further into 4 branches to supply apical, upper anterior, middle anterior and lower segments.o Thus, there are five vascular segments in each kidney Posterior, apical, upper anterior, middle anterior and lower.o Branches of renal artery are end arteries.

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Why are rounded internal line angles desirable in the preparation of amalgam restorations in primary teeth?

They decreases internal stresses in the restorative material. Due to the small size of primary molars and, therefore, small restorations as well, it is helpful to reduce stresses within the restorative material. It has been demonstrated that rounded internal line angles aid in reducing stress when compared to sharp internal line angles. Many of the burs recommended for use in primary molars have a rounded end to help achieve softened internal line angles.

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Bence Jones proteins are best described as:

Ans. is 'c' i.e., Kappa and Lambda chains (Ref: Ananthanarayan, 9th/e, p. 99 and 8th/e, p. 100)* A Bence Jones protein is a monoclonal globulin protein or immunoglobulin light chain found in the urine, with a molecular weight of 22-24 kDa. Detection of Bence Jones protein may be suggestive of multiple myeloma or Waldenstrom's macroglobulinemia.* Bence Jones proteins are light chains of immunoglobulins so may occur as Lambda or Kappa forms, but in any other patient the chain is either Kappa or Lambda, never both.

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Dichotomy means -

Dichotomy means fee splitting or bribery or commissioning. Receiving commissions on referral of a patient to a doctor or forwarding commissions, both are included under dichotomy. Dichotomy is infamous conduct as defined under the rules and regulations of MCI, 2002. If a doctor repeatedly indulges in dichotomy, a warning notice could be issued against him, if he still indulges in dichotomy, his name could be erased from the medical register and it is called as professional death sentence.

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DNA of HBV is?

Ans- D Ref 1 - Although HBV is among the smallest viruses in terms of virion and genome size, it has numerous unique features that make it completely distinct from other DNA viruses. It has a partially double stranded DNA with highly complex genome organization, life cycle and natural history. Remarkably distinct from other DNA viruses, it uses an RNA intermediate called pregenomic RNA (pgRNA) and reverse transcriptase for its genome replication. Genome replication is accomplished by a complex mechanism of primer shifting facilitated by direct repeat sequences encoded in the genome. Ref 2 - jvi.asm.org/content/81/12/6164.full Hepatitis B virus (HBV) contains a small, partially double-stranded, relaxed circular (RC) DNA genome. RC DNA needs to be converted to covalently closed circular (CCC) DNA, which serves as the template for all viral RNA transcription. As a first step toward understanding how CCC DNA is formed, we analyzed the viral and host factors that may be involved in CCC DNA formation, using transient and stable DNA transfections of HBV and the related avian hepadnavirus, duck hepatitis B virus (DHBV). Ref 3 - Genome Introduction The Hepatitis B Virus (HBV) is a major health problem worldwide with more than 350 million people being chronic carriers. HBV causes Hepatitis B, a serious and common infectious disease of the liver. Chronic infection is associated with an increased risk to develop severe liver diseases, including liver cirrhosis, and hepatocellular carcinoma (HCC), one of the most common forms of human cancer. The estimated risk of HCC in chronic HBV carriers is approximately 100 times greater than in uninfected individuals. Currently available anti-HBV drugs have limitations. Interferon alpha administration is associated with adverse reactions ; nucleoside analogues are virostatic and require long-term administration. Genome organization HBV is an enveloped DNA virus that belongs to the Hepadnaviridae family (NCBI taxonomy, ICTV, ViralZone). It contains a small, partially double-stranded (DS), relaxed-circular DNA (rcDNA) genome that replicates by reverse transcription of an RNA intermediate, the pregenomic RNA (pgRNA). Its length is comprised between 3182 and 3248 bp depending on genotypes. The genome encodes four overlapping open reading frames (ORFs) that are translated into viral core protein, surface proteins, polymerase/reverse transcriptase (RT), and HBx. Replication cycle The HBV life cycle begins when the virus attaches to the host cell and is internalized. Recent studies have demonstrated that sodium-taurocholate cotransporting polypeptide (NTCP) is a functional receptor in HBV infection.The virion rcDNA is delivered to the nucleus, where it is repaired to form a covalently closed-circular DNA (cccDNA). The episomal cccDNA serves as the template for the transcription of the pgRNA and the other viral mRNAs by the host RNA polymerase II. The transcripts are then exported to the cytoplasm, where translation of the viral proteins occurs. RT binds to pgRNA and triggers assembly of the core proteins into immature, RNA-containing nucleocapsids. The immature nucleocapsids then undergo a process of maturation whereby pgRNA is reversed transcribed by RT to make the mature rcDNA. A unique feature of hepadnavirus reverse transcription is the RT primed initiation of minus-strand DNA synthesis, which leads to the covalent linkage of RT to the 5' end of the minus-strand DNA. The mature, rcDNA-containing nucleocapsids are then enveloped by the viral surface proteins and secreted as virions (secretion pathway) or alternatively, are recycled back to the nucleus to further amplify the pool of cccDNA (recycling pathway). Persistence of cccDNA in hepatocyte plays a key role in viral persistence, reactivation of viral replication after cessation of antiviral therapy and resistance to therapy.

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A 5-week-old male infant is born without a thymus or inferior parathyroid glands. Which of the following pharyngeal arches is most likely involved?

Absence of the thymus and inferior parathyroid glands would be due to defective development of the third pharyngeal pouch, their normal site of origin. The first pouch gives rise to the tympanic membrane and cavity. The second pouch gives rise to the palatine tonsils and tonsillar sinus. The fourth pharyngeal pouch gives rise to the superior parathyroid glands and the parafollicular cells of the thyroid gland. The fifth pharyngeal pouch contributes to the formation of the parafollicular cells of the thyroid gland.

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Pompholyx affects:

Ans. d. Palm & solesPompholyx is a form of recurrent palmoplantar eczema with firm deep-seated vesicles on sides of finger giving sago grain or tapioca like feel

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Best quality proteins are found in highest quantities in –

Rice proteins are richer in lysine than other cereal proteins, and for this reason, rice protein is considered to be a better quality.

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Jet black pigmentation of tongue with tactile hallucination is a feature of which substance use

Chronic cannabis use can lead to jet black pigmentation of tongue. And patients may also have feeling of insects crawling under the skin also known as magnan phenomenon.

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SIADH -- all are features except,

Low blood pressure due to volume depletion The serum sodium concentration is normally regulated by ? The balance of water intake. Renal excretion of sodium and ADH mediated water conservation by distal renal tubule. These processes are mediated by ? Stimulation of thirst Secretion of ADM Feedback mechanisms of the renin angiotensin aldosterone system and variation of renal handling of .filtered sodium. Disorders in any one of the these components of sodium balance can result in sodium imbalance. Action of ADH ADH is secreted by the posterior pituitary glandQ. Its effect in kidney is mediated by the vasopressin. (V2 receptors) on the basolateral surface of the principal cells of the collecting duct. The key action of ADH in the kidney is increasing the permeability of water. It allows water to be reabsorbed from the medullary interstitium thus enhancing water reabsorption. In SIADH the A.D.IL level is inappropriately elevated The inappropriately elevated level of vasopressin enhances the reabsomtion of water thereby leading to. - Production of concentrated urine. - Inability to excrete water and consequently - Hyponatrernia Clinical features of SIADH - HyponatrenziaQ (sodium < 135 mEq/L) - Inappropriately elevated urine osmolalityQ (> 150 mosm/kg) - Excessive urine sodium excretionQ (it Nu > 30 mEq/L) - Decreased serum osmolalityQ (< 280 mosm/kg) These findings occur in - Absence of diuretic therapy - In the presence of euvulemiaQ without edemaQ - In the setting of otherwise normal cardiac, renal, adrenal, hepatic and thyroid function. Remember, The key to pathophysiological signs, symptoms and eventual treatment of SIADH is an understanding that the hyponatremia is a result of excess water and not a sodium deficiency. Laboratory features of SIADH . HyponatrentiaQ (sodium < 135 mEq/L) . B.U.N. and serum uric acid tends to falP because of plasma dilution' and increased excretion of nitrogenous products. . Serum potassium and Bicarbonate levels are normal in SIADH (hypokalemia and metabolic acidosis suggests, diuretic therapy or vomiting) . Low serum osmolalityQ. Remember, These characteristic features of SIADH - There is increase in urinary concentration of sodium in the presence of hyponatremia. - There is increase in urine osmolarity in the presence of with decrease in serum osmolarity.

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The following statements regarding Turner syndrome are true except -

Occurence of Turner syndrome is not affected by maternal age. It is Down's syndrome which is affected by maternal age (Risk of Down's syndrome increases after 35 yrs. of maternal age*)

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A 33-year-old man presents at OPD complaining of fever and headache. On examination, he had leukopenia and increased liver enzymes, and inclusion bodies were seen in his monocytes. History revealed that he went on camping and remembered removing a tick from his leg. Which of the following diseases is most likely causing the symptoms described?

All the listed diseases except Q fever are tick-borne. The rickettsia C. burnetii causes Q fever, and humans are usually infected by aerosol of a sporelike form shed in milk, urine, feces, or placenta of infected sheep, cattle, or goats. Lyme disease is caused by a spirochete, Borrelia burgdorferi, and produces the characteristic lesion erythema chronicum migrans (ECM). The etiologic agent of Rocky Mountain spotted fever is R. rickettsia. It usually produces a rash that begins in the extremities and then involves the trunk. Two human forms of ehrlichiosis can occur: human monocytic ehrlichiosis (HME), caused by E. chaffeensis; and human granulocytic ehrlichiosis (HGE), caused by an as yet unnamed Ehrlichia. HME infection is transmitted by the brown dog tick and A. americanum. HGE infection is transmitted by I. scapularis, the same tick that transmits Lyme disease. Both infections cause fever and leukopenia. A rash rarely occurs. E. chaffeensis infects monocytes, and HGE infects granulocytes; both organisms produce inclusion bodies called morulae. Francisella tularensis is a small, Gram-negative, nonmotile coccobacillus. Humans most commonly acquire the organism after contact with tissues or body fluid of an infected mammal or the bite of an infected tick.

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The causative agent of Primary Amoebic Meningoencephalitis is:

(C) Naegleria fowleri # Human infection of naegleria comes from water containing the amoebae and usually follows swimming or diving in ponds.> Patients are mostly previously healthy young adults and children.> The amoebae invade the nasal mucosa, pass through the olfactory nerve and initiate an acute meningitis and encephalitis (primary amoebic meningoencephalitis).

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Adult polycystic kidney disease is inherited:March 2005

Ans. D: Autosomal dominantAutosomal dominant polycystic kidney disease (ADPKD) is one of the most common inherited disorders. It is the most frequent genetic cause of renal failure in adults,It is a multisystemic and progressive disorder characterized by the formation and enlargement of cysts in the kidney and other organs (e.g., liver, pancreas, spleen).Clinical features usually begin in the third to fouh decade of life, but cysts may be detectable in childhood and in utero.Some other autosomal dominant disorders:Huntington choreaNeurofibromatosisMyotonic dystrophyHereditary spherocytosisMarfan syndromeOsteogenesi imperfectAchondroplasia

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