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In the stage of Grey hepatization -

Pathological changes of bacterial pneumonia A. Lobar pneumonia Large confluent area of the lung or entire lobes is consolidated. The lower lobes are affected most commonly. There are four stages of the inflammatory response (Laennec's stages) - 1. Stage of congestion (initial phase) The affected lobe is enlarged, heavy, dark red and congested. Cut surface exudes blood-stained frothy fluid. There are dilatation and congestion of alveolar capillaries. There are few neutrophils and numerous bacteria in the alveolar fluid. 2. Stage of red hepatization (early consolidation) The term hepatization refers to the liver-like consistency of the affected lobe on cut section. The affected lobe is red and firm. The edema fluid of preceding stage is replaced by strands of fibrin. There is marked cellular exudate of neutrophils with extravasation of red cells. 3. Stage of gray hepatization (late consolidation) The affected lobe is grayish brown, firm and dry. The fibrin strand are dense and more numerous. There is progressive disintigration of red cells and neutrophils. The macrophages begin to appear in the exudate. The organisms are less numerous and appear as degenerated forms. 4. Resolution The previously solid and fibrinous constituent is liquefied by enzymatic action. Granular and fragmented strands of fibrin in the alveolar spaces are seen due to progressive enzymatic digestion. There is progressive removal of fluid content as well as cellular exudate from the air spaces, resulting in restoration of normal lung parenchyma with areation. B. Bronchopneumonia Patchy areas of red or grey consolidation, more often multilobar and frequently bilateral and basal (lower zones) because of tendency of secretions to gravitate into lower lobes. There is suppurative exudate, consisting chiefly neutrophils, filling bronchi, bronchioles and adjacent alveolar spaces. Alveolar septa thicken due to congested capillaries and leucocytic infiltration.

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A child presents with ascending flaccid paralysis. There is subsequent respiratory muscle involvement. CSF examination shows albuminocytological dissociation. Treatment of choice is :

Answer is D (I.V. Immunoglobins): The characteristic clinical presentation and CSF finding lead us to the diagnosis of GBS Either high does intravenous immunoglobulins or plasmapharesis can be initiated as they are equally effective. -- Harrison 's Glucocoicoids have not been found to be effective in GBS - Harrisons Steroids do not reduce the duration but may increase the risk of infection and worsen the problem. Steroids should be considered contraindicated in the treatment of GB syndrome - API 6th/ 835

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Which of the following is true in respect to the ciliary ganglion?

Afferent fibers from the iris and cornea pass through the ciliary ganglion.

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Aplastic anemia in hereditary spherocytosis precipitated by-

Answer is A (Parvovirus) Aplastic crisis is usually triggered by an acute parvovirus infection.

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Howell-Jolly bodies are seen in-

Howell Jolly bodies are purple nuclear remnants ,usually found singly, and are larger than basophilic stippling.They are present in megaloblastic anemia & after splenectomy.Reference :Harsh Mohan Textbook of pathology sixth edition pg no 293.

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All act by inhibiting call wall synthesis except ?

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

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A mother brings her 10 year old son to OPD because of a history of medullary carcinoma of thyroid in his father and grandparents. There are no findings on physical examination. Which of the following tests you would perform?

Most cases of medullary thyroid carcinomas (MTC) are sporadic. But 25% occur in inherited syndromes such as familial medullary thyroid cancer and MEN types 2A and 2B. These occur due to germline mutations in the RET protooncogene. MEN2A consists of Medullary thyroid cancer, Pheochromocytoma and Primary hyperparathyroidism. MEN 2B consists of MTC, Pheochromocytoma, Mucosal neuromas, Gangliomas, and aMarfan-like habitus. Any patient with MEN 2A or MEN 2B may develop medullary carcinoma at a very young age and therefore should be followed carefully for pheochromocytoma with urine VMA, for hyperparathyroidism with serum calcium, and for medullary carcinoma with serum calcitonin.

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Molybdenum is a constituent of:

Molybdenum containing enzymes include aldehyde oxidase, sulfite oxidase and xanthine oxidase.

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Which one of the following serum levels would help in distinguishing an acute liver disease from chronic liver disease

Answer- D. AlbuminSerum albumin has a long half life 15-20 days with approximately 4% degraded per day

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True about optic nerve glioma

Optic Nerve Glioma *Can cause gradual, painless, unilateral Proptosis *a/w Neurofibromatosis 1 *Mainly affect children (1-10 year) *Have characteristic fusiform enlargement of optic nerve Optic Nerve Glioma - Fusiform Enlargement of optic nerve - Nerve is not seen separately from the mass

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Serum alkaline phosphate is not rassed in ?

Ans. is 'c' i.e., Multiple Myeloma

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Golden S sign is seen in:

Ans. (a) Bronchogenic carcinoma with collapse of lung* The Golden S sign (reverse S sign of Golden.) is seen in PA chest radiographs with right upper lobe collapse.* It is caused by a central mass obstructing the upper lobe bronchus and should raise suspicion of a primary bronchogenic carcinoma.* The right upper lobe appears dense and shifts medially and upwards with a central mass expanding the hilum. The combination of two changes together form a reverse S shane.

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Which of the following is a mineralocoicoid antagonist ?

Ans. is 'a' i.e., Spironolactone

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A male 25 years old presents to the dental clinic with a black spot. He also gives the history of previous dental treatments of other teeth as well and wants gold to be filled in his tooth. On examination, it is revealed that 16 no. tooth has pit and fissure caries. Which preparation is used for retention in this restoration?

Skirts.   Skirts are preparation features used in cast gold restorations that extend the preparation around some, if not all, of the line angles of the tooth. When properly prepared, skirts provide additional, opposing vertical walls that increase retention of the restoration. The placement of skirts also enables increased resistance to fracture by allowing the envelopment of the remaining compromised tooth structure with the restorative material. Sturdevant operative dentistry  7th  E D I T I O N, Page No:131

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First pathological change apparent in Nephrotic syndrome is

Most forms of primary GN and many of the secondary glomerular diseases in human beings have immunologic pathogenesis. This view is largely based on immunofluorescence studies of GN in humans which have revealed glomerular deposits of immunoglobulins and complement in patterns that closely resemble those of experimental models. The consequences of injury at different sites within the glomerulus in various glomerular diseases can be assessed when compared with the normal physiologic role of the main cells involved i.e. endothelial, mesangial, visceral epithelial, and parietal epithelial cells as well as of the GBM as summed up in Table 22.8.<\p> text book of pathology harshmohan 6th edition page 662

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Well known Zadek's procedure is:

Ans. (b) Resection of complete nail with part of nail bed* Zadek's procedure is the surgical correction of ingrowing toe nail.* Removal of complete nail with part of nail bed.

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In cystoid macular edema fluid collects in the macular region at the level of

Ans. Outer plexiform layer

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Unna boot is used for treatment of:

Unna boot is used for the varicose vein ulcers.

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Endogenous triglycerides are maximum in:

More the fat content less will be the density The density increases from: VLDL< LDL< HDL. Hence VLDL have maximum amount of triglycerides. ENDOGENOUS TRIGLYCERIDES MAX IN : VLDL EXOGENOUS TRIGLYCERIDES MAX IN :CHYLOMICRON

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From the index finger infection goes to ?

Ans is A ie Thenar space

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Which one of the following drugs cause hypo magnesemia by increased excretion?

Ans. is 'a' i.e., Frusemide therapy "Loop diuretics cause the abolition of transepithelial potential difference that results in marked increase in excretion of Ca2++ and mg2++".

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Which of the following is not an established antimicrobial drug synergism at clinical level?

Combination of a bacteriostatic and a bactericidal drug in most cases is antagonistic. Bactericidal drugs act on fast multiplying organisms whereas bacteriostatic drugs inhibit the growth. Here, penicillins are bactericidal whereas tetracyclines are bacteriostatic.

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In what period, following delivery, does the cardiac output return to the pre-pregnancy state?

Cardiac output returns to pre labour values by one hour following delivery and pre pregnancy level by 4 weeks. Cardiac output: It stas to increase from 5th week of pregnancy reaches a peak 40-50% at about 30-34 weeks. It increases fuher during labour (50%) and immediately following delivery (70%) over pre labour values. Increase in cardiac output is due to: Increased blood volume To meet the additional oxygen required due to increased metabolic activity during pregnancy. Ref: Textbook of Obstetrics By D.C Dutta, 6th edn, page 53

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Alkaptonuria is due to deficiency of

(D) Homogentisic acid oxidase # Enzyme defect in Ochronosis (Alkaptonuria):> Defective enzyme in alkaptonuria is Homogentisate oxidase in tyrosine metabolism.> Homogentisate accumulates in tissues and blood, and is excreted into urine.> Homogentisate, on standing, gets oxidized to the corresponding quinones, which polymerize to give black or brown colour.> For this reason, the urine of alkaptonuric patients resembles coA are in colour.> Homogentiste gets oxidised by polyphenol oxidase to benzoquinone acetate which undergoes polymerization to form a pigment "Alkapton".> Alkapton gets deposited in connective tissues, bones and various organs resulting in a condition called "Ochronosis".> Many patients suffer from arthritis: and this is believed to be due to the deposition of pigment alkapton in the connective tissues.

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A colles fracture is

C i.e. Common in elderly women Coll's fracture is fracture of lower end of radius at its coico cancellous junctionQ (- 2.5 cm / 1.5 inch above the distal aicular surface) mostly occuring in post menopausal osteoporotic elderly womenQ ; as a result of fall on outstretched hand. (with wrist in extension). It is most common of all fractures in older people.

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In patients with breast cancer, chest wall involvement means involvement of any one of the following structure except

.Spread into the Deeper Plane * Into pectoralis major muscle (is confirmed by observing the restricted mobility of the swelling while contracting the PM muscle). * Into latissimus dorsi muscle (extending the shoulder against resistance). * Into serratus anterior (by pushing the wall with hands without flexing the elbow). *Into the chest wall (breast will not fall forward when leaning forward, and while raising the arm above the shoulder, breast will not move upwards as it is fixed to the chest wall). ref:SRB&;s manual of surgery,ed 3,pg no 472

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The function of g DNA Polymerase

Ref: Harper&;s Biochemistry; 30th edition; Chapter 35; DNA Organization, Replication, & Repair

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In normal conditions of temperature and atmosphere, the rate of cooling of dead body is:

The dead body cools at an average rate of 1.5 degree F per hour in temperate climate and 0.75 degree F in a tropical climate. According to Simpson, the cooling of the body is the only reliable indicator of the lapse of time during the first 18 hours after death. Factors controlling the cooling rate are: Condition of the body Clothing Atmospheric temperature Mode of death Medium Ref: Forensic Medicine By P.V. Guhara page 62.

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Moderate exercise tachypnea is due to stimulation of which of the following receptor?

Afferent impulses from Proprioceptors and psychic stimuli are causes for hyperventilation during the beginning of an exercise Ref: Ganong 25th ed/page 658

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First radiological sign of Crohn's disease in terminal ileum is:

Ans. Aphthoid ulceration

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Following pathogenetic mechanisms operate in septic shock except -

Ans. is 'a' i.e., Increased peripheral vascular resistance

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All are vitamin K dependent clotting factors of hepatic origin except

Vitamin K has an impoant role in the blood clotting process. It brings about the posttranslational modification of ceain blood clotting factors clotting factor II (prothrombin), factor VII (SPCA) factor IX (Christmas factor) factor X (Stua prower factor) they are synthesized as inactive precursors (zymogens) in the liver ref DM Vasudevan 8th ed page 462

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Liver biopsy is indicated for diagnosis/evaluation of all EXCEPT?

Ans. (c) HemangiomaRef.: Bailey & Love 26th ed. /1083Hemangioma being a vascular tumor is diagnosed by imaging techniques and liver biopsy is contraindicated. Cavernous hemangiomas arise from the endothelial cells that line the blood vessels and consist of multiple, large vascular channels lined by a single layer of endothelial cells and supported by collagenous walls. These tumors are frequently asymptomatic and incidentally discovered at imaging, surgery, or autopsy.

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Post exposure vaccine of rabies already immunised patient is ?

- for post - exposure treatment of person who have been vaccinated for rabies previously is given rabies vaccine on days 0 and 3 intradermally or 1 dose delivered intramuscularly. Reference : Park's textbook of preventive and social medicine, 23rd edition, pg no:280 <\p>

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In depression, there is a deficiency in

SEROTONIN is produced from TRYPTOPHAN it is a neuro transmitter that controls the well being of the individual it controls drive to day to day activities, controls sleep and appetite. TRPTOPHAN helps in production of MELATONIN MELATONIN controls SLEEP A decreased level of brain 5-hydroxytryptamine (5-HT) has been theorized to be a factor in depression. The theory arose from clinical observations that drugs enhancing extracellular levels of 5-HT have antidepressant effects in many patients. Reference: Kaplon and sadock, 11 th edition, synopsis of psychiatry, 11 th edition, pg no. 752

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Treatment of choice of flail chest is

.It is fracture of two or more consecutive ribs, with each rib having two or more fracture sites. Such segment is called as flail segment. Treatment  Intercostal tube drainage.  Applying clips to fracture ribs and fi xing above and below to normal ribs.  Antibiotics like penicillins, cefotaxime.  Blood transfusion, IV fluids.  Bronchodilators, steroids.  Ventilator suppo with IPPV--IPPV is treatment of choice. Assisted ventilation is required for several days until the chest wall stabilises. If ventilator suppo is required for more than 10 days, then tracheo stomy is done to prevent laryngeal stenosis which can occur due to prolonged endotracheal intubation.  Thoracotomy--when required only. Ref: SRB's Manual of Surgery, 4th Edition, pg. no. 1196

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Latent phase of HIV -

Ans. is 'a' i.e., Viral replication, 'b' sequestred in lymphoid tissue, 'c' i.e., Infective Latent phase of HIV . After acute HIV syndrome, most of the patient's develop a clinically asymptomatic stage . Active virus replication is on going and progressive during the asymptomatic period . Lymphoid tissues are the major anatomic sites for the establishment and propagation of HIV infection. Virus replication occurs mainly in lymphoid tissue and not in blood. . Though patients are asymptomatic (clinical latency) they do not have microbiologic latency as there is low level of viremia due to active replication. So patient is infective during this period There is steady progressive decline (not rapid) of CD4 + Tcell count during latent phase. The average rate of CD4 + T cell decline is 50/m1 per year.

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Testing of HLA-B' 5701 is recommended prior to initiation of this antiretroviral agent:-

Testing of HLA-B' 5701 is recommended prior to initiation of abacavir. Abacavir if given in a patient who has HLA-B' 5701 causes high risk of MI.

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A lady died due to unnatural death within seven years after her marriage. The inquest in this case will be done by

C i.e. Sub divisional magistrate

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Bronchopulmonary segments in right and left lungs respectively -

Ans. is 'c' i.e., 10, 9 Right lung Upper lobe Middle lobe Lower lobe 1. Apical 2. Posterior 3. Anterior 4. Lateral 5. Medial 6. Superior 7. Anterior basal 8. Medial basal 9. Lateral basal 10. Posterior basal Left lung Upper lobe Lower lobe 1. Apical 2. Posterior 3. Anterior } Upper division 6. Superior 7. Anterior basal 8. Lateral basal 9. Posterior basal 4. Superior lingular 5. Inferior lingular } Lower division

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Necrotizing granulomatous inguinal lymphadenopathy is caused by -

Ans. is 'a' i.e., Syphilis

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Meningomyelocele patient after being operated developed hydrocephalus due to -

Meningoceles (or meningomyeloceles) are commonly associated with Arnold Chiari malformation which cause hydrocephalus. Ref : CSDT 13/e p852

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Wernicke's hemianopic pupillary response is seen in lesion of-

. *Wernicke's hemianopic pupil indicates lesions of optic tract . In this condition light reflex is absent when light is thrown on temporal half of retina of affected side and nasal half of opposite side. Ref Harrison20th edition pg 2456

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In which of the following condition, positive Rinne test is seen?

PRESBYCUSIS Sensorineural hearing loss associated with physiological aging process in the ear is called presbycusis. It usually manifests at the age of 65 years but may do so early if there is hereditary predisposition, chronic noise exposure or generalized vascular disease. Four pathological types of presbycusis have been identified. 1. Sensory. This is characterized by degeneration of the organ of Coi, staing at the basal coil and progressing gradually to the apex. Higher frequencies are affected but speech discrimination remains good. 2. Neural. This is characterized by degeneration of the cells of spiral ganglion, staing at the basal coil and progressing to the apex. Neurons of higher auditory pathways may also be affected. This manifests with high tone loss but speech discrimination is poor and out of propoion to the pure tone loss. 3. Strial or metabolic. This is characterized by atrophy of stria vascularis in all turns of cochlea. In this, the physical and chemical processes of energy production are affected. It runs in families. Audiogram is flat but speech discrimination is good. 4. Cochlear conductive. This is due to stiffening of the basilar membrane thus affecting its movements. Audiogram is sloping type. Patients of presbycusis have great difficulty in hearing in the presence of background noise though they may hear well in quiet surroundings. They may complain of speechbeing heard but not understood. Recruitment phenomenon is positive and all the sounds suddenly become intolerable when volume is raised. Tinnitus is another bothersome problem and in some it is the only complaint. Patients of presbycusis can be helped by a hearing aid. They should also have lessons in speech reading through Visual cues. Cuailment of smoking and stimulants like tea and coffee may help to decrease tinnitus. Ref : ENT textbook by Dhingra 6th edition Pgno : 37

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Mechanism of action of Aspirin

Ans. (b) Inhibit TXA2 formationRef KDT 6th ed. / 609; Katzung 9th ed. / 446Thromboxane helps in platelet aggregation.* TXA2 formation is suppressed at very low doses of aspirin.* Aspirin blocks thromboxane formation by inhibiting COX activity by enzyme COX1 and TX- synthase irreversibly.

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Fibroadenoma is commonly seen in which age group:

Ans. is 'a' i.e.Young females o Fibroadenosis, Fibrocystic disease, chronic mastitis & mastopathy are old nomenclature used to describe the spectrum of benign breast disease. The new name coined to avoid all the confusing names is ANDI i.e. Aberration of normal development and involution.o The basic principles behind ANDI are:Benign breast disorders and diseases are aberrations of the normal dynamic changes occurring throughout the life with superimposed menstrual changes.It includes a spectrum of breast conditions that range from normal to mild abnormality to severe abnormality (disease).o These disorders are classified into 3 groups.Nonproliferative Breast ChangesProliferative disease without atypiaProliferative disease with atypiay Duct ectasiay Cystsy Apocrine changesy Mild hyperplasiay Adenosisy Fibroadenoma without complex featuresy Moderate or florid hyperplasiay Sclerosing adenosisy Papillomay Complex sclerosing lesion (radial sar)y Fibroadenoma with complex featuresy Atypical ductal hyperplasiay Atypical lobular hyperplasiaThe cancer risks associated with Benign Breast disorders are as follows :AbnormalityRelative RiskNonporliferative lesionsNo increased riskSclerosing adenosisNo increased riskIntraductal papillomaNo increased riskModerate or Florid epithelial hyperplasia1[?]5 to 2 foldAtypical lobular hyperplasia4-foldAtypical ductal hyperplasia4-foldDuctal involvement by cells of atypical ductal hyperplasia7-foldo Epitheliosis implies epithelial hyperplasia.o Of the fibrocystic (or AND!) changes only epitheliosis or epithelial hyperplasia is associated with increased risk of malignancyo Not all epithelial hyperplasias are associated with increased risk. It is moderate or florid hyperplasia and hyperplasia with atypia that is associated with increased risk. Mild hyperplasia is not associated with increased risk.

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Rarest variety of multiple myeloma:

Ans: c (IgE) Ref: Harrison's, 16th ed, p. 657; 17th, ed, p. 703Multiple myeloma represents a malignant proliferation of plasma cells derived from a single clone. The serum M component is IgG in 53% of patients, IgA in 25% and IgD in 1 %. IgE is very rare. The most common translocation is t( 11:14).Myeloma is more commonly seen than expected among farmers, wood workers, leather workers, and those exposed to petroleum products.Bone pain is the most common symptom in multiple myeloma, effecting nearly 70% of patients.Hypercalcaemia is the most common cause of renal failure. The earliest manifestation of tubular damage is the adult Fanconi syndrome.Anaemia in multiple myeloma is normocytic normochromic and occurs in about 80% of patients.The classical triad of multiple myeloma is:Marrowplasmacytosis (.>10%),Lytic lesions, andSerum and/or urine M component.Diagnosis of multiple myeloma (The Dune and Salmon myeloma diagnostic criteria).The diagnosis of multiple myeloma requires a minimum of one major and one minor criteria or three minor criteria as defined in the Table belowMajor criteria1) Plasmacytoma on tissue biopsy2) Bone marrow palsmacytosis with 30% plasma cells3) Monoclonal globulin spike (M protein) on SPEP:IgG>3.5 g/dl,IgA > 2.0g/dl, light chain excretion on UPEP >= 1 g per 24 hr in the absence of amylodosisMinor criteriaa) Bone marrow plasmacytosis with 10-30% plasma cellsb) Monclonal globulin spike present ,but lower levels than defined in major criteriac) Lytic bone lesionsd) Normal IgM >50 mg/dl, IgA > 100 mg/dl, or IgG >600 mg/dlThe diagnosis of myeloma requires a minimum of one major criteria and one minor criteria (although 1 +a is not sufficient) or three minor criteria that must include a+b (SPEP-serum protein electrophoresis, UPEP-urineprotein electrophoresis)

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Game Keeper's thumb is

A i.e. Ulnar collateral ligament injury of MCP Joint

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Goose skin also called cutis anserina is seen in

Goose skin is seen in drowning. (usually cold water). It is due to contraction of erector pili muscles, attached to hair follicle.

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Lesser sac of stomach is bounded by:

A. i.e. Posterior wall of stomach - Lesser sac/ Omental bursa is bounded anteriorly by stomach, caudate lobe of liver, lesser omentum & greater omentum (ant. 2 layers); and posteriorly by structures forming stomach bed (i.e. diaphragm, pancreas, spleen etc) & greater omentum (posterior 2 layers) Lesser sac or omental bursa is the site for abscess formation in posterior perforation of gastric ulcer and internal hernia through epiploic foramen

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The color code of plastic bag for disposing microbial laboratory culture waste-

Ans. is `b' i.e., Red Microbial laboratory culture wastes are category No. 3. o Category 3 wastes have color code Fellow or red. o See above explanation.

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True about Conn's syndrome

Answer is B (Proximal myopathy): Conn syndrome is associated with hypokalenzia and muscle weakness (proximal myopathy) Patients with Conn's syndrome characteristically do not have edema, and Plasma rennin activity is typically low (decreased).

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A 70-year-old female presented to the OPD with deforming ahritis of hands which is B/L symmetrical. Various deformities were observed. A lymph nodal mass is also observed in the cervical region. Which of the following markers would be most likely positive if the biopsy of the lymph node is done: -

This is a case of rheumatoid ahritis. 1st image shows the boutonniere's deformity. 2nd image shows the Z-deformity of the thumb. 3rd image shows the trigger finger. Most common lymphoma associated with RA is DLBCL. Most common marker of DLBCL is BCL-6 > BCL-2

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In Erb's palsy, the limb is in which position:

Ans. C. Extended, medially rotated, pronatedErb's paralysis is caused by the excessive increase in the angle between the head and shoulder, which may occur by fall from the back of horse and landing on shoulder or traction of the arm during birth of a child.This involves upper trunk (C5 and C6 roots) and leads to a typical deformity of the limb called policeman's tip hand/porter's tip hand/waiter's tip hand. In this deformity, the arm hangs by the side, adducted and medially rotated, and forearm is extended and pronated.Clinical features are as follows:a. Adduction of arm due to paralysis deltoid muscle.b. Medial rotation of arm due to paralysis supraspinatus, infraspinatus, and teres minor muscles.c. Extension of elbow, due to paralysis of biceps brachii.d. Pronation of forearm due to paralysis of biceps brachii.e. Loss of sensation (minimal) along the outer aspect of arm due to involvement of roots of C6 spinal nerve.

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All are congenital myopathies except

3 forms of congenital myopathies that may present in adulthood are central core disease, nema line myopathy and centronuclear myopathy. Ref Harrison20th edition pg 2345

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The breast becomes fully differentiated during pregnancy and lactation. All the following statements are true regarding the pregnant and lactating breast, EXCEPT:

The breast becomes fully differentiated during pregnancy and lactation. The terminal lobular units are most affected during this physiologic state. Several histologic changes occur in the terminal ducts and lobules with enlargement and formation of new lobular units early in pregnancy. By the end of the second trimester secretory changes are well developed and the cuboidal luminal epithelial cells show evidence of vacuolization. Accumulation of fat droplets occurs within the cytoplasm of the epithelium of the lobules during the third trimester. The lobules undergo striking hyperplasia to occupy most of the breast parenchyma during this time, with a decrease in the interlobular connective tissue. At term the expanded lobular units show marked distention of their lumina by colostrum. Ref: Cunningham F.G., Leveno K.J., Bloom S.L., Hauth J.C., Rouse D.J., Spong C.Y. (2010). Chapter 5. Maternal Physiology. In F.G. Cunningham, K.J. Leveno, S.L. Bloom, J.C. Hauth, D.J. Rouse, C.Y. Spong (Eds), Williams Obstetrics, 23e.

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Doppler effect results from change in -

Doppler effect is due to shift in sound frequency as the sound as reflected from the moving Red blood cells. If the motion of RBC is towards the transducer, the returning sound wave has higher frequency than transmitted wave. If the motion of RBC is away the transducer, the returning sound wave has lower frequency than transmitted wave. Color intenstiy indicates the relative velocity of the red blood cells.

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Most common site of extra - pulmonary TB in children is ?

Ans. is 'c' i.e., Lymphnode Most common site of extra pulmonary TB is lymphnode Most children who develop tuberculosis disease experience pulmonary manifestations 25 to 35 percent of children have an extrapulmonary presentation. The most common extrapulmonary form of tuberculosis is lymphatic disease accounting for about two thirds of cases of extrapulmonary tuberculosis. the second most common form is meningeal disease occurring in 13% of patients

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Which thalamic nucleus projects to the striatum?

The striatum (caudate nucleus & putamen) receives thalamic input from centromedian nucleus. centromedian nucleus- largest of the intralaminar nuclei.

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Early cord clamping is done is all except :

Postmaturity

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You are the MO in charge in a PHC and there has been a plague epidemic in your area. Which of the following measure is the LEAST appropriate for controlling epidemic?

After vaccination it takes about 5-7 days for the immunity to develop. So it should be carried out at least a week before the expected outbreak. This vaccination is only used for prevention and not control of outbreak. Also know: Tetracycline is the drug of choice for chemoprophylaxis against plague. Ref: Park, Edition 21, Page - 271.

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In Fetal Life RBC are produced in all except

In fetal life, RBC is produced in 3 phases according to growth of foetusMesoblastic stage: In yolk sacHepatic stage: In Liver and spleenMyeloid phase: In bone marrowRef: Medical Physiology Indu Khurana 2015 edition page No:104

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A 42 year old man in Mumbai is being treated for Atrial Fibbrillation (AF). You suspect thromboembolism on fuher investigatins. Thromboembolism of axillary aery can affect all of the following vessels, EXCEPT:

Suprascapular aery is a branch of thyrocervical trunk of the subclan aery, not axillary aery. The axillary aery has several smaller branches. First pa (1 branch) Superior thoracic aery Second pa (2 branches) Thoraco-acromial aery Lateral thoracic aery Third pa (3 branches) Subscapular aery Anterior humeral circumflex aery Posterior humeral circumflex aery It continues as the brachial aery past the inferior border of the teres major.

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Mad Cow disease (Bovine Spongioform Encephalopathy) is similar in man to -

CJD is a subacute preaenile encephalopathy with progressive incordination and dementia ending fatally in about a year.It is a prion disease. prion disease in animals include scrapie,mink encephalopathy,BSE madcow disease.These are caused by slow virus group B. REF:ANANTHANARAYAN AND PANIKER'S TEXTBOOK OF MICROBIOLOGY 9TH EDITION PAGE NO:556,557

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Vitamin A deficiency is considered a public health problem if prevalence rate of night blindness in children between 6 months to 6 years is more than –

Prevalence criteria for determining the Xerophthalmia problem in a community

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A young man weighing 65 kg was admitted to the hospital with severe burns in a severe catabolic state. An individual in this state requires 40 kcal per kg body weight per day, 1 gm of protein/kg body weight/day. This young man was given a solution containing 20% glucose and 4.25% protein. If 3000 ml of solution in infused per day:

Calories are calculated by catabolism of glucose (not proteins). Glucose: Amount of glucose in 20% glucose in 3000 ml of solution: 3000 x 20/100 = 600 gms 1 gm glucose on catabolism produces: 4.2 kcal 600 gms of glucose would produce: 600 x 4.2 = 2520 kcal Protein: Percentage of protein in fluid: 4.25% Percentage of protein in 3000 ml of fluid: 3000 x 4.25/100 = 127.5 gms Calories required for the patient: 40x65 = 2600 kcal Proteins required for the patient: 2 x65 = 130 gms

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Which of the following is used to take cervical smear:

Ayre's spatula Used to take cervical smear(Pap smear) It is a wooden spatula with U shaped openings on one side and a flat surface on another. Takes sample from squamocolumnar junction.

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Antidiabetic used safely in renal failure

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

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Usual site of TB bursitis -

TB is is still a common infection in developing countries. After lung and lymph nodes bone and joint is the next common site of TB in the body. The commonest bursa involved in TB is trochanteric bursa resulting in trochanteric bursitis. REF:Essential ohopaedics- Maheshwari- 5th edn - pg no 182.

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Which of the following statements about lepromin test is not true -

LEPROMIN TEST The test is performed by injecting intradermally 0.1 ml of lepromin into the inner aspect of the forearm of the individual. As a routine, the reaction is read at 48 hours and 21 days. Two types of positive reactions have been described: (a) EARLY REACTION : The early reaction is also known as Fernandez reaction. An inflammatory response develops within 24 to 48 hours and this tends to disappear after 3 to 4 days. It is evidenced by redness and induration at the site of inoculation. If the diameter of the red area is more than 10 mm at the end of 48 hours, the test is considered positive. The early positive reaction indicates whether or not a person has been previously sensitized by exposure to and infection by the leprosy bacilli. In this sense, the early reaction is much superior to the late reactfon. The early reaction has been described as delayed hypersensitivity reaction to "soluble" constituents of the leprosy bacilli. The reaction corresponds to the Mantoux reaction in tuberculosis, caused by the soluble antigens (PPD) of the tubercle bacilli. (b) LATE REACTION : This is the classical Mitsuda reaction. The reaction develops late, becomes apparent in 7-10 days following the injection and reaching its maximum in 3 or 4 weeks. The test is read at 21 days. At the end of 21 days, if there is a nodule more than 5 mm in diameter at the site of inoculation, the reaction is said to be positive. The nodule may even ulcerate and heal with scarring if the antigen is crude. It may be noted that the diameter of the red area in the early reaction, and the diameter of the nodule in the late reaction are measured. The early reaction is induced by the soluble constituents of the leprosy bacilli; and the late reaction by the bacillary component of the antigen. It indicates cell-mediated immunity. In the first 6 months of life, most children are lepromin negative; some may become positive by the end of first year. Data obtained from different pas of the world indicate that in endemic areas, lepromin reaction is already positive in 20 per cent of children under 5 years of age, and this propoion increases to around 60 per cent or more in the 10-14 years age group, and to 80 per cent or more in persons over 19 years of age. BCG vaccination is capable of conveing the lepra reaction from negative to positive in a large propoion of individuals. Value of the lepromin test Lepromin test is not a diagnostic test. The two drawbacks that stand in the way of this test being used for diagnosis are : (i) positive results in non-cases, and (ii) negative results in lepromatous and near-lepromatous cases. The test has been generally accepted as a useful tool in evaluating the immune status (CMI) of leprosy patients. It is of considerable value in confirming the results ofclassification of cases of leprosy on clinical and bacteriological grounds. In other words, the test is widely used as an aid to classify the type of disease. The test is also of great value in estimating the prognosis in cases of leprosy of all types. The test is usually strongly positive in the typical tuberculoid cases, and the positivity getting weaker as one passes through the spectrum to the lepromatous end, the typical lepromatous cases being lepromin negative indicating a failure of CMI. It is known that lepromin negative individuals are at a higher risk of developing progressive multibacillary leprosy, but those who are lepromin positive either escape the clinical disease (the majority) or develop paucibacillary disease (the minority). Ref: Park 25th edition Pgno : 338

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An 8-year old child was brought to you for a high grade fever of 3 days duration with vomiting headache and decreased responsiveness. Examination revealed a distressed child , in shock with maculopapular and ecchymotic rashes on the skin with bleeding from venepuncture sites and hepatomegly. Investigation showed PCV =65% WBC 4000 platelet 25000 & mildly prolonged PT. CXR revealing left sided pleural effusion. Diagnosis is ?

Generalized body aches, high grade fever followed by clinical deterioration and bleeding diathesis with raised hematocrit (65%) and low platelet and leucopenia strongly suggest dengue haemorrhagic fever, although meningococcemia is always a close diagnosis and many times requires serological confirmation. Complicated malaria usually has anemia and splenomegaly Leptospirosis may occur in icteric as well as nonicteric form. In nonicteric form shock and skin rashes are uncommon. Prominent features are severe myalgias and exquisite tenderness.

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False about trans fatty acid

Trans fatty acids (TFA) are atherogenic. They lower HDL level and elevate LDL level. TFA is present in dairy products and hydrogenated edible oils. It is widely used in the food industry since it increases the shelf life of fried food. Cooking media containing PUFA and fast food preparations have a high content of trans fatty acids. Trans fatty acids adversely affect endothelial function and aggravate insulin resistance and diabetes. It is high in processed foods and bakery products, where hydrogenated vegetable oils are used for cooking.Ref: DM Vasudevan - Textbook of Biochemistry, 6th edition, page no: 437

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The most accurate imaging for the diagnosis of pulmonary embolism is -

Ans. is 'd' i.e., CT pulmonary angiography o Invasive pulmonary angiography is the most accurate method for diagnosis of PE, it is an invasive procedure. # Investigation of choice for PE - Chest CT with contrast (especially MDCTA) # Investigation of 2nd choice - Lung scan (V/Q scan) # Best investigation for PE - Chest CT with contrast (MDCTA) # Most accurate investigation for PE - Invasive pulmonary angiography # Gold - standard test for PE - Invasive pulmonary angiography # Screening test for PE - D-dimer assay

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Arborescent marks' or 'filigree burns' are seen in

Ans. d (Lightening) (Ref. Forensic Medicine Reddy, 17th/ Page 261; Forensic Medicine 1st /Apurva Nandy, 286)# Filigree burns are seen in lightening# Crocodile Flash Burns and "arc eye" are seen in Electrical Injuries# Joule Burn is seen in Electrical Injuries# Spark Burns are seen in Electrical InjuriesLIGHTENING# Mode- Direct Strike- Side Flash - Hits another object and then enters the subject- Conduction through another object# Burns may be- Linear# 3 to 30 cm in length, 0.3 to 2.5 cm in width# Often in moist creased and skin folds- Arborescent or Filigree or Lichtenberg's flowers# Superficial, Thin, Irregular and Tortuous# Fern like pattern# Resembles a tree- Surface burns# True bums which occur beneath metallic objects worn or carried by the person# Cause of Death- Cerebral "Anaemia"# Due to spasmodic contraction of cerebral vesselsEducational Points# Filigree bums usually imply that the effect is superficial and are more often seen in cases where the victims have "escaped". They are seen in shoulders and flanks and pass away in due course of time.# They do not follow the path of blood vessels.# They may be due to:- Copper deposits in Dermis- Deposits of Hemoglobin from RBCs lysed by the current

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In thromboasthenia there is a defect in –

Platelet adhesion Platelet adhesion referes to the binding of platelets to subendothelial matrix. Platelet membrane glycoprotein Ib-IX is essential for platelet adhesion to subendothelial matrix. Platelet aggregation Platelet aggregation referres to adherence of platelets to one another. Platelet membrane glycoprotein ddb-IIIa helps in aggregation. Congenital dysfunction of platelet 1. Bernard-soulier syndrome Defect in platelet adhesion due to inherited deficiency of glycoprotein Ib-IX. 2. Glanzmann's thrombasthenia Defect in platelet aggregation due to inherited deficiency of glycoprotein Ilb-IIIa.

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O2 which is about 21% of inspired air exerts a partial pressure of

In inspired air, partial pressure of O2- 158mmHg

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Safe yield of water source -

The safe yield is generally defined as the yield that is adequate for 95% of the year. The safe yield of the source must be sufficient to serve the population expected at the end of the design period which may be to 10 to 50 years in future. (PARK TB of social and preventive medicine pg 766 25th edition)

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Risk factors for coronary aery disease (CAD) -

Ref: R Alagappan - Manual of Practical Medicine 4th Edition.pg no:182 Risk Factors Category I (For which interventions have been proved to lower CVD risks) 1. Raised LDL cholesterol 2. Reduced HDL cholesterol 3. Atherogenic diet 4. Cigarette smoking 5. Hypeension 6. LVH 7. Thrombogenic factors Category II (For which interventions are likely to lower CVD risks) 1. Diabetes mellitus 2. Physical inactivity 3. Increased triglycerides 4. Small dense LDL 5. Obesity Category III (Associated with increased CVD risk that, if modified, might lower risk) 1. Psychosocial factors 2. Increased Lipoprotein a (normal level--0-3 mg/dl) 3. Hyperhomocysteinemias 4. No alcohol consumption 5. Oxidative stress 6. Post-menopausal status Category IV (Associated with increased CVD risk which cannot be modified) 1. Age 2. Male gender 3. Low socio-economic status 4. Family history of early onset CVD

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Most crucial part of tuberculosis control programme is –

The most powerful weapon in tuberculosis control is → case finding and t/t. Cases are defined by WHO as a patient whose sputum is positive for tubercle bacilli.

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Which of the following is present intracellularly in muscle cells -

Ans. is `b' i.e., Coicosteroids o Insulin, epinephrine and glucagon act on membrane receptors. o Coicosteroids act on intracellular (cytoplasmic receptors).

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In the Forrest classiflcation for bleeding peptic ulcer with a visible vessel or pigmented protuberance is classified as -

Clinical features of Peptic ulcers Peptic ulcer disease is a chronic condition with spontaneous relapses and remissions lasting for decades, if not for life. The most common presentation is with recurrent abdominal pain that has three notable characteristics: localisation to the epigastrium, relationship to food and episodic occurrence. Occasional vomiting occurs in about 40% of ulcer subjects; persistent daily vomiting suggests gastric outlet obstruction. In one-third, the history is less characteristic, especially in elderly people or those taking NSAIDs. In this situation, pain may be absent or so slight that it is experienced only as a vague sense of epigastric unease. Occasionally, the only symptoms are anorexia and nausea, or early satiety after meals. In some patients, the ulcer is completely 'silent', presenting for the first time with anaemia from chronic undetected blood loss, as abrupt haematemesis or as acute perforation; in others, there is recurrent acute bleeding without ulcer pain. The diagnostic value of individual symptoms for peptic ulcer disease is poor; the history is therefore a poor predictor of the presence of an ulcer. Ref Davidson edition23rd pg 799

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The predominant colonic bacteria are -

Ans. is 'b' i.e., Largely anaerobic " The greatest number of bacteria found in colon are bacteriods, a group of gram- negative, anaerobic, non-spore forming bacteria. "-------Todar s 68o Anaerobic bacterias exist as components of the normal flora on the mucosal surfaces of humans and animals,o The major reservoirs of these bacteria are the mouth, lower gastrointestinal tract, skin and female genital tract.Oral cavityo Among the constituents of the oral flora, anaerobes are the predominant organisms, ranging in concentration from l09ml in saliva to 1012/ml in gingival scrapings.o In the oral cavity, the ratio of anaerobic to aerobic bacteria ranges from 1:1 on the surface of tooth to 1000:1 on the gingival crevices.Gastrointestinal tracto Anaerobic bacteria are not found in appreciable numbers in the normal upper intestine until the distal ileum,o In the colon, the proportion of anaerobes increases significantly as does the overall bacterial count,o For example in colon there are I011 to 1012 organism per gram of stool with an anerobe to aerobe ratio of 1000:1. Female genital tracto In the female genital, there are ~ 10* organisms per millilitre of secretions with anaerobe to aerobe ratio ~ 10:1.

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A PTT is required for monitoring of ?

Ans. is'c'i.e., Heparin(Ref KDT &/e p. 598, 599; Katzung llnle p. 592)

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Irreversible pulpitis leads to:

Pulpal Necrosis As stated before, pulp is encased in rigid walls, it has no collateral blood circulation, and its venules and lymphatics collapse under increased tissue pressure. Therefore irreversible pulpitis leads to liquefaction necrosis

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Michaelis Gutmann bodies are seen in

Michaelis guttman bodies (malacoplakia) # Chronic granulomatous infection as a result of the inability of macrophages to kill phagocytosed E. coli. # Most commonly affects immunosuppressed(BMT> HIV/AIDS) # Most commonly affects GU tract; may affect skin of perianal/genital region (ulcerated abscesses and soft polypoid lesions) Histology:- Dense granulomatous infiltrate comprised of von Hansemann cells (large macrophages w/ eosinophilic cytoplasm) containing Michaelis Gutmann bodies (round, laminated, calcified basophilic intracytoplasmic inclusions; comprised of incompletely killed bacteria within calcified phagolysosomes; stain w/ von Kossa, PAS, Perls, Giemsa). Treatment:- * Localized: surgical excision * Nonsurgical candidates: difficult to treat; may try long courses of ciprofloxacin, TMP/SMX, or clofazimine. Ref:- Review of Dermatology by Alikhan pg num:-298

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A female undergone surgery for left breast cancer 3 yrs back now developed blue nodule on same side -

Ans. is 'a' i.e.. Lymphangiosarcoma o Angiosarcoma is a vascular tumor which may arise de novo in the breast or as a complication of the radiation therapy."This vascular tumor may occur de novo in the breast, but the clinically important presentation is in the dermis after breast radiation or in the lymphedematous upper extremity, following radical mastectomy'' ___ Sabiston

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ICD 10

ICD-10 is the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD) Medical classification list by the World Health Organization (WHO); Revised every 10years Consists of 21chapters The ICD-10 consists of: Tabular lists containing cause-of-death titles and codes (Volume 1) Inclusion and exclusion terms for cause-of-death titles (Volume 1) Description, guidelines, and coding rules (Volume 2) and An alphabetical index to diseases and nature of injury, external causes of injury, table of drugs and chemicals (Volume 3) Ref : Park's textbook of preventive and social medicine; 23rd edition

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Nail involvement is not a feature of :

B i.e. DLE

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The acid fast staining characteristic of Mycobacteria appears to be due to which of the following cell wall constituent

(A) Mycolic acid # Acid fastness is attributed to the organisms' high content of mycolic acids, long chain cross-linked fatty acids and other cell wall lipids.

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Not a common cause of meningitis in a child of age 8 years is:

S. aureus REF: Nelson 17th edition page 863, "Meningitis due to S. aureus is not common; it is associated with cranial trauma and neurosurgical procedures ( e.g. craniotomy, cerebrospinal fluid shunt placement) and less frequently with endocarditis, parameningeal foci (e.g., epidural or brain abscess), diabetes mellitus, or malignancy. The CSF profile in S. aureus meningitis is indistinguishable from that in other bacterial causes of meningitis" Causes of bacterial meningitis vary by age group and comorbid conditions: Age Group & conditions Causes Premature babies & New- horns up to 3 month Group B Streptococci (mc), Streptococcus pneumoniae, Escherichia coli (carrying K1 antigen), Listeria monocytogenes Infants Neisseria meningitidis, Haemophilus influenzae, Streptococcus pneumoniae Children (2-29 years) N. meningitidis (mc), S. pneumoniae Adult S. pneumoniae (mc), N. meningitidis, Mycobacteria Impaired cellular immunity L monocytogenes, gram-negative bacilli, S pneumoniae Postsurgical or posttraumatic Staphylococcus aureus, S pneumoniae, gram-negative bacilli

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Primary intentional healing which is true ?

Ans. is 'a' i.e., Neovascularization is maximum by day 5Skin wound healingSkin wounds are classically described to heal by primary or secondary intention.A. Healing by primary intention It occurs in wounds with opposed edges, e.g., surgical incision.The healing process follows a series of sequantial steps : ?Immediate after incision Incisional space filled with blood containing .fibrin and blood cells.Dehydration of the surface clot forms scab that covers the wound.Within 24 hours Neutrophils appear at the margins of wound.In 24-48 hoursEpithelial cells move from the wound edges along the cut margin of dermis, depositing basement membrane components as they move.They fuse in the midline beneath the surface scab, producing a continuous but thin epithelium layer that closes the wound.By day 3Neutrophils are largely replaced by macrophages.Granulation tissue progressively invades the incision space.Collegen fibers now present in the margin but do not bridge the incision.By day 5Incisional space is largely filled with granulation tissue.Neovascularization is maximum.Collegen fibrils become more abundant and begin to bridge the incision.The epidermis recovers its normal thickness.During second weekLeukocytes and edema have disappeared.There is continued accumulation of collegen and proliferation of fibroblast.By the end offirst month Scar is made up of a cellular connective tissue devoid of inflammatory infiltrate covered now by intact epidermis.B. Healing by secondary intention It occurs in wounds with seperated edges in which there is more extensive loss of cells and tissue.Regeneration of parenchymal cells cannot completely restore the original architecture, and hence abundant granulation tissue grows.Healingby secondary from primary intention in several respects : Inflammatory reaction is more intense.Much larger amounts of granulation tissue are formed.Wound contraction occurs - Feature that most clearly differentiate secondary from primary healing.Permanent wound contraction requires the action of myolifibroblasts - Fibroblasts that have the ultrastructural characteristic of smooth muscle cells.

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What is the most characteristic of congenital hypertrophic pyloric stenosis?

Ans. (b) The pyloric tumour is best felt during feedingRef: Sabiston 20th Edition, Page 1869* Baby is not marasmic. It feeds vigorously in between the episodes of vomiting

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Which of the following drug binds only with the anionic site of cholinesterase ?

Physostigmine, neostigmine and pyridostigmine are carbamates by chemical nature, they bind to both esteritic as well as anionic site whereas edrophonium is an alcohol and binds to anionic site only.

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A child was treated for H. Influenza meningitis for 6 month. Most impoant investigation to be done before discharging the patient is:

H. Influenza Type Meninigtis It is frequent in children between the ages of 3 and 12 months. Residual auditory deficit is a common complication. - Ghai 6th/ed Since, residual auditory deficit is a common complication of H. influenza meningitis, audiological test to detect the deficit should be performed before discharging any patient suffering from H. influenza meningitis. In children best test to detect hearing loss is brainstem evoked auditory response.

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Early onset and bad prognosis is seen in:

Early onset and bad prognosis is seen in Disorganized / hebephrenic schizophrenia According to DSM 4, types of schizophrenia Paranoid schizophrenia Most common type Characterized by predominant positive symptoms Late onset and good prognosis Catatonic schizophrenia Predominant catatonic or motor symptoms Best prognosis out of other schizophrenia 1st line treatment - i.v lorazepam & electroconvulsive therapy Disorganized / hebephrenic schizophrenia Characterized by disorganized symptoms Early onset with bad prognosis Significant disorientation of personality Simple schizophrenia Predominant negative symptoms Worst prognosis of all types Post schizophrenic depression Max chance of suicidal attempt

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Which of the following is/are extracellular matrix protein:

A, B, C i.e. Collagen, Laminin, Fibronectin

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A patient on aspirin for long period is selected for elective surgery. What should be done

In moderate-risk to high-risk patients who are receiving acetylsalicylic acid and require noncardiac surgery, continuing acetylsalicylic acid around the time of surgery is suggested instead of stopping acetylsalicylic acid 7 to 10 days before surgery.

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In one-stage Full mouth disinfection scaling is done in 2 visits within:

The oral cavity offers a range of different niches (mucosa, tongue, tonsils, saliva and teeth, etc.) where the bacteria can adhere and survive. The transmission of bacteria from one niche to another is likely to occur. If this transmissions occurs at high speed (nothing but translocation), it could jeopardize the outcome of periodontal therapy (because of reinfection). This can be prevented by 'One-stage Full mouth disinfection', which is nothing but scaling and root planning of all pockets in 2 visits within 24 hrs, in combination with tongue brushing with 1% chlorhexidine gel for 1 min, mouth rinsing with 0.2% chlorhexidine solution for 2 mins and subgingival irrigation of all pockets with 1% chlorhexidine gel. This concept was given by Quirynen

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Hemotoxylin bodies seen in

Ref Robbins 9/e p218 Systemic lupus erythematosus (SLE) is a multisystem auto- immune disease of protean manifestations and variable clinical behavior. Clinically, it is an unpredictable, remit- ting and relapsing disease of acute or insidious onset that may involve viually any organ in the body; however, it affects principally the skin, kidneys, serosal membranes, joints, and hea. Immunologically, the disease is associ- ated with an enormous array of autoantibodies, classically including antinuclear antibodies (ANAs). The clinical pre- sentation of SLE is so variable, with so many overlapping features with those of other autoimmune diseases (RA, polymyositis, and others), that it has been necessary to develop diagnostic criteria for SLE (Table 4-9). The diag- nosis is established by demonstration of four or more of the criteria during any interval of observation. Hematoxylin bodies are seen these are deposition of antigen antibody complexes in various tissues

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Which is caused by Rickettsia?

Ans. (b) Rocky mountain spotted fever Family rickettsiae includes six genera: - Rickettsia - Ehrlichia - Orientia - Anaplasma - Neorickettisa - Coxiella

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