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Alcoholic presents with psychosis and memory loss. Probable diagnosis is:

Alcoholic patients with chronic thiamine deficiency may also have central nervous system (CNS) manifestations known as Wernicke's encephalopathy, consisting of horizontal nystagmus, ophthalmoplegia (due to weakness of one or more extraocular muscles), cerebellar ataxia, and mental impairment. When there is an additional loss of memory and a confabulatory psychosis, the syndrome is known as Wernicke-Korsakoff syndrome. Ref: Harrison's principle of internal medicine 17th edition, chapter 71.

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All of the followings are signs of reversible cell injury; except:

Ans. (d) Dense Mitochondrial depositRef: Robbins and Cotran Pathologic Basic Disease 9th Ed; Page No-40Cell injuryReversible cell injuryIrreversible cell injury* Cellular swelling* Loss of microvilli* Formation of cytoplasmic blebs* ER swelling* Ribosomal detachment* Myelin figures* Clumping of nuclear chromatin* Flocculent, amorphous mitochondrial densities* Swelling & disruption of lysosomes* Plasma membrane damage* Pyknosis* Karyolysis* Karyorrhexis

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Power of reduced eye is ?

Ans. is b' i.e., 60 D Reduced eve (Reduced schematic eye) In schematic model, the optical system of eye behaves like a combination of lenses. The reduced schematic eye treats the eye as if it were a single refracting element consisting of an ideal spherical surface separating two media of refractive indices of 1.00 (air in external environment) and 1.33 (eye as a whole). So, in reduced eye, the entire system (of eye) can be regarded as one lens with one optical centre which lies in the posterior pa of crystalline lens. The diopteric power of reduced eye is + 60D, of which + 44D is contributed by cornea and + 16D by the crystalline lens. Reduced eye concept was introduced by Listing, therefore, it is also referred to as Listing's reduced eye.

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The length of the eye ball is

D. i.e. 24 mm Antero posterior diameter of eye is 17.5 mm at bih and reaches 24 mm in adultQ Eye Diameter Power Pressure Refractory index Veical 23 mm Lens +16DQ Goldmann 10.4 - 20. Air 1 Horizontal 23.5 Cornea +44 DQ applantation 4 mmHg Aqueous 1.336 mm Total +60 DQ Schiotz 10.5- 21.7 Humor Anteroposte- 24 New born eye +2.5 Indentation mmHg Vitrous 1.336 nor (adult) mmQ is DQ Humor A-P (bih) 17.5 hypermetropic Cornea 1.376 mm Crystaline 1.386? Circumference 75mm Lens 1.406Q Volume 6.5 ml (coex? core nucleus) Weight 7 gm

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Wilm' s tumor associated with A/E

The genitourinary anomalies most commonly associated with Wilms tumor are hypoplasia, fusion and ectopia of the kidney, duplications of the collecting systems, hypospadias, and cryptorchidism (Bilateral polycystic kidney disease is not associated with the Wilm's tumor) Syndromes Associated with Wilms Tumor Several syndromes and congenital abnormalities commonly are reported in patients with Wilms tumor. WAGR syndrome (contiguous gene deletion of WT1 & PAX6 on 11P13) It consists of Wilms tumor, Aniridia, Genitourinary abnormalities (cryptorchidism, streak ovaries, bicornuate uterus, ambiguous genitalia), and Mental retardation. Patients with this syndrome have a constitutional deletion of chromosome 11p13 where the Wilms tumor gene, WT1, and the aniridia gene, PAX6, are located. Denys- Drash syndrome(missense mutation in WT1 gene)  It is characterized by Male pseudohermaphrodism, Early-onset renal failure characterized by mesangial sclerosis and Increased risk of Wilms tumor. Patients with this syndrome typically carry a missense mutation in the WT1 gene. Beckwith-Wiedemann syndrome (WT2 gene abnormality on chromosome 11P15.5) It is characterized by Hemihypertrophy, Macroglossia, Visceromegaly, Omphalocele Risk of developing Wilms tumor (3-5%) A variety of 11p15.5 abnormalities have been reported in patients with this syndrome, and it is postulated that a second Wilms tumor gene, WT2, is located in this region. Loss of imprinting of the insulin-like growth factor 2 gene, an epigenetic process, also is associated with Wilms tumor. Other syndromes or conditions with an increased risk of Wilms tumor include: Hemihypertrophy, Sporadic aniridia, Genitourinary anomalies, Pearlman syndrome, Sotos syndrome, Neurofibromatosis (von Recklinghausen disease), and Von Willebrand disease. About option 'c' Hypertension. "Hypertension also has been described and probably is due to renal ischemia."- Nelson More about Wilm's tumor (also k/a nephroblastoma): Wilm's tumor is the most common renal neoplasm & 2nd most common malignant abdominal tumor, in children (Most common abdominal malignant tumor is neuroblastoma) Peak incidence is between 2 and 5 yrs of age. 5-10% are bilateral; either both kidneys are involved simultaneously (synchronous) or one after the other (metachronous) Clinical features of W.T. Abdominal lump (most common presenting feature) Abdominal pain Vomiting Hematuria Hypertension Treatment: High cure rates of 80-90% can be achieved with multimodality treatment using surgery, chemotherapy & radiotherapy Surgical resection is done in all stages followed by chemotherapy (stage I&II) or chemotherapy + radiotherapy (stage III, IV, V) Pre op chemotherapy is given in inoperable & bilateral cases Chemotherapeutic agents used are Vincristine, Dactinomycin, Doxorubicin & Cyclophosphamide.

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All are caused by Herpes simplex virus except

CA cervix is caused by human papilloma virus.

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Great auricular nerve originates from?

The great auricular nerve is a superficial branch of the cervical plexus composed of branches of spinal C2 and C3. It provides sensory innervation to the skin overlying the parotid gland, angle of mandible, external ear and posterior auricular region. The skin of the face is supplied by three divisions of the trigeminal nerve except for the small area over the angle of mandible and parotid gland which is supplied by greater auricular nerve(C2,C3).

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Function of CAMP

CAMP is a secondary messager, used for intracellular signal transduction, such as transferring into cells the effect of hormones like glucagon etc.it is involved in activation of protein kinase Ref:Guyton and Hall textbook of medical physiology 12th edition,page number 540 ,541,542

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Birth trauma is a risk factor for:

Birth trauma is an important aetiological factor for prolapse.

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During an operation if a pair of scissors is left in abdomen it is known as:(2004)

Ans: cRef: Parikh, 6th ed, p. 1.43

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Paranasal sinuses presents at bih are

Paranasal sinuses develop as outpouchings from the mucous membrane of a lateral wall of the nose. The growth of sinuses continues during childhood and into early adult life. Radiologically maxillary sinuses can be identified at 4-5 months, ethmoids at 1 year, sphenoid at 4 years and frontals at 6 years. Reference: Diseases of ear, nose and throat; PL Dhingra; 6th edition; Pg no.189

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The incidence of carcinoma cervix in women with multiple sexual paners is 5 times the incidence seen in those with a single paner. Based on this, what is the attributable risk?

- If the incidence of carcinoma cervix in those with single paner is 'I' , then the incidence in those with multiple sexual paners will be 5 'I'. - Now attributable risk = (Incidence in exposed-Incidence in non-exposed/Incidence in exposed ) X 100 = (5I-I / 5I) X 100 = (4/5) X 100 = 80%.

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Secondary amyloidosis complicates which of the following:

Chronic osteomyelitis

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Thiopentone is used for induction anaesthesia, because it is –

All inducing agents have smooth and fast induction. Therefore they are used as inducing agents. Rapid redistribution is responsible for very short duration of action (rapid recovery), not for induction.

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If TFR in a population is 4, then GRR would be (approx.)

- GRR or NRR= 1/2 TFR (approx.) - In given question, TFR is 4; hence GRR is half of 4 = 2

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Pericardial space is present between ?

Pericardial space (pericardial cavity) lies between parietal serous pericardium and visceral serous pericardium.

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Chacroid is caused by?

See APPENDIX-47 for list of “STDs” CHANCROID (SOFT SORE) This venereal infection is caused by the Gram-negative bacillus Haemophilus ducreyi. One to 5 days postinfection, 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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Metrifonate is effective against:

Schistosomiasis

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For which malignancy, intensity Modulated Radiotherapy is the most suitable

The prostate is a walnut-sized gland located between the bladder and the penis. The prostate is just in front of the rectum. The urethra runs through the center of the prostate, from the bladder to the penis, letting urine flow out of the body. The prostate secretes a fluid that nourishes and protects sperm. During ejaculation, the prostate squeezes this fluid into the urethra, and it’s expelled with sperm as semen.

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Most common cause of secondary postpaum hemorrhage:-

Most common cause of secondary postpaum hemorrhage is retained tissues Secondary postpaum hemorrhage is bleeding 24 hours to 12 weeks after delivery. Causes of PPH(10 and 20) : Uterine atonicity Injury to any pa of genital tract Coagulopathy (von Willebrand's disease) Retained tissues - MCC of 20PPH

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A 53 year old male presents with an enlarged supraclavicular lymph node, and examination reveals enlargement of the Waldeyer ring of oropharyngeal lymphoid tissue. There is no hepatosplenornegaly. Lymph node biopsy reveals replacements by a monomorphous population of large lymphoid cells with enlarged nuclei and prominent nucleoli. The CBC is normal except for finding of mild anemia. Immunohistochemical staining and flow cytometry of the node reveals that most lymphoid cells are CDl9 CD10=,CD3-, CD15-, and negative (TdT). These findings are most consistent with a diagnosis of

Diffuse large B-cell lymphoma occurs in older individuals and frequently presents as localized disease with extranodal involvement, paicularly of the Waldeyer ring. The staining pattern indicates a B-cell proliferation (CD19, CD1O). T-cell (CD3) and monocytic (CD15) markers are absent, TdT can be expressed in B- lineage cells at an earlier stage of maturation. Small lymphocytic lymphoma is also a B-cell neoplasm, but it manifests with widespread lymphadenopathy, liver and spleen enlargement, and lymphocytosis, Lymphoblastic lymphoma is a T-cell neoplasm that occurs typically in the mediastinum of children. Reed-Stem berg cells characterize Hodgkin disease. In chronic lymphaderiitis, the lymph node has many cell types-macrophages, lymphocytes, and plasma cells. A monomorphous infiltrate is typical of non-Hodgkin lymphomas.

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Clonorches sinenensis is-

Ans. is 'd' i.e., FlukeTrematodes (fluke)o These are flat, leaf like helminths.o They can be classified depending on their site of localization in human tissues.Blood flukesVesical venous plexus: Schistosoma hematobium.Rectal venous plexus & portal venous system : S mansoni (inferior mesentric vein), S japonicum (superior mesenteric vein).Intestinal flukesSmall intestine : Fasciola buski, Heterophyes heterophes, Metagonimus vokogawi, Watsonius watsoni.Large intestine : Gastrodiscoides hominis.Tissue flukesLiver flukes : Fasciola hepatica, Clonorchis sinensis, Opisthorchis felineus, O viverrini.Lung fluke : Paragonimus westermani.o Trematodes are monoecious (hermaphrodite), i.e. sexes are not separate. One exception being Schistosomes, which are diecious with separate sexes.o Trematodes complete their life cycle in three hosts: One definitive (man) and two intermediate hosts (Freshwater snail or mollusc as first intermediate host and fish or crab as second intermediate host),o Trematodes are Oviparous and lay operculated eggs, except for schistosomes which lay non-operculated eggs.Metazoa (Helminths)NemathelminthesPlatyhelminthes ||||Class : Nemafoda(Roundworms)Class : Cestoda(Tapeworms)Class: Trematoda(Flukes)||||||||Intestinal speciesIntestinal-tissue speciesBlood-tissue speciesIntestinal speceisIntestinal-tissue speciesIntestinal speciesBlood speciesTissue species1. Enterobius vermicularisl. Triehinella spiralis1. Wuchereria bancrofti1. Taenia sagnata1. Echinococcus granulosus1. Fasciolo- psis buski1. Schis- tosoma species1. Fasciola hapatic (liver fluke)2. Trichura trichisis2. Dracunculus medinensis2. Brutgia malayi2. Taenia solium 3. Ascaris lumbricoides 3. Loa toa4. Onchocerca3. Hvmenolepsis nana 2. Parago- nimus wester-mni (lung fluke)4. Necator americanus volvulus4. Diphyllobothrium latum 5. Ancylotoma duodenalc 6. Strongyloide stercoraliss

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Use of FAST?

Ans. is 'a' i.e., To detect fluid in pericardial and peritoneal sacs o FASTFocused Assessment of Sonographic examination of Trauma patient is a rapid diagnostic examination to assess patients with potential thoraco abdominal injuries.It sequentially survavs for pressence of blood in pericardial sac and dependent abdominal regions.It is exquistely sensitive for detecting fluid of > 250 ml. After application of vs transmission gel, a 3.5 MHZ convex transducer is used to assess, in sequence-pericardial area, RUQ, LUQ and Pelvis.It is very accurate in assessing Hypotensive patients with blunt trauma abdomen; if FAST positive, immediate surgery is justified.

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The 'Japanese Detergent Suicide Technique' involves mixing of common household chemical to produce:

A ie. H2S - Japanese Detergent Suicide technique involves mixing of house hold chemicals like bath sulfur with toilet bowl cleaner to produce a deadly poisonous hydrogen sulfide gas cloudQ. It is used in enclosed spaces like car or closets to achieve near instant death. American version substitutes a common insecticide for bath sulfur as bath sulfur is not available in US.

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Substance with same atomic number but different mass number –

Isotopes → Atoms of the same elements with same atomic number but different atomic mass (mass number).

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NSAIDs are used in all except -

Ans. is 'b' i.e., Peptic ulcer o Peptic ulcer is a contraindication.

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On USG finding of cystic hygroma in fetus is suggestive of

C i.e. Turner's Syndrome

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A 22-year-old man has a sudden loss of vision in the right eye. On physical examination, there is a subluxation of the right crystalline lens. On auscultation of the chest, a midsystolic click is audible. An echocardiogram shows a floppy mitral valve and dilated aortic arch. The patient's brother and his cousin are similarly affected. He is prescribed a beta-blocker. A genetic defect involving which of the following substances is most likely to be present in this patient?

Marfan syndrome is an autosomal dominant condition that is most often caused by qualitative defects in fibrillin from missense mutations in the fibrillin (FBN1) gene. An abnormal collagen gene can cause osteogenesis imperfecta and Ehlers-Danlos syndrome. Genetic mutations in the dystrophin gene are involved in Duchenne and Becker muscular dystrophies. The NF1 protein is abnormal in neurofibromatosis type 1. Disordered spectrin causes hereditary spherocytosis.

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Hypokalemia is seen with -

Furosemide also can lead to gout caused by hyperuricemia. Hyperglycemia is also a common side effect. The tendency, as for all loop diuretics, to cause low serum potassium concentration (hypokalemia) has given rise to combination products, either with potassium or with the potassium-sparing diuretic amiloride (Co-amilofruse). Other electrolyte abnormalities that can result from furosemide use include hyponatremia, hypochloremia, hypomagnesemia, and hypocalcemia. In the treatment of hea failure, many studies have shown that the long-term use of furosemide can cause varying degrees of thiamine deficiency, so thiamine supplementation is also suggested. Although disputed, it is considered ototoxic: "usually with large intravenous doses and rapid administration and in renal impairment". Other precautions include: nephrotoxicity, sulfonamide (sulfa) allergy, and increases free thyroid hormone effects with large doses Ref Davidson 23rd edition pg 365

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An 19-year-old man is admitted to the emergency room following a motorcycle accident. He is ale and fully oriented, but witnesses to the accident repo an interval of unresponsiveness following the injury. Skull films show a fracture of the left temporal bone. Following x-ray, the patient suddenly loses consciousness and dilation of the left pupil is noted. This patient should be considered to have?

Epidural hematomas are typically caused by a tear of the middle meningeal aery or vein or a dural venous sinus. Ninety percent of epidural hematomas are associated with linear skull fractures, usually in the temporal region. The lesion appears as a hyperdense biconvex mass between the skull and brain on CT scan. The typical history is one of head trauma followed by a momentary alteration in consciousness and then a lucid interval lasting for up to a few hours. This is followed by a loss of consciousness, dilation of the pupil on the side of the epidural hematoma, and then compromise of the brainstem and death.

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All these structures are found in the lateral nasal wall except:

(b) Vomer(Ref. Cummings, 6th ed., 659)Vomer is an independent separate bone which forms the postero-inferior part of the septum proper, i.e. the medial wall of nose.Rest all are found on the lateral wall

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If thiopentone is injected accidently into an artery the first symptom is –

First symptom of inadverent intra-arterial injection is pain and first sign is blanching.

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True about pugilistic attitude?

Puglistic attitude : It is due to coagulation of the proteins of the muscles and dehydration which cause contraction. The flexor muscles being bulkier than extensor, contracts more due to which joints of all limbs are flexed. It occurs whether the person was alive or dead at the time of burning. So it is non specific ,hence Cannot differentiate between antemoem & postmoem burn

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Which of the following drug when taken in excess can be removed by dialysis?

Forced alkaline diuresis or hemodialysis is indicated in severe salicylate poisoning to remove unabsorbed drug. Other treatment modalities in salicylate poisoning are external cooling and intravenous fluids with sodium, potassium, bicarbonate and glucose. Gastric lavage is done to remove the unabsorbed drug. Blood transfusion and vitamin K is given if bleeding occurs. Fatal dose in salicylate poisoning is 15-30gm. Serious toxicity occur at serum salicylate levels >50mg/dl. Manifestations include vomiting, dehydration, acidotic breathing, hypoglycemia, delirium, hallucinations, convulsion, coma and death due to respiratory failure and cardiovascular collapse. Ref: Essentials of Medical Pharmacology, 5th Edition, Pages 172-3; Irwin and Rippe's Intensive Care Medicine By Richard S. Irwin, Page 1553; Pediatric Critical Care Medicine: Basic Science and Clinical Evidence By Derek S. Wheele, Page 1633.

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All of the following are true about cluster sampling except-

.

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Dofetilide is which class of anti arrhythmia drug

Refer kDT 7/e 529 Dofetilide is a class III antiarrhythmic agent Dofetilide is used for the maintenance of sinus rhythm in individuals prone to the occurrence of atrial fibrillation and flutterarrhythmias, and for chemical cardioversionto sinus rhythm from atrial fibrillation and flutter

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Bone pearl's or wax drippings is pathogonomic of:

Ans. (D). Electrocution(Ref: Review of Forensic Medicine & toxicology; Gautum Biswas; 2nd edition; Pg - 275)

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Metal fume fever can be seen in poisoning by all EXCEPT: March 2003

Ans. B i.e. Arsenic

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Fructose is transpoed by:

GLUT 5is membrane channel for the facilitated diffusion of glucose It is seen in testis,gastrointestinal tract

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A child with alopecia, hyperpigmentation, hypogonadism and rash of genital area and mouth is likely to suffer from:

Ans. (b) Zinc deficiencyRef. Harrison's 19th ed. / 96e-9* Zinc is an essential trace nutrient required for the proper function of more than 100 enzymes and plays a crucial role in nucleic acid metabolism.* Acrodermatitis enteropathica is an autosomal recessive disorder postulated to occur as a result of mutations in the SLC39A4 gene located on band 8q24.3.* This protein is highly expressed in the enterocytes in the duodenum and jejunum. Therefore, affected individuals have a decreased ability to absorb zinc from dietary sources. Absence of a binding ligand needed to transport zinc may further contribute to zinc malabsorption.* Clinical manifestations include diarrhea, alopecia, muscle wasting, depression, irritability, and a rash involving the extremities, face, and perineum. The rash is characterized by vesicular and pustular crusting with scaling and erythema.* Features of acrodermatitis enteropathica start appearing in the first few months of life, if mother discontinues breast milk.Deficiency and toxicity of several metalsPhosphorus ElementDeficiencyToxicityTolerable Upper (Dietary) Intake LevelBoronNo biologic function determinedDevelopmental defects, male sterility, testicular atrophy20mg/d (extrapolated from animal data)CalciumReduced bone mass, osteoporosisRenal insufficiency (milk-alkali syndrome) nephrolithiasis, impaired iron absorption, thiazide diuretics.2500 mg/d (milk alkali)CopperAnemia, growth retardation, defective keratinization and pigmentation of hair, hypothermia, degenerative changes in aortic elastin, osteopenia, mental deterioration.Nausea, vomiting, diarrhea, hepatic failure, tremor, mental deterioration, hemolytc anemia, renal dysfunction10 mg/d (liver toxicity)ChromiumImpaired glucose toleranceOccupational',Renal failure, dermatitis, pulmonary cancerNot determinedFluoride|Dental cariesDental and skeletal flurosis, osteosclerosis10 mg/d (Blurosis)IodineThyroid enlargement, |T4 cretinismThyroid dysfunction, acne-like eruptions.1100 mg/d (thyroid dysfunction)IronMuscle abnormalities, koilonychia, pica anemia, |work performance, impaired cognitive development, premature labor, |perinatal maternal deathGastrointestinal effects, (nausea, vomiting, diarrhea, constipation), iron overload with organ damage, acute and chronic systemic toxicity, increased susceptibility to malaria, increased risk association with certain chronic diseases (e.g. diabetes)45 mg/d of elemental Iron (gastrointestinal side effects)ManganeseImpaired growth and skeletal development reproduction, lipid and carbohydrate metabolism, upper body rashGeneral: Neurotoxicity, Parkinson-like symptoms Occupational: Encephalitis like syndrome, Parkinson like syndrome, psychosis, pneumoconiosis.11 mg/d (neurotoxicity)MolybdenumSevere neurologic abnormalitiesReproductive and fetal abnormalities2mg/d (extrapolated from animal data)SeleniumCardiomyopathy, heart failure, striated muscle degenerationGeneral: Alopecia , nausea, vomiting, abnormal nails, emotional400 pg/d (hair, nail changes)PhosphorusRickets (osteomalacia) proximal muscle weakness, rhabdomyolysis, paresthesia, ataxia, seizure confusion, heart failure, hemolysis acidosis.Hyperphosphatemia4000 mg/dZincGrowth retardation, |taste and smell alopecia, dermatitis, diarrhea, immune dysfunction, failure to thrive, gonasal atrophy, congenital malfomations.General: Reduced copper, absorption, gastritis, sweating fever,nausea, vomitingOccupational; Respiratory distress, pulmonary fibrosis40 mg/d (impaired copper metabolism)

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Which of the following nerve fibers are first to get blocked by local anaesthetic

Sequence of block is Beta > A delta = C > A gamma > A beta >A alpha

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Ketamine belongs to which of the following group of drugs ?

Ketamine is a phencyclidine derivative presented as a racemic mixture of R-and S-ketamine.

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Anti-D Rh is given for: September 2005

Ans. D: Rh positive father,Rh negative mother Rho(D) Immune Globulin is given by intramuscular injection that is used to prevent the immunological condition known as Rhesus disease (or hemolytic disease of newborn) paicularly when father is Rh positive and mother is Rh negative. It is a solution of IgG anti-D (anti-RhD) antibodies that bind to, and lead to the destruction of, fetal Rh D positive red blood cells that have passed from the fetal circulation to the maternal circulation. Therefore, in a Rhesus negative mother it can prevent sensitization of the maternal immune system to Rh D antigens, which can cause rhesus disease in the current or in subsequent pregnancies

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About Ectopia vesicae, following is true except ?

Answer is 'b' i.e. Ventral curvature of penis Ectopia vesicae is associated with epispadias in which dorsal or upwards curvatuve of penis is noted. Ventral curvature is noted in hypospadias.

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On USG finding of cystic hygroma in fetus is suggestive of :

Turner's syndrome (XO) may have - Cystic hygroma, Widely spaced nipples, Webbed neck, Infertility, Normal I.Q.

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Oesophageal atresia may occur as a pa of VACTERAL group of anomalies. What does `TE' stand for?

Ans. is 'c' i.e., Tracheo-oesophageal fistulaVACTERL association is a disorder that affects many body systems. VACTERL stands for :V:Veebral defectsA:Anal atresiaC:Cardiac defectsTE:Tracheo-Esophageal fistulaR:Renal anomalies,L:Limb abnormalities.People diagnosed withVACTERL association typically have at least three of these characteristic features.

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The time between primary and secondary case is called:

Serial interval - gap in time between onset of the primary case and the secondary case. A period of communicability - time during which an infectious agent may be transferred directly or indirectly from an infected person to another person, from an infected animal to man or from an infected person to an animal including ahropods. Incubation period - time interval between invasion by an infectious agent and appearance of the first sign or symptoms of the disease Generation time - interval of time between reciept of infection by a host and maximal infectivity of the host Ref: Park 21st edition, page 95.

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Best treatment of old fracture is

Nonunion fracture shaft femur requires open reduction and rigid internal fixation with either intramedullary nail or DC plating and bone grafting.

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Duodenal adenocarcinoma -a) Most common small bowel carcinomab) Periampullary carcinomac) Jaundice & anemia - most common symptomd) Local resection - curative

• Duodenum is MC site of small intestinal adenocarcinoma • 15% in the proximal; 40% in the middle and 45% in the distal duodenum (MC) • Resectability and prognosis are better than other upper GI cancers. Clinical Features • Most often presents as obstruction, with nausea, vomiting, and abdominal pain as the most frequent symptoms. • Anemia from bleeding and biliary or pancreatic obstructive symptoms can also be seen on initial presentation if the tumor is located within the periampullary region. Diagnosis • Endoscopy is the diagnostic test of choice for duodenal tumors, which allows for direct visualization and biopsy as needed. Treatment • For 1st or 2nd portion: Whipple procedure • For 3rd or 4th portion: Segmental duodenal resection

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A 10-year old boy presents to the pediatric emergency unit with seizures. Blood pressure in the upper extremity measured as 200/140 mm Hg. Femoral pulses were not palpable. The most likely diagnosis amongst the following is:

Isolated upper extremity hypeension (200/140 mm Hg), with absent/diminished femoral pulses, is characteristic of coarctation of the aoaSeizures may be due to severe hypeension or due to intracranial haemorrhage(from berry aneurysms which are more common in patients with coarctation)The classic sign of coarctation of the aoa is a disparity in pulsations and blood pressures in arms and legsThe femoral, popliteal, posterior tibial and dorsalis pedis pulses are weak (or absent in about 40% of patients) in contrast to bounding pulses in the arms and carotid vesselsBP in the legs is lower than in the arms and 90% of patients have hypeension in upper extremity greater than the 95th percentile for ageAge (yrs)95th percentile (mm Hg)>1 110/601-5115/756-10125/8511-18140/90Takayasu aooaeritis may also present with severe hypeension and absent femoral pulses due to acquired mid-aoic coarctation (but this is an uncommon presentation)Most commonly affects subclan aery and more commonly presents with claudicationCoarctation TakayasuMore commonMore common in boysUpper extremity hypeensionBounding pulses in arms and diminished or absent pulses in lower limbsHypeension is frequentLess commonMore common in girls (8:1 = f:m)Absent or decreased upper limb pulses and blood pressure difference between left and right arms are characteristicHypeension is frequentSystemic symptoms are more common(ref: Harrison's 18/e p1925)

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Over closure of jaws is accentuated muscle activity:

Hyperactive mentalis activity and abnormal buccinator activity is seen in class-II division-1 cases. Over closure of jaws is associated with accentuated temporatis muscle activity.

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Artifical radioisotopsa) Radiumb) Uraniumc) Plutoniumd) Iridiume) Cobalt

Important artificial radionuclides :- Tritium - 1, Carbon - 14, Cobalt - 60, Strontium 89, Strontium - 90, Iodine 131, Cesium 134, Cesium 137, Plutonium - 239, Iridium, Tc - 99.

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According to Poiseuille's law, reducing the radius of an airway to one-third will increase its resistance how many fold?

Poiseuille's law states that during laminar flow, airway resistance is inversely propoional to the 4th power of the radius, other things being equal. Therefore, a reduction in the radius by a factor of 3 increases the resistance by 34, that is, 81.

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Which is used for sterilization of cystoscope

Ans. (a) Glutaraldehyde

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A neonate is said be low birth weight (LBW) if his weight is less than ----- gms:

Ans. C. 2500 gramsA neonate weighing < 2500 grams at birth irrespective of gestational age is classified as low birth weight (LBW). A neonate weighing less than 1500 grams is classified as very low birth weight (VLBW). A neonate weighing less than 1000 grams at birth irrespective of the gestational age is classified as extremely low birth weight (ELBW)

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Which is most lipogenic carbohydrate:

All carbohydrates (if in excess), gets conveed to fat in body (endogenous fat). Sucrose is made up of glucose and fructose. So, when sucrose is taken instead of glucose, it increases lipogenesis because: Fructose is most rapidly metabolised sugar It bypasses PFK-1 step (Rate Limiting Enzyme of glycolysis). So fructose forms acetyl CoA and thus fats. So fructose is regarded as most lipogenic sugar. Fructose | Uses the enzymes of Glycolysis | Finally forms Pyruvate | Acetyl CoA | Fats (TG, Fatty Acids, Cholesterol) Fructose is present in fruits, honey, table sugar.

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The nucleotide triplet CTC in the sixth position of the l3-chain in DNA forms the complementary nucleotide on (mRNA) that codes for glutamic acid. A point mutation on the l3-chain resulting in the nucleotide triplet CAC forms a com¬plementary nucleotide on mRNA that codes for valine. In sickle cell anemia, you would expect the comple¬mentary nucleotide triplet on mRNA from 5' to 3' to read

Note that by changing the CTC triplet to a CAC, the messenger RNA (mRNA) changes from GAG, which normally codes for glutamic acid in the sixth position of the -chain of hemoglobin, to GUG, which now codes for valine. This point mutation of a single base pair is responsible for sickle cell anemia.

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Which of the following condition masks low serum haptoglobin in hemolysis?

Haptoglobin is a glycoprotein synthesized in the liver that binds free hemoglobin. Its scavenging function counteracts the potentially harmful oxidative and nitric oxide-scavenging effects associated with "free" hemoglobin. Low haptoglobin is considered an indicator of hemolysis. But it is increased in biliary obstruction, hence it will mask the effect of hemolysis on haptoglobin. Increased in: Acute and chronic infection (acute-phase reactant) Malignancy Biliary obstruction Ulcerative colitis Myocardial infarction Diabetes mellitus Decreased in: Newborns and children Pregnancy Malnutrition Posttransfusion Intravascular hemolysis Autoimmune hemolytic anemia Liver disease Ref: Nicoll D., Lu C.M., Pignone M., McPhee S.J. (2012). Chapter 3. Common Laboratory Tests: Selection and Interpretation. In D. Nicoll, C.M. Lu, M. Pignone, S.J. McPhee (Eds), Pocket Guide to Diagnostic Tests, 6e.

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EBV causes: March 2013

Ans. D i.e. All of the above Epstein-Barr virus (EBV)/ Human herpesvirus 4 (HHV-4) It is a virus of the herpes family, and is one of the most common viruses in humans. It is best known as the cause of infectious mononucleosis (glandular fever). It is also associated with paicular forms of cancer, such as Hodgkin's lymphoma, Burkitt's lymphoma, nasopharyngeal carcinoma, and conditions associated with human immunodeficiency virus (HIV) such as hairy leukoplakia and central nervous system lymphomas. There is evidence that infection with the virus is associated with a higher risk of ceain autoimmune diseases, especially dermatomyositis, systemic lupus erythematosus, rheumatoid ahritis, Sjogren's syndrome, and multiple sclerosis. Infection with EBV occurs by the oral transfer of saliva and genital secretions.

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Which of the following snake produces paralysis with convulsions -

Types of venom -- may be * Neurotoxic -- cobra, krait * Hemotoxic -- vipers * Myotoxic -- sea snake NEUROTOXIC in krait,eventhough it is neurotoxic,there is no swelling or burning pain at the site of bite and convulsions are milder REF;THE SYNOPSIS OF FORENSIC MEDICINE:KS NARAYANA REDDY;28th EDITION

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Dehiscence in the external auditory canal cause infection in the parotid gland via:

(a) Fissure of Santorini(Ref. Cummings, 6th ed., 1981)The notch of Rivinus is the upper attachment of pars flaccida.Petro-tympanic fissure is present on the anterior wall of middle ear, on which attaches the anterior malleolar ligament.Retropharyngeal fissure does not exist.

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Amino acids not coded by triplet codon:

B i.e. Hydroxyproline

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Which index of obesity does not include height?

Ref: Park 25th edition Pgno : 418

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Lalita, a female patient presents with pigmentation of the lips and oral mucosa and intestinal polyps. Her sister also gives the same history. Most probable diagnosis is:

The polyps of Peutz-Jeghers syndrome are generally considered to be hamaomas Hamaomatous polyps (usually <100) throughout the GIT, most common in jejunum Associated with Hypermelanotic macule in the perioral region, buccal mucosa. Mucocutaneous pigmentation usually occurs during infancy and most commonly noted in perioral and buccal region. Pigment spots usually appear in first few years of life, reach a maximum level in early adolescence and can fade in adulthood. However, pigmentation on the buccal mucosa remains throughout the life. The pigmented macules of PJS have no malignant potential. Screening consists of a baseline colonoscopy and upper endoscopy at age 20 years, followed by annual flexible sigmoidoscopy thereafter.

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Nesidioblastoma is due to hyperplasia of?

Ans. is 'b' i.e., Beta cell Nesidioblastoma is due to hyperplasia of B cell of panceatic islets.

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In the treatment of undiagnosed megaloblastic anemia, vitamin B12 and folic acid should be given together because :

Vitamin B12 is required for conversion of methionine to homocysteine and for the formation of succinyl CoA from methylmalonyl CoA. Deficiency of vitamin B12 results in megaloblastic anemia, GI manifestations and neurological abnormalities (due to demyelination). Folic acid alone will correct the symptoms of megaloblastic anemia but it does not prevent neurological abnormali­ties, which continue to proceed. Neurological abnormalities manifest initially in the form of loss of posterior column sensations (vibration, proprioception etc.), but later on, can result in subacute combined degeneration of the spinal cord.

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Most common cause of neonatal meningitis –

E. coli & streptococcus agalactie (group B streptococci) are the two most common cause of neonatal sepsis and meningitis

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Adduction of thumb occurs at:

C i.e. Carpometacarpal joint 1st carpometacarpal joint (cmj) is the only cmj with seperate joint cavity so the movements are much free. Flexion- extension (in the plane of palm), adduction - abduction (at right angles to the plane of palm), opposition & circumduction, movements of thumbQ take place at 1st CM Joint.

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Meniere's disease is characterised by:

Meniere's disease is due to raised endolymphatic pressure and clinically presents with vertigo, tinnitus, sensorineural hearing loss and sense of aural fullness. Vertigo can be accompanied by nausea and vomiting. Choice (a) is excluded due to conductive loss, (b) due to headache and ear discharge, and (c) due to headache. Presence of headache with vertigo and tinnitus may be a feature of neurological disorder.

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Influenza virus causes new epidemic by (3-5 yrs) -

Antigenic variations in Influenza Antigenic shift Antigenic drift Occurs due to Genetic recombination/reassoment / Rearrangement Point mutation Nature Sudden Gradual / insidious May lead to Epidemics/ pandemics Sporadic cases Ref: Park 25th edition Pgno : 166-172

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All of the following are causes of pneumoperitoneum except -

Ans. is 'd' i.e., Hirschsprung's Disease o Gas under left hemidiaphragm is due to fundal gas, a normal finding. When gas is present under right hemidiaphragm also it's due to pneumoperitoneum.Causes of Pneumoperitoneum1. Perforation of GI tract# Peptic ulcer# Inflamamtion (diverticulitis, appendicitis, toxic megacolon, necrotizing enterocolitis)# Infarction# Malignant neoplasm# Obstruction# Pneumatosis cystoides rupture# Iatrogenic-endoscopy2. Iatrogenic# Surgery, peritoneal dialysis, drainage catheters, biopsies3. Penetrating abdominal injury.4. Through female genital tracta. Spontaneousb. Iatrogenic# Iatrogenic perforation of uterus or vagina# Culdocentesis# Tubal patency test5. Gas forming peritonitis6. Pneumothorax with pleuroperitoneal fistula

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Hypercalcemia related to malignancy is seen in which of the following cancers?

Answer- D. All the aboveMalignancy related-Solid tumor with metastasis/ paraneoplastic syndromeCarcinoma breast/ Lung/ Kidney etcHematological: Multiple myeloma/Lymphoma/LeukemiaAluminum intoxicationMilk Alkali syndrome

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Which of the following is not used for procuring criminal aboion

Drugs having poisonous effects on body causing aboion:- Unripe fruit of papaya Saffron Seeds of carrot Unripe fruit of pineapple juice of calotropis juice of plumbago

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Chromosome associated with ADPKD

ADPKD Cytogenetic defect Chromosome 16 (85%): ADPKD-1 & Chromosome 4 (15%): ADPKD-2 ARPKD Cytogenetic defect Chromosome 6 Ref: HARSH MOHAN TEXTBOOK OF PATHOLOGY 6th ed. pg no: 659

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Down’s cephalometric analysis of a patient reveals a high mandibular plane angle. Which of the following landmarks are used for the construction of the mandibular plane in this analysis?

Tweed and Ricketts- straight line tangent to the lower most border of the mandible. Downs- line joining Gonion to menton. Steiner- line joining Gonion to gnathion. Bimler’s line- line joining menton to antegonial notch. Ref: Radiographic cephalometry:Jacobson A

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Which is not true of malaria Eradication programmea) Started in 1953b) Modified plan started in 1970c) Incidence was 2 million cases in 1958d) Incidence decreased to 50,000 in 1961

National anti-malaria Programme The Programme began initially as National Malaria control Programme in 1953. Because of the spectacular success achieved in the control of malaria, the control programme, was converted into an eradication programe in 1958 with the object of eradicating malaria once and for all from the country. The programme went on well for sometimes. The incidence of malaria declined from 75 million cases and 8 lakhs death in 1953 to about 1-2 million cases and no death in 1972. But thereafter the programme suffered serious set backs. There was a sharp increase in malaria incidence, in 1976, there were 6.47 million cases with 59 deaths. The Govt of India in 1977 evolved a "Modified plan of operation" based on "effective control" rather than eradication. The plan has since been implemented and the incidence of malaria began to decline. However, there was gradual, increased in falciparum malaria incidence. Hence a programme for containment of P.falciparum was also launched within the NMEP. Note : Option 'c & d' were given in 19th/e. of Park : - "The incidence of malaria had declined sharply from 75 million cases in 1953 to 2 million cases in 1958". "The annual incidence of malaria cases in India escalated from 50000 in 1961, to a Peak of 6.4 million cases in 1976". Strategic Action plan for malaria control in India (2007-2012) Malaria control is now incorporated into the health service delivery programmes under the umbrella of NRHM. The strategies of National malaria control programme are as follows : - Malaria Control strategies The strategies for prevention and control of malaria and its transmission are-: 1. Surveillance and case management Case detection (passive and active). Early diagnosis and complete treatment. Sentinel surveillance. 2. Integrated vector management (IVM) Indoor residual spray (IRS). Insecticide treated bed nets (ITNs)/ Long Lasting Insecticidal Nets (LLINs). Antilarval measures including source reduction. 3. Epidemic preparadness and early response 4. Supportive interventions Capacity building  Behaviour change communication (BCC) Intersectoral collaboration Monitoring and evaluation Operational research and applied field research. Goals for strategic Plan 2007-2012 The main national goals for malaria control are given below : - At least 50 percent reduction in mortality due to malaria by the year 2010, as per National Health Policy document 2002. At least 80 percent of those suffering from malaria get correct, affordable and appropriate treatment within 24 hours of reporting to the health system, by the year 2012. At least 80 percent of those at high risk of malaria get protected by effective preventive measures such as ITNs/LLINs or IRS by 2012.

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Which is a immunological marker of type I diabetes?

Ans. B. GADImmunologic markers in type 1 DM:a. Islet cell autoantibodies (ICAs)b. Antibody to insulin (IAA)c. Glutamic acid decarboxylase, (GAD)d. Tyrosine phosphatase (IA-2 & IA- 2B)e. Beta cell specific zing transporter (ZnT - 8)

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Katayama fever is seen in

S. mansoni more likely to cause Katayama fever than Japonicum.

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A year 6 old child with IQ of 50. Which of the following can the child do -

Ans. is 'a' i.e. Identify colours IQ is defined by as the mental age divided by the chronological age multiplied by 100. So a child 6 years of age with an IQ of 50%, means that his mental age is that of a 3 year old child. Thus we have to look for the developmental milestones of a 3 year old child. o At 3 years of age, a child can identify two colours. o A 3 year old child can speak a small sentence but he cannot read a sentence. o At 3 years, a child can ride a tricycle (not a bicycle). o A child copies a triangle at 5 years of age.

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Histogram is used to describe-

<p> Histogram is used to describe quantitative data of a group of patients. Histogram is graphical presentation for. &;Continuous quantitative data&;. Reference: Simple Biostatistics by Indeayan & Indrayan,1st edition,pg no:104 and Methods in Biostatistics by Mahajan,6 th edition,pg no.20, K . Park,23rd edition, pg no.844-846. <\p>

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True about calcium in kidney is

Parathormone secreted by parathyroid glands regulates the blood calcium level. Ref: guyton and hall textbook of medical physiology 12 edition page number: 495,496,497

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All are cluster B personality disorders except?

Ans. is 'c' i.e., Avoidant Personality disorders1. Clustor A (Odd. and Eccentric): Paranoid, Schizoid, Schizotypal.2. Clustor B (Dramatic, Emotional and Erratic) : Antisocial (Dissocial), Flistrionic, Narcissistic, Borderline.3. Clustor C (Anxious and fearful): Anxious (avoidant), Dependent, obsessive - compulsive (anankastic).

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Chancre redux is a clinical feature of

Chancre- primary lesion in syphilis (hard chancre)Chancre redux is the relapse of the chancre lesions in the early stage of syphilisSecondary syphilis-Cutaneous lesionsRoseolarsyphilidePapularsyphilidePsoriasiform lesion CondylomataMalignant syphilidePalm & sole lesion ( Coppery red lesion )Mucosal lesions Mucous patches Snail track ulcers Lymphadenopathy Generalized symmetrical rubbery lymphadenopathy Systemic involvement Periostitis, Ahritis Iridocyclitis, Uveitis, ChorioretinitisNephritic syndrome Late or teiary syphilis- cardiovascular lesions and tabes dorsalis seen(Ref: Ananthanarayan 9th edition, p372)

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All of the following are features of prematurity in a neonate, except –

The ears in a premature neonate are soft and flat with ear cartilage being deficient and plant (and not thick) Features of prematurity in a Neonate : Baby is small in size usually less than 47 cm long. Head is relatively large, sutures are widely separated and fontanelle are large The face is small and buccal pad of fat is minimal Skin is thin and pinkish and appears shiny due to generalized edema. Skin is covered with abundant lanugo and there is little vernix caseosa. Subcutaneous fat is reduced The breast nodule is less than 5 mm wide The ears are soft and flat with ear cartilage being deficient and plant Testes are not descended into the scrotal sac. (Empty scrotum) Scrotal sac is poorly pigmented and has fewer rugosities. In females labia majora appears widely separated, exposing the labia minora and the clitoris. Deep creases are not well developed in the sole. (There may be a single deep crease over the anterior one-third of the sole)  Neonatal reflexes such as Moro, Suckling & Swallowing are sluggish. There is hypotonia with a poor recoil of the flexed forearm when extended.

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Features of systemic sclerosis include all of the following, Except:

Answer is D (More common in young patients): Systemic sclerosis is primarily a disease of adults and the mean age of presentation is around 50 years. Systemic sclerosis is not a disease of young individuals The mean age of presentation of systemic sclerosis is 50 years -- Current Diagnosis & Treatment in Rheumatology 2nd/228 The peak incidence of systemic sclerosis is 50-60 years -- Robbins 7th/239 The most common age of onset in the range of 30-50 years -- Harrison 171h/2097 Systemic sclerosis is more common in women Like other connective tissue disorders systemic sclerosis shows a female predominance- Harrison 17th/2097 Systemic sclerosis is primarily a disease of women (female to male ratio is 3: I) -- Robbin,s Systemic sclerosis may present with Calcinosis, Sclerodactyly and hyperpiamentation The skin of extremities and trunk may be darkly pigmented. Diffuse tanning in the absence of sun exposure may be a very early manifestation of skin involvement -- Harrisons Calcinosis and sclerodactyly are pa of the 'Crest syndrome' in limited systemic sclerosis CREST syndrome C Calcinosis R Raynauld's E Esophageal dysmotility S Sclerodactyly T Telengactasia

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The most recent direct filling gold which produces the hardest surface on condensation is

Mat gold made of electrolytic precipitate from gold, which is alloyed with a trace amount of calcium, can yield a further increase in hardness by dispersion strengthening without affecting the handling properties.

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True about severe barbiturate poisoning except -

There is fall in BP (hypotension).

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Most common neoplasm of appendix is

Carcinoid tumours arise in argentaffin tissue (Kulchitsky cells of the crypts of Lieberkuhn) and are most common in the vermiform appendix.The tumour can occur in any pa of the appendix, but it is frequently found in the distal third.Ref: Bailey & Love&;s Sho Practice of Surgery

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Contraindication of Coitus interruptus is:

Withdrawal method or coitus interruptus means the discharge of semen outside the female genitalia at the end of intercourse. Premature ejaculation is the only contraindication. The advantages of the withdrawal method are that it (a) involves no expense, (b) needs no medical supervision, (c) requires no prior preparation, and (d) causes no definite harm. The main drawbacks are the lack of full sexual satisfaction and the relatively higher failure rate.

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Inversion and eversion occurs at which joint

A. i.e. Subtalar & mid tarsal joint

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Hypermability of joint and hyperelasticity is seen in -

Ans. is `b' i.e., Ehlers Danlos syndromeEhlers Danlos syndrome (EDS)o EDS comprises a clinically and genetically heterogenous group of disorders that result from some defect in the synthesis or structure of collegen and characterized by hyperelasticity of skin and hypermobile joints.Several types of EDS have been described based on the extent to which the skin, joints and other tissues are involved, mode of inheritence and biochemical analysis. Type I - severe- II Type mild Classic EDS --> Involvement of both joints & skin. Type III - Hypermobile EDS --> Joints > skin Type IV - Vascular EDS --> Vascular and intestinal intAolvement. Type V --> Similar to classic Type VI - Occular scliotic EDS --> Eye and spine involvement. Type VII - Dermatosparactic EDS --> Dysmorphic features Type VIII --> Perodontal EDS --> Dental involvement.o EDS shows all patterns of mendelian inheritance ?Type I, II, III, IV, VII A & B, VIII Autosomal dominant.Type IV & VII C ----> Autosomal recessiveType V X-linked recessive.o Clinical manifestations 1. SkinSkin is hyperextensible --* Rubber man syndrome.o Patient can develop cigarette - paper scar.o There is easly bruisability.Jointso There is ligament laxity and hypermobility of joint ---> Patient can bend thumb back to touch farearm. o Dislocation of hip or other joints may occur.OthersMitral valve prolapse pn classic (type I) EDSDiaphragmatic herniao Rupture of colon and large aeries -k In vascular (type IV) EDS.o Rupture of cornea and retinal detachmento Kyphoscoliosis In ocular-scoliotic (type VI) EDS.o Blue sclerao Absorptive periodontosis with premature loss of teeth -4 In periodontic (type VIII) EDS.

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Burnt rope smell is due to poisoning of ?

Ans. is 'a' i.e., Cannabis Odors associated with poisoning Garlik like : Phosphorus, arsenic, zinc phosphide, aluminium phosphide (celphos), arsine gas, tellurium, parathion, malathion, arsenic. Rotten eggs : Hydrogen sulphide, mercaptans, disulphiram. Fishy or musty : Zinc phosphide. o Bitter almonds : Cyanide, HCN. Acrid : Paraldehyde, chloral hydrate. o Burnt rope : Cannabis. Kerosene like : Kerosene and organophosphates. Phenolic smell : Carbolic acid.

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Which organ does not utilise ketone bodies:

A i.e. Liver

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The following drug is effective in treatment of ptyriasis versicolor -

Ans. is 'a' i.e., Ketoconazole Pityriasis versicolor (Tinea versicolor!o Tinea versicolor is a misnomer as it is not caused by dermatophyte; Pityriasis versicolor is more appropriate term. It is caused by a nondermatophyte fungus called Pityrosporum ovale (Malasezia furfur). It usually affects young adults.Clinical featureso There are multiple small scaly hypopigmented macules (macules may be hyperpigmented also). Scaling is furfuraceous or rice powder like. Macules start around the hair follicles and then merge with each other to form large areas. Affects trunk and shoulders (mainly chest and back). There may be loosening of scales with finger nails - Coupled onle or stroke of nail. Lesions are recurrent in nature (may reappear after treatment).Diagnosis of P.versicoloro Examination of scales in 10% KOH shows short hyphae and round spores (Sphagetti and meatball appearance). Wood's lamp shows apple green fluorescence (blue-green fluorescence). Skin surface biopsy - A cyanoacrylate adhesive (crazy glue) is used to remove the layer of stratum comeum on glass slide and then stained with PAS reagent.Treatment of P.versicolorSystemic agents : - Systemic azoles provide a convenient therapeutic option. Drugs used are ketoconazole, Fluconazole or intraconazole.Topical antifungals :- Topical antifungals used are : -Azoles - Clotrimazole, econazole, Miconazole, Ketoconazole.Others - Selenium Sulfide, Sodium thiosulphate, Whitfield's ointment (3% salicylic acid + 6% Benzoic acid).

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Vision 2020 "The right to sight" includes all except

Epidemic conjunctivitis Vision 2020 : The Right to Sight, is a global initiative launched by WHO in Geneva in 1999 in coalition with Task force of International NGOs' Globally, WHO has identified 5 major blinding eye conditions, for immediate attention : i) Cataract ii) Childhood blindness iii) Trachoma iv) Refractive errors and low vision v) Onchocerciasis (River blindness) The Government of India has adopted 'Vision 2020: Right to Sight' under 'National Programme for Control of Blindness' in 2001. Target diseases identified for intervention under 'Vision 2020' initiatives in India are : i) Cataract ii) Childhood blindness iii) Trachoma iv) Refractive errors and low vision v) Corneal blindness vi) Diabetic retinopathy vii) Glaucoma Objective of Vision 2020 - is to eliminate avoidable blindness by the year 2020 and reduce the global burden of blindness.

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All of the following statements are true about congenital rubella except-

. <p>congenital rubella syndrome:- Refers to infants born with defects secondary to intrauterine infection or who manifest symptoms or signs of intrauterine infection sometime after bih. Congenital infection is considered to have occurred if the infant has IgM antibodies sholy after bih.( as IgM antibodies do not cross placenta,their presence indicate they must have been synthesised by the infant inutero) or if IgG antibodies persist for more than 6 months. At bih virus is easily detected in pharyngeal secretion,multiple organs, CSF ,urine and rectal swabs. Rubella infection inhibits cell division. The classic triad- deafness,cardiac malformation and cataract. Other defects include glaucoma, retinopathy, microcephalus, cerebral palsy, intrauterine growth retardation,hepatosplenomegaly, mental and motor retardation. These defects occuring singly/in combination is known as " congenital rubella syndrome ". Congenital rubella- chronic infection Acquired rubella- acute infection. The gestational age at which maternal infection occurs is a major determinant for extend of foetal infection. 1. First trimester- most disastrous as the organs are developing. Infection during this period results in abnormalities in 85% cases. 2. Second trimester- 16% cases. 3. After 20 weeks- bih defects uncommon. {Reference: park&;s textbook of preventive and social medicine, 23rd edition, pg no.151}</p>

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Black malarial pigment is seen in: September 2009

Ans. B: P.falciparum In well-stained preparations the nuclei of the parasites are always stained red and the cytoplasm blue. The presence of malaria pigment is very characteristic of the older stages of Plasmodium sp. P. falciparum often contains a single black dot. P. vivax often contains countless fine golden yellow/brown specks of malaria pigment. In P. ovale and P. malariae the pigment inclusions are many and brownish black. Countless fine red spots in the red blood cell (Schiiffner's dots) can be seen in P. vivax and P. ovale (the more mature the parasite, the more dots). In P. ovale the dots are sometimes called James's dots. Sometimes a few flecks can be observed in P. falciparum (Maurer's dots or clefts). P. malariae almost never exhibits dots (Ziemann's dots). The visibility of these dots depends to a great extent on the acidity (pH) with which the thin slide preparation is stained (slightly alkaline: pH = 8 is best). The acidity is impoant because blood smears are usually stained for haematological tests with a slightly acid pH.

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The given karyotype is seen in which of the following syndrome?

Cri du chat syndrome is caused by a deletion of the end of the sho (p) arm of chromosome 5. (5P- syndrome)Symptoms include characteristic cat-like cry of affected children, epicanthus, severe intellectual disability, low set ears.

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A 40-year-old male with h/o progressive dysphagia for liquid has dilated esophagus on barium meal. Most likely cause is

Achalasia cardia * All of the above mentioned condition except Achalasia cardia occur around 60 years of age. Features for differentiation between achalasia cardia and carcinoma esophagus: Achalasiacardia Carcinomaesophagus a. Around30-40 yearsofage a. Presentationafter60yearsofage b. No dysphagiafor solids b. Dysphagiafor solidspresent c. Dysphagiaforliquidspresent c. Dysphagiaforliquidsonlyat verylatestages

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Secondary glaucoma in early stage of herpes zoster ophthalmlcus occurs due to

HERPES ZOSTER OPHTHALMICUS Ocular lesions: Ocular complications usually appear at the subsidence of skin eruptions and may present as a combination of two or more of the following lesions: 1. Conjunctivitis: It is one of the most common complication of herpes zoster. It may occur as mucopurulent conjunctivitis with petechial haemorrhages or acute follicular conjunctivitis with regional lymphadenopathy. Sometimes, severe necrotizing membranous inflammation may be seen. 2. Zoster keratitis: May precede the neuralgia or skin lesions. 3. Episcleritis and scleritis: These usually appear at the onset of the rash but are frequently concealed by the overlying conjunctivitis. 4. Iridocyclitis: It is of a frequent occurrence and may or may not be associated with keratitis. There may be associated hypopyon and hyphaema (acute haemorrhagic uveitis). 5. Acute retinal necrosis: 6. Anterior segment necrosis and phthisis bulbi. 7. Secondary glaucoma: It may occur due to trabeculitis in early stages and synechial angle closure in late stages. Ref:- A K KHURANA; pg num:-104,105

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