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Not a premalignant condition: March 2005

Ans. A: Retinitis pigmentosaGIT premalignant conditionsOf the four major primary small-bowel tumors (adenocarcinomas, lymphomas, carcinoid, and leiomyosarcomas), adenocarcinomas and lymphomas are associated with diseases that seem to increase the risk of developing these malignancies.Immunoproliferative small intestinal disease and celiac disease, are thought to predispose patients to the development of primary lymphoma.Increased risk is also associated with conditions, such as immunodeficiency syndromes, nodular lymphoid hyperplasia, Crohn's disease, the gastrointestinal polyposis syndromes, hereditary nonpolyposis colon cancer, neurofibromatosis, long-standing ileostomy, and urinary diversion procedures.Patient with long standing ulcerative colitis are at risk of developing colonic epithelial dysplaia and carcinoma.Oral cavity premalignant conditionsMany oral SCCs develop from premalignant conditions of the oral cavity.A wide array of conditions have been implicated in the development of oral cancer, including leukoplakia, erythroplakia, palatal lesion of reverse cigar smoking, oral lichen planus, oral submucous fibrosis, discoid lupus erythematosus, and hereditary disorders such as dyskeratosis congenital and epidermolysis bullosaOther pre-malignant conditions include actinic keratosis, Barrett's esophagus and cervical dysplasia.

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Which of the following is false about Takotsubo Cardiomyopathy

Echo comes back to normal in two weeks.

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Hereditary non-polyposis colorectal cancer (HNPCC) has an increased risk of all the following except

Hereditary non-polyposis colorectal cancer (Lynch syndrome)Hereditary non-polyposis colorectal cancer (HNPCC) is characterised by an increased risk of colorectal cancer and also cancers of the endometrium, ovary, stomach and small intestine.It is an autosomal dominant condition caused by a mutation in one of the DNA mismatch repair genes. The most commonly affected genes are MLH1 and MSH2. The lifetime risk of developing colorectal cancer is 80%, and the mean age of diagnosis is 45 years. Most cancers develop in the proximal colon. Females have a 30-50% lifetime risk of developing endometrial cancerRef: Bailey and Love, 27e, page: 1260

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Iodine RDA is -

Ans. is 'c' i.e., 150 microgram o The RDA of iodine for adults is 150 microgram.GroupRecommended daily intakePreschool children (0-59 months)School children (6 - 12 years)Adults (>12 years)Pregnancy and lactation90 meg120 meg150 meg250 meg

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Spanish windlass was practices in Spain as a method of execution. It is a type of:

Garrotting Garrotting: One of the methods of hemicidal strangulation The victim is attacked from behind without warning and strangled by grasping throat or by throwing a ligature over the neck and tightening it quickly. In this way a single assailant can kill a healthy robust adult. Garrotting was practices as a mode of execution in Spain. Pougal and Turkey. In Spain it was known as `spanish windlass' in which an iron collar around the neck was tightened by a screw for strangling Other common methods of homicidal strangulation are: Throttling - by hand Bansdola - In this type of strangulation the neck is compressed between two sticks of bamboos one in front and other behind the neck. Both the ends are tied with a rope squeezing the victim to the death. Sometimes a single stick is placed across the .front of the neck with a foot on each end of the stick. Mugging - Strangulation is caused by holding the neck of the victim in the bend of the elbow.

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Dispropoionately increased blood urea levels compared to serum creatinine (urea creatinine ratio 20:1) can be seen in the following except -

Intrinsic or intrarenal acute renal failure (ARF) occurs when direct damage to the kidneys causes a sudden loss in kidney function. The most common causes of intrinsic acute renal failure are acute tubular necrosis (ATN), acute glomerulonephritis (AGN), and acute interstitial nephritis (AIN) . Ref Harrison20th edition pg 236

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For RNA, which blotting technique is used -

Ans. is 'b' i.e., Northern blot TechniqueSample analyzedGel usedProbeSouthern blotDNAQYesRadioactive DNAAllele specific oligonucleotide (ASO)DNANoAllele specific oligonucleotideMicroarravm-RNA or c-DNANoDNA probeNorthern blotRNAQYesDNA probeWestern (immuno) blotProtein QYesLabeled antibody QSouth Western blotProtein DNANoDNA probeELISAProtein or antibodiesNoAntibody Q (Specific for protein to be measured)ProteomicsProtein QYes-

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Which bacteria acts by inhibiting protein synthesis?

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

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Panthothenic acid is coenzyme of which of the following reaction (s):

D i.e. Acetylation Pantothenic acid is necessary for synthesis of coenzyme A (CoA)Q, which functions as a coenzyme for acetylation reactionsQ

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Oesophageal motility disorder are best diagnosed by?

Answer is B (Endoscopy): Dysphagia for solids alone suggests a probable mechanical cause for dysphagia such as carcinoma, stricture or esophageal web. The investigation of choice for such cases is Endoscopy.

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Quinine given to a patient of falciparum malaria caused sweating and palpitation, the likely cause is?

Ans. is 'c' i.e., Hypoglycemia o Sweating and palpitations suggest hypoglycemia; which can occur due to quinine. Cinchonism is characterized by ringing in ears, nausea, vomiting, veigo, headache, mental confusion, difficulty in hearing and vision. Hypotension and cardiac arrhythmias develop on rapid i.v. injection.

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Good pasture's syndrome is characterized by all of the following, except:

Answer is B (Leucocytoclastic Vasculitis) Leucocytoclastic vasculitis is not a typical feature of Good pasture's syndrome Triad of Goodpasture's syndrome (Ferri 's Color Atlas & Text of Clinical Medicine) Glomerulonephritisdeg (RPGN; crescents) Pulmonary HaemorrhageQ (Diffuse Alveolar Haemorrhage) Antibodies to basement membrane antigensQ (Anti-GBM antibodies)

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Main source of energy derived from

Glycogen is the reserve carbohydrate in animals. It is stored in liver and muscles.The phosphorylated enzyme is less sensitive to allosteric inhibitors. Thus even if cellular ATP and glucose-6-phosphate are high, Phosphorylase will be active. The glucose-1-phosphate produced from glycogen in the liver may be conveed to free glucose for release to the blood.

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Reverse Coarctation is seen in

Reverse Coarctation ;weak or absent pulse in upper limb + pulse present in lower limb.

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Measures involved in sentinel surveillance includes all of the following except.

Ans. (d) Identifying cases free of disability* Surveillance: Is the ongoing systematic collection and analysis of data and the provision of information which leads to action being taken to prevent and control a disease, usually one of an infectious nature* Surveillance is of many types:- Passive Surveillance: Data is itself reported to the health system; For e.g., A patient with fever coming on his own to the PHC, CHC, Dispensary, Private Practitioner, Hospital- Active Surveillance: Health system seeks out 'actively' the collection of data, i.e., goes out to community to collect data; For e.g., Stool sample collection from home in Polio Program.- Sentinel Surveillance: Monitoring of rate of occurrence of specific conditions to assess the stability or change in health levels of a population, It is also the study of disease rates in a specific cohort, geographic area, population subgroup, etc. to estimate trends in larger population; For e.g., Use of health practitioners to monitor trends of a health event in a population- 1. Sentinel Surveillance helps in 'identifying missing cases' and 'supplementing notified cases'ALSO REMEMBER* Most of the national health programs in India rely on Passive Surveillance for morbidity and mortality data collection.* Active Surveillance: Is seen in NVBDCP (Health worker goes house to house every fortnight to detect fever cases, collect blood slides and provide presumptive treatment under malaria component) and National Leprosy Elimination Program (Modified Leprosy Elimination Campaigns)* Sentinel Surveillance is done in National AIDS Control Program wherein STD Clinics, ANC Clinics have been identified as sentinel sites to monitor trends of HIV/AIDS in the country

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Which of the following drug crosses placenta

(Warfarin) (601-KDT6th)* WARFARIN - It crosses placenta and is secreted in milk however quantity of active form is generally insufficient to affect the suckling infants* HEPARIN - does not cross BBB or placenta**- It is the anticoagulant of choice during pregnancy*** Bleeding due to overdose is the most serious complication of heparin therapy** other side effects are thrombocytopenia, * alopecia, * osteoporosis*, hypersensitivity reactions.

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Thymic hypoplsia is seen in which of the following

Ref Robbins 9/e p224 Thymic Hypoplasia: DiGeorge Syndrome DiGeorge syndrome results from a congenital defect in thymic development with deficient T cell maturation. T cells are absent in the lymph nodes, spleen, and peripheral blood, and infants with this defect are extremely vulnera- ble to viral, fungal, and protozoal infections. Patients are also susceptible to infection with intracellular bacteria, because of defective T cell-mediated immunity. B cells and serum immunoglobulins are generally unaffected. The disorder is a consequence of a developmental mal- formation affecting the third and fouh pharyngeal pouches, structures that give rise to the thymus, parathy- roid glands, and poions of the face and aoic arch. Thus, in addition to the thymic and T cell defects, there may be parathyroid gland hypoplasia, resulting in hypocalce- mic tetany, as well as additional midline developmental abnormalities. In 90% of cases of DiGeorge syndrome there is a deletion affecting chromosomal region 22q11, as discussed in Chapter 6. Transplantation of thymic tissue has successfully treated some affected infants. In patients with paial defects, immunity may improve spontane- ously with age.

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Rett's syndrome occurs due to deficiency of ?

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

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The Triat in which the parents are clinically normal and only siblings are affected but males and females are affected in equal propoions is:

AR

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True about primary peritonitis

(D) Occurs with Cirrhosis of liver # # PRIMARY (SPONTANEOUS) BACTERIAL PERITONITIS> Peritonitis is either primary (without an apparent source of contamination) or secondary.> The types of organisms found and the clinical presentations of these two processes are different. In adults, primary bacterial peritonitis (PBP) occurs most commonly in conjunction with cirrhosis of the liver (frequently the result of alcoholism).> However, the disease has been reported in adults with metastatic malignant disease, postnecrotic cirrhosis, chronic active hepatitis, acute viral hepatitis, congestive heart failure, systemic lupus erythematosus, and lymphedema as well as in patients with no underlying disease. PBP virtually always develops in patients with ascites.> While enteric gram-negative bacilli such as Escherichia coli are most commonly encountered, gram-positive organisms such as streptococci, enterococci, or even pneumococci are sometimes found.> In PBP, a single organism is typically isolated; anaerobes are found less frequently in PBP than in secondary peritonitis, in which a mixed flora including anaerobes is the rule. In fact, if PBP is suspected and multiple organisms including anaerobes are recovered from the peritoneal fluid, the diagnosis must be reconsidered and a source of secondary peritonitis sought.

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Osgood Schlatter disease is associated with osteochondritis of

Types of Osteochondritis and Nomenclature Traction apophysitis (chronic strain injuries) Tibial Tuberosity Osgood-Schlatter Calcaneum Sever The lower pole of patella Sinding-Larsen&;s

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Datura seeds resemble -

↵The seeds of datura closely resemble those of the capsicum universally used over India as a condiment, and the difficulty of their detection is enhanced by the fact that, apart from the bitterness, the poison-seeds have little taste and as impure salt is generally used in India.

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Measles is infective for:

Measles/English Measles is spread through respiration (contact with fluids from an infected person&;s nose and mouth, either directly or through aerosol transmission), and is highly contagious -- 90% of people without immunity sharing a house with an infected person will catch it. The infection has an average incubation period of 14 days (range 6-19 days) and Period of communicability in measles is approximately 4 days before and 5 days after the appearance of the rash. Measles is an infection of the respiratory system caused by a virus, specifically a paramyxovirus. REF : ananthanarayana 10th ed

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True about Caspases is?

ANSWER: (A) Involved in apoptosisREF: Robbins pathology 7th edition page 27-29Caspases are essential in cells for apoptosis, or programmed cell death, in development and most other stages of adult life, and have been termed "executioner" proteins for their roles in the cell Some Caspases are also required in the immune system for the maturation of lymphocytes

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Metachromatic granules are stained by?

Ans. is 'a' i.e., Ponder's stain

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Finger print bureau was first established in the following country:

Dactylography or fingerprint system or dermatoglyphics or Galton system was first used in India in 1858, by Sir William Herschel in Bengal. Sir Francis Galton systematised this in 1892. Finger print bureau was first established in Kolkata.Fingerprints are impressions of patterns formed by the papillary or epidermal ridges of the fingeips. Ref: The essentials of forensic medicine and toxicology by Dr K S Narayan Reddy, 27th edition, Page 76.

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Which of the following drug acts against Pseudomonas -

Ans. is 'a' i.e., Piperacillin Drugs acting against Pseudomonas. o Penicillins- Piperacillin, Carbenicillin, Ticarcillin, Mezlocillin. o Cephalosporins - Ceftazidime, Cefoperazone, Cefepime. o Carbapenems- Imipenem, meropenem o Monobactams - Aztreonam. o Aminoglycosides - Tobramycin, Gentamycin, Amikacin. o Fluroquinolones - Ciprofloxacin, Levofloxacin, Norfloxacin.. o Other - Polymixin B, Colistin.

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Cicatrial Alopecia is seen in:

C. i.e. DLE

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According to Spetzler-Main criteria, how much score is given for a 5 cm nidus with AV malformation?

Spetzler-Main AVM grading scale. Graded Feature Points Assigned Size of AVM < 3 cm 3-6 cm >6 cm 1 2 3 Eloquence1 of adjacent brain Noneloquent Eloquent 0 1 Venous drainage Superficial Deep 0 1 'Eloquent areas include: visual, language, and sensorimotor coex; the thalamus and hypothalamus; the internal capsule; the brainstem; the cerebellar peduncles; and the deep cerebellar nuclei.

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Which of these following statements is wrong about Tacrolimus?

The side effects of Tacrolimus includes, nephro and hepato toxicity. It can also cause hypeension, tremors, seizure, diabetes mellitus and blurred vision. It should be better avoided with other hepato and renal toxicity drugs. Ref: Manzoor M. Khan (2008), Chapter 4 "Immunesupressive Agents", In the book, "Immunopharmacology", Springer Publications, USA, Page 91 ; Katzung, 9th Edition, Pages 941, 942

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Macrosomia is a

Macrosomia:- A condition where a baby is large before bihFactors causing macrosomia:Mother having diabetesMother having gestational diabetesObese mother(Refer: Nelson's Textbook of Pediatrics, SAE, 1st edition, pg no. 777, 897 - 899)

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Which one of the following device conves radioactive emissions to light for detection?

Scintillation counter: It measures ionizing radiation. The sensor, called a scintillator, consists of a transparent crystal, usually phosphor, plastic, or organic liquid that fluoresces when struck by ionizing radiation. A sensitive photomultiplier tube (PMT) measures the light from the crystal. The PMT is attached to an electronic amplifier and other electronic equipment to count and possibly quantify the amplitude of the signals produced by the photomultiplier. Geiger counter: Is a type of paicle detector that measures ionizing radiation. They detect the emission of nuclear radiation: alpha paicles, beta paicles or gamma rays. It detects radiation by ionization produced in a low pressure gas in a Geiger Muller tube.

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Enterobius commonly inhabit the: September 2011

Ans. D: Caecum Adult Enterobius vermicularis worms inhabit the caecum, appendix and adjacent poions of the ascending colon, lying closely applied to the mucosal surface. Pinworm (genus En terobius)/Threadworm/Seatworm, It is a nematode (roundworm) and a common human intestinal parasite, especially in children. It inhabits the caecum, appendix and adjacent poion of the ascending colon, lying closely applied to the mucosal surface It causes enterobiasis, or less precisely as oxyuriasis in reference to the family Oxyuridae. The pinworm appears as a white, small and delicate nematode. The adult female has a sharply pointed posterior end, is 8 to 13 millimeters long, and 0.5 millimeter thick. The adult male is considerably smaller, measuring 2 to 5 millimeters long and 0.2 millimeter thick, and has a curved posterior end. The eggs are translucent and have a surface that adheres to environmental objects. The eggs measure 50 to 60 micrometers by 20 to 30 micrometers, and have a thick shell that is flattened on one side. The small size and colorlessness of the eggs make them invisible to the naked eye, except in barely visible clumps of thousands of eggs. Eggs may contain a developing embryo or a fully developed pinworm larva.Inside the host, the larvae grow to 140-150 micrometers in length Pinworms spread through human-to-human transmission, by ingesting (i.e., swallowing) infectious pinworm eggs and/or by anal sex. The eggs are hardy and can remain ble (i.e., infectious) in a moist environment for up to three weeks.They do not tolerate heat well, but can survive in low temperatures: two-thirds of the eggs are still ble after 18 hours at -8 degrees Celsius (18 degF). After the eggs have been initially deposited near the anus, they are readily transmitted to other surfaces through contamination. The surface of the eggs is sticky when laid, and the eggs are readily transmitted from their initial deposit near the anus to fingernails, hands, night-clothing and bed linen.From here, eggs are fuher transmitted to food, water, furniture, toys, bathroom fixtures and other objects.Household pets often carry the eggs in their fur, while not actually being infected. Dust containing eggs can become airborne and widely dispersed when dislodged from surfaces, for instance when shaking out bed clothes and linen.Consequently the eggs can enter the mouth and nose through inhalation, and be swallowed later. Although pinworms do not strictly multiply inside the body of their human host, some of the pinworm larvae may hatch on the anal mucosa, and migrate up the bowel and back into the gastrointestinal tract of the original host. This process is called retroinfection. Despite the limited, 13 week lifespan of individual pinworms, autoinfection (i.e., infection from the original host to itself), either through the anus-to-mouth route or through retroinfection, causes the pinworms to inhabit the same host indefinitely

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Which of the following results in increase in secretion of ADH?

Ans: C HypovolemiaRef: Guyton 12th/e p. 9051Hypovolemia (Decreased ECF) stimulates the release of ADH.Vasopressin secretion is increased by: - i) Increased osmolarity (osmotic pressure) of plasma; ii) Decreased ECF volume; iii) Pain, emotion, stress, exercise; iv) Nausea and vomiting; v) Standing; vi) Clofibrate, Carbamazapine; vii) Angiotensin II.

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Urine osmolality in Diabetes insipidus is

Diabetes insipidus is condition characterised by excessive thirst excretion of large amounts of severely diluted urine Those with diabetes insipidus continue to uinate large amount of urine in spite of water deprivation.Ref: DM Vasudevan, 7th edition, page no: 373

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1-a hydroxylation in Vitamin-D metabolism takes place in

Vitamin D is a fat-soluble vitamin molecule found in fish liver oils, and also produced in the skin when subjected to ultraviolet rays from sunlight. The main function of the vitamin is to increase the utilization of calcium and phosphorus in bones and teeth. A mixture of several forms of vitamin D: Vitamin D3 is synthesized in the skin upon exposure to ultraviolet light; in contrast, vitamin D2 is obtained only from the diet. Both vitamins D2 and D3 are metabolized to 25-hydroxyvitamin D in the liver, and then to the active 1,25 dihydroxy form in the kidney. Vitamin D has a major role in the intestinal absorption of calcium, bone calcium balance and renal excretion of calcium.Ref: Ganong&;s review of medical physiology;24th edition; page no-379

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Magaldrate is conveed by gastric acid to ?

Ans. is `c' i.e., Magnesium hydroxide and Aluminium hydroxide Magaldrate: Magaldrateis a common antaciddrug that is used for the treatment of duodenal and gastric ulcers, esophagitis from gastroesophageal reflux. Magaldrate is a hydroxymagnesium aluminate complex that is conveed rapidly in gastric acid to Mg(OH), and Al(OH)3, which are absorbed poorly and thus provide a sustained antacid effect.

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Which of the following nerves are affected after spinal anaesthetic block –

Local anesthetics block generation and conduction of nerve impulse at all part of neuron where they come in contact, without causing structural damage. Thus not only sensory but motor impulses and autonomic control is also interrupted.

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Drug of choice for Treponema Pallidum is?

ANSWER: (A) Penicillin GREF: Microbiology, Volume 2; Volume 9, Part 2 edited by E. Edward Bittar, Neville Bittar p; 241See APPENDIX-65 for "SEXUALLY TRANSMITTED DISEASES""Parenteral penicillin G remains the treatment of choice for syphilis (Treponema pallidu and resistance to penicillin has not been reported"

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If hemoglobin status of a population with mean value is 10.3 gm % with SD 2 gm%, then 5% population will be below what value of Hb?

.

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Inclusion body conjunctivitis true is all except:

Ans. Present only in infants

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EBV causes all EXCEPT:

ANSWER: (C) Verrucous lymphomaREF: Jawett's 24th edition Section IV. Virology > Chapter 33. Herpesviruses Cancer by EBV:EBV is recognized as a cause of Burkitt's lymphoma, nasopharyngeal carcinoma, Hodgkins disease, and some other lymphomas. Sera from patients with Burkitt's lymphoma or nasopharyngeal carcinoma contain elevated levels of antibody to virus-specific antigens, and the tumor tissues contain EBV DNA and express a limited number of viral genes. EBV-associated B cell lymphomas are a complication for immunodeficient patients

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All of the following are required more during lactation as compared to pregnancy, except ?

Ans. is 'a' i.e., Iron Required more during lactation as compared to pregnancy : Energy, Vitamin A, thiamin, riboflavin, Vitamin C, niacin, and Vitamin B12. Required more during pregnancy : Iron, protein, and folate. Same requirment in pregnancy and lactation : Fat, calcium, zinc, magnesium, and vitamin B6.

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Not a B cell marker -

. CD 134

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In sebaceous glands, accumulation of sebum leads to:

Ans. b. Acne4 steps in pathogenesis of Acne are:Sebum productionHyperkeratosis of pilosebaceous unitPropionibacterium acnes colonization of pilosebaceous unit Inflammation

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A young girl presents with abdominal pain and a recent change in bowel habit, with passage of mucus in stool. There is no associated blood in stool and symptoms are increased with stress. The most likely diagnosis is-

Childhood Chronic ill health in childhood or adolescent IBD may result in growth failure, metabolic bone disease and delayed pubey. Loss of schooling and social contact, as well as frequent hospitalisation, can have impoant psychosocial consequences.Treatment is similar to that described for adults and may require glucocoicoids, immunosuppressive drugs, biological agents and surgery. Monitoring of height, weight and sexual development is crucial. Children with IBD should be managed by specialised paediatric gastroenterologists and transitioned to adult care in dedicated clinics . Pregnancy A women's ability to become pregnant is adversely affected by active IBD. Pre-conceptual counselling should focus on optimising disease control. During pregnancy, the rule of thirds applies: roughly one-third of women improve, one-third get worse and one-third remain stable with active disease. In the post-paum period, these changes sometimes reverse spontaneously. Drug therapy, including aminosalicylates, glucocoicoids Delayed growth and pubeal development: chronic active inflammation, malabsorption, malnutrition and long-term glucocoicoids contribute to sho stature and delayed development, with physical and psychological consequences. * Metabolic bone disease: more common with chronic disease beginning in childhood, resulting from chronic inflammation, dietary deficiency and malabsorption of calcium and vitamin D. * Drug side-effects and adherence issues: young people are more likely to require azathioprine or biological therapy than adults. Poor adherence to therapy is more common than with adults, as younger patients may feel well, lack self-motivation to adhere and believe that drugs are ineffective or cause side-effects. * Loss of time from education: physical illness, surgery, fatigue in chronic inflammatory bowel disease, privacy and dignity issues, and social isolation may all contribute. * Emotional difficulties: may result from challenges in coping with illness, problems with forming interpersonal relationships, and issues relating to body image or sexual function. Ref Davidson edition23rd pg823

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Length of umbilical cord is?

ANSWER: (C) 30-100 cmsREF: Dutta 6th ed p. 40The normal length of umblical cord is around 50cms with usual variation between 30-100 cms

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Vitamin B12 intrinsic factor absorption occurs in

Most of the vitamins are absorbed in the upper small intestine, but vitamin B12 is absorbed in the ileum.Vitamin B12 binds to intrinsic factor and the complex is absorbed across the ileal mucosa.Vitamin B12 and folate absorption are Na+ independent.Other vitamins are absorbed by carriers that are Na+ cotranspoers.(Ref: Ganong&;s Review of medical physiology, 23 rd edition, page 458)

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Splenunculi are commonly seen in

A. (Hilum of spleen) (1103-B & L 25th)ACCESSORY SPLEEN (Splenunculi) - probably results from a failure of infusion of splenic embryonic tissues* They are located near the hilum of the spleen in 50% of cases and related to the splenic vessels or behind the tail of pancreas in 30%. The remainder are located in the mesocolon or the splenic ligaments* These are functionally similar to the spleen and while performing splenectomy for blood dyscrasias removal of these accessory spleens are obligatory, otherwise there always remains a chance of recurrence* Axis of spleen enlargement projects into- Greater sac**

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Causative agent of Favus is:

Ans. A. Tinea schoenleiniiFavous usually affect scalp, but occurring occasionally on any part of the skin and even at times on mucous membrane, caused by Tinea schoenleinii.

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Zona Pellucida disappears by:-

Zona pellucida is thick membranous covering made up of glycoprotein, the microvilli of oocyte and follicular cells project into zona pellucida for nutrition. it prevent polyspermy and implantation. Blastocyst forms at 4th day and by the end of 5th day, zona pellucida disappears and implantation takes place at 6th -7th day after feilization.

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Storage form of thyroid hormone-

The synthesis and storage of thyroid hormones occurs between the follicular cells and the colloid. The storage form of thyroid hormone is thyroglobulin. Thyroglobulin is a large glycoprotein synthesized in the follicular cells and has a molecular weight of around 650 000 with about 140 tyrosine residues, depending on the form of thyroglobulin. Approximately one quaer of these residues is iodinated at the apical-colloid interface. Once iodinated, thyroglobulin is taken up into the colloid of the follicle where, still incorporated in the protein, a coupling reaction between pairs of iodinated tyrosine molecules occurs. The coupling of two tyrosine residues each iodinated at two positions (di-iodotyrosine, DIT) produces tetra-iodothyronine or thyroxine (T4 ) whilst the combination of DIT with mono-iodotyrosine (MIT) produces tri-iodothyronine (T3 ). Such coupling can occur within a single molecule of thyroglobulin or between dimerized molecules of the protein. This coupling is catalyzed by TPO. Thyroid hormones are stored in this state and are only released when the thyroglobulin molecule is taken back up into the follicular cells. Stimulated by TSH, thyroglobulin droplets are captured by the follicular cells by a process of pinocytosis. Fusion of the droplets with lysosomes results in hydrolysis of the thyroglobulin molecules and release of T3 and T4. Reference : page 2285 Harrison's Principles of Internal Medicine 19th edition

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Congenital hepatic fibrosis is a characteristic feature of

Infantile and Iuvenile forms are associated with congenital Hepatic fibrosis.

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MHC restriction is a pa of all except aEUR'

Autoimmune disorder Major histocompatibility complex : Major histocompatibility complex, also called the human leucocyte antigen (HLA) complex is a 4 megahase region on chromosome 6. This region is densely packed with genes. These genes encodes two major proteins or antigens i.e., MHC I & MHC II. These proteins play an impoant role in the differentiation of foreign cells from host cell. Presence of these proteins is necessary for identification of host cells. Identification of the cells is impoant for immune responses. If the cell is recognised as self, the immune system will not mount an immune response against it. How does MHC helps in this ??? Cells continuously display small pieces of their own internal protein, carrying them, outsie the cell membrane where the immune system can see them. These peptides are just pieces of the normal proteins found inside the cell. These peptides are held together at the cell surface by major histocompatibility complex, which holds these peptides together for the immune system to examine them. Each persons immune system is customized early in life to ignore these peptides, so healthy cells are not able to trigger the immune system and they are left alone. But if any virus or other microorganism is multiplying inside the cell, the peptides synthesized by it also is displayed on the surface. The MHC displays these unusual (foreign) protein on the surface of the cell. The immune system is triggered because of these peptides, staing, a series of event that will eventually lead to killing of the cell containing foreign peptide. MHC is also the cause of tissue rejection during skin grafts and organ grafts. This is how the MHC protein got its name; the term histocompatibility refers to the difficulty of finding compatible grafts between a donor and a patient. Each person has their own collection of MHC molecules. If you graft a piece of skin that has a different collection of MHC types they will trigger the immune system to destroy the cell. So a compatible donor is needed such as a relative who has a similar collection of MHC molecules. MHC is also active against cancer Cancer cells, like normal cells, display pieces of their own protein on their surface. So if any of these proteins carries recognizable cancer mutations, this provides a signal to the immune system that something is wrong and the cell is killed. MHC plays role in activation of T helper cells (Th) MHC class II molecules are present on the membranes of dendritic cells, macrophages. These cell function as antigen presenting cell during immune response. They capture the antigen and present it to T helper cells. In response, the T helper cells secrete cytokines that stimulate B cell proliferation and antibody production. The impoant point about T helper cells is that they respond to only those antigens which have been presented to them by cells that have host matching MHC complex on the presenting cell. In general the antigen presenting cell .first phagocytoses the protein antigen and cleaves it to peptides in the lysosomes. These peptides are then extruded and attached to the presenting cell's surface MHC complex. T helper cells first, make sure, that these MHC class II molecules are host's own MHC and then responds appropriately. So, we can say that receptor on the T helper cell is thus responsive to the combination of antigen and host matching MHC complex on the presenting cell. Helper / inducer T cells (CD4)---) MHC class II restriction - Suppressor T cells (CD8) MHC class I restriction Cytolytic cytotoxic T cells (CD8) MHC class I restriction (Kills viral infected cells, tumor cells, facilitates graft rejection)

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During cardiac imaging the phase of minimum motion of hea is:

D i.e. Mid diastole- During cardiac imaging (such as MRI, CT, electron beam tomography), mid diastolic phase (or diastasis) of cardiac cycle is usually (but not always) associated with lowest (minimum) mean motion of hea.Q- Optimum phase (i.e. with minimum cardiac motion) for cardiac and coronary vessel imaging is mid-diastole (diastasis) at low or intermediate hea rates; but is variable and may occur in late systole at high hea rates.Cardiac Motion and Imaging- Radiological imaging by CT and MRI can detect coronary aery disease in early stage. However, the use of these tools to cardiac imaging is severely limited because of motion aifacts produced by constantly in motion hea completing an entire cycle of contraction and relaxation in about 1 second.- So radiological cardiac imaging requires a 'window' of minimum cardiac motion to reduce motion aifacts and achieve meaningful images. The phase of minimum cardiac motion is although variable and depends on several factors especially hea rate and the chamber (i.e. right /left - atrium or ventricle) to be specifically imaged. However, the phase of minimum cardiac motion (= optimum phase for cardiac & coronary vessel imaging).

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Mandibular nerve does not supply:?

A. i.e. Buccinator

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A 68-year-old man is admitted to the coronary care unit with an acute myocardial infarction. His postinfarction course is marked by congestive hea failure and intermittent hypotension. On the fouh day in hospital, he develops severe midabdominal pain. On physical examination, blood pressure is 90/60 mm Hg and pulse is 110 beats per minute and regular; the abdomen is soft with mild generalized tenderness and distention. Bowel sounds are hypoactive; stool Hematest is positive. Which of the following is the most appropriate next step in this patient's management?

In the absence of peritoneal signs, angiography is the diagnostic test of choice for acute mesenteric ischemia. Patients with peritoneal signs should undergo emergent laparotomy. Acute mesenteric ischemia may be difficult to diagnose. The condition should be suspected in patients with either systemic manifestations of aeriosclerotic vascular disease or low cardiac-output states associated with a sudden development of abdominal pain that is out of propoion to the physical findings. Because of the risk of progression to small-bowel infarction, acute mesenteric ischemia is an emergency and timely diagnosis is essential. Although patients may have lactic acidosis or leukocytosis, these are late findings. Abdominal films are generally unhelpful and may show a nonspecific ileus pattern. Since the pathology involves the small bowel, a barium enema is not indicated. Upper gastrointestinal series and ultrasonography are also of limited value. CT scanning is a good initial test, but should still be followed by angiography in a patient with clinically suspected acute mesenteric ischemia, even in the absence of findings on the CT scan. In addition to establishing the diagnosis in this stable patient, angiography may also assist with operative planning and elucidation of the etiology of the acute mesenteric ischemia. The cause may be embolic occlusion or thrombosis of the superior mesenteric aery, primary mesenteric venous occlusion, or nonocclusive mesenteric ischemia secondary to low-cardiac output states. A moality of 50% to 75% is repoed. The majority of affected patients are at high operative risk, but early diagnosis followed by revascularization or resectional surgery or both are the only hope for survival. Celiotomy must be performed once the diagnosis of aerial occlusion or bowel infarction has been made. Initial treatment of nonocclusive mesenteric ischemia includes measures to increase cardiac output and blood pressure. Laparotomy should be performed if peritoneal signs develop

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Drugs undergoing acetylation include all except:

Ans. B. MetoclopramideAcetylation by N-acetyl transferases (NAT)e.g, S - SulfonamidesH - HydralazineI - IsoniazidP - Procainamide, PASD - DapsoneC - Clonazepam, Caffeine

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A group of expes discussing a topic in front of the audience without any specific order. This mode of communication is known as: September 2008

Ans. A: Panel discussion In panel discussion there is a chairman/moderator and 4-8 speakers. Each speaker prepares separately, the other speakers hear one another for the time at the session itself. Panel discussions, however, differ from team presentations. Their purpose is different. In a team presentation, the group presents agreed-upon views; in a panel discussion, the purpose is to present different views. Also in a team presentations, usually speakers stand as they speak; in panel discussions, usually speakers sit the whole time. Technically, a panel discussion consists of questions and answers only, and a symposium consists of a series of prepared speeches, followed by questions and answers. The chairman/ moderator must monitor time and manage questions. If each paicipant is making a speech for a set period of time, he should signal the speakers at the one minute to go mark and at the stop mark. If a speakers goes more than one or two minute he can stop them to gave the equal rights to each speakers. The chairman/ moderator must be a biased person; he is neither in our nor against the topic. At the end the compare should summarize the discussion and thank the panel members.

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Starvation and diabetes mellitus can lead on to ketoacidosis which of the following features is in our of ketoacidosis due to diabetes mellitus.

A i.e. Increase in glucagons/ insulin ratio, increased C- AMP & increased blood sugar.In diabetes little glucose is oxidized as fuel, except by the brain. The rest of tissues burn a large amount of fat, paicularly the liver where the amount of acetyl COA formed from fatty acids exceeds the capacity of the tricarboxylic acid cycle to oxidize it. The excess acetyl COA is conveed to ketone bodies l/t ketonemia, ketonuria & ketoacidosisDiabetics not only have a defect in the tissue utilization of glucose but also appears to be metabolically poised to produce maximum amount of glucose from amino acids (gluconeogenesis) and to prevent glucose from being utilized to to form fat. (fat synthesis)Insulin is decreased & glucagons is increased 1/t Dglucagon/ insulin ratioQ. Glucagon acts elevation in C- AMPQ

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ARDS true?

ARDS is a clinical syndrome of severe dyspnoea of rapid onset, hypoxaemia and diffuse pulmonary infiltrates leading to respiratory failure.ARDS is characterised by Po2/Fio2(inspiratory O2 fraction)<200 mmHg.There will be no hypercapnia, so the patient will have type 1 respiratory failure. There will be a stiff-lung syndrome with collapse and decreased compliance of the lungs due to loss of surfactant.

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Hypeension is seen with all except-

Ans. is d i.e., Levodopa Drug causing hypeension Cocaine MAO inhibitors Oral contraceptives Clonidine withdrawl Tricyclic antidepressants Cyclosporine Glucocoicoids Rofecoxib (NSAID) Erythropoietin Valdecoxib (NSAID) Sympathomimetics

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Beta 2 agonist used in rescue therapy in acute respiratory conditions are all except?

Ans. is 'd' i.e., Ketotifen Formoterol, Salbutomol and bambuterol are p 2 agonists. o Ketotifen is a mast cell stabilizer.

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The post mortem report in case of death in police custody should be recorded as

Ans. b (Video recording). (Ref. Parikh, FMT, 5th ed., 130)Installation of video camera in jail and recording of postmortem in case of death in police custody is according to human rights.

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Reversible loss of polarity with abnormality in size and shape of cells is known as?

Dysplasia is reversible Anaplasia is irreversible

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During autopsy for virology study which agent is used for storing tissue: NEET 14

Ans. 50% glycerine

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The protective bacterium in the normal vagina is:

Vagina has inhabitant bacteria called as Doderleins bacteria which is a lactobaccilli, and converts the glycogen present in vaginal epithelium into lactic acid. Thus, pH of the vagina is acidic The pH of the vagina in an adult woman is 4 -5.5 with an average of 4.5. The pH of vagina varies with age — for further details see preceding text.

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Bence jones proteinuria is derived from?

Ans. (b) Light chain globulins(Ref: R 9th/pg 598-602)Excretion of light chains in the urine has been referred to as Bence Jones proteinuria.Light chains includes k and l (kappa and lambda)

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Pradhan mantra swasthya suraksha yojana was launched in:

Pradhan mantra swasthya suraksha yojana was approved in 2006 with the objective of correcting imbalances in availability of affordable teiary level healthcare in the country. Ref: National Health Programmes in India, J.Kishore, 10th edition pg: 84

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Which of the following measures sensitivity: September 2011

Ans. B: True positives Sensitivity denotes true positives

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Caput succedaneum in a newborn is: Karnataka 07

Ans. Collection of sero-sanguineous fluid in the scalp

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Zero order kinetics is seen in all except

Zero order kinetics is seen in high dose of salicylates,ethanol and phenytoin. Ref-KDT 6/e p31

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In a normal healthy person the arterial oxygen is considered satisfactory if SPO2 is more than

Ans. c (90) (Ref H-17th/l590-91; pg. A-15)In a normal healthy person the arterial oxygen is considered satisfactory if SP02 is more than 90.Arterial O2 tensionPaO212.7 +- 0.7 kPa (95 +- 5 mm Hg)Arterial CO2 tensionPaCO25.3 +- 0.3 kPa (40 +- 2 mm Hg)Arterial O2 saturationSaO20.97 +- 0.02 (97 +- 2%)Arterial blood pHpH7.40 +- 0.02Arterial bicarbonateHCO3-24 + 2 mEq/LBase excessBE0 +- 2 mEq/LDiffusing capacity for carbon monoxide (single breath)DLCO0.42 mL CO/s/mm Hg (25 mL CO/min/mm Hg)Dead space volumeVD2 mL/kg body wtPhysio dead space; dead space-tidal vol ratioVD/VTKnow at rest & exercise(a) Rest < 35% VT(b) Exercise < 20% VTAlveolar-arterial difference for O2P(A -a) O2< 2.7 kPa (20 mm Hg)Educational Point# Alveolar hypoventilation exists by definition when arterial PC02 (PaC02) increases above the normal range of 37-43 mm Hg, but in clinically important hypoventilation syndromes PaC02 is generally in the range of 50-80 mm Hg.# A decrease in the Anion Gap can be due to:- an increase in unmeasured cations;- the addition to the blood of abnormal cations, such as lithium (lithium intoxication) or cationic immunoglobulins (plasma cell dyscrasias);- a reduction in the major plasma anion albumin concentration (nephrotic syndrome); (A fall in serum albumin by 1 g/dL from the normal value decreases the anion gap by 2.5 mEq/L).- a decrease in the effective anionic charge on albumin by acidosis; or- hyperviscosity and severe hyperlipidemia.

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A 40-year-old man presents with 5 days of productive cough and fever. Pseudomonas aeruginosa is isolated from a pulmonary abscess. CBC shows an acute effect characterized by marked leukocytosis (50,000/mL) and the differential count reveals shift to left in granulocytes. Which of the following terms best describes these hematologic findings?

Circulating levels of leukocytes and their precursors may occasionally reach very high levels (>50,000 WBC/mL). These extreme elevations are sometimes called leukemoid reactions because they are similar to the white cell counts observed in leukemia, from which they must be distinguished. The leukocytosis occurs initially because of accelerated release of granulocytes from the bone marrow (caused by cytokines, including TNF and IL-1) There is a rise in the number of both mature and immature neutrophils in the blood, referred to as a shift to the left. In contrast to bacterial infections, viral infections (including infectious mononucleosis) are characterized by lymphocytosis Parasitic infestations and ceain allergic reactions cause eosinophilia, an increase in the number of circulating eosinophils. Leukopenia is defined as an absolute decrease in the circulating WBC count.

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A patient present with dysphagia of 4 weeks duration. Now he is able to swallow liquid food only. Which of the following is the one investigation to be done:

Answer is B (Upper GI endoscopy is to be done) The patient is presenting with new onset dysphagia for solids alone (able to swallow liquids). This suggests dysphagia due to mechanical obstruction (carcinoma, stricture, web) which is best diagnosed by endoscopy. Note: Barium swallow is the recommended initial investigation Endoscopy is the investigation of choice.

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Inhalation of fungal spores can cause primary lung infections. Of the following organisms, which one is most likely to be associated with this mode of transmission?

C. albicans and Candida tropicalis are opportunistic fungi, and as part of the normal flora are not transmitted by inhalation. C. immitis is a dimorphic fungus and inhalation of the spores transmits the infection. Sprothrix is also a dimorphic fungus but its portal of entry is cutaneous. Trychophyton is a dermatophyte and one of the causes of athlete's foot.

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Fleeting skin lesions are often present in patients with:

Fleeting skin lesions are often presents in patients with hepatitis B. Ref: Schiff's diseases of liver, Edition -11, Page - 3.

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In which of the following locations, Carcinoid tumor is most common

carcinoid tumour commonly occurs in appendix(45%),ileum(25%),rectum(15%).other sites are(15%)other pas of GIT ,bronchus, and testis SRB,5th,877.

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S100 is a marker used in the diagnosis of all Except

Acidic protein, 100% Soluble in ammonium sulfate at neutral pH (derivation of name) S100 protein family is multigenic group of nonubiquitous cytoplasmic EF-hand Ca2+-binding proteins, sharing significant structural similarities at both genomic and protein levels; S100 protein family has 24 known human members each coded by a separate gene; at least 19 on chromosome 1q21 Helps regulate cell contraction, motility, growth, differentiation, cell cycle progression, transcription and secretion Structurally similar to calmodulin

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A Patient who is on antihypertensive drug develops a dry cough. Which of the following drug might be responsible for the condition:

The angiotensin-converting enzyme normally helps in conversion of angiotensin I to angiotensin II, which acts as a vasoconstrictor in case of hypovolemia. In addition to that, ACE also helps in the breakdown of bradykinin. When ACE inhibitors (captopril) are given, it inhibits ACE and in addition inhibits the breakdown of bradykinin also, which leads to accumulation of bradykinin level in the body. This increased level of bradykinin presents with a Dry cough, rashes, urticaria and angioedema.

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Mad Cow disease (Spongiform disease) occurs due to

Mad cow disease or bovine spongiform encephalopathy i.e. Caused by “prions” “PRIONS” are unconventional transmissible agents, proteinaceous in nature.” Diseases caused by prions are Kuru Creutzfeldt Jakob Disease. Gerstmann Straussler Scheinker Syndrome Fatal Familial Insomnia. Scrapie Of Sheep Transmissible Encephalopathy of Mink. Bovine Spongiform Encephalopathy (Mad Cow Disease)

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A patient on lithium therapy was found to be hypeensive also. Which of the following antihypeensive drugs is contraindicated in a patient on lithium therapy in order to prevent toxicity?

Diuretics (thiazide, furosemide) by causing Na+ loss promote proximal tubular reabsorption of Na+ as well as Li+ --plasma levels of lithium rise. ref : KD Tripati 8th ed.

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In marasmus, which of the following is not seen?

Edema is a feature of Kwashiorkor, not seen in marasmus. Kwashiorkor Marasmus Edema Present absent appetite poor Voracious appetite CNS involvement apathy Active child Hepatomegaly seen Not seen Skin and hair changes More common Less common

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A 23-year-old woman presents with a rubbery, freely movable 2-cm mass in the upper outer quadrant of the left breast. A biopsy of this lesion would most likely histologically reveal

The most common benign neoplasm of the breast is fibroadenoma, which typically occurs in the upper outer quadrant of the breast in women between the ages of 20 and 35. These lesions originate from the terminal duct lobular unit and histologically reveal a mixture of fibrous connective tissue and ducts. Clinically, fibroadenomas are rubbery, freely movable, oval nodules that usually measure 2 to 4 cm in diameter. Numerous neutrophils are seen in acute bacterial infection of the breast (acute mastitis), which is usually seen in the postpaum lactating or involuting breast. Dilation of the breast ducts (ectasia) with inspissation of breast secretions is characteristic of mammary duct ectasia, which is common in elderly women. If large numbers of plasma cells are also present, the lesion is called plasma cell mastitis. Fat necrosis of the breast, associated with traumatic injury, is characterized by necrotic fat surrounded by lipid-laden macrophages and a neutrophilic infiltration. Fibroadenoma Reference: Robbins & Cotran Pathologic Basis of Disease, 9edition

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Most common pa of larynx involved in TB ?

Ans. is 'b' i.e., Posterior Essential otolaryngology 2"d/e p. 1139] Disease affects the posterior third of larynx more commonly than anterior pa. The pas affected in descending order of frequency are :- i) Interarytenoid fold, ii) Ventricular band, iii) Vocal cords, iv) Epiglottis.

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Pyogenic granuloma is associated with

Pyogenic granuloma is a misnomer as there is no granuloma. It is a benign vascular lesion that bleeds easily on trauma. It is associated with Inflammatory Bowel disease (Ulcerative colitis > Crohn's disease).

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Muscle relaxant used in renal failure -

As Atracurium and Cis-atracurium are inactivated by Hoffman's elimination, they are the muscle relaxants of choice for both liver and renal failure.

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Ramachandran is on the surgical ward with non-seminomatous tumor of testis and more than 4 retroperitoneal lymph nodes involved. You are the resident who is making a decision about fuher management. The treatment include all of the following, except:

Inguinal orchiectomy with high ligation of the cord at the internal ring is the initial management of testicular tumour. Multi Agent chemotherapy and followed by surgical resection is one modality of treatment. Ref: Bailey & Love, 25th Edition, Page 1269.

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A 34-year-old female has a history of intermittent episodes of severe abdominal pain. She has had multiple abdominal surgeries and exploratory procedures with no abnormal findings. Her urine appears dark during an attack and gets even darker if exposed to sunlight. The attacks seem to peak after she takes erythromycin, because of her penicillin allergy. This patient most likely has difficulty in synthesizing which one of the following?

The patient has acute intermittent porphyria, which is a defect in one of the early steps leading to heme synthesis. The buildup of the intermediate that cannot continue along the pathway leads to the dark urine, and it turns darker when ultraviolet (UV) light interacts with the conjugated double bonds in the molecule. Erythromycin is metabolized through an induced P450 system, which requires increased heme synthesis. This leads to metabolite buildup to the level where the abdominal pain appears. The defect in heme synthesis does not affect creatine phosphate, cysteine, thymine, or methionine levels.

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Most common type of hypospadias is: September 2011

Ans. A: Glandular Glandular hypospadias is common and does not usually require treatment Hypospadias: The external meatus opens on the underside of the penis or the perineum, and the inferior aspect of the prepuce is poorly developed (hooded prepuce) Meatal stenosis occurs Bifid scrotum 6 - 10 months of age is the best time for surgery

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In a subclan aery block at outer border of 1st rib, all of the following aeries help in maintaining the circulation to upper limb, EXCEPT?

A rich anastomosis exists around the scapula between branches of subclan aery (first pa) and the axillary aery (third pa). This anastomosis provides a collateral circulation through which blood can flow to the limb when the distal pa of subclan aery or the proximal pa of axillary aery is blocked. Scapular anastomoses occur between the following branches of proximal subclan and distal axillary aery: Branches of Subclan aery: Thyrocervical trunk, Suprascapular and Deep branch of transverse cervical.Branches of Axillary aery: Subscapular, Posterior circumflex humeral and Thoracoacromial aeires.

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Lymphatics of suprarenal gland drain into lymph nodes -

Suprarenal glands drain into para-aortic nodes.

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All of the following can be involved in an injury to the head of the fibula, EXCEPT:

The common peroneal nerve is extremely vulnerable to injury as it winds around the neck of the fibula. At this site, it is exposed to direct trauma or is involved in fractures of the upper pa of the fibula. While passing behind the head of the fibula, it winds laterally around the neck of the bone, pierces peroneus longus muscle, and divides into two terminal branches: the superficial peroneal nerve and deep peroneal nerve (anterior tibial nerve). Injury to common peroneal nerve causes foot drop.Ref: Clinical Anatomy By Regions By Richard S. Snell, 9th edition, Page 485.

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Pain felt between great toe and 2nd toe is due to involvement of which nerve root -

First web space of foot is supplied by deep peroneal nerve (L5)

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Which of the following is non-competitive inhibitor of intestinal alkaline phosphatase?

Ans. d (L-Phenylalanine) (Ref. Biochemistry by Vasudevan, 4th ed., 57; 5th ed., 55-56)ALKALINE PHOSPHATASE# The pH optimum for the enzyme reaction is between 9 and 10.# It is activated by magnesium and manganese.# Zinc is a constituent ion of ALR# It is produced by osteoblasts of bone, and is associated with the calcification process.# It is localised in cell membranes (ecto-enzyme), and is associated with transport mechanisms in liver, kidney and intestinal mucosa.# For estimation, sodium phenyl phosphate is used as the substrate, pH is adjusted to 9.9, serum sample is added as the source of ALP and incubated.# Normal serum value of ALP is 40-125 U/L.# Raised Levels:Mild increasepregnancy.Moderate (2-3 times) increaseIn infective hepatitis, alcoholic hepatitis or hepatocellular carcinoma, Hodgkin's lymphoma, congestive cardiac failure or ulcerative colitis.Very high levels of ALP (10-12 times)In extrahepatic obstruction (obstructive jaundice) or cholestasis.Drastically high levels of ALP (10-25 times)Bone diseases where osteoblastic activity is enhanced such as Paget's disease, rickets, osteomalacia, osteoblastoma, metastatic carcinoma of bone, and hyperparathyroidism.Iso-enzymes of Alkaline Phosphatase# Alpha-1 ALP moves in alpha-1 position, it is synthesized by epithelial cells of biliary canaliculi. It is about 10% of total activity and is increased in obstructive jaundice and to some extent in metastatic carcinoma of liver.# Alpha-2 heat labile ALP is stable at 56degC; but loses its activity when kept at 65degC for 30 minutes. It is produced by hepatic cells. Therefore, exaggerated alpha-2 band suggests hepatitis. This liver iso-enzyme forms about 25% of total ALP.# Alpha-2 heat stable ALP will not be destroyed at 65degC, but is inhibited by phenylalanine. It is of placental origin, which is found in blood in normal pregnancy. An iso-enzyme closely resembling the placental form is characteristically seen in circulation in about 15% cases of carcinoma of lung, liver and gut and named as Regan iso-enzyme (after the first patient in whom it was detected) or carcinoplacental iso-enzyme. Chronic heavy smoking also increases Regan iso-enzyme level in blood. Normal level is only 1% of the total ALP.# Pre-beta ALP is of bone origin and elevated levels are seen in bone diseases. This is most heat labile (destroyed at 56degC, 10 min). Wheat germ lectin will precipitate bone isoenzyme. This constitutes about 50% of normal ALP activity.# Gamma-ALP is inhibited by phenylalanine and originates from intestinal cells. It is increased in ulcerative colitis. About 10% of plasma ALP are of intestinal variety.# Leucocyte alkaline phosphatase (LAP) is significantly decreased in chronic myeloid leukemia. It is increased in lymphomas and leukemoid reactions.ALANINE AMINO TRANSFERASE (ALT)# It is also called as serum glutamate pyruvate transaminase (SGPT).# The enzyme needs pyridoxal phosphate as co-enzyme.# Normal serum level of AL T for male is 13^4-0 U/L and for female is 10-28 U/L.# Very high values (100 to 1000 U/L) are seen in acute hepatitis, either toxic or viral in origin.# Both ALT and AST levels are increased in liver disease, but ALT > AST.# Moderate increase (25 to 100 U/L) may be seen in chronic liver diseases such as cirrhosis, Hepatoma.# A sudden fall in ALT level in cases of hepatitis is very bad prognostic sign.NUCLEOTIDE PHOSPHATASE# It is also known as 5' nucleotidase.# It is a marker enzyme for plasma membranes and is seen as an ecto-enzyme (enzyme present on the cell membrane).# Serum samples contain both ALP and NTP.# These are distinguished by Nickel ions which inhibit NTP but not ALP.- Normal NTP level in serum is 2-10 IU/L. It is moderately increased in hepatitis and highly elevated in biliary obstruction.# Unlike ALP, the level is unrelated with osteoblastic activity and therefore unaffected by bone disease.GAMMA GLUTAMYL TRANSFERASE (GGT)# The old name was gamma glutamyl transpeptidase.# It can transfer gamma glutamyl residues to substrate.# In the body it is used in the synthesis of glutathione.# It is seen in liver, kidney, pancreas, intestinal cells and prostate gland.

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Mondors disease is:

Ans: D (Thrombophlebitis of superficial veins of breast) Ref: Bailey dt Love's Short Practice of Surgery, 25th Edition,833-4Explanation:Mondor's diseaseThrombophlebitis of the superficial veins of the breast and anterior chest wallCan also involve armCauseIdiopathicClinical featuresThrombosed subcutaneous vessel , usually attached to the skin - pathognomonic feature.When the skin over the breast is stretched by raising the arm. a narrow, shallow subcutaneous groove alongside the cord becomes apparent.Differential DiagnosesLymphatic permeation from occult carcinomaManagementConservativeRestriction of arm movements is advised.Resolv es within few months without any complicationAssociation with breast carcinoma is Coincidental

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Treatment of Choice in Sleep Apnea Syndrome:

(A) Continuous positive pressure ventilation# Sleep apnea: Sleep apnea is a sleep disorder characterized by pauses in breathing during sleep. Each episode, called an apnea, lasts long enough so that one or more breaths are missed, and such episodes occur repeatedly throughout sleep.> The standard definition of any apneic event includes a minimum 10 second interval between breaths, with either a neurological arousal (a 3-second or greater shift in EEG frequency, measured at C3, C4, O1, or O2), a blood oxygen desaturation of 3-4deg/: or greater, or both arousal and desaturation. Sleep apnea is diagnosed with an overnight sleep test called a polysomnogram, or a "Sleep Study".> Treatment: The most common treatment and arguably the most consistently effective treatment for sleep apnea is the use of a continuous positive airway pressure (CPAP) device, which 'splints' the patient's airway open during sleep by means of a flow of pressurized air into the throat. However the CPAP machine only assists inhaling whereas a BiPAP machine assists with both inhaling and exhaling, and is used in more severe cases. Medications like Acetazolamide lower blood pH and encourage respiration. Low doses of oxygen are also used as a treatment for hypoxia but are discouraged due to side effects.

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Rectal polyp most commonly presents as

.LOWER GI BLEED- * Bleeding in the GIT below the level of the ligament of Treitz. * Normal faecal blood loss is 1.2 ml/day. A loss more than 10 ml/day is significant.* Angiodysplasia. * Diveicular disease - commonest cause in Western countries. * Tumours of colon or small bowel. * Anorectal diseases--Haemorrhoids, fissure in ano. * Ulcerative colitis * Crohn's disease. * Colorectal polyps; rectal carcinomas. * Intussusception ref:SRB&;s manual of surgery,ed 3,pg no 925.

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Ulipristal acetate is a/an:

Ans. is d, i.e. Selective progesterone receptor modulatorRef: Harrison's Principles of Internal medicine 19th/ed, p2391Ulipristal acetate (trade name Ella One in the European Union, Ella in the US for contraception, and Esmya for uterine fibroid) is a selective progesterone receptor modulator (SPRM).PharmacodynamicsAs an SPRM, ulipristal acetate has partial agonistic as well as antagonistic effects on the progesterone receptor. It also binds to the glucocorticoid receptor, but is only a weak anti-glucocorticoid relative to mifepristone, and has no relevant affinity to the estrogen, androgen and mineralocorticoid receptors. Phase II clinical trials suggest that the mechanism might consist of blocking or delaying ovulation and of delaying the maturation of the endometrium.Medical Uses* Emergency contraception: For emergency contraception, a 30mg tablet is used within 120 hours (5 days) after an unprotected intercourse or contraceptive failure. It has been shown to prevent about 60% of expected, pregnancies, and prevents more pregnancies than emergency contraception with levonorgestrel.* Treatment of uterine fibroids: Ulipristal acetate is used for preoperative treatment of moderate to severe symptoms of uterine fibroids in adult women of reproductive age in a daily dose of a 5mg tablet. Treatment of uterine fibroids with ulipristal acetate for 13 weeks effectively controlled excessive bleeding due to uterine fibroids and reduced the size of the fibroids.InteractionsUlipristal acetate is metabolized by CYP3A4 in vitro. Ulipristal acetate is likely to interact with substrates of CYP3A4, like rifampicin, phenytoin, St John's wort, carbamazepine or ritonavir. Therefore, concomitant use with these agents is not recommended. It might also interact with hormonal contraceptives and progestogens such as levonorgestrel and other substrates of the progesterone receptor, as well as with glucocorticoids.Adverse EffectsCommon side effects include abdominal pain and temporary menstrual irregularity or disruption. Headache and nausea were observed under long-term administration (12 weeks), but not after a single dose.ContraindicationsUlipristal acetate should not be taken by women with severe liver diseases because of its CYP-mediated metabolism. It has not been studied in women under the age of 18.Pregnancy: Unlike levonorgestrel, and like mifepristone, ulipristal acetate is embryotoxic in animal studies. Before taking the drug, a pregnancy must be excluded.

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A patient presented with ahritis and purpura. Laboratory examination showed monoclonal and polyclonal cryoglobulins. Histopathology showed deposits of cryoglobulins around the vessels. The patient should be tested for which of the following ?

Hepatitis C This is caused by an RNA flavivirus. Acute symptomatic infection with hepatitis C is rare. Most individuals are unaware of when they became infected and are identified only when they develop chronic liver disease. Eighty per cent of individuals exposed to the virus become chronically infected and late spontaneous viral clearance is rare. There is no active or passive protection against hepatitis C virus (HCV). Hepatitis C infection is usually identified in asymptomatic individuals screened because they have risk factors for infection, such as previous injecting drug use , or have incidentally been found to have abnormal liver blood tests. Although most people remain asymptomatic until progression to cirrhosis occurs, fatigue can complicate chronic infection and is unrelated to the degree of liver damage. Hepatitis C is the most common cause of what used to be known as 'non-A, non-B hepatitis'. If hepatitis C infection is left untreated, progression from chronic hepatitis to cirrhosis occurs over 20-40 years. Risk factors for progression include male gender, immunosuppression (such as co-infection with HIV), prothrombotic states and heavy alcohol misuse. Not everyone with hepatitis C infection will necessarily develop cirrhosis but approximately 20% do so within 20 years. Once cirrhosis has developed, the 5- and 10-year survival rates are 95% and 81%, respectively. One-quaer of people with cirrhosis will develop complications within 10 years and, once complications such as ascites develop, the 5-year survival is around 50%. Once cirrhosis is present, 2-5% per year will develop primary hepatocellular carcinoma. Ref Davidson edition23rd pg877

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