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a child gets good marks in his exam and his father got a bicycle, he staed to read well, what is the line of therapy

Behavioral therapy is learning given by BF Skinner , according to him all behaviors are learned phenomenon and thus can be unlearned Positive reinforcement a type of reinforcement when a behavior is rewarded there is more chance that the behavior is repeated Negative reinforcement is that when a behavior is done and an aversive response is removed, the behavior is repeated. When I go and meet my girlfriend, she checks my messages and picks up fight (aversive response) suddenly I delete all messages one day and that day there was no fight (no aversive response) then that behavior is repeated (delete all messages before meeting my girlfriend) Extinction is the type of reinforcement where a behavior is done and a rewarding response is removed the chance is that behavior will not be repeated A child likes to play with children( reward) but when the child fights with other children( undesirable behavior) the child will be removed from playing( removing a reward) , then the child stops fighting with other children( reduction of undesirable behaviour) Ref. kaplon and sadock synopsis, 11 th edition, pg no. 845

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The most important action of Secretin is to

Main Action of Secretin: Secretin increases the secretion of bicarbonate by the duct cells of the pancreas and biliary tract. It thus causes the secretion of a watery, alkaline pancreatic juice (with high content of bicarbonate). Its action on pancreatic duct cells is mediated via cAMP. Secretin causes alkaline pancreatic juice to flood into the duodenum, neutralizing the acid from the stomach and thus inhibiting further secretion of the hormone - feedback control. Other actions: Inhibits gastric juice secretion. Inhibits gastric motility. Causes contraction of pyloric sphincter. Augments the potency of action of cholecystokinin on pancreatic secretion.

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Which is NOT used in treatment of heroin dependence?

Ans. is 'a' i.e., Disulfiram o Heroin is diamorphine and is 3 times more potent than morphine.Treatment of morphine or heroin poisoningo Treatment can be divided into:-A. Treatment of toxicity (overdose)# Overdose is a medical emergency, and is treated with opioid antagonist to reverse the complications (respiratory depression) by antagonizing the action on opioid receptors. Intravenous naloxone is the antagonist of choince for morphine (heroin) poisoning. Oral naltrexone is used for maintenance therapy, once acute poisoning has been treated by iv naloxone. Intravenous nalmefene is another specific antagonist.B. Treatment of dependence# Treatment of dependence include medically supervised withdrawal and detoxification, followed by maintenance therapy.a) Detoxificationo Detoxification process include abrupt withdrawal of opioid followed by management of the emergent withdrawal symptoms, i.e., treatment of withdrawal syndrome. Detoxification can be done by any of the following.1. Substitution of long-acting opioid agonism:- Methadone is the treatment of choice. Because of its agonistic activity on opioid receptors it suppresses withdrawal symptoms. L-alpha-acetyl-methadol/ Levomethyl (LAAM) is the other opioid agonist which was used for this purpose. However it is no longer in use because some patients developed prolonged QT intervals (torsades de points).2. Substitution of partial agonist:- Buprenorphine can be used in place of methadone because of its partial agonistic activity on opioid receptor.3. Substitution by a2 agonists:- Clonidine acts as a sympatholytic agent due to its agonistic action on central presynaptic a2 receptors which reduce nor-adrenergic activity. Therefore, clonidine reduces the adrenergic withdrawal symptoms. Lofexidine another a2 agonist, is an alternative to clonidine.4. Clonidine plus naltrexone:- A more rapid detoxification can occur when clonidine is used along with naltrexone. Naltrexone, when given in opioid dependent patient, causes withdrawal symptoms because of its antagonistic action. These can be treated with clonidine. The addition of short acting Benzodiazepine (lorazepam or oxazepam) and NSAIDs, will help relieve withdrawl symptoms not covered by clonidine. It should be kept in mind that naltrexone should not be used alone for detoxification (to treat withdrawl syptoms) as it precipitates or worsens the withdrawl syndrome.5. Other drugs:- Dextropropoxyphene, diphenoxylateb) M aintenance therapyo Once detoxification phase is over (i.e., withdrawal symptoms have been managed), the patient is maintained on any of the following drugs to prevent relapse by reducing craving and preventing 'kick' or 'euphoria' produced by opioids (morphine or heroin). Drugs used are:-1. Methadone:- Reduces craving and 'kick/euphoria' from morphine or heroin because their opioid receptors are already occupied.2. LAAM and buprenorphine:- Similarly reduce craving.3. Opioid antagonists (naltrexone):- Naltrexone can be used orally to assist in the rehabilitation of exopioid abusers who are fully withdrawn (otherwise it induces an acute withdrawl syndrome). Naltrexone prevents relapse by discouraging substance seeking behavior - If a patient, who is on naltrexone maintenance therapy, takes an opioid, there is no 'kick' or 'euphoria' as opioid receptors are already blocked. Naltrexone can be used with clonidine as in detoxification.

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Aldosterone acts at:

Ans. A Collecting ductRef: Ganong, 23rd ed. pg. 648* Aldosterone is secreted from adrenal cortex.* Action of aldosterone is localized to distal tubule are collecting duct.* Mechanism: Stimulates Na+K+ ATPase at basolateral end which generate gradient for movement of sodium ion from apical membrane causing an increase in sodium: reabsorption.

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DNA enzyme for aging:

Ans. (c) TelomeraseRef: Harper's Biochemistry, 30th ed. pg. 374, 732, 26th ed. Pg- 318* The ends of each chromosome contain structures called telomeres.* Telomeres consist of short, repeat TG-rich sequences. Human telomeres have a variable number of repeats of the sequence 5'-TTAGGG-3', which can extend for several kilobases.* Telomerase, is related to viral RNA-dependent DNA polymerases (reverse transcriptases) and is the enzyme responsible for telomere synthesis and thus for maintaining the length of the telomere.* Telomere shortening has been associated with both aging and malignant transformation. Because of this reason, telomerase has become an attractive target for cancer chemotherapy and drug development.

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Maternal mortality is maximum in which period –

Maternal death mostly occur from the third trimester to the first week after birth. Studies show that mortality risks for mothers are particularly elevated in the first two days after birth.

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Cataract blindness is:

Ans. Curable

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Investigation of choice for intramedullary SOL is -

Ans. is 'a' i.e., MRI o Investigation of choice for intramedullary space occupy lesion is MRI.

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Daclizumab acts through ?

Ans. is 'c' i.e., IL 2 receptor blocker Monoclonal antibodies (daclizumab and basiliximab) that block the interleukin 2 receptor and are used in prevention of graft rejection as immunosuppresant.

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Actinomycetoma is caused by-

Ans. is 'a' i.e., Actinomyces; 'b' i.e., Nocardia; 'c' i.e., Streptomyces

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Glycosylated hemoglobin in a normal pregnant lady should be less than:

The cut off for glycosylated hemoglobin in a pregnant lady is less than 6.5 %.

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'Bird beak' appearance on barium swallow is feature of?

Ans. A. Achalasia cardia. (Harrison's Medicine, 18th ch. 292; /Fig. 292-5).Achalasia cardia- Megaesophagus/sigmoid esophagus- "Bird beak" deformity- Absence of primary peristalsis below level of cricopharyngeus- Hurst phenomenon (temporary transit through cardia when hydrostatic pressure of barium column is above toxic LES pressure)- Vigorous achalasia (numerous tertiary contractions in non-dilated distal esophagus of early achalasia).Hiatus hernia- Epiphrenic bulge- >4 longitudinal coarse thick gastric folds above gastroesophageal junction or in the suprahiatal pouch- A Schatzki or B ring if present, is pathognomonic of a hiatal hernia because it marks the junction between squamous and columnar epithelium and represents the Z line.- Distance between B ring and hiatal margin > 2 cm- Peristalsis causes above hiatus.Schatzki ring (B ring/Lower esophageal mucosal ring, seen as a thin, web-like annular constriction at the esophagogastric junction is associated with a small hiatal hernia.Lye stricture(alkali/caustic strictures) - Long, tight and smooth stricturePeptic stricture- Short and tubular narrowing.Carcinoma oesophagus- Typical annular narrowing with overhang- ing margins and destruction of the mucosa.- 'Rat-tail' esophagus- Shouldering signLeomyoma/GIST- Smooth filling defect with right angles of origin from the esophageal wall (Submucosal smooth lesion)Cytomegalovirus esophagitis- iant ovoid flat ulcers (vasculitis of submucosal vessels)- Gastroesophageal junction with adjacent part of stomach is commonly affected.Herpes esophagitis- Discrete superficial punctate/linear serpentine/stellate/diamond shaped ulcers.Candidial esophagitis- Cobble stone mucosa- 'Shaggy' contour of the esophagus with small diffuse superficial ulcers- Irregular plaque-like filling defectsTertiary esophageal contractions (presbyesophagus, diffuse esophageal spasm, neuromuscular diseases)- "Corkscrew" appearance- "Rosary-bead/Shish kebab" configuration- "Yo-Yo" motion of bariumScleroderma- Esophageal shortening- Sliding hiatus hernia- Hidebound esophagus

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Which is the first organ to be affected in left ventricular failure?

Ans. (a) LungsRef: Robbin's pathology 9th ed. /529-30* In left ventricular failure, the pooling of blood in lungs will result and will lead to development of pulmonary edema which causes hypoxia and findings of dysnea, orthopnea, pink frothy sputum and death. Hence lungs are immediately affected following LVF.* Subsequently due to low BP the kidneys shall be affected and in severe LVF brain perfusion shall also be affected.

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Neurofibromatosis 1 criteria include all except:

In Neurofibromatosis 1 (NF1), two or more of the following clinical manifestations are present: Six or more Cafe-au-lait macules Axillary and inguinal freckling Two or more iris Lisch nodules Two or more neurofibromas or 1 plexiform neurofibroma A distinctive osseous lesion such as sphenoidal and tibial dysplasia Optic gliomas A 1st degree relative with NF1 Ref: Nelson textbook of pediatrics 21st edition pgno: 3141

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In rectus sheath which branch of aoa make anastmosis with superior epigastric aery

The external iliac aeries are two major aeries which bifurcate off the common iliac aeries anterior to the sacroiliac joint of the pelvis. They proceed anterior and inferior along the medial border of the psoas major muscles. They exit the pelvic girdle posterior and inferior to the inguinal ligament about one third laterally from the inseion point of the inguinal ligament on the pubic tubercle at which point they are referred to as the femoral aeries. The external iliac aery is usually the aery used to attach the renal aery to the recipient of a kidney transplant. Ref - BDC vol2 6e pg339 , britannica.com

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Pain sensations from the ethmoidal sinus are carried by-

As discussed in preceeding text, nasociliary nerve–branch of opthalmic division of trigeminal nerve carries pain sensation from ethmoid sinus.

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Conjunctiva epithelium is:

C i.e. Stratified non keratinized epithelium Conjunctival epithelium is stratified non keratinized squamous epitheliumQ. Conjunctiva has palpebral (marginal, tarsal, orbital), bulbar & fornix pas. Marginal palpebral conjunctiva has transitional zone (not epithelium) covered with stratified epithelium with characteristics of both skin & conjunctiva.

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Which of the following is the national level system that provides annual national as well as state level reliable estimates of fertility and mortality?

Sample Registration System (SRS) was initiated in 1964–65 (on a pilot basis; full scale from 1969–70) to provide national as well as state level reliable estimates of fertility and mortality • SRS is a dual record system: Field Investigation: continuous enumeration of births and deaths by an enumerator. Independent retrospective survey: every 6 months by an investigator-supervisor.

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How much Potassium is present in the Ringer Lactate solution -

Ans. is 'b' i.e., 4 mEq/L SolutionVolumebNa+K+Ca2+Mg2+Cl-hco3 (as la- ctate)Dext rose(g/L)mOsm/LExtracellular fluid--14245310327 280-310Lactated ringer's--13043--10928--2730.9% NaCl--154------154----3080.45% NaCl--77------77----154D5W--------------50252D5/0.45% NaCl--77------77--50406D5LR--13043--10928505253% NaCl--513------513----1,0267.5% NaCl--1,283------1,283----2,5676% hetastarch500154------154---- .31010% dextran-405000/154deg------0/154deg----3006% dextran-705000/154deg------0/154deg----3005% albumin250, 500130-160<2.5----130-160----33025% albumin20,50,100130-160<2.5----130-160----330Plasma protein fraction250, 500145 145 300

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Sex worker with discharging ulcer, gram negative diplococci & growth on modified Thayer main media. Diagnosis ?

Ans. is 'a' i.e., N. gonococci Information in this question are ? Gram negative diplococci. Growth on modified Thayer-main media. o Neisseria gonorrhoeae is a gram negative diplococci and Thayer-main medium is the selective medium for gonococci. Lab diagnosis of gonorrhea Urethral discharge is the most impoant specimen. Transpo media La It processing is to occur within 6 hrs ---> Stua medium or A mies medium. If processing is to occur > 6 hrs --> JEMBEC or Gono - Pak system (media with self - contained CO2 -generating system). Cluture media In acute cases --> Chocolate agar or Muller - Hinton agar. In chronic cases ---> Selective medium - Thayer main medium. Normally the diagnosis of gonorrhoea is made by isolating the organism in culture. It may not be possible to obtain gonococci in culture from some chronic cases or from patients with metastatic lesions such as ahritis. Serological test may be of value in such instances. In serological tests antibodies to gonococcal pili, LPS and outer membrane proteins are detected. o Various tests are ? Complement fixation text Precipitation Passive agglutination lmmunofluorescence Radioimmunoassay Enzyme - linked immunosorbent assay (ELISA) However, no serological test has been found useful for routine diagnostic procedure.Immunobloting

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All of the following are true regarding diuretics except:-

Name Site of action Example Mechanism Loop diuretics Thick ascending limb of Loop of Henle Furosemide Torsemide Na-K-2Cl sympoer inhibition Carbonic anhydrase inhibitors PCT Acetazolamide Dorzolamide Brinzolamide Carbonic anhydrase inhibition Thiazides DCT Hydrochlohiazide Chlohalidone Na-Cl sympoer inhibition Osmotic diuretics Non-specific Mannitol By osmotic effect Epithelial sodium channel blockers Collecting duct Amiloride Triamterene eNa channel blockade Aldosterone antagonists Collecting duct Spironolactone Epleronone Antagonism of aldosterone receptors

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In case of hypothyroidism which investigation is most informative and most commonly used:

TSH* Most informative among thyroid function test parameters because of ultra-sensitivity* Can detect subclinical hypothyroidism & subclinical hypehyroidism* Hypothyroidism - TSH |* Hypehyroidism - TSH |

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Mobile medical care constitutes all except

Ref:Park's Textbook of Preventive and Social Medicine 25th Ed

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Monozygotic twins do not have same-

Ans. is "a' i.e., Fingerprints o Monozygotic twins are a result of the division of the single fertilized egg into two embryos. Thus, they have exactly identical DNA, except for the generally undetectable micromutations that begin as soon as the cell starts dividing.o Fingerprints of the identical twins start their development from the same DNA so they show considerable genetic similarity.o However identical twins are situated in different parts of the womb during development, so each fetus encounters slightly different intrauterine forces than their siblings.o As a result fingerprints of the identical twins have different microdetails which can be used for identification purposes.

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What is approx fetal weight, if height of uterus is above pubic symphysis is 35 cm and station of head -2?

Ans. is c, i.e. 3.5 kgRef. Dutta Obs. 9/e, p 68Estimation of fetal weight can be done using Johnson formula:If station of head below ischial spine x 155If fetal head is at or above ischial spine- x 155 Here fetal head is at - 2, i.e. above ischial spine, so it will be (35 - 12) x 155 = 3.5 kg.Also Know:USG measurement of fetal weight =Shephard formula =Log10 EFW(gm)=1.2508+-(0.002646xACxBPD)Hadlock formula =Log10 EFW(gm)=1.3596-0.00386(ACxFL)+0.0064(HC)+0.00061(BPDxAC)+0.0425(AC)+0.0174(FL)

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A 44-year-old businessman presents to a physician because of a markedly inflammed and painful right great toe. He states that he just returned from a convention, and had noticed increasing pain in his right foot during his flight back home. Physical examination is remarkable for swelling and erythema of the right great toe as well as small nodules on the patient's external ear. Aspiration of the metatarsal-phalangeal joint of the affected toe demonstrates needle-shaped negatively birefringent crystals. Which of the following agents would provide the most immediate relief for this patient?

The patient has gout, which is due to precipitation of monosodium urate crystals in joint spaces (notably the great toe) and soft tissues (causing tophi, which are often found on the external ears). Colchicine reduces the inflammation caused by the urate crystals by inhibiting leukocyte migration and phagocytosis secondary to an effect on microtubule assembly. Allopurinol and its metabolite, oxypurinol, inhibit xanthine oxidase, the enzyme that forms uric acid from hypoxanthine. Therapy with this agent should be begun 1-2 weeks after the acute attack has subsided. Aspirin competes with uric acid for tubular secretion, thereby decreasing urinary urate excretion and raising serum uric acid levels. At high doses (more than 2 gm daily) aspirin is a uricosuric. Probenecid and sulfinpyrazone are uricosuric agents, increasing the urinary excretion of uric acid, hence decreasing serum levels of the substance. Therapy with these agents should be begun 1-2 weeks after the acute attack has subsided.

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Which of the following is not a feature Eustachian tube in children

The Eustachian tube in children is shoer (16-18mm), wider and more horizontal. It is also less taut due to lack of elastin. The above differences make the infant more prone for retrograde reflux of nasopharyngeal secretions and milk while feeding in supine position. Differences between Infant & adult ET INFANT ET ADULT ET Length 16-18 mm 36 mm Angle with horizontal 100 (more horizontal) Normalizes at 7yrs 450 Isthmus Straight Angulated Width Wider bony pa Narrow Cailage Flaccid Rigid Elastin at roof Less dense Very dense Ostmann's pad of fat Less in volume More in volume

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Platelet aggregation is blocked by aspirin due to its action on:

Ans. c. Thromboxane A2 (Ref: Goodman Gilman 12/e p868; Katzung 12/e p638; KDT 7/e p195, 6/e p186, 609)Aspirin causes several different effects in the body, mainly the reduction of inflammation, analgesia, the prevention of clotting, and the reduction of fever. Much of this is believed to be due to decreased production of prostaglandins and TXA2."In platelets, the major cyclooxygenase product is TxA2 (thromboxane A 2), a labile inducer of platelet aggregation and a potent vasoconstrictor. Aspirin blocks production of TxA2 by acetylating a serine residue near the active site of platelet cyclooxygenase-1 (COX-1), the enzyme that produces the cyclic endoperoxide precursor of TxA2. Because platelets do not synthesize new proteins, the action of aspirin on platelet COX-1 is permanent, lasting for the life of the platelet (7-10 days). Thus. repeated doses of aspirin produce a cumulative effect on platelet function. "-- Goodman Gilman 12/e p868Drugs affecting Thromboxane A2COX inhibitors like aspirin decreases the synthesis of TXA2QDaltroban & Sultroban are TXA2 receptor antagonistsQDazoxihen inhibits the enzyme thromboxane synthetaseQAspirinAspirin is now rarely used as an anti-inflammatory medication and used for its anti-platelet effectsQ (doses of 81-325 mg once daily).Mechanisms of Action:In platelets, the major cyclooxygenase product is TxA2, a labile inducer of platelet aggregation & a potent vasoconstrictorQ.Aspirin blocks production of TxA2 by acetylating a serine residue near active site of platelet cyclooxygenase-1 (COX-1), enzyme that produces cyclic endoperoxide precursor of TxA2Q.Because platelets do not synthesize new proteins, the action of aspirin on platelet COX-1 is permanent, lasting for the life of the platelet (7-10 days)Q.Clinical UsesAspirin decreases the incidence of transient ischemic attacks, unstable angina, coronary artery thrombosis with myocardial infarction & thrombosis after coronary artery bypass graftingQ.Epidemiologic studies suggest that long-term use of aspirin at low- dosage is associated with a lower Incidence of colon cancer, possibly- related to its COX-Inhibiting effectsQ.Adverse EffectsGastric upset (intolerance) and gastric & duodenal ulcersQ.Hepatotoxicity, asthma, rashes, GI bleeding & renal toxicity rarely if ever occur at antithrombotic doses.Antiplatelet action of aspirin contraindicates its use by patients with hemophiliaQ.

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Medium used for antibiotic sensitivity:

Antibiotic sensitivity testing Antibiotic sensitivity testing is carried out to determine appropriate antibiotic to be used for a paicular strain isolated from clinical specimens. Antibiotic testing can be carried out by two broad methods a) Disc diffusion tests b) Dilution tests REF : ananthanarayana 10th ed

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A person working in an abattoir presented with pustule on hand which turned into ulcer. Which of the following will best help in diagnosis?

Cutaneous anthrax generally occurs on exposed surfaces of the arms or hands. A pruritic papule develops 1-7 days after entry of the organisms and rapidly changes into a necrotic ulcer. The lesion is called a malignant pustule. The anthrax bacillus is Gram positive and nonacid fast. The spores do not stain by ordinary methods. When blood films containing anthrax bacilli are stained with polychrome methylene blue for a few seconds and are examined under microscope, an amorphous purplish material is noticed around the bacilli. This represents the capsular material and is characteristic of the anthrax bacillus. This is called "McFadyean's reaction" and is employed for the presumptive diagnosis of anthrax. Ref: Ananthanarayan and Paniker's Textbook of Microbiology By Ananthanarayan And Paniker, 2006, Page 242.

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Which is the cause of hemolysis in G6-PD deficiency?

Ans. is 'b' i.e., Oxidative stress * Normally RBCs are protected from oxidant injury by reduced glutathione. Reduced glutathione is generated from oxidized glutathione and the reducing equivalent for this reaction is provided by NADPH. This NADPH is generated in HMP shunt by enzyme Glucose-6-phosphate dehydrogenase, while oxidizing glucose-6-phosphate.* If G6PD is deficient, NADPH production will be reduced that results in increased susceptibility of RBC to oxidative damage because of unavailability of reduced glutathione. So, whenever there is oxidant stress, e.g. by drugs, infection or foods, hemolysis occurs. G6PD deficiency causes episodic intravascular and extravascular hemolysis.

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Bitemporal hemianopic field defect is characteristic of:

Ans. is 'c' i.e. Pituitary tumour Bitemporal hemianopia results due to central (sagittal) lesion of the optic chiasma, common causes of which are tumors of the pituitary gland, craniopharyngioma, suprasellar meningioma, glioma of third ventricle, chiasmal arachnoiditis, third ventricular dilatation.Sites of lesion of visual path and corresponding field defects. Site of lesionField defect1. Optic nerveIpsilateral blindness2. Proximal part of ONIpsilateral blindness with contralateral hemianopia or superior quadrantanopia3. Central lesion of chiasmaBitemporal hemianopia4. Optic tractHomonymous hemianopia5. Temporal lobeQuadrantic homonymous defect6. Optic radiationHomonymous hemianopia7. Anteriorly in occipital cortexContralateral temporal crescentic field defect8. Occipital lobeHomonymous hemianopia (usually sparing the macula)

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A 31-year-old woman has new-onset headaches and blood pressure elevation. She also notices that the symptoms come episodically and consist of palpitations, headache, anxiety, and marked blood pressure elevation. She undergoes a workup for secondary causes of hypertension, and is found to have elevated free catecholamines in her urine.For the patient with systemic disease, select the typical cardiovascular involvement

Focal myocardial necrosis and inflammatory cell infiltration caused by high circulating levels of catecholamines are seen in about 50% of patients who die with pheochromocytoma.Hypertension can further impair left ventricular function.

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Macewan's sign is seen in:

Alcoholism

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Phenol red thread test is used for dry eye. This test-

*Phenol red dye test measures the production of tears without topical anesthesia, as the dye changes its color to red on contact with tears. It doesn't require pH meter for reading the result. Ref: Ophthalmology Yanoff and Duker 4th/e p.277

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Vallecula sign is seen in

Depressing the tongue with a tongue depressor may show red and swollen epiglottis. Indirect laryngoscopy may show oedema and congestion of supraglottic structure. This examination is avoided for fear of precipitating complete obstruction. It is better done in the operation theatre where facilities for intubation are available. Ref: PL Dhingra 7th edition of Ear, Nose and Throat; Pg no 327

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Devic's disease is associated with

(D) Aquaporin 4 # NEUROMYELITIS OPTICA (NMO) or Devic's disease or Devic's syndrome, is a heterogeneous condition consisting of recurrent and simultaneous inflammation and demyelination of the optic nerve (optic neuritis) and the spinal cord (myelitis).> Currently at least two different causes are proposed based on the presence of autoantibodies against AQP4.> Autoimmune reactions against aquaporin 4 produce Devic's disease Mutations in the aquaporin-2 gene cause hereditary nephrogenic diabetes insipidus in humans. Mice homozygous for inactivating mutations in the aquaporin-0 gene develop congenital cataracts.> A small number of people have been identified with severe or total deficiency in aquaporin-1. Interestingly, they are generally healthy, but exhibit a defect in the ability to concentrate solutes in the urine and to conserve water when deprived of drinking water.

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Melanin is formed from which aminoacid?

Ans. is 'b' i.e., TyrosineAmino acidsBiological important compoundTyrosineCatecholamines (epinephrine, norepinephrine, dopamine), thyroxine, triiodothryonine, melanin.(Note : - Phenylalanine is the precursor of tyrosine, thus it can also give rise to all these compounds through tyrosine (phenylalanine - Tyrosine - Catecholamines, thyroxine, T3' melanin).TryptophanVitamin niacin, melatonin, SerotoninGlycine, Arginine, methionineCreatineGlycine, cysteineBile saltsGlycineHemeAspartic acid and glutaminePyrimidine basesGlycine, aspartic acid, glutaminePurine basesb-alanineCoenzyme-AArginineNitric oxideHistidine, Arginine, lysineKeratinMethionine, lysineCarnitineGABAGlutamateGlutamate, cysteine, glycineGlutathione

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An obese 50-year-old woman undergoes a laparoscopic cholecystectomy. In the recovery room she is found to be hypotensive and tachycardic. Her arterial blood gases reveal a pH of 7.29, partial pressure of oxygen of 60 kPa, and partial pressure of CO2 of 54 kPa. The most likely cause of this woman's problem is

Because of the ease with which carbon dioxide diffuses across the alveolar membranes, the PaCO2 is a highly reliable indicator of alveolar ventilation. In this postoperative patient with respiratory acidosis and hypoxemia, the hypercarbia is diagnostic of alveolar hypoventilation. Acute hypoxemia can occur with pulmonary embolism, pulmonary edema, and significant atelectasis, but in all those situations the CO2 partial pressures should be normal or reduced as the patient hyperventilates to improve oxygenation. The absorption of gas from the peritoneal cavity may affect transiently the PaCO2 , but should have no effect on oxygenation.

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During intraoperative period following capnograph waveform is seen. What does it signify.

Above ETCO2 curve depictsSpontaneous effos It signifies return of spontaneous ventilation and the patient is coming out of the anaesthesia The cleft is K/ACURARE CLEFT Repeat a dose of neuromuscular blocker if you want to maintain the muscle paralysis ??"Malignant hypehermia:Progressive rise in ETCO2 ??"Bronchospasm:Shark fin appearance ??"Esophageal intubation:

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A 3 year old child presents with a history of repeated sinopulmonary infections caused by encapsulated organisms. Which of the following is most likely to be deficient in this case?

Deficiency of IgG2 results in recurrent sinopulmonary infections with encapsulated organisms. Deficiency of IgG1 - Bacterial infections (Diptheria, tetanus) Deficiency of IgG3 - Viral infections Deficiency of IgG4 - Parasitic infections IgG is the only maternal immunoglobulin that is normally transpoed across the placenta and provides natural passive immunity to the newborn. Maximum placental transfer - IgG1 Minimum placental transfer - IgG2 Reference: Ananthanarayan and Paniker&;s Textbook of Microbiology Tenth edition

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Glucose transpo occur with the help of following ion in absorption in gut region

Glucose is absorbed into the epithelial cells lining the mucous membrane of the small intestine from their brush border surface by an active transpo mechanism Sodium co-transpo mechanism. Binding of glucose & Na+ to carrier protein: The carrier protein in cell membrane has 2 binding sites, one for sodium & another for glucose.It is called sodium-dependent glucose transpoer-I. The conformational change in the carrier protein occurs only when the binding sites are occupied by the sodium & glucose present in the gut lumen forming the sodium- glucose - carrier complex. Ref: Medical Physiology, Indu Khurana

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Thomas splint most troubling is:

(a) Ringbecause it impinges against proximal thigh.

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Aziththromyan prophylaxis in trachoma is given when prevalence is above?

<p> Current WHO recommendations for antibiotic treatment of trachoma District level prevalence is >10% in 1-9 years old children: mass treatment with azythromycin Reference:WHO Trachoma control:A guide for programme managers,2006;page no:21-22. <\p>

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Does not include in strand field's "seven I" principles of health education

"SEVEN I" principle of strandfield : Identification. Indigenization. Involvement. Indoctrination. Integration. Influencess. Innovation.

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Mechanism of action of ciprofloxacin in gram negative bacteria:-

MECHANISM OF FLUOROQUINOLONES (FQ) In gram negative bacteria, FQ inhibit DNA gyrase by binding to its A subunit and interfere with cutting and resealing function. In gram positive bacteria, FQ inhibit similar enzyme DNA topoisomerase IV.

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Most common tumor to extend from intracranial to orbit is –

"Meningiomas are the most common intracranial tumor to extend to the orbit".......... Ophthalmic oncology Meningiomas commonly arise from the dura of sphenoid wing, i.e. sphenoid wing meningioma.

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What is the generation time of Mycobacterium leprae?

Generation time of bacteria refers to the doubling time. Mycobacterium leprae is the slowest growing human bacterial pathogen, it has a doubling time of 14 days. It grows best at 30 degree C, at a temperature lower than body temperature, therefore it grows preferentially in the skin and superficial nerves. Mycobacterium leprae is transmitted by prolonged contact with patients with lepromatous leprosy, who discharge M. leprae in large numbers in nasal secretions and from skin lesions. 2 forms of leprosy are: Tuberculoid and Lepromatous. In tuberculoid type: CMI response to the organism limits its growth, very few acid-fast bacilli are seen, and granulomas containing giant cells form. In lepromatous leprosy: CMI response to organism is poor, the skin and mucous membrane lesions contain large numbers of organisms, foamy histiocytes rather than granulomas are found, and the lepromin skin test result is negative. Ref: Levinson W. (2012). Chapter 21. Mycobacteria. In W. Levinson (Ed), Review of Medical Microbiology & Immunology, 12e.

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A 35 year old male presents to the urologist for an infeility evaluation. A biopsy of his testis is performed to check sperm production and maturation. A microscopic section reveals only a few germ cells near the basal lamina in the seminiferous tubule. Which of the following cells is the germ cell closest to the basal lamina in the seminiferous tubule?

Maturation of germ cells (spermatogenesis) within the seminiferous tubules occurs in a concentric pattern with the less mature spermatogonia near the basal lamina and the mature forms near the tubule center. Spermatogonia are 2N cells and mature into larger primary spermatocytes (4N) . These mature into secondary spermatocytes (2N) , and finally into spermatids (1N) . Spermatids undergo spermatogenesis to become mature spermatozoa . Acrosomes form from the Golgi apparatus and a flagellum forms from microtubules. Unneeded organelles are shed. The seminiferous tubules of a reproductive-age male should exhibit all stages of maturation, with mature flagellated sperm in their centers.

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A child has mid-crown fracture in a permanent maxillary central incisor several months ago, the pulp is now necrotic, radiographic examination reveals an incompletely formed root with an open apex. The treatment of choice is:

Apexification is the process of inducing the development of the root and the apical closure in an immature pulpless tooth with an open apex. The main aim of apexification is to preserve the Hertwig’s root sheath and apical pulp tissue. Ref: Textbook of endodontics, Nisha Garg and Amit Garg, 3rd edition, pg no:548

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In Chronic Viral Hepatitis:

. Grading refers to the extent of necrosis andinflammations

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The double decidual sac sign (DDSS) is the best method for ultrasound diagnosis of

Double decidual sac sign on USG - Intra-uterine sac (Eccentrically placed) Outer layer - Decidua Parietalis Inner layer - Decidua Capsularis Indicates - Intrauterine pregnancy Intradecidual ring sign is the first sign of pregnancy on USG.

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Which of the following predisposes to placenta previa?

Ans: D

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All are true regarding Crohn's disease except:

Ref: Harrison s Principles of Internal Medicine, 18th edition, pg 2486 Explanation: Crohn's disease- MC site-terminal ileum with rectal sparing, skip areas + It is transmural, hence more of fistula formation More of systemic symptoms, pain, abdominal mass Toxic megacolon - Perforation Intraabdominal abscess, fallopian tube scarring - infertility Intestinal obstruction, massive hemorrhage, malabsorption, severe perianal disease Cobblestoning on endoscope Response to antibiotics and recurrence after surgery ASCA(anti-saccharomyces cerevisiae antibody)-positive Treatment - Antibiotics, corticosteroids, sulfasalazine, mercaptopurine, azathioprine, methotrexate. cyclosporine, tacrolimus Anti-TNF: Infliximab, adalimumab. certolizumab pegol Anti-integrin: Natalizumab Risk of Ca increases with duration & severity of the disease (See the following table)

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Nucleic acids absorb UV light maximally at the wavelength of

Nucleic acids absorb UV light maximally at the wavelength of 260 nm 260/280 ratio of pure DNA/RNA is in the range of 1.8 to 2. Amino acids absorb U.V light (not visible light)- colorless. Aromatic amino acids absorb U.V light at 250-290 nm (maximum absorption is at 280nm) because of conjugated double bonds.

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Children born to mothers with systemic lupus erythematosus are likely to have one of the following anomalies:

d. Complete heart block(Ref: Nelson's 20/e p 2171-2174, Ghai 8/e p 457-461)Congenital complete AV blockIt is presumed to be caused by autoimmune injury of fetal conduction system by maternally derived anti-SSA/Ro, anti-SSB/ La antibodies in a mother with systemic lupus erythematosus (SLE) or Sjogren syndromeAutoimmune disease accounts for 60-70% of all cases of congenital complete heart block

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All of the following cause hyperventilation except

Arterial hypoxemia is defined as an arterial P02 (partial pressure of oxygen) less than 80 mmHg, who is breathing room air at sea level. And because the partial pressure of a gas is determined by the soluble fraction of gas and not by the amount carried chemically bound to hemoglobin - the Hb does not determine P02 and hypoxemia does not depend on Hb level. In CO poisoning effective hemoglobin that can carry O2 decreases (because CO occupies Hb binding site) since P02 or arterial blood O2 remains normal, peripheral chemoreceptors are not stimulated and hyperventilation is not seen.  In hypoxia, with the reduction of PO2 cerebral blood flow increases (d/t vaso dilatation)to maintain O2 delivery in the brain. The cerebral cortex can tolerate acute hypoxia for 5-10 min at 28°C, 20 min at 20°C, and 50 min at 50°C. Hypoxic ischemia almost invariably involve hippocampus. The hippocampal CA1 neurons are vulnerable to even brief episodes of hypoxic ischemia.

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Stem cells are present where in cornea -

Answer- A. LimbusLimbal stem cells (also called corneal epithelial stem cells) are stem cells located in the basal epithelial layer of the corneal limbus.Proliferation of limbal stem cells maintains the cornea; for example, replacing cells that are lost tears.Limbal stem cells also prevent the conjunctivalepithelial cells from migrating onto the surface ofthe cornea.

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A child brought to casualty with reports of violent shaking by parents. The most likely injury is?

Violent shaking (by parent) may cause subdural hematoma; whereas ruptured spleen occurs due to compression of abdomen; long bone fracture due to compression, bending, direct blow, pulling and twisting; and skull fractures due to direct blow. Caffey (1974) described the effects of shaking as a major cause of subdural haematoma and intraocular bleeding in battered babies or infantile whiplash syndrome.

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"Inflation of lungs induces fuher inflation" this is explained by

Head's paradoxical reflex is paradoxical to Hering- Breuer inflation reflex This reflex might be the cause for inflation of the lungs in the newborn when the newborn takes the first breath

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Most common cause of Acute Aseptic Meningitis in children is

(C) Enterovirus # VIRAL CAUSES INCLUDE THE FOLLOWING: Enteroviruses - coxsackievirus, echovirus, poliovirus. Herpes simplex virus (HSV) types 1 and 2 (HSV-1, HSV-2) Varicella-zoster virus. Arboviruses, Epstein-Barr virus, HIV, Influenza virus types A and B, Mumps virus.> Many different viruses can cause meningitis.> About 90% of cases of viral meningitis are caused by members of a group of viruses known as Enteroviruses, such as Coxsacki-eviruses and Echoviruses.> These viruses are more common during summer and fall months.>Herpesviruses and the mumps virus can also cause viral meningitis.

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Reids index is increased in: March 2007

Ans. C: Chronic bronchitisThe Reid Index is a mathematical relationship that exists in a human bronchus section observed under the microscope. It is defined as ratio between the thickness of the submucosal mucus secreting glands and the thickness between the epithelium and cailage that covers the bronchi.It isn't of diagnostic use in vivo since it requires a dissection of the airway tube, but it has value in post moem evaluations and for research.RI = gland/wallRI is the Reid IndexWall is the thickness of the airway wall between the epithelium and the cailage's perichondriumGland is the thickness of the mucous producing gland at the location of inspection.A normal Reid Index should be smaller than 0.4, the thickness of the wall always more than double the thickness of the glands it contains.Hyperplasia and hyperophy of mucous glands as in chronic bronchitis causes them to be present at deeper levels in the bronchial wall and thicker in size, thus increasing the Reid Index beyond the normal value.

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In psychoanalytic terms, obsessive-compulsive disorder is fixed at -

OCD results from a regression from the oedipal phase to anal phase of psychosexual development, i.e. In OCD fixation occurs in anal stage (Note - Regression is reversion from higher level of development to lower level of development).

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Subconjunctival cyst is seen in?

Ans. is b i.e., Cysticercosis Parasitic cysts occurs in subconjunctival cysticercus, hydatid cyst and filarial cyst.

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"Antihistone" antibodies are detectable in:

Drug induced Lupus

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The best method of teaching an urban slum about ORS is -

A demonstration is a carefully prepared presentation to show how to perform a skill or procedure.Here a procedure is carried out step by step before an audience or the target group,the demonstrator asceaining that the audience understands how to perform it (refer pgno:864 park 23 rd edition)

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Tardy ulnar nerve palsy occur as a delayed sequele of

C i.e. Fracture lateral condyle humerus

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Characterstic X Ray finding in ASD is:

C i.e. Pulmonary plethora

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Pain relief in chronic pancreatitis can be obtained by destruction of

Chronic pancreatitis Pain from the pancreas is carried in sympathetic fibres that traverse the Celiac ganglion, reach the sympathetic chain through the splanchnic nerves, and then ascend to the coex Celiac plexus nerve blocks performed either percutaneously or endoscopically have been employed to abolish this pain with inconsistent results Ref: Sabiston 20th edition Pgno :1534

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All are true about peritoneal folds except

Urachus fistula is a remnant of allantoic diveiculum. It is a diveiculum of hind gut and connects umbilicus to urinary bladder. The lumen of allantoic duct-is obliterated at the time of bih. Median Umblical Ligament is the remanant of urachus. It covers allantois. Urine keeps on dribbling in urachal fistula Figure showing Urachal fistula

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The principal characteristics of attention-deficit/hyperactivity disorder are all of the following except one. Which one is the exception?

Inattention and hyperactivity/impulsivity are the key behaviors of ADHD. Some people with ADHD only have problems with one of the behaviors, while others have both inattention and hyperactivity-impulsivity. Most children have the combined type of ADHD. In preschool, the most common ADHD symptom is hyperactivity. It is normal to have some inattention, unfocused motor activity, and impulsivity, but for people with ADHD, these behaviors: Are more severe Occur more often Interfere with or reduce the quality of how they function socially, at school, or in a job.

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21st tooth erupts at:-

Eruption is defined as the superior pa of crown of the tooth appearing level with the surface of the alveolar bone.Temporary dentition: total 20 number of teeth, stas at 6 months till 2 years.Permanent dentition: total 32 number of teeth, stas at 6 years completed by 17 - 25 years.1st to erupt is molar 1 (M1) and last to erupt is molar 3 (M3).21st teeth refers to 1st permanent tooth, which erupts at 6 years.

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Most common viral cause of Fulminant hepatic failure in pregnancy?

HEV- increases risk of fulminant hepatic failure in pregnancy

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True about diabetic nephropathy -

Beta islet cell/ pancreatic transplantation can improve proteinuria in early stages.. Strict control of blood glucose retards the progression of any diabetes related complication Early pathological change and albumin excretion abnormalities is reversible with normalization of plasma glucose Administration of ACE inhibitors or ARB&;s, is also effective in slowing progression from Microalbuminuria to ove nephropathy Ref Harrison 17/e p 2287-88

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Which of the following is an adrenergic drug preferred for arresting labour?

(Ref: KDT 6/e p323) Isoxsuprine and ritodrine are selective b2 agonists useful as tocolytic agents for arresting labour. Pulmonary edema is an impoant adverse effect of these agents.

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Sixth cranial nerve palsy causes of left eye causes?

Ans. is 'd' i.e., Diplopia in left gaze o Sixth nerve supplies lateral rectus, therefore its palsy results in abduction weakness (not adduction weakness)o In left gaze, there is abduction of left eye and adduction of right eye. If there is paralysis of lateral rectus of left eye (6th nerve paralysis), abduction of left eye will not be possible in left gaze, while adduction of right eye is normal. Therefore, there will be diplopia in left gaze.

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Father of modern toxicology -

orfila is known as father of modern toxicology Ref: FORENSIC MEDICINE AND TOXICOLOGY Dr PC IGNATIUS THIRD EDITION PAGE 397

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5-year-old male brought to casualty by his mother because of episode of sudden vomiting. He has been behaving strangely according to mother. Laboratory findings showed microcytic hypochromic anemia with the above finding. The most probable poisoning is:

Ans. (B). Chronic lead poisoningThe above blood picture shows basophilic stippling of RBCs.Basophilic stippling (dots in the red blood cells) is due to the inhibition of 5 pyrimidine nucleotidase enzyme resulting in aggregation of ribosomes.Other findings in blood: Microcytic hypochromic anemia, anisocytosis, poikilocytosisBasophilic stippling is also seen in megaloblastic anemia.

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Submandibular gland is crossed by which nerve?

Submandibular duct is thin-walled and is about 5 cm long.it emerges at the anterior end of the deep pa of the gland and runs forwards on the hyoglossus between the lingual and hypoglossal nerves.at the anterior border of the hyoglossus, the duct is crossed by lingual nerve.it opens on the floor of the mouth on the summit of the sublingual papilla at the side of the frenulum of the tongue. Ref BDC volume 3; 6th edition pg 135

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Patient with fixed dilated pupil, with iris atrophy and secondary glaucoma after penetrating keratoplasty is suggestive of:

Ans. d. Urrets Zavalia syndrome (Ref: style="font-size: 1.04761904761905em; font-family: Times New Roman, Times, serif">icles/PMC1770988)A fixed dilated pupil following penetrating keratoplasty is a well recognized if rare postoperative complication.The mydriasis following penetrating keratoplasty was first described by Castroviejo but it was Urrets-Zavalia who first published his observations on a series of six cases and suggested an association of fixed dilated pupil, iris atrophy, and secondary glaucoma.The pupil can become abnormally dilated following penetrating keratoplasty for keratoconus, particularly if dilating drops are used.In addition to the pupil and iris abnormalities, Urrets-Zavalia also described other features--iris ectropion, pigment dispersion, anterior subcapsular cataract and posterior synechiae.Urrets Zavalia SyndromeUrrets Zavalia Syndrome is characterized by triad of: Secondary glaucoma + Iris atrophy + Fixed dilated pupilQUrrets-Zavalia syndrome (UZS) consists of a fixed dilated pupil associated with iris atrophy.It is a poorly understood complication following penetrating keratoplasty for keratoconus.Posner Shlossman syndromeIt is also called as glaucomatocyclitic crisis.Episodic unilateral mild anterior uveitis, photophobia, reduced vision and colored rings around lights (from secondary corneal edema)Benedict's SyndromeIf red nucleus is involved, tremors and jerky movements occur in contralateral side of the body.This condition combined with ipsilateral 3rd nerve paralysis is called as Benedict's syndrome.McKusick-Kaufmann SyndromeMcKusick-Kaufman syndrome: A rare genetic disorder characterized by hydrometrocolpos (fluid buildup in vagina and uterus), extra fingers and congenital heart defects.

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Treatment of acute asthma include all except-

Ans. is 'c' i.e., Salmeterol o Long acting Beta - 2 agonists have no role in acute attack of asthma. They are useful in persistent asthma.

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Characteristic visual field defect in optic chiasma lesion -

Ans, is 'b' i.e,. Bitemporal hemianopia Site of lesionVisual field defectOptic nerveBlindnessOptic cbiasmaBitemporal hemianopiaOptic tractIncongruent homonymous hemianopiaLateral geniculate bodyHomonymous hemianopiaOptic radiation (Total)Homonymous hemianopia, sometimes with macular sparingOptic radiation lower fibres (temporal lobe)Homonymous upper quadrantanopiaOptic radiation upper fibres (parietal lobe)Homonymous lower quadrantanopiaVisual cortex (anterior occipital cortex)Homonymous hemianopia with macular sparingOccipital cortex tipHomonymous macular defect

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Ehrlich's test is done to detect:

D Harper, 26th ed, p. 283 & 25th ed, p. 370

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Millenium development goals formulated in 2000 were to be achieved by -

- During September 2000, representatives of 189 countries met at Millennium Summit in New York to adopt United nations Millennium Declaration. - the goals in the area of development and povey eradication are now referred as Millennium Development Goals. - Governments have set date of 2015 by which they would meet the MDGs. Reference : Park's textbook of preventive and social medicine, 23rd edition, pg no:893 <\p>

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In the stage of Grey hepatization-

Ref:Textbook of pathology (Harsh mohan)6th edition,page no. 469 GREY HEPATISATION: LATE CONSOLIDATION This phase lasts for 4 to 8 days Grossly, the affected lobe is firm and heavy. The cut surface is dry, granular and grey in appearance with liverlike consistency .The change in colour from red to grey begins at the hilum and spreads towards the periphery. Fibrinous pleurisy is prominent. Histologically, the following changes are present i)The fibrin strands are dense and more numerous. ii)The cellular exudate of neutrophils is reduced due to disintegration of many inflammatory cells as evidenced by their pyknotic nuclei. The red cells are also fewer. The macrophages begin to appear in the exudate. iii)The cellular exudate is often separated from the septal walls by a thin clear space. iv)The organisms are less numerous and appear as degenerated forms.

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Twin pregnancy, but due to two different men is called: NEET 14

Ans. Superfecundation

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Low bih weight baby is defined as baby weighing: September 2006

Ans. D: 2500 gm Low bih weight (LBW) is defined as a fetus that weighs less than 2500 g (5 lb 8 oz) regardless of gestational age. Other definitions include Very Low Bih Weight (VLBW) which is less than 1500 g, and Extremely Low Bih Weight (ELBW) which is less than 1000 g. Normal Weight at term delivery is 2500 g - 4200 g. SGA is not a synonym of LBW, VLBW or ELBW. Small for gestational age (SGA) babies are those whose bih weight, length, or head circumference lies below the 10th percentile for that gestational age

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Drug of choice for OCD is?

ANSWER: (B) FluoxetineREF: Kaplan 9th ed p - 622OCDTreatment of choice: behaviour therapyDrug of choice: SSRI2nd drug of choice: comipramine

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PAS positive are all the following except -

Ans-DThe basement membrane of bacteria

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Increased serum amylase in pleural effusion is seen in

(Malignancy) (269- CMDT-08) (1658-H17th)Serum amylase level in PE - suggest pancreatits, pancreatic pseudocyst, adenocarcinoma of the lung or pancreas or esophageal rupture, - MalignancyGlucose < 60 mg/ dL - occurs in Malignancy, Bacterial infections, Rheumatoid pleuriticIncreased amvlase acids are found in perforated duodenal ulcers acute cholecystitis. High intestinal obstruction, acute mesenteric vascular occlusion, DKA leaking aortic aneurysm, mumps, ectopic pregnancy after administration of narcotics, after abdominal surgery* Bacterial pneumonia and cancer are the most common cause of exudative effusion* High concentration of cholesterol in most rheumatoid effusions

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Pyrogens act on which site of brain ?

Ans. is 'd' i.e., Hypothalamus PyrogenesPyrogenes are substances that cause fever.Pyrogens may be exogenous or endogenousExogenous - Bacterial toxinsEndogenous - IL-1, TNF-a, IL-6, Interferons, Ciliory's neurotropic factorThese pyrogenes increase the level of PGE, in the hypothalamus that elevates the thermoregulatory set point and causes fever.

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Hypertrophy means -

Ans. is 'b' i.e., Increase in size of cells Hypertrophy o Hypertrophy refers to an increase in the size of cells without increase in the number, resulting in an increase in the size of tissue. Hypertrophy involves cell enlargement without cell division. So, hypertrophied organ has just larger cells, but no new cells Hyperplasia o Hyperplasia refers to an increase in number of cells without increase in cell size. It occurs due to cell division and proliferation, in hyperplasia there is increase in number of new cells without increase in size.

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A patient was diagnosed with schizophrenia and was staed on haloperidol 5mg. On 3rd day he presented with uprolling of eyes. A complete neurological examination revealed no spasticity or any other abnormalities except uprolling of eyeballs. Visual acuity was found to be normal. What is your likely diagnosis?

* <48 hours of staing antipsychotics * M.C in======Younger black males * If a patient develops dystonia he is more prone for eps Patient considers this as an Allergic reaction , thereby may stop drugs Layryngeal dystonia is a Psychiatric emergency, should be treated with IV lorazepam TREATMENT * Diphenhydramine * Benztropine mesylate * Prophylactic anticholinergics helps Ref.Kaplon and sadock, synopsis of psychiatry, 11 th edition, pg no. 923

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Risk factor prevention at which level

(A) (Primordial) (39 - Park 22nd)PRIMORDIAL PREVENTION* Special attension is the prevention of chronic disease* Prevention of the emergence or development of risk factors in countries or population groups in which they have not yet appeared* For example, many adult health problems (eg obesity hypertension) have their early origins in childhood, because this is the time when life styles are formed (for example smoking, eating pattern, physical exercise)* Efforts are directed towards discouraging children from adopting harmful lifestyles* Main intervention in primordial prevention is through individual and mass educationTABLE Levels of preventionLevelPhase of diseaseAimActionsTargetPrimordialUnderlying economic, social, and environmental conditions leading to causationEstablish and maintain conditions hat minimize hazards to healthMeasures that inhibit the emergence of environmental, economic, social and behavioural conditionsTotal population or selected groups; achieved through public health policy and health promotion.PrimarySpecific causal factorsReduce the incidence of diseaseProtection of health by personal and community efforts, such as enhancing nutritional status, providingimmunizations, and eliminating environmental risks.Total population, selected groups and individuals at high risk; achieved through public health programmesSecondaryEarly stage of diseaseReduce the prevalence of disease by shortening its durationMeasures available to individuals and communities for early detection and prompt intervention to control disease and minimize disability (e,g. through screening programmes)Individuals with established disease; achieved through early diagnosis and treatmentTertiaryLate stage of disease (treatment, rehabilitation)Reduce the number and/or impact of complicationsMeasures aimed at softening the impact of long-term disease and disability; minimizing suffering; maximizing potential years of useful life.Patient achieved through rehabilitation* 'YOGA' is a practice that involves training of the mind, body and breathing to deliver various health benefits,Repular practice of yoga can be best defined as a form of "Preventive Medicine" that has shown beneficial effects on several ailments including Backache, Anxiety, Hypertension etc.Health promotionSpecific protection* Health education* Environmental modifications* Nutritional intervention* Lifestyle and behavioural changes* Immunization *** Use of specific nutrients eg vit A *** Chemoprophylaxis* Protection against accident carcinogen etc* Protection against occupational hazards* HIV sentinel surveillance is for Detecting trend of the disease* STEPS done for surveillance of risk factors of non communicable disease

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Venous drainage of upper pa of uterus and placenta is through :

Ovarian vein

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Which of the following is true about venous thrombosis?

Answer- B. Most impoant factor for development of deep venous thrombosis is hospital admissionVenous thrombosis is the formation of a semi-solid coagulum within the venous system and may occur in the superficial system.Patients are at risk of dweloping a post-thrombotic limb and venous ulceration Virchow triad-Changes in the wssel wall (endothelial damage)Stasis, which is diminished blood flow through the veinsCoagulability of blood (thrombophilia)The most impoant factor is a hospital admission for the treatment of a medical or surgcal condition.The coralline thrombus then progresses as a propagated loose red fibrin clot, containing many red cells.

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Gateway of tears is:

Killians dehiscence is also called 'gateway of tears'

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A 27 year old sexually active male develops a vesiculobullous lesion on the glans soon after within 8hrs taking tablet diclofenac for viral fever. The lesion healed with hyperpigmentation.The most likely dignosis is-

Fixed drug eruption It characteristically recur at the same site following administration of offending drugs or occasionally a member of the same group of drugs. They occur 30min to 8hrs after drug administration Most common drugs: Sulfonamides NSAIDS Dapsone Batbiturates Ciprofloxacin Phenytoin Griseofulvin Metronidazole Antituberculous drugs Pathomechanism Drug induced CD8 positive Tcells induce INFs and TNFalpha dependent damage to keratinocytes Clinical features Single / multiple, round / oval lesions Well demarcated erythematous edematous plaques that resolve with violaceous /hyperpigmented macules Associated burning/ stinging and pruritus Most common sites: oral mucosa; glans penis; hands and feet Bulbous fed: generalised well defines erythematous and bulbous lesions bilateral and symmetrical. Pseudoephedrine causes nonpigmented FDE lesion heal without pigmentation Investigations: oral or topical provocation test. Test drug is taken orally or applied topically Treatment Discontinue the offending drug Coicosteroids: topical and systemic Antihistamines. IADVL textbook of dermatology page 1664

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Isotope (s) used in high dose rate brachytherapy – a) lr192b) Co–60c) Cs–l33d) Ra 226 e) Pd103

"Although cobalt - 60 and cesium - 137 have been used in the past, iridium - 192 is the most commonly used radioisotope in HDR brachytherapy".                                                                       — The physics of radiation therapy Note - Cs-137 is used in HDR brachytherapy, while option c i.e. Cs - 133 (not Cs - 137).

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A patient presents with erythematous scaly lesions on extensor aspect of elbows and knee. The clinical diagnosis is got by :

Ans. is 'a' ie Auspitz signErythematous scaly lesions on extensor aspect of elbow and knee favours the diagnosis of Psoriasis.The clinical diagnosis of psoriasis can be made by demonstrating Auspitz sign.It is a characteristic finding of psoriasis in which removal of scale leads to pinpoint bleeding.Tzanck testis used in the clinical diagnosis of PemphigusNote that Tzanck smear is used in the diagnosis of herpes virus infection.KOH smearis used for diagnosing fungal infections such as ringworm infections

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