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Open Life Science AI 35

Urinary tract

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Chronic urethral obstruction because of urinary calculi, prostatic hyperophy, tumors, normal pregnancy, tumors, uterine prolapse or functional disorders cause hydronephrosis which by definition is used to describe dilatation of renal pelvis and calculus associated with progressive atrophy of the kidney due to obstruction to the outflow of urine Refer Robbins 7yh/9,1012,9/e. P950

Anatomy

Vitamins and Minerals

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Ans. (c) Vitamin B12 Ref: Harrison's 19th ed. P 640* Vitamin B12 (Cobalamin) is synthesized solely by microorganisms.* In humans, the only source for humans is food of animal origin, e.g., meat, fish, and dairy products.* Vegetables, fruits, and other foods of nonanimal origin doesn't contain Vitamin B12 .* Daily requirements of vitamin Bp is about 1-3 pg. Body stores are of the order of 2-3 mg, sufficient for 3-4 years if supplies are completely cut off.

Biochemistry

Surgical Treatment Obesity

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Ans. is 'd' i.e., Roux en Y Duodenal Bypass Bariatric surgical procedures include:a. Vertical banded gastroplastyb. Adjustable gastric bandingc. Roux-en Y gastric bypass (Not - Roux-en Y Duodenal Bypass)d. Biliopancreatic diversione. Duodenal switcho The surgical treatment of morbid obesity is known as bariatric surgery.o Morbid obesity is defined as body mass index of 35 kg/m2 or more with obesity related comorbidity, or BMI of 40 kg/m2 or greater without comorbidity.o Bariatric operations produce weight loss as a result of 2 factors. One is restriction of oralintake. The other is malabsorbtion of ingested food.o Gastric restrictive procedures include Vertical banded gastroplasty & Adjustable gastric bandingo Malabsorbtive procedures include Biliopancreatic diversion, and Duodenal switcho Roux-en Y gastric bypass has features of both restriction and malabsorptionBariatric Operations: Mechanism of ActionRestrictiveVertical banded gastroplastyLaparoscopic adjustable gastric bandingLargely Restrictive/Mildly MalabsorptiveRoux-en-Y gastric bypassLargely Malabsorptive/Mildly RestrictiveBiliopancreatic diversionDuodenal switch

Surgery

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The central aery of the retina is a branch of the ophthalmic aery. It is the sole blood supply to the retina; it has no significant collateral circulation and blockage of this vessel leads to blindness. The branches of this aery are what you view during a fundoscopic exam. Note: The infraorbital aery is a branch of the maxillary aery. It comes through the infraorbital foramen, inferior to the eye. It supplies the maxillary sinus, the maxillary incisors, canine and premolar teeth, and the skin of the cheek below the orbit. The supraorbital aery is another branch of the maxillary aery. It comes through the supraorbital foramen and supplies blood to the muscles, skin and fascia of the forehead. The lacrimal aery is a branch of the ophthalmic aery that supplies the lacrimal gland. The nasociliary aery doesn't exist, but there is a nasociliary nerve that travels with the ophthalmic aery. Ref: Moon D.A., Foreman K.B., Albeine K.H. (2011). Chapter 18. Orbit. In D.A. Moon, K.B. Foreman, K.H. Albeine (Eds), The Big Picture: Gross Anatomy.

Ophthalmology

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Ans. is 'b' i.e., IGI-1GH has two major functions :-i) Growth of skeletal system :- The growth is mediated by somatomedins (IGF). Increased deposition of cailage (including chondroitin sulfate) and bone with increased proliferation of chondrocytes and osteocytes.ii) Metabolic effects :- Most of the metabolic effects are due to direct action of GH. These include gluconeogenesis, decreased peripheral utilization of glucose (decreased uptake), lipolysis and anabolic effect on proteins.

Physiology

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Ans. C i.e. Mite

Social & Preventive Medicine

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Abnormal vascular pattern include punctation, mosaicism and atypical vessels.

Gynaecology & Obstetrics

Urology

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PILONIDAL SINUS/DISEASE (Jeep Bottom; Driver's Bottom) Pilus--hair; Nidus--nest It is epithelium lined tract, situated sho distance behind the anus, containing hairs and unhealthy diseased granula- tion tissue. It is due to penetration of hairs through the skin into subcutaneous tissue. It forms granuloma/unhealthy granulation tissue in the deeper plane. It is of infective origin and occurs in sacral region between the buttocks, umbilicus, axilla. Other indications of per rectal examination are:Carcinoma rectum, Stricture rectum, Polyps, BPH and carcinoma prostate, Secondaries in the rectovesical pouch (Blumer shelf), Sphincter tone, Pelvic abscess (is felt as boggy swelling), to feel the internal opening of anal fistulas, in bimanual palpation of the bladder or pelvic tumours, in acute abdominal conditions--it reveals dilated empty rectum with tenderness.Reference : page 967 and 952 SRB's manual of surgery 5th edition

Surgery

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Remifentanil is the shortest acting opioid due to its metabolism by plasma esterase → dose adjustment is not needed in liver or kidney disease. It is more potent than alfentanil : Order of potency is Sufentanil > Fentanyl = Remifentanil > Alfentanil.

Anaesthesia

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Ans. C. Deficit of expression by gestureHypomimiaHypomimia or amimia is a deficit or absence of expression by gesture or mimicry.This is usually most obvious as a lack of facial expressive mobility (mask - like facies).This is a feature of frontal subcoical disease.

Psychiatry

Bacteriology

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Nagler's reaction - when Clostridium perfringens is grown in media containing 6 % agar, 5% Fildes peptic digest of sheep blood and 20% human serum, with antitoxin spread on one half of plate, colonies in the other half without antitoxin will be surrounded by a zone of opacity. No opacity around the colonies on the half of plate with antitoxin, this is due to the specific neutralization of the alpha-toxin. This specific lecithinase effect, known as the Nagler's reaction. Reference: Textbook of Microbiology; Anathanarayan and paniker's; 10th edition; Page no: 263

Microbiology

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Here statement 1 & 3 are wrong. It is actually a direct pick from harrison, an impoant topic for entrance examinations hirsutism is seen in 10% of woman. Acromegaly rarely causes hirsutism. Ref: Harrisons Principles of Medicine, 18th Edition, Pages 380-382

Medicine

General anatomy

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One of the most impoant pharmacokinetic changes associated with aging is decreased renal elimination of drugs. After age 40, creatinine clearance decreases an average of 8 mL/min/1.73 m2/decade; however, the age-related decrease varies substantially from person to person. Serum creatinine levels often remain within normal limits despite a decrease in GFR because older adults generally have less muscle mass and are generally less physically active than younger adults and thus produce less creatinine. Maintenance of normal serum creatinine levels can mislead clinicians who assume those levels reflect normal kidney function. Decreases in tubular function with age parallel those in glomerular function. Refer katzung 11/e p1039

Anatomy

general microbiology

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Lag phase: Immediately following the seeding of a culture medium, there is no appreciable number, though there may be an increase in the size of the cells. This initial period is the time required for the adaptation to the new environment, during which the necessary enzymes and metabolic intermediates are built up in adequate quantities for multiplication to proceed. The duration of the lag phase varies with the species, sizes of the inoculation, nature of the culture media and the environmental factors such as temperature REF:Ananthanarayan & Panicker's Textbook of Microbiology 8th edition pg no: 24

Microbiology

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Urine microscopy for malignant cytology "Painless haematuria is by far the most common symptom of bladder cancer and should be regarded as indicative of a bladder carcinoma until proven otherwise." Bailey & Love 25/e p1336 (24/e p1363) Cigarette smoking is the main etiological factor and accounts ,for about 50% of bladder cancers Among the given options 'urine microscopy' is the best choice for investigating a pt. with high suspicion for bladder ca. This is not a good screening test but a positive result is highly specific. The best investigation would be cystoscopy & biopsy. Investigations for bladder cancer 1. Urinary cytology - Exfoliated cells from both normal and neoplastic urothelium can be readily identified in voided urine. Examination of cytological specimens can detect the malignant cells either at the time of initial presentation or during follow-up. Cytological examination may be especially useful in screening high-risk population and assessing the response to treatment. 2. Cystourethroscopy and tumor resection - The diagnosis and initial staging of bladder cancer is made by cystoscopy and transurethral resection. 3.Imaging (IVP, CT, MRI) - Although various imaging techniques can detect bladder cancer, its presence is confirmed by cystoscopy & biopsy. - Therefore imaging modalities are used to image the upper urinary tract and, when infiltrating bladder tumors are detected to assess the depth of muscle wall infiltration and the presence of local & distant metastasis. - Intravenous urography remains one of the most common imaging tests for the evaluation of hematuria. However, intravenous pyelography is increasingly being replaced by computed tomography (CT) urography, which is more accurate, for evaluation of the entire abdominal cavity, renal parenchyma, and ureters in patients with hematuria. Bladder tumors may be recognized as pedunculated, radiolucent filling defects projecting into the lumen; nonpapillary, infiltrating tumors may result in fixation or flattening of the bladder wall. 4. Urinary tumor markers - - Several new tests have been developed in order to overcome the shocomings of urinary cytology such as the low sensitivity for low-grade superficial tumors and inter-observer variability. - Commercially available tests include, the BTA test, the BTA stat test, the BTA TRAK assay determination of urinary nuclear matrix protein (NMP22), Immunocyt and UroVysion . - These tests can detect cancer specific proteins in urine (BTA/NMP22) or augment cytology by identifying cell surface or cytogenetic markers in the nucleus. Other tests under investigation include identification of the Lewis X antigen on exfoliated urothelial cells, and the determination of telomerase activity in exfoliated cells. - These tests have been demonstrated to enhance detection of bladder cancer when used either individually or in combination with cytology. They have been used to detect both new index tumors as well as recurrent tumors.

Surgery

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Pharmacology

General anatomy

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Ref William hematology 6/e p1268 The term cryoglobulinemia refers to the presence in the serum of proteins that precipitate at temperatures below 37 degrees C and redissolve on rewarming. ... The elective treatment for hyperviscosity syndrome, whether associated with monoclonal, mixed, or polyclonalcryoglobulinemia, is plasma exchange.

Anatomy

Biostatistics

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A distribution is negatively skewed, or skewed to the left, if the scores fall toward the higher side of the scale and there are very few low scores. In positively skewed distributions, the mean is usually greater than the median, which is always greater than the mode. Ref :

Social & Preventive Medicine

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Maturation (cement)—The process of hardening a cement matrix through hydration with oral fluids to achieve greater mechanical strength. Ref: Phillip’s Science of Dental Materials ed 12 pg 309

Dental

Embryology

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Ans. C Cardinal veinRef; hangman's essesntial medical Embroyology pg. 57# During early embryonic development (through 4th week), paired cardinal veins drain the body. Anterior cardinal veins drain the head and upper limb buds, while posterior cardinal veins drain the body. Both the anterior and posterior veins on each side unite at the common cardinal veins that flow into the sinus venosus and ultimately into the common atrium (Image).# Anterior cardinal veins are retained. An anastomosis between the two forms the left brachiocephalic vein, and anterior segments from both form the jugular system for the head and neck (Image).# Most of the posterior segment on the left disappears except for that forming the left superior intercostal vein, whereas the right posterior segment forms the superior vena cava.Extra mileDefects of SVC Development* Double inferior vena cava occurs when the left supracardinal vein persists, thereby forming an additional inferior vena cava below the level of the kidneys.* Left superior vena cava occurs when the left anterior cardinal vein persists, forming a superior vena cava on the left side. The right anterior cardinal vein abnormally regresses.* Double superior vena cava occurs when the left anterior cardinal vein persists, forming a superior vena cava on the left side. The right anterior cardinal vein also forms a superior vena cava on the right side.

Anatomy

Testis & Scrotum

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Ans) a (Abdominal aorta ....) Ref Chaurasia vol 2 pg 186Testicular artery is a branch of abdominal aorta given off at the level of vertebrae L2.Venous drainageVeins emerging from the testis forms pampiniform plexus. Plexus condenses into 4 veins at the superficial inguinal ring & into 2 veins at the deep inguinal ring.Ultimately one vein is formed which drains into IVC (on right side) or left renal vein (on left side).

Surgery

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The vocal fold of the excised larynx is known to be located at an intermediate position(the so-called cadaver position).

ENT

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Microbiology

Non communicable diseases

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WHO CUT-OFF POINTS OF WHR Indicator CUT-OFF points Risk of metabolic complications Waist circumference >94 cm (M) >80 cm (W) Increased Hip cirrcumference >102 cm (M) >88 cm (W) Substantially increased Waist-Hip ratio >= 0.95(M) >= 0.80(W) Substantially increased Ref: Park 23rd edition Pgno : 400 WC & WHR, WHO Consultation 2008

Social & Preventive Medicine

Kidney

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Chronic pyelonephritis is characterized by renal inflammation and scarring induced by recurrent or persistent renal infection, vesicoureteral reflux, or other causes of urinary tract obstruction. VUR is a congenital condition that results from incompetence of the ureterovesical valve due to a sho intramural segment Ref Harrison20th edition pg 234

Medicine

Poisoning

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All patients with a history of snake bite should be observed for 8-12 h after the bite, if the skin is broken and the offending snake cannot be positively identified as non-poisonous. Ref: Krishnan vij ; 5th ed; Page no: 484

Forensic Medicine

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Intracranial CSF leaks cause bacterial meningitis, about 80% are caused by S. Pneumoniae. Other causative organisms are meningococcus, Hemophilus species and S.aurues. Ref: Clinical Pediatric Neurology By Ronald B. David, Page 217

Pediatrics

Facial Nerve And Its Disorders

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(b) Facial nerve repair(Ref. Scott Brown, 6th ed., 1404)Since generally following trauma the facial nerve injury occurs as sudden onset. Facial decompression should be the best option.

ENT

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Ans. B i.e. Demonstrations Demonstration involves showing by reason or proof explaining or making clear by use of examples or experiments. Put more simply, demonstration means to clearly show

Social & Preventive Medicine

24b17b1d-0dac-4da1-b215-22451784b9b6

Anatomy

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Ans. is 'a' i.e., Age < 3 years Post operative nausea and vomiting (PONY) following strabismus surgery It can cause post - op wound dehiscence, hematoma, orbital hemorrhage and aspiration. 30 % of all procedures are associated with PONV. Major risk factors are: Age > 3years Duration of anesthesia > 30 mins Personal or family history of post - op nausea and vomiting Personal or family history of motion sickness Medical management of PONV includes: dimenhydrinate, metoclopramide, droperidol, dexamethasone, ondansatron

Anaesthesia

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Orthopaedics

Spos Injury

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Standard poals in knee ahroscopy Anterolateral poal Almost all the structures within the knee joint can be seen except- posterior cruciate ligament anterior poion of the lateral meniscus periphery of the posterior horn of the medial meniscus in tight knees. Anteromedial poal Additional viewing of lateral compament Posteromedial poal Used for viewing the posteromedial structures For repair or removal of the displaced posterior horn of meniscal tears Superolateral poal Used for diagnostically viewing the dynamics of patella-femoral joint, excision of medial plica.

Orthopaedics

Miscellaneous (Obs)

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Ans. C. Most common in non-pregnant womenCandidiasis is caused by Candida albinism which thrives in an acidic medium with an abundant supply of carbohydrates. It is found commonly in pregnancy, and in patients on oral contraceptives, antibiotics and. corticosteroids. It is also seen in patients with diabetes. It causes a profuse discharge and intense pruritus with soreness of vagina and dysuria. Vagina and vulva are edematous and excoriated and the white patches of cheesy material on the vagina and vulva can be easily identified. A 10%KOH smear shows the buds and hyphae of the Candida organism. Nystatin or ketoconazole vaginal tablets used for one week are curative when used along with a cream of the same medication for External use.

Gynaecology & Obstetrics

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Left lateral decubitus view demonstrates the air between dense shadow of liver and the abdominal wall.

Radiology

Mycology

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Aspergillus species are widely distributed on decaying plants, producing chains of conidia. Aspergillus species unlike Candida species do not form the pa of normal flora of humans. They are ubiquitous in the environment; hence transmission of infection is mostly exogenous. Aspergillus transmission occurs by inhalation of airborne conidia. Risk Factors for invasive aspergillosis are: Glucocoicoid use (the most impoant risk factor) Profound neutropenia or Neutrophil dysfunction Underlying pneumonia or COPD, tuberculosis or sarcoidosis Antitumor necrosis factor therapy.

Microbiology

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Ans. is 'c' i.e., KaryotypingTOF has been associated with untreated maternal diabetes, phenylketonuria, and intake of retinoic acid.Associated chromosomal anomalies occur in 30% cases and include trisomies 21, 18, 13 and 22q11 microdeletion, especially in pulmonary atresia and absent pulmonary valve syndrome (APVS).There is also a high association with extra - cardiac anomalies in paicular, abdominal and thoracic abnormalities.When a TOF is diagnosed during fetal life, karyotyping and targeted morphologic ultrasound examination should be offered.Isolated TOF - Good prognosis in TOF with pulmonary stenosis (>90% survival after surgery).However, other forms of TOF such as pulmonary atresia and absent pulmonary valve syndrome do not have a good prognosis (moderate prognosis for pulmonary atresia and bad prognosis for APVS).

Pediatrics

Anatomy of Bone & Fracture Healing

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Ans. is 'a' i.e., Calcification of discAlkaptonuria# It is due to deficiency of homogentisate oxidase. As a result homogentisic acid (homogentisate) is excreted execessively in urine, There are three important characteristic features in alkaptonuria-Urine becomes dark after being exposed to air. It is due spontaneous oxidation of homogentisate into benzoquinone acetate, which polvmerse to form black-brown pigment alkapton which imparts a characteristic black-brown colour to urine.Alkapton deposition occurs in sclera, ear, nose, cheeks and intervertebral disc space. A condition called ochronosis. There may be calcification of intervertebral discs.Onchronosis arthritis affecting shoulder, hips, knee.# Benedict's test is strongly positive in urine and so is the ferric chloride (FeClyl test. Benedict's reagent gives a greenish brown precipitate with brownish black supematent. Feh ling's reagent (FeClj gives blue green colour.

Orthopaedics

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Dental

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Ans. is b' i.e., Mean-Mode Measures of Skewness o There are following measures of skewness 1. Karl pearson's measure The formula for measuring skewness is divided into a) absolute measure Skewness = Mean - Mode b) relative measure The relative measure is known as the Coefficient of Skewness and is more frequently used than the absolute measure of skewness. Fuher, when a comparison between two or more distributions is involved, it is the relative measure of Skewness which is used.

Social & Preventive Medicine

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Ans. is 'd' i.e., Corneal ulceration

Ophthalmology

General anatomy

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Red pulp and White pulp are present in spleenHistologically, a lymph node is subdivided into three regions: coex, paracoex, and medulla. All three regions have a rich supply of sinusoids, enlarged endothelially lined spaces through which lymph percolates.The afferent lymph vessels pierce the capsule on the convex surface of the node and empty their lymph into the subcapsular sinus. This sinus is continuous with the coical sinuses and delivers the lymph into the medullary sinuses, eventually to enter the efferent lymphatic vessels.Reference: Krishna Garg Histology; 5th edition; Page no: 92

Anatomy

Cerebrum

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Ans. is 'a' i.e Rt. Leg and perineum Paracentral lobule:On the medial surface of cerebral hemisphere, the U shaped gyrus around the end of the central sulcus is the paracentral lobule.Motor cortex is located in the precentral gyrus on the superolateral surface of the hemisphere and in the anterior part of the paracentral lobule.Stimulation in this area results in movements in the opposite half of the body.The body is represented upside down in this area.A look at the motor homunculus in Ganong will show that the leg and perineum are represented in the paracentral lobule.

Anatomy

Trauma

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Chronic Subdural Empyema It may be primary infection of subdural space from sinusitis focus causing suppuration and pus formation. It can be complication of the chronic subdural haematoma. It is due to secondary bacterial infection of collected clot/fluid. Infection is from sinusitis scalp (common)/through earlier trauma wound/haematogenous. Commonly Gram positive organisms cause empyema like streptococci (viridans/milleri) but other virulent organisms like Gram negative bacteria (H.influenzae) occasionally can cause. There is coical venous thrombophlebitis and coical infarction. Headache, fever, meningism and convulsions are the features. MRI is ideal than CT to diagnose. Treatment: Antibiotics, craniotomy and drainage; anticonvulsants, ICU care, proper monitoring, regular follow up. Condition has got 10% moality. Ref: SRB's Manual of Surgery 5th edition Pgno : 1097

Surgery

Reversible Cell Injury

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The increased size of the cells is due to the synthesis and assembly of additional intracellular structural components. Hyperophy refers to an increase in the size of cells, which results in an increase in the size of the affected organ. Cells capable of division may respond to stress by undergoing both hyperplasia and hyperophy. The hyperophied organ has no new cells, just larger cells.

Pathology

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A i.e. Na+

Physiology

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Medicine

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Medicine

Biosynthesis of Fatty Acids and Eicosanoids

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Ans : B (NAD+) & C (NADPH) In chronic alcoholism rate limiting component for alcohol metabolism is NAD* & NADPHOxidation of ethanol by alcohol dehydrogenaseQ & NADQ leads to excess production of NADHSome metabolism of ethanol takes place via a cytochrome P450 dependent microsomal ethanol oxidising systme (MEOS) Q involving NADPH & O2:, This system increase in activity in chronic alcoholism & may account for the increased metabolic clearnce in this condition.Ethanol + NADPH + H+ O2 MEOS Acetaldehyde

Biochemistry

Other NHPs

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National Iodine deficiency disorder programme , 1992: - National goitre control programme, 1962 is conveed to NIDDCP, 1992 - Impact indicators: Major indicator - Urinary iodine excretion levels ( generally measured in pregnant women over 24hrs) Others - Neonatal hypothyroidism , Goitre - Level of salt iodinisation: 30 ppm at production level 15 ppm at consumer level - Two-in-one salt: 40mcg iodine + 1mg iron/gm of salt MBI kits- Field Test Kits that allow Iodised salt manufacturers, quality controllers, health inspectors, social workers, NGO activists and even school children to assess the amount of iodine in iodised salt.

Social & Preventive Medicine

Concept of Health and Disease

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(A1I of the above) (54- Park 20th)Specific death rates - may be (a) cause or disease specific e.g. TB, cancer, accidents (b) Related to specific groups e.g. age specific, sex specific, age and sex specific etc.* Rates can also be made specific for many others variables such as income, religion, race, housing etc.* Specific death rates can help us to identify particular groups or groups "at risk" for preventive action. They permit comparisons between different causes within the same populations* Specific death rates are obtained mainly in countries in which a satisfactory civil registration system operates and in which a high proportion of death is certified medically.

Social & Preventive Medicine

Communicable diseases

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New recommended regimen/Schedule (New guidelines( Type of prophylaxis Regimen Post exposure Intramuscular Essen Regimen (1-1-1-1-1) Day 0,3,7,14,28 Post exposure intradermal Updated Thai Red Cross Regimen (2-2-2-0-2) Day 0,3,7,28 Post exposure in vaccinated individuals Day 0,3 Pre-exposure prophylaxis Day 0,7,21/28 Minimum potency: 2.5 IU per IM dose Zagreb regimen of rabies Vaccine (Intramuscular Post-exposure) : 1. 4-dose abbreted multisite regimen 2-0-1-0-1 (2 doses on Day 0,1 dose on Day 7, 1 dose on day 21 Ref: Park 25th edition Pgno : 297-298

Social & Preventive Medicine

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Ans. C: Epiphora SjOgren's syndrome (also known as "Mikulicz disease" and "Sicca syndrome", is a systemic autoimmune disease in which immune cells attack and destroy the exocrine glands that produce tears and saliva SjOgren's syndrome can exist as a disorder in its own right (Primary Sjogren's syndrome) or it may develop years after the onset of an associated rheumatic disorder such as rheumatoid ahritis, systemic lupus erythematosus, scleroderma, primary biliary cirrhosis etc. (Secondary SjOgren's syndrome)

Ophthalmology

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A i.e. Fine froth in mouth & nostril

Forensic Medicine

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Ans. B i.e. Sickle cell anemia Splenomegaly Splenomegaly refers strictly to spleen enlargement, and is distinct from hyperspineism , which connotes overactive function by a spleen of any size. Splenomegaly and hypersplenism should not be confused. Each may be found separately, or they may coexist. Clinically if a spleen is palpable, it means it is enlarged as it has to undergo enlargement by at least two folds to become palpable. However, the tip of the spleen may be palpable in a newborn baby up to 3 months of age Early sickle cell anemia may present with splenomegaly

Pathology

Antiplatelets and Fibrinolytics

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Ans. is 'd' i.e., Prasugrel Glycoproteins lIb / IIIa inhibitorso The platelet glycoprotein mediates platelet aggregation via binding of adhesive proteins such as fibrinogen and Von Willebrand factor.o GP lib / Ilia inhibitors, inhibit platelet aggregation by blocking GPIIb / IlIa.o They are more complete inhibitors than either aspirin or clopidogrel / ticlopidinejj because they inhibit final pathway in platelet aggregation (whether it is mediated by ADP or TXA2), while aspirin blocks only TXA2 pathway and clopidogrel blocks only ADP pathway,o Drugs are -o In addition to inhibiting Gp lib / Ilia receptor, abciximab also inhibits ay(33 receptor (which binds vitronectin) and amb2 (a leukocyte integerin). This action is responsible for anti-inflammatory and antiproliferative properties of abciximab.

Pharmacology

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Social & Preventive Medicine

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Carboxylation is a function of carboxylase enzymes which belong to the class of 'Ligases'. It is not a function of oxygenase enzymes. Monoxygenases incorporate one atom of oxygen and play an impoant role in hydroxylation of steroids. Dioxygenases incorporate 2 atoms of oxygen into the substrate. Ref: Harper's Illustrated Biochemistry 27th Edition, Page 96, 97; Enzyme Assays: High-Throughput Screening, Genetic Selection and Fingerprinting edited by Jean-Louis Reymond, 2006, Page 85.

Biochemistry

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Ans. Gross negligence

Forensic Medicine

Immunology

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An antigen is any substance that causes an immune system to produce antibodies against it. Antigens are usually peptides, polysaccharides or lipids. In general, molecules other than peptides (saccharides and lipids) qualify as antigens but not as immunogens since they cannot elicit an immune response on their own. Ref: Ananthanarayan & Panikers textbook of microbiology 9th edition pg:88

Microbiology

Epidemiology

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Tools of measurement in epidemics: - Rate = x 1000/ 10000/ 100000 ; a is pa of b - Ratio = a/b ; a is not a pa of b - Propoion = x 100 = % ; a is pa of b Prevalence = No. of all current cases of a disease at a time /Estimated total population at that time X 100 Hence, Prevalence is a propoion (Prevalence is NOT a Ratio): Numerator is a pa of denominator & is always expressed in percentage. Incidence is rate.

Social & Preventive Medicine

General

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Ans. is 'a' i.e., 3rd left intercostal space o Best areas to auscultate for both components of the second heart sound (A2 and P2) are either the left sternal border at the level of second intercostal space (Pulmonic area) or the left sternal border at the level of third intercostal space (Erb s point).

Medicine

Congenital Dislocation of Hip (C.D.H.)

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Ans. is 'b' i.e., Flexion, adduction & internal rotation Hip conditionDeformitySynovitisArthritisPosterior dislocationAnterior dislocationFemoral neck fractureIntertrochantric fractureFlexion, abduction, external rotation, apparent lengtheningFlexion, adduction, internal rotation, true shorteningFlexion, adduction, internal rotation, apparent & true shorteningFlexion, abduction, external rotation, true lengtheningExternal rotation, later adduction & flexionMarked external rotation, later adduction & flexion

Orthopaedics

Complications Of Anaesthesia

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Ans. b. SuxamethoniumSuxamethonium is the drug most commonly responsible for causing malignant hyperthermia.'Drugs causing malignant hyperthermia are- succinylcholine (most common cause), halothane (MC inhalational agent), iso/des/sevo/methoxy- fluranes, lignocaine, TCA, MAO inhibitors and phenothiazines.''Thiopentone and pancuronium are protective drugs for malignant hyperthermia, as these raise the triggering threshold.''In malignant hyperthermia susceptible patients, safe anesthetics are N2O, Non-depolarizing muscle relaxants (atracurium), opiates, tranquilizers, etomidate, barbiturates (thiopentone) and propofol.'Malignant Hyperthermia* Autosomal dominant genetic disorder of skeletal muscle* Occurs in susceptible individuals due to exposure to some triggering agents, typically Suxamethonium or volatile agents, which cause an abnormal increase in intracellular calcium.* It is caused by dysregulation of excitation-contraction coupling in skeletal muscle.Triggering Agents:* Succinylcholine (most common cause)* Halothane (MC inhalational agent)* Halogenated Anesthesia:- Fluranes: Isoflurane, desflurane, sevoflurane. methoxy-flurane- Ether- Cyclopropane* Lignocaine* TCA* MAO inhibitors* PhenothiazinesClinical Features:* Rise in end tidal CO2 (1st sign)* Masseter muscle rigidity (MMR) and tachycardia are earliest sign* Hypermetabolic features, metabolic acidosis, fever, hyperthermia* Sympathetic over activity: Tachycardia, arrhythmia, unstable BP. initial hypertension* Muscle damage: Masseter muscle spasm, generalized rigidity, hyperkalemiaTretment:* Triggering agent must be stopped and hyperventilate with 100% oxygen* The mainstay of therapy is immediate administration of IV dantrolene.* Dantrolene is the only drug effective in reversing the symptoms and preventing the episode.

Anaesthesia

Environment and Health

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Ans. is 'a' i.e., Malathion* Insectisides used for control of malaria are-i) Residual sprapy-# In residual spray, spraying of houses with residual insectisides is done. Residual insectisides remains active over extended periods i.e., they have residual action even after the time of spray.# Commonly used residual insectisides are - Malathion, DDT, Lindane, propoxure (OMS-33).ToxicantDosage in g/m2Average duration of effectiveness (months)DDT1 to 26 to 12Lindane0-53Malathion23OMS-3323ii) Space spray# Space sprays are those where the insecticidal formation is sprayed into the atmosphere in the form of a mist or fog to kill insect. Action is short lived and temporary since there is no residual action.# The most commonly used space spray insecticide is Pyrethrum.# New equipment has been developed to use residual insectiside as space spray by ultra low volume (ULV) technique. Malathions and fenthion are most commonly used.

Social & Preventive Medicine

G.I.T

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Obstructive jaundice Most common surgical cause of obstructive jaundice is CBD stones Characterized by dark urine, pale coloured stools, icterus and Pruritus Presence of urobilinogen in urine rules out obstructive jaundice USG is the best test to differentiate medical from surgical jaundice Unconjugated bilirubin is normal Ref: Harrison's 19th edition Pg no : 1998

Anatomy

Head and neck

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structures outside the sinus: 1. Superiorly: optic tract, optic chiasma, olfactory tract, internal carotid aery and anterior perforated substance. 2.inferiorly: foramen lacerum and the junction of the body and greater wing of the sphenoid bone 3.medically: hypophysis cerebri and sphenoidal air sinus 4.laterally: temporal lobe with uncus 5.below laterally: mandibular nerve 6.anteriorly: superior orbital fissure and apex of the orbit 7.posteriorly: apex of the petrous temporal and the crus cerebri of the midbrain Ref BDC volume 3:sixth edition pg 193

Anatomy

Intra Uterine Growth Restriction, Intrapaum and Antepaum Fetal Surviellance

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Electrical Fetal hea monitoring is useful as: (1) Provides accurate information, (2) Helpful in diagnosing fetal distress, (3) Directs about intervention to prevent fetal death or morbidity, (4) It is superior to intermittent monitoring methods.

Gynaecology & Obstetrics

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The spirometer is a simple device for measuring gas volumes. The frequently used water spirometer, rolling seal spirometer and bellows spirometer. The last two are not water-filled and are more poable. The VT, IRV, ERV, IC, and VC can all be measured with a spirometer (as can the forced expiratory volume in 1 second , forced vital capacity , and forced expiratory flow ). The RV, the FRC, and the TLC, however, cannot be determined with a spirometer because the subject cannot exhale all the gas in the lungs. The lung volumes not measurable with spirometry can be determined by the nitrogen-washout technique, by the helium-dilution technique, and by body plethysmography. The FRC is usually determined, and RV (which is equal to FRC minus ERV) and the TLC (which is equal to VC plus RV) are then calculated from volumes obtained by spirometry. Ref: Levitzky M.G. (2007). Chapter 3. Alveolar Ventilation. In M.G. Levitzky (Ed), Pulmonary Physiology, 7e.

Physiology

Enterobecteriaceae

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Ans: a (Salmonella typhimurium) Ref: Ananathanarayan,7th ed, p. 303Of the above given, S. typhimurium causes food poisoningSalmonella gastroenteritisS. typhimurium is the most common cause of food poisoning due to salmonella species.Incubation period--6-24 hrsFood poisoning is never caused by S. typhi. Source of transmission: poultry, meat, milk and milk products.C/F-nausea, vomiting, diarrhoea, abdominal cramps, fever.Blood culture is usually negativeNoteS. aureus is the most common cause of food poisoning in the westIP and clinical features of various bacteria causing food poisoiningIncubation period Organism responsible 1- hrs S. aureus-nausea, vomiting, diarrheaB. cereus-nausea, vomiting 8-16 hrs C. perfringes-abdominal cramps, diarrhoea (vomiting rare)B. cereus-abdominal cramps, diarrhoea, vomiting > 16 hrs Vibrio cholera-watery diarrhoeaETEC-watery diarrhoeaEHEC-bloody diarrhoeaSalmonella species-inflammatory diarrhoeaCamphylobacter jej uni-inflammatory diarrhoeaShigella species- dysentryV. parahaemolyticus-dysentry

Microbiology

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Ans. is 'd' i.e., Endothelium The most acceptable hypothesis for the pathogenesis of atherosclerosis is "the response to injury hypothesis". According to this hypothesis, atherosclerosis is a chronic inflammatory response of the aerial wall initiated by injury to endothelium. Pathogenesis of atherosclerosis Following stages occurs in the pathogenesis of Atherosclerosis: Endothelial injury Earliest stages of the development of atherosclerosis are mediated by the inflammatory cascade. Inflammation mediated injury to endothelium is the cornestone in the development of atherosclerosis. After injury, endothelium is activated and there is increased expression of adhesion molecule-VCAM-1 and there is increased permeability to endothelium. TNF is the major cytokine to induce this expression. Migration of leukocytes When VCAM-1 is expressed on endothelium, leukocytes adhere to the endothelium. Leukocytes than cross the endothelial barrier and begin to accumulate in subendothelial intimal space. Macrophages engulf LDL cholesterol and form foam cells - formation of earliest lesion, i.e. fatty streak. Macrophages also form oxygen free radicals that cause oxidation of LDL to yield oxidized LDL (modified LDL). Smooth muscle cell migration and proliferation Inflammatory cells in subendothelial intimal space secrete cytokines, mainly PDGF, TGF-ct and FGF which cause migration of smooth muscle cells from media to subendothelial intimal space as well as their proliferation. Maturation of plaque Smooth muscle cells synthesize extracellular matrix (especially collegen) and conve a fatty streak into a mature fibrofatty atheroma, and contribute to the progressive growth of atherosclerotic lesions.

Pathology

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Monocyte is considered as the second line of defence.   Phagocytosis by Macrophages. Macrophages are the end-stage product of monocytes that enter the tissues from the blood. When activated by the immune system, they are much more powerful phagocytes than neutrophils, often capable of phagocytizing as many as 100 bacteria. They also have the ability to engulf much larger particles, even whole RBCs or, occasionally, malarial parasites, whereas neutrophils are not capable of phagocytizing particles much larger than bacteria. Also, after digesting particles, macrophages can extrude the residual products and often survive and function for many more months. Reference: GUYTON AND HALL TEXTBOOK OF MEDICAL PHYSIOLOGY, THIRTEENTH EDITION(INTERNATIONAL EDITION ) page no 458

Physiology

Psychiatric Illness

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Lithium Use : Prophylaxis of mania alone, with sedatives in acute mania. Monitoring of S. concentration is significant to know the toxicity of drug S/E of Lithium Lithium use for a long time causes benign and reversible T-wave flattening Seizures Polyuria and compensatory polydipsia Dermatitis, folliculitis, vasculitis Weight gain

Pharmacology

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Pulse oxymetry- Based on Beer Lambert law Utilization of a probe that transmits red (640 mm) and infrared light Photo detector as a receptor site Different absorption ability of light by oxygenated and deoxygenated haemoglobin leads to changes in the amount of light differently absorbed by the vascular bed before reaching the photo detector.

Dental

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Surgery

All India exam

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Causes of congenital blindness:ToxoplasmosisCongenital cataractsGenetic diseaseCongenital rubellaCongenital glaucomaUsher syndrome(Refer: Nelson's Textbook of Pediatrics, SAE, 1st edition, pg no. 318 - 319)

Pediatrics

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"In epidemic dropsy, glaucoma is wide angle glaucoma, with normal chamber and angle. Outflow is within normal limits. The queous shows raised level of histamin, prostaglandin and protein suggesting that glaucoma is hypersecretory". _ Mukherjee

Ophthalmology

Myasthenia Gravis and Muscular dystrophy

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Facial muscle involvement is not seen with Becker and Limb-girdle muscular dystrophy Emery Dreifuss and Becker are XLR disease so can't be present in a girl child. Hence by exclusion the diagnosis is Dx: Scapulo-Faciohumeraldystrophy. Facio-Scapulo-humeral dystrophy Autosomal dominant inheritance and has an onset in childhood or young adulthood. Facial weakness is the initial manifestation-->inability to smile, whistle or fully close the eyes. Weakness of the shoulder girdles-->makes arm elevation difficult. Scapular winging becomes apparent with attempts at abduction and forward movement of the arms. The serum CK level may be normal or mildly elevated. No specific treatment is available, ankle-foot ohoses are helpful for foot-drop.

Medicine

Anatomy

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Ans. b (normal rye medium will permit wavelength of 400- 700 ntn) Ref: yanoff 3rd ed p 383, internet sitesCornea and lens act as special filters absorbing the more energetic wavelength of the electromagnetic spectrum that can damage the retina. Cornea absorbs wavelength below 295nm where as lens absorbs strongly in the long U V B (300 - 315) and most of the UV A (315 - 400) wave-lengths. Eye light transmittance is relatively high in the 400nm-700nm range.

Ophthalmology

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Extensor digitorum Hybrid muscles are the muscles having more than one nerve supply Pctoralis major: lateral & medial pectoral nerves Brachialis: additional proprioceptive fibres from radial nerve, in addition to its muscular nerve, musculocutaneous nerve. Extensor digitorum is supplied by the posterior interosseous nerve only.

Surgery

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D i.e. All

Surgery

Respiratory System

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Ans: a (Intrapleural) Ref: Ganong,22nd ed,p. 6651The main pressure in lung related to inspiration is intrapleural pressure.Intrapleural pressure.The pressure in the intrapleural space between the lungs and chest wall is intrapleural pressure.Intrapleural pressure changes from -2.5 to -6 mmHg during inspiration. During strong inspiratory effort it may reach up to -30 mmHg.Transpulmonary pressureIt is the difference between alveolar pressure and intrapleural pressure. It is the measure of elastic forces in the lungs.Alveolar pressure or intrapulmonary pressureIt is the pressure inside the lung alveoli. When no air flows the alveolar pressure is considered to be equal to the atmospheric pressure, i.e., 0 cm of water.During inspiration it decreases to -1 cm of water.During expiration it increases to+1 cm of water.

Physiology

Biostatistics

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Ref:Parks 23rd edition pg 849. 1SD : confidence limit = 68% 2SD : confidence limit = 95% 3SD : confidence limit = 99.7%

Social & Preventive Medicine

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Ans. is 'b' i.e., EBV EBV encephalomyelitis shows :Abnormal white matter with perivascular infiltrates of inflammatory cells and foam cells.Some myelin is replaced by lipid-filled macrophages and hyperplastic astrocytes.

Microbiology

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Surgery

Acute coronary syndrome

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Option C = Rescue P.C.I. After thrombolysis ST Elevation begin to reduce If ST Elevation persisting in spite of thrombolysis. So it's failure of thrombolysis | within 90 minutes Rescue PCI Types of PCI Primary PCI done for STEMI (Door to device time < 90 minutes). Delayed PCI done for Unstable Angina NSTEMI Rescue PCI Failure of thrombolysis (within 90 minutes).

Medicine

General physiology

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Fever right shifts the oxygen dissociation curve, which allows for a greater release of oxygen to the tissue, making oxygen easily available to neutrophils and monocytes for use in the oxygen-dependent myeloperoxidase system of bactericidal killing. Having more oxygen available to tissue also enhances wound healing. In addition, fever interferes with bacterial and viral replication by providing a hostile environment for incubation. Fever is produced by the release of interleukin-I from macrophages. Interleukin-I, in turn, stimulates the hypothalamus to synthesize prostaglandins, which interact with the thermoregulatory center to produce fever.

Physiology

Injuries

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Ans. is 'b' i.e., Uterus Order of putrefactiono Order of appearance of putrefaction from earliest to last is : larynx, trachea > stomach, intestine > spleen, liver > brain, lungs > heart > kidney, bladder > uterus/prostate > bone.o Amongst the soft tissues uterus in female and prostate in malesm are last to undergo putrefaction, as uterus and prostate resist putrefaction. Otherwise bones are last to undergo putrefaction, overall.

Forensic Medicine

Respiration

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Ans. (d) Congenital cystic adenomatoid malformation(Ref: Robbins 9th/pg 670; 8th/pg 679)Congenital cystic adenomatoid malformation (CCAM): Hamartomatous Q or dysplastic lung tissue, usually confined to one lobe.

Pathology

Bacteria

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ANSWER: (C) CSF examinationREF: Harrison 17th ed chapter 376The diagnosis of bacterial meningitis is made by examination of the CSF. The need to obtain neuroimaging studies (CT or MRI) prior to LP requires clinical judgment.A broad-range PCR can detect small numbers of viable and nonviable organisms in CSF and is expected to be useful for making a diagnosis of bacterial meningitis in patients who have been pretreated with oral or parenteral antibiotics and in whom Gram's stain and CSF culture are negative

Microbiology

Abdominal Radiography

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Ans: D (Kawasaki disease) Ref: Manual of Emergency Critical Care Ultrasound Vicke E Noble. 2nd ed. Pg 156Explanation:Kawasaki disease is associated with hydrops of gallbladder.Gallbladder Wall Thickening A gallbladder wall that is thickened is a sign of inflammation. This is a non-specific finding, and many other pathologic processes, as well as a postprandial gallbladder, can give you falsely elevated measurements.It is important to measure the wall of the anterior gallbladder surface because of the acoustic enhancement artifact mentioned.Because sound waves travel through a fluid-filled structure, no attenuation occurs. Thus, when those sound weaves hit the back of the gallbladder, they will be so strong that they will obscure an accurate picture of the wall thickness.For gallbladder wall thickness, greater than 3 mm is abnormal.Differential for Thickened Gallbladder WallPostprandialRenal failureAscitesHepatitisHypoalbuminemiaHIV/AIDSAdenomyomatosisMultiple myelomaCholecystitisCongestive heart failure

Radiology

Assessment of Vestibular Function

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Ans. is 'b' i.e., Opposite side [Ref: Dhingra 5th/e p. 48}o Each ear is irrigated twice : once with cold water (70C below the body temperature, i. e. 300C) and then with warm water (70C above the body temperature, i.e. 440C).o Cold water provokes nystagmus towards the opposite ear, while warm water provokes nystagmus towardssame ear (COWS Cold - oppsite, Warm - same).

ENT

Communicable diseases

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Incidence of TB infection (Annual infection rate, Annual risk of Infection ARI) : Percentage of population under study who will be newly infected (not diseased or cases) with TB among Non-infected in 1 year. Expresses attacking force of TB in community In developing countries 1% ARI corresponds to: 50 SS +ve cases per 100,000 general population Tuberculin conversion index is the "best indicator for evaluation of TB problem and its trend" in the community. Current ARI in India : 1.5% Ref: Park 25th edition Pgno : 190-191

Social & Preventive Medicine

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The history and findings are consistent with a lobar pneumonia. The most common etiologic agent of lobar pneumonia is Streptococcus pneumoniae. ESSENTIALS OF DIAGNOSIS Productive cough, fever, rigors, dyspnea, early pleuritic chest pain Consolidating lobar pneumonia on chest radiograph Lancet-shaped gram-positive diplococci on Gram stain of sputum Ref: Papadakis MA, McPhee SJ, "Pneumonia, Pneumococcal." Quick Medical Diagnosis & Treatment

Microbiology

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A.i.e. Henosch Schonlein purpura

Skin

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Dental

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Ovulation occurs due to the effect of increased concentration of LH. In the pre-ovulatory phase of the menstrual cycle, the ovarian follicle will undergo a series of transformations called cumulus expansion, which is stimulated by FSH. This is followed by LH surge.

Physiology

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B. i.e. Frontoparietal sutureSkull sutures (except sphen-occipital), vomer- sphenoid rostrum schindylesisQ, inferior tibiofibular syndesmosis and dentoalveolar gomphosis (tooth socket) joints are fibrous joints. A Schindylesis is a specialized suture where a rigid bone fits into a groove on a neighbouring element eg a cleft between the alae of vomer, which receives the rostrum of the sphenoid. (i.e. vomer - sphenoidal rostrum junction)Q- Epiphyseo-diaphyseal growth plateQ, costochondral, 1st chondrosternal and sphenoocipital joints are synchondrosis/ syncendrosis or primary cailaginous joints; whereas, symphysis pubis, symphysis menti, sacrococcygeal, interveebral and manubriosternal jointsQ are symphyses or secondary cailaginous joints.Aicular cailage of most (not all) synol joints are lined by hyaline cailage Q. In some synol joints the cavity is paially or completely subdivided into two by an aicular disc, made up of fibrocailage eg. Temporomadibular jt, sternoclavicular jt, menisci of knee joint. More mobile the joint the more commonly it discloates eg shoulder jtQ. MCP Jt. is a condylar - synol joint

Anatomy

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The body is exhumed only when, there is written order from the executive magistrate.

Forensic Medicine

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Radiological signs: The lesion presents as a chance radiographic finding. It is a round or an ovoid (<3 cm) uniform radiolucency with a well-defined, usually corticated, margin. Stafne’s bone cavity is non-expansile and is found below the mandibular canal just anterior to the angle of the mandible. The location of Stafne’s bone cavity distinguishes it from odontogenic lesions, whose origin is within the alveolar bone.

Radiology