APPG 2011: QUESTIONS WITH EXPLANATIONS

Discussion in 'NEET 2013 All india Exam' started by Guest, Mar 14, 2011.

  1. Guest

    Guest Guest

    1)Scottish terrier sign is best seen in
    Lateral view,
    PA view ,
    AP View
    Oblique view

    Ans D
    Spondylolisthesis is defined as the anterior displacement of one vertebral body on another. Typically, the posterior portion of the arch, including the inferior facets, remains aligned with the sacrum, while the anterior portion of the vertebral body slips forward. If disruption of the interarticular portion of the vertebral arch occurs without anterior displacement of the vertebral body, it is termed spondylolysis. Spondylolisthesis occurs with a prevalence of 5% in the general population, and is equally distributed between the sexes.

    friend to make it better and easy...i hav toiled to make this effort..pls add answered the left out unanswered and controversial questions with explanations or references.

    please do not add questions which are already in this post so that it reduces the confusion.


    Spondylolisthesis is graded based on the degree of anterior displacement of the upper vertebra relative to the lower:
    Grade 1: <25% displacement
    Grade 11: 25-50% displacement
    Grade 111: 50-75% displacement
    Grade 1V: >75% displacement


    Spondylolisthesis is also divided into five etiologic classifications:

    Type I: Dysplastic- congenital abnormality of the upper or lower sacral facets that allows slipping of L5 on S1. No pars interarticularis defect is present.
    Type II: Isthmic- bilateral defect in the pars interarticularis allows slipping of L5 on S1. This type is typical of pars interarticularis fractures.
    Type III: Degenerative- typically occurs in patients >50 yo with degenerative changes in the facet joints.
    Type IV: Traumatic- occurs with posterior vertebral fracture at a site other than the pars interarticularis.
    Type V: Pathological- occurs secondary to localized or generalized bone disease.


    For radiographic examination of spondylolisthesis, the views of choice include lateral and oblique radiographs of the lumbar spine. The normal oblique view of the LS spine shows a "Scotty Dog" shape


    2) Hemochromotosis gene- HFE gene…answer
    Human hemochromatosis protein also known as the HFE protein is a protein which in humans is encoded by the HFE gene. The HFE gene is located on short arm of chromosome 6 at location 6p21.3. Unusually, the official gene symbol (HFE for High Iron Fe) is not an abbreviation of the official name (hemochromatosis).[1]

    3) To do endoscopic Dacryocystorhinostomy , anaesthesia used is ?
    Nasociliary block
    Frontal block
    Local anesthesia
    Ans C
    Anesthesia used: 4% xylocaine mixed with 1 in 10,000 adrenaline for topical anesthesia. Cotton pledgets dipped in this solution is used to pack the nasal cavity. Before attempting to pack the nose the cotton pledgets must be squeezed dry of xylocaine solution to avoid xylocaine overdosage and toxicity. It is safe to use only 7 ml of 4% xylocaine for topical nasal packing. Three pledgets are used for packing. One each is placed inside each meatus. The packing must be left in place for atleast 15 minutes for optimal effec t.


    4) Eculizumab used in paroxysmal nocturnal hemoglobinuria

    Eculizumab belongs to a class of medications called monoclonal antibodies and treats a type of blood disease called paroxysmal nocturnal hemoglobinuria (PNH).
    Eculizumab blocks substances in the blood, called complements, and reduces the premature breakdown of red blood cells, called hemolysis. By minimizing hemolysis, eculizumab treats many of the underlying complications associated PNH.

    5) danazol side effects all except
    vaginal dryness
    acne
    hirsutism
    gynaecomastia
    ANS D

    Side-effects
    Androgenic side effects are of concern, because in sensitive female patients, danazol can enhance unwanted hair growth, leading to hirsutism. On rare occasion, it can deepen the voice. Other possible side effects include acne and oily skin. Because danazol is metabolized by the liver, it cannot be used by patients with liver disease, and in patients receiving long-term therapy, liver function must be monitored on a periodic basis. Some patients who use danazol experience weight gain and fluid retention. Due to these limitations, danazol is seldom prescribed continuously beyond six months.
    The use of danazol for endometriosis has been linked to an increased risk of ovarian cancer.[6] Patients with endometriosis have specific risk factors for ovarian cancer so this may not apply for other uses.
    Danazol has, like most other androgenic agents, been linked with an increased risk of liver tumors. These are generally benign.[7]
    Unlike GnRH agonists, danazol does not induce osteoporosis. Also, symptoms of hot flushes tend to be less common or severe.
    Danazol is used for treatment for gynecomastia.

    6) aplastic crisis caused by
    cmv
    coxsakie
    parvo b19
    ANS C

    In patients with hemolytic anemia, parvovirus B19 supresses bone marrow erythropoietic activity, leading to transient aplastic crisis


    7 } B/L acral, target like lesions - erythema multiforme

    Erythema multiforme (EM) was initially described in 1866 by Ferdinand von Hebra as an acute self-limited skin disease, symmetrically distributed on the extremities with typical and often recurrent concentric "target" lesions (see the first image below). Lesions may also appear as arcuate lesions (see second image below). The term EM minor was proposed later to differentiate the mild cutaneous syndrome from the more severe form, EM major, which involves several mucous membranes


    8) highest produced placental hormone
    estradiol
    progesteron
    hcg
    hpl

    READ THE BELOW LINES FROM WILLIAMS OBSTETRICS 22ND EDITION :

    There are five genes in the growth hormone–placental lactogen gene cluster that are linked and located on chromosome 17. Two of these genes, hPL2 and hPL3, both encode hPL, and the amount of mRNA in the term placenta is similar for each. In contrast, the prolactin gene is located on chromosome 6 (Owerbach and colleagues, 1980, 1981). The production rate of hPL near term, about 1 g/day, is the greatest, by far, of any known hormone in humans.

    9) Ocular cicatrial pemphigoid not true ??

    occurs in young females
    leads to cicatrical synblepharon
    tear drops used
    distribution differs with geography and race …………answer…

    Distribution appears to be worldwide. No geographical predilection is reported.
    OCP can occur in all races.


    10)morbidly adherent placenta is due to lack of

    Nitabauchs fibrinoid layer Decidua basalis

    Placenta accreta is a life-threatening condition characterized by placental
    villi being abnormally adherent to the myometrium due to the absence of, or defects in, the normal decidual basalis and the fibrinous Nitabuch layer .


    11)kehr sign is
    pain in left shoulder ..answer
    pain in right shoulder
    pain legs

    Kehr's sign is the occurrence of acute pain in the tip of the shoulder due to the presence of blood or other irritants in the peritoneal cavity when a person is lying down and the legs are elevated. Kehr's sign in the left shoulder is considered a classical symptom of a ruptured spleen.[1] May result from diaphragmatic or peridiaphragmatic lesions, renal calculi, splenic injury or ectopic pregnancy.
    Kehr's sign is a classical example of referred pain: irritation of the diaphragm is signalled by the phrenic nerve as pain in the area above the collarbone. This is because the supraclavicular nerves have the same cervical nerves origin as the phrenic nerve, C3 and C4.
    The discovery of this is often attributed to a German gall bladder surgeon named Hans Kehr, but extensive studies into research he conducted during his life shows inconclusive evidence as to whether or not he actually discovered it.[2]

    12)Epulis arises from-gingiva…answer

    The word, "epulis", can be used to describe any gingival tumor…


    13)mucocoele of GB-cholecyetectomy is treatment of choice

    Treatment
    Medical Therapy
    Do not consider a medical line of management with oral dissolution therapy in obstructed gallbladders. In acalculous hydrops observed in children as a part of a wider spectrum, expectant management may be considered.
    Surgical Therapy
    Cholecystectomy is the definitive treatment for an obstructed gallbladder. Laparoscopic cholecystectomy is the criterion standard procedure.11,12,13 (A 2009 study derived from database information and a literature review found evidence that even when gallstones are absent in patients with RUQ pain and a positive HIDA scan, symptom relief is more likely to occur following cholecystectomy than it is after medical treatment.14 )

    Open cholecystectomy may be performed in patients with a very large gallbladder, with greatly thickened gallbladder walls, and with an obliterated Calot triangle, in whom laparoscopic dissection could be difficult and time-consuming.
    In some patients, percutaneous (ultrasonographically guided) or open cholecystostomy may be used as a temporary measure; cholecystostomy is usually performed in patients who are very sick or when the dissection is technically very difficult. A subsequent completion cholecystectomy may be carried out once the initial condition improves.

    14)saints triad all except renal stones….. answer
    Saint's triad is a medical term used to describe the concurrence of the following:
    1. Cholelithiasis
    2. Hiatal Hernia
    3. Diverticular Disease

    15)splenic vein thrombosis …treatment of choice is splenectomy
    The treatment of ISVT is conservative, given the low risk of associated gastric variceal bleeding.
    Once there is an index episode of
    gastrointestinal bleeding, splenectomy is the treatment of choice.


    16)adequate colposcopy…visualization of squamocolumnar jn …answer..
    The ability to see the transformation zone and the entire extent of any lesion visualized determines whether an adequate colposcopic examination is attainable.

    17)lethal dose of krait venom -6mg


    18)hbf composition-alpha2 gaama 2
    fetal hemoglobin is composed of two alpha and two gamma subunits, commonly denoted as α2γ2

    19)hallwerdenspatz disease…its iron storage disorder in brain

    HALLERVORDEN-SPATZ DISEASE: (PANTOTHENATE KINASE-ASSOCIATED NEURODEGENERATION)
    Hallervorden-Spatz disease (HSD) is a rare disorder characterized by progressive extrapyramidal dysfunction and dementia. Onset is most commonly in late childhood or early adolescence.
    Abnormal peroxidation of lipofuscin to neuromelanin and deficient cysteine dioxygenase lead to abnormal iron accumulation in the brain.

    20)apt test…detect blood in stools

    Finally, the Apt test can be used after birth (postpartum hemorrhage) if the newborn has bloody vomiting, bloody stool, or active bleeding from the nasogastric tube. A positive apt test would mean that the blood is either due to gastrointestinal or pulmonary bleeding from the neonate. A negative Apt test would indicate that the blood is of maternal origin, suggesting that the neonate swallowed or aspirated maternal blood, either during delivery or during breastfeeding (e.g., from breast fissures).

    21)emergency contraception mechanism all except?
    1 inhibiting ovulation
    2 prev of implantation
    3interreference in early pregnancy
    4 inhibiting fertilization
    answer D

    Emergency contraceptive pills (ECPs)—sometimes simply referred to as emergency contraceptives (ECs) or the "morning-after pill"—are drugs that act both to prevent ovulation or fertilization (contraceptive) and possibly post-fertilization implantation of a blastocyst (contragestive).[1] ECPs are distinct from medical abortion methods that act after implantation.


    22)absolute indication for tonsillectomy – 5yr child with OSA
    • Absolute indications
    o Enlarged tonsils that cause upper airway obstruction, severe dysphagia, sleep disorders, or cardiopulmonary complications
    o Peritonsillar abscess that is unresponsive to medical management and drainage documented by surgeon, unless surgery is performed during acute stage
    o Tonsillitis resulting in febrile convulsions
    o Tonsils requiring biopsy to define tissue pathology
    • Relative indications
    o Three or more tonsil infections per year despite adequate medical therapy
    o Persistent foul taste or breath due to chronic tonsillitis that is not responsive to medical therapy
    o Chronic or recurrent tonsillitis in a streptococcal carrier not responding to beta-lactamase-resistant antibiotics
    o Unilateral tonsil hypertrophy that is presumed to be neoplastic

    23) Not a demyleinating disorder??
    GPI
    MLD
    SSPE ,PMLE
    ANS. A
    general paresis is due do parenchymatous inflammation..

    24)mechanism of injury in anterior dislocation of shoulder
    1 internal rotation adduction
    2 internal rotation in extension
    3 abduction external rotation
    ANS 3

    Mechanism
    Anterior dislocation is caused by a combination of abduction, extension, and external rotation forces. Due to this force is indirectly transferred to the anterior capsule and ligament resulting in dislocation. Trauma is the most common cause of anterior dislocation.

    25)diagnostic test of carpal tunnel syndrome…nerve conduction velocity

    Carpal tunnel syndrome is most accurately diagnosed using the patients' descriptions of symptoms, and electrodiagnostic tests that measure nerve conduction through the hand. If electrodiagnostic testing is not available, symptom descriptions and a series of physical tests are useful.

    26)soft lens true is???????

    for astigmatism
    made up PMMA
    high water content
    do not tear

    ANS C

    27)which is not a quadrant of tympanic membrane… posterior anterior… answer

    28)Chlamydia not true ??
    divides by binary fission
    has DNA only …..answer….
    freely filterable
    Chlamydia has both dna and rna..

    29)min amt of blood to cause melena
    10
    40
    60ml
    Answer 60ml ..previous repeat

    30)NRHM ans year 2005..answer

    31)ESSURA..hysterscopic micro inserts…answer
    Essure is a permanent birth control device that has recently become available as an alternative to traditional tubal ligation methods. The spring-like device is inserted through the uterine cavity into the tubal openings using a hysteroscope. This can be done as an in-office procedure. The device expands to fill the tubal opening and then becomes scarred into place, forming a barrier so that sperm cannot reach the egg. Because of the scar formation, it cannot be pulled out of the tube. It is advertised by the manufacturer as a permanent method of birth control. In this respect, it is similar to other tubal ligation methods that are considered by most doctors to be permanent.

    32)Not a radiological involvement in sarcoidosis?
    Milliary mottling
    Egg shell calcification
    Enlarged b/l lymphadenopathy
    Pleural involvement
    Ans D Pleural involvement >a

    33)chlorination in of well in rainy season.......?
    once daily
    once weekly
    twice weekly
    once monthly

    usually its done 2-3 times a week and during cholera epidemics daily..dont know what the examiner means.

    34)pepsin gets inactivated at ph of?
    4.5 answer.

    Pepsin can be inhibited in two ways. The first method is introducing a pepsin inhibitor compound, and the second method is decreasing the acidity level to which the pepsin becomes inactive. This is usually around a pH of 4-5.

    35)crypta magna seen in palatine tonsils.

    36)large breast seen in all except ?

    large fibroadenoma
    schirrous ca
    filariasis breast
    Ans – Schirrous carcinoma

    37)which is not safety system ?
    1 pin index
    2 link25 system
    3Minimal mandatory airflow?? 4Air flow meter
    answer.D???.

    38)pulmonary hypertention… BMPR2 gene answer

    39)medullary thyroid carcinoma treatment of choise is..total thyroidectomy..answer
    •
    Surgical treatment goals of medullary thyroid carcinoma (MTC) are as follows:
    o Provide local control of the cancer.
    o Maintain laryngoesophageal function (speech and swallowing).
    o Tailor surgical treatment according to the type of MTC presentation (ie, sporadic, familial).
    • Sporadic MTC occurring in patients presenting with a palpable thyroid nodule verified by fine-needle aspiration is treated as follows:
    o Perform a total thyroidectomy and central neck dissection for cases of symptomatic (clinically detected) MTC.
    o For patients with microscopic involvement of regional lymph nodes, advocate a central neck dissection, which involves complete dissection of structures and removal of node-bearing tissue between the hyoid bone and innominate vessels, sternothyroid resection, removal of paratracheal lymph nodes, and possible thymectomy.
    o Autograft an inferior parathyroid gland that is histologically confirmed as cancer-free into the sternocleidomastoid or forearm muscle.

    40)not a test of ovulation test ?
    21 day progestron
    3 day progestron
    transvaginal us g
    21 day estrogen
    answer..D

    41)abacept used in rx of rheumatoid arthritis..answer

    Abatacept is currently approved for use in rheumatoid arthritis patients who have had an inadequate response to one or more DMARDs.[3] It is useful in delaying the progression of structural damage and reducing symptoms of rheumatoid arthritis

    42)enfuvirtide is a fusion inhibitor..answer

    Enfuvirtide (INN) is an HIV fusion inhibitor, the first of a novel class of antiretroviral drugs used in combination therapy for the treatment of HIV-1 infection. It is marketed under the trade name Fuzeon (Roche)

    43)drugs not used for menopausal flushing..SERM .

    SERMs are a category of drugs that act selectively as agonists or antagonists on the estrogen receptors throughout the body. Tamoxifen, a drug used in the treatment of some types of breast cancerand which can cause hot flashes as a side effect.

    44)Not a branch of celiac trunk-superior mesenteric artery .

    the superior mesenteric artery (SMA) arises from the anterior surface of the abdominal aorta, just inferior to the origin of the celiac trunk, and supplies the intestine from the lower part of the duodenum through two-thirds of the transverse colon, as well as the pancreas.

    45)not a part of basal ganglion..thalamus…answer
    .
    The main components of the basal ganglia are the striatum (also called neostriatum) composed of caudate and putamen, globus pallidus or pallidum composed of globus pallidus externa (GPe) or globus pallidus interna (GPi), substantia nigra composed of both substantia nigra pars compacta (SNc) & substantia nigra pars reticulata (SNr), and the subthalamic nucleus (STN)

    y not claustrum…?? bcz The claustrum, which is suspected to be present in all mammals, is a fairly thin (fraction of 1 mm to multiple mms) vertical curved sheet of subcortical gray matter oriented sagittally between the white matter tracts of the external capsule and extreme capsule. The Claustrum is lateral to the putamen and medial to the insular cortex and is considered by some sources to be part of the basal ganglia

    46)miliary tuberculosis in children spread thru

    lympho hematogenous ….answer..
    bronchogenic
    rupture of cavity

    Disseminated tuberculosis (TB)(milliary tb) is a contagious bacterial infection that has spread from the lungs to other parts of the body through the blood or lymph system

    47)rotator cuff muscles a/e
    deltoid
    supraspinatus
    infra spinatus
    teres minor
    ANS A

    Muscle Origin on scapula Attachment on humerus Function Innervation
    Supraspinatus muscle
    supraspinous fossa
    superior and middle facet of the greater tuberosity
    abducts the arm

    Suprascapular nerve (C5)
    Infraspinatus muscle
    infraspinous fossa
    posterior facet of the greater tuberosity
    externally rotates the arm Suprascapular nerve (C5-C6)

    Teres minor muscle
    middle half of lateral border
    inferior facet of the greater tuberosity
    externally rotates the arm Axillary nerve (C5)

    Subscapularis muscle
    subscapular fossa
    lesser tuberosity (60%) or humeral neck (40%)
    internally rotates the humerus
    Upper and Lower subscapular nerve (C5-C6)

    48)roll back malaria..answer all

    Three Components of the Global Strategy: Control, Elimination and Research
    The Global Strategy consists of three components (Figure II.1) that will ensure these ambitious goals can be achieved: 1) Controlling malaria, 2) Eliminating malaria and 3) Research into new tools and approaches.
    1. Control. The majority of malaria-endemic countries can make a substantial impact on their malaria burden by controlling it with existing tools. By first scaling up appropriate interventions for all populations at risk and then sustaining control over time, malaria will cease to be a major source of deaths world-wide.
    2. Elimination. Reducing to zero all locally-acquired infections within a country will bring the world closer to the ambitious goal of global eradication. Some countries are currently engaging in elimination and more will transition to elimination after achieving control provided there is strong rationale for this move. In high transmission settings, complete interruption of malaria transmission will require additional, new control tools.
    3. Research. Malaria control and elimination efforts will require continued research to be successful. International research is needed to create new tools, as well as inform policy and improve operational implementation of strategies. Then, national and local health systems must focus on how to use the tools and sustain the gain


    49)true about cochlear implants…not contraindicated in cochlear malformation..answer

    Contraindications
    Contraindications to cochlear implantation may include deafness due to lesions of the eighth cranial nerve or brain stem. In addition, chronic infections of the middle ear and mastoid cavity or tympanic membrane perforation can be contraindications. The absence of cochlear development as demonstrated on CT scans remains an absolute contraindication. Certain medical conditions that preclude cochlear implant surgery (eg, specific hematologic, pulmonary, and cardiac conditions) also may be contraindications. The lack of realistic expectations regarding the benefits of cochlear implantation and/or a lack of strong desire to develop enhanced oral communication skills poses a strong contraindication for implant surgery


    50)A man with monoclonal gammmopathy plasma cells 10-30 percent, no symptoms, esr lymphoplasmacytic lymphoma
    Smoldering myeloma vs Monoclonal gammopathy of undetermined significance (MGUS):
    In mgus
    1. Serum paraprotein <30 g/L AND
    2. Clonal plasma cells <10% on bone marrow biopsy AND
    3. NO myeloma-related organ or tissue impairment
  2. Guest

    Guest Guest

    A panel consists of a small group of six or eight persons

    who carry on a guided and informal discussion before an audience as if the panel were meeting alone. The proceedings of the panel should be the same as those described for informal discussion: volunteering of facts, asking questions, stating opinions-all expressed with geniality, with respect for the contributions of other members, without speech making, and without making invidious personal references. This primary function should occupy approximately two-thirds of the allotted time-say forty minutes of an hour’s meeting. The secondary function of the panel is to answer questions from the audience. This discussion method is suitable for use when a relatively large audience is anticipated. The disadvantage of the method is that it confines most of the discussion to the panel itself. The audience listens and is given a chance to ask questions, but for the most part is passive and receptive.
    Panel discussions, if well conducted, are usually more interesting to the audience than is the single-speaker forum. They provide sufficiently varied clash of opinion and presentation of facts to give even the quiet members of the audience a feeling of vicarious participation.
    Quality and tasks of leadership in panel discussion are similar to those described for informal discussion. The leader must in addition take special care to select panel members who can think and speak effectively. He must also be sure that they prepare themselves to discuss the subject. During the discussion by the panel the leader has substantially the same duties as in informal discussion except that he should keep himself more in the background as chairman of the panel. He can do so because each member of the panel is in reality an assistant to the leader and is responsible for specific contributions to the proceedings.

    52)acute epiglottitis …thumb sign on lateral view..answer..

    53)which of the following not found in greater wing
    foramin ovale
    formin spinosum
    foramuin rotundum
    optic canal
    answer…. D

    The superior or cerebral surface of each greater wing forms part of the middle cranial fossa; it is deeply concave, and presents depressions for the convolutions of the temporal lobe of the brain. It has a number of foramina (holes) in it:
     The foramen rotundum is a circular aperture at its anterior and medial part; it transmits the maxillary nerve.
     The foramen ovale is behind and lateral to this; it transmits the mandibular nerve, the accessory meningeal artery, and sometimes the lesser petrosal nerve.
     The sphenoidal emissary foramen is occasionally present; it is a small aperture medial to the foramen ovale, opposite the root of the pterygoid process; it opens below near the scaphoid fossa, and transmits a small vein from the cavernous sinus.
     The foramen spinosum, in the posterior angle near to and in front of the spine; it is a short canal which transmits the middle meningeal vessels and a recurrent branch from the mandibular nerve.
    Lateral surface
    The lateral surface [Fig. 2] is convex, and divided by a transverse ridge, the infratemporal crest, into two portions.
     The superior temporal surface, convex from above downward, concave from before backward, forms a part of the temporal fossa, and gives attachment to the temporalis;
     the inferior infratemporal surface, smaller in size and concave, enters into the formation of the infratemporal fossa, and, together with the infratemporal crest, serves as an attachment to the lateral pterygoid muscle.
    It is pierced by the foramen ovale and foramen spinosum, and at its posterior part is the sphenoidal spine, which is frequently grooved on its medial surface for the chorda tympani nerve.
    To the sphenoidal spine are attached the sphenomandibular ligament and the tensor veli palatini muscle.
    Medial to the anterior extremity of the infratemporal crest is a triangular process which serves to increase the attachment of the lateral pterygoid muscle; extending downward and medialward from this process on to the front part of the lateral pterygoid plate is a ridge which forms the anterior limit of the infratemporal surface, and, in the articulated skull, the posterior boundary of the pterygomaxillary fissure.
    Orbital surface
    The orbital surface of the great wing [Fig. 2], smooth, and quadrilateral in shape, is directed forward and medially and forms the posterior part of the lateral wall of the orbit.
     Its upper serrated edge articulates with the orbital plate of the frontal bone.
     Its inferior rounded border forms the postero-lateral boundary of the inferior orbital fissure.
     Its medial sharp margin forms the lower boundary of the superior orbital fissure and has projecting from about its center a little tubercle which gives attachment to the inferior head of the lateral rectusmuscle; at the upper part of this margin is a notch for the transmission of a recurrent branch of the lacrimal artery.
     Its lateral margin is serrated and articulates with the zygomatic bone.
     Below the medial end of the superior orbital fissure is a grooved surface, which forms the posterior wall of the pterygopalatine fossa, and is pierced by the foramen rotundum.


    54)Dacryocytes …tear drop cells,, ,answer….

    These abnormal erythrocytes have a teardrop, or pearlike, shape. They are associated with disorders with an abnormal spleen or bone marrow, such as idiopathic myelofibrosis, thalessemia, or myelophthisis.

    55)DOC in stress incontinence ..tolteridene…answer.

    MEDICATIONS
    Medicines tend to work better in patients with mild to moderate stress incontinence. There are several types of medications that may be used alone or in combination. They include:
    • Anticholinergic agents (oxybutynin, tolterodine, enablex, sanctura, vesicare, oxytrol)
    • Antimuscarinic drugs block bladder contractions (many doctors prescribe these types of drugs first)
    • Alpha-adrenergic agonist drugs, such as phenylpropanolamine and pseudoephedrine (common ingredients in over-the-counter cold medications), help increase sphincter strength and improve symptoms in many patients
    • Imipramine, a tricyclic antidepressant, works in a similar way to alpha-adrenergic drugs
    Estrogen therapy can be used to improve urinary frequency, urgency, and burning in postmenopausal women. It also can improve the tone and blood supply of the urethral sphincter muscles.
    However, whether estrogen treatment improves stress incontinence is controversial. Women with a history of breast or uterine cancer usually should NOT use estrogen therapy for the treatment of stress urinary incontinence.

    56)Paltauffs hemorrhages …lungs…answer

    *Paltauf’s hemorrhage
    Shining, pale bluish red and may be minute or 3-5 cm in diameter, subplerual hemorrhage seen due to alveolar rupture in drowning.

    57)Dry drowning…laryngeal spasm..answer..

    Dry drowning occurs when a person's lungs become unable to extract oxygen from the air, due primarily to:
     Muscular paralysis
     Puncture wound to the torso (affecting ability of diaphragm to create respiratory movement)
     Changes to the oxygen-absorbing tissues
     Persistence of laryngospasm when immersed in fluid
     Prolonged exposure to any gas that is not inherently toxic, but that displaces oxygen from the lungs. (e.g. methane)
     Overdose of free water (solute free) which leads to decreased sodium in the blood hyponatremia which leads to massive swelling in the brain.


    58)Not seen in lateral condylar fracture??malunion..answer..???

    59)Adduction type of hyoid#
    manual strangulation
    ligature strangulation
    bansdola
    hanging
    Ans A

    60) ITGCN predisposes TO
    spermatocytic seminoma
    Yolk sac tumour
    Endodermal tomour
    Embryonal cell ca
    answer..D

    ITGCNU is seen in the following settings:[3]
     Almost all invasive germ cell tumours of the testis in adults
     Fifty percent of patients with ITGCNU developed invasive germ cell tumours within five years of initial diagnosis.
     Five percent of contralateral testes in men with a history of prior testicular germ cell tumour.
     Less than five percent of cryptorchid testes.
     Less than one percent of patients with infertility.
    [edit]Germ cell tumors that do not arise from ITGCNU
    Not all germ cell tumors (GCTs) arise from intratubular germ cell neoplasia. The following testicular GCTs do not arise from ITGCN:
     Spermatocytic seminoma[5]
     Pediatric Yolk sac tumors (endodermal sinus tumour).[6] This is currently an area of controversy as some authors dispute the absence of ITGCN in these cases.[3]
     Teratoma (rare exceptions)[3


    61)world wide mc cause for contact dermatitis ??
    Nickel
    Chromium
    gold
    mercury
    Ans A

    62)Periungual telangiectasia not seen in??
    SLE
    Dematomyositis
    Scleroderma
    Mixed connectine tissue disorder
    answer..D

    Periungual telangiectasias are pathognomonic signs of the 3 major connective tissue diseases, ie, lupus erythematosus, scleroderma, and dermatomyositis.


    63)Trendenlenberg sign not seen in ????

    Perthes ds
    CDH
    Ununited # neck femur
    Tom smith arthritis sequelae

    64)Symmetric tonic reflex…not true…its abnormal and reflects CNS dysfunction…answer..

    a normal response in infants to assume the crawl position by extending the arms and bending the knees when the head and neck are extended. The reflex disappears when neurologic and muscular development allows independent limb movement for actual crawling. Also called crawling reflex. See also tonic neck reflex.

    65)Seligiline mechanism of action not true is??

    MAO-B inhibitor
    antioxidant property
    increase dopamine synthesis
    increase dopamine release
    answer....D

    Metabolites...
    1) Desmethylselegiline

    Desmethylselegiline may have neuroprotective antiapoptotic properties. A large multicenter study suggests a decrease in the disease progression of parkinsonism but may have reflected other symptomatic response.[16] Desmethylselegiline is metabolized by CYP2C19.[17]

    2) L-amphetamine and L-methamphetamine
    Selegiline is partly metabolized to l-methamphetamine, one of the two enantiomers of methamphetamine in vivo.[18] A characteristic metabolic pattern was noted, exemplified by a ratio of l-methamphetamine to l-amphetamine of about 2.8.[19] This stereoisomer is not considered psychoactive and has little abuse potential.[20]

    The stimulatory effect on locomotor activity and dopamine synthesis[/u} may be contributed to by the action of l-methamphetamine. If anyone is prescribed and takes selegiline, they can and will test positive for amphetamine/methamphetamine on most drug tests, however the prescription for selegiline would explain why they test positive for amphetamine/methamphetamine.

    Mechanism of Action
    Selegiline is a selective inhibitor of MAO-B; MAO-B metabolizes dopamine and phenylethylamine.[16] Selegiline exhibits little therapeutic benefit when used independently, but enhances and prolongs the anti-Parkinson effects of levodopa.

    66) Criminal negligence..304A …answer…

    67)All are used for skeletal traction except
    k wire
    steinmann pin
    danhams pin
    knowles pin
    answer…D ..it’s a intramedulary devise…


    68)sudden ophthalmoplegia in thai child eating raw fish n cooked rice-thiamine..answer..

    69)increased viscosity of blood causes increase in
    MAP
    diameter of resistance vessels
    diameter of capacitance vessels CVP

    70)Adult with U/L proptosis, illdefined lesion extending into orbit from eye ball???
    malignent melanoma
    choirdal hemangioma
    lymphoma Pseudo tumour

    71)baciillary angiomatosis not true??
    Caused by b.henslae
    Can cause peliosis heaptis
    Aminoglycosisdes used
    Brain is involved in AIDS pt.

    Ans C

    Bacillary angiomatosis: A bacterial infection due to a cat scratch most often seen today in people with HIV. The disease characteristically presents with swollen lymph nodes (lymphadenitis), sore throat, fatigue, and fever, chills, sweats, vomiting, loss of appetite, and weight loss. There is usually a little bump (a papule) which may be pus-filled (a pustule) at the site of the scratch. Then more nodules appear on and under the skin. As the number of nodules increases, patients get sicker.

    In normal people the disease is self-limited and usually goes away by itself in a few weeks. It can also be treated with antibiotics.

    In persons with HIV/AIDS the disease can cause severe inflammation of the brain, bone marrow, lymph nodes, lungs, spleen and liver. The disease can be fatal in persons with HIV. It can be easily treated with antibiotics such as erythromycin and doxycycline. Treatment is given until the skin lesions resolve, usually in 3 to 4 weeks.

    Bacillary angiomatosis is so characteristic today of AIDS that it is an AIDS defining disease, according to the CDC (Centers For Disease Control).

    The disease is caused by a bacterium called Rochalimaea henselae, which was reclassified as Bartonella henselae, named for Diane Hensel, a microbiologist. Bacillary angiomatosis has also been called cat scratch disease, cat scratch fever, regional lymphadenitis, and benign lymphoreticulosis.

    treatment erythromycin drug of choice.......


    72)Inverted - Y shaped sutures present
    ant adult n infantile
    ant infantile n foetal
    post adult n infantile
    post infantile n foetal
    ANS D

    Lens fibers continue to form from the cells at the equator so that several layers are produced. The new fibers extend anteriorly and posteriorly to join with other fibers in a linear fashion forming suture lines which take on an upright 'Y' appearance anteriorly and an inverted 'Y' appearance posteriorly. This is the appearance of the lens at birth.


    73)sniff test- ???bact vaginosis> trichomonas answer


    74)perichondritis of ear ----pseudomonas>s.aureus…answer…

    75)oval window opens into ------scala vestubuli…answer…

    76)nobel prize for work on vascular ligature and grafting of blood vessels and organs .. Alexis Carrel …answer..

    77)MC tumor of liver…..mets…

    78)Baby developed signs and symtoms of cong.syphilis after two ween..supported by??
    Kassowitz’s law
    Profeta law
    Colles law
    Didays law

    Ans c

    78)Diuretic with direct vasodilatory effect..indapamide..answer..

    79)Drug used to delay uterine contractions in labour …salbutamol..answer..

    80)Difference between vaginal cyst and cystocele… answer..vaginal cyst not reducible..ref shaw..prolapse dd..

    81) Mechanism of camp action on GIT causing diarrhea??
    Increased secretion of chlorides…answer..

    82)Not done in PMSTR

    knot release
    Deep deltoid lig release
    Achilles tendon release
    spring ligament release.
    Ans B
    Sequential Strategy for Release:
    - supine position;
    - posteromedial skin incision;
    - initial identification, mobilization, and protection of the neurovascular bundle;
    - release of plantar fascia inorder to adress forefoot equinus (first ray is now aligned with the talus);
    - the abductor hallucis is released inorder to optimize exposure of the medial structures;
    - distal tendon excision preferred;
    - superficial deltoid ligament is released but deep deltoid ligament is preserved;
    - identification and mobilization of the tibialis posterior, FDL, and FHL tendons w/ determination of excursions of each;
    - Z lengthening of contracted tendons w/ some excursion;
    - resection of tendons w/ no excursion
    - excision of tendon sheaths from above the medial malleolus thru the Knot of Henry;
    - excision of tissue filling the interval between the medial malleolus, tuberosity of the navicular, and sustentaculum tali;
    - medial and dorsal release of the talonavicular joint capsule;
    - the navicular is moved away from the medial malleolus and then realigned with the talus
    - tendon-achilles z-lengthening and posterior ankle joint capsular release to fibula and posterior deltoid ligament release;

    83)Not seen in HUS
    1)subnephrotic range protinuria
    2)hypofibrogenimia
    3)thrombocytopenia
    4)positive coombs test

    ans 4 coz HUS is mechanical hemolysis not immune

    84)Hyperchloremic acidosis seen with…uretero sigmoidostomy..answer..

    As well as this, the urine entering the colon can cause diarrhea and salt imbalance due to the sodium and chloride in the urine. Urea levels in the blood are higher due to urea crossing the colon wall. In the large intestine, sodium is swapped for potassium, and chloride for bicarbonate, this causes an acidosis and hypokalaemia. Many patients take sodium bicarbonate to combat this.

    85)regarding spingomylein?? Choline or amino cooh group not sure??

    86)starvation – alanine ANS

    When food intake ceases, the body enters the starvation response. Initially, the body's glycogen stores are used up in about 24 hours.[citation needed] The level of insulin in circulation is low and the level of glucagon is very high. The main means of energy production is lipolysis. Gluconeogenesis converts glycerol into glucose and the Cori cycle converts lactate into usable glucose. Two systems of energy enter the gluconeogenesis: proteolysis provides alanine and lactate produced from pyruvate, while acetyl CoA produces dissolved nutrients (Ketone bodies), which can be detected in urine and are used by the brain as a source of energy.

    87)2.5cms renal stone in child- pyelolithotomy answer

    The American Urological Association Stone Guidelines Panel has classified ESWL as a potential first-line treatment for ureteral and renal stones smaller than 2 cm.

    88)Rt pleural effusion - rt lateral decubitus best view …answer..

    89)Frozen section used in diagnosis of fat..answer..

    sually a lower temperature is required for fat or lipid rich tissue

    90)Mc side effect of pyrizinamide is arthritis/arthalgia…answer…


    91)acarbose MOA… inhibits alphaglucosidase …answer..

    Acarbose inhibits enzymes (glycoside hydrolases) needed to digest carbohydrates, to be specific, alpha-glucosidase enzymes in the brush border of the small intestines and pancreatic alpha-amylase. Pancreatic alpha-amylase hydrolyzes complex starches to oligosaccharides in the lumen of the small intestine, whereas the membrane-bound intestinal alpha-glucosidases hydrolyze oligosaccharides, trisaccharides, and disaccharides to glucose and othermonosaccharides in the small intestine. Inhibition of these enzyme systems reduces the rate of digestion of complex carbohydrates. Less glucose is absorbed because the carbohydrates are not broken down into glucose molecules. In diabetic patients, the short-term effect of these drugs therapies is to decrease current blood glucose levels; the long-term effect is a reduction in HbA1c level.[1] This reduction averages an absolute decrease of 0.7%, which is a decrease of about 10% in typical HbA1c values in diabetes studies.

    92)LCAT activator apo A????

    93)Drug causing HDL elevation…Nicotinic acid/niacin…answer..

    Causes of hyperalphalipoproteinemia (HALP) may be primary or acquired (secondary). Primary factors can include familial syndromes of elevated high-density lipoprotein (HDL) cholesterol levels, which in some cases may be associated with a decreased risk for coronary artery disease .
    • Primary causes
    o Familial HALP - Familial HALP includes CETP deficiency, familial hepatic lipase deficiency, and primary HALP. A selective up-regulation of apo A-I production is one metabolic cause of familial HALP and leads to high plasma concentrations of HDL cholesterol, apo A-I, and lipoprotein A-I. It possibly may also result in protection from atherosclerotic coronary heart disease (CHD).17,18Familial HALP can involve premature corneal opacity, reduced hepatic lipase activity, and reduced uptake of HDL by lymphocytes.
    o Primary HALP - This is a term used for familial elevated HDL cholesterol levels that are not due to CETP deficiency. Epidemiologic studies have suggested that this syndrome is associated with a decreased risk for coronary artery disease and with increased longevity.
    o CETP deficiency - This asymptomatic, hereditary syndrome is caused by low CETP levels. Decreased CETP activity slows the transport of cholesteryl esters from HDL to apo B–containing lipoproteins. The condition is frequently observed in Japanese Americans. Clinical features include marked elevations of plasma HDL cholesterol in homozygotes (usually >100 mg/dL) and probably lower rates of CHD. In heterozygotes, the HDL levels are only moderately elevated. CETP deficiency has not yet been demonstrated to be associated with a decreased risk for atherosclerotic cardiovascular disease, and some experts do not consider this condition protective against cardiovascular disease.19
    o LCAT overexpression - Rarely, HALP has been reported to be due to LCAT overexpression. The activity of LCAT is increased in blood plasma and is associated with high levels of HDL. Reduction in the fractional catabolic rate of HDL is considered to be the predominant mechanism by which LCAT overexpression modulates HDL concentrations. Such patients may have reduced risk of developing CHD.
    o Up-regulation of apo A-I production - Selective up-regulation of apo A-I production is another cause of familial HALP. Affected individuals have elevated HDL cholesterol and apo A-I levels. Additionally, many patients have a reduced risk of atherosclerotic CHD.
    • Secondary causes4,6
    o Vigorous and sustained aerobic exercise (eg, long-distance running)
    o Regular, substantial alcohol consumption
    o Treatment with oral estrogens, particularly if not opposed by progestins
    o Treatment with statins
    •
    o Treatment with nicotinic acid (niacin) at doses greater than 1 g/d
    •
    o Treatment with phenytoin
    o Primary biliary cirrhosis
    o Treatment with fibrates (eg, bezafibrate, clofibrate, fenofibrate, gemfibrozil)


    94)normal distribution curve what is correct . .mean=median…answer

    The normal distribution is a symmetric distribution with well-behaved tails and a single peak at the center of the distribution. By symmetric, we mean that the distribution can be folded about an axis so that the 2 sides coincide. That is, it behaves the same to the left and right of some center point. For a normal distribution, the mean, median, and mode are actually equivalent. The histogram above generates similar estimates for the mean, median, and mode. Therefore, if a histogram or normal probability plot indicates that your data are approximated well by a normal distribution, then it is reasonable to use the mean as the location estimator.

    95)vortex keratopathy NOT seen in…copper excess..answer..

    Rest all..ie fabry,amiodarone and chloroquine cause it.


    96)pregnancy by ELISA first detected on….first day of missed cycle of 28 day duration..answer…


    97)not used in heroine detoxification….disulfiram answer..

    A range of treatments exist for heroin addiction, including medications and behavioral therapies. Science has taught us that when medication treatment is combined with other supportive services, patients are often able to stop using heroin (or other opiates) and return to stable and productive lives.
    Treatment usually begins with medically assisted detoxification to help patients withdraw from the drug safely. Medications such as clonidine and buprenorphine can be used to help minimize symptoms of withdrawal. However, detoxification alone is not treatment and has not been shown to be effective in preventing relapse—it is merely the first step.
    Medications to help prevent relapse include the following:
    • Methadone has been used for more than 30 years to treat heroin addiction. It is a synthetic opiate medication that binds to the same receptors as heroin; but when taken orally, it has a gradual onset of action and sustained effects, reducing the desire for other opioid drugs while preventing withdrawal symptoms. Properly administered, methadone is not intoxicating or sedating, and its effects do not interfere with ordinary daily activities. Methadone maintenance treatment is usually conducted in specialized opiate treatment programs. The most effective methadone maintenance programs include individual and/or group counseling, as well as provision of or referral to other needed medical, psychological, and social services.
    • Buprenorphine is a more recently approved treatment for heroin addiction (and other opiates). Compared with methadone, buprenorphine produces less risk for overdose and withdrawal effects and produces a lower level of physical dependence, so patients who discontinue the medication generally have fewer withdrawal symptoms than those who stop taking methadone. The development of buprenorphine and its authorized use in physicians’ offices give opiate-addicted patients more medical options and extend the reach of addiction medication. Its accessibility may even prompt attempts to obtain treatment earlier. However, not all patients respond to buprenorphine—some continue to require treatment with methadone.
    • Naltrexone is approved for treating heroin addiction but has not been widely utilized due to poor patient compliance. This medication blocks opioids from binding to their receptors and thus prevents an addicted individual from feeling the effects of the drug. Naltrexone as a treatment for opioid addiction is usually prescribed in outpatient medical settings, although initiation of the treatment often begins after medical detoxification in a residential setting. To prevent withdrawal symptoms, individuals must be medically detoxified and opioid-free for several days before taking naltrexone.
    • Naloxone is a shorter-acting opioid receptor blocker, used to treat cases of overdose.
    For pregnant heroin abusers, methadone maintenance combined with prenatal care and a comprehensive drug treatment program can improve many of the detrimental maternal and neonatal outcomes associated with untreated heroin abuse. Preliminary evidence suggests that buprenorphine may also be a safe and effective treatment during pregnancy, although infants exposed to either methadone or buprenorphine prenatally may still require treatment for withdrawal symptoms. For women who do not want or are not able to receive pharmacotherapy for their heroin addiction, detoxification from opiates during pregnancy can be accomplished with medical supervision, although potential risks to the fetus and the likelihood of relapse to heroin use should be considered.
    There are many effective behavioral treatments available for heroin addiction—usually in combination with medication. These can be delivered in residential or outpatient settings. Examples are individual or group counseling; contingency management, which uses a voucher-based system where patients earn “points†based on negative drug tests—these points can be exchanged for items that encourage healthy living; and cognitive-behavioral therapy, designed to help modify a patient’s expectations and behaviors related to drug abuse, and to increase skills in coping with various life stressors.


    99)once a week pill…centchroman…answer..
    Ormeloxifene(centchroman) may be used as a weekly oral contraceptive. This is touted as a major advantage by its developer and its manufacturer. Hormonal birth control pills should be taken at approximately the same time each day. In the case of progestogen only pills other than Cerazette that do not consistently inhibit ovulation, a delay of as little as three hours can increase the risk of pregnancy because of the limited duration of their effect on the cervical mucus. Ormeloxifene's weekly schedule is an advantage for women who prefer an oral contraceptive, but find it difficult or impractical to adhere to a daily schedule.
    For the first sixteen weeks of use, it is advised to take the ormeloxifene pill twice per week. From the thirteenth week on, it is taken once per week. [5] The consensus is that backup protection in the first month is a cautious but sensible choice. A standard dose is 30mg weekly, but 60mg loading doses can reduce pregnancy rates by 38%. [6]

    100)no birth dat…child woman ratio …answer..
  3. Guest

    Guest Guest

    101)wegeners differs from other small vessel vasculitis by…invlmnt of nasal septum..answer..

    102) sepsis treatment : activated protien c used in early cases
    high dose of anti inflammatory drugs cause injury
    antibiotics
    methyl prednisolone

    103)In systemic inflammatory response all are seen except:

    white cell count 10000microns/l
    resp rate >24
    bodytemp>38
    PR >90/min
    ANS A

    Body temperature less than 36°C or greater than 38°C
    Heart rate greater than 90 beats per minute
    Tachypnea (high respiratory rate), with greater than 20 breaths per minute; or, an arterial partial pressure of carbon dioxide less than 4.3 kPa (32 mmHg)
    White blood cell count less than 4000 cells/mm³ (4 x 109 cells/L) or greater than 12,000 cells/mm³ (12 x 109 cells/L); or the presence of greater than 10% immature neutrophils (band forms)
    SIRS can be diagnosed when two or more of these criteria are present.


    104)Epleys maneuver used in rx of BPPV…answer..

    The Epley maneuver (or Epley's exercises) is a maneuver used to treat benign paroxysmal positional vertigo (BPPV).[1] It is often performed by a doctor or a physical therapist, but can be performed by the patient at home. This maneuver was developed by Dr. John Epley and first described in 1980.[2]
    The procedure is as follows:
    1. Sit upright.
    2. Turn your head to the symptomatic side at a 45 degree angle, and lie on your back.
    3. Remain up to 5 minutes in this position.
    4. Turn your head 90 degrees to the other side.
    5. Remain up to 5 minutes in this position.
    6. Roll your body onto your side in the direction you are facing; now you are pointing your head nose down.
    7. Remain up to 5 minutes in this position.
    8. Go back to the sitting position and remain up to 30 seconds in this position.
    The entire procedure should be repeated two more times, for a total of three times.


    105)Cidex is gltaraldehyde…answer..

    Cidex is one of the brand names for Glutaraldehyde, a toxic colourless, oily liquid also available as an aqueous solution

    106)Tall slender young woman with disproportionate armspan length
    what systems to check....opthalmic and cardiovascular systems…answer…
    Case of marfans syndrome..


    107)mc cof rectal bleed in 5 yr old…rectal polyp..answer ... repeat bit.

    108.In pheochromocytoma all are given before surgery except:

    alpha blocker
    beta blocker
    steroids ...........answer........
    volume Loading

    • Start alpha blockade with phenoxybenzamine 7-10 days preoperatively to allow for expansion of blood volume.
    • The patient should undergo volume expansion with isotonic sodium chloride solution. Encourage liberal salt intake.
    • Initiate a beta blocker only after adequate alpha blockade. If beta blockade is started prematurely, unopposed alpha stimulation could precipitate a hypertensive crisis.
    • Administer the last doses of oral alpha and beta blockers on the morning of surgery.

    109)G-csf
    human stem cell product derivative
    recombinant cytokine …answer…
    recombinant monoclonal antibody

    G-CSF is produced by endothelium, macrophages, and a number of other immune cells. The natural human glycoprotein exists in two forms, a 174- and 180-amino-acid-long protein of molecular weight 19,600 grams per mole. The more-abundant and more-active 174-amino acid form has been used in the development of pharmaceutical products by recombinant DNA (rDNA) technology.

    110)Tinea capitis caused by …microsporum sps…answer…

    Tinea capitis (also known as "Herpes tonsurans",[1] "Ringworm of the hair,"[1] "Ringworm of the scalp,"[1] "Scalp ringworm"[2], and "Tinea tonsurans"[1]) is a superficial fungal infection (dermatophytosis) of the scalp.[3] The disease is primarily caused by dermatophytes in the Trichophyton and Microsporumgenera that invade the hair shaft. The clinical presentation is typically a single or multiple patches of hair loss, sometimes with a 'black dot' pattern (often with broken-off hairs), that may be accompanied by inflammation, scaling, pustules, and itching. Uncommon in adults, tinea capitis is predominantly seen in pre-pubertal children, more often in boys than girls.

    111)Pt on risperidone case…neurolept malignant synd…answer..

    The first symptom to develop is usually muscular cramps, fever, symptoms of instability of the autonomic nervous system such as unstable blood pressure, and changes in cognition, including agitation, delirium and coma. Other symptoms may include muscle tremors. Once symptoms do appear, they rapidly progress and can reach peak intensity in as little as three days. These symptoms can last anywhere from eight hours to forty days.[2] The muscular symptoms are most likely caused by the blockade of D2 which cause problems in the basal ganglia motor loop of the brain similar to that which exists in Parkinson's disease.[3]
    A raised white blood cell count and creatine phosphokinase (CPK) plasma concentration will be reported due to increased muscular activity and rhabdomyolysis (destruction of muscle tissue).[4] The patient may suffer hypertensive crisis and metabolic acidosis. A non-generalized slowing on an EEG is reported in around 50% of cases.
    The fever is believed to be caused by hypothalamic dopamine receptor blockade. The peripheral problems (the white blood cell and CPK count) are caused by the antipsychotic drugs. They cause an increased calcium release from the sarcoplasmic reticulum of muscle cells which can result in rigidity and eventual cell breakdown. No major studies have reported an explanation for the abnormal EEG, but it is likely also attributable to dopamine blockage leading to changes in neuronal pathways.[5]
    Unfortunately, symptoms are sometimes misinterpreted by doctors as symptoms of mental illness, delaying treatment.[6] NMS is less likely if a person has previously been stable for a period of time on antipsychotics, especially in situations where the dose has not been changed and there are no issues of noncompliance or consumption of psychoactive substances known to worsen psychosis


    112)Lesion with clear fluid of .5cm…vesicle …answer…>.5 is bulla

    Vesicle
    Vesicles are small fluid-filled blisters less than 0.5cm diameter. They may be single or multiple.

    Pustule
    A pustule is a purulent vesicle. It is filled with neutrophils, and may be white, or yellow. Not all pustules are infected.

    Bulla
    A bulla is a large fluid-filled blister. It may be a single compartment or multiloculated.

    Abscess
    An abscess is a localised collection of pus.

    113)c reactive protein------- acute phase reactant…answer…

    C-reactive protein (CRP) is a protein found in the blood, the levels of which rise in response to inflammation (i.e. C-reactive protein is an acute-phase protein). Its physiological role is to bind to phosphocholine expressed on the surface of dead or dying cells (and some types of bacteria) in order to activate the complement system via the C1Q complex.[1]
    CRP is synthesized by the liver[2] in response to factors released by fat cells (adipocytes).[3] It is a member of the pentraxin family of proteins.[2] It is not related to C-peptide or protein C.

    114)pt.with diabetic keto acidosis and coma….high potassium levels…answer…

    K shifts: Factors that shift K in or out of cells include the following:
    • Insulin concentrations
    • β-Adrenergic activity
    • Acid-base status
    Insulin moves K into cells; high concentrations of insulin thus lower serum K concentration. Low insulin concentrations, as in diabetic ketoacidosis, cause K to move out of cells, thus raising serum K, sometimes even in the presence of total body K deficiency.

    β-Adrenergic agonists, especially selective β2-agonists, move K into cells, whereas β-blockade and α-agonists promote movement of K out of cells.
    Acute metabolic acidosis causes K to move out of cells, whereas acute metabolic alkalosis causes K to move into cells. However, changes in serum HCO3 concentration may be more important than changes in pH; acidosis caused by accumulation of mineral acids (nonanion gap, hyperchloremic acidosis) is more likely to elevate serum K. In contrast, metabolic acidosis due to accumulation of organic acids (increased anion gap acidosis) is not associated with hyperkalemia. Thus, the hyperkalemia common in diabetic ketoacidosis results more from insulin deficiency than from acidosis. Acute respiratory acidosis and alkalosis affect serum K concentration less than metabolic acidosis and alkalosis. Nonetheless, serum K concentration should always be interpreted in the context of the serum pH (and HCO3 concentration).


    115)not true about SSPE…fever and headache…answer,..

    Characterized by a history of primary measles infection usually before the age of 2 years, followed by several asymptomatic years (6–15 on average), and then gradual, progressive psychoneurological deterioration, consisting of personality change, seizures, myoclonus, ataxia, photosensitivity, ocular abnormalities, spasticity, and coma

    116) pyrimidine inhibitor with dihydro orotate hehydrogenase inhibitor action…leuflunamide…answer..

    Leflunomide is an immunomodulatory drug inhibiting dihydroorotate dehydrogenase (an enzyme involved in de novo pyrimidine synthesis) (abbreviation DHODH).[3] Genuine antiproliferative activity has been proven. In addition, several experimental models (both in vivo and in vitro) have demonstrated an anti-inflammatory effect. This double action is supposed to slow progression of the disease and to cause remission/relief of symptoms of rheumatoid arthritisand psoriatic arthritis such as joint tenderness and decreased joint and general mobility in human patients

    117)hepatic blood flow and oxygenation minimally altered by which anesthetic ???

    sevoflurane
    desflurane
    isoflurane
    enflurane
    Ans Isoflurane

    118)ASD with left axis deviation…ostium primum defect..
    In addition to the PR prolongation, individuals with a primum ASD have a left axis deviation of the QRS complex while those with a secundum ASD have a right axis deviation of the QRS complex. Individuals with a sinus venosus ASD exhibit a left axis deviation of the P wave (not the QRS complex).

    119)Mc cause of prolonged rocuronium action…decreased elimination…answer..

    120)Rays produced by nuclear decay/disingration…gamma rays…answer…

    A classical gamma ray source is a type of radioactive decay called gamma decay where an excited nucleus emits a gamma ray almost immediately on formation. However, gamma decay may also describe isomeric transition which involves an inhibited gamma decay with a relatively much longer half life.


    121)Quadrivalent Human Papillomavirus against..Types 6,11,16, 18….answer…

    122) ) in pregnancy not true

    hypertrophy of bladder muscle
    increase in peristalsis of ureter …………answer…………
    rise in gfr
    rise in renal plasma flow

    Pyelonephritis is a common medical complication of pregnancy that is attributed to mechanical compression of the urinary collection system by the gravid uterus, as well as to a decrease in ureteral motility mediated by progesterone.


    123) schwangershaft protein is other name for - pregnancy-specific β glycoprotein (PSBS)

    Schwangerschafts protein 1 (SP1), also known as pregnancy-associated plasma protein C (PAPP-C) or pregnancy-specific β glycoprotein (PSBS), is produced by the syncytiotrophoblast. The main advantage of SP1 level assessment may be in the diagnosis of conception after recent hCG administration. A level of 2 ng/L might be used for the diagnosis of pregnancy; however, it is doubtful that a diagnosis can be established before delay of menses. Although the level of SP1 increases late in all patients with a nonviable pregnancy, a single SP1 level assessment does not have prognostic value

    124)True regarding PCOD….raised LH levels …answer…

    Polycystic ovaries develop when the ovaries are stimulated to produce excessive amounts of male hormones (androgens), particularly testosterone, either through the release of excessive luteinizing hormone (LH) by the anterior pituitary gland or through high levels of insulin in the blood (hyperinsulinaemia) in women whose ovaries are sensitive to this stimulus.

    125) severity of the disease is -- case fatality rate ...answer....

    126) erythropoeitin secreting tumor-cerebellar haemangioblastoma

    The paraneoplastic syndrome of erythrocytosis is associated with a variety of neoplasms including renal adenocarcinoma, cerebellar hemangioma, and hepatoma.

    127)Placental harmone with highest carbohydrate content …hcg
    WILLIAMS OBSTETRICS 22ND EDITION :

    Chorionic gonadotropin is a glycoprotein (molecular weight 36,000 to 40,000 d) with the highest carbohydrate (30 percent) content of any human hormone. The carbohydrate component, and especially the terminal sialic acid, protects the molecule from catabolism. The 36-hour plasma half-life of intact hCG is much longer than the 2 hours for LH. The hCG molecule is composed of two dissimilar subunits, designated (92 amino acids) and (145 amino acids), which are noncovalently linked. They are held together by electrostatic and hydrophobic forces that can be separated in vitro. Isolated subunits are unable to bind the LH receptor and thus lack biological activity.

    128)MBA Psych case…neologism…. Answer

    In psychiatry, the term neologism is used to describe the use of words that only have meaning to the person who uses them, independent of their common meaning.[2] This is considered normal in children, but a symptom of thought disorder (indicative of a psychotic mental illness, such as schizophrenia) in adults.[3] People with autism also may create neologisms.[4] In addition, use of neologisms may be related to aphasia acquired after brain damage resulting from a stroke or head injury.

    129)Co2 laser…10600…answer..

    130) components of IMCI diseases all except ??

    diarrhoea
    ac.respiratory infections
    malaria
    childhood tb ..............answer...........

    This is an innovative approach which was started in 1995 by WHO and UNICEF with the aim of introducing a comprehensive and timely management of the 5 most common causes of ill health and death among the under-fives. These illnesses are:

    • Pneumonia;
    • Diarrhoea;
    • Malaria;
    • measles;
    • malnutrition.


    131)NOT true in ankylosis spondy…UL mc involved than lower limb…answer…

    132)best position in percutaneous nephrolithotomy operation left kidney …supine

    133)spider cell.. Cardiac rhabdomyoma…answer…

    The nuclei of the rhabdomyoma cells are central or eccentrically located. In some cells, eosinophilic septae stretch from the cell membrane to a centrally placed nucleus, imparting a "spiderlike" appearance to the cell. These "spider cells" are pathognomonic for cardiac rhabdomyomas and are thought to represent degenerating rhabdomyocytes .

    134) best test for for fetal rh iso immunisation ???

    cord blood
    NST
    usg placenta
    increased middle cerebral artery blood flow
    Ans D

    135)CCF which is not true....echo is diagnostic…answer… ???

    136)rx of pseudo pancreaticcyst.... surgical internal drainage…answer..

    small pseudocyst that is not causing any symptoms may be managed conservatively. However, a large proportion of them will need some form of treatment, The interventions available are:
     Endoscopic trans-gastric drainage..if the same term was given then this would b the answer.
     Imaging guided percutaneous drainage
     Laparoscopic/open cystogastrostomy


    137)post radiation hodgkins case….hypothyroidsm due to ??? ??

    138)glaucoma visual field defects best detected by…HFA….answer…

    139)dangerous placenta is type 2 B that is placenta posterior previa….answer,….

    140)Cresentic glomerulo nephritis…RPGN..answer…

    Acute RPGN is mediated by antibody or cellular immunity or by interaction of the two arms of the immune system. Deposition of antibody along the basement membrane and/or glomerular deposition of preformed soluble immune complexes can result in glomerulonephritis. Lymphocytes and macrophages, along with deposited antibody, are important in the production of proliferation and proteinuria. The involved lymphocytes are identified as T cells; most are helper T cells with some suppressor T cells. Antibody- and cell-mediated immunity are together responsible for many lesions observed in patients with acute RPGN, and cell-mediated immunity without antibody may produce crescentic glomerulonephritis.
    Crescents are defined as the presence of 2 or more layers of cells in the Bowman space. The presence of crescents in glomeruli is a marker of severe injury.
    The initiating event is the development of a physical disruption in the GBM. The lesions are mediated by processes involving macrophages and cell-mediated immunity. Following disruption of the glomerular capillary, circulating cells, inflammatory mediators, and plasma proteins pass through the capillary wall into the Bowman space. Cells and mediators from the interstitium enter the Bowman space with disruption of the Bowman capsule, which leads to development of crescents.
    The major participants in crescent formation are coagulation proteins, macrophages, T cells, fibroblasts, and parietal epithelial cells. Activated macrophages contribute to the crescents by proliferating and releasing procoagulant tissue factor, interleukin-1 (IL-1) and tumor necrosis factor (TNF). T cells are not prominent components, but they play an important role in glomerular injury by antigen recognition and macrophage recruitment.
    The reversibility of crescents correlates with relative predominance of cellular components. Whether crescents progress or resolve may depend upon the integrity of the Bowman capsule and resulting cellular composition of the crescent. Progression to fibrous crescents is more common when capsular rupture occurs and fibroblasts along with macrophages are prominent in the Bowman space. The presence of fibrous crescents usually correlates with glomerular sclerosis or irreversibility.


    141)IODINE disinfection TRUE is???

    Protein coagulation
    iodine from iodophore at alkaline ph
    kills mycobacteria,virus and spores…answer…
    dna damage


    142)Large fiber neuropathy cause????

    a.vincristine
    b.cisplatin.
    c.thalidomide
    ans B

    LARGE-FIBER NEUROPATHY=CISPLATIN
    Cisplatin causes dose-dependent large-fiber neuropathy by damaging dorsal root ganglia.Cisplatin typically produces large-fiber neuropathy with loss of vibratory and position sense.

    143)cervix cancer…stage IA2…answer…

    The TNM staging system for cervical cancer is analogous to the FIGO stage.
     Stage 0 - full-thickness involvement of the epithelium without invasion into the stroma (carcinoma in situ)
     Stage I - limited to the cervix
     IA - diagnosed only by microscopy; no visible lesions
     IA1 - stromal invasion less than 3 mm in depth and 7 mm or less in horizontal spread


     IA2 - stromal invasion between 3 and 5 mm with horizontal spread of 7 mm or less

     IB - visible lesion or a microscopic lesion with more than 5 mm of depth or horizontal spread of more than 7 mm
     IB1 - visible lesion 4 cm or less in greatest dimension
     IB2 - visible lesion more than 4 cm
     Stage II - invades beyond cervix
     IIA - without parametrial invasion, but involve upper 2/3 of vagina
     IIB - with parametrial invasion
     Stage III - extends to pelvic wall or lower third of the vagina
     IIIA - involves lower third of vagina
     IIIB - extends to pelvic wall and/or causes hydronephrosis or non-functioning kidney
     Stage IV - extends outside the vagina
     IVA - invades mucosa of bladder or rectum and/or extends beyond true pelvis
     IVB - distant metastasis


    144)Herpes genitalis definitive diagnosis…virus cultre …answer…

    145)Late expanding stage…death rate declines more than birth rate…answer…..

    In the late expanding or the third stage of the demographic cycle the birth tends to fall but the depth rate declines still further and the population continues to grow as the births exceeds deaths, e.g. India, China, Singapore, etc

    146)stage 4 in AIDS doesnt include oral candidiasis…answer…

    147)h.pylori cause g.carcinoma due to??????????

    The mechanism by which H. pylori infection leads to cancer is unknown, but it appears to be related to the chronic inflammation induced by the organism

    148)Mc site of peptic ulcer perforation….anterior duodenal ulcer…answer…

    149)leukemia associated syndrome- down syndrome…answer…
    .
    Children with Down syndrome have an increased risk of developing leukemias, including acute lymphoblastic leukemia and myeloid leukemia;10 However, the risk of cancer in general is not increased because of a reduced propensity for solid tumors.11,12 Approximately 10% of newborns with Down syndrome develop a preleukemic clone, originating from myeloid progenitors in the fetal liver that is characterized by a somatic mutation in GATA1, which is localized on the X-chromosome. Mutations in this transcription factor lead to a truncated mutant protein GATA1short or GATA1s.13,14 This preleukemia is referred to as transient leukemia (TL), transient myeloproliferative disease (TMD), or transient abnormal myelopoiesis (TAM)
    The relative risk of acute leukemia in the first 5 years of life is 56 times that of individuals without Down syndrome. Approximately one in 150 patients develops leukemia. Neonatal leukemoid reactions (ie, pseudoleukemia) are common, and distinguishing this from true leukemia frequently poses a diagnostic challenge.
    TMD is a hematologic abnormality that primarily affects infants with Down syndrome in the neonatal period.15,16TMD is characterized by an excessive proliferation of myeloblast cells in the infant's blood and bone marrow.17Approximately 10% of infants with Down syndrome have TMD.18 However, this estimate probably identifies only patients with symptoms severe enough to warrant a CBC count and in whom the presence of blasts was of concern to the primary care provider.19 An estimated 25% of infants with Down syndrome who present with TMD develop megakaryocytic leukemia 1-3 years later.20 TMD is associated with pancytopenia, hepatosplenomegaly, and circulating immature WBCs. TMD spontaneously regresses within the first 3 months of life. However, in some children, it can be life threatening.21,22 Despite the high rate of spontaneous regression, TMD can be a preleukemic disorder in 20-30% of children with Down syndrome.
    Acute myeloid leukemia is as common in these individuals as acute lymphoid leukemia. Acute megakaryocytic leukemia is the most common form of acute myeloid leukemia in affected children and is uncommon in children who do not have Down syndrome.
    Although the risk for leukemia is higher in individuals with Down syndrome, these patients have a lower risk of developing solid tumors, with the exception of germ cell tumors and, perhaps, retinoblastomas and lymphomas.
    The patient's risk of carrying hepatitis B is increased if previously institutionalized.


    150)Not a sign of ileocaecal tb….competent ileo caecal valve…
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    Guest Guest

    151)Hirschsprung disease…couldn’t recollect the answer.???

    152)Whats the answer for mindblowing shigella question???

    153) 8mm gall stone in bile duct t/t …endoscopic removal..answer most prob…

    154)motor unit is nerve endin and muscle fibre…answer….

    A motor unit is a single α-motor neuron and all of the corresponding muscle fibers it innervates; all of these fibers will be of the same type (either fast twitch or slow twitch). When a motor unit is activated, all of its fibers contract. Groups of motor units often work together to coordinate the contractions of a single muscle; all of the motor units that subserve a single muscle are considered amotor unit pool. Larger motor units have stronger twitch tensions

    155)action potential in cochlear cells arise from inner hair cells …answer…(outer hair cells produce otoacoustic emissions)

    156)normal conversation in quiet room…50-60db
    Sound Intensity Decibels (dB) Sounds
    1 0 just detectable
    100 20
    1,000 30
    10,000 40 quiet room
    100,000 50
    1,000,000 60 normal conversation
    10,000,000 70
    100,000,000 80 alarm clock
    1,000,000,000 90
    10,000,000,000 100
    100,000,000,000 110 rock concert (90–130 dB)
    1,000,000,000,000 120 shout into ear at 20 cm
    10,000,000,000,000 130
    100,000,000,000,000 140 air raid siren


    157)azygous lobe?????????????

    Azygos lobe is a rare congenital variation of the upper lobe of the right lung. Embryologically, it arises from an anomalous lateral course of the azygos vein. In a pleural septum within the upper lobe. As it has no bronchi, veins and arteries of its own, it is not a true, or even accessory, pulmonary lobe, but rather an anatomically separated part of the upper lobe. It is usually an incidental finding on chest x-ray or computed tomography and is as such not associated with any morbidity but can cause technical problems in thoracoscopic procedure

    158)carcinoid of GIT false is ???????

    1) circumcribed lesion in mucosa
    2)muticentric
    3)coliky abdominal pain
    4)massive retroperitonial fibrosis

    159)Mc cause of post renal arf – ans in BOO Ref harrison

    160)Pyogenic liver abscess ...most common route of spread…assecending infection via biliary trac…answer.

    Biliary disease accounts for 21-30% of reported cases.3,7,9 Extrahepatic biliary obstruction leading to ascending cholangitis and abscess formation is the most common cause7,9 and is usually associated with choledocholithiasis, benign and malignant tumors,4 or postsurgical strictures. Biliary-enteric anastomoses (choledochoduodenostomy or choledochojejunostomy) have also been associated with a high incidence of liver abscesses.2,9 Biliary complications (eg, stricture, bile leak) after liver transplantation are also recognized causes of pyogenic liver abscesses.


    161)gilbert syndrome false is ……….conjugated elevated …answer…

    Gilbert's syndrome (English pronunciation: /ʒiːlˈbɛər/, zheel-BAIR), often shortened to GS, also called Gilbert-Meulengracht syndrome, is the most commonhereditary cause of increased bilirubin and is found in up to 5% of the population (though some gastroenterologists maintain that it is closer to 10%). A major characteristic is jaundice, caused by elevated levels of unconjugated bilirubin in the bloodstream (hyperbilirubinemia).
    The cause of this hyperbilirubinemia is the reduced activity of the enzyme glucuronyltransferase, which conjugates bilirubin and some other lipophilic molecules. Conjugation renders the bilirubin water-soluble, after which it is excreted in bile into the duodenum.


    162)blunt trauma to pancreas false....usually isolated is false…..answer…..

    Isolated blunt trauma to pancreas is very rare.

    163)oesophageal perforation false…..penetration most common cause of injury(iatrogenic trauma mc cause)>>>barium swallow..

    The frequency of esophageal perforation is 3 in 100,000 in the United States. The distribution by location is cervical (27%), intrathoracic (54%), and intra-abdominal (19%). The most common cause of esophageal perforation is medical instrumentation for diagnostic and therapeutic endeavors; in one series, such instrumentation caused 65% of all perforations. The frequencies of other causes include postemetic (16%) and trauma, including postoperative trauma (11%). All other causes (caustic, peptic ulcer disease, foreign body, aortic pathology, and diseases of the esophagus) occur rarely, with a frequency of approximately 1%.

    164)false about mvp…both echoi and auscultatiry findings required for diagnosis..?????

    165)gut endometriosis all except ????????????
    periodic rectal bleeding
    involves mucosa
    surgery t/t of choice
    mucosa n other layers involved??

    166)IUCD should not be inserted during??? ?????????

    167)specific pattern of cataract not seen in… leprosy….answer…

    168)albumin to globulin near term.... 1:1…0.9 to b specific at term…answer…

    169)All are prophylactic for Atonic PPH except??????????????

    1. 125 microgram Carboprost IM at delivery of anterior shoulder
    2. Methergine IV at delivery of anterior shoulder
    3. Controlled cord traction at delivery of placenta
    4. 10 units Oxytocin within 10 mins after delivery

    170)Clotting factors icreased in pregnancy except??
    2
    7
    10
    11….answer…..

    170)age estimation...first trimester..... Crl…answer……….

    171) most common spinal defect in infant of diabetic mother??
    Spina bifida???,
    Caudal regression???

    172) In pregnancy CVP
    rises
    no change
    decreases
    ANS B {NO CHANGE}

    173)In rx of amoebiasis NOT true???

    A.METRO for invasive
    b.paromomycim for noninvasive
    c.p+m better (???Combination toxic??) not sure of the answer…
    d.treat ment different foe invasive and non invasive.


    174) ) most appropriate x-ray for age estimation btw 1- 12yrs...
    1)ankle
    2)hand and wrist
    3)shoulder
    4)knee or femur(not sure of fourth option)
    Ans is hand n wrist

    175) which is not metabolised in lung? ???????????
    serotonin
    pgE
    ANGIOTENSIN
    BRADYKININ

    176)Not true in rheumatic fever…arthritis persists for >6months.

    • Arthritis in rheumatic fever

    o Polyarthritis is the most common symptom and is frequently the earliest manifestation of acute rheumatic fever (70-75%).
    o Characteristically, the arthritis begins in the large joints of the lower extremities (ie, knees, ankles) and migrates to other large joints in the lower or upper extremities (ie, elbows, wrists).
    o Affected joints are painful, swollen, warm, erythematous, and limited in their range of motion. The pain is out of proportion to clinical findings.
    o The arthritis reaches maximum severity in 12-24 hours and persists for 2-6 days (rarely more than 4 wk, but has been reported to persist 44 d) at each site and is migratory but not additive.
    o The arthritis responds rapidly to aspirin, which decreases symptoms in affected joints and prevents further migration of the arthritis.
    o Polyarthritis is more common and more severe in teenagers and young adults than in younger children.
    o Patients suffering multiple attacks may exhibit destructive arthritis (Jaccoud arthritis).

    177)increased ICT causes a/e …tachycardia…answer…

    178)NOT a absolute contra for organ donation

    a.>70yrs
    b.hiv
    c.malignancy
    d..15min cvs death
    Ans a>70yrs

    Absolute contraindications

    Age older than 80 years
    HIV infection
    Active metastatic cancer
    Prolonged hypotension or hypothermia
    Disseminated intravascular coagulation
    Sickle cell anemia or other hemoglobinopathy

    Relative contraindications
    Malignancy other than in the central nervous system (CNS) or skin that is in remission (>5 y)
    Hypertension
    Diabetes mellitus (DM)
    Physiologic age older than 70 years
    Hepatitis B or C
    History of smoking

    179)ocpills not contraindicated in ?

    a.cvs severe
    b.obesity ..answer…
    c.htn
    d.thromboembolic

    180)metastatic calcification…hyperparathyroidism…answer…

    181)menkes disease - copper transport….answer…

    182)acid fast organism.... nocardia…answer….

    183) 200)commonest complication og femoral vein acsess?
    Infection
    Hemorrhage
    Dvt
    Injury to artery and nerve
    …

    184) Maximum dark adaptation time????
    a)10 sec
    b)20 mins-anwer
    c)40 mins
    b)5 min
    for light adaptation-5 min


    186} Surgery Not used in short bowel loop management
    lenthening of bowel
    stricturoplasty
    resection of dilated bowel loop
    ANS ??

    Operative therapies for short-bowel syndrome can be divided into 2 broad categories: (1) intestinal or combined liver-intestinal transplantation, and (2) nontransplant operations. Nontransplant components of the surgical armamentarium for the treatment of short-bowel syndrome include intestinal lengthening (Bianchi) procedures, intestinal tapering for dilated dysfunctional bowel segments, stricturoplasty, and creation of intestinal valves or reversed bowel segments for patients with rapid intestinal transit times.

    187} newborn- frothing mouth - unable to pass ng tube - gasless abdomen - ans> oesophagial atresia with NO FISTULA…answer…

    190)Blood stored for 21 days at 2-6 degrees true all except?? .platelets remains viable....answer....
    Platelets get destroyed in 24 to 48 hours.

    191) Lytic lesions not seen in?
    oseoid osteoma...answer

    192).Antigen binding site of anti body -- Isotype/Idiotype

    193)clid presented with watering of eye,o/e upturned cilia touching the cornea . diagnosis??...trichiasis..answer.

    194} m/c site of TB spine involvement??

    *anterior spine
    *posterior spine
    *paradiscal
    *vertebral body

    ans C Para discal
    TB Spine most common site: Paradiscal because the blood supply is common for adjacent 2 vertebras paradiscal areas, together with intervening disc, as it develops from same sclerotome.
    galactose metabolism195}. a infant fed , start vomiting , mild hepatomegaly on examination what may be the defect

    196} to put forward a national programme...
    incentives
    service approach
    regulatory approach

    197}. budd chiari syndrome as it is not associated with following one
    a leukemia
    b sickle cell disease
    c polycythemia
    d congestive heart failure ......answer is d
     The cause cannot be found in about half of the patients
     Primary (75%): thrombosis of the hepatic vein
     Secondary (25%): compression of the hepatic vein by an outside structure (e.g. a tumor)
     Hepatic vein thrombosis is associated with the following in decreasing order of frequency.
    (A)Polycythemia vera (B)pregnancy (C)post partum state (D)use of oral contraceptive (E)paroxysmal nocturnal hemoglobinuria (F)Hepatocellular carcinoma.
     Infection such as TB
     Congenital venous webs
     Occasionally inferior vena caval stenosis
    Often, the patient is known to have a tendency towards thrombosis, although Budd–Chiari syndrome can also be the first symptom of such a tendency. Examples of genetic tendencies include Protein C deficiency, Protein S deficiency, the Factor V Leiden mutation, and Prothrombin Mutation G20210A.[2] An important non-genetic risk factor is the use of estrogen-containing (combined) forms ofhormonal contraception. Other risk factors include the antiphospholipid syndrome, aspergillosis, Behçet's disease, dacarbazine, pregnancy, and trauma.
    Many patients have Budd–Chiari syndrome as a complication of polycythemia vera (myeloproliferative disease of red blood cells).[3] Patients suffering from paroxysmal nocturnal hemoglobinuria (PNH) appear to be especially at risk for Budd–Chiari syndrome, more than other forms of thrombophilia: up to 39% develop venous thromboses [4] and 12% may acquire Budd-Chiari.[5]
    A related condition is veno-occlusive disease, which occurs in recipients of bone marrow transplants as a complication of their medication. Although its mechanism is similar, it is not considered a form of Budd–Chiari syndrome.
    Other toxicologic causes of veno-occlusive disease include plant & herbal sources of pyrrolizidine alkaloids: Borage, Boneset, Coltsfoot, T'u-san-chi, Comfrey, Heliotrope (sunflower seeds), Gordolobo, Germander, and Chaparral.


    198).anti diabetic drugs to decrease glucose levels in sepsis leads to good prognosis ?????
    199)not a lytic lkesion of bone… osteoid osteoma… answer..

    200) not caused by echo virus?
    Herpagina
    Pleurodynia
    Hemorrhagic fever....answer...
    Myocarditis
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    International
    Distribution appears to be worldwide. No geographical predilection is reported.

    Mortality/Morbidity
    Oral lesions occur in 75-100% of patients with OCP. Skin involvement (eg, face, neck, scalp) occurs in approximately 25% of patients with OCP.

    Race
    OCP can occur in all races.

    Sex
    Females predominate patients diagnosed with OCP. The female-to-male ratio is estimated to be 1.5:1 to 3:1.

    Age
    Average age of onset is 50-60 years; however, the exact age of onset may be younger, since most patients with early stages of OCP remain undiagnosed. Some cases have been diagnosed as early as 12 and 19 years.


    From the above statements it is clear that there is no race and geographic predilection. So the answer probably is THE DISEASE IS PREDOMINANT IN MIDDLE AGED FEMALES AND NOT YOUNG FEMALES' .
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    stone of 2.5 cms in renal pelvis in a child , the management is percutaneous nephrolithotomy according to nelson paediatrics 18th edition .


    TABLE 547-5 -- Primary Surgical Treatment Options Versus Stone Size and Location
    STONES SHOCK WAVE LITHOTRIPSY URETEROSCOPY PERCUTANEOUS NEPHROLITHOTOMY
    RENAL
    <1 cm Most common Optional Optional
    1–2 cm Most common Optional Optional
    >2 cm Optional Rare Most common

    LOWER POLE
    <1 cm Most common Optional Optional
    >1 cm Optional Optional Most common

    URETERAL
    Proximal Most common Optional Occasional
    Distal Optional Most common Rare

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