IMP QUESTIONE WITH ANSWERS

Discussion in 'Question Zone' started by Joseph., Nov 5, 2007.

  1. Live2serve.

    Live2serve. Guest

    CERVICAL SPINE INJURIES: MECHANISM OF INJURY

    CERVICAL SPINE INJURIES: MECHANISM OF INJURY

    FLEXION

    1. Anterior subluxation (hyperflexion sprain)
    2. Bilateral interfacetal dislocation
    3. Clay-shoveler’s fracture
    4. Flexion teardrop fracture
    5. Simple wedge fracture

    FLEXION—ROTATION

    1. Rotatory dislocation with interlocking
    2. Unilateral interfacetal dislocation or fracture-dislocation

    EXTENSION—ROTATION

    1. Pillar fracture
    2. Pedicolaminar fracture separation

    VERTICAL COMPRESSION

    1. Burst fracture
    a. Burst fracture of lower cervical vertebrae
    b. Fracture of occipital condyle
    c. Jefferson fracture of atlas

    EXTENSION

    1. Avulsion fracture anterior arch of atlas
    2. Extension teardrop fracture
    3. Hyperextension dislocation or fracture-dislocation
    4. Laminar fracture
    5. Posterior dislocation of atlas with fractured odontoid
    6. Posterior neural arch fracture of atlas
    7. Spinous process fracture
    8. Traumatic spondylolisthesis; hangman’s fracture (deceleration; hyperextension)

    LATERAL FLEXION

    1. Jefferson fracture, asymmetric (Jefferson variant)
    2. Lateral compression fracture
    3. Occipital condyle fracture
    4. Transverse process fracture
    5. Uncinate process fracture

    COMPLEX OR POORLY UNDERSTOOD MECHANISM

    1. Acute traumatic transverse atlantal ligament rupture
    2. Occipitoatlantal dissociation
    3. Odontoid fracture
    4. Rotary subluxation/fixation C1-2 (torticollis)
    5. Acute traumatic rotary atlantoaxial dissociation


    BICONCAVE (“FISH”) VERTEBRAE (INCLUDING STEP-LIKE VERTEBRAE*)

    COMMON
    1. Hyperparathyroidism, primary or secondary (renal osteodystrophy)*
    2. Metastatic disease
    3. Osteomalacia; rickets
    4. Osteoporosis (e.g., senile or postmenopausal; malnutrition; steroid therapy)
    5. Paget’s disease
    *6. Schmorl’s nodes
    *7. Sickle cell disease

    UNCOMMON
    *1. Anemias, other (e.g., thalassemia; hereditary spherocytosis; iron deficiency)
    *2. Gaucher’s disease
    *3. Homocystinuria
    4. Lymphoma
    5. Osteogenesis imperfecta
    6. Sponastrine dysplasia

    * “Step-like” vertebra with H-shaped or Lincoln log configuration may occur.


    BONE-IN-BONE OR SANDWICH VERTEBRA

    COMMON
    *1. Osteopetrosis
    2. Paget’s disease
    3. Physiologic in newborn (often premature) infant
    *4. Renal osteodystrophy (secondary hyperparathyroidism), healing

    UNCOMMON
    1. Chronic illness (growth arrest lines)
    *2. Hypercalcemia; hypervitaminosis D
    *3. Lead poisoning, chronic
    4. Radiation therapy
    5. Thorotrast

    * May have a “rugger jersey spine” or “sandwich vertebra” appearance


    IVORY VERTEBRAE

    1. Lymphoma
    2. Myelosclerosis (myeloid metaplasia)
    3. Osteoblastic metastasis
    4. Osteomyelitis, chronic sclerosing (e.g., tuberculosis; syphilis; brucellosis; typhoid)
    5. Paget’s disease
    6. Chordoma
    7. Fluorosis
    8. Osteopetrosis


    ERLENMEYER FLASK DEFORMITY OF METAPHYSIS

    1. Anemia, primary (e.g., thalassemia; sickle cell disease)
    2. Gaucher disease; Niemann-Pick disease
    3. Hereditary multiple exostoses (multiple cartilaginous exostoses; osteochondromatosis)
    4. Osteopetrosis
    5. Pyle dysplasia (familial metaphyseal dysplasia)


    DUMBBELL BONES (SHORT LONG BONES WITH PRONOUNCED METAPHYSEAL FLARING)

    1. Achondroplasia
    2. Kniest dysplasia
    3. Metatropic dysplasia
    4. Pseudoachondroplasia (pseudoachondroplastic spondyloepiphyseal dysplasia), severe


    “BONE WITHIN A BONE” APPEARANCE

    1. Bone infarct (e.g., sickle cell disease)
    2. Growth arrest and recovery, “growth lines” (e.g., due to severe childhood disease; infection; scurvy; rickets; stress; immobilization; leukemia chemotherapy)
    3. Idiopathic
    4. Normal neonate (esp. spine)
    5. Osteopetrosis
    6. Paget’s disease


    MOTHEATEN OR PERMEATIVE OSTEOLYTIC LESION(S)

    COMMON
    1. Ewing sarcoma
    2. Lymphoma; leukemia
    3. Metastasis (incl. neuroblastoma)
    4. Multiple myeloma
    5. Osteomyelitis
    6. Osteosarcoma

    UNCOMMON
    1. Adamantinoma (esp. tibia)
    2. Chondrosarcoma
    3. Giant cell tumor (at margins)
    4. Hemangioendothelioma; angiosarcoma
    5. Landing-Shirkey disease (multifocal granulomatous osteomyelitis in a compromised child)
    6. Langerhans cell histiocytosis (esp. eosinophilic granuloma in children)
    7. Malignant fibrous histiocytoma; fibrosarcoma
    8. Rhabdomyosarcoma
    9. Syphilis; yaws


    AGE RANGE OF HIGHEST INCIDENCE OF VARIOUS BONE NEOPLASMS AND TUMOR-LIKE LESIONS

    TUMOR and AGE (YEARS)

    1. Adamantinoma (esp. tibia) 15–35
    2. Aneurysmal bone cyst 10–30
    3. Bone cyst 5–20
    4. Chondroblastoma (Codman tumor) 10–25
    5. Chondromyxoid fibroma 10–30
    6. Chondrosarcoma 30–60
    7. Chordoma 30–70
    8. Cortical/periosteal desmoid 10–20
    9. Desmoplastic fibroma 10–40
    10. Enchondroma 5–50
    11. Ewing sarcoma 5–25
    12. Fibrosarcoma 20–70
    13. Fibrous dysplasia 2–30
    14. Giant cell tumor 20–45
    15. Hemangioma 30–70
    16. Langerhans cell histiocytosis 0–15
    17. Lymphoma 15–40
    18. Malignant fibrous histiocytoma 20–60
    19. Metastasis 40–80
    20. Multiple myeloma 40–80
    21. Neuroblastoma, metastatic 0–10
    22. Nonossifying fibroma (fibroxanthoma); fibrous cortical defect 5–20
    23. Ossifying fibroma (face, jaws) 5–30
    24. Osteoblastoma 10–25
    25. Osteochondroma 10–25
    26. Osteofibrous dysplasia (esp. tibia) 0–15
    27. Osteoid osteoma 10–30
    28. Osteoma 30–50


    RADIOLOGIC CRITERIA SUGGESTING MALIGNANT BONE NEOPLASM

    1. Bone destruction (esp. motheaten or permeative, but may be geographic – particularly with wide transition zone 1C margin)
    2. Irregular ill-defined margins of lesion (“wide transition zone” between normal and abnormal bone)
    3. Cortical erosion or destruction
    4. Codman triangle
    5. Periosteal lamellation (“onion skin”)
    6. Periosteal right angle spiculation (“sunburst” or “hair-on-end”)
    7. Soft tissue mass adjacent to bone destruction
    8. Chondroid or osteoid matrix (esp. in extraosseous tissues)
    9. Metastasis to distant site


    CLUES TO THE BATTERED CHILD SKELETAL INJURIES

    HIGH SPECIFICITY
    1. Classic metaphyseal lesion (corner fracture; bucket handle fracture; avulsion fracture; metaphyseal infraction)
    2. Rib fractures (esp. posterior)
    3. Scapular fractures
    4. Spinous process fractures
    5. Sternal fractures

    MODERATE SPECIFICITY
    1. Multiple fractures
    2. Bilateral fractures
    3. Fractures at different stages of healing
    4. Epiphyseal separations
    5. Vertebral fractures or subluxations
    6. Fractures of digits of hands or feet
    7. Complex skull fractures

    COMMON BUT LOW SPECIFICITY
    1. Subperiosteal new bone formation
    2. Excessive callus formation
    3. Clavicular fractures
    4. Fractures of shafts of long bones
    5. Simple linear skull fractures

    OTHER FEATURES
    1. Unsuspected or inadequately or inappropriately explained fractures or other injuries
    2. Multiple bruises; healed lacerations; burns
    3. Thoracic findings consistent with contusion (e.g., focal infiltrate without respiratory infection or fever; pneumothorax; pneumomediastinum; hemothorax; chylothorax)
    4. Intramural intestinal hematoma
    5. Pneumoperitoneum
    6. Pseudocyst of pancreas
    7. Solid organ laceration
    8. Subdural hematoma
    9. Underdevelopment; failure to thrive; poor hygiene
    10. Inappropriate affect by the child’s caregiver (profound indifference or exaggerated concern)


    “SPLIT” OR DOUBLE-LAYER CORTEX

    1. Bone infarct (e.g., sickle cell disease)
    2. Healing fracture; battered child S.
    3. Normal infants, esp. premature (physiologic periostitis of newborn)
    4. Osteomyelitis
    5. Osteoporosis (esp. disuse; immobilization)
    6. Postsurgical removal of intramedullary rod


    SITES OF PSEUDOFRACTURES (LOOSER’S ZONES, MILKMAN SYNDROME)

    1. Femur (neck and shaft)
    2. Ischial and pubic rami
    3. Scapula, outer margin
    4. Clavicle
    5. Ribs
    6. Other long bones (esp. proximal ulna shaft; distal radius shaft)
    7. Metacarpals, metatarsals and phalanges


    ARTHRITIS WITH “SWAN-NECK” DEFORMITY*

    1. Jaccoud’s arthritis (post-rheumatic fever)
    2. Lupus erythematosus
    3. Mixed connective tissue disease (MCTD)
    4. Psoriatic arthritis
    5. Rheumatoid arthritis
    6. Scleroderma
    7. Trauma
  2. Live2serve.

    Live2serve. Guest

    ROENTGEN SIGNS OF LYMPHATIC CHANNEL OBSTRUCTION

    ROENTGEN SIGNS OF LYMPHATIC CHANNEL OBSTRUCTION

    1. Backflow
    2. Collateral circulation
    3. Dilatation of lymph vessels
    4. Extravasation
    5. Stasis of lymph flow


    LEFT TO RIGHT SHUNT IN CONGENITAL HEART DISEASE

    1. Atrial septal defect (ASD)
    2. Atrioventricular (AV) canal defect, partial or complete
    3. Patent ductus arteriosus (PDA)
    4. Ventricular septal defect (VSD)


    RIGHT-TO-LEFT SHUNT CONGENITAL HEART DISEASE

    1. APVC, total (above the diaphragm)
    2. Double outlet right ventricle (DORV)
    3. Left to right shunt progressing to reversal or high resistance vascularity (Eisenmenger Physiology )
    4. Tetralogy of Fallot
    5. Transposition of great vessels
    6. Tricuspid atresia
    7. Truncus arteriosus


    TYPES OF DEXTROCARDIA

    1. Situs inversus (all visceral organs opposite of normal; slightly increased incidence of cardiac anomalies in 5% to 10% of patients)

    2. Dextroposition with situs solitus (cardiac apex displaced into right hemithorax—e.g., hypoplasia of right lung; venolobar S.)

    3. Dextroversion with situs solitus (anatomic relations are normal, but cardiac apex is in right side of chest—due to abnormal rotation of embryonic cardiac loop)

    4. Dextrocardia with situs ambiguus in asplenia S. (bilateral right-sidedness—absent spleen; three lobes in each lung; left lobe of liver same size as right lobe; malrotation of bowel; cardiac apex in either hemithorax—cardiac anomalies include common atrium; single ventricle; PS; transposition of great vessels; and TAPVR)

    5. Dextrocardia with situs ambiguus in polysplenia S. (bilateral left-sidedness—each lung has two lobes; hepatic segment of IVC is absent; cardiac apex is in right hemithorax in 50% of patients—cardiac anomalies include ASD; PAPVR; and interruption of IVC with azygos continuation)


    COMPLICATIONS OF MYOCARDIAL INFARCTION REQUIRING RADIOLOGICAL EVALUATION

    1. Heart failure
    2. Left ventricular aneurysm
    3. Pericardial effusion
    4. Ruptured interventricular septum
    5. Ruptured papillary muscle


    COMMON CARDIAC CONDITIONS DIAGNOSED BY ECHOCARDIOGRAPHY

    1. Aortic stenosis or insufficiency
    2. Bacterial endocarditis
    3. Cardiac tumor (esp. myxoma of LA)
    4. IHSS
    5. Mitral stenosis or insufficiency
    6. Mitral valve prolapse (MVP)
    7. Myocardiopathy
    8. Pericardial effusion
    9. Shunts (with evaluation of flow and direction by pulsed Doppler)


    COMPLICATIONS OF CENTRAL VENOUS (SUBCLAVIAN, JUGULAR) OR PULMONARY ARTERY CATHETERIZATION

    1. Arterial insertion with perforation (esp. subclavian or carotid artery)
    2. Catheter embolism; broken, trapped, or occluded catheter
    3. Extravascular infusion (e.g., mediastinal; intrapleural; subcutaneous)
    4. Infection (local or sepsis)
    5. Malpositioned or dislodged catheter (e.g., in RV, IVC, hepatic vein, jugular vein)
    6. Perforation of vessel with hematoma, hemothorax, hydrothorax, hemopericardium, or hemomediastinum
    7. Pneumothorax
    8. Thrombosis (e.g., SVC); thrombophlebitis; pulmonary thromboembolism


    ROENTGEN SIGNS OF ALVEOLAR DISEASE (CONSOLIDATION, AIR SPACE PATTERN)

    1. Acinar or peribronchiolar nodules
    2. Air alveologram and bronchiologram
    3. Air bronchogram
    4. Butterfly or “bat’s wing†distribution
    5. Coalescence (early)
    6. Fluffy, ill-defined margins
    7. Perihilar, diffuse, segmental or lobar distribution
    8. Present soon after onset of symptoms; rapid change


    REVERSE BUTTERFLY PATTERN

    1. ARDS
    2. Contusion of lung
    3. Eosinophilic pneumonia (PIE; Löffler syndrome)
    4. Pneumonia
    5. Sarcoidosis


    ROENTGEN PATTERNS OF INTERSTITIAL DISEASE

    1. Bronchial disease (e.g., peribronchial thickening; mucoid impaction; bronchiectasis)
    2. Discrete miliary nodules
    3. Honeycomb lung
    4. Kerley lines
    5. Small irregular shadows (reticular or reticulonodular pattern)
    6. Vascular abnormality (incl. pulmonary arterial, pulmonary venous, or bronchial arterial)


    ACUTE DIFFUSE FINE RETICULAR OPACITIES (KERLEY LINES, ACUTE— A, B, AND C)

    1. Pneumonia (esp. interstitial—infectious mononucleosis, cytomegalovirus, H. influenzae;
    Mycoplasma; atypical mycobacterial; Pneumocystis carinii)
    2. Pulmonary edema (esp. heart failure; myocardial infarction; valvular heart disease; renal failure; uremia; fluid overload; drug reaction)
    3. Transient tachypnea of the newborn (retained fetal lung fluid); Wilson-Mikity S.; bronchopulmonary dysplasia


    KERLEY LINES, CHRONIC—A, B, AND C

    1. Bronchogenic carcinoma (lymphangitic spread of tumor)
    2. Idiopathic pulmonary fibrosis (IPF)
    3. Lymphangitic metastases
    4. Pneumoconiosis (esp. silicosis)
    5. Mitral stenosis


    GROUND-GLASS OPACITIES ON HRCT

    1. Hypersensitivity pneumonitis (extrinsic allergic alveolitis) (e.g., farmer’s lung, bagassosis)
    2. Nonspecific interstitial pneumonia (NSIP) (idiopathic or associated with collagen vascular disease or AIDS)
    3. Acute interstitial pneumonia (AIP)
    4. Idiopathic pulmonary fibrosis (IPF) and active phase
    5. Pulmonary hemorrhage (e.g., bronchitis; bronchiectasis; pulmonary thromboembolism; bronchogenic carcinoma; contusion of lung; vasculitis—Wegener granulomatosis, Goodpasture S., lupus erythematosus; aspergilloma; anticoagulation; bleeding diathesis; arteriovenous malformation; DIC; vascular metastases
    6. Connective tissue disease (esp. lupus erythematosus; scleroderma)
    7. Sarcoidosis
    8. Bronchiolitis obliterans with organizing pneumonia (BOOP)
    9. Bronchiolitis obliterans
    10. Infection
    a. Pneumocystis carinii pneumonia
    b. Viral (esp. cytomegalovirus in immunocompromised patients)
    c. Bacterial
    d. Tuberculosis; atypical mycobacterial infection (“tree-in-budâ€)


    MASS IN A PULMONARY CAVITY (MENISCUS OR [bleep]’S EYE SIGN)

    1. Fungus ball (esp. Aspergillus; rarely Cryptococcus; Candida; Coccidioides)
    2. Hydatid cyst


    BLURRING OF THE HEART BORDER ON PA CHEST FILM

    1. Idiopathic
    2. Infiltrate or edema in left lingula, right middle lobe, or anterior segment of an upper lobe
    3. Mediastinal lesion, anterior (e.g., thymoma; thymic cyst; thymolipoma; teratoma; lymphoma; pericardial cyst; lipoma; mediastinitis; fibrosis)
    4. Normal or congested blood vessels (esp. right heart border)
    5. Pericardial fat pad
    6. Pleural fluid
    7. Pleuropericardial adhesion; postinfarction myocardial scar
    8. Pneumoconiosis (esp. asbestosis)


    TYPE OF PLEURAL FLUID— TRANSUDATE (Protein < 3 g/dl)

    1. Cirrhosis
    2. Fluid overload
    3. Heart failure
    4. Renal failure; uremia


    TYPE OF PLEURAL FLUID—EXUDATE (Protein > 3 g/dl)

    1. Lymphoma; leukemia
    2. Metastases to pleura (esp. bronchogenic carcinoma)
    3. Pneumonia (esp. bacterial); lung abscess
    4. Pulmonary thromboembolism
    5. Tuberculosis


    UNILATERAL ELEVATED HEMIDIAPHRAGM

    1. Atelectasis
    2. Distended stomach or splenic flexure of colon
    3. Eventration
    4. Idiopathic; normal variant
    5. Inflammatory disease in abdomen (e.g., subphrenic, perinephric, hepatic, or splenic abscess; pancreatitis; cholecystitis; perforated ulcer)
    6. Interposition of colon between liver and right hemidiaphragm (Chilaiditi S.)
    7. Paralysis (e.g., phrenic nerve palsy or paralysis, esp. from bronchogenic carcinoma; primary or metastatic mediastinal malignancy; extrinsic pressure from intrathoracic goiter or aortic aneurysm; trauma; iatrogenic-surgical transection)
    8. Pleural disease (e.g., acute pleurisy; fibrosis; old empyema, hemothorax or pleural tuberculosis; mesothelioma)
    9. Postoperative (e.g., lobectomy; pneumonectomy); postpericardiotomy S. (post-CABG)
    10. Ruptured spleen or liver (esp. subphrenic hematoma)
    11. Scoliosis (on side of concavity)
    12. Splinting of diaphragm or guarding from acute process (e.g., fractured rib; chest wall trauma; pulmonary infarct; pneumonia)
    13. Subphrenic mass (e.g., enlargement, tumor, cyst, or abscess of liver or spleen; carcinoma of stomach)
    14. Trauma to phrenic nerve, thorax, cervical spine, or brachial plexus


    EGGSHELL CALCIFICATIONS IN THE CHEST (ESP. MEDIASTINAL LYMPH NODES)

    1. Aneurysm of great vessels
    2. Idiopathic
    3. Silicosis; coal-worker’s pneumoconiosis
  3. Live2serve.

    Live2serve. Guest

    DOUBLE-BARREL ESOPHAGUS*

    DOUBLE-BARREL ESOPHAGUS

    1. Dissecting intramural hematoma or hemorrhage
    a. Severe vomiting (e.g., Boerhaave S. with esophageal perforation, or Mallory-Weiss S. with esophageal tear)
    b. Trauma
    c. Instrumentation (e.g., nasogastric intubation; endoscopy)
    d. Ingestion of sharp foreign body
    e. Spontaneous (e.g., bleeding diathesis)

    * Barium opacification of an intramural dissecting channel separated from the normal esophageal lumen by an intervening radiolucent mucosal stripe.


    DUODENAL OBSTRUCTION IN AN INFANT (DOUBLE BUBBLE SIGN)

    COMMON
    1. Annular pancreas
    2. Congenital peritoneal bands (Ladd’s bands)
    3. Duodenal atresia or stenosis, esp. with trisomy 21 S. (Down S.)
    4. Midgut volvulus with malrotation

    UNCOMMON
    1. Choledochal cyst
    2. Diaphragm or web; intraluminal diverticulum
    3. Duplication cyst
    4. Intramural hematoma
    5. Preduodenal portal vein
    6. Retroperitoneal tumor (e.g., teratoma) or lymphadenopathy


    SENTINEL LOOP (LOCALIZED DILATATION OF SMALL AND/OR LARGE BOWEL)

    1. Acute appendicitis (right lower quadrant)
    2. Acute cholecystitis (right upper quadrant)
    3. Acute diverticulitis (left lower quadrant)
    4. Acute pancreatitis (upper or mid-abdomen)
    5. Acute ureteral colic (stone)
    6. Infarction or ischemia of bowel
    7. “Paralytic ileusâ€
    8. Perforated peptic ulcer (upper abdomen)


    “THUMBPRINTING†OF THE GASTROINTESTINAL TRACT (MULTIPLE INTRAMURAL DEFECTS)

    1. Crohn’s disease
    2. Diverticulitis
    3. Ischemic colitis with hemorrhage into bowel wall
    4. Ulcerative colitis


    B.U.L.L.’S EYE LESION (SOLITARY OR MULTIPLE NODULES IN THE GASTROINTESTINAL TRACT WITH LARGE CENTRAL ULCERATION)

    1. Gastrointestinal stromal tumor (esp. leiomyoma; leiomyosarcoma; neurofibroma)
    2. Lymphoma
    3. Metastatic melanoma
    4. Peptic ulcer

    STRUCTURES THAT SONOGRAPHICALLY MIMIC THE GALLBLADDER

    1. Abscess (esp. near ligamentum teres)
    2. Choledochal cyst
    3. Dilated cystic duct remnant
    4. Fluid-filled duodenal bulb
    5. Hepatic cyst
    6. Omental cyst
    7. Renal cyst


    LIVER LESION CHARACTERIZED BY B.U.L.L.’S EYE APPEARANCE

    1. Fungus disease (e.g., candidiasis, usually in immunocompromised individual); other opportunistic infections
    2. Kaposi sarcoma
    3. Lymphoma; leukemia
    4. Metastasis
    5. Sarcoidosis
    6. Septic emboli


    DAMPING OF HEPATIC VEIN DOPPLER WAVEFORM (US)

    1. Budd-Chiari syndrome
    2. Cirrhosis
    3. Extrinsic compression of hepatic veins
    4. Passive hepatic congestion
    5. Various parenchymal abnormalities of liver


    ALTERATION IN DENSITY OF THE MESENTERIC FAT ON CT (“Misty Mesenteryâ€)

    1. Hemorrhage (e.g., trauma)
    2. Inflammation (e.g., Crohn’s disease)
    3. Lymphedema
    4. Mesenteric edema
    5. Neoplasm, e.g., carcinomatosis; mesothelioma (esp. after chemotherapy)
    6. Retractile mesenteritis (chronic fibrosing mesenteritis; mesenteric lipodystrophy; panniculitis; Weber- Christian disease)


    “PSEUDOKIDNEY†OR “B.U.L.L.’S EYE†SIGN IN THE ABDOMEN (US)

    1. Gastroesophageal junction
    2. Hypertrophic pyloric stenosis
    3. Inflammatory bowel disease with wall thickening (e.g., amebiasis; Crohn’s disease; diverticulitis; Whipple’s disease)
    4. Intussusception (multiple concentric rings)
    5. Malignant neoplasm with thickening of bowel wall (e.g., carcinoma; lymphoma; leiomyosarcoma; metastasis to serosa)
  4. Live2serve.

    Live2serve. Guest

    BLADDER CANCER

    BLADDER CANCER

    90% develop in the bladder
    8% in the renal pelvis

    Median age at diagnosis is 65 years.

    EPIDEMIOLOGY

    Cigarette smoking
    Aniline dyes
    Phenacetin
    External beam radiation
    Chronic cyclophosphamide exposure increases risk nine-fold.
    Diets rich in meat and fat
    Schistosoma haematobium

    Pathology

    90 to 95% of bladder tumors diagnosed are transitional cell tumors

    Adenocarcinomas develop primarily in the urachal remnant in the dome of the bladder or in the periurethral tissues

    75% of tumors present as superficial lesions, 20% with muscle invasion, and 5% with metastatic disease

    Low-grade papillary lesions that grow on a central stalk are most common.

    Very friable,

    A tendency to bleed

    High risk for recurrence

    Carcinoma in situ (CIS) is a high-grade tumor that is considered a precursor of the more lethal muscle-infiltrating cancers.

    Rated by histologic type and grade.

    PATHOGENESIS

    Multicentric nature

    Primary chromosomal aberration
    Secondary changes associated with progression
    9q deletions are an early event in cancer development
    3p and 5q deletions were more prevalent in invasive
    Deletions of 17p (TP53 locus), 18q (the DCC gene locus),
    RB gene locus on chromosome 13q24 were seen only in invasive disease
    Deletions of 3p and 11p occur in both superficial and invasive tumors
    p53 overexpression correlates with a higher probability of progression to


    CLINICAL PRESENTATION, DIAGNOSIS, AND STAGING

    Hematuria occurs in 80 to 90% of patients with exophytic tumors

    Irritative symptoms are more common for patients with in situ disease.

    Microscopic hematuria is more commonly of prostatic origin (25%),

    Hematuria

    Cytology, visualization of the urothelial tract by sonography or an intravenous pyelogram (IVP), and cystoscopy

    Screening has not been shown to confer a survival benefit

    Ureteral obstruction may result in flank pain or discomfort

    Endoscopic evaluation includes an examination under anesthesia to determine whether or not palpable

    A visual inspection is then carried out and a cystoscopic map completed that includes the size, location, and number of lesions and their growth pattern (solid vs. papillary)

    Random biopsies of "normal" mucosal areas are conducted to assess for a field defect.

    Positive cytology and no apparent tumor within the bladder, selective catheterization of the ureter is required with retrograde examination to evaluate for upper tract disease.

    Distal metastases are assessed by CT of the abdomen, pulmonary x-rays, or radionuclide imaging of the skeleton.

    TREATMENT

    Based on the extent and depth

    Management of a tumor that has not invaded the bladder wall is a complete endoscopic resection with or without intravesical therapy

    Recurrences are seen in 50% or more of cases,

    Number of lesions, the depth of invasion, and whether or not CIS is present. Solitary papillary lesions are generally treated by surgery alone. Intravesical therapy is usually recommended for recurrent disease.

    CIS frequently follows a more aggressive course. As such, intravesical therapy is generally recommended earlier in the clinical course.

    Radical cystectomy

    Superficial Disease

    Intravesical treatments are advised for four or more recurrences in a given year
    40% involvement of the bladder surface
    Documented T1 disease
    Bacillus Calmette-Guerin (BCG)
    Thiotepa, doxorubicin, mitomycin-C, and interferon
    Dysuria, frequency, and, depending on the drug, myelosuppression or a contact dermatitis (from mitomycin C)
    Significant BCG toxicities occur in 6% of patients.
    Successful treatment of tumors in the bladder is an increase in the frequency of extravesical recurrences

    Muscle-Infiltrating Disease

    Radical cystectomy is considered the standard treatment, although in selected cases bladder-sparing approaches using an aggressive endoscopic resection, partial cystectomy, or a combined modality approach with resection, systemic chemotherapy, and external beam radiation therapy are used.

    Radical cystectomy
    Evaluation of the pelvic lymph nodes, removal of the primary tumor, and creation of a conduit or reservoir for urinary flow
    Bladder, prostate, seminal vesicles, proximal vas deferens, and proximal urethra, with a margin of adipose tissue and peritoneum
    Females the procedure includes removal of the bladder, urethra, uterus, fallopian tubes, ovaries, anterior vaginal wall, and surrounding fascia
    A uretero-ileal conduit probably is the most widely used
    Hypochloremic acidosis, hyperkalemia, hyponatremia, and uremia has been described when a segment of jejunum is utilized
    Patients with ureterosigmoid diversion require periodic colonoscopy because of the risk of cancer.
    Cystectomy is major surgery, and appropriate medical clearance is essential.
    This procedure can be considered when a lesion develops on the dome of the bladder where a 2-cm margin can be achieved, CIS is absent in other sites of the bladder, and bladder capacity is adequate after the tumor is removed.
    Indications for cystectomy
    Muscle-invading tumors not suitable for segmental resection;
    Low-stage tumors unsuitable for conservative management due to, for example, multicentric and frequent recurrences resistant to intravesical instillations;
    High grade tumors (T1G3) associated with CIS or bladder symptoms such as frequency or hemorrhage rendering the patient a "bladder cripple."

    Metastatic Disease

    Cisplatin, paclitaxel, and gemcitabine are considered most active
    VAC (methotrexate, vinblastine, doxorubicin, and cisplatin), PT (cisplatin and paclitaxel)
    VAC is considered standard but can be associated with significant toxicities
  5. Live2serve.

    Live2serve. Guest

    PANCREATIC CANCER

    PANCREATIC CANCER

    INCIDENCE AND ETIOLOGY

    More common in males
    Blacks
    Rarely develops before the age of 50.

    Risk factors:
    Cigarette smoking
    Chronic pancreatitis
    Long-standing diabetes mellitus
    Obesity

    Not risk factors:
    Alcohol abuse
    Cholelithiasis
    Coffee consumption

    Mutations:
    K-ras
    p16INK4
    Chromosome 9p21

    CLINICAL FEATURES

    Ductal adenocarcinomas
    90%
    Islet cell tumors
    5 to 10%.
    Pancreatic head (70% of cases)

    Exception of jaundice

    Pain
    Gnawing, visceral quality,
    Occasionally radiating from the epigastrium to the back.
    Severe problem in lesions arising in the body or tail of the gland
    Improves somewhat when the patient bends forward

    Retroperitoneal invasion and infiltration of the splanchnic nerves,
    Indicates that the primary lesion is advanced and is not surgically resectable.

    Transient and associated with hyperamylasemia,

    The weight loss observed in most patients is primarily the result of anorexia,

    Jaundice

    Biliary obstruction
    80% of patients having tumors in the pancreatic head and is typically accompanied by dark urine

    Claylike appearance of stool; pruritus

    Contrast to the "painless jaundice"

    Although the gallbladder is usually enlarged in patients with carcinoma of the head of the pancreas, it is palpable in 50% (Courvoisier's sign).

    Glucose intolerance
    Within 2 years of the clinical diagnosis

    Migratory thrombophlebitis (Trousseau's syndrome),

    Gastrointestinal hemorrhage from varices due to compression of the portal venous system by tumor, and splenomegaly caused by cancerous encasement of the splenic vein

    DIAGNOSTIC PROCEDURES

    Carcinoembryonic antigen (CEA)

    CA 19-9,

    Ultrasound should be performed to visualize the gallbladder and the pancreas, as well as upper gastrointestinal contrast radiographs to rule out a hiatal hernia or a peptic ulcer.

    CT scan should be considered
    CT is technically simpler,
    False-positive results occur in about 5 to 10% of case

    Magnetic resonance imaging (MRI)
    Not been shown to be better than CT in the evaluation of pancreatic lesions.

    Endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic ultrasonography (EUS) may clarify the cause of ambiguous CT or ultrasound findings

    Selective and superselective angiography
    Angiography is an effective means of detecting carcinomas in the body and tail of the pancreas by the demonstration of vascular narrowing, displacement, or occlusion by tumor.

    Angiography is being replaced as a diagnostic and staging procedure by spiral CT scanning with contrast imaging.

    Histologic confirmation of pancreatic cancer is mandatory

    Percutaneous needle aspiration biopsy of the pancreas with CT or ultrasonographic guidance

    TREATMENT

    Complete surgical resection of pancreatic tumors offers the only effective treatment for this disease

    Mortality rates of 15%
    The 5-year survival rate following such operations is only 10%.

    The risk for tumor recurrence is not affected by the type of operative procedure i.e., total pancreatectomy versus pancreaticoduodenectomy ("Whipple resection") but it is increased by the presence of lymph node metastases or tumor invasion into adjacent viscera

    Pancreaticoduodenectomy or distal pancreatectomy seems preferable

    Median survival for patients whose pancreatic cancers are surgically unresectable is 6 months

    Nonoperative biliary decompression by endoscopic or percutaneous, transhepatic biliary drainage or surgical biliary bypass.

    External beam radiation

    Unresectable tumors that have not spread beyond the pancreas does not appear to prolong survival,
    Addition of chemotherapy with fluorouracil (5-FU) to external beam irradiation has increased the survival time for these patients

    5-FU acts as a radiosensitizing agent

    Intraoperative radiation therapy has the potential to deliver higher doses of radiation to the tumor while sparing neighboring tissues but does not give better results than external beam treatment.

    Chemotherapy with Gemcitabine
  6. Live2serve.

    Live2serve. Guest

    STAGING OF VARIOUS CANCERS..... CA ENDOMETRIUM

    STAGING OF VARIOUS CANCERS.....


    CA ENDOMETRIUM
    Staging:
    • The International Federation of Gynecology and Obstetrics (FIGO) staging system for carcinoma of corpus uteri is as follows:
    o Stage IA - Tumor limited to endometrium
    o Stage IB - Invasion to less than one half the myometrium
    o Stage IC - Invasion to more than one half the myometrium
    o Stage IIA - Endocervical glandular involvement only
    o Stage IIB - Cervical stromal invasion
    o Stage IIIA - Tumor invades serosa and/or adnexa and/or positive peritoneal cytology
    o Stage IIIB - Vaginal metastasis
    o Stage IIIC - Metastases to pelvic and/or para-aortic lymph nodes
    o Stage IVA - Tumor invasion of bladder and/or bowel mucosa
    o Stage IVB - Distant metastases including intra-abdominal and/or inguinal lymph nodes
    • Cases of carcinoma of the corpus should be classified (or graded) according to the degree of histologic differentiation. The histopathology and degree of differentiation is as follows:
    o Class G1 - Nonsquamous or nonmorular solid growth pattern of 5% or less
    o Class G2 - Nonsquamous or nonmorular solid growth pattern of 6-50%
    o Class G3 - Nonsquamous or nonmorular solid growth pattern of more than 50%

    ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
    CA VAGINA
    TNM definitions
    The definitions of the T categories correspond to the several stages accepted by FIGO.
    Primary tumor (T)
    TX: Primary tumor cannot be assessed
    T0: No evidence of primary tumor
    Tis 0: Carcinoma in situ
    T1 I: Tumor confined to vagina
    T2 II: Tumor invades paravaginal tissues but not to pelvic wall
    T3 III: Tumor extends to pelvic wall
    T4* IVA: Tumor invades mucosa of the bladder or rectum and/or extends beyond
    the true pelvis ([bleep] edema is not sufficient evidence to
    classify a tumor as T4.)
    *Note: If the bladder mucosa is not involved, the tumor is Stage III.
    Regional Lymph Nodes (N)
    NX: Regional nodes cannot be assessed
    N0: No regional lymph node metastasis
    N1: Pelvic or inguinal lymph node metastasis
    Distant metastasis (M)
    MX: Distant metastasis cannot be assessed
    M0: No distant metastasis
    M1: Distant metastasis



    Stage
    ________________________________________

    0 Carcinoma in situ
    I Carcinoma limited to vaginal wall
    II Carcinoma involves subvaginal tissue but has not extended to pelvic wall
    III Carcinoma extends to pelvic wall
    IV Carcinoma extends beyond true pelvis or involves mucosa of bladder or rectum





    --------------------------------------------------------------------------------------------------------------------------------------------------------------CA CERVIX

    Histological staging:
    • 0 - CIN III (carcinoma in situ)
    • IA - microinvasive carcinoma
    • Stage 0 - carcinoma in situ
    • Stage 1 - the cancer is just in the neck of the womb
    • Stage 2 - the cancer has begun to spread around the neck of the womb
    • Stage 3 - the cancer has spread into the pelvis
    • Stage 4 - the cancer has spread into other body organs
    AJCC TNM staging classification 1
    The primary tumor (T) is staged in the following way:
    • TX. Primary tumor cannot be assessed.
    • T0. No primary tumor is seen.
    • Tis (Carcinoma in situ). The cancer is found only in one area of the cervix and only in a few layers of cells. This type of cervical cancer is called carcinoma in situ.
    • T1. Cervical carcinoma is only found in the uterus.
    o T1a. Invasive carcinoma diagnosed by microscopy with stromal invasion is no more than 5 mm in depth and 7 mm wide.
     T1a1. Stromal invasion is 3 mm or less in depth and 7 mm or less in width. This is also called microinvasive carcinoma.
     T1a2. Stromal invasion is between 3 mm and 5 mm in depth and 7 mm or less in width.
     T1b. Visible tumor only on the cervix or by microscopy is larger than 5 mm in depth and 7 mm wide.
     T1b1. Visible tumor is 4 cm (1.6 in.) or less in size.
     T1b2. Visible tumor is more than 4 cm (1.6 in.) in size.
    • T2. Cancer invades beyond the uterus but not the pelvic wall or the lower third of the vagina.
    o T2a. Tumor does not involve the connective tissue (parametrium) around the uterus.
    o T2b. Tumor does extend into the parametrium around the uterus.
    • T3. The tumor extends to the pelvic wall or involves the lower third of the vagina or causes an obstructed kidney that forms a cyst or a nonfunctioning kidney.
    o T3a. Tumor involves lower third of vagina but no extension into the pelvic wall.
    o T3b. Tumor extends to pelvic wall or causes an obstructed kidney or nonfunctioning kidney.
    • T4. Tumor invades the lining of the bladder or rectum, or extends beyond the pelvis.
    o M1. Distant metastasis: The cancer has spread to distant parts of the body.
    After the tumor (T) is staged, the TNM system stages lymph node involvement (N) to help determine the treatment options at each stage. Lymph node involvement is staged in the following way:
    • NX. Lymph nodes near the primary tumor cannot be evaluated.
    • N0. Cancer has not spread to lymph nodes near the primary tumor.
    • N1. Cancer has spread to lymph nodes near the primary tumor.
    The last part of staging cervical cancer is to determine whether cancer has spread to other parts of the body (metastasized). The TNM system stages metastasis (M) in the following way:
    • MX. Distant metastasis cannot be assessed.
    • M0. No distant metastasis is found.
    • M1. Metastasis to another part of the body has occurred.
    Medical Care: The treatment of cervical cancer varies with the stage of the disease. For early invasive cancer, surgery is the treatment of choice. In more advanced cases, radiation combined with chemotherapy is the current standard of care. In patients with disseminated disease, chemotherapy or radiation provides symptom palliation.
    • Stage 0: Treatment options for stage 0 cancer include loop electrosurgical excision procedure (LEEP), laser therapy, conization, and cryotherapy.
    • Stage IA: The treatment of choice for stage IA disease is surgery—total hysterectomy, radical hysterectomy, and conization are accepted procedures. Intracavitary radiation is an option for selected patients.
    • Stage IB or IIA
    o For patients with stage IB or IIA disease, treatment options are either combined external beam radiation with brachytherapy or radical hysterectomy with bilateral pelvic lymphadenectomy.
    o Most retrospective studies have shown equivalent survival rates for both procedures, although such studies usually are flawed due to patient selection bias and other compounding factors. However, a recent randomized study showed identical overall and disease-free survival rates.
    o Quality-of-life data, particularly in the psychosexual area, is relatively scant.
    o Postoperative radiation to the pelvis decreases the risk of local recurrence in patients with high-risk factors (positive pelvic nodes, positive surgical margins, and residual parametrial disease).
    o A recent randomized trial showed that patients with parametrial involvement, positive pelvic nodes, or positive surgical margins benefit from a postoperative combination of cisplatin-containing chemotherapy and pelvic radiation.
    • Stage IIB-IVA
    o For locally advanced cervical carcinoma (stages IIB, III, and IVA), radiation therapy was the treatment of choice for many years. However, the results from large randomized clinical trials demonstrated a dramatic improvement in survival with the combined use of chemotherapy and radiation.
    o For treatment with radiation alone, 5-year survival rates reportedly are 65-75%, 35-50%, and 15-20% for stages IIB, III, and IVA, respectively.
    o Radiation therapy begins with a course of external beam radiation to reduce tumor mass to enable subsequent intracavitary application. Brachytherapy is delivered using afterloading applicators that are placed in the uterine cavity and vagina.
    o The results of prospective, randomized, well-conducted studies of concurrent chemoradiation changed the standard of care in this group of patients.
    o In the Radiation Therapy Oncology Group trial, 403 patients with bulky IB and IIB-IVA cancers were randomized to either radiotherapy to a pelvic and paraaortic field or pelvic radiation with concurrent cisplatin and fluorouracil. Rates of both disease-free survival and overall survival were significantly higher in the group that received combination treatment.
    o Rose and associates conducted a Gynecologic Oncology Group (GOG) trial for patients with stage IIB, III, or IVA cancer, comparing the combination of radiation with 3 different chemotherapy regimens (cisplatin alone, cisplatin/5-fluorouracil/hydroxyurea, and hydroxyurea alone). Overall survival rates were significantly higher in the 2 groups that received cisplatin-containing regimens.
    o In another GOG trial, patients with bulky stage IB disease were randomized to either radiation alone or a combination of weekly cisplatin and radiation. All patients had adjuvant hysterectomy. Both disease-free survival and overall survival rates were significantly higher in the combined-therapy group at 4 years of follow-up.
    o Based on the aforementioned study results, using cisplatin-based chemotherapy in combination with radiation for patients with locally advanced cervical cancer represents the standard of care.
    • Stage IVB and recurrent cancer
    o These patients are treated with chemotherapy. For many years, single agent cisplatin represented the standard of care. Recently, the combined use of cisplatin and topotecan was shown to significantly improve survival compared with single-agent cisplatin.
    o Palliative radiation is often used individually to control bleeding, pelvic pain, or urinary or partial large bowel obstructions from pelvic disease.
    o Total pelvic exenteration may be considered in patients with an isolated central pelvic recurrence.
    Surgical Care:
    • Carcinoma in situ (stage 0) is treated with local ablative measures such as cryosurgery, laser ablation, and loop excision.
    o Hysterectomy should be reserved for patients with other gynecologic indications to justify the procedure.
    o After local treatment, these patients require lifelong surveillance.
    o Palliative radiation often is used individually to control bleeding, pelvic pain, or urinary or partial large bowel obstructions from pelvic disease.
    o Invasive procedures such as nephrostomy or diverting colostomy sometimes are performed in this group of patients to improve their quality of life.
    o Special effort should be made to ensure comprehensive palliative care, including adequate pain control for these patients.
    • The standard treatment for microinvasive disease (stage IA) is total hysterectomy.
    o Lymph node dissection is not required if the depth of invasion is less than 3 mm and no lymphovascular invasion is noted.
    o Selected patients with stage IA1 disease but no lymphovascular space invasion who desire to maintain fertility may have a therapeutic conization with close follow-up, including cytology, colposcopy, and endocervical curettage.
    o Patients with medical comorbidities who are not surgical candidates can be successfully treated with radiation.

    -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
    CA UTERUS


    Table 1. Staging of Cancer of the Uterine Corpus
    Stage Characteristics
    Stage I (grade 1, 2, or 3)* IA Limited to the endometrium
    IB Invasion of less than one half of the myometrium
    IC Invasion of one half or more than one half of the myometrium
    Stage II (grade 1, 2, or 3) IIA Endocervical glandular involvement only
    IIB Cervical stromal invasion
    Stage III (grade 1, 2, or 3) IIIA Invades serosa and/or adnexa and/or positive peritoneal cytology
    IIIB Vaginal metastases
    IIIC Metastases to pelvic and/or para-aortic lymph nodes
    Stage IV (grade 1, 2, or 3) IVA Invasion of bladder and/or bowel mucosa
    IVB Distant metastases, including intra-abdominal metastases and/or inguinal lymph nodes
    *Tumor confined to the uterine corpus
    Most endometrial cancers are diagnosed as stage I tumors. In fact, most endometrial cancer can be cured with surgery alone, and relatively few patients need adjuvant radiotherapy. In the past, surgery and radiation therapy were both used as primary therapy. Now, survival rates with surgery are known to be 15-20% better than with primary radiation therapy. Thus, primary radiation therapy is reserved only for patients who are poor surgical candidates or for those with unresectable disease.
    Like endometrial cancer, primary surgical therapy is the first step in treatment of uterine sarcomas. In fact, these tumors are often found at the time of surgery for benign indications such as uterine leiomyomata and dysfunctional uterine bleeding, or they are found postoperatively. Approximately 1 of every 2000 women older than 40 years who are undergoing a hysterectomy for uterine leiomyomata have LMS on final pathologic diagnosis.
    T — Primary tumour 1,2
    TNM FIGO
    Categories Stages
    TX Primary tumour cannot be assessed
    T0 No evidence of primary tumour
    Tis 0 Carcinoma in-situ (preinvasive carcinoma)
    T1 I Cervical carcinoma confined to uterus (extension to corpus should be disregarded)
    T1a IA Invasive carcinoma diagnosed only by microscopy. All macroscopically visible lesions — even with superficial invasion — are T1b/Stage IB
    T1a1 IA1 Stromal invasion no greater than 3.0 mm in depth and 7.0 mm or less in horizontal spread
    T1a2 IA2 Stromal invasion more than 3.0 mm and not more than 5.0 mm with a horizontal spread 7.0 mm or less

    Note: The depth of invasion should not be more than 5 mm taken from the base of the epithelium, either surface or glandular, from which it originates. The depth of invasion is defined as the measurement of the tumour from the epithelial-stromal junction of the adjacent most superficial epithelial papilla to the deepest point of invasion. Vascular space involvement, venous or lymphatic, does not affect classification.
    T1b IB Clinically visible lesion confined to the cervix or microscopic lesion greater than T1a2/IA2
    T1b1 IB1 Clinically visible lesion 4.0 cm or less in greatest dimension
    T1b2 IB2 Clinically visible lesion more than 4 cm in greatest dimension
    T2 II Tumour invades beyond uterus but not to pelvic wall or to lower third of the vagina
    T2a IIA Without parametrial invasion
    T2b IIB With parametrial invasion
    T3 III Tumour extends to pelvic wall, involves lower third of vagina, or causes hydronephrosis or non-functioning kidney
    T3a IIIA Tumour involves lower third of vagina, no extension to pelvic wall
    T3b IIIB Tumour extends to pelvic wall or causes hydronephrosis or non-functioning kidney
    T4 IVA Tumour invades mucosa of bladder or rectum or extends beyond true pelvis

    Note: The presence of [bleep] oedema is not sufficient to classify a tumour as T4.
    M1 IVB Distant metastasis


    N - Regional Lymph Nodes3
    NX Regional lymph nodes cannot be assessed
    N0 No regional lymph node metastasis
    N1 Regional lymph node metastasis


    M - Distant Metastasis
    MX Distant metastasis cannot be assessed
    M0 No distant metastasis
    M1 Distant metastasis


    Stage grouping
    Stage 0 Tis N0 M0
    Stage IA T1a N0 M0
    Stage IA1 T1a1 N0 M0
    Stage IA2 T1a2 N0 M0
    Stage IB T1b N0 M0
    Stage IB1 T1b1 N0 M0
    Stage IB2 T1b2 N0 M0
    Stage IIA T2a N0 M0
    Stage IIB T2b N0 M0
    Stage IIIA T3a N0 M0
    Stage IIIB T1, T2, T3a N1 M0
    T3b Any N M0
    Stage IVA T4 Any N M0
    Stage IVB Any T Any N M1
  7. Guest

    Guest Guest

    Skin conditions--Acne vulgaris

    Skin conditions

    The list is in the following order:

    Diagnosis
    Common Distribution
    Usual Morphology

    1. Acne vulgaris
    Face, upper back
    Open and closed comedones, erythematous papules, pustules, cysts


    2. Rosacea
    Blush area of cheeks, nose, forehead, chin
    Erythema, telangectasias, papules, pustules


    3. Seborrheic dermatitis
    Scalp, eyebrows, perinasal areas
    Erythema with greasy yellow-brown scales


    4. Atopic dermatitis
    Antecubital and popliteal fossae
    Patches and plaques of erythema, scaling and lichenification; pruritus



    5. Stasis dermatitis
    Ankles, lower legs
    Patches of erythema and scaling on background of hyperpigmentation associated with signs of venous insufficiency


    6. Dyshidrotic eczema
    Palms, soles, sides of fingers and toes
    Deep vesicles

    7. Allergic contact dermatitis
    Anywhere
    Localized erythema, vesicles, scales and pruritus


    8. Psoriasis
    Elbows, knees, scalp, lower back, fingernails
    Papules and plaques, covered with silvery scales, pitted nails
    Signs:
    - Candle Grease Sign (Tache de Bouge)
    - Auspitz Sign
    - Koebner’s Phenomenon*

    9. Lichen planus
    Wrists, ankles, mouth
    Violaceous flat-topped papules and plaques


    10. Melasma
    Forehead, cheeks, temples, upper lip
    Tan to brown patches


    11. Vitiligo
    Periorificial, trunk, extensor surfaces of extremities, flexor wrists, axillae
    Chalk-white macules


    12. Actinic keratosis
    Sun-exposed areas
    Skin-coloured or red-brown macule or papule with dry, rough, adherent scale


    13. Basal cell carcinoma
    Face
    Papule with pearly, telangiectatic border on sun-damaged skin

    14. Squamous cell carcinoma
    Face, especially lower lip, ears
    Indurated and possibly hyperkeratotic lesions often showing ulceration and/or crusting


    15. Seborrheic keratosis
    Trunk, face
    Brown plaques with adherent greasy scale; “stuck on” appearance

    16.Folliculitis
    Any hair-bearing area
    Follicular pustules


    17. Impetigo
    Anywhere
    Papules, vesicles, pustules, often with honey-coloured crusts


    18.Herpes simplex
    Lips, genitalia
    Grouped vesicles progressing to crusted erosions


    19. Herpes zoster
    Dermatomal, usually trunk but may be anywhere
    Vesicles limited to a dermatome (often painful)


    20. Varicella
    Face, trunk
    Lesions arise in crops and quickly progress from erythematous macules to papules to vesicles to pustules to crusts


    21. Pityriasis rosea
    Trunk (Fir tree pattern) herald patch followed by multiple smaller lesions
    Symmetric erythematous patches with a collarette of scales

    22. Tinea versicolor
    Chest, back, abdomen, proximal extremities
    Scaly hyper- or hypopigmented macules


    23. Candidiasis
    Groin, inframammary, vagina, oral cavity
    Erythematous macerated areas with satellite pustules; white friable patches on mucosa


    24. Scabies
    Groin, axillae, between fingers and toes, inframammary
    Excoriated papules, burrows, pruritus

    25. Keloid
    Any site of previous injury
    Firm tumor, pink, purple or brown


    26. Dermatofibroma
    Anywhere
    Firm red to brown nodule that shows dimpling of overlying skin with lateral compression


    27. Acrochordons (Skin tags)
    Groin, axilla, neck
    Fleshy papules

    28. Urticaria
    Anywhere
    Wheals, sometimes with surrounding flare; pruritus


    29. Xerosis
    Extensor extremities, especially legs
    Dry, erythematous, scaling patches; pruritus


    * Koebner’s Phenomenon is also seen in Warts and Lichen Planus.


    30. Dermatitis Herpetiformis
    # Also known as Duhring's Disease.
    #Associated with Coeliac Sprue.
    Elbows, knees, back, and buttocks (pressure points)
    Itchy rash consisting of Papules and Vesicles

    There are three types of Pemphigus which vary in severity:

    1. Pemphigus Vulgaris
    2. Pemphigus Foliaceus
    3. Paraneoplastic pemphigus

    Pemphigus Vulgaris:

    The most common form.
    It occurs when antibodies attack Desmoglein 3, a protein that keeps cells bound together. Thus, cells simply fall apart, causing skin to slough off.
    Most common in the middle aged and elderly. Sores often originate in the mouth.

    Pemphigus Foliaceus:

    Least severe.
    Desmoglein 1, the protein that is destroyed by the body's immune system is only found in the top dry layer of the skin, so mouth sores do not occur.
    Characterized by crusty sores that often begin on the scalp, and may move to the chest, back, and face.


    Paraneoplastic pemphigus:

    Least common and most severe type.
    This disorder is usually found in conjunction with an already-existing malignancy.
    Very painful sores appear on the mouth, lips, and the esophagus.
    The disease process often involves Bronchiolitis obliterans, a fatal destruction of alveoli in lung tissue.
  8. Live2serve

    Live2serve Guest

    Cycles and their Rate Limiting Enzymes:

    Cycles and their Rate Limiting Enzymes:

    Glycolysis: Phosphofructokinase

    Glycogenesis: Glycogen Synthase

    Glycogenolysis: Phosphorylase

    Gluconeogenesis:
    Pyruvate Carboxylase
    Fructose 1,6 Bisphosphatase

    Fatty Acid Synthesis: Acetyl CoA Carboxylase

    Bile Acid Synthesis: 7 α Hydroxylase

    Cholesterol Synthesis: HMG CoA Reductase

    Uric Acid Synthesis: Xanthine Oxidase

    Ketone Body Synthesis: HMG CoA Synthetase

    Urea Cycle: Carbamoyl Phosphate Synthase

    Hemoglobin Synthesis: ALA Synthetase (δ-aminolaevulinic acid)

    Catecholamine Synthesis: Tyrosine Hydroxylase (Tyrosine→Dopa)
  9. Live2serve

    Live2serve Guest

    Radiosensitivity of Tumors:

    Radiosensitivity of Tumors:

    Highly Sensitive:

    Seminoma / Dysgerminoma
    Lymphoma
    Myeloma
    Ewing’s Sarcoma
    Wilm’s Tumor


    Moderately Sensitive:

    Small cell lung carcinoma
    Ca Breast
    Teratoma
    Ca Ovary
    BCC
    Medulloblastoma
    Nasopharyngeal carcinoma


    Relatively Resistant:

    SCC Lung
    Renal Cell Carcinoma
    Ca Rectum / Ca Colon
    Ca Bladder
    Soft tissue sarcoma
    Ca Cervix


    Highly Resistant:

    Melanoma
    Osteosarcoma
    Ca Pancreas
    Hepatoma
  10. Live2serve

    Live2serve Guest

    TRIPLE TEST---->

    TRIPLE TEST---->best-done b/w 16-20 weeks. MS-AFP, hCG, and estriol. Generally results go as follows: in Trisomy 21, MS-AFP and estriol are decreased but hCG is increased. For Trisomy 18, all three markers are decreased. and in neural tube defects, MS-AFP is increased, the rest are decreased.

    Triple + Sr. inhibin= Quadruple test

    Adson's test ---a test for thoracic outlet syndrome;
    The patient is seated, with head extended and turned to the side of the lesion; with deep inspiration there is a diminution or total loss of radial pulse on the affected side. Syn: Adson maneuver.

    Allen’s test--- To test the integrity of palmer arch.

    Ascoli's test ----a precipitin test for anthrax using a tissue extract and anthrax antiserum.

    Bárány's caloric test = a test for vestibular function, made by irrigating the external auditory meatus with either hot or cold water; this normally causes stimulation of the vestibular apparatus, resulting in nystagmus and past-pointing; in vestibular disease, the response may be reduced or absent. Syn: caloric test, nystagmus tests.

    Bender gestalt test = a psychological test to measure a person's ability to visually copy a set of geometric designs; useful for measuring visuospatial and visuomotor coordination to detect brain damage. Syn: Bender Visual Motor Gestalt test.

    Benzidine test = a test for blood; the suspected fluid is treated with glacial acetic acid and ether, and the latter is then decanted and treated with hydrogen peroxide and a solution of benzidine in acetic acid; the presence of blood is indicated by a bluish color turning to purple. Syn: Adler's test.

    Benedict's test for glucose

    Bettendorff's test
    a test for arsenic

    Marshall test
    stress urinary incontinence. Syn: Bonney test, Marshall-Marchetti test.

    Breath-holding test
    a rough index of cardiopulmonary reserve measured by the length of time that a subject can voluntarily stop breathing; normal duration is 30 seconds or more; diminished cardiac or pulmonary reserve is indicated by a duration of 20 seconds or less.

    CAMP test
    a test to identify Group B beta-streptococci based on their formation of a substance (CAMP factor) that enlarges the area of HEMOLYSIS formed by streptococcal beta-hemolysin.

    Capillary fragility test
    a tourniquet test used to determine presence of vitamin C deficiency or thrombocytopenia; a circle 2.5 cm in diameter, the upper edge of which is 4 cm below the crease of the elbow, is drawn on the inner aspect of the forearm, pressure midway between the systolic and diastolic blood pressure is applied above the elbow for 15 minutes, and a count of petechiae within the circle is made: 10, normal; 10 to 20, marginal zone; over 20, abnormal. See Also: Rumpel-Leede test. Syn: capillary resistance test, vitamin C test.
  11. R.dass

    R.dass Guest

    A 32 y lady is afraid to go out whenever she is out she comes running and gasping and locks her doors after reaching home otherwise she is normal in home
    what is the single most appropriate mangement option
    a inform social services
    b imipramine
    c refer to a dietician
    d counseling
    e refer to psychiatrist

    Answer: e.

    A 40 y lady is recovering from hystrectomy 2 days ago at night she becomes agitated and complains of seeing animals and children walking around the ward what is the dx
    a paraphernia
    b mania
    c drug induced
    d toxic confusional state
    e personality disorder

    Answer : C.

    A 55y lady with mania associated with cyclic and frequent depressive features hat is the most single treatment

    a TCA
    b MAOI
    c reserpine
    d carbamazepin
    e NA valproate
    Answer: E.


    A 40 y old man with repeated episode of depressed mood in response to feeling rejected and craving for sweets and hypersomnia lethargy and incresed appeitite and carbohydrate
    a TCA
    b MAOI
    c reserpine
    d carbamazepine
    e NA valproate

    Answer: b.

    A 45y man with breathlessness you dignose pleural effusion ,on aspiraton u find esinophlia
    a asbestose pleural effusion
    b drug reaction
    c fungal infection
    d haemopneumothorax
    e malignant pleural effusion

    Answer: e.
  12. R.dass

    R.dass Guest

    multiple duodenal ulcers
    causes are all except
    1)tuberculosis
    2)sarcoidosis
    3)enteric fever
    4)crohns disease

    CAFE AU LAIT SPOTS:SEEN IN ALL EXCEPT
    1)FANCONI SYNDROME
    2)TUBEROUS SCLEROSIS
    3)ALPORTS SYNDROME
    4)MC CUNE ALBRIGHT SYNDROME

    generalised gall bladder wall thickening:causes are all except
    1)CHF
    2)BENIGN ASCITES
    3)HEPATITIS
    4)HEREDITARY SPHEROCYTOSIS

    obliterative bronchiolitis in bilateral lung transplantation patient : which is true
    1)no satisfactory treatment for reversal of this condition
    2)fibrosis can be reversed by increasing dose of steroids and immunosuppressants
    3)occurs in <5% of LT patients
    4)OB is manifestation of acute rejection
  13. Joseph.

    Joseph. Guest

    The graph showing relation b/n cervical dilatatn & duration of labour
    a.partogram
    b.cervicograph
    c.dilatatn chart
    Ans: a.

    CPD is best assessed by
    a.CT scan
    b.US
    c.radiopelvimetry
    d.bimanual examintn
    ans-a given


    THE MOST SENSITIVE METHOD FOR DETECTING CERVICAL CHLAMIDIA INFCTN
    a.direct fluorescent Ab test
    b.EIA
    c.PCR
    d.culture on irradiated MACKONKEY
    ans-a given

    Commonest type DUB
    a.secretory
    b.hyperplastic
    c.proliferative
    d.mixed

    ans-C given

    The best way 2 treat decubitus ulcer
    a.bed rest
    b.antibiotics
    c.antiseptic dressing
    d.reductn vt tampoon

    ans-D given
  14. Dr.Shiva.

    Dr.Shiva. Guest

    INFECTIOUS DISEASE

    1. which one of the following infection is transmitted by the route stated below?
    A. Meningococcal inf- feacal-oral spread
    B. Legionellosis- faecal-oral spread
    C. Giardiasis- faecal-oral spread
    D. Listeosis- airborne
    E. Gonococcal inf- transplacental

    2. Which one of these diagnostic techniques is clinically useful in the following infections?
    A. Gastric aspirate microscopy- Entamoeba histolytica
    B. Stool culture- pneumocystis carinii
    C. Bone marrow culture- streptococcus pneumoniae
    D. Rising titre of IgM antibodies- histoplasma capsulatum

    3. Which one of the following is contraindication to active immunization?
    A. Atopic disposition
    B. HIV inf if live vaccines are required
    C. Pregnancy if killed vaccines are required
    D. Chronic cardiac or respi failure
    E. F/o of allergy to vaccine

    4. In which one of the following infections is a live virus usually used for active immunization?
    A. Polio
    B. Pertussis
    C. Typhoid fever
    D. Hepatitis A
    E. Hepatitis B

    5. In which one of the following disorders is there an indication for passive immunization with human immunoglobulins?
    A. Hepatitis C
    B. Tetanus
    C. Influenza A
    D. Meningococcaemia
    E. Typhoid fever

    6. A 23 yr old student consults her GP with a history of painless diarrhoea lasting 5 days following her return from a holiday in north Africa. Which one of the following statements is true?
    A. Causative organism is unlikely to be identified from a stool culture
    B. Antibiotic t/t should be instituted after stool culture has been undertaken
    C. Antidiarrhoeal agents are particularly useful in children
    D. Ciprofloxacin therapy is of proven prophylactic benefit
    E. Doxycycline prophylaxis is advisable to all travelers to sub Saharan Africa.

    7. Which one of the following statements about HIV infections is true?
    A. An RNA retrovirus
    B. Transmission via drug abusers occur more often than by sexual transmission in UK
    C. There is no involvement of B lymphocytes
    D. The virus affects suppressor T lymphocytes more than helper T lymphocytes
    E. The presence of Kaposi’s sarcoma indicates a better prognosis

    8. Which one of the following statements about HIV infection is true?
    A. 80% of vertically transmitted infections are transplacental
    B. A child born to an infected mother has a 90% chance of acquiring HIV
    C. Transmission can occur via breast milk
    D. Risk of fetal transmission is unaffected by prepartum antiviral agents
    E. Vertical transmission is the major mode of transmission worldwide

    9. Following unprotected sex 3 weeks ago, a 19 yr old girl consults her GP for an HIV test. Which one of the following statements is true?

    A. ELISA testing has a high false negative rate
    B. Seroconversion typically occurs in under 3 weeks
    C. A full blood count should be undertaken to check the lymhocyte count
    D. The virus can be readily cultured from saliva
    E. Serial testing is necessary to confirm the infection in some individuals

    10. In a patient with AIDS, cryptococcal meningitis is
    A. Less likely to be the cause of meningitis than meningococcal infection
    B. Characterized by abrupt onset of classical features of a bacterial meningitis
    C. Diagnosed by Indian ink stain of CSF
    D. Typically associated with an abnormal cerebral CT scan
    E. Typically associated with a high CSF polymorph count

    11. pneumocystis carinii infection in an HIV positive patient is
    A. The commonest cause of respi inf in African patients
    B. Characterized by copious sputum production
    C. Characterized by widespread fine pul crackles
    D. More likely to occur when the CD4 count is <200/mm3
    E. Excluded by the finding of normal chest xray

    12. A 16 yr old boy consults his GP with a fever and morbiliform rash and a history that is 3 yr old sister has measles. One of the following statements is true?
    A. Measles inf is due to a DNA myxovirus
    B. Rhinorrhoea and conjunctivitis occurs during the recovery phase of the illness
    C. Koplik’s spots appear at the same time as the skin rash
    D. The skin rash typically desquamates as it disappears
    E. The infectivity of measles is confined to the prodromal phase

    13. Which one of the following features is typical of mumps
    A. Infection with DNA myxovirus
    B. High infectivity for 3 weeks after the onset of parotitis
    C. Dev of an acute lymphocytic meningitis
    D. Abdo painis usually attributable to mesenteric adenitis
    E. Orchitis is usually B/L and predominantly occurs prepubertally

    14. Which one of the followinf features is a typical of Rabies?
    A. An enterovirus infection
    B. An incubation period of 4-8 days
    C. A good prognosis if symptoms develop slowly
    D. Encephalitis or ascending paralysis
    E. Active and passive vaccination are useful in prevention and therapy

    15. Which one of the following statements about helicobacter pylori(HP) infection is true?
    A. The diagnosis can be confirmed by decreased urease conc in the gastric mucosa
    B. The presence of oesophagitis indicates the need for HP eradication therapy
    C. HP eradication is enhanced by low gastric pH
    D. Amoxicillin plus metronidazole therapy is more effective than amoxicillin alone
    E. HP eradication reduces recurrence rates of duodenal ulcers but not gastric ulcers

    16. A middle aged woman is referred to a hospital with fever, abdo pain and diarrhoea. Which one of the following statements about Yersinia infection is true?
    A. Transmission of the infection is waterborne
    B. There is an association with exudative pharyngitis and enterocolitis
    C. There is an association with chronic ileitis
    D. Erythema marginatum is a characteristic occurrence
    E. There is likely to be a good clinical response to benzylpenicillin therapy

    17. Which one of the following clinical features is typical of Lassa fever?
    A. Endemic infection in south America
    B. Transmission via mosquito
    C. No useful response to any antiviral agents
    D. Acute liver failure is a recognized complication
    E. An incubation period of 3-6 weeks

    18. Which one of the following features is typical of yellow fever?
    A. A togavirus inf is transmitted by mosquito
    B. An incubation period of 3-6 weeks
    C. Peripheral blood leucocytosis is contrast to viral hepatitis
    D. Fever, headache and severe myalgia with bone pain
    E. Response to ribavirin drug therapy

    19. Which one of the following is characteristic of an influenza virus infection?
    A. Occurs exclusively in humans
    B. Low levels of antigenic shift
    C. Transmissible by oro-feacal route
    D. An incubation period of 5-7 days
    E. Infection complicated by Reye’s syndrome

    20. Which one of the following features is typical of RSV infection?
    A. Infection more common in adults than children
    B. Infection is best diagnosed by serology
    C. Infants are protected from infection due to maternally acquired antibodies
    D. Infection is typically associated with bronchiolitis
    E. Involvement of the lower urinary tract is characteristic

    21. A young man is admitted with right sided abdo pain and jaundice. Which one of the following features is most consistent with a diagnosis of leptospirosis?
    A. Incubation period of 1-2 months
    B. History of leisure pursuits involving inland waterways
    C. Absence of fever or constitutional symptoms
    D. Dev of meningitis suggests infection with Leptospira icterohaemorrhagiae
    E. Gram-positive rods seen on the blood film

    22. Which one of the following statements about syphilis is true?
    A. Infection is usually caused by Treponema pertenue
    B. Untreated, infectivity is restricted to first 2 months
    C. The distinction between early and late syphilis is made at 2 yrs
    D. The incubation period for primary syphilis is typically 6 months
    E. Tertiary syphilis usually develops within the first year after the initial infection

    23. A 60 yr old man consults his GP ,worried he may have contracted syphilis. Which one of the following statements about sec syphilis is true?
    A. Macular rash occurs 6 months after the appearance of a penile rash
    B. Wart like papules on the perineum suggests tertiary syphilis
    C. Generalized lymphadenopathy and oro-genital mucous ulceration
    D. CSF cytology is likely to demonstrate pleocytosis
    E. The presence of soft, early diastolic murmur indicates sec syphilis

    24. In a 28 yr old woman presenting with vaginal discharge, which one of the following features suggests an alternative diagnosis to that of gonorrhoea?
    A. An incubation period of 3-4 weeks
    B. Presence of urethritis
    C. Right hypochondrial pain
    D. A pustular haemorrhagic rash
    E. An acute monoarthritis of the knee joint

    25. Which one of the following statements about bacteraemic shock is true?
    A. Endotoxin initiates disseminated intravascular coagulation
    B. Peripheral vascular resistance remains normal throughout
    C. Acute circulatory failure is usually due to cardiac failure
    D. Leucocytosis and thrombocythaemia indicates a poor prognosis
    E. Antibiotic therapy should await bacteriological results

    26. In a patient presenting with a sore throat, diphtheria rather than streptococcal tonsillitis is suggested by which one of the following findings?

    A. Tender cervical lymphadenopathy
    B. Blood stained nasal discharge
    C. A tonsillar exudates that is easily removed with a spatula
    D. Normal movement of the soft palate
    E. Onset with a high fever and rigors

    27. A farm worker presents with a fever following laceration of his left shin. Which one of the following features most suggests the dev of tetanus?
    A. An incubation period of 2-3 days
    B. Muscular spasms typically starting in the masseters
    C. Convulsions associated with loss of consciousness
    D. Absence of abdominal muscle rigidity
    E. Bacteriological isolation of Clostridium tetani from the wound

    28. Which one of the following statements about the t/t of tetanus is true?
    A. Tetanus toxoid should be given iv as soon as possible
    B. Wound debridement should be undertaken prior to any other therapy
    C. Human anti tetanus immunoglobulin should be given immediately
    D. Diazepam should be avoided because of the hazards of oversedation
    E. Cephalosporin therapy is the antibiotic t/t of choice

    29. Following meal at a lcal restaurant, a 31 yr old woman is admitted with collapse. Which one of the following features most suggests botulism?
    A. Ingestion of infected material 2-4 hours prior to the onset of symptoms
    B. Onset with an acute gastroenteritis associated with postural hypotension
    C. Absence of autonomic nervous system involvement
    D. Bulbar palsy developing slowly over 10-14 days
    E. Dramatic clinical response to parenteral antitoxin

    30. Which one of the following features is typical of anthrax?
    A. Occupational exposure to fish products
    B. An incubation period of 1-3 weeks
    C. Painful lymphadenopathy
    D. Presentation with bronchopneumonia
    E. Multiple antibiotic resistance is common

    31. Which one of the following features is characteristic of leprosy?
    A. An incubation period of 3-6 weeks
    B. Growth of the organism on Lowenstien-jensen medium after 2-3 months
    C. Spread of tuberculoid form on prolonged patient contact
    D. Spontaneous healing of the earliest macule
    E. A cell mediated immune response in the lepromatous form

    32. Which one of the following features is characteristic of lepromatous leprosy?
    A. Absence of infectivity of affected patients
    B. Unlike the tuberculoid form organisms are scanty in number
    C. Blood-borne spread from the dermis throughout the body
    D. Strongly positive lepromin skin test
    E. Anaesthetic hypopigmented skin macules and plaques

    33. Which one of the following statements about life cycle of plasmodium is true?
    A. Sporozoites disappears from blood 3-7 days post infection
    B. Merozoites re-entering RBC undergo sexual but not asexual reproduction
    C. All plasmodium multiply in the liver but not in the RBC
    D. Dormant hypnozoites remain within the liver cells in all species
    E. Fertilization of the gametocytes occurs in the human RBC

    34. Which one of the following statements about the diagnosis and therapy of amoebiasis is true?
    A. The presence of cystic forms of amoeba can be demonstrated in most amoebic liver abscesses
    B. Stool trophozoites are unlikely to be found in the rectal mucous
    C. Liver abscesses are often undetected b liver USG
    D. Metronidazole therapy is effective in both liver and colonic disease
    E. Diloxanide therapy is ineffective in eliminating amoebic cysts in the colon

    35. Which one of the following statements about visceral leishmaniasis is true?
    A. Spread of Leishmania donovani is principally via anophelline mosquito
    B. An incubation period of 1-2 weeks
    C. Rigors with hepatomegaly but no splenomegaly is a typical feature
    D. Diagnosis is best confirmed by microscopy of a peripheral blood film
    E. A good clinical response to pentavalent antimonial therapy is to be expected

    36. Which one of the following feature is typical of cutaneous leishmaniasis?
    A. Nasal and mouth mucosal ulcers
    B. Painful ulcers in the groin and axillae
    C. Marked splenomegaly and lymphadenopathy
    D. Ulcers which heal without scarring
    E. Negative leishmanin skin test

    37. Which one of the following feature is typical of schistosoma haematobium infection?
    A. Disease is confined to the urinary tract
    B. Presentation with painless haematuria
    C. Spontaneous resolution within a year of leaving endemic area
    D. Absence of involvement of the uterine cervix and seminal vesicles
    E. An endemic disease in china and the far east

    38. Which one of the following statements about coxsackie B virus infection is true?
    A. The virus is an RNA arbor virus
    B. It causes hand, foot and mouth disease
    C. It is typical cause of pancreatitis
    D. It is likely to cause aseptic meningitis
    E. It is likely cause of herpangina

    39. A 35 yr old man returns from holiday in Egypt with a fever, headache and severe limb pain. Which one of the following features is most suggests dengue fever?
    A. History of rat bite 2 weeks previously
    B. Marked peripheral blood leucocytosis
    C. Cervical lymphadenopathy
    D. Erythema nodosum
    E. Yellow fever vaccination prior to travelling

    40. Which one of the following infection is attributable to chlamydial organisms?
    A. Psittacosis
    B. Epidemic typhus
    C. Yellow fever
    D. Yaws
    E. Q fever

    41. Which one of the following statements about trachoma is true?
    A. Blepharospasm is a common presenting feature
    B. It is often complicated by acute glaucoma producing blindness
    C. Acute ophthalmia neonatorum is a recognized presentation
    D. T/t with penicillin eye drops is likely to be effective
    E. Blindness is usually due to the formation of cataract

    42. A 50 yr old housewife presents with a febrile illness characterized by a cough. Which one of the following features is most consistent with the diagnosis of psittacosis?
    A. An incubation period of 4 weeks
    B. An acute small joint polyarthritis
    C. Pul infiltrates on chest xray not apparent on clinical examination
    D. The family pet snake was recently unwell and required antibiotic therapy
    E. Prompt resolution with sulphonamide therapy

    ANSWERS

    1. C –as in campylobacter infection
    2. E, (A)-rectal biopsy and stool microscopy in amoebic dysentery, (B)-lung biopsy and sputum microscopy, (C) –useful eg brucellosis , TB, (D)- useful in brucella and other infections
    3. B-also contraindicated in other immunosuppressed states
    4. A
    5. B-for susceptible injured persons
    6. D, (A)-common causes include E.coli, (B)- most resolves spontaneously, (C)-avoid, may cause toxic dilation of the bowels, (E)-reserved for susceptible persons
    7. A, (B)- promiscuity and male homosexuality are more common in UK, (C)- greater effects on T lymphocytes , (D) –CD4 helper T cells are principally involved
    8. C-10-20% additional risk for breastfed babies
    9. E- because of delay in seroconversion in some patients
    10. C- and serum/CSF culture
    11. D- in 95% cases
    12. D, (A)- single stranded RNA paramyxovirus, (B)- at the onset the catarrhal phase, (E)- avoid contact for 7 days after the onset of the rash
    13. C
    14. D
    15. D- eradication rates are increased from 65% to 90% by therapy by these 2 antibiotics
    16. B
    17. D-in severe cases
    18. D
    19. E-occurs in children given aspirin therapy
    20. D- also pneumonia
    21. B- also abattoirs and farms
    22. C
    23. C-‘snail tract’ ulcers
    24. A- usually 2-10 days
    25. A
    26. B-suggests anterior nasal infection and myocarditis
    27. B- causing trismus
    28. C
    29. B
    30. D-also gastroenteritis and meningitis
    31. D
    32. C-no cell mediated immune response
    33. A- sporozoites enter the liver within 30 min of inoculation
    34. D- or tinidazole together with diloxanide therapy
    35. E-pentamidine is an effective alternative
    36. A-secondary to intial cutaneous ulceration
    37. B- due to early egg deposition in the bladder mucosa
    38. D- together with echoviruses causes 90% of cases of aseptic meningitis
    39. C
    40. A- chlamydia psittaci
    41. C
    42. C-as in other ‘atypical’ pneumonia
  15. Joseph.

    Joseph. Guest

    hemolytic diseases of the newborn

    Which one of the following manifestations of hemolytic diseases of the newborn has the greatest potential for lifelong disability?
    a- Kernicterus
    b- Renal failure
    c- Cardiogenic shock
    d- Cardiac failure
  16. Joseph.

    Joseph. Guest

    Answer: A. Kernicterus, staining of a variety of CNS structures by unconjugated bilirubin, often results in permanent neurologic damage.
  17. David.

    David. Guest

    True statements about Appendix:
    a- does not have mesentery
    b- has taenia coli
    c- develops from midgut
    d- supplied by appendicular branch of ileocolic artery
    e- supplied by inferior mesenteric artery

    Answer: c; d.
    - Appendix is a worm-like diverticulum arising from posterolateral wall of the caecum. About 2 cm below the ileocecal orifice.
    - Appendix is suspended by a small triangular fold of peritoneum, called mesoappendix or appendicular mesentery. The fold passes upwards behind the ileum, and attached to the left layer of the mesentery.
    - Appendix is supplied by appendicular artery which is a branch of the lower division of the ileocolic artery.
    - Taeniae coli proximally converge at the base of appendix and distally they spread out on the terminal part of the sigmoid colon to become continuous with the longitudinal muscles of the rectum.
    - The Caecum and appendix arises as diverticulum from antimesenteric border of caudal limb of midgut loop.
  18. David.

    David. Guest

    Axillary nerve supplies:
    a- Deltoid + Teres major
    b- Deltoid + Teres major
    c- T. major + T. major
    d- Coracobrachialis + Short head to biceps

    Answer: B.
    Axillary nerve supplies Deltoid and Teres minor
    Coracobrachialis and biceps brachii are supplied by musculocutaneous nerve.
    Teres major is supplied by lower subscapular nerve.
  19. David.

    David. Guest

    Which of the following are situated away from the coding region:
    a- Promoter
    b- Enhancer
    c- Operator

    Ans: A, B.
    DNA dependent RNA polymerase initiates transcription at distinct sites called the promoter. The starting point of transcription corresponds to the 5’ nucleotide of the mRNA. This is designated position +1, as is the corresponding nucleotide in the DNA. The number increases as sequence proceeds downstream.
    The nucleotide in the promoter adjacent to the transcription initiation site is designated - 1 and these negative numbers increase as sequence proceeds upstream, away from the initiation site. This provides a conventional way of defining the location of regulation elements in the promoters.
    Enhancers : DNA segments that enhance or facilitates initiation at promoter. Properties of enhancers :
    - Work when located long distance from the promoter
    - Work when upstream or downstream from the promoter
    - Work when oriented in either direction
    - Work through hetrologus promoters
    - Work by binding one or more proteins
    - Work by fascinating binding of the basal transcription complex to the promoter.
  20. David.

    David. Guest

    Brain fingerprinting :
    a- Used lie-detector
    b- Used by ECG on lead
    c- Used for quantitative measurement of sulci, gyri
    d- Used by DNA


    Ans: B. Brain fingerprinting is a techniques that measures recognition of familiar stimuli by measuring electrical responses to words, phrases, or pictures that are presented on a computer screen. Brain fingerprinting was invented by Dr. Lawrence, Farewell. The theory is that the suspect’s reaction to the details of an event or activity will reflect if the suspect had prior knowledge of the event or activity. This test uses the MERMER to detect familiarity reaction. The person to be tested wears a special headband with electronic sensors that measure the Electroencephalography from several locations on the scalp. In order to calibrate the brain fingerprinting system, the testee is presented with a series of irrelevant stimuli, words, and pictures, and a series of relevant stimuli, words, and pictures. The test subject’s brain response to these two different types of stimuli allow the testor to determine if the measured brain responses to test stimuli, called probes, are more similar to the relevant or irrelevant responses.
    The technique uses the fact that an electrical signal known as P300 is emitted from an individual’s brain approximately 300 milliseconds after it is confronted with a stimulus that has special significance to that individual (e.g. a murder weapon or a victim’s face). Because it is based on EEG signals, the system does not require the testee to issue verbal responses to questions or stimuli.
    Brain fingerprinting uses electrical brain responses to detect the presence or absence of information stored in the brain. Because it depends only on information stored in the brain and cognitive brain responses, brain fingerprinting does not depend on the emotions of the subject, nor is it affected by emotional responses. Brain fingerprinting is fundamentally different from the Polygraph (lie-detector), which measures emotion-based physiological signals such as heart rate, sweating, and blood pressure. Also, unlike polygraph testing, it does not attempt to determine whether or not the subject is lying or telling the truth. Rather, it measures the subject’s brain response to relevant words, phrase, or pictures to detect whether or not the relevant information is stored in the subject’s brain.
  21. David.

    David. Guest

    True statements about DNA structure :
    a- All nucleotides are involved in linkage
    b- Antiparallel
    c- Parallel
    d- Bases are perpendicular to DNA
    e- Attached by hydroxy bond


    Ans: a, b, d.
    DNA is a polymer of deoxyribonucleotides and is found in chromosomes, mitochondria and chloroplasts.
    a. Primary structure of DNA : The backbone of the primary structure is the linear stand of interconnected sugar phosphate residues (3’ - 5’ phosphodiester linkage among nucleotides) while purine or pyrimidine base connected to sugar residues projects laterally from the backbone.
    The primary structure is the number and sequence of different deoxyribonucleotides. In its strands joined together by phosphodiester linkages.
    b. Secondary structure : This consists of double stranded helix formed by the two-polydeoxyribonucleotide strands around the central axis. The helix is usually a right-handed helix.
    The two sugar phosphate backbones wing around outside the bases. The phosphodiester bonds in two interwoven strands run in opposite directions. Therefore the strands are called anti parallel. The polarity of the two strands will be 3’ - 5’ and 5’ - 3’.
    The aromatic bases are hydrophobic and they are stacked in the interior, nearly perpendicular to the long axis of the helix.
    The two strands of the helix are held in register by hydrogen bonds between purine and pyriminidine bases of the linear molecules.
  22. Inayath.

    Inayath. Guest

    . Clostridium group causes all except ?

    . Clostridium group causes all except ?

    a. Acute Oesophagitis
    b. Diarrhoea
    c. Local necrosis
    d. Antibiotic associated changes


    2. Mallory bodies are seen in all except ?

    a. Alcoholic cirrhosis
    b. Biliary Cirrhosis
    c. Cardiac Cirrhosis
    d. Wilson disease

    3. Which of the following flavi virus is closely related to Russian spring summer encephalitis causing virus ?

    a. Dengue
    b. Chikungunya
    c. KFD
    d. Yellow fever
  23. Inayath.

    Inayath. Guest

    clostridium all except... acute esophagitis

    as it causes diarrhoea... by cl.perfringes

    local necrosis ... by cl.perfringes

    antibiotic asoociated diarrhoea by... cl.difficale

    2. mallory bodies r seen in all except ... cardiac cirrhosis

    mallory bodies r d hyaline bodies seen in alcoholic liver diseases, wilson's disease...
  24. R.dass

    R.dass Guest

    11.You are a 4 yr medical student with a pt who has been in a severe motor vehicle accident. the pt has a subdural hematoma that led to cerebral herniation before it coudl be drained. over the last few days ,the pt has lost all brain stem reflexes nas is now brain dead. i have the closest relationship with the family than anyone on the team. the ventilator is to be removed soon and organ donation is considered.

    who should ask for consent for organ donation???

    a.you, because you haev the best relationship with the family

    b the resident since u are only a student

    c.attending on record

    d.hospital administration

    e.organ donor network.

    12.A man arrives at the ER on a ventilator after an accident. He is brain dead by all criteria. He has an organ donor card in his wallet indicating his desire to donate. The organ donor team contacts the family. The family refuses to sign consent for donation.
    What should be done??

    a.remove organs anyway

    b.wait for the pts heart to stop to remove organs.

    c.Stop the ventilator & remove organs

    d.Seek a court order to overrule the family

    e.Honor the wishes of the family , no donation

    13/You are the staff physician in a state penitentiary in a state where capital punishment is legal. An execution is in progress & the warden calls u because the technician is unable to start the IV line. The warden wants u to start the line & supervise the pharmacist.

    What should u tell him ?

    A no problem, I will start the line

    b.i can start the line but I will no push the medications

    c.i am sorry I cannot participate

    d.i can take care of all of it.

    14.you have been invited toe participate in a “medical jeopardy†game sponsored by a pharmaceutical manufacuterer. the winners receive a 100$ gift certificate to the medical school bookstore. All the participants receive a stethoscope. The audience are participants receive a free meal.

    Which of the foll is most appropriate to accept?

    A,all the gifts

    b.only the meal

    c. only the stethoscope

    d.the meal ,stethoscope, not the gift certificate

    e.none of it

    15.A 16 yr old female comes to your clinic .her pregnancy test is +. She wants to start prenatal care with you . she is adamant that you keep the pregnancy confidential from her parents.what should u tell her?

    a.i will give u the care & keep the info confidential

    b. I will not mention it to your parents unless they ask , I cant lie

    c.iam sorry bu t I must tell them

    d.i will not tell your parents but I must inform the father of the baby.

    16. 17 year old boy with cystic fibrosis with near complete collapse of pulmonary functioning which the doctors think will never be better . he is on ventillator . a few days later when the doctor visits him the boy says that wants mechanical ventillation to be terminated . i thought about it a lot and that is my wish . when the boys wishes are related to the parents they r upset and ambivalent as how to proceed . the most likely outcome of this case is , the mecahanical ventillation will be

    a maintained indefinitely

    b maintained until such time that the parents give a clear decision

    c maintained until the boy reaches the majority age

    d terminated as the boy requests

    e terminated or maintained at the attending physicians discretion.

    17.A 37 yr old man comes to your office for his regular visit. He has seemed severyly depressed fro some time but refuses to discuss either his feelings or treatment options. He does not want antidepressants .

    his only medication is Vitamins, your relationship with him is excellent but he just wont confide his feelings although he firmly denies suicidal ideation.

    You prescribe a SSRI for him & tell him that it is a vitamin.Over a period of several months, his mood markedly improves & he feels much better

    Which of the foll most appropriately characterizes your action????

    a.Is appropriate because it benefited the patient.

    b.Is appropriate because there were no side effects

    c.Is not appropriate because you are not a psychiatrist

    d.Is not appropriate because u treated the pt without his consent


    e.Is acceptable as long as u inform the pt now that he is feeling better.

    18.A 52 yr olds man with cerebral palsy is being evaluated for screening colonoscopy. He has a mental age of an 8 yr old & a second grade reading level in terms of comprehension.

    He lives alone & survives on combination of Public assistance & part time jobs sweeping floors. U have thoroughly explained the procedure to him in terms of risks & benefits. He repeatedly refuses the procedure entirely on the basis of “ I just don’t want it “

    What should u do?

    a.perfoem the procedure

    b.seek consent from the family

    c.honor his decision & do not perform the colonoscopy

    d.seek a court order mandating the procedure

    19.45 yr old Mr.Smith consents to a procedure on his left ear. After the pt is anaesthetized Dr.Wright discovers that the right ear is in greater need for surgery. What should the surgeon do??

    a.perform the procedure on the right ear as it is more necessary

    b wake up the pt & seek consent for the procedure on the right ear

    c. seek a second opinion from another surgeon & proceed with the more necessary procedure

    d.seek consent from family.

    e.perform the procedure on both ears

    20.An unconscious man is brought to the ER from a car crash. He is hemorrhaging profusely ,hypotensive & stuporous.

    U have never met the pt before & the hospital has no records of him . He is wearing a Tshirt “ kiss me I am a Jehovah;s witness( the people who refuse blood & blood products )â€Â.

    What should u do ?

    a.give the blood

    b.wait for him to awaken to sign the consent

    c.wait for family

    d.seek a court order

    e.only use IV fluids.
  25. R.dass

    R.dass Guest

    21.A 45 yr old man attempted suicide by driving his car into a pole with an intentional purpose of ending his life . he was found severly hemorrhaging & in the ER he refuses to give consent for surgery to stop the bleeding. He states to end his life. He was recently diagnosed with cancer & he refused surgery to remove it . he states that his life is complete & he wishes to end it .

    What should u do about the surgery to stop the bleeding???

    a.follow his stated wish & withhold surgery

    b perform the surgery

    c obtain a court order

    d.ask family members for consent.

    22.A 60 yr old male physician who is an internist has a female patient for the past 20 yrs. Both of them lost their spouses several years ago . they start spending time together outside the office. The female pt wants to begin a romantic relationship with the physician.

    What should he tell her?

    a.I can never do that with you ever.

    b.We can be social but not sexual

    c.We need the ethics board;s approval first

    d.I cannot date u & be your doctor. May be in the future we can date, after u get another doctor.

    e.Because this is your initiative ,we can begin dating.

    23.A 38 yr old bus driver is seen in the clinic for fever , cough,with an apical infiltrate & sputum that is positive for acid fast bacilli. The pt is unwilling to take Anti TB medications & consistently the sputum is testing +. Directly observed therapy at home has failed. You continue to cajole , discuss, encourage, threaten, educate, advise him to take the medications, but he refuses,

    What should u do.

    a.nothing ,as he has a right to autonomy

    b.arrest the patient & put him in prison

    c.remove the pt from his job as bus driver & incarcerate him in the hospital to take medications.

    d.Get a court order

    24.You have a HIV+ pt in the office, U ask her if she has informed her partner of her + status. She has repeatedly resisted yout attempts to have her inform her partner. She is pregnant with his child. The partner is in the waiting room ,you have met him several times.

    What should u do?

    A inform the partner now

    B respect her confidentiality

    C refer the pt to another physician who is comfortable with her wishes

    D tell the partner to practice safe sex from now on but don’t tell him of the HIV status.

    25.A 34 yr old man is brought to the ER with fever, headache & a change in mental status leading to significant disorientation. His head CT is normal but he is in need for an urgent LP & IV antibiotics.

    He is agitated & is waving at anyone who tries to get ner him . Co-workers accompany him . the resident informs u that the pt is pushing away the LP needle.

    What should u do ?

    A sedate the pt with lorazepan & perform LP

    B wait for family to obtain consent

    C use blood cultures as an alternative

    D MRI of brain

    E ask co-workers to sign consent.

    26. A 70 yr old man is admitted to the hospital with endocarditis. At 7 days of therapy the antibiotic order expires & u forgot to re oder the medications for 2 days in the middle of the 4 week therapy. There is no clinical deterioration ans the antibiotics are restarted.

    What should u do/

    A.tell the pt it was a clerical error

    B.because ti was nto clinicall ysignificant u do not have to say anything

    C.Apologize & tell the pt that u forgot to reorder & that he will be alright

    D.Inform the chief resident but not the pt

    E.Ask the nurse to tell the pt about the error.

    27.A physician in a busy inner city environment has developed his practice over the years to the point that he no longer needs to solicit new pts. He does not want to expand his hours of work, so he decides to limit his practice. He instructs his office staff to begin refusing to accept new pts.

    Which of the foll most appropriately describes the action?

    a.it is both legal & ethical

    b.it is ethically acceptable but not illegal

    c.he is within his legal rights to refuse pts but is ethically unacceptable

    d.it is both illegal & unethical

    e.it is ethical as long as he arranges transfer of care to another physician

    28.U see a 14 yr old boy for an inguinal hernia. The pt requires elective surgery . U ask the parents for consent. The Father consents but the mother refuses . what should u do?

    a.Do the surgery ,one parental consent is enough

    b.Do not do the surgery since both parents need to sign consent

    c.Get a court order

    d.Do not perform surgery until the strangulation of bowel occurs.

    29.An elderly pt with progressive Parkinson disease come s to see u because of fever, cough ,shortness of breath, sputum production with pneumonia. The pt’s Parkinson disease has been worsening & he has become quite depressed. He has insomnia ,early morning waking, & wt loss as well as anhedonia. He is refusing antibiotics & is asking for palliative care only to help him die.

    What should u do?

    a.psychiatric evaluation

    b sedate the pt

    c.comply with pt’s wishes

    d seek opinion of family

    e.ethics committee referral.

    30.An 84 yr old woman with sever Alzheimer’s disease is admittied , she has lost the ability to communicate , is bed bound & is unable to eat. She did not appoint a proxy & there is no written will or clear verbal advance directive. Multiple family members routinely visit her & u are unable to achieve as clear consensus amongnst family members of what the pt ‘s wishes were.
    What should u do in terms of her care?

    a.follow the wishes of the eldest child

    b.follow what u think is best

    c.ask another attending of his opinion

    d.ask the hospital administrator for consent

    e.pursue an ethics committee evaluation.
  26. R.dass

    R.dass Guest

    31. A 70 yr old man has been brought to a chronic care facility for long term ventilator management., the pt has advanced COPD and is unable to be weaned from the ventilator. A tracheostomy has been placed.

    A nasogastric tube is in place to deliver tube feeding. The pt is fully alert & understands the situation. He is asking to have the nasogastric tube removed because of discomfort.

    What should u tellhim?

    a.i will get that tube out right away Sir.

    B lets see how much u are able to eat first

    c. I will pull it out if u allow me to insert a gastric tube

    d. let me talk to your family.

    e.i cant let my pt starve to death.

    32.A pt comes to your office with a + pregnancy test , she is 8 weeks pregnant & requests a referral for an abortion. U are an extremely religious person & opposed to abortion.

    What should u do?

    a.inform the pt that u are morally opposed to abortion & cannot provide the referral

    b.discuss other options with pt

    c.terminate the doc/pt relationship.

    d.Tell her u will make the referral after a 30 day consideration , time can change her mind

    e.Refer the pt for an abortion.

    33.A man comes to the ER after a stab wound. Your notes document a 500 ml loss of blood. Later that night the pt develops asystole & dies. You find that the loss of blood was originally really 3000ml,which was not recorded by you.

    What should u do to correct the documentation?

    A use correction fluid to eliminate the original note

    B erase the original note

    C remove the original note from the chart

    D write a new note timing & dating it at the same time as the original note

    E write a new note with the current date & time.

    34.An 84 yr old woman is admitted with abdominal pain , on the 2 day she becomes febrile ,hypotensive & tachycardic from an intestinal perforation. The pt is disoriented with no capacity to understand her medical problems., there is no response to AB, fluids, dopamine for the next 48 hours, & there are signs of significant anoxic encephalopathy. Although there is no health care proxy the family is in uniform agreement on what the pt would have wanted for herself, had she been able to speak.

    Which of the foll cannot be stopped at the direction of the family

    a.Ventilator

    b blood tests

    c dopamine

    d fluids & nutrition

    e there are no limits.

    35. 42 yr old man comes to see u for routine management when u inquire about multiple scratches & contusions as well as a black eye. He says his wife routinely abuses him & “is beating me up pretty regularlyâ€.he denies hitting his wife. You see him a few weeks later & he has a new version of the same injuries. You are very concerned. He clealy states that he does not want the abuse reported.

    What do you tell him ?

    a.u have no choice but to report

    b.u will report the injury only with his consent

    c.u will honor his wish but must report if there is another episode

    d.there is no spousal abuse reporting

    e.u will report if u find the wife is the attacker

    36. A 92 yr old man with Alzheimer;s disease has been admitted to the hospital with aspiration pneumonia , he is on a ventilator & has a naso gastric tube in place but does not have the medical capacity to understand his medical condition.

    You find a living will that is in an old chart (dated 2 yrs ago) that says “ no heroic measures, I want to be DNR,& I wish to be kept comfortableâ€. There is no proxy & no family available with him to discuss the matter. He has no private physician with whom u can discuss .

    What should u do regarding the ventilator & naso gastric tube.??

    a.continue both for now

    b remove the ventilator & tube feeding

    c remove the naso gastric tube but continue the ventilator

    d.seek a court appointed guardian

    e.decide what u think is best for pt.

    37.U are in the process of finalizing the results of your research for publication. I are the principla investigator of a clinical trial studying the effects of HMG-Co A reductase inhibitors on cardiac mortality. A prominent manufacturer of one of these medications provided the major funding for the study.

    Which of the foll is the most accurate in an ethical preparation for authorship of the publication?

    a.Accepting money from a company prohibits u from being listed as an Author

    b Funding source has no impact on publication requirements

    c U can be listed as the author after the institutional review board checks the paper for evidence of bias

    d There are no restrictions on your authorship as long as u disclose the financial affiliation

    e. there are no requirements as long as the data is accurate

    38.U are an attending physician at the University hospital (hurray!!!!!!!!!!!!). one of the attendins from another division seems to be having memory difficult . U found him twice in the hallway having forgotten where he was going .

    The residents tell u on the side that they don’t rely on him at all because “ he forgets everything we say anywayâ€. The chief of service knows but doesn’t have enough attendings to fill a yearly schedule so he remains in place supervising both the resident performance as welll as patient care.

    What should u do?

    a.Nothing, the chief of service already knows

    b. talk ti him directly

    c.tell your division head

    d.report him to the state licensing board.

    39.A medical resident admits a pt overnight with uncontrolled BP. He means to write an order for AG receptor bloacker Diovan at 10 mg once a day. Because of his sloppy handwrtiting the nurses & pharmacy administer Digoxin at 10 mg a day. This is a drug that is rarely used at ther dose above 0.5 mg a day. 3 days later , the pt develops a hemodynamically unstable rhythm disorder that the resident very sincerely tries to decipher but he is unable until the pt is transferred to the ICU. At this point they discover the overdose of digoxin. The pt and the family never discover the overdose.

    Which of the foll most acuurately describes this situation??

    a.there is no liability for the resident because the overdose was unintentional

    b.there is no liability for the resident because the pharmacy should have detected the error

    c.No liability exists because the error was unknown to the pt

    d.No liability exists because it was an accident

    e.The resident and the hospital are both liable for harm to the pt

    40.A 27 yr old man is seen by you after the diagnosis of syphilis. As you are administering his treatment U find that he is quite promiscuous ( Don’t ask me how!!!!!!!). U inform him that u must notify the Dept of health & that his sexual contacts need to be treated. He is extremely embarrassed(little late for that I think) & asks how will they find out.

    a.u will notify them yourself but u will not give his name

    b.U will notify them & must let them know he was the contact

    c.U will tell the Dept of health but he himself must tell the others

    d.The dept of health will call or send letters to the contacts regarding a serious health
    issue.They will test & treat but without revealing his name.

    e.He doesn’t have a choice ,he has to give the names

    f.Their individual doctors will inform the contacts
  27. R.dass

    R.dass Guest

    41.An elderly pt with multiple medical problems has been admitted to your care in the ICU. The pt is in a persistent vegetative state secondary to anoxic encephalopathy & has now developed sepsis ,hypotension, GI bleeding & respiratory failure, requiring intubation. There is no improvement expected in the underlying severe brain damage . renal failure develops to the point of needing dialysis but u feel the dialysis would be completely futile.

    Which of the foll is the most appropriate step in management ?

    a.hemodialysis

    b.Peritoneal dialysis

    c.Renal transplantation

    d.Give albumin

    e.Recommend that dialysis not be performed.

    42.You have a 65 yr old Mr.Johnson with progressive glaucoma in your office. His vision is severly impaired & getting worse . u strongly doubt that he can read traffic signs on the highway. U have repeatedly encouraged him to curtail his driving but he has not.

    What is your responsibility towards this pt.?

    a.keep the information confidential

    b.Seek the pts family & inform them

    c.Inform the pt of your duty to report to the DMV

    d.Take away his driver;s license

    e.Suspend his DL

    43.A 7-year-old girl is brought to the emergency department by her mother because of "fever and a rash." When asked to give a more detailed history, the mother has difficulty providing any additional information. The mother appears tearful and the child cannot take her eyes off the floor. U are unable to engage the child in any conversation. Her temperature is 36.7 C (98.0 F). Physical examination is unremarkable.

    The most appropriate next step is to

    A. admit the child to the hospital for evaluation and protection

    B. ask if there is anyone else in the house that is sick

    C. ask the mother and child separately what is concerning them

    D. obtain a psychiatry consult immediately

    E. send the child home and arrange for a family assessment on a home visit Explanation:

    44,A 30-year-old woman comes to your office "for a prescription of propranolol for stage fright." She tells U that she is a professional singer and lately she has been experiencing "butterflies" and palpitations before performances. She has been so worried about having one of these symptoms that she is having trouble sleeping at night.

    She tells U that a friend of hers has a similar problem and propranolol has "cured her." She has been a patient of yours for the past 10 years and you remember that she has severe asthma, requiring many hospitalizations, the most recent being 2 weeks ago. Her asthma attacks have been increasingly more severe and have been occurring at an increased frequency. She tells U that she is in a rush and all she needs is the prescription.

    The most appropriate next step is to

    A. administer a pulmonary function test

    B. explain that propranolol is not a good drug for her

    C. give her a referral to a psychiatrist

    D. order a chest x-ray

    F.prescribe propranolol for her to take before her performances

    45.A 23-year-old woman is admitted to the hospital for altered mental status. On evaluation in the emergency department, the patient was found to have severe hypernatremia, a serum sodium of 161 mEq/L. There is no other past medical history or allergy history available.

    The patient appeared pale and profoundly dehydrated. She had evidence of prior scars, possibly surgical, on her abdomen, chest, and arms. The patient was admitted and over the next few days the patient's hypernatremia was corrected and her metabolic parameters normalized. She was able to give a more detailed history about her social situation.

    She describes feeling very depressed lately and having had an argument with her new boyfriend several days prior to her admission. U suspect that she may be a victim of domestic abuse.

    The most appropriate initial step in addressing your concern is to

    A.ask her for the number of her boyfriend to address your concerns with him directly

    B. ask her to offer more details about the nature of her relationship with her new boyfriend

    C. explain to her that her relationship is obviously not having a positive impact on her life

    D. refer her case to the department of social services in obligation of your reporting duty as a physician

    E. refer her to a psychiatrist who specializes in domestic abuse

    46.A 58-year-old man comes to the office 7 weeks after his wife died from complications during breast cancer surgery. He says that he "misses her like crazy" and it is so hard for him because he did not expect to "ever lose her." He often finds himself crying in the bathroom at work.

    However, it is the weekends that are especially difficult. He goes out for dinner and to the movies with their 2 children and his friends, but he typically feels a little detached. It is "really hard to handle" seeing other men with their wives. He is very "sad" and wants to know if he is going to be "okay".

    The most appropriate response to this patient is

    A. "It seems like you are experiencing a major depressive episode that we can treat with fluoxetine"

    B. "Let's see how you feel in a few weeks and we will discuss the most appropriate treatment then"

    C. "You are experiencing grief, which is a completely normal and expected reaction to the loss of your wife"

    D. "You have an adjustment disorder that should be treated with psychotherapy"

    E. "You should have your friends set you up with a widowed woman who will understand you"

    47.A 16-year-old girl comes to the office after her boyfriend of 2 years abruptly ended their relationship. She has been a patient of yours for the past 7 years and seems to feel very comfortable talking about relationships and sexual issues with you.

    She says that she just decided to have sexual intercourse with him a month ago and that this was a "huge deal" because it was her first "abandoned" her. She suddenly becomes silent and begins to cry. She takes a tissue out her pocketbook and remains silent.

    At this point you should

    A. advise her to "pull herself together"

    B. maintain eye contact, and after a few minutes say, "I understand that this is hard for you"

    C. remain silent for however long she needs to compose herself

    D. tell her not to cry and say, "he is not worth getting so upset over"

    E. use this time to review the notes in her chart

    F.recommend that she go talk to a psychiatrist

    48. A 70-year-old man is admitted to the hospital for weight loss, anemia, and worsening of his stomach pain that he thinks is due to an ulcer. However, the results of tests that are performed confirm the diagnosis of an inoperable cancer. U are told that when one of your residents tried to break the news to him, he became mad, frustrated, and began to yell. He accused him of being ignorant and threatened to sue him.

    U go to see the patient and he says, "U think I am crazy and don't see what you are doing? They called you so that I don't sue your young doctor for not knowing what he is doing. U just want to help your buddies here, but you really can't help me".

    The most appropriate management is to

    A. clarify that the other physician is not a "buddy" and offer to help him explore his decision about a lawsuit

    B. empathize with his feelings of anger, grief, and fear indicating that anger is a defense against intolerable emotions

    C. explain that suing physicians is not always successful, and instead suggest that the patient should take care of his affairs given his prognosis

    D. offer to refer the patient to another team and physician in order to help him find someone he can trust

    E. sympathize with how badly he is treated and support the lawsuit

    49.U are notified that one of your patients, a 30-year-old woman, delivered a healthy baby girl 6 hours earlier. U happen to be in the hospital discharging another patient, so U go to the labor and delivery floor to see her. She has had depressive disorder over the years. She developed postpartum "blues" after her last child was born that resolved spontaneously after 5 days.

    U hear a woman screaming as U get off the elevator and head towards her room. As U get closer, U recognize the voice and realize that it is your patient. She is running around her room, tearing off the hospital gown, and yelling that, "they are coming to get her." When she sees that U are standing in the room, she begins to throw flower vases, the telephone, and the bedding at U.

    The nurses appear and tell you that she has been very disorganized and has had bizarre, grandiose delusions. She then goes back to the nurse's station. U notice the newborn in the corner of the room.

    The most appropriate next step is to

    A. ask the nurse to get haloperidol from the medication closet

    B. call for an immediate psychiatry consultation

    C. encourage her to breastfeed and bond with her newborn

    D. remove the newborn from the room

    E. try to talk to her and calm her down

    50.A 35-year-old obese man comes your office because he has been "feeling really bad lately." He says that for the past three months he has been having trouble sleeping and has not been "in the mood" to go out.

    He has even stopped going to basketball games with friends, which was his favorite hobby. He has missed many days of work and finds it very difficult to concentrate. He states that he feels "pretty helpless." All of his friends from college are married with kids, and he says that he "can't even get a date," so he basically gave up on having a family. He just feels "worthless".

    The most vital question to ask at this time is

    A. "Are you currently questioning your sexual orientation?"

    B. "Do you ever feel like 'life really is not worth it and that you should end it all'?"

    C. "Do you think that your life would be much better if you were dating?"

    D. "Have any of your friends ever tried to set you up on a blind date?"

    E. "Why haven't you tried to lose weight?"

    51,A 35-year-old woman comes to the office asking you to drug test her 12-year-old son. She states that her son is normally a very kind and interactive child, however, for the last 3 months, he has become increasingly withdrawn. He is in his room most of the time except for when he is at school.

    His grades have dropped from an A- average to C- this past semester. He refuses to see any of his friends and does not even eat much during dinner anymore. She has confronted her son multiple times about his situation, but he continually denies everything, including drug or alcohol use.

    The mother is visibly upset at this situation and is tearful about it. She tells you that you are her son's "only help." The most appropriate response to the mother's request is:

    A. "Just bring your son in and we can then get a urine test for alcohol and substance use."

    B. "I am sorry but I can't legally test your son for any drugs without him consenting to it first."

    C. "It is possible that your son may be suffering from depression and I think that you should bring him in for me to talk to him."

    D. "These are classic symptoms for schizophrenia. The best thing to do would be to start him on some anti-psychotic medications."

    E. "Your son is most probably abusing drugs and alcohol, so you should send him to a rehabilitation facility immediately."
  28. R.dass

    R.dass Guest

    1.you are a resident at the ER. An irate parent comes to you furious because the social worker has been asking him about striking his child. The child is a 5 yr old who has been in the ER 4 itmes this year with several episodes of trauma that did not seem related. Today,the child is brought with a complaint of “slipping into a hot bathtub†with a burn wound on his legs., the parent threatens to sue you & says†how dare you think that about me , I love my son !â€Â.

    What should you do?

    a.give assurance to the parents & treat the patient;s injury appropriately

    b.ask risk management to evaluate the case

    c.admit the child to remove him from possibly dangerous environment

    dcall the police

    e.ask the father yourself if there has been any abuse

    f.speak to the wife privately about possible episodes of abuse

    g.explain to the parents that next time this happens you will have to call child protective services

    h.report the family to child protective services

    2.Your patient has just recently been diagnosed with familial adenomatous polyposis (FAP). The patient has become divorced and refuses to give you consent to inform his ex-wife who now has custody of their children. He threatens to sue u if u reveal elements of his medical care to his ex-wife.

    What should u do?

    a.respect the patients right to confidentiality.

    b.transfer the patient’s care to another physician

    c.ask the health dept to inform the ex-wife

    d.seek a court order to inform the ex-wife

    e.inform the ex-wife of the risk to the children.

    f.inform the ex-wife;s doctor.

    3.You are seeing a pt who has TB.he is undocumented (illegal ) immigrant .His family will need to be screened for TB with PPD testing. He is frightened of being deported if the dept of health learns of his illegal status.

    What should u tell him ?

    a.dont worry the dept of health does not ask or report immigration status

    b.only people who are noncompliant with medications are reported to the govt.

    c.dont worry I will fully treat u before we deport u.

    d.iam sorry but there is nothing I can do about this. There is mandatory reporting to the govt

    4.A couple comes to see you after having tried INvitro fertilization & artificial insemination. Thery are very happy because now they have a child. They have a significant amount of left over sperm ,eggs, and some fertilized embryos & are thinking about selling them.

    What should u tell them?

    a.it is legal to sell only eggs

    b.it is legal to sell only sperm

    c.it is legal to sell both the sperm and eggs not the embryos

    d,it is illegal to sell any of them

    e.it is legal to sell all of them

    5.you have a pt with severe MS that is advanced & progressive who now develops renal failure secondary to DM, the pt is alert & has erected to put DNR order in place at her own discretion. The pts K levels are now elevated at 8 meq/l.

    Which of the foll is most appropriate.

    a.dialysis cannot be done because of the DNRorder

    b.you can do the dialysis if the DNR is reversed for the procedure

    c.go ahead with the dialysis, ignore the DNR order

    d.Give kayexalate until DNR status is discussed with the family.

    6.A 35 yr old female comes to your office with a large form to be filled certifying that she is in good health. This is part of her pre employment evaluation. The form also asks for the results of the patient;s adenomatous polyposis coli gene. This is in order for the company to deternmisne which of its long term employees will need care.

    What should be your response?

    a.perform the test

    bperform the test but do not share the results with the employer.

    c., do not perform the test

    d.ask the pt if she wants the test done and the results reported.

    e. perform the colonoscopy ,the employer is entitiled to know about current health problems not future ones,

    f.include the test only if pt has family members with the disease.

    7. you have a pt who is a HIV + physician. He has recently found out his status & you are the only one who know about it. Who are u legally obligated to inform??

    a.his insurance company

    b.state govt.

    c.his patients

    d.his patients only if he performs surgery where transmission is possible

    e.no one without his written consent

    f.his employer

    g.the hospital HR dept.

    8.You are a resident managing a pt with cellulitis . the pt has a history of CCF and a normal EKG. The pt is on digoxin, ACE inhibitor & diuretic but not a beta blocker. You cannot find a CI to the use of a beta blocker in the chart or in discussion with pt. u ask the attending why there is no beta blocker & he looks at u as if u had an anoxic encephalopathy., he says “ I have been in practice for 40 yrs , don’t u think I know what am doing ?????.beta blockers are dangerous in CCFâ€Ââ€Â. The pt looks proudly at the attending & says “ I have the smartest doctor in the worldâ€Â.

    What should u do??

    a.wait for the attending to leave & give pt a prescription for carvedilol

    b.suggest the pt tofind another doctor.

    c.report the physician to the state licensing board

    d.do nothing he is the attending on record

    e.bring the disagreement to the chief of staff

    f.help the pt find a good lawyer & volunteer to testify.

    9.A 47 yr old man with end stage renal failure has asked u to stop his dialysis. The pt fully understands he will die if dialysis is stopped for more than a few days or weeks . he is not depressed and not encephalopathic

    What should u tell him?

    a.I need a court order first

    b.iam sorry ,I don’t feel comfortable doing that.

    c.I cant do that. Physician assisted suicide is not ethical.

    d.I will stop when u get a kidney transplant

    e.Although I disagree with your decision I will stop dialysis.

    10. A patient comes to the ER with a gun shot wound in his thigh. He says he was shot accidentally while hunting with his cousin . You treat the wound & give him antibiotics.

    What should u do now?

    a.report to the police

    b.do not report to the police

    c.it was accidental ,so It does not warrant to report

    d.encourage the patient to report to the police

    e report only if patient consents to it.
  29. Joseph.

    Joseph. Guest

    What is the best way to prevent a urinary tract infection in a patient with a Foley catheter?
  30. Joseph.

    Joseph. Guest

    Q. Trinucleotide repeats are found in :
    a- Huntington’s disease
    b- Spinocerebellar ataxia
    c- Amyotropic lateral sclerosis

    Ans: A, B. 10.01.2008.
    - ALS (Amyotropic Lateral Sclerosis) may be sporadic or genetic in origin (autosomal dominant or negative and mitochondrial).

    Q. HLA typing is used in :
    a- Disputed paternity
    b- Thanatology
    c- Organ transplant
    d- Dactylography

    Ans: C. c- Organ transplant

    Q. True about MHC-class II :
    a- Not involved in innate immunity
    b- Cytotoxic T-cell involved
    c- Present in nucleated cells
    d- Present in B-cells

    Ans: A, D.
    * Class II MHC Proteins are glycoprotein present on the surface of certain cells including macrophages, B-cells, Dendrite cells of the spleen and langerhans cells of the skin. MHC II located in chromosome no 15.
    * Cytotoxic T-cells responded to antigen in association with class I MHC.
    * Helper T-cell recognizes class II.
    MHC genes and proteins also important in following conditions :
    - Many autoimmune disease can occur in people carrying certain types of MHC gene
    - Organ transplantation.
  31. Joseph.

    Joseph. Guest

    Q. In antibiotic associated colitis, organism involved is :
    a- Clostridium difficile
    b- Pseudomonas
    c- Staphylococcus
    d- Enterococcus

    Ans: A. Clostridium difficile.

    Q. Aspirin toxicity true are :
    a- Tinnitus early symptom
    b- 10 - 30 gm causes poisoning
    c- Hyperthermia, tachypnea early complications
    d- Cause thrombocytopenic purpura.

    Ans: A, B.
    * Symptoms of aspirin poisoning
    - Nausea, vomiting, tinnitus, hyperpnea, malaise
    - Fever suggest poor prognosis in adults.
    - Severe intoxication causes lethargy, convulsion and coma.
    - Non-cardiogenic pulmonary edema occurs in upto 30% cases in adults.
    - Electolyte imbalance, acidotic breathing, hyper/hypoglycemia, petechial haemorrhage, restless and delirium, hallucination, hyperpyrexia, convulsions, coma and death due to respiratory failure and cardiovascular collapse.
    - At anti-inflammatory dose (3-6 gm/day) produces the syndrome called Salicylism comprising of dizziness, tinnitus, vertigo, excitement, mental confusion, reversible impairment of hearing and vision.
    - The dose has to be titrated to one which is just below that produces these symptoms, tinnitus is a good guide.
    - Aspirin causes platelet dysfunction by inhibiting cyclooxygenase pathway.
    - Fatal dose in adult is 15-30 gms but considered lower in children.

    Q. True statements about parotid gland :
    a- Duct opens opposite to upper 2nd molar tooth
    b- Duct pierces Masseter
    c- Develops from ectoderm
    d- Develops from mesoderm
    e- Secretomotor fibers come from facial nerve

    Ans: A, C.
    - The parotid duct is thick walled; about 5 cm long and emerges from the middle of anterior border of the gland. It opens into the vestibule of mouth opposite to crown of upper 2nd molar tooth.
    - In its course, it pierces : The buccal pad of fat, Buccopharyngeal fascia and Buccinator (obliquely).
    - The secretomotor fibers for the parotid gland reach the gland through the Auriculotemporal nerve.
    - Salivary glands develops as an outgrowth of buccal epithelium near the junctional area between ectoderm of somatostodaeum and endoderm of foregut. That’s why it is difficult to say whether it is endoderm or ectodermal. The growth of parotid gland arises in relation to along with maxillary and mandibular process to fuse to form the gland. So, it is considered ectodermal origin.
  32. Joseph.

    Joseph. Guest

    Q. True statements about lower 1/4th Ant. Abdominal wall :
    a- Linea Alba is poorly formed
    b- Two layers of rectus sheath present
    c- External oblique poorly formed
    d- Ext. oblique muscle well formed & strong
    e- Rectus abdominis is divided.

    Ans: A, C.
    - The linea alba is a raphe formed by interlacing of the fibers of the three aponeurosis forming the rectus sheath. It extends from xiphoid process to pubic symphysis. Above the umbilicus it is about 1cm wide, but below umbilicus it is narrow and difficult to define.
    - The anterior layer of rectus sheath is complete, covering the rectus abdominis muscle from end to end. But posterior layer is incomplete, being deficienct above the costal margin and below the arcuate line. The arcuate line lies at the level of midway between the umbilicus and the pubic symphysis.
    - There are three transverse fibrous bands that divide the rectus muscle into smaller parts. One lies opposite to the umbilicus, 2nd at free end of xiphoid and 3rd in between the two. One or two incomplete intersections may be present below the umbilicus. Embyologically, they represent the segmental origin of muscle, but functionally they make the muscle more powerful by increasing the number of muscle fibers.
    - The external oblique muscles fibers rarely descend beyond the line from anterior superior iliac spine to the umbilicus. Therefore, the external oblique muscle in the lower 1/4th anterior abdominal wall become aponeurotic.
  33. R.dass

    R.dass Guest

    Q. True statements about ions composition in body :
    a- Intracellular & Extracellular ions compositions are same.
    b- Phosphorus and Mg++ are major ions intracellularly
    c- Na+, CI- principal in E.C.F.
    d- Kidney tightly regulates Na+, K+, CI- composition.

    Ans: B, C, D.
    - ECF contains large amounts of Na+, and CI- reasonably large amounts of HCO35 but only small quantities of K+, Ca2+, Mg2+, PO42- and organic acid ions.
    - The composition of ECF is carefully regulated by various mechanisms but especially by kidneys. This allows cells to remain continually bathed in a fluid that contains the proper concentration of electrolytes and nutrients for optimal cell function.
    - ICF contains large amount of K+ and PO42- plus moderate quantities of Mg2+ and sulfation, but only small quantities of Na+ and CI- and almost no Ca2+.
  34. R.dass

    R.dass Guest

    Q. Greatest stimulator for ADH secretion :
    a- Hyper osmolarity
    b- Hyponatremia
    c- Hypotension
    d- Hypovolemia

    Ans: A. Hyper osmolarity.
    Regulation of ADH secretion :
    Increase ADH Decrease ADH
    ↑ Plasma osmolarity ↓ plasma osmolarity
    ↓ bl. Volume ↑ bl. Volume
    ↓ BP ↑ BP
    Nausea Drugs
    Hypoxia Alcohol
    Drugs Clonidine
    Morphine Haloperidol
    Cyclophosphamide

    - ADH is considerably more sensitive to small changes in osmolarity than to similar changes in blood volume e.g. change in osmolarity by 1% is sufficient to increase ADH, by contrast, ADH response occurs until blood volume decreased by 10% with further decrease in blood volume, ADH level rapidly increase. Thus severe decrease in blood volume, the cardiovascular reflex plays a major role in stimulating ADH secretion.
    - Osmotic regulations cause ADH secretion as high as 20 times the normal, while hypovolemia (15-25% decrease) cause as high as 50 times normal.
  35. R.dass

    R.dass Guest

    Q. Hormones secreted by kidneys :
    a- Erythropoietin
    b- 1, 25 dihydroxy cholecalcifevol
    c- Granulocyte-Monocyte-CSF

    Ans: A, B.
    - Hormones produced by kidneys:
    - Renin
    - 1,25 dihydroxy cholecalciferol
    - Erythropoietin
    - GM CSF secreted by activated macrophage.
  36. R.dass

    R.dass Guest

    Q. Axonotmesis includes discontinuity in :
    a- Perineurium
    b- Epineurium
    c- Endoneurium
    d- Axon
    e- Myelin sheath

    Ans: D, E.
    - Axonotmesis is characterized by axonal and myelin sheath damage that results in loss of continuity with the cell body and its end organ. There is preservation of the endoneurium, perineurium, and epineurium. This type of nerve damage may cause paralysis of the motor, sensory, and autonomic functions. If the force creating the nerve damage is removed in a timely fashion, the axon may regenerate, leading to recovery.

    Seddon’s classification for nerve injury :
    1. Neurapraxia - pressure on the affected nerve with no loss of continuity.
    2. Axonotmesis - neural tube intact, but axons are disrupted. These nerves are likely to recover.
    3. Neurotmesis - the neural tube is severed. These injuries are likely permanent without repair, and will likely only achieve partial recovery at best.
  37. R.dass

    R.dass Guest

    Q. Type of collagen forming basement membrane of kidney :
    a- I
    b- II
    c- III
    d- IV
    e- V

    Ans: D. IV.

    Q. Functions of limbic system :
    a- Emotion
    b- Memory
    c- Higher function
    d- Planned motor activity

    Ans: A, B, C.
    - The functional anatomy of limbic system in our body :
    i) Hypothalamus : it is one of the central elements of limbic system. It’s functions:
    - Vegetative functions e.g. body temperature, osmolality, drive to eat and drink, body weight etc.
    - Behavioral control e.g.
  38. R.dass

    R.dass Guest

    Q. All of the following disorders are correctly paired with related characteristics EXCEPT
    a- atelectasis - bronchial obstruction
    b- adult respiratory distress syndrome - hyaline membranes
    c- cystic fibrosis - α1-antitrypsin deficiency
    d- acute epiglottitis - Haemophilus influenzae
    e- asbestosis - ferruginous bodies

    Answer: C. Cystic fibrosis is associated with a mutation in the cystic fibrosis transmembrane conductance regulator (CFTR) gene; it is not associated with α1-antitrypsin deficiency.
  39. R.dass

    R.dass Guest

    All of the following disorders are correctly paired with rel

    Q. All of the following disorders are correctly paired with related characteristics EXCEPT
    a- sarcoidosis - noncaseating granulomas
    b- idiopathic pulmonary hemosiderosis - anti-glomerular basement membrane antibodies
    c- idiopathic pulmonary fibrosis - immune complex disease
    d- eosinophilic granuloma - Birbeck granules
    e- Goodpasture’s syndrome - renal lesions

    Answer: B. Idiopathic pulmonary hemosiderosis is characterized by hemorrhagic lung involvement similar to Goodpasture’s syndrome, but notable differences include the absence of anti-glomerular basement membrane antibodies or renal involvement.
  40. R.dass

    R.dass Guest

    Q. All of the following types of pneumonia are correctly paired with related findings EXCEPT
    a- Streptococcus pyogenes pneumonia - lobar involvement
    b- staphylococcal pneumonia - abscess formation
    c- Mycoplasma pneumonia - cold agglutinins
    d- Haemophilus pneumonia - infants and children
    e- Klebsiella pneumonia - high mortality in elderly

    Answer: A. The most frequent etiologic agent of lobar pneumonia is S. pneumoniae, not S. pyogenes. Staphylococcus pneumonia is often complicated by pulmonary or extrapulmonary abscess formation as well as by empyema, bronchopleural fistula, or bacterial endocarditis. Diagnosis of Mycoplasma pneumonia, the most common nonbacterial pneumonia, is facilitated by laboratory demonstration of nonspecific cold agglutinins directed against red blood cells as well as by complement-fixing antibodies and microbiologic culture techniques. Haemophilus pneumonia is most often observed in infants and young children. Klebsiella pneumonia has a high mortality rate in the elderly.
  41. R.dass

    R.dass Guest

    Q. All of the following causative microorganisms or disease entities are correctly paired with a frequent association or effects EXCEPT
    a- bronchiectasis - abundant sputum
    b- bronchogenic carcinoma - lung abscess
    c- Mycoplasma pneumoniae - cold agglutinins
    d- Staphylococcus aureus - lobar pneumonia
    e- Streptococcus pneumoniae - exudate in pleural space

    Answer: D. Lobar pneumonia is typically caused by S. pneumoniae. In contrast, pulmonary infection with S. aureus is most often associated with bronchopneumonia, often with formation of multiple small abscesses.
  42. R.dass

    R.dass Guest

    Q. All of the following disorders are correctly paired with related characteristics EXCEPT
    a- Legionnaires’ disease - air-conditioning systems
    b- Q fever - livestock workers
    c- ornithosis - rickettsial disease
    d- measles - giant cells

    Answer: C. Ornithosis, caused by an organism of the genus Chlamydia, is not a rickettsial disease. Legionnaires’ disease, Legionella pneumophila infection, has often been traced to contamination of air-conditioning systems. Q fever, the most common rickettsial pneumonia, often affected livestock workers who handle cattle or ship. Pneumonia from the measles virus can take the form of giant cell pneumonia.
  43. Joseph.

    Joseph. Guest

    Q. pt with heart rate of 45/min, BP 90/50, PR constant.Every third wave without QRS complex?
    management?
    A) atropine IV push
    b)observation
    c)external pacemaker
    d)transvenous pacemaker

    Ans: 2nd degree heart block
    Immediate treatment--> IV Atropine
    Definite treatment--> external pacemaker

    Q. how to u follow Multiple sclerosis?

    Ans: MS follow up(options?)
    Expanded Disability Status Scale??

    Q. which of the following is not sexually transmitted from a prostitute
    a. Hep B
    b. treponema pallidum
    c. HPV
    d. tricomonas
    e. neisseria gonarrhea

    Q. the most likely disease that one can get from in discriminate sexual activity:
    gonorrhea
    chlamydia
    HIV
    HBV

    Ans: Chlamydia

    Q. a young female came with acne you prescribed topical isotretinoin later after few weeks
    she came with complaint of its itching of amole under her breast which has become itchy after the usage
    , your response is
    1.isotretinoin causes itching some times
    2.itching may be an indication for the removal of the mole.
    3/4
    isotretinoin causes itching some times??
    you have to biopsy the mole?

    Ans: if the mole was already present - then option1

    Q. Female comes for treatment of recurrent herpes.
    Do you tell her to send her sex partner for examination????

    Ans: ask her to encourage him to be examined
  44. Joseph.

    Joseph. Guest

    1)pregnant exposed to a lacy rashed boy:

    1- it will not affect you.
    2- you get mild disease.
    3- you are vaccinated to this.no harm
    4- your may loose your fetus

    2)Who should discuss with the family regarding donation

    the neurosurgeon who declared the brain death
    ,the harvesting team
    ,or the trauma care team

    3)abt a Down's pt whose parents are killed in a accident and the Down's pt is also brain dead,
    THE SISTER IS ALIVE AND SHE WANTS TO USE THE BROTHER'S ORGANS .
    Who should give the consent?

    the sister,or ethics comittee or to get a court order



    4)Q)DMI glucose 160 wants to sport:
    1- insulin before match.
    2- glucose before match.
    3-nothing…
    ..GLUSOCE BEFORE MATCH OR NOTHING???

    5)Q)A man with 5x5 cm mass in left lobe of thyroid which is found to be papillary carcinoma..
    The man has develop HOARSENESS. the right lobe of thyroid is irregular on exam..
    what is the best treatment
    a)radiation
    b)partial thyroidectomy plus radiation
    c)total thyroidectomy with left neck dissection
    d) total thyroidectomy with removal of enlarged nodes

    6)2 yo child, mother reports he is pulling his LEFT ear, no fever vomiting,
    appetite good exam reveals cooperative kid,tympanic membrane red, no fluid on tympanogram.
    . what will u do?

    a)PO amoxillin
    b)gentamycin ear drops
    c)refer to ENT d)tylenol only
    E) reassurance
  45. R.dass

    R.dass Guest

    Q. All of the following phenomena related to lung cancer are correctly matched with the appropriate association EXCEPT
    a- bronchial squamous metaplasia - cigarette smoking
    b- facial swelling and cyanosis - recurrent laryngeal nerve paralysis
    c- Pancoast’s tumor - superior sulcus
    d- ptosis, miosis, and anhidrosis - Horner’s syndrome
    e- paraneoplastic syndrome - small cell carcinoma

    Answer: B. Facial swelling and cyanosis, often with dilatation of the veins of the head and neck, is characteristically caused by partial obstruction of the superior vena cava and is referred to as the superior vena cava syndrome. These findings are most often a manifestation of lungs cancer. Another quite unrelated complication of lung cancer is hoarseness caused by involvement of the recurrent laryngeal nerve.
  46. R.dass

    R.dass Guest

    Q. All of the following statements concerning respiratory tract neoplasms are correct EXCEPT
    a- the most common site of extramedullary plasmacytoma is the upper respiratory tract
    b- a singer’s nodule is a small, benign laryngeal polyp induced by chronic irritation.
    c- papillomas of the larynx tend to be single in adults and multiple in children
    d- squamous cell carcinoma is the most common malignant tumor of the larynx
    e- most laryngeal carcinomas have a subglottic location

    Answer: E. The most common location of laryngeal carcinoma is on the true vocal cords (glottis). Tumors in on this region have the best prognosis since the glottis has almost no lymphatic drainage. The second most common location is supraglottic, and tumors in this location have a poorer prognosis. The least common location is the subglottic region, and tumors in this region have the poorest prognosis.
  47. R.dass

    R.dass Guest

    Q. Markers of plasma membrane are :
    a- Galactosyl transferase
    b- 5-Nucleotidase
    c- Adenyl cylase
    d- ATP synthase
    e- Glucokinase

    Ans: B, C.
    Enzymatic markers of different membranes :
    - Plasma - Nucleotidase
    Adenyl cyclase
    Na+ K+ ATPase
    - Endoplasmic reticulum - Glucose - 6 - phosphatase
    - Golgi apparatus -Glc NAc tranferase I
    Golgi mannosidase II
    Galactosyltransferase
    Sialytransferase
    - Inner mitochondrial membrane - ATP synthase
    - Glucokinase is a cytosolic enzyme.
  48. R.dass

    R.dass Guest

    Q. Hemoprosthetic group is found in :

    a- Myoglobin
    b- Cytochrome oxidase
    c- Xanthine oxidase
    d- Tyrosine

    Ans : A, B.
    - Hemoproteins are :
    - Hemoglobin
    - Myoglobin
    - Cytochrome
    - Catalase
    - Tryptophan pyrrolase
    - Cytochrome oxidase is a hemoprotein widely distributed in different tissues.
    - Xanthine oxidase is a flavoprotein, contains molybdenum and plays an important role in conversion of purine bases to uric acid.
  49. R.dass

    R.dass Guest

    Q. Creatinine is formed from :

    a- Arginine
    b- Lysine
    c- Leucine
    d- Histamine

    Ans: A. Arginine.
  50. Abrahm.

    Abrahm. Guest

    Q. 18 yr old patient with IDDM. everything is well for the pt. meds
    include OCPs, insulin, diet,exercise IS THERE any need of a change in mgt?

    d/c OCP and give depo progestrone or no change?


    Q. pt with clinical features of measles, then the child is ataxic,
    what will you advize will you give to the parents????


    Q. A 56 y/o man came to PMD, he is s/p CABG 10 yeas back, c/o SOB with exertion and chest pain.
    He is relived with rest. What is next step?
    a. EST
    b. thalliun stress test
    c. dobutamine test
    d. 12 leads EKG

    Q. baby around 8 months . Gets up middle of the night and drinks milk. What advise to mom?

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