Discussion in 'NEET 2013 All india Exam' started by Guest, Jan 25, 2010.

  1. Guest

    Guest Guest

    True or False: Acute renal failure is a benign disease.
    False: It has a 31% mortality rate in patients.

    How do you treat acute renal failure?
    Fluid management: hypovolemia potentiates and exacerbates all forms of ARF
    Urinary catheter in case of postrenal cause
    Renal replacement therapy
    Intermittent hemodialysis
    Mannitol (with rhabdo)
    Diuretics (nonoliguric ARF)

    True or False: Reversal of hypovolemia by rapid fluid infusion often is sufficient to treat many forms of acute renal failure.

    What do you need to be aware of befor initiating fluid in acute renal failure?

    What are the indications for dialysis in treating acute renal failure?
    volume overload
    acid/base disorders
    symptomatic uremia
    uremia (BUN>100)
    dialyzable intoxications (aspirin, lithium
  2. Guest

    Guest Guest

    What is the most common cause of infectious disease-related death worldwide?
    TB caused by Mycobacterium tuberculosis

    What are the two classifications of MTB?
    Latent TB and active TB (both patient groups will test positive)
    -Persons w/ latent TB are not infectious and cant spread disease to others.

    What is the difference in manifistations between someone infected w/ TB vs. someone with TB disease?
    Chest XRay normal for infection and TB disease X-ray reveals lesion
    Sputum and culture is neg for infection
    and positive for disease.
    -asymptomatic for infection and cough, fever, weight loss for disease

    T/F Humans are the only reservoir for MTB?
    T (organism is transmitted by airborne droplet nuclei that often contains 3-5 bacilli/droplet
  3. Guest

    Guest Guest

    ● Skeletal damage implies chronic disease and therefore may be present in individuals with some resistance to TB. Those with little resistance probably died before the skeleton could be affected.
    ● Care must be taken to distinguish pathological lesions of the skeleton from post-mortem abnormalities.
    ● The most common skeletal deformity caused by TB is destruction of the vertebral bodies leading to angulation of the spine.
    ● The hip and knee are the next most common sites, but any bone may be affected.
    ● The previous belief that TB was spread from animals to humans as they were domesticated has been put in doubt by evidence of humans being infected by TB before domestication of animals took place. Genomic studies have also cast doubt on the earlier held theory.
    ● Study of skeletal remains of animals has not been helpful in assessing the extent of TB in ancient times and whether TB in animals presented a risk for humans
  4. Guest

    Guest Guest

    Cell wall. Many of the special characteristics of TB are ascribed to the chemistry of their cell wall, which features a murein layer as well as numerous lipids, the most important being the glycolipids (e.g., lipoarabinogalactan), the mycolic acids, mycosides, and wax D.
    Glycolipids and wax D.
    — Responsible for resistance to chemical and physical noxae.
    — Adjuvant effect (wax D), i.e., enhancement of antigen immunogenicity.
    — Intracellular persistence in nonactivated macrophages by means of inhibition of phagosome-lysosome fusion.
    — Complement resistance.
    — Virulence. Cord factor (trehalose 6,6-dimycolate).
  5. Guest

    Guest Guest

    What lines are involed in CML?
    1.) myeloid
    2.) monocytic
    3.) erythroid
    4.) megakaryocytic
    5.) B-lymphoid
    6.) some T-lymphoid cells

    Age range of CML
    30-50 years old

    Pathophysiology of CML
    - disorderly expansion of myeloid progenitor cells results from alterations in their proliferative capacity and a shift in the balance between self-renewal and differentiation toward differentiation
    - increased progenitor cells
    - decreased pool of stem cells

    Cytogenics of CML
    - Ph1 chromosome result from reciprocal translocation of DNA between chromosomes 9 and 22
    - makes 2 novel fusion genes: BCR:ABL on 22q-(Philadelphia) and ABL-BCR on 9q+

    ABL gene
    - produces a protein tyrosine kinase
    - fusion protein BCR-ABL has constitutive kinase activity that deregulates signal transduction pathways causing:
    * abnormal cell cyclin
    * inhibition of apoptosis
    * increased proliferation of cells

    Phases of CML
    1.) Initial (chronic)
    2.) Accelerated
    3.) Blast crisis (acute)
  6. Guest

    Guest Guest

    Where does Non-Hodgkin's Lymphoma originate?
    In the cells and organs of the immune system

    In what cells does N-H lymphoma originate?
    Undifferentiated lymphoid cells

    T or F: N-H lymphoma is thought to result from genetic deviation that influences cell proliferation, differentiation, & cell death.

    Recurrent, nonrandom chromosome translocations are seen in what disease's cytogenetic studies?

    What immunodeficiency syndromes are associated with a higher risk of NHL?
    1. Wiskott-Aldrich
    2. Ataxia-telangiectasia
    3. Other inherited or acquired immunodeficiencies

    What role does the EBV virus have regarding NHL?
    EBV is thought to precede or occur along with B-cell transformation (assoc. with Burkitt's lymphoma)

    Why is histologic classification important in NHL?
    It helps to identify the malignant cell of origin, therefore aiding in the understanding of the biologic behavior of the tumor.

    How is Non-Hodgkin's lymphoma divided?
    Into T-cell and B-cell lymphomas; subdivisions are specific to precursor characteristics
  7. Guest

    Guest Guest

    What area is one most likely to find lymphadenopathy in a LL patient?

    T or F: T-cell LL does not typically spread to the BM or CNS or gonads.
    False: It commonly spreads to those areas

    If a T-cell LL patient has >25% blasts in their bone marrow, what is their diagnosis?
    Acute Lymphoblastic Leukemia (ALL)

    How does B-cell origin LL typically present in terms of overall disease?
    Localized disease of bone, lymph nodes, and skin

    T or F: BL and BLL account for about 50% of all childhood NHL.
    False: They account for about 40%

    How is BL characterized in terms of chromosomal abnormalities?
    Translocation is t(8;14;q24;q11) - involves gene for immunoglobulin heavy chain.

    What are the common sites for disease in BL or BLL?
    Abdomen and pelvis

    What are some common presenting signs in BL or BLL?
    1. rapidly enlarging mass
    2. abdominal pain
    3. intussusception
    4. intestinal obstruction/perforation

    What is associated with improved outcome in relation to the BL or BLL tumor?
    Complete excision is indicated

    T or F: Peripheral lymph nodes, bone and bone marrow are other sites of BL or BLL disease

    What percentage of BL or BLL patients have CNS involvement?
    approximately 10% of all cases

    How is Non-Hodgkin's lymphoma divided?
    Into T-cell and B-cell lymphomas; subdivisions are specific to precursor characteristics

    What four classifications does the WHO divide NHL into?
    1. Lymphoblastic lymphoma (LL)
    2. BL & Burkitt-like lymphoma (BLL)
    3. Diffuse large B-cell lymphoma
    4. Anaplastic large-cell lymphoma (ALCL)

    T or F: LL accounts for one-third of all childhood lymphomas

    What cell line accounts for 85-90% of all LL?
    Immature Tcells undergoing differentiation in the thymus

    What cell line accounts for only 10-15% of all LL?
    only 10-15% express the phenotype of pre-B cells, along w/multiple cytogenetic abnormalities

    What physical sign do 70% of T-cell LL patients present with at diagnosis?
    Mediastinal mass

    What symptoms occur in relation to the presence of a mediastinal mass?
    Compression symptoms: dyspnea, stridor, wheezing, dysphagia, & swelling of the head & neck.
  8. Guest

    Guest Guest

    Genetic Hearing Loss
    Once environmental factors have been excluded (as far as possible), a genetic aetiology becomes more likely. Although hearing impairment can be inherited as an autosomal recessive, dominant, X-linked or matrilineal (mitochondrial) trait, recessive causes account for about 80% of all cases of genetic deafness. The implication of this is that most children with genetic deafness will be born to normally hearing parents and will have no family history of deafness, yet their parents have a 25% chance of having a subsequent child with a similar hearing impairment. The difficulty is that in many cases, a genetic cause cannot be excluded as not all genes can be tested (see below), so the geneticist may have to rely on empirical data in order to provide recurrence risks. It may be a surprising fact that for children born with a severe/profound hearing impairment in whom no definite aetiology can be ascribed, that about 1:8 of their parents will go on to have a further deaf child. This is presumably because the group of children with “unknown causes” will include both recessive cases (with a 1:4 recurrence risk) and those with an undiagnosed environmental cause with a lower recurrence risk.
  9. Guest

    Guest Guest

    Genetic Hearing Loss
    ■ ENT surgeons who practice otology need to have a working knowledge of genetics relevant to their field.
    ■ A large proportion of those with deafness of unknown aetiology have a genetic cause.
    ■ GJB2 testing should be offered to all those with bilateral permanent non-syndromic hearing loss.
    ■ Many genes can cause non-syndromic deafness, and genetic testing is not yet available for a significant number.
    ■ Some genetic causes of non-syndromic deafness may have distinct phenotypes that may be a clue to the underlying aetiology.
    ■ It is likely that within a few years, a precise aetiological diagnosis of deafness will be necessary in order to determine appropriate medical and surgical management.
    ■ Consent should always be sought before genetic testing, because of implications for other family members.
    ■ The audiological/cochlear implant team may benefit from close liaison with their Regional Genetics Service, for difficult or rare syndrome diagnoses, for genetic counselling and for interpretation of genetic laboratory results.
  10. Guest

    Guest Guest

    ▪ Short stature is defined as height at least 2.5 standard deviations below the mean (-2.5 SD), or height less than the third percentile.
    ▪ Growth hormone therapy is accepted for growth hormone deficiency or insufficiency, chronic renal insufficiency (pretransplantation), Turner syndrome, adults with growth hormone deficiency, adults with acquired immunodeficiency syndrome wasting, Prader-Willi syndrome, and children born small for gestational age without adequate catch-up growth by 2 years.
    ▪ Growth hormone therapy is most controversial for children with idiopathic short stature.
    ▪ The dose of growth hormone, most often administered via daily subcutaneous injection, is 0.17 to 0.33 mg/kg/week.
    ▪ Side effects of growth hormone therapy include local irritation, local or generalized edema, pseudotumor cerebri, slipped capital femoral epiphysis, and impaired glucose tolerance.
    ▪ For the duration of growth hormone therapy, patients are monitored every 3 to 4 months. Insulin-like growth factor-1 and insulin-like growth factor–binding protein-3 are monitored every 6 to 12 months, and bone age determinations are made annually.
    ▪ Growth hormone therapy should be continued until final adult height is reached; then growth hormone sufficiency should be re-evaluated.
    ▪ Ethical considerations may surround the decision to treat patients with growth hormone.
  11. Guest

    Guest Guest

    1. The risk of familial ovarian cancer is high if:
    A. Two first-degree relatives have ovarian cancer.
    B. One woman has ovarian cancer and a first-degree relative under 50 years of age has breast cancer.
    C. The BRCA1 gene is detected.
    D. One woman has ovarian cancer and two first-degree relatives have breast cancer diagnosed before 60 years of age.
    E. One woman has ovarian cancer and three first-degree relatives have colorectal cancer with at least one case diagnosed before 50 years of age.

    2. The following substances are safe in pregnancy:
    A. Chlorpheniramine.
    B. Aspirin.
    C. Vitamin A.
    D. Vitamin D.
    E. Polio vaccination.
    F. Tuberculosis vaccination.

    A. True.
    B. True.
    C. True.
    D. True.
    E. True.

    A. True. Antihistamines such as chlorpheniramine and terfenadine are thought to be safe during pregnancy.
    B. True. In the CLASP study (1995) there was no significant problem. However, it may lead to haemorrhage due to impaired platelet function.
    C. False. Vitamin A is found in high concentrations in the liver and cod liver oil capsules; these should be avoided in early pregnancy.
    D. False.
    E. False. Live vaccines, such as BCG, MMR, oral polio, oral typhoid and yellow fever should be avoided if possible.
    F. False.
  12. Guest

    Guest Guest

    Muscarinic receptors
    Whereas acetylcholine acts through the nicotinic receptor to stimulate contraction of skeletal muscle, it decreases the rate and force of contraction of heart muscle through muscarinic receptors. These belong to the seven transmembrane-spanning (7TM) superfamily of G protein-linked receptors and they exist as fi ve subtypes, M1, M2, M3, m4, and m5. All fi ve subtypes are present in the CNS. M1 receptors are expressed in ganglia and a number of secretory glands. M2 receptors are present in the myocardium and in smooth muscle and M3 receptors are also present in smooth muscle and in secretory glands
    Muscarine and related compounds have many actions, dependent on the tissues to which they are applied and the receptor subtypes that are expressed. The structures and the mechanisms of action of the receptors activated by muscarine are closely related to those activated by the catecholamines. Like the adrenergic receptors, the diversity of their functions fi rst became apparent with the development of a specifi c antagonist. This was pirenzepine, which blocks M1 receptors and prevents gastric acid secretion while being without eff ect on a number of other responses elicited by muscarinic receptors.
    Although the muscarinic and nicotinic receptors share a common physiological stimulus, and although the muscarinic receptors can regulate ion fl uxes indirectly (for example in the heart), they are not in themselves ion channels. The diff erence goes much further than this. Not only are these receptors unrelated in terms of structure and evolution, but the conformation of the acetylcholine as it binds is likely to be diff erent. While nicotine and muscarine are very diff erent from one another and contain ring structures that lend rigidity, the acetylcholine molecule is more fl exible and is able to adopt diff erent conformations that may be stabilized as it slots into its binding sites in the two receptors.
  13. Guest

    Guest Guest

    Developmental Dysplasia of the Hip Joint

    The definition of dysplasia is abnormal growth or development. Dysplasia of the hip encompasses a spectrum of conditions in which there is an abnormal relationship between the proximal femur and the acetabulum. In the most severe condition, the femoral head is not in contact with the acetabulum and is classified as a dislocated hip. A dislocatable hip is one in which the femoral head lies within the acetabulum at rest but can be dislocated with a provocative maneuver. A subluxatable hip is one in which the femoral head comes partially out of the joint with a provocative maneuver. Acetabular dysplasia is a term describing insufficient acetabular development on radiograph.

    Congenital dislocation of the hip occurs in approximately 1 in 1000 live births. At birth, both the acetabulum and femur are underdeveloped
    The diagnosis of hip dislocation in the newborn depends on demonstrating instability of the joint. The infant is placed supine and complete relaxation is obtained by feeding with a bottle if necessary. The examiner's long finger is then placed over the greater trochanter and the thumb over the inner side of the thigh. Both hips are flexed 90 degrees and then slowly abducted from the midline, one hip at a time. With gentle pressure, an attempt is made to lift the greater trochanter forward. A feeling of slipping as the head relocates is a sign of instability (Ortolani sign). When the joint is more stable, the deformity must be provoked by applying slight pressure with the thumb on the medial side of the thigh as the thigh is adducted, thus slipping the hip posteriorly and eliciting a jerk as the hip dislocates (Barlow sign).
  14. Guest

    Guest Guest

    Blood biochemistry confirms the presence of jaundice by revealing elevated serum bilirubin and helps to differentiate predominantly conjugated (direct) hyperbilirubinaemia from predominantly unconjugated (indirect) hyperbilirubinaemia on the basis of their behaviour in the van den Bergh (diazo) reaction.
    Unconjugated hyperbilirubinaemia may arise from:
    ● increased bilirubin production (haemolysis, reabsorption of large haematoma);
    ● decreased hepatic uptake or conjugation as in Gilbert’s syndrome (a common genetic defect in the UDP-glucuronyl transferase gene, where patients report yellow discoloration of their skin during stress, e.g. exercise or fasting, with spontaneous resolution).
    Conjugated hyperbilirubinaemia usually arises when the liver has lost at least 50 per cent of its excretory capacity as a consequence of hepatocellular damage (hepatic jaundice) or obstruction of biliary ductal system (obstructive jaundice). The latter could arise from several causes In this chapter we discuss the management of patients with obstructive jaundice, which is traditionally most relevant to the general surgeon.

    It is essential to differentiate between hepatic and obstructive jaundice in order to initiate appropriate management. History , physical examination and blood biochemistry are reliable tools that help to distinguish between these two causes of conjugated hyperbilirubinaemia

    Hepatic jaundice may be associated with:
    ● history of excessive alcohol consumption or presenting acutely with low-grade fever, abdominal pain and flu-like symptoms (acute hepatitis);
    ● stigmata of liver disease encountered during physical examination (palmer erythema, Dupuytren’s contracture, chest wall spider angioma, gynaecomastia);
    ● signs of portal hypertension (mental changes, flapping tremor, caput medusa, ascites, splenomegaly).

    It is often the pattern of liver enzyme alteration on blood biochemistry, however, that helps to distinguish hepatic from obstructive jaundice.
    Full assessment involves identification of the predominant pattern of liver enzyme abnormalities, the magnitude of the enzyme alterations, and the nature and rate of enzyme alteration:
    ● Slightly elevated conjugated serum bilirubin (< 35 μmol/L), with markedly elevated aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels, and a mild abnormality of alkaline phosphatase (ALP) and γ-glutamyl transpeptidase (GGT), are suggestive of hepatocellular jaundice, as injury to hepatocytes results in elevation of both AST and ALT.
    ● Altered liver enzymes with a predominantly elevated ALP and a mild raise in ALT are suggestive of obstructive jaundice.
    It is important to remember that an atypical obstructive enzyme pattern could be due to a cholestatic drug reaction (including commonly used drugs, e.g. angiotensin-converting enzyme inhibitors or oestrogens) and may also occur in autoimmune cholestatic diseases (primary biliary cirrhosis, primary sclerosing cholangitis).
  15. Guest

    Guest Guest

    Caroli’s Disease
    Caroli’s disease, also known as communicating cavernous ectasia=dilatation of the biliary tree, is a rare congenital disorder characterized by non-obstructive, saccular or fusiform dilatations of the intrahepatic bile ducts. It corresponds to type V of the Todani Classification and to type F of the Miyano Classification and occurs with equal frequency in males and females.
    Two types of the disease have been described: the real, so-called “pure” type, and the more common type associated with congenital hepatic ibrosis. The less common pure form is characterized by saccular, digitate, or moniliform estasia of the intrahepatic bile ducts, with no other istologic abnormalities. The abnormalities typically predominate in one segment, usually in the left lobe, and may be diffuse or localized. The ectasias communicate freely with the bile ducts, promoting stasis and sludge formation, which can lead to lithiasis and cholangitis.Biliary infection and stones account for the usual presenting symptoms of fever and abdominal pain. Cholangiocarcinoma develops in approximately 5-10% of cases
  16. Guest

    Guest Guest

    # RBC transfusion is indicated for patients with evidence of hemorrhagic shock.
    # RBC transfusion may be indicated for patients with evidence of acute hemorrhage and hemodynamic instability or inadequate oxygen delivery.
    # A "restrictive" strategy of RBC transfusion is defined as transfusing when Hb levels are less than 7 g/dL.
    # A "liberal" strategy of RBC transfusion is defined as transfusing when Hb levels are less than 10 g/dL.
    # For critically ill patients with hemodynamically stable anemia, except possibly for those with acute myocardial ischemia, "restrictive" and "liberal" transfusion strategies are equally effective.
    # The decision to transfuse should be based not only on Hb level but also on intravascular volume status, evidence of shock, duration and extent of anemia, and cardiopulmonary physiologic parameters.
    # Except for patients with acute hemorrhage, RBC transfusion should be given as single units.
    # Transfusion should be considered for Hb levels of less than 7 g/dL in critically ill patients requiring mechanical ventilation. The "liberal" transfusion strategy offers no added benefit.
    # Transfusion should be considered if Hb level is less than 7 g/dL in resuscitated, critically ill trauma patients, with no benefit of a "liberal" transfusion strategy
  17. Guest

    Guest Guest

    # Transfusion should be considered if Hb level is less than 7 g/dL in critically ill patients with stable cardiac disease, with no benefit of a "liberal" transfusion strategy.
    # In critically ill patients, RBC transfusion should not be considered as an absolute method to improve tissue oxygen consumption.
    # RBC transfusion may be beneficial for patients with acute coronary syndromes and anemia (Hb levels < 8 g/dL) on hospital admission.
    # RBC transfusion is associated with increased rates of nosocomial infection, including wound infection, pneumonia, and sepsis, independent of other factors.
    # RBC transfusion is an independent risk factor for multiple organ failure and sepsis inflammatory response syndrome.
    # Some studies have shown a reduction in infectious complications of RBC transfusion with prestorage leukocyte depletion, but definitive evidence is lacking.
    # RBC transfusions are independently associated with longer intensive care unit and hospital length of stay, increased complications, and greater mortality rates.
    # RBC transfusion is associated with acute lung injury and acute respiratory distress syndrome.
  18. Guest

    Guest Guest

    ● When given to infants, BCG affords good protection against death from TB and against disseminated and meningeal TB.
    ● Vaccination of older children is not as reliable as vaccination of infants.
    ● In randomized clinical trials with BCG among adolescents and young adults, only the study carried out in the UK in the 1950s has shown good protection.
    ● Hypotheses as to why there is such variation in BCG efficacy are many and varied. None provides a sufficient explanation, although some, such as the role of heterologous immunity resulting from infection with environmental mycobacteria deserve further study.
    ● The efficacy of BCG should not be ‘averaged’ across different trials. The fact is that some trials have shown protective efficacy of 80 per cent and some none.
    ● No trial has shown BCG to have important harmful effects.
    ● BCG is recommended for infants in developing countries where TB is common. It continues to be given in some countries where the prevalence is low, but the majority of low-incidence countries in Western Europe have relinquished its use and in others this policy is under some review.
    ● Some countries, such as the USA and The Netherlands, have never routinely used BCG.
  19. Guest

    Guest Guest

    Gold salts when used in the treatment of progressive rheumatoid arthritis:
    a) Are usually administered daily by intravenous injection
    b) If effective, benefit should be observed after the first week of treatment
    c) Produce objective improvement in about 75 per cent of patients
    d) Can cause skin rashes which can necessitate treatment cessation
    e) If they cause stomatitis this may be due to neutropenia

    a) False Gold (as sodium aurothiomalate) is usually administered
    b) False as weekly intramuscular injections or by mouth daily.
    c) True Benefit is not anticipated for at least six weeks. Blood
    d) True dyscrasias and glomerular injury (nephrotic syndrome)
    e) True occur and monitoring of blood counts and urine is performed monthly. Rashes may progress to exfoliation

    Glucocorticosteroids inhibit:
    a) Platelet thromboxane A2 synthesis
    b) Histamine release
    c) Leukotriene C4 and D4 synthesis
    d) Arachidonic acid metabolism
    e) Transcription of tumour necrosis factor (TNF) and interleukin 6 (IL-6)

    a) False Glucocorticosteroids reduce the transcription of
    b) True proinflammatory mediators (e.g. TNF, IL-6) and inhibit
    c) True type I, II, III and IV hypersensitivity reactions. They are the
    d) True most widely used immunosuppressive agents. They inhibit
    e) True eicosanoid synthesis from arachidonic acid in nucleated cells by increasing the production of lipocortin, an inhibitor of phospholipase A2 (PLA2)
  20. Guest

    Guest Guest

    The following agents are used to prevent or treat graft-versus-host disease:
    a) Methylprednisolone
    b) Ciclosporin
    c) Mycophenolate mofetil
    d) Tacrolimus
    e) Infliximab
    a) True
    b) True – Specific T lymphocyte suppressor, primarily against T helper cells
    c) True – Need regular blood counts
    d) True – Is neurotoxic and nephrotoxic
    e) True – Monoclonal antibody which binds TNF and prevents its action

    Adverse effects associated with ciclosporin include:
    a) Reduced glomerular filtration pressure leading to nephrotoxicity
    b) Gingival hyperplasia
    c) Alopecia
    d) Tremor
    e) Hypokalaemia
    a) True – Also may cause hypertension. Nephrotoxicity may be reduced by concurrent calcium channel blockade
    b) True
    c) False – Hirsutism
    d) True – May be an early sign of toxic plasma concentrations
    e) False – Causes hyperkalaemia

    Administration of basiliximab (IL-2 receptor blocking antibody) may cause the following side-effects:
    a) Hypotension
    b) Delayed, severe dyspnoea and wheezing
    c) Fever and chills
    d) Aseptic meningitis
    e) Cardiomyopathy
    a) True – Any murine/humanized monoclonal antibody when given to humans may cause anaphylaxis
    b) True – Manifestation of a delayed hypersensitivity reaction
    c) True
    d) False – Intravenous human normal immunoglobulin (HNIG) in high dose can cause this
    e) False
  21. Guest

    Guest Guest

    open-angle glaucoma treatment
    ↓aqueous humor -->
    betablockers (timolol, betaxolol, levobunolol)
    alpha agonists (apraclonidine, brimonidine)
    carbonic ahydrase inhibitors (dorzolamide, brinzolamide)

    ↑outflow -->
    prostaglandins (latanoprost, travoprost) and pilocarpine

    if medical treatment doesnt work --> laser trabeculoplasty, surgical trabeculectomy

    closed-angle glaucoma presentation
    eye is red
    hard to palpation
    fixed midpoint pupil
    clouded cornea
    diminished visual acuity

    closed-angle glaucoma treatment
    opthalmologic emergency
    IV azetazolamide, urea, osmotic diuretics
    pilocarpine to open canal of Schelmm
    betablockers to decrease production of aqueous humor
    if all fails --> laser trabeculoplasty

    opacification of lens results in slow progressive blurry vision
    diagnose with physical exam and slit lamp
    treatment is surgical removal of lens with intraocular lens placement

    bacterial --> unilateral red eye with discharge and little itching
    treat with topical erythromycin, sulfacetamide, fluoroquinolones

    viral --> more often bilateral, red eyes with severe itching
    symptomatic treatment
  22. Guest

    Guest Guest

    What cancer is the 2nd leading cause of death due to cancer?

    Colon cancer risk increases with age and peaking age what ages?
    70's and 80's

    What also increases your risk of colon cancer/
    -positive family hx
    -decreased fiber intake
    -increased fat intake
    -colorectal polyps

    Right sided colon CA is more common in what sex/

    Carcinoma of the retum are more common in what sex?

    Colorectal tumors are mostly what cell type?

    What are some S/S of righ sided colon cancer?
    -R sided ab discomfort that is often post prandial
    -occasional palpable mass

    Which anti-depressants can --> delirium
    how to treat this?
    IV BZ (lorazepam is a good one, b/c there is a short t 1/2)

    how many days should you wait to give an SSRI, in a pt that has been previously treated with MAOI?
    14 days

    what is used to treat atypical depression?

    which etoh detox drugs are metabolized by the liver?
    chlordiazepoxide (librim)

    which etoh detox drug is good to give to someone w impaired liver fxn?
    oxazepam (serax)

    what effect do SSRIs have on post-synaptic 5HT-2 receptors?
    downregulates them

    which NSAID does not interfere with lithium metabolism?

    what decreases lithium excretion?
    ACE inhibitors
    Thiazide diuretics
    NSAIDS (not ASA)

    what increases lithium clearance?
    Osmotic diuresis
  23. Guest

    Guest Guest

    Function and chemical composition of bacterial structure: Peptidoglycan
    1. Rigid support
    2. Protects against osmotic pressure

    Chemical composition:
    Sugar backbone with cross-linked peptide side chains

    Function and chemical composition of bacterial structure: Cell wall/cell membrane
    Gram positives only

    Function: Major surface antigen

    Chemical composition: Teichoic acid, which induces TNF and IL-1

    Function and chemical composition of bacterial structure: Outer membrane
    Gram negatives only

    Function: Site of endotoxin (lipopolysaccharide) and major surface antigen

    Chemical composition: Lipid A induces TNF and IL-1, and polysaccharide is the antigen
  24. Guest

    Guest Guest

    Function and chemical composition of bacterial structure: Capsule
    Function: Protects against phagocytosis

    Chemical composition: Polysaccharide (except Bacillus anthracis which contains D-glutamate)

    Function and chemical composition of bacterial structure: Pilus/fimbria
    Function: Mediates adherence of bacteria to cell surface; sex pilus forms attachment between 2 bacteria during conjugation

    Chemical composition: Glycoprotein

    Function and chemical composition of bacterial structure: Flagellum
    Function: Motility

    Chemical composition: Protein

    Function and chemical composition of bacterial structure: Spore
    Function: Provides resistance to dehydration, heat, and chemicals

    Chemical composition: Keratin-like coat and dipicolinic acid

    Function and chemical composition of bacterial structure: Plasmid
    Function: Contains a variety of genes for antibiotic resistance, enzymes, and toxins

    Chemical composition: DNA
  25. Guest

    Guest Guest

    What is the site of action for neuromuscular blocking agents?
    Neuromuscular junction

    Does neuromuscular blockade provide anesthesia, analgesia and paralysis?
    No, it only provides paralysis

    What type of channels are located at the neuromuscular junction?
    Voltage gated calcium channels

    What type of receptors are located on the muscle membrane at the neuromuscular junction?
    Nicotinic cholinergic receptors

    How many receptors must be activated for normal muscle contraction?

    During depolarization, the nerve terminal releases ACh across the synaptic cleft, via what process?

    The ACh receptor in the neuromuscular junction consists of what type and how many subunits?
    Five protein subunits (2 alpha, a single beta, delta and epsilon subunits)

    Which of those subunits are capable of binding with ACh molecules?
  26. Guest

    Guest Guest

    CD 21: ST on B-cells and also EBV receptor on B-cells
    CD 1a: Langerhans Cells, Histeocytosis X, Langerhans Cells
    CD 2: Adhesion molecule on T-Cells, NK Cells and LAK Cells.
    CD 3: Signal transduction for T-Cells
    CD 4: Helper T-Cell Marker, Binds MHC II, Marker for HIV
    CD 8: Cytotoxic T-Cell Marker, Binds MHC I
    CD 10:Marker for ALL
    CD 14: Macrophage Marker
    CD 15 and 30: Hodgkin's Lymphoma
    CD 16 and 56: NK and LAK cell marker
    CD 19: Signal Transduction and Emumerating B cells
    CD 20: ST on B-cells
    CD 21: ST on B-cells and also EBV receptor on B-cells
    CD 28: Costimulatory MOlecule required to activate T-cell (binds to B7
    on B-cell or APC)
    CD 40: Memory and class switching on B-Cells (binds to CD 40 ligand
    on T-Cells)
    CD 45: Leukocyte Marker -useful in surgical patho to differentiate
    leukocyte from epithelial malignancy.
  27. Guest

    Guest Guest

    ACh must bind with how many sites, for an ion channel to open?

    Describe how an end-plate potential is generated.
    Cations flow through the open ACh receptor channel (sodium and calcium in; potassium out

    A single vesicle may contain a quantum of ACh, how many molecules of ACh are in a quantum?
    5,000 to 10,000

    A decrease/increase in extracellular ionized calcium concentration causes the number of quanta to be released during a nerve impulse?
    An increase in extracellular ionized calcium concentration

    How many quanta are released by a single nerve impulse?

    What makes the end-plate potential strong enough to depolarize the perijunctional membrane?
    When enough receptors are occupied by ACh

    ________ channels within the perijunctional membrane open when what voltage is reached?
    Sodium / threshold voltage or -45mv
  28. Guest

    Guest Guest

    Function and chemical composition of bacterial structure: Glycocalyx
    Function: Mediates adherence to surfaces, especially foreign surfaces (eg indwelling catheters)

    Chemical composition: Polysaccharide

    Function of this structure: IgA proteases
    Function: Allow some organisms to colonize mucosal surfaces

    Which bacteria have IgA proteases?
    1. Streptococcus pneumoniae
    2. Neisseria meningitidis
    3. Neisseria gonorrheae
    4. Hemophilus influenzae

    Which bacterial substances induce cytokines, and which are they?
    Cytokines induced:
    1. IL-1
    2. TNF

    Gram positive inducer: Teichoic acid

    Gram negative inducer: Lipopolysaccharide (Endoxtoxin)
  29. Guest

    Guest Guest

    What animal has the highest reported incidence of rabies in the US and what is a close second?
    Raccoon, with skunk a close second

    The majority of rare human cases of rabies occurred due to exposure with what animal?

    Describe the rabies virus in terms of what family it is in, the genome, and the structure
    Rabies is a rhabdovirus that is a zoonotic agent with a -ssRNA genome and an envelope glycoprotein

    What is the major land animal in Kentucky with rabies?

    How does one contract the rabies virus and where in the body does it replicate?
    Rabies is contracted after a bite, scratch, or exposure to saliva of an infected animal; the initial replication of the virus is in the striated muscle using the acetlycholine receptor at the neuromuscular junction

    How does the rabies virus spread and to where does it spread?
    It infects the nerve endings and spreads via the motor and sensory axons to the spinal cord, brain, and salivary gland

    Describe the incubation period of the rabies virus
    It is long and variable, depending on the initial site of exposure and distance from the CNS
  30. Guest

    Guest Guest

    A full course of immunization against, Tetanus with 3 doses of Tetanus toxoid,
    confers immunity for how many years?
    10 years

    Microalbuminuria is defined as an increase in urinary albumin excretion at a level below that reliably detected by urine dipsticks (30 -299 mg/day or 20 -199 ug/minute).The normal urine range is 800 to 2000 milliliters per day

    The level of albumin protein produced by microalbuminuria cannot be detected by urine dipstick methods. A microalbumin urine test determines the presence of the albumin in urine. In a properly functioning body, albumin is not normally present in urine because it is retained in the bloodstream by the kidneys.

    Microalbuminuria is diagnosed either from a 24-hour urine collection (between 30-300 mg/24 hours) or, more commonly, from elevated concentrations in a spot sample (30 to 300 mg/L). Both must be measured on at least two of three measurements over a two- to three-month period.[1]. An albumin level above these values is called "macroalbuminuria", or sometimes just albuminuria.
  31. Guest

    Guest Guest

    ▪ Bacterial meningitis is a complex process involving systemic infection (bacteremia/sepsis) as well as central nervous system (CNS) infection.
    ▪ The primary pathophysiologic event is the disruption of the blood–brain barrier.
    ▪ Maintenance of adequate CNS and systemic perfusion is critical.
    ▪ Bactericidal antibiotics given in concentrations adequate to penetrate into the cerebrospinal fluid and to cover potentially antibiotic-resistant bacteria are essential.
    ▪ Strategies to control CNS inflammation, such as the administration of corticosteroids, are likely to be useful, especially if given very early in therapy.
    ▪ Fluid and electrolyte status must be carefully monitored.
    ▪ Effective vaccines are available to prevent common causes of bacterial meningitis.

    Vaccines for Meningitis
    ▪ Haemophilus influenzae type b (Hib): Conjugate vaccines given at 2, 4, and 6 months of age are highly effective against H. influenzae type b and have dramatically reduced the incidence of this once common disease.
    ▪ Prevnar (Streptococcus pneumoniae): A conjugate vaccine that includes coverages against seven common pneumococcal capsular types is routinely given to infants. However, because there are many other capsular types, this vaccine does not provide protection against all pneumococci.
    ▪ Neisseria meningitidis: A serogroup-specific vaccine consisting of purified bacteria capsular polysaccharide from group A, C, Y, and W–135 is available for children older than 2 years. A conjugate vaccine also was recently made available for children ages 11 to 18 years. Immunization is recommended for children at high risk (complement deficiency, asplenic hosts), travelers to endemic areas, and college students. No vaccine is currently available against type B capsular types associated with sporadic infections.

    Complications Bacterial meningitis

    The resolution of the acute infection and sterilization of the CSF does not signify the end of treatment for meningitis. Depending on the age of the patient, S. pneumoniae is associated with the most severe neurologic sequelae, ranging from blindness, quadriplegias or hemiplegias, and psychomotor retardation to seizure disorders. Frequent complications include deafness or hearing impairment in approximately 10% to 20% of patients. Even children seemingly left unscathed by this infection are often found to have significant psychomotor delay and behavioral abnormalities, and they perform less well in school than matched controls.

    Common Pitfalls

    ▪ Failure to hydrate these patients adequately may result in focal areas of hypoperfusion of the brain with resultant neurologic sequelae.
    ▪ Bleeding and clotting abnormalities are a common component of the pathophysiology of meningitis and may require therapy.
    ▪ Prolonged fever during the recovery phase of illness is not necessarily caused by ongoing bacterial infection, but it is more likely a result of persistent immune stimulation despite appropriate antimicrobial therapy.
  32. Guest

    Guest Guest

    Which is caused by Neisseria meningitidis? type of meningitis
    Neisseria meningitides. It is a gram negative, small diplococcus. It causes meningococcal meningitis.

    How is meningococcal meningitis transmitted?
    By airborne droplets. The bacteria inhibit the upper respiratory tract causing influenza-like symptoms, before traveling into the bloodstraem. From the blood, they pass into the meninges. Most symptoms are due to its toxins.

    What is meningococcemia?
    When meningococci enter the blood, they cause malaise and toxemia-meningococcemia. Endotoxin shock accompanies this condition, and many patients succumb to the disease at this stage.

    What are some characteristics of meningeal infection?
    Patients may display a stiff and arched neck. Headaches are painful, and skin spots may occur on the body surface.

    What is Waterhouse-Friderichsen syndrome?
    In addition to the other symptoms noted with meningitis, there is inflammation of the adrenal glands accompanied by severe hemorrhages
  33. Guest

    Guest Guest

    (1) Pleurisy or pleuritic pain occurs in association with pneumonia, pulmonary infarction from a PE, neoplasia, TB, connective tissue disorders, uraemia, or following trauma.
    (2) It may also be due to viruses, especially enteroviruses, and may be mimicked by a pneumothorax or epidemic myalgia (Bornholm disease).
    (3) The pain is sharp, knife-like, localized and exacerbated by moving, coughing or breathing, which tends to be shallow. Radiation to the shoulder or abdomen occurs with diaphragmatic involvement.
    (4) Listen for a pleural rub, although this may be inaudible if pain limits deep breathing, and disappears as an effusion develops.
    (5) Send ABGs if there are significant signs of pulmonary parenchymal disease. Perform an ECG which should be normal.
    (6) Request a CXR that may reveal the underlying cause or may be quite normal.

    (1) Give the patient oxygen and a non-steroidal anti-inflammatory analgesic such as ibuprofen 200–400 mg orally t.d.s. or naproxen 250 mg orally t.d.s.
    (2) Exclude a pulmonary embolus if there was sudden dyspnoea, tachypnoea and risk factors for thromboembolism. A PE is possible even with a normal CXR and ECG .
    (3) Refer the patient to the Medical team for treatment of the underlying cause, or discuss with the senior ED doctor before discharging.
  34. Guest

    Guest Guest

    Complications of otitis media, either acute or chronic, occur when the infective process spreads beyond the confines of the middle ear. From the middle ear and mastoid antrum infection may spread in the following directions:1. Medially to the labyrinth, through the oval window, round window or by erosion of the lateral semicircular canal. Occasionally there may be erosion of the promontory or the other semicircular canals. Meningitis commonly occurs in this way.2. Superiorly towards the middle cranial fossa resulting in an extradural abscess or in an abscess of the temporal lobe; meningitis occasionally results from spread of infection by this route.3. Posteriorly towards the posterior cranial fossa producing an extradural abscess between the sigmoid sinus and its bony wall (perisinus abscess) or an abscess medial to the sinus, septic thrombosis of the sigmoid sinus, meningitis beginning in the posterior cranial fossa, cerebellar abscess.4. Inferioriy through the floor of the tympanum producing a septic thrombosis of the bulb of the internal jugular vein.Complications are more likely to arise from chronic otitis media than from acute otitis media and are divided into two groups—extracranial and inlracranial.They are not mutually exclusive, however, as one complication may precede or lead to another, e.g. labyrinthitis may lead to meningitis or mastoiditis may lead to an extradural abscess

    To the present day our antivirals have been found by true Pasteurian logic, to be paraphrased as ‘discovery favours with prepared mind’. In practical laboratory terms ‘off-the-shelf’ chemicals are subjected to a biological screen. A virus-susceptible cell line is incubated with a non-toxic concentration of novel drug and the ‘target’ or ‘challenge’ virus is then added. If the cell is rendered uninfectable or if there is a 10–100-fold reduction in the quantity of virions produced by the drug-treated cell, the drug is further investigated. The many stages of the lifecycle of a virus give chemotherapeutists the opportunity to design or find compounds which interrupt virion binding, penetration or more usually some vital step dependent upon a unique viral enzyme such as RNA polymerase, protease or integrase . Virologists have screened through libraries of millions of already synthesized compounds, either using biological or, increasingly, automated ELISA screens against particular viral proteins. Once a molecule binding to a viral protein has been located, a more efficient molecule can be ‘designed’ by the chemists. Excellent examples of semi-designed antivirals are inhibitors of the common cold virus, which bind tightly to the viral capsid protein and which can be visualized by X-ray crystallography in the binding pocket on the virion surface, and also inhibitors of the influenzavirus neuraminidase enzyme. In the latter case the enzymeactive site had been identified as a saucer-like depression on the top of the viral neuraminidase protein and X-ray crystallography dentified exactly which amino acids of the viral protein were interacting with an inhibitor

    Chemists have modified an already discovered drug by addition of a single side chain to enable it to bind more strongly to the influenza neuraminidase protein and hence cause stronger inhibition of viral replication. The effects occur at a late stage of viral growth where the function of the neuraminidase is to cause release of newly synthesized virus from the infected cell.
    But, do not forget that the members of the plant kingdom are excellent chemists as well and laboratories are intensifying the search to discover novel molecules in plant extracts which, by chance, inhibit viruses. There is a strong history here to remember, with A. Fleming’s discovery of the penicillin antibiotic, synthesized by a penicillium mould on an orange.
    Chemists also believe that thousands of nucleoside analogues remain to be synthesized and tested as antivirals. Alternatively, these compounds may already be in existence and on the shelf as part of a completely unrelated biological screening programme. The now classic anti-herpes nucleoside analogue aciclovir was initially synthesized as an anti-cancer drug. Aciclovir is structurally related to the natural nucleoside 2’ deoxyguanosine but has a disrupted sugar ring (acyclic). Nucleoside analogues are some of our most powerful antivirals and even more surprisingly some, like aciclovir, appear to be extraordinarily safe in the clinic and, not surprisingly, have become the virologists’ favourite molecule.
  35. Guest

    Guest Guest

    Regarding meningococcal meningitis, how is diagnosis and treatment carried out?
    Spinal tap of the patient. The CSF is examined for the presence of Gram-neg diplococci.
    Aggressive therapy with penicillin and rifampin and other A/Bs is the preferrede treatment.

    What is Hib disease?
    Another form of meningitis is caused by Haemophilus influenzae type b. It also affects the meninges, but most cases occur in children between the ages of 2-5. The disease is occasionally fatal, but the mortality is generally lower than for meningococcal meningitis.

    Is there a way of preventing Haemophilus meningitis?
    A vaccine known as the Hib vaccine, which consists of polysaccharides from the agent. It is available to children and is often combined with the DPT or DTaP injection.

    The drug Rifampin is routinely used for the treatment of Haemophilus meningitis. TRUE/FALSE
    TRUE. The drug can be employed if exposure has taken place and it usually precludes the development of the disease.

    Can other bacteria cause meningitis?
    Streptococcus and Staphylococcus. Strep. pneumoniae is a common cause of meningitis when it infects the blood after establishing itself in the nasopharynx.
    Staph. meningitis can be due to Staph. aureus which enters via the respiratory tract or via a skin wound. Both can be fatal. They must be treated aggressively
  36. Guest

    Guest Guest

    Blood: basic description of amount in a person, and composition
    70cc/kg in a normal person
    the only liquid organ
    composed of cells (erythrocytes, leukocytes, thrombocytes) and plasma (electrolytes, proteins, lipids)

    Proteins in blood plasma and serum
    albumin, globulins (antibodies), clotting factors

    serum has no fibrinogen or clotting factors

    What are the life times of blood cells, and why are they as such?
    -short life span (except lymphocytes and macrophages)
    -multiplicity of cell types
    -widely distributed throughout body
    -bone marrow must respond quickly to emergency needs for additional cells (7-8x)
    -stem cells must be maintained in adequate numbers throughout life, i.e. self renewal

    Describe the maturation of red blood cells right before they leave the bone marrow.
    In the stage right before it fully matures: orthochromatic erythroblasts. They have small nuclei, which become extruded and the left over cell leaves the bone marrow into the peripheral blood stream. It is now slightly bluer than fully mature blood cells (polychromasia-- a sign of newly synthesized cells: reticulocytes)
    These continue to circulate for 48 hours to make Hemoglobin to make normochromic, normocytic (normal sized) red blood cells.
  37. Guest

    Guest Guest

    What is the lifespan of an RBC?
    120 days

    What is the composition of Myeloid tissue?
    composed of the granulocytes, erythrocytes, monocytes and

    Where would you find Myeloid tissue?
    Confined to bone marrow

    Where do lymphoid elements primarily mature?
    Lymphoid organs

    Lymphoid stem cells originate from the _____________.
    Bone Marrow

    At the beginning of week __, _________ cells from the wall of the yolk sac differentiate into blood cells and blood vessels.
    week 3


    What is the primary hematopoietic organ from 3 weeks to 3 months?
    Yolk sac

    From 3-7 months what organ takes over hematopoiesis? Assisted somewhat by the ______.

  38. Guest

    Guest Guest

    elliptocytes are caused by
    hereditary elliptocytosis

    tear drops are caused by

    basket cells are caused by
    oxidative damage, e.g. G6PD deficiency

    microcytes are caused by (2)
    Fe deficiency

    mean life span of RBC
    120 days

    mean life span of platelet
    8--10 days

    mean life span of neutrophil
    2--4 days

    mean life span of monocyte

    mean life span of lymphocyte

    hemopoiesis during the first 6 weeks of gestation is in the ___
    yolk sac

    hemopoiesis from week 6 till month 6-7 is in the ___ (2)

    hemopoiesis from month 6-7 and on is in the ___
  39. Guest

    Guest Guest

    Flow cytometry is a measure of two things, what are they?
    Light scattered by cells and fluorescence from fluorochromes attached to cells.

    How do cells flow through the central core?
    In single file

    Does the sample fluid mix with the sheath fluid?

    Fluorochromes bound to cells are excited by the laser and emit light at higher or lower wavelengths?

    Laser is usually at wavelenght of 488nM

    How do you deal/adjust for compensation in flow cytometry of more than one wavelength?
    Conjugate beads to just FITC, and beads to just PE and then you can subtract for compensation.

    In flow cytometry are you measuring in all blood cells?
    No, you lyse the RBC's prior to the procedure.

    If you are measuring with 4 "filters", how many measurements will you have in the end?
    Six. Forward scatter (size), 90 degree scatter (internal strx) and the four filters.
    (filters have increasingly higher frequency.)
  40. Guest

    Guest Guest

    How is the graph set up for flow cytometry?
    Horizontal axis (x) is the fluorescence intensity, and the vertical (y) axis and the cell number.

    What is "Gating"
    Selecting to measure info on only one group of cells.

    Can multiple antigens be in the same tube?
    No, but don't ask me what that means:)
    "Each antigen requires a diff tube"

    Light is collected at 90degrees and:
    In front (forward scatter)

    More forward scatter, means:
    A larger cell

    1. Small, (so little forward scatter), no granules or segmentation (so not much 90degree scatter).
    2. Larger, more internal strx
    3. Larger, segmented, more granules (so more 90 degree scatter)
    1. Lymphocytes
    2. Monocytes
    3. Granulocytes
  41. Guest

    Guest Guest

    Restless legs syndrome
    Restless legs syndrome (RLS) is currently defined as [1]:
    An urge to move the lim • bs with or without sensations
    • Worsening at rest
    • Improving with activity
    • Worsening in the evening or night.
    The diagnosis of RLS is exclusively based on these four criteria, all of which are required to make the diagnosis. A validated diagnostic phone interview [2], rating scales [3] and quality-of-life scales [4] have all been developed based on these features.
    Patients, however, seldom quote the RLS inclusion criteria at presentation, and often have difficulty describing the sensory component of their RLS. The descriptions are quite varied and tend to be suggestible and education dependent.
    The sensation is always unpleasant but not traditionally painful in most cases.
    It is usually deep within the legs. In one study, the most common terms used, in descending order of frequency, included: “need to moveâ€, “crawlingâ€, “tinglingâ€, “restlessâ€, “crampingâ€, “creepingâ€, “pullingâ€, “painfulâ€, “electricâ€, “tensionâ€, “discomfort†and “itching†[5]. Patients usually deny any “burning†or “pins and needles†sensations, commonly experienced in neuropathies or nerve entrapments, although neuropathic pain and RLS can coexist. Arm involvement is common but generally only occurs after many years of leg involvement. The face and torso should not be involved in RLS.
  42. Guest

    Guest Guest

    From 3-7 months what organ takes over hematopoiesis? Assisted somewhat by the ______.


    From 3-7 months the _____ mainly produces lymphocytes.

    From 7 months to death __________ becomes the main hematopoietic organ.
    Bone Marrow

    Where do you find hematopoietic marrow?
    Central skeleton; proximal ends of femurs and humeri

    _________ are conditions where hematopoiesis occurs outside the bone marrow. (Pathology)

    _____ is defined as the process of hematopoiesis occuring outside the medullary cavity/compartment.
    Extramedullary Hematopoiesis

    ____________are the cells that give rise to the cells that develop in the hematopoietic line.
    Stem cells
  43. Guest

    Guest Guest

    True False Questions
    1. Making the anatomical diagnosis is in most cases the most fundamental step in reaching a diagnosis
    2. Only the deductive form of logic is of relevance in the diagnosis of blood disease
    3. The anatomical diagnosis in blood diseases always refers to the bone marrow or spleen
    4. It is not important to make the first-stage diagnosis in bleeding disorders because they are all due to hereditary causes
    5. The physical examination typically contributes only 5% to the final diagnosis and is therefore not worth doing
    6. Amaurosis fugax is a transient disturbance of vision in one eye and is always followed by full recovery

    1T; 2F; 3F; 4F; 5F; 6T

    7. Pigment gallstones due to chronic hemolysis are unusual in that they may resolve spontaneously
    8. Depletion of iron stores due to blood donation only occurs after donation of more than 5 units per annum
    9. Tetracycline and antacids may cause malabsorption of iron
    10. Vitamin B12 deficiency may present with agitated dementia
    11. A common association of cachexia is achlorhydria and therefore of folate deficiency
    12. Pheochromocytoma is characterized by marked pallor due to bleeding from the tumor
    13. Statistical methods are a valuable aid in diagnosis
    7F; 8F; 9T; 10T; 11F; 12F; 13T;

    14. A classical symptom of anemia is dyspnea relieved by sitting up
    15. 80% of iron deficiency cases are due to malabsorption
    16. Transient ischemic episodes are almost always diagnosed on the history
    17. Gold therapy is a well-known cause of neutropenia
    18. Vitiligo is a common accompaniment of pernicious anemia due to folate deficiency
    19. A common association of cachexia is achlorhydria, which may contribute to iron deficiency
    20. The suggested logical approach to diagnosis means that the history, physical examination, and special investigations be performed in strict sequence
    21. Vivax and ovale malaria typically follow a tertian fever pattern
    22. Dysphagia in the iron-deficient patient is most commonly due to bleeding from a carcinoma at the gastro-esophageal junction
    23. Differentiating between a very large spleen and a very large left kidney can reliably be made clinically
    14F; 15F; 16T; 17T; 18F; 19T; 20F; 21T; 22F; 23T
  44. Guest

    Guest Guest

    1. What is correct?
    (a) The canalicular membrane contains several ATP-dependent transporters
    (b) Conjugated bile salts are taken up by the basolateral NTCP transporter
    (c) The apical transporter MRP2 excretes conjugated bilirubin into the bile
    (d) Tight junctions are essential to seal the bile canaliculus
    (e) All the above statements are correct

    2. Hepatocytes synthesize
    (a) Von Willebrand factor
    (b) Immunoglobulins
    (c) Complement C1q
    (d) Factor V
    (e) Growth hormone

    3. What is correct?
    (a) Insulin induces the expression of PECK and G6Pase
    (b) Glucagon inhibits the expression of PECK and G6Pase
    (c) Glucocorticoids inhibit the expression of PECK and G6Pase
    (d) Plasma membrane transport of glucose is a major regulatory site
    (e) Hepatocytes use the glucose transporter Glut2

    4. What is incorrect regarding SER?
    (a) It is involved in protein synthesis
    (b) It is involved in drug metabolism
    (c) It is involved in cholesterol metabolism
    (d) It is involved in bile acids synthesis
    (e) It contains cytochrome P450 enzymes

    5. Which of these factors is not involved in the development of biliary epithelial cells?
    (a) Notch-2
    (b) Jag1
    (c) HNF-6
    (d) HNF-1b
    (e) Prox-1

    Ans: 1e 2d 3e 4a 5e
  45. Guest

    Guest Guest

    ›› Hepatocytes are arranged in plates between the portal space and the central vein.
    ›› Hepatocytes are polarized cells with an apical membrane facing the bile canaliculus and a basal side facing the sinusoid.
    ›› Hepatocytes in adults are frequently polyploid.
    ›› Hepatocytes play a central role in lipid, cholesterol, and glucose metabolism.
    ›› Hepatocytes are responsive to acute phase signals and massively increase the synthesis of specific proteins.
    ›› Hepatocytes regulates iron metabolism and secrete hepcidin.
    ›› Hepatocytes are not only targets for hormones such as insulin and glucagons, but synthesize hormones such as IGF-1 and, during the fetal life, EPO.
    ›› Hepatocytes are equipped with numerous transporters.
    ›› Hepatocytes excrete into the bile conjugated bile salts, conjugated bilirubin and phospholipids.
    ›› Hepatocytes excrete into the bile copper
  46. Guest

    Guest Guest

    Magnetic resonance imaging
    ■ Generally considered the best tool for staging the extent of tumor in the breast. May be indicated before breast conservation surgery, especially for women with invasive lobular carcinoma, large areas of ductal carcinoma in situ, or dense breasts that are not well assessed by mammography
    ■ For women undergoing breast conservation in whom the initial attempt at therapeutic surgery showed positive margins, it is appropriate to obtain an MRI to assess the extent of residual disease in the breast before repeat surgery is performed
    ■ For women with probably metastatic breast cancer in axillary nodes but no evidence of primary tumor on physical examination or mammography, MRI should be used to attempt to detect a tumor within the breast
    ■ Women undergoing MRI for known breast cancer should also have the contralateral breast imaged, because otherwise-unsuspected cancer is detected in 9%
    ■ Occasionally, MRI is useful to further assess an indeterminate mammogram, sonogram, or physical examination
  47. Guest

    Guest Guest

    1. Total parenteral nutrition for an average adult should include:
    a) magnesium
    b) 14 grams of nitrogen daily
    c) 1mL water for each kcal
    d) fat solutions in hepatic failure
    e) glucose.
    1. a) True; b) True; c) True; d) True; e) True
    2. In carbon monoxide poisoning the following are seen:
    a) arrhythmias
    b) hypotension
    c) extensor plantars
    d) cyanosis
    e) hyperventilation.
    3. Pulmonary oxygen toxicity during oxygen therapy is associated with:
    a) prolonged exposure
    b) high altitude
    c) increased muscle activity
    d) increased carbon dioxide tension
    e) anaemia.
    2. a) True; b) True; c) True; d) False; e) True
    3. a) True; b) False; c) False; d) False; e) False
  48. Guest

    Guest Guest

    1. In the early detection of an air embolism, the following are useful:
    a) ECG
    b) ultrasound
    c) end-tidal CO2
    d) fall in blood pressure
    e) change in ventilatory pattern.
    2. High central venous pressure, low blood pressure and acute circulatory
    failure are found in:
    a) tension pneumothorax
    b) pulmonary embolism
    c) congestive cardiac failure
    d) venous air embolism
    e) haemorrhage.
    3. In acute cardiac tamponade there is:
    a) ascites
    b) hypotension
    c) bradycardia
    d) a prominent ‘a’ wave in the CVP trace
    e) cyanosis and cold extremities.
    1. a) False; b) True; c) True; d) False; e) False
    2. a) True; b) True; c) True; d) True; e) False
    3. a) False; b) True; c) False; d) True; e) True
    4. Immediate treatment of venous air embolism during posterior fossa surgery
    should include the following:
    a) turn the patient right side down
    b) give mannitol
    c) raise the intracranial venous pressure
    d) give a rapid fluid infusion
    e) turn off nitrous oxide.
    5. Recognised features of fat embolism include:
    a) mental confusion
    b) bradycardia
    c) petechial rash
    d) respiratory distess syndrome
    e) pyrexia.
    4. a) False; b) False; c) True; d) True; e) True
    5. a) True; b) False; c) True; d) True; e) True
  49. Guest

    Guest Guest

    6. In cardiopulmonary resuscitation:
    a) lignocaine should be given before adrenaline in ventricular fibrillation
    b) the optimal treatment of ventricular tachycardia involves synchronised
    50-joule DC shock
    c) the tracheal dose of adrenaline is 0.5mg
    d) 50mL NaHCO3 should be given every 10 minutes
    e) calcium should be given to renal failure patients on dialysis.
    7. Hypokalaemia
    a) causes ST segment depression on the ECG
    b) causes mental depression
    c) precipitates digoxin toxicity
    d) may precipitate muscle paralysis
    e) occurs in untreated hyperosmolar non-ketotic diabetic coma
    6. a) False; b) False; c) False; d) False; e) True
    7. a) True; b) False; c) True; d) True; e) True
    8. After massive inhalation of gastric acid one would expect the following:
    a) lung abscess
    b) severe hypercapnia
    c) bacteraemia
    d) hypovolaemia
    e) destruction of surfactant.
    9. Postoperative hypoxia at 15 minutes may be due to:
    a) mild hypercapnia
    b) nitrous oxide diffusion
    c) central depression
    d) increased V/Q scatter
    e) shivering.
    10. Ventricular arrhythmias are more common in the presence of:
    a) hypokalaemia
    b) hypoxia
    c) thyrotoxicosis
    d) cardiopulmonary bypass and digoxin treatment
    e) essential hypertension
    8. a) False; b) False; c) False; d) True; e) True
    9. a) True; b) False; c) True; d) True; e) True
    10. a) True; b) True; c) True; d) True; e) True
  50. Guest

    Guest Guest

    3. Folic acid:
    A. Is water-soluble.
    B. Requires gastric intrinsic factor for its absorption.
    C. Is necessary for nucleic acid synthesis.
    D. Is heat-stable.
    E. Is involved in the tricarboxylic acid (Krebs) cycle.

    4.Vitamin C:
    A. Is found only in animal foodstuffs.
    B. Is rapidly destroyed by heating.
    C. There are normally large stores in the pancreas.
    D. Impaired wound healing is one of the characteristic features of severe vitamin C deficiency.
    E. Excess vitamin C can lead to the formation of oxalate stones in the urinary tract.

    5. Vitamin B:
    A. Vitamin B1 (thiamin) deficiency leads to impaired collagen formation.
    B. Vitamin B1 (thiamin) stores in the body are adequate for up to 9 months.
    C. Vitamin B2 (riboflavin) concentration is higher in the fetus than in the mother.
    D. Vitamin B6 (pyridoxine) requirement in pregnancy is 25 mg/day.
    E. Niacin is synthesized in the body from tryptophan.

    A. True.
    B. False.
    C. True. Tetrahydrofolate is essential for both purine and pyrimidine biosynthesis.
    D. False. The normal Western diet contains 500–700μg per day, of which 10–100 per
    cent may be lost in cooking.
    E. False.

    A. False. Citrus food and leafy green vegetables are rich in vitamin C, while animal
    sources contain only traces.
    B. True.
    C. False. The eye and the adrenal glands contain large quantities of vitamin C.
    D. True.
    E. True.

    A. True.
    B. False. The body contains only 30 mg (the average adult requirement is
    1–1.5 mg/day).
    C. True. As with other water-soluble vitamins, vitamin B crosses the placenta by active mechanisms, which results in higher concentration in the fetus.
    D. False. The true figure is 2.5 mg per day, and in non-pregnant adult is 2 mg per day.
    E. True.

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