MODEL QS FOR FUTURE ALL INDIA PRE PG EXAM

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

  1. Guest

    Guest Guest

    Focal dystonia describes a dystonia where a single region of the body is
    involved:
    – writer’s cramp: arm/forearm
    – blepharospasm: eyes
    – hemifacial spasm: face
    – cervical dystonia (also known as torticollis): neck
    – spasmodic dysphonia: larynx
    – Meigs’ syndrome: a mixture of above

    • segmental dystonia describes a dystonia that includes two or more contiguous areas
    – craniocervical dystonia
    – crural dystonia: one leg and trunk/both legs
    – brachial dystonia: one arm and trunk/both arms.
    • M ultifocal dystonia includes all those disorders where more than two areas are affected; these are often in unrelated regions of the body.
    • Hemidystonia refers to dystonia that is confined to only one side of the body. This usually follows a disease process such as a stroke.
    • Generalized dystonias are much more severe and can affect the entire body.
    This is also referred to as primary torsion dystonia.

    Describe Hemispheric Lateralization

    hemiplegia?
    left cerebral hemisphere receives sensory from and sends messages to right side of body

    right cerebral hemisphere receives sensation from/sends messages to left side of body

    hemiplegia involves only 1 cerebral hemisphere

    Function of frontal lobe?
    parietal lobe?
    occipital lobe?
    temporal lobe?
    frontal lobe- judgment and primary motor (body movement)

    parietal lobe- sensation

    occipital lobe- vision

    temporal lobe- hearing

    What are the presenting symptoms of AML?
    * Recent onset fatigue (anemia)
    * Weakness (anemia)
    * Fever/infection (neutropenia)
    * Bleeding (thrombocyto.)

    What causes the presenting symptoms of AML?
    Marrow infiltration and replacement of normal blood precursor cells.

    What are the tell-tale signs of AML on a peripheral blood smear?
    * High white cell count (may be normal or low)
    * Leukemic blast cells (>20% is diagnostic)
  2. Guest

    Guest Guest

    What is the diagnostic test for AML?
    Bone marrow aspirate, showing a hypercellular blast count >20%

    Other than blood, are other tissues involved in AML?
    Yes. Leukemic infiltration of the GUMS (gingival hyperplasia), skin or CNS. Site tumors are CHLOROMAS.


    [Peripheral Smear] What are these cells called? What are their characteristics?
    Myeloblast Cells from AML
    * Mononuclear
    * Scant cytoplasm
    * Prominent pale nuclei

    What are the two classification schemes for AML?
    1) French-American-British (FAB - Older)
    2) WHO (newer)

    How are AML sub-type diagnoses performed?
    1) Histologically (FAB)
    2) Molecular subtypes
    3) Cytogenetics (WHO)

    What two disorders often lead to AML
    1) Myelodysplastic Sydrome
    2) Myeloproliferative Disorders (P Vera, ET, etc.)
  3. Guest

    Guest Guest

    Definition of infertility?
    Hetrosexual couple who had had unprotected sex without (1) getting pregnant or (2) maintaining a pregnancy.

    Percentage of married couples who are infertile?
    15%

    Causes of couple infertility?
    - 35% mom
    - 35% dad
    - 15% both
    - 10% unknown

    Percentages of female infertility?
    20-24: 4.1%
    30-34: 9.4%
    35-39: 20%

    Causes of female infertility?
    1. Failure to ovulate
    2. Tubal blockage
    3. Absence of implantation
    4. Miscarriage
    5. Reduces sperm transport
    6. Abs to sperm
  4. Guest

    Guest Guest

    Bronchial Hyperactivity
    A pathologic
    increase in the bronchconstrictor
    response to antigens and irritants caused by
    Bronchial inflammation.

    IgE-mediated disease
    Disease caused by excessive or misdirected immune response mediated by IgE antibodies

    Mast cell degranulation
    Exocytosis of granules from mast cells with release of mediators of inflammation and
    bronchconstriction

    Normal bronchial smooth muscle is controled by what?
    Vagal Innervation

    What happens in patients who are treated with B adrenergic blocking drugs (ie: propranolol)?
    They have increased adrenergic activity, so it manifests as wheezing

    Allergens can trigger asthma, can antihistimines treat it?
    no

    What role do leukotrienes play in the development of asthma?
    Leukotrienes are primary bronchoconstrictors

    What is LTD4?
    same as histamine but
    1000x as potent

    second line agents for treatment of asthma that inhibit the synthesis or action of the LTs are known as what?
    leukotriene modulators (LTMs)

    1 Staphylococcus aureus
    A. Is a gram negative bacteria.
    B. Exotoxin release leads to the toxic shock syndrome.
    C. Is usually sensitive to oral erythromycin.
    D. Causes Scarlet Fever.
    2 The Brown-Sequard Syndrome
    A. Is the result of spinal cord hemisection.
    B. Occurs more commonly in closed than penetrating injury.
    C. Results in contralateral paralysis below the injury.
    D. Results in contralateral temperature sensory loss.
    3 Electrical shock injuries
    A. May result in myoglobinuria and acute renal failure.
    B. Cardiac arrhythmias are more common if only a single limb is involved.
    C. Lightning causes a DC shock of very high voltage and short duration.
    D. Assymptomatic patients with a high voltage conduction injury should be admitted for
    observation and monitoring.
    1
    A. F – Staphylococcus aureus is a gram positive coccus
    B. T
    C. T
    D. F – Scarlet fever is caused by streptococcal infection
    2
    A. T
    B. F
    C. F
    D. T
    3
    A. T
    B. F – Cardiac arrhythmias occur more commonly when the electrical energy passes
    transthoracically i.e. from limb to limb through the thorax.
    C. T
    D. T
  5. Guest

    Guest Guest

    What are the common sites of bleeding in a child with hemophilia?

    a. joint
    b. muscle
    c. mouth
    d. gi
    e. hematuria
    f. all of the above
    g. a, b and c
    f. all of the above

    Joints - primary site is synovium that lines the joint (causes tingling sensation, followed by warmth then increased pain and decreased ROM). If untreated can lead to chronic joint disease.

    Muscle - second most frequent site of bleeding, often is difficult to find as it is deep in the muscle. Large muscle bleeds can lead to muscle contractures due to fibrosis and atrophy.

    Mouth - bleeding to frenulum or oral mucosa from trauma can be difficult to control and can results in large amount of blood loss.

    GI - can be serious and requires aggressive factor replacementand careful blood- monitoring. Potential for shock.

    Hematuria - Can occur spontaneously. Painless episodes have noknow cause and do not produce large blood loss.

    What is chronic joint arthropathy?
    The synovial membrane releases plasmin to break down the blood protein. Because it does not differentiate between proteins, it also breaks down the cartiliage protein in the process. This destroys the synovium and subsequentlym hemosiderin (iron containing compounds in the blood) collects into the joint cartilage and synovial membrane and evolves into chronic inflammation. The inflammation can lead to synovitis and utilmately, narrowing of joint space, bone erosion, and cyst formation, limiting ROM, and leading to chronic arthritis and disability.

    4. Regarding the azygos venous system:
    (a) The azygos vein at the level of the fourth thoracic vertebra arches over the root of the right lung to end in the superior vena cava (SVC).
    (b) About 10% of the population have an azygos lobe.
    (c) The thoracic duct and aorta are to the right of the azygos vein.
    (d) The second, third and fourth intercostal spaces on the right, drain via the right superior intercostal vein into the azygos vein.
    (e) In congenital absence of IVC the azygos vein enlarges
    (a) True
    (b) False – in 1% of the population, the azygos vein traverses the lung before entering the SVC resulting in the azygos fissure. The azygos ‘ lobe’ is not a true segment.
    (c) False – they are to its left.
    (d) True – hemiazygos, accessory hemiazygos, oesophageal, mediastinal, pericardial and right bronchial veins drain into the azygos system.
    (e) True – in the azygous continuation of the IVC, the azygos is a large structure, but otherwise the anatomy is unaltered. This may be confused with a mediastinal mass


    How many types of influenza are there?
    3
    A,B,C

    What type of influenza is most severe?
    Type A

    "Incubation period" for influenza
    1 - 3 days

    Potential complications of influenza
    Primary influenza pneumonia (rare)
    Secondary bacterial superinfection/pneumonia (more common)

    When is flu season?
    Late Fall, Winter, Early Spring

    What was particularly unusual about Spanish Flu Pandemic?
    Severe illness and excess mortality in healthy young adults

    How does influenza enter cells?
    Receptor-mediated endocytosis

    How many gene segments does influenza have?
    8
  6. Guest

    Guest Guest

    How many gene segments does influenza have?
    8

    What does influenza bud through?
    Host cell plasma membrane

    What 3 proteins are on influenza's surface?
    Hemagglutinin
    Neuraminidase
    M2

    Characteristic of HA in infectious virions
    Has a "nick" that allows conformational change @ low pH

    Function of M2 protein
    Acts as an ion channel
    Allows H+ ions into endosome

    Low pH allows viral RNA to separate from M1 and shell

    Inhibiting M2 would suppress what?
    Viral replication

    Inhibiting M2 would suppress what?
    Viral replication

    Function of M1 protein
    Provides structural integrity
    Underlies the lipid membrane
    Attached to viral RNA

    This attachment is compromised at low pH

    Function of NP protein
    Covers RNA, protecting it from degradation
    Contains NUCLEAR LOCALIZATION SIGNAL

    Where does influenza replication occur?
    In the nucleus

    Function of viral transcriptase complex
    Made of PA, PB1, PB2
    Initiate viral transcription in the nucleus
  7. Guest

    Guest Guest

    Nascent VLDL released from the liver contains Apolipoprotein B100, apolipoprotein C-I (apoC-I), apolipoprotein E (apoE), cholesterol, cholestryl esters, and triglycerides. As it circulates in blood, it picks up apolipoprotein C-II (apoC-II) and additional apoE donated from high-density lipoprotein (HDL). At this point, nascent VLDL becomes a mature VLDL. Once in circulation, VLDL will come in contact with lipoprotein lipase (LPL) in the capillary beds in the body (adipose, cardiac, and skeletal muscle). LPL will remove triglycerides from VLDL for storage or energy production.

    VLDL now meets back up with HDL where apoC-II is transferred back to HDL (but keeps apoE). HDL also transfers cholesteryl esters to the VLDL in exchange for phospholipids and triglycerides via cholesteryl ester transfer protein (CETP).

    As more and more triglycerides are removed from the VLDL because of the action of LPL and CETP enzymes, the composition of the molecule changes, and it becomes intermediate-density lipoprotein (IDL).
    Composition of VLDL
    B-100 - contains B-48 domain
    C-II contains activation of lipoprotein lipase
    E- RME receptor mediated endocytosis (RME)

    Composition of LDL
    B-100- B-48 domain
    high cholesterol

    excess cholesterol
    not needed
    esterified
    ACAT
    acyl Coa- cholesterolacyltransferase

    metabolization of LDL
    LDL receptors on liver recognize the apoprotein B-100 and do RME
  8. Guest

    Guest Guest

    What are bile salts?
    esterified cholesterols
    charged phospholipids
    amphipathic cholesterol analogs with detergent properties***********
    hydrolyzed forms of triacylglycerols


    Which dietary fat is typically nonesterified?
    cholesterol************
    glycerophospholipids
    triacylglycerols
    fatty acids


    What is the lipoprotein with the highest ratio of protein:lipid?
    IDL
    VLDL
    HDL************
    LDL
    chylomicrons


    What does the core of a typical lipoprotein primarily consist of?
    triacylglycerols and cholesterol esters************
    apoB-100
    phospholipid
    apoB-48
    cholesterol


    What is the lipoprotein that delivers dietary cholesterol to the liver?
    IDL
    chylomicron remnants*********
    chylomicrons
    HDL
    VLDL
    LDL


    Which lipoprotein accumulates in the bloodstream of patients with familial hypercholesterolemia?
    chylomicron
    IDL
    HDL
    LDL*******
    VLDL
  9. Guest

    Guest Guest

    Development of the Nose
    * A newborn is noted to be cyanotic in the well-born nursery. On stimulation he cries and becomes pink again. The nurse has difficulty passing a catheter through the nose. This is choanal atresia.
    * Choanal atresia is a septum between the nose and pharynx. Presents at birth because babies are obligate nose breathers. When they get stimulated they cry and breath through their mouth.
    * Choanal atresia key is blue baby that pinks up with crying.
    * Associated with CHARGE syndrome: Coloboma, Heart disease, choanal Atresia, Retarded growth/development,
    Genital anomalies (e.g. hypogonadism), Ear anomalies (e.g. deftness).
    * Diagnostic test is inability to pass catheter through nose. Fiber-optic rhinoscopy can be done to see the plate.
    * Treatment is ABC (establish airway), surgical correction.
    * Common colds usually caused by rhinoviruses.
    * Children are the major reservoirs for the common cold. Residents and medical students will catch these illnesses because they haven’t been exposed to these germs in a long time.
    * Incubation period for common cold is 2-5 days, large droplet or small aerosol transmission (coughing, sneezing) and gets on hands, especially in kids who get snot all over and don’t wash their hands.
    * Symptoms are fever, nasal congestion, rhinorrhea, sneezing, pharyngitis, malaise may be present.
    * Treating with antihistamines does not help. It will last a week without treatment and 7 days with treatment (joke).
    * Decongestants may help. Vitamin C, Zinc, Echinacea, all not proven to help.
    * Sinusitis is caused by strep pneumonia, moraxella, nontypable h. influenza, sometimes staph or anaerobes.
    * Look for purulent nasal drainage and coughing with sinusitis.
    * If child has had a cold for more than 10 days, think sinusitis. If child has been improving with a cold then spikes a fever, think sinusitis. If drainage become purulent after 7-10 days, think sinusitis.
  10. Guest

    Guest Guest

    Somatoform Disorders
    * A group of disorders characterized by the presentation of physical symptoms with no medical explanation(s). The symptoms are severe enough to interfere with the patient’s ability to function in social or occupational activities.
    * These patients miss work, call in sick, get fired, don’t have many friends, won’t go out for fun because they are going to the hospital to get tests or procedures.
    * Somatization disorder is a patient with multiple physical symptoms affecting multiple organs.
    * Somatization disorder affects women more than men, inversely related to SES, usually begins by age 30, male relatives tend to have antisocial personality disorder, female relatives tend to have histrionic personality disorder.
    * Need 8 symptoms, 4 pain, 2 GI symptoms, 1 pseudo-neurological, and 1 sexual. Basically they will have everything on a review of systems without you prompting them. Again, seen in lower SES.Socioeconomic status (SES)
    * Patient will have a long, complicated medical history. Will likely have interpersonal and psychological problems.

    * If you find nothing on the exam or with tests, they will think you’re a bad doctor and go elsewhere.
    * Commonly associated with major depression, personality disorders, and drug disorders.
    * Treatment involves having a single identified physician as the primary caretaker (minimize referrals). The answer in somatoform disorders is never telling the patient “there is absolutely nothing wrong with you†because you are never absolutely sure, don’t give false hope.
    * Treatment also involves limiting visits, such as once a month, “regular office visits.â€
    * Treatment of choice is psychotherapy, not medications.
    * DDx includes MS, myasthenia gravis, SLE, AIDS, thyroid.
    * Conversion disorder is a disorder in which the individual experiences on or more neurologic symptoms that cannot be explained by any medical or neurologic disorder.
    * Typically, these are patients who have experienced a stressor and will usually have symptoms involving either voluntary muscle or sensory control (hears bad news and becomes deft, sees bad things and becomes blind)

    * Example: woman slapped by husband and two hours later she cannot move her legs; conversion disorder.
    * Associated with passive aggressive, histrionic, antisocial disorders.
    * Voluntary muscle disorder is usually paralysis, could be weakness, tics, jerks. Pseudo-seizures may be seen.
    * Primary gain: keeps internal conflicts outside patient’s awareness.
    * Secondary gain: benefits received from being sick.
    * La bella (“the beautifulâ€) indifference: patient seems unconcerned about impairment.
    * Identification/modeling: patient usually models their behavior on someone who is important to them.
    * Important note about conversion disorder, if the patient is blind, they will still not be injured due to their blindness; meaning they won’t walk into walls or trip on things. Unconsciously, they are convinced they are blind. These patients are not trying to lie to you, they are not trying to deceive you, they truly believe they are blind.
    * Treatment is psychotherapy. Another option is amobarbital (Amytal) interview. “Truth serum.â€
    * DDx includes dementia, tumors, basal ganglia disease, optic neuritis, schizophrenia, factitious, malingering.
    * Hypochondriasis is a disorder characterized by the patient’s belief that he/she has some specific disease.
  11. Guest

    Guest Guest

    SLE stands for
    systemic lupus erythematosus

    SLE is normally a diagnosis of
    exclusion

    SLE is more common in
    young women, more in African Americans

    SLE is associated with
    ANA (antinuclear anti-body)

    red Rash, joint pain (common in knees) not symetrical and malar rash (across cheeks) pt. has
    SLE

    nephritis is common in patients with
    SLE

    a pt with ____ will have alopecia, oral ulcers, malar rash
    SLE

    Tendon subluxation in SLE is called
    Jaccoud

    a pt. with ___ will be in a hypercoagulable state due to having anticardiolipin antibody
    SLE

    3 bone marrow probs with SLE:
    anemia, thrombocytopenia, neutropenia

    A positive Smith and DS DNA
    means the patient has SLE

    need _ /11 things for diagnosis of SLE
    4

    you should always ___ when using steroids
    taper

    Only treat SLE with steroids when they are having a ___
    flare

    this is muscle inflammation only
    polymyositis

    this involves inflammation of skin and muscle and shows a rash
    dermatomyositis
  12. Guest

    Guest Guest

    1. During liver regeneration, KC
    (a) Are activated by complement components
    (b) Release TNF and IL-6
    (c) Are activated by interaction with neutrophils
    (d) Stimulate hepatocyte proliferation
    (e) All the above

    2. CD14
    (a) Is a G protein-coupled receptor
    (b) Is a tyrosine kinase receptor
    (c) Is a glycosylphosphatidylinositol (GPI) an-chored receptor
    (d) Does not signal through MyD88
    (e) Has cAMP as second messenger

    3. Acetaminophen toxicity:
    (a) Is reduced by KC activation
    (b) Is reduced in NADPH oxidase knockout mice
    (c) Is reduced by NO derived by KC
    (d) Is mediated by LPS activation of KC
    (e) All the above are wrong

    4 1e 2c 3e

    Q. Which is the correct statement?
    (a) KC production of proinflammatory cytokines is stimulated by acute exposure to alcohol
    (b) KC production of proinflammatory cytokines is inhibited by chronic exposure to alcohol
    (c) KC activation results in a decrease of portal pressure
    (d) KC activation by increased permeability of the gut to endotoxins is supported by studies showing hepatoprotection in ethanol-fed animals given nonresorbable antibiotics*********
    (e) Alcoholic liver injury is worse in TNF receptor- 1 lock out mice

    276. Scrotum derives from:
    a. mesonephrons
    b. Wolffian duct
    c. Mullerian duct
    d. urogenital sinus *******

    Q. Males with Klinefelter's syndrome have:
    a. hirsutism
    b. female internal genitalia
    c. female external genitalia
    d. none of the above *****************

    Q. Gonadal dysgenesis is the most common cause of:
    a. ptosis
    b. lymphedema
    c. low birth weight
    d. primary amenorrhea *****************

    Q. Which of the following is an autosomal dominant disorder?
    a. Werner syndrome
    b. Fanconi syndrome
    c. Noonan syndrome ***************
    d. ataxia telangiectasia
  13. Guest

    Guest Guest

    What is the only IV anesthetic that causes cardiovascular stimulation?
    Ketamine

    Which bacteriostatic drug whose major side effect is the lepra reaction inhibits folic acid synthesis?
    Dapsone

    What form of antimicrobial therapy is best for an immunocompromised patient?
    Bactericidal

    Which direct-acting vasodilator is associated with SLE-like syndrome in slow acetylators?
    Hydralazine

    What class of heparin is active against factor Xa and has no effect on PT or PTT?
    Low molecular weight heparin (LMWH)

    What is the DOC for coccidioidomycosis?
    Fluconazole

    What three cephalosporins have good penetration against Bacteroides fragilis?
    1. Cefotetan
    2. Cefoxitin
    3. Ceftizoxime
  14. Guest

    Guest Guest

    Which form of alcohol toxicity results in ocular damage?
    Methanol

    What immunosuppressive agent is converted to 6-mercaptopurine?
    Azathioprine

    Which size nerve fibers (small or large diameter) are more sensitive to local anesthetic blockade?
    Nerve fibers with small diameter and high firing rates are most sensitive to local blockade

    What enzyme is inhibited by trimethoprim?
    Dihydrofolate reductase

    What are the two absolute requirements for the cytochrome P450 enzyme system?
    NADPH and molecular O 2

    What PG is a potent platelet aggregator?
    TXA2

    Is any particular racial group more likely to get lung cancer? to die from it?
    AA menAfrican American
    , both.

    WIll a family history of lung cancer increase risk even w/o smoking?

    Are the following, or are they not risk factors for lung cancer:
    Smoking
    Previous tobacco related cancer
    occupational exposures
    COPD
    Gender

    If you quit smoking, will your lung cancer risk ever drop back to normal?
    yes, 2-3 fold in both smokers and non.

    No.
  15. Guest

    Guest Guest

    What PG is a potent platelet aggregator?
    TXA2

    A depressive patient who is taking paroxetine goes to the ER with pain and is given meperidine. Shortly afterward she develops diaphoresis, myoclonus, muscle rigidity, hyperthermia, and seizures. What is your diagnosis, what can cause it (4), and what is the treatment?
    Serotonergic crisis may be precipitated when an SSRI is mixed with MAOIs, TCADs, dextromethorphan, and meperidine. Treat it with cyproheptadine.

    What class of drugs is used in the treatment of demineralization of the bone?
    Bisphosphonates

    What is the only class of diuretics to retain Cl- used in the short-term treatment of glaucoma and of acute mountain sickness?
    Acetazolamide

    True or false? All aluminum-containing antacids can cause hypophosphatemia.
    True. Aluminum reacts with PO4, resulting in AlPO4, an insoluble compound that cannot be absorbed.

    What TCAD causes sudden cardiac death in children?
    Desipramine

    What two β2-agonists are used to produce bronchodilation?
    Metaproterenol and albuterol

    ANA
    SLE, not specific

    Anti-dsDNA abs
    specific SLE

    Anti-Smith abs
    specific SLE

    Antihistone abs
    drug-induced lupus. HIPP: hydralizine, isoniazid, procainamide, phenytoin

    C-ANCA
    antineutrophil. Vasculitis. Wegener's granulomatosis.

    P-ANCA
    antineutrophil. vasculitis. PAN

    Anticentromere
    Scleroderma (CREST)

    Anti-Scl-70
    Scleroderma (diffuse)
  16. Guest

    Guest Guest

    What IV-only agent inhibits water reabsorption in the PCTs and is used to treat increased intracranial pressure, increased intraocular pressure, and acute renal failure?
    Mannitol

    What cell type do cromolyn and nedocromil affect for prophylactic management of asthma via blockade?
    They prevent mast cell degranulation.

    What two β2-agonists cause myometrial relaxation?
    Ritodrine and terbutaline

    Where in the spinal cord are the presynaptic opioid receptors?
    In the dorsal horn of the spinal cord on the primary afferent neurons

    What thrombolytic agent is derived from β-hemolytic streptococci, is antigenic, and produces depletion of circulating fibrinogen, plasminogen, and factors V and VII?
    Streptokinase

    What antifungal agent is used to treat dermatophyte infections by inhibiting squalene epoxidase?
    Terbinafine
  17. Guest

    Guest Guest

    The intercostal spaces are drained by two anterior veins and a single posterior intercostal vein.True

    posterior intercostal veins drain into the brachiocephalic vein and azygos system. The anterior veins drain into the musculo-phrenic and internal thoracic veins

    Regarding the secondary pulmonary lobule:
    (a) It consists of approximately ten acini.
    (b) The lobular vein follows the branches of the bronchioles.
    (c) Lymph drainage is both interlobular and central along the arteries.
    (d) Lobules are best demonstrated nearer to the hilum of the lung on CT.
    (e) The interlobular septa are seen usually on conventional CT.
    (a) True – acini are 8–20 mm in diameter and consists of respiratory bronchioles, alveolar ducts and alveoli.
    (b) False – the lobular artery follows the branches of the bronchioles. Peripheral veins drain the lobule and run along the interlobular septum.
    (c) True
    (d) False – lobules are surrounded by connective tissue septa which contain veins and lymphatic vessels, in the lung periphery. Therefore they are best demonstrated in the periphery of the lung.
    (e) False – they can just be appreciated on HRCT

    What are the four muscles of mastication?
    1. Masseter
    2. Temporalis
    3. Medial pterygoid
    4. Lateral pterygoid

    With what thoracic vertebra or vertebrae does rib 7 articulate?
    Rib 7 articulates with T7 and T8. Each rib articulates with the corresponding numerical vertebral body and the vertebral body below it.

    What are the three branches of the inferior mesenteric artery?
    Left colic, superior rectal, and sigmoidal arteries

    What is the only valve in the heart with two cusps?
    Mitral (bicuspid) valve

    What are five clinical signs of portal HTN?
    Caput medusa, internal hemorrhoids, esophageal varices, retroperitoneal varices, and splenomegaly

    What three muscles constitute the erector spinae?
    1. Iliocostalis
    2. Longissimus
    3. Spinalis

    What nerve is compromised in carpal tunnel syndrome?
    Median nerve

    What vascular injury may result from a supracondylar fracture of the femur?
    The popliteal artery, the deepest structure in the popliteal fossa, risks injury in a supracondylar fracture of the femur.

    What nerve and artery could be affected in a midshaft humeral fracture?
    Radial nerve and the profunda brachii artery

    Name the 10 retroperitoneal organs.
    1. Duodenum (all but the first part)
    2. Pancreas
    3. Ascending Colon
    4. Descending colon
    5. Rectum
    6. Supra renal glands (adrenals)
    7. Kidneys
    8. Ureters
    9. Aorta
    10. IVC

    D CUPS DAKRI is the mnemonic, everything else is covered with peritoneum
  18. Guest

    Guest Guest

    1. The following are largely metabolised in the body prior to elimination:

    a) midazolam
    b) atracurium
    c) halothane
    d) isoflurane
    e) gallamine

    2. Calcium channel blockers include:

    a) verapamil
    b) beta-blockers
    c) nifedipine
    d) captopril
    e) hydralazine

    3. Regarding the Magill breathing system:

    a) fresh gas flow should always be greater than 8 litres/minute
    b) it always contains an expiratory valve
    c) it has the same physical properties as a Bain system
    d) it is equivalent to the Mapleson C classification
    e) it is more efficient for spontaneous respiration than intermittent positive pressure ventilation

    1. TTFFF
    2. TFTFF
    3. FTFFT

    4. The MAC value of:

    a) enflurane is greater than that of isoflurane
    b) halothane is greater than that of cyclopropane
    c) nitrous oxide is greater than 1 atmosphere
    d) methoxyflurane is greater than that of isoflurane
    e) halothane is greater than that of enflurane

    5. In the first 3 days following major surgery, urinary excretion of the following will be reduced:

    a) sodium
    b) chloride
    c) water
    d) potassium
    e) nitrogen

    6. Boundaries of the epidural space include the:

    a) interspinous ligament
    b) posterior surface of the lamina
    c) anterior longitudinal ligament
    d) posterior longitudinal ligament
    e) sacro-coccygeal membrane
    4. TFTFF
    5. TTTFF
    6. FFFTT
  19. Guest

    Guest Guest

    What is PCR?
    An in vitro method for amplifying selected nucleic acid sequences

    What does the PCR method consist of?
    Repetitive cycles of DNA denaturation, annealing and extension by heat stable DNA polymerases

    What type of primers are used for PCR?
    Synthetic oligonucleotides

    What are requirements for the synthetic oligonucleotides?
    -They must have different sequences
    -THey must be complementary to sequences on OPPOSITE strands of the template DNA
    -They must flank the segment of DNA that is to be amplified

    What is the first step of PCR?
    THe template DNA is denatured by heating in the presence of a large molar excesss of each of the two primers and the four dNTPs
  20. Guest

    Guest Guest

    a child was anemic since birth. In what disease would a splenectomy result in increased hematocrit?
    spherocytosis

    A person has macrocytic, megaloblastic anemia. Why should you not give folate alone?
    It might be B12 deficiency. If you give folate, the symptoms improve, but nerve damage continues

    Person has anemia, hypercalcemia, bone pain. Bone marrow cells are hypercellular with large nuclei. What's the dx, and what will be in the pee?
    Multiple myeloma. You will likely see Bence-Jones protein in the urine

    Which neoplasms are associated with AIDS?
    B-cell lymphoma, Kaposi's sarcoma

    What chemotherapeutic medicine should be avoided in patients with CHF?
    doxyrubicin
  21. Guest

    Guest Guest

    What lower extremity nerve is described by the following motor loss?
    • Loss of adduction of the thigh
    Obturator nerve

    What nerve lesion presents with ape or simian hand as its sign?
    Median nerve lesion

    What muscle acts in all ranges of motion of the arm?
    Deltoid

    What is the first branch of the abdominal aortic artery?
    Inferior phrenic artery

    What vessel does the right gonadal vein drain into?
    The right gonadal vein drains into the inferior vena cava directly, and the left gonadal vein drains into the left renal vein.

    What two muscles do you test to see whether CN XI is intact?
    Trapezius and sternocleidomastoid

    At what point does the axillary artery become the brachial artery?
    When it crosses the teres major

    What direction would the tongue protrude in a left CN XII lesion?
    Left CN XII lesion would result in the tongue pointing to the left (points at the affected side).

    At what vertebral level does the common carotid artery bifurcate?
    C4 (the upper border of the thyroid cartilage)

    True or false? Males are more likely to develop femoral hernias than females.
    False. Females are more likely to develop femoral hernias then males (remember Female's Femoral).
  22. Guest

    Guest Guest

    The Indole Test

    The test organism is inoculated into tryptone broth, a rich source of the amino acid tryptophan. Indole positive bacteria such as Escherichia coli produce tryptophanase, an enzyme that cleaves tryptophan, producing indole and other products. When Kovac's reagent (p-dimethylaminobenzaldehyde) is added to a broth with indole in it, a dark pink color develops. The indole test must be read by 48 hours of incubation because the indole can be further degraded if prolonged incubation occurs. The acidic pH produced by Escherichia coli limits its growth.

    The Methyl Red and Voges-Proskauer Tests

    The methyl red (MR) and Voges-Proskauer (VP) tests are read from a single inoculated tube of MR-VP broth. After 24-48 hours of incubation the MR-VP broth is split into two tubes. One tube is used for the MR test; the other is used for the VP test.

    MR-VP media contains glucose and peptone. All enterics oxidize glucose for energy; however the end products vary depending on bacterial enzymes. Both the MR and VP tests are used to determine what end products result when the test organism degrades glucose. E. coli is one of the bacteria that produces acids, causing the pH to drop below 4.4. When the pH indicator methyl red is added to this acidic broth it will be cherry red (a positive MR test)

    The Citrate Test

    The citrate test utilizes Simmon's citrate media to determine if a bacterium can grow utilizing citrate as its sole carbon and energy source. Simmon's media contains bromthymol blue, a pH indicator with a range of 6.0 to 7.6. Bromthymol blue is yellow at acidic pH's (around 6), and gradually changes to blue at more alkaline pH's (around 7.6). Uninoculated Simmon's citrate agar has a pH of 6.9, so it is an intermediate green color. Growth of bacteria in the media leads to development of a Prussian blue color (positive citrate). Enterobacter and Klebsiella are citrate positive while E.coli is negative.

    Thus E.coli gives ++-- results on the IMViC tests, while Enterobacter and Klebsiella give the reverse: --++
  23. Guest

    Guest Guest

    Which anti-depressants can --> delirium
    how to treat this?
    MAOI
    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?
    MOAI

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

    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

    what drugs can be used to treat OCD?
    Clomipramine
    Fluvoxamine

    What decresaes impulsiveness in Borderline PD?
    SSRI (esp fluoxetine)
    haloperidol

    If looking for immediate relief of GADGeneral Anxiety Disorder (GAD), what class of meds should be given?
    BZ

    Effect of lithium in pregnancy?
    %?
    Ebstien's
    7.7%

    mood stabilizer that has causes fetal abnormalities if given during pregnancy?
    clonazepam

    Whath meds can be given to delirius pts?
    low-dose atypical antipsychotics
    low-dose haldol

    why do atypical antipsychotic meds --> orthostatic hypotension?
    alpha 1 blockade

    What drugs are used to treat PTSD and why?
    which drug class is NOT effectve in PTSD?
    Clonidine: to decrease the re-experiencing of PTSD
    SSRIs: to reduce the "numbness" associated w PTSD
    BZ not effective

    What is the 1st line med for panic d/o?
    other drugs to treat panic d/o?
    fluvoxamine
    imipramine and phenelzine can also be used, but less desirable d/t side effects

    which mood stabilizer --> pancreatitis?
    valproic acid

    how long should pts be treated for 1st episode of depression?
    at least 6 mos, usually 8-12 mos to prevent relapse

    how to treat drooling associated with clozapine?
    anti-cholinergic

    how to treat clozapine induced tachycardia?
    propanolol
  24. Guest

    Guest Guest

    pregnant woman in 3rd trimester has normal BP when standing and sitting. When supine BP drops to 90/50. what is the dx?
    compression of the IVC

    35 y/o man has high BP in arms and lowBP in his legs. what is the dx
    coarction of teh aorta

    5 y/o boy presents with a systolic murmur and a wide fixed split S2. what is the dx
    ASD

    During a game a young football player collapses and dies immediately. What is the most likely type of cardiac dz
    hypoertrophic cardiomyopathy

    pt has a stroke after incurring multiple long bone fractures in trauma stemming from a MVA. What caused the infarct
    fat emboli
  25. Guest

    Guest Guest

    naloxone causes all EXCEPT:
    a)pulmonary edema
    b)seizures

    ANS=A

    Side Effects by Body System - for Healthcare Professionals
    Cardiovascular

    A 45-year-old male narcotic addict and alcoholic with hepatitis and undiscovered cardiomyopathy was given 0.8 mg of naloxone intravenously over a 2 minute period and developed ventricular fibrillation. The patient required naloxone once more for this episode and again developed ventricular fibrillation. A second opiate overdose in the same patient was treated with an initial dose of 0.4 mg intravenously, followed by 0.4 mg intravenously, then intramuscularly. Each time the patient developed ventricular fibrillation responsive to cardioversion and/or lidocaine.

    Severe hypertension (mean arterial pressure rising from a baseline of 107 mmHg to 147 mmHg in about 2 to 3 hours) has been reported in an essential hypertension patient given an initial 8 mg dose of naloxone intravenously, followed by an infusion of 0.13 mg/min over the next 2.5 hours. When the naloxone was discontinued the blood pressure quickly returned to normal.

    Mild hypotension and one case of moderate hypertension were observed in patients receiving a bolus dose of 4 mg/kg of naloxone followed by 2 mg/kg/hour for 24 hours. One study reported that the newborn infants of mothers who have received naloxone near term may experience tachycardia.

    Cardiovascular side effects with the use of naloxone have included hypotension, hypertension, atrial and ventricular tachycardia, ventricular fibrillation, left ventricular failure and cardiac arrest (mostly in postoperative patients, many of whom had cardiovascular disease).

    Cardiovascular side effects including a decrease in blood pressure and tachycardia have been reported infrequently with the use of pentazocine.
    Other

    Withdrawal syndromes from the use of naloxone may be precipitated by as little as 0.05 to 0.2 mg intravenously in patients taking 24 mg per day of methadone.

    Other side effect including withdrawal in patients receiving opiates have been precipitated by naloxone. Withdrawal is characterized by nausea, vomiting, sweating, lacrimation, rhinorrhea, cramping, insomnia, chills/hot flashes, piloerection, tachycardia, anxiety, restlessness, irritability, tremulousness, hypertension, seizures, and cardiac arrest. Similar symptoms have been noted in patients with pruritus of cholestasis who were not receiving opiates.

    Other side effects including tinnitus have been reported with the use of pentazocine.
    Respiratory

    Three cases, treated with numerous drugs, developed clinical evidence of pulmonary edema shortly after intravenous administration of naloxone (0.3 to 1.6 mg).

    Respiratory side effects including pulmonary edema have been uncommon from the use of naloxone.

    Respiratory side effects including respiratory depression have rarely been reported with the use of pentazocine.
    Nervous system

    A 51-year-old male was given 0.8 mg of naloxone for obtundation. Within 30 seconds of administration a grand mal seizure occurred. The patient had Pseudomonas sepsis with negative CSF cultures.

    Nervous system side effects including seizures and paresthesias have been reported at both standard and high dosages of naloxone. Seizures have been reported in 5% of patients receiving a bolus of 4 mg/kg followed by 2 mg/kg/h for 24 hours. Agitation has been noted in 3%, tremors in 3%, and headache in 5%. Rarely, agitation, tremors, headache, alteration in mood and cognition, mental discomfort, sleepiness, and confusion have been reported at high dosages. Lethargy has been reported in manic and control patients. Naloxone administration may worsen obsessive compulsive behavior.

    Nervous system side effects including sweating, dizziness, lightheadedness, hallucinations, sedation, euphoria, headache, confusion, and disorientation have been reported with the use of pentazocine. Weakness, flushing, disturbed dreams, insomnia, and syncope have been reported infrequently. Tremor, chills, paresthesia, irritability, and excitement have been reported rarely.
    Gastrointestinal

    Nausea and/or vomiting occurred in 32% of patients in one study on naloxone who received a bolus of 4 mg/kg followed by 2 mg/kg/h for 24 hours.

    Gastrointestinal side effects of nausea and vomiting have been reported in patients receiving high dose naloxone therapy.

    Gastrointestinal side effects including nausea and vomiting have been reported with the use of pentazocine. Constipation has been reported infrequently. Abdominal distress, anorexia, and diarrhea have been reported rarely.
    Genitourinary

    Genitourinary side effects including an increase in urinary urgency have rarely been reported with the use of naloxone. The drug may also have a mild diuretic effect.

    Genitourinary side effects including urinary retention have rarely been reported with the use of pentazocine.

    A 75-year-old was treated with naloxone for senile dementia. A dosage of 0.8 mg in 25 mL of normal saline was given as an infusion over 10 minutes. The treatment was given 6 times, each time the patient experienced urinary urgency (at least 5 small volume urinations over 2 hours).
    Hematologic

    Depression of the white blood cell count is usually reversible.

    Hematologic side effects including depression of the white blood cell count (especially granulocytes) and moderate transient eosinophilia have been reported with the use of pentazocine.
    Hypersensitivity

    Hypersensitivity reactions including rash have been reported infrequently. Urticaria and edema of the face have been reported rarely with the use of pentazocine. One instance of an apparent anaphylactic reaction has been reported.
    Dermatologic

    Dermatologic side effects including erythema multiforme, Stevens-Johnson syndrome, and toxic epidermal necrolysis have been reported rarely with the use of pentazocine.
    Ocular

    Ocular side effects including visual blurring and focusing difficulty have been reported infrequently with the use of pentazocine.
    Psychiatric

    Psychiatric side effects including depression have been reported infrequently with the use of

    Lethal acute pulmonary edema following intravenous naloxone in a patient received unrelated bone marrow transplantation.
    Wang WS, Chiou TJ, Hsieh RK, Liu JH, Yen CC, Chen PM.
    Source

    Department of Medicine, Veterans General Hospital-Taipei, Taiwan, R.O.C.
    Abstract

    A 39-year-old man was diagnosed as having acute myeloid leukemia and received 6 courses of chemotherapy. The bone marrow revealed complete remission. He had no prior history of cardiac or pulmonary disease. HLA-matched unrelated bone marrow transplantation (BMT) was performed in September 1995. Pre-transplant studies including chest X-ray, electrocardiogram and pulmonary function test were normal. The procedure of BMT was smooth and serial bone marrow examination showed successful engraftment. Serial chest X-rays done every week after BMT were normal. There were no evidence of fluid overload but severe mucositis was noted. On the 38th day after BMT, intravenous injection of 10 mg morphine was prescribed to relief severe oral pain. Respiratory depression developed right after, and naloxone 0.4 mg was given by an intravenous route. One hour later, severe shortness of breath was noted and the emergent chest X-ray revealed acute pulmonary edema. He became unconscious 2 hours later and expired 24 hours after naloxone injection in spite of intensive medical treatment. Naloxone-induced acute pulmonary edema is an extremely rare but lethal complication. Only a few cases have been reported in English literature. We report a case of acute myeloid leukemia receiving unrelated BMT to develop acute pulmonary edema rapidly after intravenous injection of naloxone. The clinical features and pathogenesis are discussed.
  26. Guest

    Guest Guest

    Q. All are risk factors for carcinomatous change in a case of Adenomyomatosis except-
    1.Age>60yrs
    2.Polyp>5mm size
    3.Documented increase in size of polyp
    4.Associated gall stones

    polyp >5 mm is the answer...risk factors for gall bladder ca includes size >1 cm or 10 mm n not 5 mm..its a repeat..

    Gallstone size and the risk of gallbladder cancer.
    Moerman CJ, Lagerwaard FJ, Bueno de Mesquita HB, van Dalen A, van Leeuwen MS, Schrover PA.
    Source

    Dept. of Epidemiology, National Institute of Public Health and Environmental Protection, Bilthoven, The Netherlands.
    Abstract

    The relation between gallstone size and gallbladder cancer was investigated in a matched hospital-based case-control study of surgical patients in a predominantly white population. Stone size was considered to be an indicator of the damaging effects of gallstones on gallbladder mucosa, which may enhance carcinogenesis. A radiologist determined the size of the largest gallstone within the gallbladder by reviewing hard copies of the ultrasonographic examinations of cases and controls. Between 1983 and 1989, 83 surgical patients with gallbladder cancer were identified in 18 participating hospitals. Hard copies were available for 72 patients and 208 matched controls. For 43 cancer patients and [snip] matched controls stone size could be determined. In contrast to two other studies, no relation was found between stone size and gallbladder cancer. The reasons for this discrepancy are discussed.

    Q. laudanosine
    a)atracurium
    b)cis-atracurium

    ANS=A

    Laudanosine – Epileptic foci

    Because atracurium undergoes Hofmann elimination as a primary route of chemodegradation, not surprisingly one of the major metabolites from this process is laudanosine, a tertiary amino alkaloid reported to be a modest CNS stimulant with epileptogenic activity and cardiovascular effects such a hypotension and bradycardia. As part of the then fierce marketing battle between the competing pharmaceutical companies (Burroughs Wellcome Co. and Organon, Inc.) with their respective products, erroneous information was quickly and subtly disseminated very shortly after the clinical introduction of atracurium that the clinical use of atracurium was likely to result in a terrible tragedy because of the significant clinical hazard by way of frank seizures induced by the laudanosine by-product. The purported hypothesis being that the laudanosine produced from the chemodegradation of parent atracurium would cross the blood-brain barrier in sufficiently high enough concentrations that lead to epileptogenic foci. Fortunately, both for the public and for atracurium, rapid initial investigations irrefutably failed to find any overt or EEG evidence for a connection between atracurium administration and epileptogenic activity. Indeed, because laudanosine is cleared primarily via renal excretion, a cat study modelling anephric patients went so far as to corroborate that EEG changes, when observed, were only evident at plasma concentrations eight to 10 times greater those observed in humans during infusions of atracurium. Thus, the cat study predicted that, following atracurium administration in an anephric patient, laudanosine accumulation and related CNS or cardiovascular toxicity were unlikely - a prediction that correlated very well with a study in patients with renal failure and undergoing cadaveric renal transplantation. Furthermore, almost a decade later, work by Cardone et al.. confirmed that, in fact, it is the steroidal neuromuscular blocking agents pancuronium and vecuronium which, when introduced directly into the CNS, were likely to cause acute excitement and seizures owing to accumulation of cytosolic calcium caused by activation of acetylcholine receptor ion channels. Unlike the two steroidal agents, neither atracurium nor laudanosine caused such accumulation of intracellular calcium. Just over two decades later with uninterrupted clinical availability of atracurium, there is now little doubt that laudanosine accumulation and related toxicity will likely ever be seen with the doses of atracurium that are administered in clinical practice.

    Laudanosine is also a metabolite of cisatracurium which, because of its identical structure to atracurium, undergoes chemodegradation via Hofmann elimination in vivo. Plasma concentrations of laudanosine generated are lower when cisatracurium is used.

    Q. HIStory of verrucous lesion with vacuolate cells
    a)verrucous epidemal naevus
    b)linear darrier disease

    can any one recall the Q stem with other options/

    ANS=?

    Darier disease is an uncommon genodermatosis characterized by verrucous papules in a seborrheic distribution. The linear form of this disease is rare and could result from genetic mosaicism in this autosomal dominant disorder. We report a case of linear Darier disease that involved the right lower limb with a zosteriform distribution.

    Q. Q. In protein losing enteropathy radiotracer nt used
    1 tc99 albumin
    2 tc99 dextran
    3 transferrin
    4 tc99 ??

    In 1956, Kimbel et al. first described an increased gastric albumin secretion by using radioiodinated albumin. Thereafter, a variety of radiolabelled serum proteins or macromolecules have been used to determine enteric protein loss, such as 131I-polyvinylpyrrolidone (131I-PVP), 125I-PVP, 51Cr-labeled albumin, 51Cr chromic chloride, 125I-albumin, In-111 chloride, In-111 transferrin, Tc-99m dextran, and Tc-99m human immunoglobulin (HIG)

    Other Tc-99m labeled agents

    l Diagnosing PLE by Tc-99m human immunoglobulin has been reported, but no systematic study with large number of patients has been performed.

    l Tc-99m dextran was reported to be a promising PEL imaging agent. In a prospective study, twenty-two patients with diseases commonly associated with PLE and 12 healthy control subjects underwent Tc-99m dextran scintigraphy. All the patients showed significant radiotracer accumulation in the intestines within 3-4 hours post injection. Four of the 12 healthy subjects also showed minimal accumulation in the abdominal area occurring late in the study period. The authors considered that Tc-99m dextran has faster background clearance than Tc-99m HAS, giving a higher target to non-target ratio, and is a promising radiopharmaceutical for imaging PLE.

    l However, both Tc-99m dextran and Tc-99m human immunoglobulin are also inflammation-seeking radiotracers. Therefore, it is not possible with Tc-99m dextran and Tc-99m HIG to easily differentiate PLE from localized bowel loop inflammation if there is no luminal transit.
    Conclusion

    l In summary, Tc-99m HSA with serial scanning for up to 24 hours is useful for diagnosing and monitoring PLE. There are also some other methods can be used. Advantages and limitations should be considered in choosing the method.

    Linear verrucous epidermal nevus (also known as a "Linear epidermal nevus," and "Verrucous epidermal nevus") is a skin lesion characterized by a verrucous skin-colored, dirty-gray or brown papule. Generally, multiple papules present simultaneously, and coalesce to form a serpiginous plaque. When this nevus covers a diffuse or extensive portion of the body's surface area, it may be referred to as a systematized epidermal nevus, when it involved only one-half of the body it is called a nevus unius lateris

    Q. subcutaneous fat necrosis in newborn resemble;
    a)lupus panniculitis
    b)lipoystrophy?
    c)steroid panniculitis
    d)//

    4th option ?

    Mostly lobular panniculitis with vasculitis is only represented by erythema induratum of Bazin. In contrast, mostly lobular panniculitides without vasculitis comprise a large series of disparate disorders, including sclerosing panniculitis, calciphylaxis, sclerema neonatorum, subcutaneous fat necrosis of the newborn, poststeroid panniculitis, lupus erythematosus profundus, pancreatic panniculitis, alpha(1)-antitrypsin deficiency panniculitis, subcutaneous Sweet syndrome, infective panniculitis, factitial panniculitis, lipodystrophy, traumatic panniculitis, subcutaneous sarcoidosis, and sclerosing postirradiation panniculitis
  27. Guest

    Guest Guest

    Q. protein movement fromcytoplasm to nucleus is seen by:
    a)FARP
    b)confocal
    microscopy

    ANS=B/A?(BETTER ANS SEEMS TO BE OPTION B ,OPEN FOR DISCUSSION)

    Green fluorescent proteins and confocal microscopy are technological advances that allow observation of protein movement in real time. "The part of transport that was historically most lagging is RNA transport. I think that had been lagging because people have not had the wherewithal to look at the RNA directly," she says.

    FRAP
    Meaning: Fluorescence Recovery After Photo-bleaching

    In a FRAP experiment, a region with fluorescent molecules is irradiated or photo-bleached with laser light. This results in the fluorescent molecules inside that region to become non-fluorescent. The recovery part of this experiment is the subsequent redistribution of fluorescent and bleached molecules throughout the volume. This gives information on their mobility.

    Using FRAP, one can determine the mobility of fluorescently tagged proteins in living cells. FRAP allows quantitation of a number of 'dynamic parameters' such as diffusion coefficient, immobile fraction and binding or residence time.

    * FRAP can be applied to one photon or multi-photon
    * Slow FRAP takes seconds and fast FRAP takes micro- to milli-seconds
    * The amount of light that recovers (returns) relative to the amount of light that was there before the photobleaching is the percent recovery
    * The speed with which the fluorescent molecules migrate back into the photobleached area is a measurement of the "diffusional mobility" which is usually called lateral mobility

    Q. Resistant nephrotic syndrome treatment include:
    a)oral cyclophosphamide
    b)i.v cyclophosphamide
    c)oral cyclosporine

    ANS=B

    Efficacy of intravenous pulse cyclophosphamide treatment versus combination of intravenous dexamethasone and oral cyclophosphamide treatment in steroid-resistant nephrotic syndrome.
    Mantan M, Sriram CS, Hari P, Dinda A, Bagga A.
    Source

    Department of Pediatrics, Maulana Azad Medical College, Delhi, India.
    Abstract

    We compared, in a randomized controlled trial, the efficacy of a regimen based on intravenous (i.v.) cyclophosphamide therapy with a combination of i.v. dexamethasone and oral cyclophosphamide therapy in inducing remission in patients with steroid-resistant nephrotic syndrome (SRNS). During April 2001 to December 2003, 52 consecutive patients with idiopathic SRNS, normal renal function and renal histology findings showing minimal change disease, focal segmental glomerulosclerosis or mesangioproliferative glomerulonephritis were enrolled into the study. Patients in group I received i.v. injection of cyclophosphamide once a month for 6 months and prednisolone on alternate days. Those in group II received i.v. treatment with dexamethasone (initially on alternate days, later fortnightly and monthly; total 14 doses), oral cyclophosphamide therapy (for 3 months) and prednisolone on alternate days. Data from 49 patients (26 in group I, 23 in group II) were analyzed; their clinical and biochemical features were similar at inclusion. Following treatment, complete remission was seen in 53.8% and 47.8% patients in groups I and II, respectively (P = 0.6). Long-term follow up showed favorable outcome in 14 (53.8%) patients in group I, and 9 (39.1%) in group II. Chief adverse effects, including cushingoid features and serious infections, were similar in both groups. Patients receiving i.v. dexamethasone therapy commonly showed hypertension and hypokalemia, while vomiting and reversible alopecia occurred in those receiving i.v. treatment with cyclophosphamide. In patients with SRNS, the efficacy of treatment intravenously with cyclophosphamide and orally with prednisolone was similar to the combination of dexamethasone intravenously, orally administered cyclophosphamide and prednisolone.

    Publication Types, MeSH Terms, Substances
    Publication Types

    * Randomized Controlled Trial

    MeSH Terms

    * Administration, Oral
    * Adolescent
    * Adrenal Cortex Hormones/therapeutic use*
    * Child
    * Child, Preschool
    * Cyclophosphamide/administration & dosage*
    * Cyclophosphamide/adverse effects
    * Dexamethasone/administration & dosage*
    * Dexamethasone/adverse effects
    * Drug Resistance
    * Drug Therapy, Combination
    * Female
    * Humans
    * Infant
    * Infusions, Intravenous
    * Logistic Models
    * Male
    * Nephrotic Syndrome/drug therapy*

    Substances

    * Adrenal Cortex Hormones
    * Dexamethasone
    * Cyclophosphamide

    Q.
  28. Guest

    Guest Guest

    Q. Fish is the source of all except?
    A. Iron
    B. Iodine
    C. Vitamin A
    D. Phosphorus

    answer : phosphorus.

    option a. iron:

    Iron levels are not high in white or oil-rich fish, but since the iron present is easily absorbed, especially from white fish, it is a useful dietary source. Shellfish has high levels of iron, similar to that of red meat.


    option b:iodine
    Fish contains more iodine than any other food in a normal diet.
    Fish are better known for the dietary minerals they supply than for the vitamins. This is because minerals such as iodine and selenium, which are supplied by fish, are found in much lower amounts in non-marine foods.
    Fish contains more iodine than any other food in a normal diet. Eating one or two fish meals every week provides the equivalent of 100 to 200 micrograms (mcg) of iodine a day, enough to meet the RDA of 130mcg for adults. Fish is also an excellent source of selenium although the amount of selenium varies significantly. The RDA for selenium is 55mcg for adults. Fish, on average, supplies 20 to 60mcg of selenium per 4oz/100g, whereas cereal and meat sources of selenium only provide about 10 to 12mcg per 4oz/100g.

    option c. vitamin A
    Fat Soluble Vitamins
    Fish and shellfish are well known as sources of the fat soluble vitamins A and D. Vitamin A can occur in two different forms - as retinol, which is easily absorbed by the body, or as carotenoids, which are less easily absorbed and have only 50% of the absorption rate of retinol. Carotenoids are converted to vitamin A once absorbed by the body. The easily absorbed retinol is the type of vitamin A found in fish.

    Vitamin A Vitamin A is found in quite high amounts in oil-rich fish such as herring and mackerel and in shellfish. 4oz/100g portions of these fish provide around 10 to 15% of the adult recommended daily amount (RDA) for retinol. Oil-rich fish are also excellent dietary sources of vitamin D3, (cholecalciferol) providing 50 to 200% of the RDA in a 4oz/100g portion.


    option d : phosphorus.

    "Vitamin D promotes the absorption of calcium and phosphorus from the intestine and regulates blood calcium levels". Without vitamin D the small intestine absorbs no more than 10 to 15% of dietary calcium. Vitamin D is also important in bone metabolism, helping to control bone formation and resorption and it may also play a role in preventing some cancers.


    Q. para 3 with hypertension and menorrhagia
    a)MIRENA
    b)TRCE

    Indications for MIRENA

    Treatment of heavy menstrual bleeding in women who choose to use intrauterine contraception as their method of contraception.

    Adult dose for MIRENA

    See literature. Insert into uterine cavity as directed. Reexamine after next menses (within 3 months). Replace at least every 5 years.
    Children's dosing for MIRENA

    Not recommended.

    Contraindications for MIRENA

    Uterine abnormality. History or risk of ectopic pregnancy. History of pelvic inflammatory disease (PID) unless subsequent intrauterine pregnancy occurred. Postpartum endometritis or septic abortion in past 3 months. Uterine or cervical neoplasia. Unresolved abnormal Pap smear. Abnormal genital bleeding. Untreated acute cervicitis or vaginitis. Acute liver disease or liver tumor. Immunosuppressed. IV drug abuse. Multiple sexual partners for patient or partner. Genital actinomycosis. Retained IUD. Breast carcinoma. Pregnancy (Cat.X).
    Warnings/Precautions for MIRENA

    Assure suitable uterine anatomy before inserting. Endocarditis risk. Anticoagulant therapy or coagulopathies. Cervical stenosis. Predisposition to syncope, bradycardia, other neurovascular episodes. Remove device if any of these occur: menorrhagia, metrorrhagia producing anemia, STDs, AIDS, endometritis, severe dyspareunia, intractable pelvic pain, uterine or cervical perforation, pregnancy, any sign of expulsion. Consider removal if first migraine, transient cerebral ischemia, severe headache, jaundice, marked increase in BP, or severe arterial disease occurs. Check placement regularly. Nursing mothers (increased risk of uterine perforation).
    Interactions for MIRENA

    May be antagonized by CYP3A4 inducers (eg, barbiturates, bosentan, carbamazepine, felbamate, griseofulvin, oxcarbazepine, phenytoin, rifampin, St. John's wort, topiramate).
    Adverse Reactions for MIRENA

    Amenorrhea, irregular bleeding, cramps, adhesions, peritonitis, intestinal perforations or obstruction, abcesses, erosion, ovarian cysts, PID, ectopic pregnancy, GI disturbances, leukorrhea, headache, vaginitis, breast or back pain, acne, depression, hypertension, nervousness, weight gain, glucose intolerance, decreased libido, abnormal Pap smear. Syncope, bradycardia, other neurovascular episodes, perforation, loss of pregnancy, sepsis (during insertion or removal). If pregnancy occurs: sepsis, miscarriage, premature labor or delivery.

    How is MIRENA supplied?

    System—1

    Related Disease:
    Heavy menstrual bleeding
    Menorrhagia


    Q. 33 weeks baby with type 1 ROP Stage 1 plus disease whats the management

    a)both eye laser photocoagulationto be done
    b)photo coagulation in one eye and follow up forother eye
    c)clinical examination for both eyes

    ANS-A(PROBABLY,OPEN FOR DISCUSSION)

    When is Treatment Considered?

    The ET-ROP study demonstrated improved visual outcomes with earlier laser treatment and has replaced previous guidelines set by the CRYO-ROP study.6-8

    Type 1 ROP
    Administer Peripheral Ablation Treatment


    Zone 2
    Plus disease with Stage 2 or 3
    Zone 1
    Plus disease with Stage 1, 2 or 3
    Stage 3 without Plus disease


    Type 2 ROP
    Wait and watch for progression

    Zone 2
    Stage 3 without Plus disease
    Zone 1
    Stage 1 or 2 without Plus disease

    Note the ET-ROP criteria for treatment emphasise the significance of “Plus disease” in Zones 1 and 2.
    Treatment is conducted for those eyes reaching Type 1 ROP (high-risk pre-threshold ROP that would normally progress to threshold ROP, if untreated).
    Threshold ROP is defined as stage 3 ROP, Zone 1, or Zone 2 in 5 or more continuous clock hours or 8 cumulative clock hours with the presence of "plus disease".9-11
    The aim of treatment is to reduce the incidence of retinal detachment and blindness.

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