NIMHANS 2015 DM/Mch/MD

Discussion in 'PG Entrance Message Board' started by samuel, Nov 10, 2014.

  1. samuel

    samuel New Member

    C/F Myasthenia Gravis :-

    Spontaneous Remission
    Proximal muscle Involvement
    Worsen by Exertion

    Thymoma associated with MG
  2. samuel

    samuel New Member

    Entacapone & Tolcapone (Anti-Parkinson Drugs)
    are COMT Inhibitors that augment the effect of l-Dopa by blocking enzymatic degradation of levi-dopa and dopamine.

    Entacapone is preferred due to lesser hematological & hepatic side-effects .
  3. samuel

    samuel New Member

    Taste Modalities :-

    (a) Bitter : Back of the Tongue(Valate Papillae)

    (b) Sour : Edges of the Tongue

    (c) Sweet : Tip of the Tongue

    (d) Salt : Dorsum Anterior of the Tongue
  4. samuel

    samuel New Member

    Auenbrugger’s sign-In pericardial effusion ,an epigastric prominence is seen.

    - Auspitz’s sign-When the scales of Psoriasis are removed ,pin point bleeding spots will be seen .

    Tests To Determine Stoppage of Circulation :-

    Diaphenous Test(TransIllumination Test)

    ICard's Test

    Magnus Test (Ligature Test)
  5. samuel

    samuel New Member

    Casper's Dictum refers to Rate of Putrefaction :-

    Putrefaction is delayed in cases of :-

    -> Less than 0 DEGREE C
    -> Dry Weather
    -> More than 48 DEGREE C
    -> Decrease in Air Velocity
    -> Tight Clothing
    -> More than metres deep Grave
    -> Body Packed in Coffin
    -> Wasting Diseases like Anaemia
    -> Poisoning Like Carbolic Acid ; Zinc Chloride
    -> Heavy Metals like As,Sb
    -> Air 1Wk Water 2Wk Soil 8Wk
  6. samuel

    samuel New Member

    Radiation Therapy is Indicated for a Patient with Stage I Disease treated with BCT. The addition of radiation therapy reduces the local recurrence rate from 30% to 9%. and it is the integral part of treatment program. Chemotherapy may or may not be indicated in a Post-Menopausal patient with early Breast Cancer.
  7. samuel

    samuel New Member

    Glomus Tumor :- Most Common Benign Neoplasm of Middle Ear.
    Rule of 10 10% Familial 10%Multicentric
    10%Functional (Secrete Catecholamine)
    Middle Age (40-50Yrs)
    Females Affected 5 Times More.
    Encapsulated Extremely Vascular Very Slow Growing Locally Invasive
    Types:- Glomus Jugulare
    Globus Tympanicum
    Globus Vagale
  8. samuel

    samuel New Member

    Most Common Presentation of Juvenile Myoclonic Epilepsy :-

    GTCS in Awake State .

    DOC-> Sod Valproate

    *Lamotrigine Can also be Used
  9. samuel

    samuel New Member

    Most Common Mechanism for Ant Shoulder Dislocation is Indirect Trauma to the Shoulder in -> Abduction ; External Rotation & Extension

    Phaeochromocytoma :-

    Adrenal -> 75%

    Adjacent to Adrenals -> 26%

    Organ of Zuckerandl -> 53%

    Bladder -> 11%

    Mediastinum & Neck -> 5%
  10. samuel

    samuel New Member

    Clinical Syndromes Asso with PNET (Primary Neuro-Ectodermal Tumour)

    Gastrinoma --- Zollinger Ellison

    Insulinoma --- Whipple Triad

    Glucagonoma --- Glucagonoma Syndrome

    VIP --- Verner Morrison Syndrome

    (Ref- Schwartz) 9th Edition
  11. samuel

    samuel New Member

    Dermatophytes -> Trichophyton (Skin ; Hair ; Nails)

    Microsporum (Skin ; Hair)

    Epidermophyton (Skin; Nails)

    Marchiafava-Bignami (Demyelination of Corpus Callosum in Chr. Alcoholics)

    Asso with Stupor ; Coma ; Altered Sensorium ..

    Divided into 2 Subtypes .
  12. samuel

    samuel New Member

    Vitiligo - Depigmented Macules (Hallmark of Vitiligo)
    In Older Lesions the hair may lose their Pigment
    -> Leucotrichia
    Commonest Type - Vitiligo vulgaris
    Depigmented Macules with Scalloped border
    Koebner's Phenomenon Seen

    Treatment-->

    Localised Lesions : Topical Corticosteroids / Topical PUVA

    Generalised Lesions : Monobenzyl Ether of Hydroquinone

    (Reference : Speed Institute Notes)
  13. samuel

    samuel New Member

    Chemical leukoderma: Contributory chemicals

    Most potent phenol/catechol derivatives
    Monobenzyl ether of hydroquinone (MBH)
    Hydroquinone
    p-tert-Butylcatechol (PTBC)
    p-tert-Butylphenol (PTBP)
    p-tert-Amylphenol (PTAP)
    Additional phenol/catechol derivatives
    Monomethyl ether of hydroquinone (MMH)
    Monoethyl ether of hydroquinone (MEH)
    p-Phenylphenol
    p-Octylphenol
    p-Cresol
    Sulfhydryls
    Cysteamine
    Sulfanolic acid
    Cystamine dihydrochloride
    Miscellaneous
    Mercurials Tretinoin
    Arsenic Benzoyl peroxide
    Cinnamic aldehyde Ammoniated mercury
    PPD Azelaic acid
    Corticosteroids Fluorouracil
    Chloroquin Briilliant lake red R
    Soymilk and derived protein Thiotepa (inhibits PAR-2)
  14. samuel

    samuel New Member

    Dermatology Imp Points

    LE CELL is a <Neutrophil>

    Strawberry Cervix Seen in Trichomonas vaginalis

    LEPRA CELL is a <PLASMA CELL>

    TZANCK CELL is a <Modified Keratinocyte>

    Clue Cells <Gardnerella Vaginalis>
  15. samuel

    samuel New Member

    Cytophagic Histiocytic Panniculitis is found in Hepatosplenomegaly

    Weber Christian Panniculitis associated with Pancreatic Disease

    Important Finding in CHP "Bean Bag Cells"

    Magenta colored Tongue Found in Ariboflavinosis
  16. samuel

    samuel New Member

    "Majocchi granuloma" -> is caused by Tinea rubrum

    "Swimming Pool granuloma" -> Mycobacterium marimum

    "Pallsading Granuloma"-> Necrobiosis Lipoidica

    "Granuloma Inguinale" -> Calymmatobacterium granulomatis
  17. samuel

    samuel New Member

    Order of Sensitivity of Nerve Fibres to Local Anaesthetic in Decreasing Order :

    Preganglionic Sympathetic(B)

    Pain(C & A Delta)

    Sensory

    Motor
  18. samuel

    samuel New Member

    Conventional AntiPsychotics:

    High Potency -> Haloperidol ; Thiothixene ; Fluphenazine

    Moderate Potency -> Trifluoperazine ; Perphenazine ; Loxapine ; Molindone

    Low Potency -> Chlorpromazine ; Thioridazine
  19. samuel

    samuel New Member

    Schwannoma - antoni a and b bodies seen

    Cri du chat - chromosome 5

    NSAIDS do not decrease effectiveness of antihypertensives/used in neuropathic disorders

    Long term followup of intraocular foreign body is with ERG

    Not used in hyperkalemia - beta antagonist

    Child with k/c/o bronchial asthma comes with resp distress rate 48/min can't speak 2 words. Wheezing present. 02 Saturation 95%. U give 3 doses of salbutamol nebulisation then he started to speak a sentence but saturation falls to 85%
    A.VP mismatch
    B.R to left shunt
    C.Due to salbutamol
    D.Faulty pulse oxymeter

    Arteritis not seen in adults - kawasaki

    Exploratory burr hole technique - opposite to side of dilated pupil/ left temporal / If no localizing signs, hole in left temporal(dominant lobe).

    Child with chronic cough h/o TEF correction. h/o cough from day of surgery. Probable Case of Tracheomalacia.

    7 month child vomiting after fruit juice feeds. enzyme defn to be evaluated? aldolase/hepatic kinase?
  20. samuel

    samuel New Member

    Most Frequently Dislocated Joint in the Body :-
    GlenoHumeral Jt

    Most Unstable Inferiorly

    MC Dislocation is Anterior

    Ratio of Fat Cells & RBC in Bone Marrow is :
    1:1

    Gs Alpha Mutation may lead to :
    Pseudohypoparathyroidism
    McCune Albright Syndrome
  21. samuel

    samuel New Member

    Normal Values :-

    Serum Calcium : 9-11 mg/dl

    Serum Phosphate : 3-5 mg/dl

    Serum Alkaline Phosphatase : 30-120 IU

    Serum Parathormone : 10-55 Units

    Serum BiCarb : 21-30 meq/L
  22. samuel

    samuel New Member

    Now According To The Above Data :-

    Q) A 2 Yr Old Boy Has Vit D Resistant Rickets.
    His Investigation Revealed Serum Calcium 9 mg/dl.
    Phosphate 2.4 mg/dl. Alkaline Phosphatase 1041 IU
    Bicarb level 22mEq/L. Intact Parathyroid Hormone.
    Most Probable Diagnosis:-

    A-> Distal RTA

    B-> Hypophosphatemic Rickets

    C-> Vit D Dependent Rickets

    D-> Hypoparathyroidism
  23. samuel

    samuel New Member

    RENAUT - Connective tissue structure found in nerve fibres

    RESIDUAL - Lipofuchsin - undigested material of lysosomes

    RESTIFORM - Part of the inferior cerebellar peduncle (also see JUXTARESTIFORM body)

    RETICULATE - Intracytoplasmic form of Chlamydia (also see ELEMENTARY body)

    RETZIUS - Pigmented mass in the acoustic papillae of the ear

    RICE - Rheumatoid arthritis
  24. samuel

    samuel New Member

    Question. ... A one year old male baby is brought with complaints of growth retardation, bone deformities and seizures. Also there is H/O alopecia. On investigations, 25 (OH) vitamin D and 1, 25 (OH) vitamin D are raised. ALP is high. All the following can be possibility in the case except
    1) Vitamin D deficient rickets
    2) Pseudovitamin D deficient rickets
    3) Vitamin D resistant rickets
    4) X linked hypophosphatemic rickets
  25. samuel

    samuel New Member

    IgA Nephropathy -> C3 Complement levels Normal
    Post-StreptoCoccal Glomerulonephritis ->
    C3 Complement levels Decreased

    Causes of Supra-Clavicular Lymphadenopathy :

    Neoplastic:
    GI Cancer
    Ca Lung
    Ca Breast
    Ca Thyroid
    Ca Testes

    Non Neoplastic:
    Sarcoidosis
    TB
    Toxoplasmosis
  26. samuel

    samuel New Member

    Cylindroma :
    Turban Tumor

    Pilomatrixoma :
    Calcifying Epithelioma of Malherbe
    Benign Hair Follicle Derived Tumor

    Euphoric Mania :
    Lithium

    Dysphoric Mania :
    Valproic Acid

    Mania with Psychosis :
    Valproic Acid + Risperidone

    Hypomania :
    Lithium or Lamotrigine
  27. samuel

    samuel New Member

    Mood Stabilizers ->

    1) Lithium
    2) Valproic Acid
    3) Carbamazepine
    4) BZD
    5) Lamotrigine

    Just for your information theme of "World Health Day 2015: Food safety"

    WHO’s Five keys to safer food offer practical guidance to vendors and consumers for handling and preparing food:

    Key 1: Keep clean
    Key 2: Separate raw and cooked food
    Key 3: Cook food thoroughly
    Key 4: Keep food at safe temperatures
    Key 5: Use safe water and raw materials.
  28. samuel

    samuel New Member

    C/F Hypercalcemia :
    PolyUrea
    Vague Abdominal Complaints
    Mental Confusion
    Reversible Renal Tubular Defects

    C/F Hypokalemia :

    Muscular Weakness ; Fatigue

    Myalgia (Lower Extremity)

    Hypoventilation

    Complete Paralysis (Paraplegia)
  29. samuel

    samuel New Member

    Selective Agonist for H3 Receptors :

    1) alpha-methyl Histamine
    2) Imetit

    Selective Antagonist for H3 Receptors :-

    1) Thioperamide

    2) Impromidine

    3) Burimamide
  30. samuel

    samuel New Member

    Genu Varum caused by X Linked Hypophosphatemia /
    X Linked Vit D Resistant Rickets:

    Surgical Correction by Ilizarov Techniques / CHAOS Surgery !

    The retinoids are medications that are derivatives of Vitamin A. They are the treatment of choice for comedonal acne, or whiteheads and blackheads.
    Tretinoin

    * The best-known topical retinoid
    * Marketed as Retin-A, Avita, and Renova
    * Also available as a generic
    * Available as a cream (0.025%, 0.05%, and 0.1%), gel (0.01% and 0.025%), and a liquid (0.05%)
    * Creams are less potent than gels, which are less potent than the liquid
    * Breaks down chemically in the presence of benzoyl peroxide, therefore cannot be applied at the same time of the day
    * High incidence of skin irritation and precautions must be taken when starting
    * Increases risk of sunburn
    * A new formulation Retin-A Micro 0.1% releases tretinoin over a longer period of time and is less irritating.
  31. samuel

    samuel New Member

    Cupuliform Cataract :

    Senile Posterior Cortical Cataract

    Traumatic Cataract :

    Rosette Cataract
    Vossius Ring

    Snow Flake Cataract:

    DM
  32. samuel

    samuel New Member

    A Pregnant Woman has deterioration of hearing loss .
    The Tympanogram is likely to show :
    As Type Curve
    Diagnosis : Otosclerosis

    Asso with Van Der Hoove Syndrome

    -> Osteogenesis Imperfecta
    -> Otosclerosis
    -> Blue Sclera
  33. samuel

    samuel New Member

    NPU of common Food Items :-

    Egg - 100

    Pulses - 65

    Meat - 80

    Milk - 75

    NPU (Net Protein Utilization)
  34. samuel

    samuel New Member

    Iron Requirement
    ICMR Guideline :

    Men - 17mg/day
    Women - 21mg/day
    Pregnancy - 35mg/day
    Lactation - 21mg/day
  35. samuel

    samuel New Member

    Complications of Hiatal Hernia :

    Sliding Hernia ->
    Esophagitis due to Reflux
    Barrett's Esophagus
    Adenocarcinoma
    Aspiration Pnemonia
    Development of Asthma
  36. samuel

    samuel New Member

    Coomonest Sites of # Mandible :

    Mnemonic :
    C A R S

    Condyle (50%)

    Angle (25%)

    Ramus

    Symphysis
  37. samuel

    samuel New Member

    Risk of HIV transmission following skin puncture from a needle or sharp object that was contaminated with blood from a person with documented HIV infection is approximately 0.3% and ART can reduce the risk of infection 8-fold. In contrast, 30% of those accidentally exposed to hepatitis infected blood become seropositive.
  38. samuel

    samuel New Member

    Extra-articular manifestations of Rheumatoid Arthritis
    Cardiac: myocarditis, accelerated atherosclerosis.
    Neurologic: mononeuritis multiplex (foot or wrist drop).
    Hematologic: anemia of chronic disease, neutropenia, or vasculitis.
    Pulmonary: pulmonary nodules, interstitial fibrosis, or pleural effusion.
    Renal: amyloid.
    Skin: rheumatoid nodules.

    Cervical spine involvement of Rheumatoid Arthritis
    Fifty percent of RA patients have cervical spine involvement.
    May present with neck pain, syncope, light-headedness, or paresthesias.
    Check cervical flexion and extension X-rays.
    Symptomatic patients require prompt intubation to maintain airway.
  39. samuel

    samuel New Member

    A couple comes in to see you because they have been unsuccessfully trying to conceive for the past 14 months.
    After a thorough history, you learn that the woman has never been pregnant and that the man has fathered no
    children to his knowledge. You also learn that the timing of their intercourse has been appropriate for conception. As
    an initial workup :-

    Semen analysis for the husband and menstrual tracking, ovulation tracking, and thyroid-stimulating hormone, folliclestimulating
    hormone, and prolactin levels for the wife
  40. samuel

    samuel New Member

    Tracheal stenosis is an abnormal narrowing of the tracheal
    lumen due to an intrinsic or extrinsic mass.
    Etiology/Types
    Etiology
    ■ Intubation trauma
    ■ Tracheostomy
    ■ Neoplasm
    ■ Infection
    ■ External trauma
    ■ Gastroesophageal reflux disease (GERD)
    ■ Inflammatory/granulomatous/autoimmune disease
    ■ Idiopathic
    Types
    ■ Congenital
    ■ Acquired iatrogenic injuries are the most common cause
    ■ Tracheostomy-related stenosis can be classified
    according to site of lesion: suprastomal, stomal, cuff,
    and cannula tip stenosis
    ■ Cotton staging system: grade 1, <50% obstruction;
    grade 2, 50% to 70% obstruction; grade 3, 71% to 99%
    obstruction; and grade 4, complete obstruction
    Epidemiology
    ■ Incidence of postintubation or post-tracheostomy
    stenosis 10% to 22%, depending on duration and
    nature of intubation
    ■ 1% to 2% are symptomatic or have severe stenosis
    Pathogenesis
    Acquired due to intubation tube cuff
    ■ Excessive endotracheal (ET) tube or tracheostomy
    tube cuff pressure (>30 mm Hg) impairs mucosal
    capillary perfusion.
    ■ Mucosal ischemia leads to ulcerations and chondritis.
    ■ Lesions heal by fibrosis, resulting in progressive cicatricial
    stenosis.
  41. samuel

    samuel New Member

    Nissl bodies can be demonstrated by a method of selective staining developed by Nissl (Nissl staining), using an aniline stain to label extranuclear RNA granules. This staining method is useful to localize the perikaryon, cell body, as it can be seen in the soma and dendrites of neurons, though not in the axon or axon hillock. RNA stains blue with this method due to its basophilic (lat. "base-loving") properties.

    These granules are rough endoplasmic reticulum (with free ribosomes) and are the site of protein synthesis.
  42. samuel

    samuel New Member

    Primary Sclerosing Cholangitis is an Extra-Intestinal Manifestation of Ulcerative Colitis that does not resolve by doing Colectomy !

    ALLERGIC URTICARIAL REACTION:
    Incidence: 1 to 3%.
    Aetiology: Antibodies to donor plasma proteins.
    Clinical picture: Allergic urticarial reaction occurs towards the end of transfusion or immediately after it and is characterized by itching, urticaria, flushing rash, rarely laryngeal oedema, bronchospasm.
    Management:
    - No Need to stop transfusion.
    - IV chlorpheniramine 25mg.
    - IV hydrocortisone 100 mg.
    - Subcutaneous adrenaline 1: 1000, ONLY if laryngeal oedema.
  43. samuel

    samuel New Member

    Minor Deep layers of the Back Constitute :


    Levatores costarum
    Cervical inter transversarii
    Interspinales
    Thoracic intertransversarii

    Left Occipital Lobe Dysfunction is associated with :-

    Right Homonymous Hemianopia
  44. samuel

    samuel New Member

    Reperfusion arrhythmias originate as a consequence of the complex of cellular and humoral reactions accompanying the opening of coronary artery. As the primary cause of their generation are considered the chemically defined substances that are produced and accumulated in myocardium during reperfusion. The key role is ascribed to free oxygen radicals but of importance are also other substances such as calcium, thrombin, platelet activating factor, inositol triphosphate, angiotensin II and others. These chemical mediators of reperfusion arrhythmias operate as modulators of cellular electrophysiology causing the complex changes at the level of ion channels. It is supposed that in the genesis of reperfusion arrhythmias unlike ischemic arrhytmias operate nonreentrant mechanisms such as abnormal or enhanced automacy and triggered activity due to afterdepolarizations. As a typical reperfusion arrhythmia is considered an early (within 6 hours after start of thrombolysis), frequent (> 30 episodes/hour) and repetitive (occurring during > 3 consecutive hours) accelerated idioventricular rhythm (AIVR). AIVR with such characteristics has a high specificity and positive predictive accuracy but relative low sensitivity as a predictor of reperfusion. Thus, in occurrence of AIVR, recanalization of infarction-related coronary artery is very probable, but in absence of AIVR, reperfusion is still not excluded. The following arrhythmias are regarded also as markers of reperfusion: frequent premature ventricular complexes (> twofold increase in frequency within 90 minutes after the start of thrombolysis), a significant increase of episodes in nonsustained ventricular tachycardia, sinus bradycardia and probably also high-degree atrioventricular blocks.
  45. samuel

    samuel New Member

    Tissues Derived from Neural Crest :-
    M- melanocytes
    O- odontoblasts
    T- tracheal cart.
    E- enterochromatin
    L- laryngeal cart.
    P- parafollicular
    A- all ganglia
    A- adrenal meduall
    S- schwann
    S- spiral membrane
  46. samuel

    samuel New Member

    Heart failure is a condition in which the ability of the
    heart to propel blood through the circulation has been
    compromised. Heart failure can be acquired in a number
    of ways, including loss of muscle mass through
    myocardial infarction, elevated workload, or myopathic
    processes, including infection. In each of these cases, the
    end result is the same: decreased stroke volume for any
    given filling pressure—decreased contractility.
    The term congestive heart failure actually describes a
    symptom complex that encompasses all conditions of
    venous congestion of cardiovascular origin regardless of
    whether the myocardium is depressed or not. Congestive
    heart failure can occur with valve dysfunctions and even
    the high cardiac output states of beriberi and overtransfusion.
    The current discussion, however, is limited
    to only those conditions in which the contractility of the
    heart is depressed.
  47. samuel

    samuel New Member

    In the past the most common test for diagnosing infectious mononucleosis was the heterophile antibody test which involves testing heterophile antibodies by agglutination of guinea pig, sheep and horse red blood cells. As with the aforementioned criteria, this test is specific but not particularly sensitive (with a false-negative rate of as high as 25% in the first week, 5-10% in the second and 5% in the third).[10] 90% of patients have heterophile antibodies by week 3, disappearing in under a year. The antibodies involved in the test do not interact with the Epstein-Barr virus or any of its antigens.[9] More recently, tests that are more sensitive have been developed such as the Immunoglobulin G (IgG) and Immunoglobulin M (IgM) tests. IgG, when positive, reflects a past infection, whereas IgM reflects a current infection. When negative, these tests are more accurate in ruling out infectious mononucleosis. However, when positive, they feature similar sensitivities to the heterophile antibody test. Therefore, these tests are useful for diagnosing infectious mononucleosis in people with highly suggestive symptoms and a negative heterophile antibody test. Another test searches for the Epstein-Barr nuclear antigen, while it is not normally recognizable until several weeks into the disease, and is useful for distinguishing between a recent-onset of infectious mononucleosis and symptoms caused by a previous infection. Elevated hepatic transaminase levels is highly suggestive of infectious mononucleosis, occurring in up to 50% of patients
  48. samuel

    samuel New Member

    Azodicarbonamide - A Novel Drug in the Treatment of HIV is a Zin Finger Inhibitor !

    Which structures come from the first pharyngeal arch?

    Maxillary prominence: upper lip, maxilla, and palate

    Mandibular prominence: lower lip and mandible

    Where is Meckels cartilage located and what does it give rise to?

    1st pharyngeal arch :- incus and malleus

    Which arch is Reicherts cartilage found in and what does it give rise to?

    2nd pharyngeal or hyoid arch; styloid process, part fo the hyoid bone and the stapes.

    What two contributions give rise to the hypophysis, or pituitary?

    Hypophysial diverticulum or Rathke’s pouch and the infundibulum of the forebrain !

    What drug is used for relaxation and detoxification for withdrawal states :
    Diazepam

    Antidote for Zolpidem overdose :
    Flumazenil

    What do all restrictive lung disease pts all die from?

    Right sided heart failure called cor pulmonale (rt. sided heart failure do to pulmonary HTN)

    What is the # 1 cause of death in the 1st 60 days of life?

    Hyaline membrane disease

    What type of ventilator is used for hyaline membrane disease HMD?

    Jet ventilator

    It reduces free radicals caused by more O2 the patient needs due to decreased diffusion from the disease.
  49. samuel

    samuel New Member

    Pearson's syndrome

    PEAR

    P-pancytopenia
    E-exocrine pancreatic insufficiency
    A-Anemia sideroblastic
    R-Renal tubular acidosis
  50. samuel

    samuel New Member

    Wiskott aldrich syndrome-

    TIER

    T- Thrombocytopenia
    I- Immunodeficiency
    E- Eczema
    R- X linked recessive

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