Topics to be well studied for NOVEMBER 2014 AIIMS

Discussion in 'AIIMS Nov 2013' started by samuel, Oct 2, 2014.

  1. samuel

    samuel New Member

    hypothalamus and thirst mechanism:

    Another appetitive mechanism under hypothalamic control is thirst. Drinking is regulated by plasma osmolality and extracellular fluid (ECF) volume in much the same fashion as vasopressin secretion. Water intake is increased by increased effective osmotic pressure of the plasma by decreases in ECF volume, and by psychologic and other factors. Osmolality acts via osmoreceptors, receptors that sense the osmolality of the body fluids. These osmoreceptors are located in the anterior hypothalamus.

    Decreases in ECF volume also stimulate thirst by a pathway independent of that mediating thirst in response to increased plasma osmolality . Thus, hemorrhage causes increased drinking even if there is no change in the osmolality of the plasma. The effect of ECF volume depletion on thirst is mediated in part via the renin–angiotensin system. Renin secretion is increased by hypovolemia and results in an increase in circulating angiotensin II. The angiotensin II acts on the subfornical organ, a specialized receptor area in the diencephalon, to stimulate the neural areas concerned with thirst. Some evidence suggests that it acts on the organum vasculosum of the lamina terminalis (OVLT) as well. These areas are highly permeable and are two of the circumventricular organs located outside the blood–brain barrier. However, drugs that block the action of angiotensin II do not completely block the thirst response to hypovolemia, and it appears that the baroreceptors in the heart and blood vessels are also involved.
  2. samuel

    samuel New Member

    digestion of FIBRES:
    herbivores/ruminants digest fibres mainly cellulose to small chain fatty acids
    acetate
    propionate
    butyrate

    which gets absorbed to portal vein
  3. samuel

    samuel New Member

    Various biochemical test asked in exams :::

    Murexide test - uric acid

    Rothera test - acetone bodies

    Ehrlich aldehyde test - urobilinogen

    Fourchet test - bile

    Obemeyer test - indican in urine

    Bi urate test - protein

    Half saturation test - globulin

    Addis urine sediment count - test for severity of renal disease

    Sehlesinger test - urobilin

    Modified koopanyi test - barbiturates in urine

    Winslow test - serum or urinary amylase

    Gerhardt test - significant ketosis

    Sulkowitch test -for urinary calcium

    Guiace test - haematuria

    Rflp - sickle cell anemia and b thalassemia trait

    Figlu - folic acid

    Northern blot - rna

    Southern blot - dna

    : Bollinger bodies fowl pox
    Brassy body- dark shrunken blood corpus in malaria
    Chromatid bodies- entamoeba histolytica precyst
    Citron bodies- clostridium septicum
    Coccoid x bodies- psittacosis
    Donovan bodies- LGV
    Henderson Paterson bodies- molluscum contagiosum
    Levinthal Coles lille bodies- psittacosis
    Mooser bodies- endemic typhus
    Paschen bodies- vaccinia
    Ross bodies- syphilis
    Sclerotic bodies- chromoblastomycosis
  4. samuel

    samuel New Member

    CONGENITAL MYOPATHY:---non progressive or slowly progressive
    hypotonia and jt contracture(arthrogryposis)

    1.central core disease---AD---ryanodine receptor mut---amorphous central core with absence of oxidative enzymes
    2.nemaline myopathy----crystalline rods composed of tropomyosin
    3.centronuclear(myotubular) myopathy----nuclei in central part of myofibril
  5. samuel

    samuel New Member

    Cause of status epilepticus in children???
    A)hypernatremia
    B)hyponatremia
    C)hyperkalemia
    D)hypokalemia
  6. samuel

    samuel New Member

    Causes of status epilepticus in children r:
    Idiopathic
    Meningitis,encephalitis
    Drug intoxication
    Hypoglycemia
    Hyponatremia
    Pyridoxin deficiency
    Head trauma
    Con neurological abnormalities
  7. samuel

    samuel New Member

    Tumors asso with NF-1
    JMML
    rhabdomyosarcoma
    optic glioma
    meningioma,ependymoma,astrocytoma
    pheochromocytoma
    neuroectodermal malignancies
  8. samuel

    samuel New Member

    Normal CSF constituents:
    Proteins:20-40mg/dl
    Sugar:40-70mg/dl
    Cells/mm3:lymphocytes0-5
    Volume:150ml
    Rate of formation:550ml/dat
    PH:7.33
    Pressure:70-180mm of water or 10 mm of Hg
    Ion with max csf/plasma ratio:Mg2+
    Min csf/plasma ratio:cholesterol nd protein
    Equal csf/plasma ratio:asmolality
    Csf gluose/plasma glucose:0.6-0.8
  9. samuel

    samuel New Member

    Csf examination of a pt shows high protein markedly low sugar low chloride nd increased neutrophils.the diagnosis is?
    A)tuberculous meningitis
    B) meningococcal meningitis
    C)viral meningitis
    D) fungal meningitis
  10. samuel

    samuel New Member

    Histrionic personality disorder---attempts suicide to gain attention and sympathy

    Borderline personality disorder----Suicide on impulse not to gain attention!!
  11. samuel

    samuel New Member

    MC manifestation of TB in eye ----- CHRONIC GRANuLOMATOUS UVEITIS
    MC etiology for phlyctenular conjunctivitis ----TB
  12. samuel

    samuel New Member

    CENTRAL SEROUS RETINOPATHY
    spontaneous resolution in 4 to 12 weeks in 80 to 90% cases

    20-40 yrs male
    type A personality
    emotional stress
    HT/SLE/systemic steroids

    diag: flourescin angiography--->
    smoke stack/mushroom/umbrella configuration/ink blot/enlarging dot pattern
  13. samuel

    samuel New Member

    ACQUIRED HEMOPHILIA:

    Acquired hemophilia is a rare but potentially life-threatening bleeding disorder caused by the development of autoantibodies directed against plasma coagulation factors, most frequently factor VIII

    The following conditions may be associated with acquired hemophilia A

    Idiopathic
    Pregnancy
    Autoimmune disorders
    Inflammatory bowel disease, ulcerative colitis
    Dermatologic disorders (eg, psoriasis, pemphigus)
    Respiratory diseases (eg, asthma, chronic obstructive pulmonary disease)
    Allergic drug reactions
    Diabetes
    Acute hepatitis B infection
    Acute hepatitis C infection
    Malignancies-solid tumors (prostate, lung, colon, pancreas, stomach, bile duct, head and neck, cervix, breast, melanoma, kidney)
    Hematologic malignancies
  14. samuel

    samuel New Member

    carl exner ---- granulosa cell tumor
    schiller duval body----endodermal sinus tumor
    reinkes crystal----hilus cell tumor
    signet ring cell----krukenberg
    meigs---fibroma
    peudo meigs-----brenner
  15. samuel

    samuel New Member

    The most common genetic abnormality found in germ cell neoplasms, i(12p) {isochromosome}

    germ cell tumor that doesnt arise as ITGCN----spermatocytic variant of seminoma
  16. samuel

    samuel New Member

    Embryonal carcinoma composed primarily of embryoid bodies
    Embryoid body has amniotic cavity-like structure and is continuous with intestinal duct, and rarely has squamous cell nests, while "yolk sac" is continuous with hepatic tissue

    polyembryoma---asso with Klinefelter syndrome

    -rare & very aggressive form of germ cell tumor usually found in the ovaries
    -features of both yolk sac tumour and undifferentiated teratoma/embryonal carcinoma, with a characteristic finding of embryoid bodies lying in a loose mesenchymal stroma.
  17. samuel

    samuel New Member

    AFP----seen only in non seminomatous tumors
    HCG and LDH---seen in both seminomatous amd non seminomatous tumors

    testicular irradiation is not a risk factor for testicular tumor!!
  18. samuel

    samuel New Member

    TM joint least vascular is

    a.articular cartilage
    b.ant portion of articular disc
    c.middle portion of articular disc
    d.post portion of articular disc
  19. samuel

    samuel New Member

    eFAST = Extended FAST = FAST (Focused Assessment with Sonography for Trauma ) + U/S of bilateral hemithoraces for finding pneumothorax and hemothorax.

    eFAST signs suggestive of Pneumothorax on M-mode:
    ? 'Stratosphere' sign (a.k.a.Barcode sign)
    ? 'Absence of pleural sliding' sign
    ? 'Lung point sign'
    ? Absence of comet-tail artefacts and B-lines
    ? Presence of A-lines

    NOTE: Seashore (sliding) sign- suggests normal lung
  20. samuel

    samuel New Member

    OPSI(schwartz extract)
    Reason for splenectomy is the single most influential determinant of OPSI risk. Case series demonstrate that those who undergo splenectomy for hematologic disease (malignancy, myelodysplasia, or hemoglobinopathy) are far more susceptible to OPSI than patients who undergo splenectomy for trauma or iatrogenic reasons

    Life-threatening infection in the asplenic patient is attributable to three factors: loss of splenic macrophages
    diminished tuftsin production
    loss of the spleen's reticuloendothelial screening function

    The most common causal organism, accounting for as many as 50 to 90% of all OPSI cases, remains pneumococcus. Meningococcus, H. influenzae type B, and group A streptococci follow in order of frequency

    vaccines:
    1.pneumococcal vaccine
    2.HiB
    3.meningococcal vaccine
  21. samuel

    samuel New Member

    ABSORPTION of nutrients
    max absorption of water -----jejunum
    vitamins except B12 ------upper small intestine
    sodium---mainly in upper and lower SI
    sugars and amino acids----mid SI
    bile salts vit b12 in ileum
  22. samuel

    samuel New Member

    RENAL CIRCULATION

    1.2 - 1.3L/min(25% CO)
    Effective RPF- 625mL/min
    {actual renal plasma flow-700mL/min}
    net filtration pressure --15mmhg
    filtration fraction=GFR/RPF=0.16 to 0.20
  23. samuel

    samuel New Member

    eFAST = Extended FAST = FAST (Focused Assessment with Sonography for Trauma ) + U/S of bilateral hemithoraces for finding pneumothorax and hemothorax.

    eFAST signs suggestive of Pneumothorax on M-mode:
    ? 'Stratosphere' sign (a.k.a.Barcode sign)
    ? 'Absence of pleural sliding' sign
    ? 'Lung point sign'
    ? Absence of comet-tail artefacts and B-lines
    ? Presence of A-lines

    NOTE: Seashore (sliding) sign- suggests normal lung
  24. samuel

    samuel New Member

    OPSI(schwartz extract)
    Reason for splenectomy is the single most influential determinant of OPSI risk. Case series demonstrate that those who undergo splenectomy for hematologic disease (malignancy, myelodysplasia, or hemoglobinopathy) are far more susceptible to OPSI than patients who undergo splenectomy for trauma or iatrogenic reasons

    Life-threatening infection in the asplenic patient is attributable to three factors: loss of splenic macrophages
    diminished tuftsin production
    loss of the spleen's reticuloendothelial screening function

    The most common causal organism, accounting for as many as 50 to 90% of all OPSI cases, remains pneumococcus. Meningococcus, H. influenzae type B, and group A streptococci follow in order of frequency

    vaccines:
    1.pneumococcal vaccine
    2.HiB
    3.meningococcal vaccine
  25. samuel

    samuel New Member

    ABSORPTION of nutrients
    max absorption of water -----jejunum
    vitamins except B12 ------upper small intestine
    sodium---mainly in upper and lower SI
    sugars and amino acids----mid SI
    bile salts vit b12 in ileum
  26. samuel

    samuel New Member

    TITBITS-4

    Smooth muscle contraction:
    1.AP releases ca which binds with CALMODULIN
    2.It activates calmodulin dependant myosin light chain kinase
    3.it phosphorylates myosin light chain kinase
    PHOSPHORYLATION OF MYOSIN IS ESSENTIAL FOR CONTRACTION
  27. samuel

    samuel New Member

    HURTHLE CELL CARCINOMA Vs FOLLICULAR CARCINOMA

    more often multifocal and B/L(30%)
    usually do not take up RAI
    more likely to metastasize(25%)
    higher mortality rate(20% at 10 yrs)
  28. samuel

    samuel New Member

    intersphincteric fistula---mc type fistula in ano
    coagulase negative Staph.aureus---MC cause for early onset (0-12 mo) prosthetic valve endocarditis
    Viridans Strep-----late onset(>12 mo) prosthetic valve endocarditis
    Staph aureus----native valve endocarditis and in IV drug users---acutr and vigorous infection
  29. samuel

    samuel New Member

    Vit K carboxylates

    1. factors 2 7 9 10
    2.protein C, S, Z
    3.bone proteins ---osteocalcin & G1a protein
    4.nerves-GAS6
  30. samuel

    samuel New Member

    INTERNAL DIVERSION OF URINE
    * reabsorption of chloride and urea and progressive dimunition of tubular func due to pyelonephritis
    *hyperchloremic acidosis with pot. depletion
    *mild acidosis=====> osteomalacia
    *vit B12 deficiency
    *stricture
    *reflux of urine
  31. samuel

    samuel New Member

    COLITIS ASSO CARCINOMA COLON
    --from flat dysplasia
    --12% multiple synchronous CA
    --mean age 30yrs
    --uniform throughout colon
    --mucinous or anaplastic CA common

    SPORADIC CA
    --arise from adenomatous polyp
    --3 to 5% synchrpus and mltiple
    --mean age 60 yrs
    --left side predominant
  32. samuel

    samuel New Member

    hyperplastic TB
    --abscesses and fistula rare (unlije crohns)
    --abd pain and intermittent diarrhoea common
    --caecum pulled up
    --ileocecal angle>90 (usually 150)
    treatment: ATT+ ileocaecal resction(if obstructed)
  33. samuel

    samuel New Member

    ULCERATIVE TB
    --transverse ulcer
    --diarrhea and weight loss
    --barium meal---->absence of filling due to narrowing and hypermotility of segments
    treatment: ATT
    surgey rarely requiredonly if perforated
  34. samuel

    samuel New Member

    LYMPHOMA OF THYROID

    Rapidly growing(similar to anaplastic carcinoma)
    rare(1%)
    NHL type
    mostly in hashimotos thyroiditis(rarely in general lymphomatous condition)
    symptoms are:acute resp distress,hoarseness,dysphagia,fever
  35. samuel

    samuel New Member

    sexual asphyxia associated with
    sadism
    masochism
    fetishchism
    voyeurism

    Masochism

    Reference: Textbook of Forensic Medicine and Toxicology by Krishnan Vij 5th edition Pg 425
  36. samuel

    samuel New Member

    arrhythmias in binge alcohol ingestion:in order of freq

    1.AF---holiday heart synd---MC
    2.Atrial flutter
    3.VPC

    chronic alcohol ingestion---DCMP
  37. samuel

    samuel New Member

    CONTRASTING DIFFERENCES IN 17th AND 18th ed HARRISON:

    17th edition:
    Gadolinium-enhanced three-dimensional
    magnetic resonance angiography (MRA) has replaced previous modalities
    as the most sensitive (>90%) and specific (95%) test for the
    diagnosis of RAS.

    18th edition:
    Magnetic resonance
    angiography (MRA) is now less often used, as gadolinium
    contrast has been associated with nephrogenic systemic fibrosis.
    Contrast-enhanced CT with vascular reconstruction provides excellent
    vascular images and functional assessment, but carries a small
    risk of contrast toxicity.
  38. samuel

    samuel New Member

    PEP-HIV

    routine prophylaxis-----2NRTI for 4 weeks
    High risk prophylaxis---2NRTI+1PI 4 weeks


    eFAST = Extended FAST = FAST (Focused Assessment with Sonography for Trauma ) + U/S of bilateral hemithoraces for finding pneumothorax and hemothorax.

    eFAST signs suggestive of Pneumothorax on M-mode:
    ? 'Stratosphere' sign (a.k.a.Barcode sign)
    ? 'Absence of pleural sliding' sign
    ? 'Lung point sign'
    ? Absence of comet-tail artefacts and B-lines
    ? Presence of A-lines

    NOTE: Seashore (sliding) sign- suggests normal lung
  39. samuel

    samuel New Member

    OPSI(schwartz extract)
    Reason for splenectomy is the single most influential determinant of OPSI risk. Case series demonstrate that those who undergo splenectomy for hematologic disease (malignancy, myelodysplasia, or hemoglobinopathy) are far more susceptible to OPSI than patients who undergo splenectomy for trauma or iatrogenic reasons

    Life-threatening infection in the asplenic patient is attributable to three factors: loss of splenic macrophages
    diminished tuftsin production
    loss of the spleen's reticuloendothelial screening function

    The most common causal organism, accounting for as many as 50 to 90% of all OPSI cases, remains pneumococcus. Meningococcus, H. influenzae type B, and group A streptococci follow in order of frequency

    vaccines:
    1.pneumococcal vaccine
    2.HiB
    3.meningococcal vaccine
  40. samuel

    samuel New Member

    DM----GB stones

    1.increased cholesterol level in bile
    2.reduced bile acid pool
    3.decreased GB motility
    radio opaque gall stones----10%

    SABISTON----Biliary sludge refers to a mixture of cholesterol crystals, calcium bilirubinate granules, and a mucin gel matrix. It is most commonly found in prolonged fasting states or with the use of parental nutrition. The finding of macromolecular complexes of mucin and bilirubin suggests that sludge may serve as the nidus for gallstone pathogenesis.

    Gallstones represent an inability to maintain certain biliary solutes, primarily cholesterol and calcium salts, in a solubilized state
  41. samuel

    samuel New Member

    black pigment stones are found in sterile gallbladder bile, and brown stones are found in infected intrahepatic or extrahepatic ducts

    Stones composed largely of cholesterol are radiolucent; sufficient calcium carbonate is found in 10% to 20% of cholesterol stones to render them radiopaque.

    infection of the biliary tract with Escherichia coli, Ascaris lumbricoides, or the liver fluke O. sinensis, increases the likelihood of pigment stone formation
  42. samuel

    samuel New Member

    MDR3 gene mutation----defective phospholipids(lecithin) secretion into bile

    CYP7A1 gene mut----7alpha hydroxylase ---decreased bile acids

    both these mutations predispose to GB stones
  43. samuel

    samuel New Member

    Bismuth Strasberg classification of biliary injuries:


    TypeA - Bile leak from a minor duct still
    in continuity with CBD like cystic duct,
    liver bed

    Type B - Occlusion of a part of biliary
    tree like injury to aberrant right
    hepatic duct.

    Type C - Injury from bile duct not in
    communication with CBD

    Type D - Lateral injury to extrahepatic
    ducts; CBD, CHD, right or left hepatic
    ducts

    Type E - Circumferential injury to major
    bile ducts
  44. samuel

    samuel New Member

    Gauchers disease- Types

    3 types
    neural inv- types 2 and 3

    m/c presentation-splenomegaly

    syst inv- haemat-anemia,TCP
    -skeletal
    -neuro( type 2 n 3)

    Type 1- jews
    pulmonary fibrosis
    pulm hypertension

    Type 2- GTCS
    hypertonia
    mental retardation

    congenital icthyosis
    death<2yrs

    Type 3a- myoclonus

    3b-MOST severe type
    3c- cardiac inv (c='cardiac')

    3b and c- supranuclear palsy
  45. samuel

    samuel New Member

    fluorosis (aiims nov 07)

    fluorine-most abundant element in nature
    inadequate--->dental caries
    excess---> endemic fluorosis

    recommended fl in drinking water- .5-.8mg/L


    Endemic fluorosis (3-5mg/L)
    1) dental - inv enamel of teeth
    earliest sign- mottling
    upper incisors
    permanent teeth

    2)skeletal-on chronic ingestion
    osteosclerosis n calcification of ligament
    first sign..restriction of spine
    movement(lumbar inv frst)
    mental faculties-remain unimpaired

    3)genu valgum-jowar diet

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