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Familial adenomatous polyposis is characterized by all except

Familial adenomatous polyposis (FAP) Is a rare, inherited condition caused by a defect in the adenomatous polyposis coli (APC) gene - located in 5q 21 chromosome. FAP is autosomal dominant- >50% chance of inheritance in family members Has > 100 adenomatous polyps 100% RISK of malignancy Polyp formation - by 15 yrs. 100% develop malignancy - by 40 yrs. TOC: Total proctocolectomy + ileal pouch-anal anastomosis (TPC + IPAA) M/C/C of death after TPC = Peri-ampullary Ca (polyps in duodenum - periampullary region) Two variants of FAP Gardner's syndrome Osteoma (mandible) Congenital hyperophy of the retinal pigmented epithelium (CHRPE) lesions Sebaceous cysts Benign lymphoid polyposis of ileum Desmoid tumors Supernumerary teeth Turcot's syndrome: Brain tumors Medulloblastoma - m/c associated with FAP Glioblastoma multiforme - m/c associated with HNPCC

Surgery

JIPMER 2017

Autosomal recessive transmission

In Steiner's analysis, SNA demonstrates:

Relating the Maxilla to the Skull: The angle SNA is formed by joining the lines S-N and N-A . The mean reading for this angle is 82°. Steiners analysis demonstrates the position of maxilla and mandible in relation to the cranial base.  If the angular reading is more than 82°, it would indicate a relative forward positioning or protrusion of the maxilla. Conversely, should the reading be less than 82°, it would indicate a relative backward or recessive location of the maxilla.

Dental

Position of maxilla in relation to cranial base

. Sulphasalazine is NOT used for the treatment of-

Sulhasalazine is not used for treatment of sarcoidosis As a treatment for sarcoidosis, these drugs are most likely to be effective in people who have skin symptoms or a high level of calcium in their blood. Hydroxychloroquine (Plaquenil) and chloroquine (Aralen) are antimalarial drugs that are used to treat sarcoidosis Ref Davidson 23rd edtion pg 981

Medicine

Miscellaneous

Sarcoidosis

Post traumatic stress disorder is differentiated from other anxiety disorders by which of the following symptoms?

This question is not about the diagnostic features of PTSD. This is about the differential diagnosis. PTSD is an anxiety disorder and it shares symptoms with other disorders. Impoant features in distinguishing the condition are given below. Differential diagnosis: Point 1: Etiologically significant trauma should be present for a diagnosis of PTSD. E.g. A traumatic event in the past. Point 2: 'Intentionality' or 'aboutness' is an impoant factor for PTSD. Nightmares, flashbacks or reliving experiences should be related to the past event. PTSD concerns memory - Intrusion of past stressors into the present. Point 3: Avoid a 'stimulus' or 'activity' that provokes the memory of the past event. In the above question, only reliving experience is mentioned as connected to the past experiences. Hence, that is the answer for this question. All other symptoms can be see in other anxiety disorders. Ref: Kaplan & Sadock's, Comprehensive Textbook of Psychiatry, 9th Edition, Page 2659

Psychiatry

Re-living of past adverse event

Which muscle is responsible for unlocking of knee?

Ans. A PopliteusRef: BDC, vol II pg. 155* Quadriceps femoris is the main and only extensor of knee.* It produces locking action as a result of medial rotation of the femur during the last stage of extension.* To reverse this lock popliteus muscle comes into action and does so by the lateral rotation of femurRemember: Lock is: Quadriceps femoris muscle and, Key is popliteus muscle.Muscles producing movements at the knee jointMovementPrincipal musclesA. Flexion * Biceps femoris* Semitendinosus* SemimembranosusB. ExtensionQuadriceps femorisC. Medial rotation of flexed leg* Popliteus* Semimembranosus* SemitendinosusD. Lateral rotation of flexed leg * Biceps femorisExtra Mile* Quadriceps femoris incudes: Rectus femoris, Vastus Lateralis, Vastis Medialis, Vastus Intermedius.* Rectus femoris is also known as "kicking muscle"

Anatomy

Lower Extremity

Popliteus

Polymorphic ventricular tachycardia can occur when terfenadine(antihistaminic):

Torsades de pointes (polymorphic ventricular tachycardia) occurs when terfenadine is taken in higher doses or when hepatic metabolism is impaired by disease or by drugs which inhibit the cytochrome P450 responsible for metabolism of terfenadine. Drugs include erythromycin, clarithromycin, ketoconazole and itraconazole. Azithromycin and fluconazole that are excreted unchanged in the urine have not been associated with impaired metabolism of terfenadine. Terfenadine blocks the delayed rectifier potassium channels and prolongs cardiac repolarization and the QT interval.

Pharmacology

Is given in higher doses

Which component transfers four protons:

A i.e. NADH-Q Oxidoreductase; C i.e. Cytochrome C-Q oxidoreductase

Biochemistry

NADH-Q Oxidoreductase

All of the following are true about Asthma, Except:

Answer is D (Small airways are not involved): Asthma involves both large and small airways but alveoli are not involved Charcot Leyden crystals may be seen in sputum: Pathology by woolf lsr (1998)/434 Sputum from Asthmatics show ceain characteristic features, including charcot leydencrystas The microscopically identifiable features described in sputum are three 'C's Charcot Leyden crystals - Derived from granules of eosnophils andfbund only in Asthma Curshmann spirals - Curiously twisted casts of airways : Whorls of shed epethelium Creola bodies - Clumps of cells or isolated metaplastic cells Reversible Airflow obstruction is a charachteristic feature (Davidsons 18th/55, 326) Reversible Bronchoconstriction is the hallmark of Asthma The charachteristic feature of Asthma is Intermittent and Reversible airflow obstruction. Narrowing of airways is usually reversible, but in some patients with chronic asthma there may be an element of irreversible airflow obstruction Asthma involves both large and small airways Asthma involves Large and small airways hut not alveoli - 'Allergic Diseases: Diagnosis Treatment' 3rd/ 120 The large and small airways are both involved in Asthma -'Childhood Asthma: Diagnosis, Treatment & Management' r/15 Intermittent Asthma responds better to bronchodilator therapy than persistant Asthma Bronchodilators are effective drugs for the treatment of acute exacerbations or intermittent episodes of Asthma but they are not sufficient to control asthma in patients with persistant symptoms (persistant asthma) Bronchodilators are not sufficient to control Asthma in patients with persistant symptoms'

Medicine

Small airways are not involved

In emergency, which aery can be safely ligated ?

Ans. is 'a' i.e. Internal iliac

Surgery

Internal iliac

Late metabolic acidosis is seen in-

Ans. is 'b' i.e., Preterm baby getting cow milk Late metabolic acidosis (LMA) o Late metabolic acidosis is a special type of acidosis in apparently healthy premature infant. o This hyperchloremic acidosis appeares during second and third week of life, and resolves spontaneously within a couple of weeks. Definition "An acidosis occuring after second day of life, in which base excess values are lower than -5meq/L on two consecutive estimations done at least 24 hours apa". Etiology o Prematurity is the most impoant single predisposing factor in the development of LMA. o The incidence varies considerably depending upon the gestational maturity and protein content of feeding formula. o In preterm neonates fed on a modified cow's milk the risk of developing LMA is very high.

Pediatrics

Preterm baby getting cow milk

Chemotherapeutic drugs can cause?

Ans. is 'c' i.e., Both necrosis and apoptosis o Injurious stimuli, e.g., radiation, cytotoxic anticancer durgs, heat and hypoxia, can induce apoptosis if the insult is mild, but large doses of same stimuli result in necrotic cell death.

Pathology

Both necrosis and apoptosis

Which of the following nerve is involved in Frey's syndrome?

Syndrome (Gustatory Sweating) aka auriculotemporal syndrome: Frey's syndrome arises as a complication of parotid surgery usually manifesting several months after the operation. lt is characterised by sweating and flushing of the preauricular skin during mastication causing nuisance to the person or social embarrassment. It is the result of damage to auriculotemporal nerve and aberrant innervation of sweat glands by parasympathetic secretomotor fibres which were destined for the parotid. Now instead of causing salivary secretion from the parotid, they cause secretion from the sweat glands. The condition can be treated by tympanic neurectomy which intercepts these parasympathetic fibres at the level of middle ear. Some people like to place a sheet of fascia lata between the skin and the underlying fat to prevent secretomotor fibres reaching the sweat glands. Generally, no treatment other than reassurance is required in most of these patients. Also known as Crocodile tears (gustatory lacrimation): There is unilateral lacrimation with mastication. This is due to faulty regeneration of parasympathetic fibres which now supply lacrimal gland instead of the salivary glands. It can be treated by section of greater superficial petrosal nerve or tympanic neurectomy.

Surgery

Ariculo temporal

Opening of mouth is caused by:

Ans. A Lateral pterygoidRef: Grays, 41st ed. pg. 507-508* The primary function of the lateral pterygoid muscle is to pull the head of the condyle out of the mandibular fossa along the articular eminence to protrude the mandible.* The effort of the lateral pterygoid muscles acts in helping lower the mandible and open the jaw whereas unilteral action of a lateral pterygoid produces contralateral excursion (a form of mastication), usually performed in concert with the medial pterygoids.* Unlike the other three muscles of mastication, the lateral pterygoid is the only muscle of mastication that assists in depressing the mandible i.e. opening the jaw. At the beginning of this action it is assisted by the digastric, mylohyoid and geniohyoid muscles.

Anatomy

Neuroanatomy

Lateral pterygoid

All are true about streptococcus Except

Mucoid colonies are due to the production of the capsule of hyaluronic acid not due to M-protein. Growth characteristic of Strep. pyogenes: On blood agar, virulent stains form matt or mucoid colonies while avirulent from glossy colonies. M, T, R are proteins found on the outer pa of the cell wall and forms the basis of Griffith classification. M protein - acts as virulence factor and antibody against it is protective. T and R protein - No relation to virulence Ref : 208

Microbiology

All India exam

M-protein is responsible for production of mucoid colonies

What is monitored in a patient of Pre eclamsia ?

Ans. is 'd' i.e. All of the abov Investigations in a case of Pre eclampsia* URINE for proteins/albumin. 24 hours urine protein* CBC: There is hemoconcentration so HB values are false elevated. Low platlets indicate HELLP syndrome* Sr uric acid: It is a biochemical marker of preeclampsia. Raised levels (>4.5 mg/dl) indicate renal involvement and also correlate with severity of preeclampsia, volume contraction and fetal jeopardy.* LFT: SGOT, SGPT, Bilirubin* RFT: Sr creatinine* Coagulation profile may be required in severe cases:i) BTii) CTiii) PT, APTTiv) Fibrinogen levelsv) FDP

Gynaecology & Obstetrics

Miscellaneous (Gynae)

All of the above

In a young female of reproductive age an absolute contraindication for prescribing oral contraceptive pills is:

Ans-D i.e., Impaired liver function Repeat Q No 173 (Nov. 2004)Absolute contraindications include:A personal h/O thromboembolic venous, arterial or cardiac disease or severe or multiple risk factor for these. Transient cerebral ischaemic attacks without a headache.Infective hepatitis, until 3 months after liver function tests has become normal, and another liver disease including disturbances of hepatic excretion e.g. cholestatic jaundice, Dubin Johnson and Rotor syndromes.A migraine, if there is a typical aura, focal features or if it is severe and lasts > 72 hours despite t/t or is treated with an ergot derivative.Carcinoma of the breast or the genital tractOther conditions including SLE, porphyria, following the evacuation of a hydatidiform mole (until urine and plasma gonadotropin concentrations are normal), undiagnosed vaginal bleeding.Relative contraindications of OCP'sThe family history of venous thromboembolism, arterial disease or a known prethrombotic condition e.g. Factor V Leiden (pretreatment coagulation investigation is advised).Diabetes mellitus which may be precipitated or become more difficult to control (avoid if there are diabetic complications).Hypertension (avoid if B.P. exceeds 160/100)Smoking > 40 Cigarettes per day (15 Cigarettes/day enhances the risk of circulatory disease and constitutes an absolute contraindication for women over 35 years.Long-term immobility (e.g. due to Leg plaster, confinement to bed.Breastfeeding (until weaning or for 6 months after birth).Obesity

Unknown

Impaired liver function

A tracheostomised patient, with poex tracheostomy tube, in the ward, developed sudden complete blockage of the tube. Which of the following is best next step in the management?

Immediate removal of the tracheostomy tube is best next step in the management in the above case -Suction of tube with sodium bicarbonate is done to avoid the blockage. -Suction of the tube with saline can't be used when there's a complete obstruction. - Jet ventilation is done below the level of larynx, when we're operating on the larynx.

ENT

Ca Larynx

Immediate removal of the tracheostomy tube

All of the following are well recognised predisposing factors for adult respiratory distress syndrome, except:

Status asthmaticus is an example of type 2 respiratory failure while ARDS is type 1 respiratory failure. All other choices lead to cytokines release and damage the alveoli leading to ARDS.

Medicine

Respiratory Failure

Status asthmaticus

Gottron papules is seen in ?

Ans. is 'a' i.e., Dermatomyositis

Skin

Dermatomyositis

Which among the following is the BEST irrigating fluid during ECCE?

BSS plus a balanced salt solution enhanced with bicarbonate, dextrose and glutathione. It is specially used for surgeries requiring prolonged irrigation such as phacoemulsification, pars plana vitrectomy and automated extracapsular cataract extraction. Balanced sterile solution is a sterile physiologically balanced irrigating fluid. It is the most frequently used solution during ophthalmic surgery to keep the cornea from drying out. BSS plus solution causes less corneal edema and endothelial cell damage following vitrectomy. The glutathione protects against depletion of endothelial ATP levels and maintains the integrity of the cell membrane by counteracting endogenous and exogenous oxidative agents. Ref: Surgical Technology for the Surgical Technologist: A Positive Care Approach By Association of Surgical Technologists page 223. Ocular Toxicity of Intraoperatively Used Drugs and Solutions By Rudolph Marie Matheus Antonius Nuijts page 16. Clinical Ophthalmology: Contemporary Perspectives, 9/e By Gupta page 43.

Ophthalmology

Balanced salt solution + glutathione

Acute Gouty ahritis is seen early in treatment following -

All of the above Rapid lowering of urate level in chronic gout, by any means, may precipitate an attack of acute gout, probably by causing the dissolution of tophi. o It is therefore usual to give prophylactic suppressive treatment with indomethacine, colchicine or steroid cover during first 2 months of allopurinol or uricosurics. o Amongs the given options, allopurinol, probenecid and Rasburicase are the drugs that lower serum urate level. So, all three can precipitate acute gout. However, among these three, allopurinol is used most commonly therefore is the best answer here.

Pharmacology

All of the above

Chandler's index is associated with: September 2006

Ans. B: Hook worm Morbidity and moality from hookworm infection depend much on the worm load. Chandler worked out an index on the basis of an average number of hookworm eggs per gram of feces for the entire community, Chandler's index is still used in epidemiological studies of hookworm disease. By this index, worm loads in different population groups can be compared and also the degree of reduction of egg output after mass treatment.

Social & Preventive Medicine

Hook worm

Heparin is the commonly used anticoagulant in cardiac surgery. All of the following are true about heparin except-

Ans. is 'a' Weakest acid found in living organism Heparin is a direct acting anticoagulant Chemical nature and preparationHeparin is a sulfated mucopolysaccharide which occurs in the secretory granules of mast cells.It is the strongest organic acid in the body and in the solution it carries an electronegative charge.It is prepared commercially from a variety of animal tissues (generally porcine intestinal mucosa or bovine lung).Mechanism of Action of HeparinHeparin acts by activating antithrombin which is a naturally occuring inhibitor of activated coagulation factors of intrinsic and common pathway. 'Adverse effects of HeparinBleedingHeparin induced thrombocytopeniaOccurs more commonly in heparin derived from bovine lung.Heparin induced thrombocytopenia should be suspected in whom the platelet count falls by 50% or more after starting heparin and usually occurs 5 or more days after starting therapy.In patients with heparin induced thrombocytopenia following drugs should be substituted.Danaparoid sodiumHirudinArgatrobanOsteoporosis - (most frequently seen in pregnancy)Hypersensitivity reactions & skin necrosis

Pharmacology

Anticoagulants and Coagulants

Weakest acid found in living things

One of the following is the first enzyme to be released at the site of wound?

Ref - Krishan Vij textbook of forensic medicine and toxicology 5e pg - 202

Forensic Medicine

Mechanical injuries

ATPase

Sign of diabetic ketoacidosis is-

Physical findings of diabetic ketoacidosis are tachycardia, dehydration/hypotension, hypothermia, tachypnea/Kussmaul respirations/ respiratory distress, abdominal tenderness (may resemble acute pancreatitis or surgical abdomen), lethargy/obtundation/cerebral edema/possibly coma. Reference : page 2418 Harrison's Principles of Internal Medicine 19th edition

Medicine

Endocrinology

Dehydration

Which of the following drug is used in scabies as single oral dose agent: March 2011

Ans. C: Ivermectin Ivermectin is used as single oral dose of 200 microgram/ kg body weight It can be repeated after 2 weeks It is indicated in epidemics of scabies in orphanages and Norwegian scabies Scabies: Incubation period: 4 weeks Pathognomic lesion: Burrow, which lies in stratum corneum MC site in infants: Scalp, face Most severe form: Norwegian scabies Drug used orally: Ivermectin

Skin

Ivermectin

Most common complication after ERCP is

Complication perforation(1.3%)/hemorrhage (1.4%),pancreatitis (4.3%) and sepsis (3-30%). Bailey & Love 26th, 208

Surgery

G.I.T

Acute Pancreatitis

Progesterone production in the ovary is primarily by:

Physiology

Corpora lutea

Which of the following clinical situations is associated with an increase in predominantly conjugated ("direct") bilirubin?

Of the conditions listed, only pancreatic head tumors are associated with an increase in conjugated ("direct") bilirubin (obstructive jaundice). Increased levels of unconjugated ("direct") bilirubin result from hemolysis over liver defects that impair uptake or conjugation mechanism in liver cells (Gilbe's syndrome, Crigler- Najjar syndrome) positive. Unconjugated bilirubin may cross the immature blood brain Barrier of the newborn and cause Kernicterus. The physiologic jaundice of the newborn observed during the first week of bih is usually mild and due to relatively immature liver conjugation. Ref: Cothren C., Biffl W.L., Moore E.E. (2010). Chapter 7. Trauma. In F.C. Brunicardi, D.K. Andersen, T.R. Billiar, D.L. Dunn, J.G. Hunter, J.B. Matthews, R.E. Pollock (Eds), Schwaz's Principles of Surgery, 9e.

Surgery

Pancreatic head tumor

The use of kinematic face bow is contraindicated in the edentulous patients because

Dental

All of the above

Regarding carcinoma Gallbladder true statement

Clinical features Most commonly presents with right upper quadrant pain often mimicking cholecystitis and cholelithiasis Weight loss, jaundice and abdominal pain are less common presenting symptoms Chronic cholecystitis with a recent change in quality or frequency of the painful episodes in 40% patients Malignant biliary obstruction with jaundice, weight loss and RUQ pain Ref: Sabiston 20th edition Pgno : 1512-1514

Anatomy

G.I.T

Present with jaundice

Which anaesthetic agent increases intracranial tension among the following

All inhalational anaesthetics directly act on cerebral blood vessels→vasodilatation→increase cerebral blood flow→ increase intracranial tension

Anaesthesia

Sevoflurane

Granules of Eleidin are present in which of the following layer?

Stratum Lucidum - Also called clear cell layer. Present only in skin of palms and soles. Translucent due to presence of refractile Eleidin granules

Dental

Layers of epidermis, dermis

Stratum lucidum

Which of the following drug is a long acting beta–2 agonist ?

Pharmacology

Salmeterol

Antidepressant drug used in nocturnal enuresis is:

Sleep related enuresis- Treatment Bed alarms (behavioral therapy)- TOC Desmopressin (DOC) Imipramine (TCA Antidepressant)

Psychiatry

Sleep Disorders

Imipramine

Five days after an uneventful cholecystectomy, an asymptomatic middle-aged woman is found to have a serum sodium level of 125 mEq/L. Which of the following is the most appropriate management strategy for this patient?

The initial, and often definitive, management of hyponatremia is free-water restriction. Symptomatic hyponatremia, which occurs at serum sodium levels less than or equal to 120 mEq/L, can result in headache, seizures, coma, and signs of increased intracranial pressure and may require infusion of hypeonic saline. Rapid correction should be avoided so as not to cause central pontine myelinolysis, manifested by neurologic symptoms ranging from seizures to brain damage and death. Additionally, a search for the underlying etiology of the hyponatremia should be undeaken. Acute severe hyponatremia sometimes occurs following elective surgical procedures due to a combination of appropriate stimulation of antidiuretic hormone and injudicious administration of excess free water in the first few postoperative days. Other potential etiologies include hyperosmolarity with free-water shifts from the intra- to the extracellular compament (eg, hyperglycemia), sodium depletion (eg, gastrointestinal or renal losses, insufficient intake), dilution (eg, drug-induced), and the syndrome of inappropriate secretion of antidiuretic hormone (SIADH).

Anaesthesia

Preoperative assessment and monitoring in anaesthesia

Restriction of free water

Reversible cause of dementia is -

Ans. is 'c' i.e., Hypothyroidism Causes of dementiaReversible causesSurgically treatableMedically treatableo Normal pressure hydrocephaluso Brain tumors (frontal lobe tumor)o Meningiomao Subdural hematoma (Head injury)o Hydrocephaluso Hypothyroidismo Depressiono HIV infectiono Alcohol abuseo Vitamin B12, Folate, Niacin deficiencyo Any metabolic or endocrine disturbanceo Neurosyphiliso Hashimoto's encephalopathy o Wilson's diseaseo Celiac disease or Whipple's diseaseo Chronic meningoencephalitiso Drugs and toxin (toxic dementia)Irreversible causeso Alzheimer's diseaseo Huntington's choreao Lewy body dementiao Vascular (Multi-infarct) dementiao Parkinson's diseaseo Creutzfeld Jakob diseaseo Pick's diseaseo Overall Alzheimer's disease is the most common cause. Vascular dementia is the 2nd most common cause.

Psychiatry

Dementia Due to Metabolic Causes

Hypothyroidism

A obese female having hirsutism on laboratory investigation has high level of LH and androgens. Likely cause is-

Ans. is 'a' i.e., PCOS o The clinical and laboratory features of the patient described in the question match with those of PCOS as depicted in the table. So the most appropriate answer is PCOS.Clinical features of polycystic ovarian diseaseClinical featureHannonalSequelaeo Young womano | E2. levelo Diabaetes (15%)o Central obesityo | FSH | LH > 10 IU/mlo CVS disorder# SMI > 30kg/cm2o | FSK/LH ratioo Lipidaemia# Waist line > 35o | Androgenso Hypertensiono Gligomenorrhoea, amenorrhoeao Testosterone,epiandrostenedione. |dehydropepiandrosterone |o Endometrial cancero Infertility (20%)o Breast cancero Hirsutismo Premature ovariano Acanthosis nigra due to insulin resistance, Thick pigmented skin over the nape of neck, inner thigh and axillao 17-alpha-hvdroxy progesterone> 800 ng.'dLfailure following surgeryo Testosterone > 2 ng/mlo Most androgens from ovaryo | fasting insulin > l0mlu/Lo Protactin |o Sex hormone binding globulin (SHBG)o | E2/oestrone (E1) ratioo F glucose,'insulin ratio <4-5 (normal 2-4-4-5)

Gynaecology & Obstetrics

Disorders of Ovulation - Anovulation

PCOS

Which of the following is a feature of papillon lefevre syndrome?

Dental

all the above

All are used in the management of head injury patient except?

Glucocoicoids are useful for management of vasogenic edema from tumor or brain abscess. In contrast glucocoicoids are avoided in case of head trauma, ischemic and hemorrhagic stroke. Norepinephrine or pressor therapy is used to maintain a MAP to maintain CPP> 60 mm Hg. Sedation is done with propofol or midazolam. Neuromuscular paralysis will be necessary and the patient will need ventilator suppo. This will ensure securing the airway and keeping pCO2 between 30-35mmHg.

Medicine

Raised ICP and Brain death

Glucocoicoids

Not a premalignant condition: March 2005

Ans. A: Retinitis pigmentosaGIT premalignant conditionsOf the four major primary small-bowel tumors (adenocarcinomas, lymphomas, carcinoid, and leiomyosarcomas), adenocarcinomas and lymphomas are associated with diseases that seem to increase the risk of developing these malignancies.Immunoproliferative small intestinal disease and celiac disease, are thought to predispose patients to the development of primary lymphoma.Increased risk is also associated with conditions, such as immunodeficiency syndromes, nodular lymphoid hyperplasia, Crohn's disease, the gastrointestinal polyposis syndromes, hereditary nonpolyposis colon cancer, neurofibromatosis, long-standing ileostomy, and urinary diversion procedures.Patient with long standing ulcerative colitis are at risk of developing colonic epithelial dysplaia and carcinoma.Oral cavity premalignant conditionsMany oral SCCs develop from premalignant conditions of the oral cavity.A wide array of conditions have been implicated in the development of oral cancer, including leukoplakia, erythroplakia, palatal lesion of reverse cigar smoking, oral lichen planus, oral submucous fibrosis, discoid lupus erythematosus, and hereditary disorders such as dyskeratosis congenital and epidermolysis bullosaOther pre-malignant conditions include actinic keratosis, Barrett's esophagus and cervical dysplasia.

Medicine

Retinitis pigmentosa

Which of the following is false about Takotsubo Cardiomyopathy

Echo comes back to normal in two weeks.

Medicine

Echo never reverts back to normal

In rheumatic heart disease, infective endocarditis is detected by echocardiogram and the largest vegetations seen are due to-

Medicine

Candida albicans

Hereditary non-polyposis colorectal cancer (HNPCC) has an increased risk of all the following except

Hereditary non-polyposis colorectal cancer (Lynch syndrome)Hereditary non-polyposis colorectal cancer (HNPCC) is characterised by an increased risk of colorectal cancer and also cancers of the endometrium, ovary, stomach and small intestine.It is an autosomal dominant condition caused by a mutation in one of the DNA mismatch repair genes. The most commonly affected genes are MLH1 and MSH2. The lifetime risk of developing colorectal cancer is 80%, and the mean age of diagnosis is 45 years. Most cancers develop in the proximal colon. Females have a 30-50% lifetime risk of developing endometrial cancerRef: Bailey and Love, 27e, page: 1260

Surgery

G.I.T

Pancreas

Iodine RDA is -

Ans. is 'c' i.e., 150 microgram o The RDA of iodine for adults is 150 microgram.GroupRecommended daily intakePreschool children (0-59 months)School children (6 - 12 years)Adults (>12 years)Pregnancy and lactation90 meg120 meg150 meg250 meg

Social & Preventive Medicine

Nutrition and Health

150 microgram

Spanish windlass was practices in Spain as a method of execution. It is a type of:

Garrotting Garrotting: One of the methods of hemicidal strangulation The victim is attacked from behind without warning and strangled by grasping throat or by throwing a ligature over the neck and tightening it quickly. In this way a single assailant can kill a healthy robust adult. Garrotting was practices as a mode of execution in Spain. Pougal and Turkey. In Spain it was known as `spanish windlass' in which an iron collar around the neck was tightened by a screw for strangling Other common methods of homicidal strangulation are: Throttling - by hand Bansdola - In this type of strangulation the neck is compressed between two sticks of bamboos one in front and other behind the neck. Both the ends are tied with a rope squeezing the victim to the death. Sometimes a single stick is placed across the .front of the neck with a foot on each end of the stick. Mugging - Strangulation is caused by holding the neck of the victim in the bend of the elbow.

Forensic Medicine

Garrotting

Dispropoionately increased blood urea levels compared to serum creatinine (urea creatinine ratio 20:1) can be seen in the following except -

Intrinsic or intrarenal acute renal failure (ARF) occurs when direct damage to the kidneys causes a sudden loss in kidney function. The most common causes of intrinsic acute renal failure are acute tubular necrosis (ATN), acute glomerulonephritis (AGN), and acute interstitial nephritis (AIN) . Ref Harrison20th edition pg 236

Medicine

Kidney

Intrinsic renal failure

For RNA, which blotting technique is used -

Ans. is 'b' i.e., Northern blot TechniqueSample analyzedGel usedProbeSouthern blotDNAQYesRadioactive DNAAllele specific oligonucleotide (ASO)DNANoAllele specific oligonucleotideMicroarravm-RNA or c-DNANoDNA probeNorthern blotRNAQYesDNA probeWestern (immuno) blotProtein QYesLabeled antibody QSouth Western blotProtein DNANoDNA probeELISAProtein or antibodiesNoAntibody Q (Specific for protein to be measured)ProteomicsProtein QYes-

Biochemistry

Molecular Biology Techniques

Northern blot

Which bacteria acts by inhibiting protein synthesis?

Ans. is 'a' i.e., Pseudomonas

Microbiology

Pseudomonas

Panthothenic acid is coenzyme of which of the following reaction (s):

D i.e. Acetylation Pantothenic acid is necessary for synthesis of coenzyme A (CoA)Q, which functions as a coenzyme for acetylation reactionsQ

Biochemistry

Acetylation

Delusion that someone from high socio economic status is loving you is in -

Psychiatry

De clerambault syndrome

Oesophageal motility disorder are best diagnosed by?

Answer is B (Endoscopy): Dysphagia for solids alone suggests a probable mechanical cause for dysphagia such as carcinoma, stricture or esophageal web. The investigation of choice for such cases is Endoscopy.

Medicine

Endoscopy

Quinine given to a patient of falciparum malaria caused sweating and palpitation, the likely cause is?

Ans. is 'c' i.e., Hypoglycemia o Sweating and palpitations suggest hypoglycemia; which can occur due to quinine. Cinchonism is characterized by ringing in ears, nausea, vomiting, veigo, headache, mental confusion, difficulty in hearing and vision. Hypotension and cardiac arrhythmias develop on rapid i.v. injection.

Pharmacology

Hypoglycemia

Good pasture's syndrome is characterized by all of the following, except:

Answer is B (Leucocytoclastic Vasculitis) Leucocytoclastic vasculitis is not a typical feature of Good pasture's syndrome Triad of Goodpasture's syndrome (Ferri 's Color Atlas & Text of Clinical Medicine) Glomerulonephritisdeg (RPGN; crescents) Pulmonary HaemorrhageQ (Diffuse Alveolar Haemorrhage) Antibodies to basement membrane antigensQ (Anti-GBM antibodies)

Medicine

Leucocytoclastic Vasculitis

Main source of energy derived from

Glycogen is the reserve carbohydrate in animals. It is stored in liver and muscles.The phosphorylated enzyme is less sensitive to allosteric inhibitors. Thus even if cellular ATP and glucose-6-phosphate are high, Phosphorylase will be active. The glucose-1-phosphate produced from glycogen in the liver may be conveed to free glucose for release to the blood.

Biochemistry

Metabolism of carbohydrate

Glycogen

Reverse Coarctation is seen in

Reverse Coarctation ;weak or absent pulse in upper limb + pulse present in lower limb.

Medicine

Takayasu arteritis

Measures involved in sentinel surveillance includes all of the following except.

Ans. (d) Identifying cases free of disability* Surveillance: Is the ongoing systematic collection and analysis of data and the provision of information which leads to action being taken to prevent and control a disease, usually one of an infectious nature* Surveillance is of many types:- Passive Surveillance: Data is itself reported to the health system; For e.g., A patient with fever coming on his own to the PHC, CHC, Dispensary, Private Practitioner, Hospital- Active Surveillance: Health system seeks out 'actively' the collection of data, i.e., goes out to community to collect data; For e.g., Stool sample collection from home in Polio Program.- Sentinel Surveillance: Monitoring of rate of occurrence of specific conditions to assess the stability or change in health levels of a population, It is also the study of disease rates in a specific cohort, geographic area, population subgroup, etc. to estimate trends in larger population; For e.g., Use of health practitioners to monitor trends of a health event in a population- 1. Sentinel Surveillance helps in 'identifying missing cases' and 'supplementing notified cases'ALSO REMEMBER* Most of the national health programs in India rely on Passive Surveillance for morbidity and mortality data collection.* Active Surveillance: Is seen in NVBDCP (Health worker goes house to house every fortnight to detect fever cases, collect blood slides and provide presumptive treatment under malaria component) and National Leprosy Elimination Program (Modified Leprosy Elimination Campaigns)* Sentinel Surveillance is done in National AIDS Control Program wherein STD Clinics, ANC Clinics have been identified as sentinel sites to monitor trends of HIV/AIDS in the country

Social & Preventive Medicine

Concept of Control

Identifying cases free of disability

Which of the following drug crosses placenta

(Warfarin) (601-KDT6th)* WARFARIN - It crosses placenta and is secreted in milk however quantity of active form is generally insufficient to affect the suckling infants* HEPARIN - does not cross BBB or placenta**- It is the anticoagulant of choice during pregnancy*** Bleeding due to overdose is the most serious complication of heparin therapy** other side effects are thrombocytopenia, * alopecia, * osteoporosis*, hypersensitivity reactions.

Pharmacology

Hematology

Warfarin

Vocal cord palsy is not associated with -

ENT

Vertebral secondaries

Thymic hypoplsia is seen in which of the following

Ref Robbins 9/e p224 Thymic Hypoplasia: DiGeorge Syndrome DiGeorge syndrome results from a congenital defect in thymic development with deficient T cell maturation. T cells are absent in the lymph nodes, spleen, and peripheral blood, and infants with this defect are extremely vulnera- ble to viral, fungal, and protozoal infections. Patients are also susceptible to infection with intracellular bacteria, because of defective T cell-mediated immunity. B cells and serum immunoglobulins are generally unaffected. The disorder is a consequence of a developmental mal- formation affecting the third and fouh pharyngeal pouches, structures that give rise to the thymus, parathy- roid glands, and poions of the face and aoic arch. Thus, in addition to the thymic and T cell defects, there may be parathyroid gland hypoplasia, resulting in hypocalce- mic tetany, as well as additional midline developmental abnormalities. In 90% of cases of DiGeorge syndrome there is a deletion affecting chromosomal region 22q11, as discussed in Chapter 6. Transplantation of thymic tissue has successfully treated some affected infants. In patients with paial defects, immunity may improve spontane- ously with age.

Anatomy

General anatomy

Agammaglobulinamia

Rett's syndrome occurs due to deficiency of ?

Ans. is 'b' i.e., Biotin

Pediatrics

Biotin

The Triat in which the parents are clinically normal and only siblings are affected but males and females are affected in equal propoions is:

AR

Pathology

AR

Vitamin K is ivolved in the posttranslational modification?

Biochemistry

Glutamate

True about primary peritonitis

(D) Occurs with Cirrhosis of liver # # PRIMARY (SPONTANEOUS) BACTERIAL PERITONITIS> Peritonitis is either primary (without an apparent source of contamination) or secondary.> The types of organisms found and the clinical presentations of these two processes are different. In adults, primary bacterial peritonitis (PBP) occurs most commonly in conjunction with cirrhosis of the liver (frequently the result of alcoholism).> However, the disease has been reported in adults with metastatic malignant disease, postnecrotic cirrhosis, chronic active hepatitis, acute viral hepatitis, congestive heart failure, systemic lupus erythematosus, and lymphedema as well as in patients with no underlying disease. PBP virtually always develops in patients with ascites.> While enteric gram-negative bacilli such as Escherichia coli are most commonly encountered, gram-positive organisms such as streptococci, enterococci, or even pneumococci are sometimes found.> In PBP, a single organism is typically isolated; anaerobes are found less frequently in PBP than in secondary peritonitis, in which a mixed flora including anaerobes is the rule. In fact, if PBP is suspected and multiple organisms including anaerobes are recovered from the peritoneal fluid, the diagnosis must be reconsidered and a source of secondary peritonitis sought.

Surgery

Miscellaneous

Occurs with Cirrhosis of liver

Osgood Schlatter disease is associated with osteochondritis of

Types of Osteochondritis and Nomenclature Traction apophysitis (chronic strain injuries) Tibial Tuberosity Osgood-Schlatter Calcaneum Sever The lower pole of patella Sinding-Larsen&;s

Microbiology

All India exam

Tibial tubercle

Datura seeds resemble -

↵The seeds of datura closely resemble those of the capsicum universally used over India as a condiment, and the difficulty of their detection is enhanced by the fact that, apart from the bitterness, the poison-seeds have little taste and as impure salt is generally used in India.

Forensic Medicine

Capsicum

Measles is infective for:

Measles/English Measles is spread through respiration (contact with fluids from an infected person&;s nose and mouth, either directly or through aerosol transmission), and is highly contagious -- 90% of people without immunity sharing a house with an infected person will catch it. The infection has an average incubation period of 14 days (range 6-19 days) and Period of communicability in measles is approximately 4 days before and 5 days after the appearance of the rash. Measles is an infection of the respiratory system caused by a virus, specifically a paramyxovirus. REF : ananthanarayana 10th ed

Microbiology

All India exam

Four days before and five days after rash

True about Caspases is?

ANSWER: (A) Involved in apoptosisREF: Robbins pathology 7th edition page 27-29Caspases are essential in cells for apoptosis, or programmed cell death, in development and most other stages of adult life, and have been termed "executioner" proteins for their roles in the cell Some Caspases are also required in the immune system for the maturation of lymphocytes

Pathology

Apoptosis

Involved in apoptosis

Metachromatic granules are stained by?

Ans. is 'a' i.e., Ponder's stain

Microbiology

Ponder's stain

Finger print bureau was first established in the following country:

Dactylography or fingerprint system or dermatoglyphics or Galton system was first used in India in 1858, by Sir William Herschel in Bengal. Sir Francis Galton systematised this in 1892. Finger print bureau was first established in Kolkata.Fingerprints are impressions of patterns formed by the papillary or epidermal ridges of the fingeips. Ref: The essentials of forensic medicine and toxicology by Dr K S Narayan Reddy, 27th edition, Page 76.

Forensic Medicine

India

Which of the following drug acts against Pseudomonas -

Ans. is 'a' i.e., Piperacillin Drugs acting against Pseudomonas. o Penicillins- Piperacillin, Carbenicillin, Ticarcillin, Mezlocillin. o Cephalosporins - Ceftazidime, Cefoperazone, Cefepime. o Carbapenems- Imipenem, meropenem o Monobactams - Aztreonam. o Aminoglycosides - Tobramycin, Gentamycin, Amikacin. o Fluroquinolones - Ciprofloxacin, Levofloxacin, Norfloxacin.. o Other - Polymixin B, Colistin.

Pharmacology

Piperacillin

Cicatrial Alopecia is seen in:

C. i.e. DLE

Skin

DLE

According to Spetzler-Main criteria, how much score is given for a 5 cm nidus with AV malformation?

Spetzler-Main AVM grading scale. Graded Feature Points Assigned Size of AVM < 3 cm 3-6 cm >6 cm 1 2 3 Eloquence1 of adjacent brain Noneloquent Eloquent 0 1 Venous drainage Superficial Deep 0 1 'Eloquent areas include: visual, language, and sensorimotor coex; the thalamus and hypothalamus; the internal capsule; the brainstem; the cerebellar peduncles; and the deep cerebellar nuclei.

Surgery

JIPMER 2018

2

Which of these following statements is wrong about Tacrolimus?

The side effects of Tacrolimus includes, nephro and hepato toxicity. It can also cause hypeension, tremors, seizure, diabetes mellitus and blurred vision. It should be better avoided with other hepato and renal toxicity drugs. Ref: Manzoor M. Khan (2008), Chapter 4 "Immunesupressive Agents", In the book, "Immunopharmacology", Springer Publications, USA, Page 91 ; Katzung, 9th Edition, Pages 941, 942

Pharmacology

It can be safely administered with any nephrotoxic drug

Macrosomia is a

Macrosomia:- A condition where a baby is large before bihFactors causing macrosomia:Mother having diabetesMother having gestational diabetesObese mother(Refer: Nelson's Textbook of Pediatrics, SAE, 1st edition, pg no. 777, 897 - 899)

Pediatrics

All India exam

Large size baby

Which one of the following device conves radioactive emissions to light for detection?

Scintillation counter: It measures ionizing radiation. The sensor, called a scintillator, consists of a transparent crystal, usually phosphor, plastic, or organic liquid that fluoresces when struck by ionizing radiation. A sensitive photomultiplier tube (PMT) measures the light from the crystal. The PMT is attached to an electronic amplifier and other electronic equipment to count and possibly quantify the amplitude of the signals produced by the photomultiplier. Geiger counter: Is a type of paicle detector that measures ionizing radiation. They detect the emission of nuclear radiation: alpha paicles, beta paicles or gamma rays. It detects radiation by ionization produced in a low pressure gas in a Geiger Muller tube.

Radiology

Nuclear medicine

Scintillation counter

Enterobius commonly inhabit the: September 2011

Ans. D: Caecum Adult Enterobius vermicularis worms inhabit the caecum, appendix and adjacent poions of the ascending colon, lying closely applied to the mucosal surface. Pinworm (genus En terobius)/Threadworm/Seatworm, It is a nematode (roundworm) and a common human intestinal parasite, especially in children. It inhabits the caecum, appendix and adjacent poion of the ascending colon, lying closely applied to the mucosal surface It causes enterobiasis, or less precisely as oxyuriasis in reference to the family Oxyuridae. The pinworm appears as a white, small and delicate nematode. The adult female has a sharply pointed posterior end, is 8 to 13 millimeters long, and 0.5 millimeter thick. The adult male is considerably smaller, measuring 2 to 5 millimeters long and 0.2 millimeter thick, and has a curved posterior end. The eggs are translucent and have a surface that adheres to environmental objects. The eggs measure 50 to 60 micrometers by 20 to 30 micrometers, and have a thick shell that is flattened on one side. The small size and colorlessness of the eggs make them invisible to the naked eye, except in barely visible clumps of thousands of eggs. Eggs may contain a developing embryo or a fully developed pinworm larva.Inside the host, the larvae grow to 140-150 micrometers in length Pinworms spread through human-to-human transmission, by ingesting (i.e., swallowing) infectious pinworm eggs and/or by anal sex. The eggs are hardy and can remain ble (i.e., infectious) in a moist environment for up to three weeks.They do not tolerate heat well, but can survive in low temperatures: two-thirds of the eggs are still ble after 18 hours at -8 degrees Celsius (18 degF). After the eggs have been initially deposited near the anus, they are readily transmitted to other surfaces through contamination. The surface of the eggs is sticky when laid, and the eggs are readily transmitted from their initial deposit near the anus to fingernails, hands, night-clothing and bed linen.From here, eggs are fuher transmitted to food, water, furniture, toys, bathroom fixtures and other objects.Household pets often carry the eggs in their fur, while not actually being infected. Dust containing eggs can become airborne and widely dispersed when dislodged from surfaces, for instance when shaking out bed clothes and linen.Consequently the eggs can enter the mouth and nose through inhalation, and be swallowed later. Although pinworms do not strictly multiply inside the body of their human host, some of the pinworm larvae may hatch on the anal mucosa, and migrate up the bowel and back into the gastrointestinal tract of the original host. This process is called retroinfection. Despite the limited, 13 week lifespan of individual pinworms, autoinfection (i.e., infection from the original host to itself), either through the anus-to-mouth route or through retroinfection, causes the pinworms to inhabit the same host indefinitely

Microbiology

Caecum

Which of the following results in increase in secretion of ADH?

Ans: C HypovolemiaRef: Guyton 12th/e p. 9051Hypovolemia (Decreased ECF) stimulates the release of ADH.Vasopressin secretion is increased by: - i) Increased osmolarity (osmotic pressure) of plasma; ii) Decreased ECF volume; iii) Pain, emotion, stress, exercise; iv) Nausea and vomiting; v) Standing; vi) Clofibrate, Carbamazapine; vii) Angiotensin II.

Physiology

Hypovolemia

Urine osmolality in Diabetes insipidus is

Diabetes insipidus is condition characterised by excessive thirst excretion of large amounts of severely diluted urine Those with diabetes insipidus continue to uinate large amount of urine in spite of water deprivation.Ref: DM Vasudevan, 7th edition, page no: 373

Biochemistry

Endocrinology

<150 mmol/L

1-a hydroxylation in Vitamin-D metabolism takes place in

Vitamin D is a fat-soluble vitamin molecule found in fish liver oils, and also produced in the skin when subjected to ultraviolet rays from sunlight. The main function of the vitamin is to increase the utilization of calcium and phosphorus in bones and teeth. A mixture of several forms of vitamin D: Vitamin D3 is synthesized in the skin upon exposure to ultraviolet light; in contrast, vitamin D2 is obtained only from the diet. Both vitamins D2 and D3 are metabolized to 25-hydroxyvitamin D in the liver, and then to the active 1,25 dihydroxy form in the kidney. Vitamin D has a major role in the intestinal absorption of calcium, bone calcium balance and renal excretion of calcium.Ref: Ganong&;s review of medical physiology;24th edition; page no-379

Physiology

Endocrinology

Kidney

Magaldrate is conveed by gastric acid to ?

Ans. is `c' i.e., Magnesium hydroxide and Aluminium hydroxide Magaldrate: Magaldrateis a common antaciddrug that is used for the treatment of duodenal and gastric ulcers, esophagitis from gastroesophageal reflux. Magaldrate is a hydroxymagnesium aluminate complex that is conveed rapidly in gastric acid to Mg(OH), and Al(OH)3, which are absorbed poorly and thus provide a sustained antacid effect.

Pharmacology

Magnesium hydroxide and Aluminium hydroxide

Which of the following nerves are affected after spinal anaesthetic block –

Local anesthetics block generation and conduction of nerve impulse at all part of neuron where they come in contact, without causing structural damage. Thus not only sensory but motor impulses and autonomic control is also interrupted.

Anaesthesia

Sensory, autonomic and motor nerves

Drug of choice for Treponema Pallidum is?

ANSWER: (A) Penicillin GREF: Microbiology, Volume 2; Volume 9, Part 2 edited by E. Edward Bittar, Neville Bittar p; 241See APPENDIX-65 for "SEXUALLY TRANSMITTED DISEASES""Parenteral penicillin G remains the treatment of choice for syphilis (Treponema pallidu and resistance to penicillin has not been reported"

Pharmacology

D.O.C

Penicillin G

If hemoglobin status of a population with mean value is 10.3 gm % with SD 2 gm%, then 5% population will be below what value of Hb?

.

Social & Preventive Medicine

Biostatistics

7.35

Inclusion body conjunctivitis true is all except:

Ans. Present only in infants

Ophthalmology

Present only in infants

A 55 year old man, a chronic smoker is brought to emergency with history of polyuria, polydipsia, nausea and altered sensorium for last two days. He had been diagnosed as having squamous cell carcinoma of lung two months prior to this. On examination, he was lethargic and confused. An ECG was normal except for a narrowed QT interval. Which one of the following is the most likely metabolic abnormality ?

Medicine

Hypercalcemia

EBV causes all EXCEPT:

ANSWER: (C) Verrucous lymphomaREF: Jawett's 24th edition Section IV. Virology > Chapter 33. Herpesviruses Cancer by EBV:EBV is recognized as a cause of Burkitt's lymphoma, nasopharyngeal carcinoma, Hodgkins disease, and some other lymphomas. Sera from patients with Burkitt's lymphoma or nasopharyngeal carcinoma contain elevated levels of antibody to virus-specific antigens, and the tumor tissues contain EBV DNA and express a limited number of viral genes. EBV-associated B cell lymphomas are a complication for immunodeficient patients

Microbiology

Virology

Verrucous lymphoma

All of the following are required more during lactation as compared to pregnancy, except ?

Ans. is 'a' i.e., Iron Required more during lactation as compared to pregnancy : Energy, Vitamin A, thiamin, riboflavin, Vitamin C, niacin, and Vitamin B12. Required more during pregnancy : Iron, protein, and folate. Same requirment in pregnancy and lactation : Fat, calcium, zinc, magnesium, and vitamin B6.

Social & Preventive Medicine

Iron

Not a B cell marker -

. CD 134

Pathology

CD 134

Actinomycosis is commonly seen in -

Medicine

Mandible

In sebaceous glands, accumulation of sebum leads to:

Ans. b. Acne4 steps in pathogenesis of Acne are:Sebum productionHyperkeratosis of pilosebaceous unitPropionibacterium acnes colonization of pilosebaceous unit Inflammation

Skin

General

Acne

A young girl presents with abdominal pain and a recent change in bowel habit, with passage of mucus in stool. There is no associated blood in stool and symptoms are increased with stress. The most likely diagnosis is-

Childhood Chronic ill health in childhood or adolescent IBD may result in growth failure, metabolic bone disease and delayed pubey. Loss of schooling and social contact, as well as frequent hospitalisation, can have impoant psychosocial consequences.Treatment is similar to that described for adults and may require glucocoicoids, immunosuppressive drugs, biological agents and surgery. Monitoring of height, weight and sexual development is crucial. Children with IBD should be managed by specialised paediatric gastroenterologists and transitioned to adult care in dedicated clinics . Pregnancy A women's ability to become pregnant is adversely affected by active IBD. Pre-conceptual counselling should focus on optimising disease control. During pregnancy, the rule of thirds applies: roughly one-third of women improve, one-third get worse and one-third remain stable with active disease. In the post-paum period, these changes sometimes reverse spontaneously. Drug therapy, including aminosalicylates, glucocoicoids Delayed growth and pubeal development: chronic active inflammation, malabsorption, malnutrition and long-term glucocoicoids contribute to sho stature and delayed development, with physical and psychological consequences. * Metabolic bone disease: more common with chronic disease beginning in childhood, resulting from chronic inflammation, dietary deficiency and malabsorption of calcium and vitamin D. * Drug side-effects and adherence issues: young people are more likely to require azathioprine or biological therapy than adults. Poor adherence to therapy is more common than with adults, as younger patients may feel well, lack self-motivation to adhere and believe that drugs are ineffective or cause side-effects. * Loss of time from education: physical illness, surgery, fatigue in chronic inflammatory bowel disease, privacy and dignity issues, and social isolation may all contribute. * Emotional difficulties: may result from challenges in coping with illness, problems with forming interpersonal relationships, and issues relating to body image or sexual function. Ref Davidson edition23rd pg823

Medicine

G.I.T

Irritable bowel syndrome

Length of umbilical cord is?

ANSWER: (C) 30-100 cmsREF: Dutta 6th ed p. 40The normal length of umblical cord is around 50cms with usual variation between 30-100 cms

Gynaecology & Obstetrics

The Amnion and Umbilical Cord

30-100 cms

Vinyl chloride has been implicated in -

Pathology

Angiosarcoma of liver

Vitamin B12 intrinsic factor absorption occurs in

Most of the vitamins are absorbed in the upper small intestine, but vitamin B12 is absorbed in the ileum.Vitamin B12 binds to intrinsic factor and the complex is absorbed across the ileal mucosa.Vitamin B12 and folate absorption are Na+ independent.Other vitamins are absorbed by carriers that are Na+ cotranspoers.(Ref: Ganong&;s Review of medical physiology, 23 rd edition, page 458)

Physiology

G.I.T

Ileum

Splenunculi are commonly seen in

A. (Hilum of spleen) (1103-B & L 25th)ACCESSORY SPLEEN (Splenunculi) - probably results from a failure of infusion of splenic embryonic tissues* They are located near the hilum of the spleen in 50% of cases and related to the splenic vessels or behind the tail of pancreas in 30%. The remainder are located in the mesocolon or the splenic ligaments* These are functionally similar to the spleen and while performing splenectomy for blood dyscrasias removal of these accessory spleens are obligatory, otherwise there always remains a chance of recurrence* Axis of spleen enlargement projects into- Greater sac**

Surgery

Spleen

Hilum of spleen

Causative agent of Favus is:

Ans. A. Tinea schoenleiniiFavous usually affect scalp, but occurring occasionally on any part of the skin and even at times on mucous membrane, caused by Tinea schoenleinii.

Skin

Fungal Infection

Tinea schoenleinii

Zona Pellucida disappears by:-

Zona pellucida is thick membranous covering made up of glycoprotein, the microvilli of oocyte and follicular cells project into zona pellucida for nutrition. it prevent polyspermy and implantation. Blastocyst forms at 4th day and by the end of 5th day, zona pellucida disappears and implantation takes place at 6th -7th day after feilization.

Anatomy

Development period- week 1,2,3,4

5th day after feilization

Storage form of thyroid hormone-

The synthesis and storage of thyroid hormones occurs between the follicular cells and the colloid. The storage form of thyroid hormone is thyroglobulin. Thyroglobulin is a large glycoprotein synthesized in the follicular cells and has a molecular weight of around 650 000 with about 140 tyrosine residues, depending on the form of thyroglobulin. Approximately one quaer of these residues is iodinated at the apical-colloid interface. Once iodinated, thyroglobulin is taken up into the colloid of the follicle where, still incorporated in the protein, a coupling reaction between pairs of iodinated tyrosine molecules occurs. The coupling of two tyrosine residues each iodinated at two positions (di-iodotyrosine, DIT) produces tetra-iodothyronine or thyroxine (T4 ) whilst the combination of DIT with mono-iodotyrosine (MIT) produces tri-iodothyronine (T3 ). Such coupling can occur within a single molecule of thyroglobulin or between dimerized molecules of the protein. This coupling is catalyzed by TPO. Thyroid hormones are stored in this state and are only released when the thyroglobulin molecule is taken back up into the follicular cells. Stimulated by TSH, thyroglobulin droplets are captured by the follicular cells by a process of pinocytosis. Fusion of the droplets with lysosomes results in hydrolysis of the thyroglobulin molecules and release of T3 and T4. Reference : page 2285 Harrison's Principles of Internal Medicine 19th edition

Medicine

Endocrinology

Thyroglobulin

Congenital hepatic fibrosis is a characteristic feature of

Infantile and Iuvenile forms are associated with congenital Hepatic fibrosis.

Pathology

ARPKD