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B. Halothane
D. Entonox
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D. Malabsorption
25. Decrease number of melanocyte is seen in:
A. Albinism
B. Piebaldism
C. Ichthyosis
D. Chemical leucoderma
26. Not a cutaneous manifestation of TB:
A. Lupus pernio
B. Lupus vulgaris
C. Erythema nodosum
D. Scrofuloderma
27. Post exposure prophylaxis, for HIV patient minimum
for:
A. 6 weeks
B. 4 weeks
C. 12 weeks
D. 8 weeks
28. Dressler's syndrome is due to:
A. Autoimmune
B. Bacteria
C. Idiopathic
D. Virus
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D. Tuberculosis
B. Hepatitis B
C. Hepatitis C
D. Hepatitis A
47. Hepatorenal syndrome characterised by all except:
A. No proteinuria
B. Normal intrinsic'kidney.
C. Liver failure
D. Urine osmolality less than plasma osmolality
48. In infant LRTI is MC caused by:
A. Streptococci
B. RSV Viruses
C. H. Influenza
D. Mycoplasma
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D. Tumor of spleen
C. Osteomyelitis of skull
D. Bowen's disease
69. Migrating thrombophlebitis seen in:
A. Buerger's disease
B. Varicose vein
C. Intra venous infusion
D. Local bacterial infection
70. Sister Joseph's nodule is seen:
A. Rheumatoid arthritis
B. Umbilicus
C. Large size condylomata lata
D. Leprosy
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D. Peak of oestrogen
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C. Alcohol Dependence
D. Borderline personality disorder
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B. Cytotrophoblast
D. Ovary
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1. Ans: (C)
Pin Index system
This is safety mechanism so that one cylinder cannot be fitted
at other's position. The pins are so positioned that one
cylinder with corresponding hole can only be fitted. Some
imp. Pin index.
Oxygen 2,5
Nitrous Oxide3,5
Cyclopropane3,6
Air1,5
Nitrogen1,4
Entonox (50% 02 + 50% nitrous oxide) 7
Carbon dioxide (>7.5%)2,6
Carbondioxide (7.5%>1,6
2. Ans: (B)
Halothane is a potent anaesthetic but poor analgesic.
Remember
Maximum AnalgesicTrilene
Profound AnalgesicKetamine
Only AnalgesicN20
AnalgesicHalothane
Remember
Post spina! headache starts in 1st 3 days and last for
1-2 weeks. Most painful on IV injection -propofal
Gag reflex is through - 9th cranial nerve.
Atracurium is metabolized by Hoffmann
degradation.
Suxamethonium is metabolized in plasma by
pseudocholine esterase.
Suxamethonium increase intra cranial pressure &
intra ocular tension.
3. Ans: (D)
Commonly used IV induction
Thiopentone Propafol Ketamine Etomidate Midazolum Althesin - Methohexirone Some important
points ' IV Anaesthesia of choice in day care surgery
is - -propofol
Sodium Thiopentone is ultra short acting due to
rapid redistribution
Dissociative anaesthesia is seen in Ketamine
Post spinal headache is due toCSF Leak
Cone, of lidocaine used in spinal anaesthesia^ 5%
Lignocaine use in different concentration:
5% Spinal anaesthesia
4% Topically in eye
0.5% Epidural anesthesia
4. Ans: (B)
The LA is injected in the sub arachnoid space
betweera L2-L3 or L3-L4.
Spinal cord extends from medullk oblongata to
lower border of L, in adult.
Spinal; cord extends from medulla oblongata to
lower border of L3 in infant & neonate., (adult
level achieved at 2 years of age)
In infancy spinal; anesthesia given at L4-L5.
Level
9. Ans: (C)
Hil Sach's lesion and Bankarfs lesion causes recurrent
dislocation of shoulder
In previous year they asked about the Luxation Inferior
dislocation.
Most common Type of Shoulder dislocation anterior
dislocation of shoulder (sub-coracoid type) dislocation.
Surgeries for Recurrent dislocation of shoulder:
Bankart's operation
Puti platt's operation
Bristow's operation.
10. Ans: (B)
Most common nerve involved in:
Anterior dislocation of shoulder-Axillary nerve
#Surgical neck of Humems-Axillary nerve
# Shaft of Humerus-Radial nerve
#Supracondylar HumerusMedian nerve
Volkman's ischemic contracture-Median nerve
Dislocation of lunate-Median nerve.
11. Ans: (A)
Tinel's Sign:
On gently taping over the course of the nerve from
distal to proximal, a sensation of current or
hyperesthesia is felt in skin which supplied by the
involved nerve.
Tinel's sign and motor examination is the sign of
regeneration.
Motor Examination:
The muscle supplied nearest to the site of injury is 1 st to
recover. It is also known as MOTOR MARCH
Types of nerve injury:
Neuropraxia "it is the compression of any nerve, in which
physiological function is lost but anatomical nerve is
intact"
Axonotemesis "in which some of the axon are injured, but
nerve is intact".
Neurotemesis "in which the nerve is not intact, here nerve
is totally injured. So regeneration of the nerve is very
poor".
Neuroma: if any muscle tissue or any fibrous is takes place in
between the proximal and distal stamp of nerve injury site,
then Axonal sprouting from proximal stamp unable to go
distal stamp. So also sprouted axons will make formation of
neuroma, which is also known as Traumatic Neuroma.
Tinel's sign is +ve because of neuroma formation.
12. Ans: (A)
Remember
Least Radiosensitive Tissue of body nervous
tissue
Least Radio sensitive blood cellPlatelet
Most radio sensitive blood cellLymphocyte
Most radio resistant organVagina
Most common organ to be affected by radiation
Skin
13. Ans: (A)
_ Head Injury
Undiagnosed acute abdominal pain
Note: Treatment of choice in Inferior wall MI/right
ventricular infarction is IV fluids.
35. Ans: (A)
Ca +ve channel blocker does not cause Tetany.
Tetany:
Low ionized calcium concentrations cause
increased excitability of peripheral nerves.
Latent Tetany may be present when sign of rest
tetany are lacking. It is best recognized by eliciting
Trousseau's sign.
A less specific sign of hypocalcaemia is that
described by Chvostek in which tapping on the
branches of the facial nerve as they emerge from the
parotid gland produces twitching of the facial muscles.
36. Ans: (A)
Aphasia is a manifestation of dominant parietal lobe
involvement. Dominant hemisphere in right handed persons is
left hemisphere and thus a right middle cerebral artery infarct
indicates non dominant parietal lobe involvement. Aphasia
will not be a manifestation because an infarction in middle
cerebral artery distribution on the right side will affect the non
dominant parietal lobe. (Left parietal lobe). - Clinical
manifestation of the middle cerebral Artery involvement:
Contralateral hemiplegia: Motor cortex
involvement
Contralateral hemianaesthesia: Sensory cortex
Involvement
Homonymous hemianopia: Optic radiation
Involvement
37. Ans: (D)
ASTEREX1S: Is the flapping tremor seen in metabolic
disturbances is as the result of intermittent failure of the
parietal mechanism which maintains posture. There is sudden
periods of cessation of muscle contraction best seen when the
patient arms are extended in front.
Causes of Asterexis
Renal/liver failure
Hypercapnia
Drug toxicity
Acute focal parietal or thalamic lesions.
LMN Lesion.
Posterior column lesion ( Tabes dorsalis )
Myopathy
Down's syndrome ^ Rickets y Deep sleep
Hypokalemia or hyperkalaemia ' Hypertonia is of two
types: Plasticity (pyramidal lesion) Rigidity (extra
pyramidal lesion) Hypertonia is seen in:
The
Treatment:
> Nasogastric suction,
> Intravenous fluid administration,
> Correction of Elecrolyte Imbalance (Hypokalemia),
> Parasympathomimetics are used (Neostigmine).
78. Ans: (B)
l lypocalcemia is the feature of acute pancreatitis.
Increased serum lipase is diagnostic of acute
pancreatitis moreover the duration ofhyperlipasemia often exceeds that of Flyperamylasemia.
The complaints of acute pancreatitis are:
1. Shock and Acute renal failure.
2. Hyperglycemia, Hypocalcemia, Hypoxia.
3. Pancreatic abscess, Pseudocyst and Obstructions.
79. Ans: (B)
Grey turner sign: Discolouration of.yeHowish brown due to
ecchymosis of extravasated blood in the loin in acute
haemorrhagic pancreatitis. Collen sign: Discoloration of
periumbilical region in acute hemorrhagic pancreatitis.
80. Ans: (A)
Zenker's diverticulum (also known as
pharvngoesophageal diverticula).
It is the most common esophageal diverticula.
Age: patient older than 60 years.
Site: Diverticulum characteristically arises within
the inferior pharyngeal constrictor between the oblique
fibres and horizontal fibres, (at killians triangle).
Zenker's diverticulum is a pulsion diverticulum.
Symptoms: Dysphagia (Particularly for solid foods)
Regurgitation of food. Halitosis, Voice change. Retro
sternal pain and Respiratory obstruction.
Most common complication of Zenker's diverticulum is Lung
abscess due to Aspiration.
81. Ans: (C)
Basal cell carcinoma is commonest form of in cancer. / Called
as
Rodent ulcer.
Arises from basal cell layer of epidermis.
It is locally invasive, it does not spreads through
Lymphatics or blood stream.
Most common site, Inner canthus of eye. Most
common type Noduloulcerative type.
Most aggressive and high recurrence in morphea
type.
Treatment: Excision with healthy margin. It is
good radiosensitive tumour also.
82. Ans: (B)
Collar - Stud abscess - It is bi-locular abscess
with one locule deep to deep fascia and another
locule in superficial fascia.
They inter communicate through perforation in
deep fascia.
2 types:
Pyogenic > More often in Palmar fascia.
Tuberculous > More often in neck.
Cold abscesses:
It is not hot and red as Pyogenic abscesses.
Seen in tuberculosis. Actinomycosis. Gumma degeneration,
Leprosy .
83. Ans: (C)
Spegelian hernia is an Interparietal hernia, that
occurs at the level of Arcuate line, that is
subumbihcal region.
It is situated beneath Internal oblique, or
between the Internal and external oblique
muscles.
Diagnosis: CT or USG.
Para - umbilical hernia: Protrusion through
linea alba, just above or below the umbiicus.
84. Ans: (C)
> Eighty percent of all salivary gland stones occur
in the submandibular gland, 10% occur in the
parotid. 7% in the sublingual and remainder occurs
in minor salivary glands.
> Eight percent of submandibular stones arc
Radioopaque.
Majority of parotid gland stones are radio-lucent.
Remember
Most common benign salivary gland tumours Plemorphic adenoma.
Most common malignant salivary gland tumour Mucoepidermoid carcinoma.
The parotid gland tumour which spreads through
neural sheath - Adenoid cystic carcinoma
85. Ans: (C)
Splenic ruptures should be suspected after any trauma,
particularly any direct injury to left upper quadrant from any
angle.
86. Ans: (C)
10
11
12
INVASIVE TEST
, Chronic villous sampling (9-12 weeks)
Amniocentesis (15-18 weeks)
Noninvasive test are done when the pregnancy are not at
risk.
Invasive test are done when the pregnancy is at risk.
The Risk factors are:
> Advanced maternal age > 35 yrs (Risk 1- 10%)
> Parent with a balanced translocation (Risk
3-20%)
>
Previous child with down syndrome (1%)
103. Ans (B)
To remember:
Epithelial lining of:
Vagina - Non keratinised stratified squamous Cervix Columnar
Uterus - Ciliated columnar ,
Urinary bladder - Transitional
Oral cavity-Non keratinised stratified squamous Tonsil - Non
keratinised stratified squamous
Bartholin duct Serous
PCT - Broad based columnar cell.
DCT - Cuboidal epithelium
Loop of Henle
Descending
Upper part - Columnar epithelium Lower
part - Squamous epithelium
Ascending
Lower part - Squamous epithelium Upper
part - Cuboidal epithelium
104. Ans: (D)
Expected date of delivery is calculated by using Naegle's
formula by adding 9 calendar month and 7 days from the first
day of last menstruation (28 days cycle) period.
105. Ans: (B)
Apgar score: It is related to the status of oxygenation of the
fetus at or immediately after birth. Long-term neurological
correlation is obtained at the. 5 minute score which is of more
value. In cases where the score remains significantly
depressed at 5 minutes. It should be evaluated again after 15
minutes. This scoring is done in a newborn baby at 1 minute,
5 minutes and 15 minutes. In this scoring we see respiratory
effort, Heart rate, Muscle tone, Reflex irritability and Colour.
Total apgar score is 10
No depression is 7-10
Mild depression is 4-6
Severe depression is 0-3
13
magnification)
Culdoscopy - Optical instrument to visualize the pelvic
structure, through an incision in the pouch of Douglas.
107. Ans: (B)
LH: FSH ratio is > 3: l in PCOD (LH increased, FSH
decreased) PCOD is also known as Stein Leventhal
syndrome
Characteristic features:
Hirsutism
Obesity
' Oligomenorrhoea or Amenorrhoea
Infertility M/c cause of hirsutism and virilising
syndrome in young women.
Lab finding
Decreased FSH and progesterone (may be absent)
No ovulation - no progesterone
USG - Necklace appearance of ovaries
DOC: Clomiphene citrate
Turner's syndrome - Testicular feminization
menopause both LH and FSH are increased
108. Ans: (A)
Vertex occupying the left anterior quadrant of the
pelvis is the commonest one and called as left occipito
anterior. Presentation
Diameter of
Engagement
Vertex
Sub-occipito Brcgmatic
Brow
Vertico mental
Face
Submcnto-Bregmatic
Brecch
Bi-ischial
Shoulder
Bi-acromial
M/c - presentation is cephalic (96.5%) M/c - presenting
part of cephalic -vertex (96%) M/c - lie-longitudinal lie
(99.5%)
109. Ans: (D)
Here they didn't ask anything specifically. So you have to rule
out all the possible methods.
110. Ans: (C)
You can't extend the Incision as it may involve the
rectum. It is the major disadvantage of median
episiotomy.
To extent the incisionmediolateral episiotomy is
relatively safer, it is used commonly, but Dyspareunia
is comparatively more.
The other two type's episiotomy- lateral and J
shaped.
Relative merits and demerits of median and
mediolateral episiotomy:
Merits of median episiotomy:
> The muscles are not cut.
> Blood loss is least.
Repair is easy.
> Post operative comfort is maximum.
> Healing is superior.
> Wound disruption is rare.
> Dyspareunia is rare.
14
15
16
Metabolic disorder
Trichotillomania
Alopecia areata
Androgenic alopecia
SLE
Remember: DLE is cause of scarring alopecia whereas SLE is
cause of non scarring alopecia.
131. Answer is A (Eccrine glands):
1. Eccrine sweat glands:
Eccrine sweat glands are present all over skin, particularly
palms and soles
These are situated in Dermis and absent in mucosa
These secrete Watery Hypotonic secretions, which contain
Chloride, Lactic acid and Fatty acid, urea, glycoprotein &
mucopolysaccharide
2. Apocrine glands:
Apocrine glands are vestigial remnants of Odoriferous glands
of lower animals, which are found in Axilla, anogenital area,
scalp and nipples.
These glands start functioning at puberty
Their secretion is sterile but because of bacterial action gives
unpleasant smell
Modified apocrine glands are: Mammary glands
: Mohl's glands in
eyelids
: Cerumin glands in ear
Canal
Obstruction of following structures lead to:
Pilosebaceous gland: Acne vulgaris
: Fordyce spot
Sweat gland: Crystalline miliaria
Apocrine gland: Fox Fordyce disease
Hair root: Boil
Remember: Fordyce spots (ectopic sebaceous gland) are
confused with Koplik's spots (pathognomic sign of
measles).These are differentiated by presence of erythematous
halo around koplik spot.
Fox Fordyee disease is a chronic itching popular eruption of
axilla and pubis due to obstruction of apocrine gland.
132. Answer is A (Lichen planus):
Mucosa is involved in Lichen planus.
Lichen Planus
It is self limiting papulosquamous inflammatory disorder of
skin of unknown origin
Typical lesion is pruritic, polygonal, purple, plain topped
papule & plaques which often has whitish lacy pattern on its
surface (Wickham's striae)
Skin lesions are most commonly present over the wrist, shins,
lower back and genitalia.
Mucous membrane is commonly involved (30:70%), most
commonly buccal mucosa and tongue.
Mucosal lesions are white lacy reticular eruptions
Koebners phenomenon is characteristic of lichen planus
Involvement of hair follicle is known as Lichen Piano Pilaris,
may lead to Cicatricial alopecia of scalp
It may lead to Squamous cell carcinoma.
Pterygium formation
Onychomedesis
Splitting of nail plate
Onychodystrophy
Skin biopsy:
Hyperkeratosis, hypergranulosis, epidermal hyperplasia
Max Joseph Cleft
Degeneration, necrosis & squmatization of basal
keratinocytes
Subepidermal lichenoid band
Pointed rete ridges (saw toothing)
Civatte /cytoid /colloid bodies
Topical steroids are mainstay of treatment.
Oral dapsone for oral LP & acute generalized LP.
133. Answer is A (P. acne):
Propionobacterium acne is normal commensal of sebaceous
gland.
In Acne vulgaris Propionibacterium acne5 (bacteria) and
Pityrosporum orbiculare5 (yeast) infects comedones.
134. Answer is A (Herpes simplex):
Koilocytes are seen in infection with Herpes simplex.
Though koilocytes are seen typically in infection of HPV
(Human papilloma virus) but it can be seen in infection with
herpes simplex.
Koilocytes can also observed in columnar cells in infection
with herpes simplex.
135. Answer is D (Lumbosacral area): Neena Khanna, 273
Most common site of Mongolian spot is lumbosacral area.
Mongolian spots:
Seen commonly in Mongoloid and Negroid infants
Bluish ill defined macule over Lumbosacral region
Regression by the age of 4 years
136. Answer is D (Bullous lesion):
Bullous lesion is not seen in leprosy.
Diagnosis of leprosy is made by
1. Clinical examination
Sensory testing
Peripheral nerve examination
2. Demonstration of acid fast bacilli
In skin smear prepared by slit 8i srape method
Nasal swabs by modified Ziehl-nelson method
3. Skin biopsy / FNAC:
Periappendigial lymphocytosis
Virchow (lepra/foam) cells are diagnostic
Useful in indeterminate leprosy & differentiating it from
other granulomatous lesion
4. Nerve biopsy
5. Foot pad culture (In mouse)
6. IgM antibodies to PGL-1 support diagnosis in lepromatous
patients not in tuberculoid leprosy
137. Answer is A (Calymmatobacterium):
Granuloma inguinale is caused by Calymmatobacterium.
17
Donovanosis/Granuloma inguinale
Caused by Calymmatobacterium granulomatis
Bleeding (red granulation tissue), painless, indurated ulcer
mostly involving genitalia (90%), inguinal (10%) & anal (5%)
region
Pseudobubo is seen
Genital swelling especially of labia (pseudoelephantiasis) is
seen
Best diagnosed by microscopy by demonstrating Donovan
bodies & Safety pin appearance
Doc is Doxy/tetracycline
In pregnancy doc is azithromycin/erythromycin
138. Answer is A (Flaring of acne initially):
There is flaring of acne initially by use of isotretenoin in acne.
Isotretenoin:
Accutane (brand name for a kind of isotretenoin) one of the
most popular topical acne treatments ever invented.
Can be used for nodulocystic acne.
Associated with adverse effects like dryness of skin, acne
flare, skin peeling and in rare cases, inflammatory bowel
disease.
139. Answer is A (Mite):
Scabies is transmitted by mite Sarcoptes scabie.
Scabies
Causative agent is Sarcoptes scabie (itch mite)
More common in winters, incubation period is 3-6 weeks
Characteristic feature is severe nocturnal itching with
positive family history
Burrow is characteristic lesion, which is a tunnel made by
female mite in stratum corneum (s shaped burrow in stratum
corneum)
Other lesions are papule, vesicles, excoriations & crusted
lesions
Mostly involves interdigital space, anterior wrist & ulnar
border of hand. In adults scalp, face, palms & soles are
characteristically spared.
In infants involve penis, palm, sole, scalp, face & neck
Nodular scabies involve scrotum
Treatment:
Doc is Permethrin (1st) BHC (2nd)
Ivermectin is the only oral drug for scabies
Other drugs are Benzyl benzoate (25%), Crotamiton (10%)
Scabicides should be applied to the whole body (below jaw
line in adults) to all members of family whether symptomatic
or not.
140. Answer is A (Contact dermatitis):
Patch test is used for diagnosis of contact dermatitis.
Patch test: it is done to confirm disorder of skin resulting
from a delayed hypersensitivity (type IV)
eg contact dermatitis. It is read after 48 hours (2 days)
Test
Patch test
Early Fernandes
reaction
In TB, induration is seen
Read after
2 days
2 days
after
Skin doubling time in
4 days
psoriasis
Kveim's test
2 weeks
Late Mitsuda reaction
3 weeks
Normal skin doubling
4 weeks
time
Remember: Contact dermatitis is diagnosed by Patch test &
Atopic dermatitis is diagnosed by clinical examination
141. Answer is A (Cis atracurium):
Metaboiization of Muscle Relaxant
Metabolized by organ Atracurium Cisatracurium
independent- Hoffman
elimination, so can be
used in both hepatic &
renal failure
Totally excreted by
Gallamine Metocurine
kidney; so
contraindicated in renal
failure
Metabolized by
Succinylcholine (shortest
psedocholine esterase acting M.R.) Mivacurium
(shortest acting non
depolarizing M.R.)
142. Answer is A (Thiopentone sodium):
Porphyria is an absolute contraindication for the use of
Thiopentone sodium.
Porphyria: Thiopentone induces enzyme amino levulenic acid
synthetase which stimulates the.formation of porphyrin in
susceptible individuals. So it is contraindicated in acute
intermittent and variegate porphyria (can be used safely in
porphyria cutanea tarda)
143. Answer is D (Quinidine):
Non depolarizing blockade is potentiated by Quinidine.
Factors prolonging the neuromuscular blockade
a. Hypothermia
b. Hypocalcemia
c. Hypokalemia
d. Acidosis
e. Hypermagnesemia
f. Quinidine, Procainamide
144. Answer is B (It teils about preoperative assessment of
individual):
ASA grading tells about preoperative assessment of individual.
Based on physical status,the patient are classified into six
categories by American Society of Anasthesiologist.The
morbidity and mortality is highest in grade V patients and
minimum in grade I patients.
I: Normal healthy patient
II: Mild systemic disease not limiting functional activity
III: Severe systemic disease that limits the activity but not
incapacitating
IV: Incapacitating disease that is a constant threat to life
V: Moribund patient who is not going to survive for more than
24 hours with or
Without operation
VI: Brain dead patients (for organ donation)
3 days
18
6.
7.
8.
Effect Of
anticholinesterase
Depolarizing
Nondepolarizing
Block
block
Also called
Also called
Leptocurare
Pachycurare
Potentiation of Reversal of block
block
(anticholinestrase
also inhibit
pseudocholinester
ase)
Agent
Less blockade
Effect of non
More blockade
depolarizing
Blockade
Effect on single
Depression
Depression
twitch height
Train of four fade
Tetanic fade
Absent
Absent
Present
Present
Post titanic
Absent
Present
facilitation
Moderately sensitive
Small cell lung cancer Breast
cancer
Basal cell carcinoma
Medulloblastoma Teratoma
Ovarian cancer
Highly resistant
Melanoma Osteosarcoma
Pancreatic carcinoma
19
Alcohol
Cysts (MC in Mid.
Med.)
- pleuropeicardial bronchogenic
- enterogenous
- neuroenteric
Vascular masses
(aneurysm)
Lymph node
enlargement (including
lymphoma)
Mesenchymal tumors
Pheochromocytoma
Neurogenic tumors
(MC overall)
Meningoceles
Gastroenteric cyst
Mesenchymal tumors
Pheochromocytoma
Lymphoma
Bochdalek hernia
Alcohol
(HIS
Delirium)
Cocaine
Features
Yawning, Insomnia, Dysphoric
mood
Water loss from different orifices
(Lacrimation, sweating, diarrhea,
vomiting, rhinorrhea)
Increased vitals (BP, Pulse, RR,
Temperature)
Pupilary dilation, piloerection
Hang over (mc)
Hallucinations (usually auditory) &
illusions
Insomnia
Seizures (Alcoholic seizures/Rum
fits)
Delirium tremens:
-Occurs within 5 days of complete or
significant abstinence from from
heavy alcohol drinking
-Recovery occurs within 7 days
-Characteristic features are clouding
of consciousness, disorientation,
hallucinations (mostly visual &
auditory), illusion, autonomic
disturbances, agitation & insomnia.
Increased or decreased
- Sleep (hypersomnia or insomnia)
-Psychomotor activity
Vivid unpleasant dreams
Increased apetite & fatigue
Schizophrenia:
-Dementia precox was coined by Emil Kraepelin.
20
Bleuler's "4A"
1. Ambivalence (confusion)
2. Autism (withdrawal into
self)
3. Affect disturbances
4. Association disturbance
2. Delusional perception
3. Thought alientation
phenomenon
a. Thought withdrawal
b. Thought insertion
c. Thought
diffusion/broadcasting
4. Passivity phenomenon
a. Made feeling (affect)
b. Made impulses
c. Made volition or acts
d. Somatic passivity
Schizophrenia
Type
Feature
1. Catatonic -Best prognosis, late onset
-Mutism, rigidity, waxy flexibility,
negativism, echolalia, echopraxia,
mannerism, grimacing, automatic
obedience, ambitendency, verbigeration,
Lethal catatonia or Pernicious catatonia
2. Paranoid -Most common type
-Amphetamine causes similar syndrome
-Worst prognosis -Most difficult
diagnosis
-Schizophrenia in presence of mental
4. Ptropf
retardation
-Early onset and bad prognosis -Senseless
5.
Hebephrenic giggling & mirror gazing
6.
Undifferenti
ated
3. Simple
Characteristic features:
Clouding of consciousness (ie decreased awareness
and decreased ability to respond to environmental
stimuli)
Disorientation (in time>place>person)
Hallucinations (mostly visual) & illusions
Autonomic dysfunctions agitation, insomnia
Carphologia/floccilation (picking movements at
clothes or coversheets) & occupational delirium
(pantomimes as if continuing the usual occupation in
hospital bed)
In delirium, the EEG characteristically shows a
generalized slowing of activity, which is useful in
differentiating it from depression or psychosis.
21
2. Somatization
disorder
3. Conversion
disorder
(Hysteria)
Features
4. Body dismorphic
disorder
Cannabis
Alcohol
LSD
Characteristic features
Magnus symptom
(cocaine bugs or Tactile
hallucination)
-Run amok
-Amotivation syndrome
-Flash backs
-Mc-Evan's sign
-Morbid jealousy
-Bad trips
-Flash backs
Amphetamin Paranoid hallucinatory syndrome
(like paranoid schizophrenia)
e
Phencyclidin Dissociative anaesthesia
e
(Angel dust)
22
f.
Diagnosis:
I131 scan is of no use as tumors are TSH independent.
Calcitonin is raised in almost all cases of medullary
carcinoma and is tumor marker.
Treatment: Total thyroidectomy + Resection of involved
nodes with radical or
modified radical neck dissection.
23
Pleomorphic
adenoma
Mucoepidermoid
carcinoma
Adenoid cystic
carcinoma
24
neural sheath
Best diagnostic modality for
parotid swelling
FNAC
Umbilical Cord
Initially there are 4 vessels- 2 arteries & 2 veins
Of the two umbilical veins, right one disappears by the 4th
month, leaving behind one vein (left vein is left)
Presence of single umbilical artery is often associated with
fetal congenital abnormalities
Single Umbilical Artery
Present in 1-2% cases, due to failure of development of one
artery or due to its atrophy in later months
More common in twins and in babies born to diabetic
mothers or in polyhydramnios
Frequently associated with congenital malformation of
the fetus (10-20%)
Renal and genital anomalies, Trisomy 18 are common
There is increased chance of abortion, prematurity, IUGR
and increased perinatal
190. Answer is A (Metformin):
Drug of choice for PCOD is metformin.
Although clomiphene is drug of choice for anovulation in
PCOD but Metformin is useful for both short term aiding of
infertility treatments and in prevention of long term sequelae
for patients with PCOD.
Role of Metformin in PCOD:
Hyperinsulinemia is believed to be a key link in the enigmatic
generation of the symptoms of polycystic ovarian syndrome,
which includes anovulatory infertility and the skin stigmata
induced by hyperandrogenism. Regression of these symptoms
may be achieved by reducing hyperinsulinelia. Metformin, an
insulin sensitizing agent, has been proven to be of clinical
usefulness both in the short- term aiding of infertility
treatments and potentially, in the prevention of the
longterm sequelae for patients of PCOD.
191. Answer is D (Ovarian cancer):
Ovarian cancer is not a side effect of OCPs. It prevents ovarian
malignancy.
Non-Contraceptive benefits of OCPs.
Improvement of menstrual abnormalities
Regulation of menstrual cycle
Reduction of dysmenorrhoea (40%), menorrhagia (50%)
Reduction of Pre-menstrual tension syndrome and
Mittelschmerz syndrome
Protection against iron deficiency anemia
Protection against health disorders
Pelvic inflammatory disease (thick cervical mucus),
Ectopic pregnancy, Endometriosis
Fibroid uterus, Hirsutism &. acne, Functional ovarian cyst,
Benign breast disease
Osteopenia & post-menopausal osteoporotic fractures
Autoimmune disorders of thyroid, Rheumatoid arthritis
Prevention of malignancies
Endometrial cancer (50%)
25
26
Normal Growth
Weight
The average birth weight of neonates is about 3 kg.
Most full term infants regain their birth weight by the age of
10 days.
An infant usually doubles his birth weight by the age of 5
months.
Thejbirth weight trebles at 1 year and is four times at 2
years of age.
Length or height
The baby measures 50 cm at birth, 60 cm at 3 months, 70 cm
at 9 months and 75 cm at 1 year of age.
The Indian child is 100 cm tall at the age of 4 Vi years.
Thereafter, the child gains about 5 cm in height every
year until the age of 10 years.
Head circumference
Birth=35 cm; 3 months=40 cm; 12 months=45 cm; 2 years=
48 cm; 12 years= 52 cm.
If the head growth exceeds 1 cm in 2 weeks during the
first 3 months, hydrocephalus should be suspected.
Crown rump length is always less than the head
circumference during the first year of life.
Chest circumference
The circumference of chest is about 3 cm less than the
head circumference at birth.
The circumference of head and chest are almost equal by the
age of 1 year. Thereafter, the chest circumference exceeds the
head circumference.
213. Answer is C (Fracture femur):
Fat embolism is most commonly associated with fracture
femur.
Fat embolism is a common phenomenon, more commonly
seen in multiple fractures (involving lower limbs especially
femur)
Fat embolism syndrome
Pathophysiology
Fat embolism is a common phenomenon, more commonly
seen in multiple fracture and in fractures involving lower
limbs especially femur.
Circulating fat globules>10 m in diameter occur in most
adults after close fracture of long bones and histological
traces of fat can be found in the lungs and other internal
organs.
Clinical presentation
It usually manifests itself within 24-48 hours.
Early warning signs (within 72 hours of injury) are a alight
rise in temperature (pyrexia) and pulse rate (tachycardia)
In more pronounced cases there is breathlessness, mild mental
confusion or restlessness, petechiae on chest, axillae, retina
& conjunctival folds; progressive to marked respiratory
distress & coma in serve cases.
Management
Supportive pulmonary care, definitive fracture management
and effective treatment of shock are the corner stones of
current fat embolism management.
Respiratory
support
Treatment of shock
Fracture
stabilization
27
Maintain adequate
intravascular volume
Aggressive fluid
resuscitation should
be instituted to
restore intravascular
volume
Appropriate
monitoring (CVP)
should
be used to avoid
fluid overload.
Albumin has been
suggested for fluid
resuscitation along
with a balanced
electrolyte solution
because it not only
restores blood
volume but also
binds free fatty
acids.
Since movement
at the fracture site
has been shown to
increase the fat
emboli in
circulation, early
immobilization of
lower extremity
fractures is
advocated
Additional therapies
Steroids: Prophylactic corticosteroids benefit high risk patients
Heparin: Increase serum lipase activity and decrease number of
circulating fat globules
Dextran: To reduce red cell aggregation, expand plasma volume,
decrease blood viscosity and reduce platelet adherence
Hypertonic glucose: Metabolically decrease production of free
fatty acids
Aprotinin: Decrease platelet aggregation and serotonin release
Alcohol: Reduces serum lipase activity
Neck of fibula
Cubital tunnel
Tarsal tunnel
Inguinal ligament
28
Thoracic outlet
Arcade of Frohse
Interosseous nerve (Posterior
(Proximal edge of Supinator) interosseous syndrome)
Guyon's canal
Morton's
metatarsalgia
Site affected
Perthes disease
Panner's disease
Capitulum
Kienbobock's disease
Lunate
Osgood-Sclatter's disease
Tibial tubercle
Sever's disease
Calcaneal tuberosity
Kohler's disease
Navicular bone
Freiberg's disease
Metatarsal head
Scheurmann's disease
Calve's disease
Complications
Injury to Sciatic nerve: More commonly, if the dislocation
is associated with a large bony fragment from the lip of
acetabulum, displaced posteriorly.
Avascular necrosis of femoral head: In 15-20% cases, the
femoral head undergoes avascular necrosis. The changes of
avascular necrosis, appears on X-ray generally 1-2 years after
the injury.
Osteoarthritis: This is a late complication.
Myositis ossificans: This occurs few weeks to months after
injury
225. Answer is C (Lachman's test):
Best test for injuries of anterior cruciate ligament is Lachman's
test.
Lachman's test is the most sensitive test for anterior
cruciate ligament tears. It is done with the knee flexed at 20.
So it can be done in acute as well as chronic injuries. (Because
in acute cases with hemarthrosis more flexion is usually not
possible, so performing anterior drawer test is difficult)
Test for ACL in decreasing order of sensitivity &
specificity: Lachman's test >Flexion-rotation drawer test
>Anterior drawer test >Pivot shift test
Test for Ligamentous Instability
Anterior
Cruciate
Posterior
Cruciate
Ligament
Ligament
Lachman's
Test
Flexion
Rotation
Drawer
Test
Posterior tibial
sag
Menisci
Collateral
Ligaments
Valgus/Varus
stress test
Apley's
grinding test
Reverse
Pivot shift
test
29
Quadriceps active
test
Anterior
drawer
test
Pivot shift
test
Minerva cast
Risser's cast
Turn-buckle cast
Shoulder spica
U-slab
Hanging cast
Colle's cast
Hip spica
Cylinder cast
Patellar-tendon
bearing cast
228.
[D] (Hepatitis-E)
229.
[D] (Either of temporal lobe involvement):
Korsakoff's psychosis - an amnestic state with impairment in
recent memory and learning may become more apparent.
It is frequently persist, the residual mental state is
characterized by gaps in memory, confabulation and
disordered temporal sequencing.
230.
[C] (Prostacyclin):
Secondary prevention/prophylaxis
Long term treatment with an antiplatelet agent
(usually Aspirin) after STEM I is associated with a
25% reduction in the risk of recurrent infarction,
stroke or cardiovascular mortality.
An alternative antiplatelet agent that may be used for
secondary prevention in patients intolerant of aspirin is the
ADP receptor antagonist Clopidogrel (75 mg 00)
ACE inhibitors should be used indefinitely by patients
with clinically evident heart failure, a moderate
decrease in global ejection fraction or a large regional
wall motion abnormality to prevent late ventricular
remodeling and recurrent ischemic attacks.
The chronic use of oral b-adrenoceptor blockers for at
least 2 years after STEMI - reduction in the rates of total
mortality sudden death and in some instances,
reinfarction.
231.
[A) (Hypercalcemic parathyroid ism crisis):
Severe calcium elevations are not typical, and the presence
of such suggests a concomitant disease such as
232.
[C] (Brady cardia):
233.
[B] (Pigmented stone):
Medical treatment of Gall bladder stone
UDCA (Ursodeoxy cholic acid) - decreasing cholesterol
saturation of bile and also appears to produce a lamellar liquid
crystalline phase in bile that allow a dispersion of cholesterol
from stone by physiochemical means
Retards cholesterol crystal nucleation
*in carefully selecting patients with functioning GB and with
radiolucent stone < 10 mm in diameter
complete dissolution can be achieved in about 50% of patients
within 6 months to 2 years with UDCA at a dose of 8-1 0
mg/Kg per day
The highest success rate (i.e. > 70%) occurs in patients with
small 5 mm) floating radiolucent gall stone
234. [C] (Pulmonary embolism):
Pulmonny embolism - Deep vein thrombosis is the most common
source of the pulmonary thromboemboli
More unusual causes are fat embolism from multiple
trauma, tumour embolus (renal carcinoma) and
amniotic fluid, Atrial myxoma
5-year
30
Adenocarcinoma
(and all subtypes)
Squamous cell
(epidermoid)
carcinoma
Small cell (oat
cell) carcinoma
Large cell
carcinoma
(%)
adjusted
rate
* 32
17
survival
rate (all
stages)
17
29
15
15
18
5*
11
238.
[B] (Left lower sternum):
Differences between Pericardial rub and Murmur
Pericardial
Murmurs
1. Cardiac cycle Does not
Coincides
coincide with
with systole
systole or
diastole
Blowing,
2. Character
Creaking,
rumbling or
scratchy
musical
rasping or
leathery
3.
4.
Conduction
Variability
None
Present
May be present
Absent
5.
Audibility
Sounds
superficial
Sounds deeper
6.
Pressure of
stethoscope
Alters the
intensity of the
rub
239.
[D] (Autosomal dominant disorder):
GAUCHER DISEASE - is an autosomal recessive
disorder that results from defective activity of acid f3glucosidase
Type I Gaucher disease is a non neuronopathic disease that
can present in childhood to adulthood with slowly to
rapidly progressive visceral disease.
Type II is rare severe CNS disease that leads to death by 2
years of age.
Type III gaucher disease has high variable manifestations
in the CNS and viscera
Angiokeratomas and acroparesthesia may appear in
childhood and lead to early diagnosis in Fabry disease
240.
[B] (Occurs above 5 years age group):
KA WASAKI DISEASE - (Mucocutaneous lymph node
syndrome) is an acute febrile, mulisystem disease of children,
some 80% of cases occur prior to the age of 5, with the peak
incidence occurring at :s; 2 years.
Characterised by - non supprative cervical adenitis and
changes in the skin and mucous membranes as edema.
Although the disease is generally benign and self-limited.
It is associated with coronary artery aneurysm in
approximately 25%.
Others manifestations include pericarditis, myocarditis, MI
and cardiomegaly.
Treatment - High doses intravenous y-globulin with aspirin is
treatment of choice.
Plasmapheresis may be useful in the upto 10% of cases
that are unresponsive to immune globulin.
31