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True about calcium is/are a. Entry is regulated by calmodulin uptake b. Extracellular concentration of calcium is 10,000 times more than intracellular c. Symport uptake d. Entry into cell is passive c. Released by sarcoplasmic reticulum Ref:: ganong 35, Quality::::spotter thinker reader BATA Discussion Explanation Correct choices: b, e . C. Which of the following are organophosphates: A. dieldrin B. parathion C. malathion D. Kepone 5. Propoxur Ref::Trip 5th Page 81 Park 550 table Quality::::reader Discussion Explanation: anticholinesterases Reversible Carbamates Acridine Physostigmine (Eserine) Neostigmine Pyridostigmine Edrophonium Rivastigmine Donepezil tacrine Irreversible Organophosphates Carbamates Dyflos DFP Echothiophate Parathion Malathion Diazinon TIK 20 Tabun Sarin Soman Carbaryl (Sevin) Propoxur(Baygon) Explanation A. dieldrin-organochlorine pesticide. incorrect choice. B. parathionirreversible OPC. correct choice. C. malathion irreversible OPC. correct choice D. Kepone/chlordecone- organochlorine pesticide. incorrect choice pesticide 5. Propoxurirreversible carbamates. incorrect choice Correct choices: b c 203. Which of the following are features of spinal shock a. Spasticity b. Urinary retention c. Areflexia d. Sensory level e. Increased DTRs Ref::clinical acumen Quality::::spotter thinker reader BATA Discussion Spinal shock(neuronal) is the initial state just after an acute insult causing an UMN lesion caused by the temporary depressant effect on the anterior horn cells. Characterized by paralysis,areflexia,flaccidity,the chracteristic hypertonia and increased relexes of cotticospinal lesion appear after few hrs-days. Explanation Correct choices B C d 217. Which of the following predispose a patient to prehepatic encepalopathy a. Constipation b. Bacterial peritonitis c. Hemorrhage d. Hyperkalemia e. Dehydration Ref: HPIM 1715 Quality::::spotter thinker reader BATA Discussion Common precipitants of hepatic failure Increased nitrogen load GIT bleeding Excess dietary protein Azotemia Constipation Electrolyte & metabolic imbalance Hypokalemia Alkalosis Hypoxia Hyponatremia Drugs Narcotics and Tranqulizers Sedatives Diuretics Miscellaneous Infection surgery Superimposed acute liver disease Progressive liver disease Explanation: A. Constipation B. Bacterial peritonitis being an infection. correct choice. C. Hemorrhage D. Hyperkalemia: Hypokalemia not Hyperkalemia is known to worsen hepatic Encephalopathy. 5. Dehydration can cause hypovolemia & electrolyte disturbances that can ppt. hepatic Encephalopathy Correct choices: a b c e 8. the drugs useful in the treatment of ectopic pregnancy is A. Methotrexate B. Actinomycin D C. Cyclophosphamide D. Potassium fluoride 5. Adriamycin Ref:: Dutta 202 Quality:::: spotter Explanation A. Methotrexate: used in medical therapy. correct choice. B. Actinomycin D. correct choice. C. Cyclophosphamide. Incorrect choice. D. Potassium fluoride: potassium chloride is used in ectopic pregnancy. Incorrect choice. 5. Adriamycin is not used in ectopic pregnancy. Correct choices A b 210. Adventitial bursitis due to tuberculosis is found in which of the following sites commonly a. Prepatellar b. Greater trochanter of femur c. Sub acromial d. Metatarsal e. Sub olecranon 209. Snow ball opacities in vitreous is seen in which of the following a. Parsplanitis b. Rheumatoid arthritis c. Anterior unietis d. Retinitis pigmentosa e. Endothelial dystrophy Ref: http://www. indmedica. com/cos/journal/vasculitis. html Quality::::spotter thinker reader BATA Explanation A. Parsplanitis is characterized by snowball opacities. B. Rheumatoid arthritis is one of the causes of pars planitis hence may show snow ball opacities C. Anterior uveitis D. Retinitis pigmentosa 5. Endothelial dystrophy Correct choices: A b 77. The left border of the heart is formed by a. Pulmonary Artery b. Pulmonary vein c. Right ventricle d. Ascending aorta e. Arch of aorta Ref:: BDC 226,Grays 38th 1476 Quality:::: spotter thinker reader BATA Discussion Anatomically Right border is formed by RA. Left border of heart is formed by LA and LV. Upper border formed by LA, asc aota & pul trunk infron of it. Inferior border of the heart is formed by RV and contribution of LV at the apex. Correct choices NONE OF THE CHOICES ARE CORRECT Or 77. left border of the heart in chest XR is formed by a. pul artery b. pul vein c. abdominal aorta d. arch of aorta e. right ventricle Quality:::: :reader Ref:: Discussion: Borders of cardiac silhouette on PA view Right border from above downwards Superior vena cava Outer border of R atrium Sometimes asc, arch of aorta & inferior vena cava Left border from above downwards Aortic knuckle Pul. Trunk or L pul artery L atrial appendage outer border of L ventricle correct choice: a d 9. the resting membrane potential depends on which of the following ions A. Magnesium B. Calcium C. Potassium D. Sodium 5. Chloride Ref:: Ganong 50 Quality:::: spotter Discussion The ionic basis of RMP: Explanation A. Magnesium has no role in RMP. B. Calcium has role in action potential in muscle cells not RMP C. Potassium. The major ion whose movements produce RMP. Correct choice. D. Sodium. incorrect choice. 5. Chloride. No role. Correct choices C 79. In acute inflammation the migration of neutrophils and its attachment to endothelium is mediated by which of the follwing. a. Integrins b. Selection s c. Adhesins d. Perforins e. Opsonins Ref:: Robbins 29, 273 Quality::::spotter thinker reader BATA Explanation a. Integrins are transmembrane glycoproteins that function as cell receptors for extra cellular matrix. correct choice. b. Selectins=the loose and transient adhesions involved in rolling of leucocytes over endothelial cells are accounted for by the selectin family of molecules. E-selectin are present on on endothelial cells, P-selectin on platelets and endothelial cells and L-Selectins on leucocytes. c. Adhesins-are molecules that bind bacteria to cells e. g. lipoteichoic acid and protein F. d. Two classes of cytotoxins include perforins and granzymes. . The perforins form pores in the targets cell membranes. incorrect choice. e. Opsonins are protiens or peptides that label targets for phagocytosis by PMNs and/or macrophages. incorrect choice, Correct choices b 102. Susruta samhita was translated by a. Celsius b. harnel c. Bhargabhatta d. heslar e. Bernard Ref: http://www. ayurveda. com/online%20resource/ancient_writings. htm Quality:::: BATA Discussion: http://www. ayurveda. com/online%20resource/ancient_writings. htm Sushruta Samhita The Sushruta Samhita deals with the practice and theory of surgery, is an important source of Ayurvedic aphorisms. This work is the first to enumerate and discuss the pitta sub-doshas and the marmas. With its emphasis on pitta, surgery, and blood, this work best represents the transformational value of life. It is dais that this work was first redacted by Nagarjuna. This work, originally written in Sanskrit, is now available in English with Devanagari. Bhishagratnas translation is English and Sanskrit. P. V. Sharma has recently written a translation with both the Sanskrit/Devanagari and English that includes Dallanas commentary. Dallana has been regarded as the most influential commentator on Sushrutas work. Explanation Correct choices B d 21. Prozone phenomenon in precipitation reaction indicates a. False positive reaction b. False negative reaction c. due to excess antibodies d. Due to excess antigens e. Broken antibodies Ref: : AN 91 Quality:::: spotter 203. Which of the following are features of spinal shock f. Spasticity g. Urinary retention h. Areflexia i. Sensory level j. Increased DTRs Ref::clinical acumen Quality::::spotter thinker reader BATA Discussion Spinal shock(neuronal) is the initial state just after an acute insult causing an UMN lesion caused by the temporary depressant effect on the anterior horn cells. Characterized by paralysis,areflexia,flaccidity,the chracteristic hypertonia and increased relexes of cotticospinal lesion appear after few hrs-days. Explanation 6. Spasticity appears hrs day after spinal shock has passed in an UMN lesion. 7. Urinary retention is a feature of spinal cord disease. appears first in case of disease originating from the canal and spreading outwards and last in mass lesions compressing spinal cord from the outside. Its a feature of spinal shock. 8. Areflexia is a feature of spinal shock. 9. Sensory level is seen in case of corticospinal lesion. 10. Increased DTRs will be seen after the spinal shock has passed. Correct choices B C d 202. Diseases inherited with triple repeat sequences include a. Huntingtons chorea b. Alzheimers disease c. Spinocerebellar ataxia d. Amyotrophic lateral sclerosis e. Ataxia telangiectasia Ref:: Robbins 197,739,741,157 Quality::::spotter thinker reader BATA Discussion Harrison 2294 table gives explicit information about genetic defects in neurological disease. Robbins has enumerated three diseases having triple repeat sequences: Fragile X syndrome Huntington;s ds, Myotonic dystrophy Explanation A. Huntingtons chorea:AD : CAG triple repeats in gene encoding proein huntingtin B. Alzheimers disease:AD mutations presenilin,apolipoprotein E4,APP genen C. Spinocerebellar ataxia:expansion of trinucleotide repeats in ataxin gene D. Amyotrophic lateral sclerosis:AD mutation in Cu-Zn superoxide Dismutase SOD. 5. Ataxia telangiectasia AR mutation in ATM gene which causes triple repeat sequences and abnormal production of protein. Correct choices A c e 59. Tumor markers of hepatocellular carcinoma include a. CEA b. Des gamma carboxyprothrombin c. CA 19-9 d. Fucosylated alpha protein e. Alpha fetoprotien elevated in greater than 70% Ref:: HPIM 579, CMDT 689 http://www. intouchlive. com/consults/ccn9903b. htm Quality::::spotter thinker reader BATA Discussion Alpha fetoprotein levels raised in Cirrhosis Massive liver necrosis Chronic hepatitis hepatocellular carcinoma Normal pregnancy Fetal distress or death Fetal neural tube defects-enencephaly & spina bifida Gonadal germ cell tumours teratoblastoma, Levels above 1000 ng/ml HCC CEA (Carcino Embryonic Antigen) elevated in: malignancies of the gastrointestinal tract (pancreas, colon, rectum), lung, breast, prostatic and ovary. inflammation and heavy smoking. CA-125 normally found in adult female fallopian tube, endometrium and endocervix. CA-15 elevated breast and lung cancer. . CA-199 elevated in intra-abdominal carcinomas, adenocarcinomas of the lung, gastric, biliary and colonic neoplasms. Explanation a. serum CEA levels alone are not specific for hepatocellular carcinoma but are nonetheless raised. correct choice. b. Des gamma carboxyprothrombin, an abnormal typre of [rothrombin which correlates with h levels of AFP. c. CA 19-9 levels are elevated in HCC. D most of the patients with hepatocellular carcinoma have an elevated serum concentration of fucosylated alpha-fetoprotein. correct choice. e. Alpha-fetoprotein elevated in greater than 70% . true. Correct choices A bcde 67. Which of the following are causes of posterior mediastinal mass: A. Neuroenteric cyst B. Neurogenic cyst C. Anterior thoraxic meningocele D. Lymphoma E. Bronchogenic cyst Anterior mediastinum: Middle Mediastinum: Posterior mediastinum: Germ cell neoplasm Lymphoma: Morgagni hernia Pericardial cyst Thymic lesions: Thyroid (Retrosternal goiter) Foregut duplication cysts Castlemans disease Lymphangioma Lymphoma Bronchogenic cyst Bochdalek Hernia Extramedullary Hematopoiesis Ganglioneuroma Ganglioneuroblastoma Neuroblastoma Lateral thoracic meningocele Malignant tumor of nerve sheath origin Neurofibroma Paraganglioma Pheochromocytoma Schwannoma Explanation A. Neuroenteric cyst is present in the posterior mediastinum or paravertebral area. B. Neurogenic cyst is present in the posterior mediastinum C. Anterior thoracic meningocele is present in the posterior mediastinum D. Lymphoma is a tumour of the middle or anterior mediastinum E. Bronchogenic cyst is a tumour of the middle mediastinum. Correct choices Abc 213. Peripheral neuropathy is seen in all of the following except a. Tuberculosis b. Polyarteritis nodasa c. Diabetes mellitus d. SLE 89. Diabetes mellitus is associated with all of the following except: a. Neuropathy b. Encephalopathy c. Myopathy d. Myelitis e. Myelopathy Ref: CMDT 1191,HPIM 2481 Quality::::spotter thinker reader BATA Discussion Diabetic neuromuscular involvement may manifest as: A. Distal symmetric polyneuropathy B. Isolated peripheral neuropathy-mononeuropathy C. Mononeuritis multiplex D. Painful neuropathy 5. Autonomic neuropathy 6. Cranial neuropathypainful opthalmoplegia 7. Diabetic amyotrophy/proximal neuropathy/lumbosacral plexopathy 8. Ischemic myopathy of thigh muscles D e 127. In carbon monoxide toxicity a. There is left shift of oxygen dissociation curve b. Saturation of oxygen at 50% PaO2 is decreased c. Oxygen content of arterial blood is decreased d. Induces a state of metabolic acidosis e. Oxygen is used in treatment Ref: Ganong 17th 633 Quality::::spotter thinker reader BATA Discussion Explanation a. There is left shift of oxygen dissociation curve. COHb shifts the curve of the remaining HbO2 to left decreasing the amount of O2 released by the normal saturated Hb. b. Saturation of oxygen at 50% PaO2 is decreased. I think this choice should be saturation of Hb at given PO2 is decreased which is untrue because the curve shifts to the left. This increases the saturation of Hb at givenPO2 and even makes the available HbO2 useless for oxygenation because it wont release the O2. c. Carboxu Hb reduces oxygen transportation by Hb thus Oxygen content of arterial blood is decreased. correct. d. Induces a state of metabolic acidosis because of the hypoxia e. Ventilation with O2 is preferable to ventilation with fresh air since O2 hastens the dissociation of COHb. Hyperbaric O2 is useful. 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Which one of the following is a recognised X-ray feature of rheumatoid arthritis? A. Juxta-articular osteosclerosis. B. Sacroilitis. C. Bone erosions. D. Peri-articular calcification. Answer: C (Bone erosions) Ref: Given in Harrison 15th edn, 312 , 1933 Quality: Reader Status: New QTDF: Harrison Discussion Early in the disease, roentgenograms of the affected joints are usually not helpful in establishing a diagnosis. They reveal only that which is apparent from physical examination, namely, evidence of soft tissue swelling and joint effusion. As the disease progresses, abnormalities become more pronounced, but none of the radiographic findings is diagnostic of RA. The diagnosis, however, is supported by a characteristic pattern of abnormalities, including the tendency toward symmetric involvement. Juxta-articular osteopenia may become apparent within weeks of onset. Loss of articular cartilage and bone erosions develop after months of sustained activity. The primary value of radiography is to determine the extent of cartilage destruction and bone erosion produced by the disease, particularly when one is monitoring the impact of therapy with disease-modifying drugs or surgical intervention. Other means of imaging bones and joints, including 99mTc bisphosphonate bone scanning and magnetic resonance imaging, may be capable of detecting early inflammatory changes that are not apparent from standard radiography but are rarely necessary in the routine evaluation of patients with RA. Explanation A. Juxta-articular osteosclerosis is not seen. Instead we have juxta-articular osteopaenia. B. Sacroilitis is not a recognised feature. C. Bone erosions are a recognised feature. D. Peri-articular calcification is not seen, but we have loss of articular cartilage. Comments The first option can be easily ruled out as we have Juxta-articular osteopenia. Tips Be prepared with the various arthritis and the joints typically involved in each one of these. 248. Fraying and cupping of metaphyses of long bones in a child does not occur in: A. Rickets. B. Lead poisoning. C. Metaphyseal dysplasia. D. Hypophosphatasia. Answer: B (Lead poisoning) Ref: Aids to Radiological Diagn. 3rd edn, Chapman, 52 Nelsons Paediatrics Footnote to Fig 45-11 3 Active rickets; cupping and fraying of the distal ends of the radius and ulna Harrison 15th edn, 395 Heavy metal poisoning -Lead Nelson chapter 665 Lead poisoning 3 Lead lines OP Ghai 4th edn, 422 Genetics and Disease 3 Cupping and fraying occurs in metaphysial dysostosis. Nelsons Paediatrics Chapter 648 Familial Hypophosphatemia Quality: Reader Status: New QTDF: Nelson Discussion Fraying occurs in: Rickets Hypophosphatasia Copper deficiency Cupping occurs in: Rickets Hypophosphatasia Bone dysplasias 3 Achondroplasia 3 Metaphyseal chondrodysplasia Scurvy Metatrophic and dystrophic dwarfism Explanation A. Rickets is classically associated with fraying and cupping of epiphysis. B. An increased density at the metaphyseal plate of growing long bones (lead lines) can develop in children. C. Cupping and fraying occurs in metaphyseal dysostosis. D. 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Cupping of the metaphysis occurs at the proximal and distal tibia, and at the distal femur, radius, and ulna. Comments Because of differences in individual susceptibility, symptoms of lead poisoning and their onset may vary. Mild intoxication may result in no more than lethargy and occasional abdominal discomfort, whereas abdominal pain (which is usually diffuse but may be colicky), vomiting, lethargy, constipation, and encephalopathy develop in more severe cases. Lead colic was first described by Hippocrates and, on occasions, has been incorrectly managed surgically as a case of an acute abdomen. Encephalopathy (seizures, mania, delirium, coma) is more common in children than in adults. Classically, lead poisoning results in foot drop attributable to primary motor peripheral neuropathy; wrist drop occurs only as a late sign of lead intoxication. Renal effects include reversible renal tubular dysfunction causing glycosuria, aminoaciduria, and phosphaturia, and irreversible interstitial fibrosis with progressive renal insufficiency leading to hypertension. Although a bluish discolouration of the gum margins is well described, it is now uncommon. Perhaps poor dental hygiene as well as deposition of lead sulphide is required for this sign. Tips Dont confuse the lead line with fraying and cupping. 249. High resolution computed tomography (HRCT) of the chest is the ideal modality for evaluating: A. Pleural effusion. B. Interstitial lung disease. C. Lung mass. D. Mediastinal adenopathy. Answer: B (Interstitial lung disease) Ref: Textbook of Radiology and Imaging 7th edn, David Sutton, 187; Harrison 15th Quality: Spotter Status: Repeat QTDF: Sutton Discussion HRCT is superior to the plain chest X-ray for early detection and confirmation of suspected ILD. Also, HRCT allows better assessment of the extent and distribution of disease, and it is especially useful in the investigation of patients with a normal chest radiograph. Coexisting disease is often best recognised on HRCT scanning, e.g., mediastinal adenopathy, carcinoma, or emphysema. In the appropriate clinical setting, HRCT may be sufficiently characteristic to preclude the need for lung biopsy in IPF, sarcoidosis, hypersensitivity pneumonitis, asbestosis, lymphangitic carcinoma, and PLCH. When a lung biopsy is required, HRCT scanning is useful for determining the most appropriate area from which biopsy samples should be taken. Explanation A. Pleural effusion is seen by plain X-ray chest AP view and in lateral decubitus view. If there are still doubts, we can go in for USG. B. Interstitial lung disease is ideally evaluated with high resolution CT. C. Lun      !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_g mass also can be evaluated by CT. D. Mediastinal adenopathy is visible in plain X-ray chest PA view as well as in CT. Comments The other tests used for interstitial lung diseases would inlcude the following. Radionuclide Scanning: Gallium-67 lung scanning is of limited value in evaluating the inflammatory component of ILD. An accelerated clearance from the lung of soluble aerosolised hydrophilic radionuclides such as 99mTc-diethylenetriamene penta-acetate (DTPA) is an index of pulmonary epithelial permeability that results from inflammation. This test may provide a means of assessing the activity of ILD. Normal 99mTc-DTPA clearance in IPF predicts stable disease, while rapid clearance identifies patients at risk for deterioration. Pulmonary Function Testing: Spirometry and lung volumes measurement of lung function is important in assessing the extent of pulmonary involvement in patients with ILD. Most forms of ILD produce a restrictive defect with reduced total lung capacity (TLC), functional residual capacity, and residual volume. Forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) are reduced, but these changes are related to the decreased TLC. The FEV1/FVC ratio is usually normal or increased. Reductions in lung volumes increase as lung stiffness worsens with disease progression. A few disorders (uncommon in sarcoidosis and hypersensitivity pneumonitis, while common in tuberous sclerosis and LAM) produce interstitial opacities on chest X-ray and obstructive airflow limitation on lung function testing. Diffusing Capacity: A reduction in the diffusing capacity of the lung for carbon monoxide DLCO is a common but nonspecific finding in most ILDs. This decrease is due, in part, to effacement of the alveolar capillary units but, more importantly, to mismatching of ventilation and perfusion (V/Q). Lung regions with reduced compliance due to either fibrosis or cellular infiltration may be poorly ventilated but may still maintain adequate blood flow and V/Q in these regions act like true venous admixture. The severity of the reduction in DLCO does not correlate with disease stage. Arterial Blood Gas: The resting arterial blood gas may be normal or reveal hypoxaemia (secondary to a mismatching of ventilation to perfusion) and respiratory alkalosis. A normal arterial O2 tension (or saturation by oximetry) at rest does not rule out significant hypoxaemia during exercise or sleep. CO2 retention is rare and is usually a manifestation of end-stage disease. Cardiopulmonary Exercise Testing: Because hypoxaemia at rest is not always present and because severe exercise-induced hypoxaemia may go undetected, it is useful to perform exercise testing with measurement of arterial blood gases to detect abnormalities of gas exchange. Arterial oxygen desaturation, a failure to decrease dead space appropriately with exercise (i.e., a high VD/VT ratio), and an excessive increase in respiratory rate with a lower-than-expected recruitment of tidal volume provide useful information about physiologic abnormalities and extent of disease. Serial assessment of resting and exercise gas exchange is an excellent method for following disease activity and responsiveness to treatment, especially in patients with IPF. Fibre optic bronchoscopy and bronchoalveolar lavage (BAL) In selected diseases (e.g., sarcoidosis, hypersensitivity pneumonitis, DAHs, cancer, pulmonary alveolar proteinosis), cellular analysis of BAL fluid may be useful in narrowing the differential diagnostic possibilities among various types of ILD. The role for BAL in defining the stage of disease and assessment of disease progression or response to therapy remains poorly understood, and the usefulness of BAL in the clinical assessment and management remains to be established. Tips Be prepared with the list of Investigation of Choice for a particular disease as well as the disease for which an investigation is used. 250. CT scan of a patient with history of head injury shows a biconvex hyperdense lesion displacing the grey-white matter interface. The most likely diagnosis is: A. Subdural haematoma. B. Diffuse axonal injury. C. Extradural haematoma. D. Haemorrhagic contusion. Answer: C (Extradural haematoma) Ref: Schwartz Surgery 7th edn, 1882: Fig 40-1; Bailey & Love, 23rd, 550; American College of Emergency Physicians1998 Scientific Assembly Notes SU-39/How to Read a Head CT. Quality: Spotter Status: Repeat QTDF: All books Discussion Epidural haematomas are biconvex (lenticular or lens shaped) but vary in appearance because of several factors: source of bleeding (arterial or venous) and the length of time between the injury and the CT scan. Most epidural haematomas are caused by arterial bleeding and are represented by a hyperdense lesion which may cause effacement of the sulci, ventricular narrowing and midline shift. If brain injury is also present, oedema and intraparenchymal haemorrhage may accompany an epidural haematoma. Because the dura is bound tightly at the suture margins, epidural haematomas do not cross sutures. Bilateral epidural haematomas are exceedingly rare. Explanation X(xKddd ,(xKdd ,(xKdd x(xKdd> x(xKdd x(xKdd x(xKdd. (xKdd ,(xKdd (xKdd ,(xKddX(xKdddMX(xKddd,X(xKdddVX(xKddd ,(xKddQ (xKdd (xKdd0 (xKddH (xKdd (xKdd ,(xKdd (xKdd (xKddh<(xKdddX(xKdddX(xKdddX(xKdddX(xKddd (xKdd (xKdd x(xKdd) x(xKdd x(xKddf x(xKdd1 (xKdd (xKdd (xKdd (xKddX(xKddd6X(xKddd6X(xKdddZGd ZGdZGdZGdZGd ZGd ZGd9ZGd ZGdZGdZGdZGdZGdZGdZGdZGdZGdZGdZGdZGdZGdZGdZGd!ZGdZGdZGdZGdZGdZGd ZGdZGdZGdSZGdZGdZGdZGdZGd ZGdZGd ZGdZGd ZGd ZGd ZGdZGdZGdZGdZGd ZGdZGdZGdZGd ZGd ZGdkZGd ZGdZGdZGd(ZGdZGdZGd&ZGdZGdZGd5ZGdZGdZGd5ZGd ZGdXZGdZGdZGdZGdZGd{ZGd9#8#CgA. Subdural haematoma will be concavo convex hypersensity in CT. It is because the blood will be between the dura and arachnoid. B. Diffuse axonal injury will not have this pattern. C. Extradural haematoma suits the description given. D. Haemorrhagic contusion will not produce a biconvex hyperdense lesion. Comments Beware of the word displacement of grey-white matter interface which occurs in extradural haemorrhage as well as in subdural haemorrhage and in any space occupying lesion. If you misinterpret the word as distortion, you may be misguided. Tips Subarachnoid haemorrhage shows a fluffy pattern. 251. Which of the following is the best choice to evaluate radiologically a posterior fossa tumour? A. CT scan. B. MRI. C. Angiography D. Myelography. Answer: B (MRI) Ref: OP Ghai 5th edn, 390; Harrison; Sutton Quality: Spotter Status: Repeat QTDF: Ghai Discussion MRI (Magnetic Resonance Imaging) was invented by Lauterbur in 1973. Hydrogen nuclei or proton in water molecules and lipids are responsible for these images Fourier transformation is used for analysis Most common contrast used is gadolinium Explanation A. CT scan will not show a posterior fossa tumour. B. MRI is the ideal. C. Angiography is not ideal. D. Myelography will hardly give any information. Comments Few posterior fossa tumours are: Astrocytoma Most common Slow growth In cerebellar hemisphere and pons Medulloblastoma Radiosensitive Rapid growth In vermis Choroid plexus papilloma In fourth ventricle Tips MRI is also useful in spinal cord tumours. 252. Most suitable radioisotope of iodine for treating hyperthyroidism is: A. I123 B. I125 C. I131 D. I132 Answer: C (I131) Ref: Schwartze 7th edn, 1673; Harrisons 15th edn, 533; KDT 4th edn, 261 Quality: Spotter Status: Repeat QTDF: Most books Discussion Radioactive iodine is used for treating hyperthyroidism. Explanation A. I123 B. I125 C. I131 is used to treat hyperthyroidism D. I132 Comments Iodine 131 acts by giving beta radiation mainly, also emits gamma rays Half life is 8.04 days Oral Dose 100 to 200 mcui Useful in follicular carcinoma and papillary carcinoma Tips Read the half life of and the particles emitted from various radioactive elements. 253. Which one of the following radioisotopes is commonly used as a source for external beam radiotherapy in the treatment of cancer patients: A. Strontium-89. B. Radium-226. C. Cobalt-59. D. Cobalt-60. Answer: D (Cobalt-60) Ref: SARP-SARP 6th edn, 143; PARAS - PARAS 4th edn, 125 Quality: Spotter Status: Repeat QTDF: All books Discussion External beam radiotherapy or teletherapy is done usually with Co 60 and also with 4Mv-Linear accelerator. Explanation A. Strontium-89 is used in brachytherapy. B. Radium-226 is used in brachytherapy. C. Cobalt-59 is not used predominantly in teletherapy. D. Cobalt-60 is the common agent used for teletherapy. Comments Cobalt 60 emits gamma rays of energy 1.17MeV, 1.33MeV Its half life is 5.26 years Tips 137Cs(Caesium) and 60Co(Cobalt) can be used for both teletherapy as well as brachytherapy, but nowadays caesium is used only for brachytherapy. 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Extradural haematoma suits the description given. D. Haemorrhagic contusion will not produce a biconvex hyperdense lesion. Comments Beware of the word displacement of grey-white matter interface which occurs in extradural haemorrhage as well as in subdural haemorrhage and in any space occupying lesion. If you misinterpret the word as distortion, you may be misguided. Tips Subarachnoid haemorrhage shows a fluffy pattern. 251. Which of the following is the best choice to evaluate radiologically a posterior fossa tumour? A. CT scan. B. MRI. C. Angiography D. Myelography. Answer: B (MRI) Ref: OP Ghai 5th edn, 390; Harrison; Sutton Quality: Spotter Status: Repeat QTDF: Ghai Discussion MRI (Magnetic Resonance Imaging) was invented by Lauterbur in 1973. Hydrogen nuclei or proton in water molecules and lipids are responsible for these images Fourier transformation is used for analysis Most common contrast used is gadolinium Explanation A. CT scan will not show a posterior fossa tumour. B. MRI is the ideal. C. Angiography is not ideal. D. Myelography will hardly give any information. Comments Few posterior fossa tumours are: Astrocytoma Most common Slow growth In cerebellar hemisphere and pons Medulloblastoma Radiosensitive Rapid growth In vermis Choroid plexus papilloma In fourth ventricle Tips MRI is also useful in spinal cord tumours. 252. Most suitable radioisotope of iodine for treating hyperthyroidism is: A. I123 B. I125 C. I131 D. I132 Answer: C (I131) Ref: Schwartze 7th edn, 1673; Harrisons 15th edn, 533; KDT 4th edn, 261 Quality: Spotter Status: Repeat QTDF: Most books Discussion Radioactive iodine is used for treating hyperthyroidism. Explanation A. I123 B. I125 C. I131 is used to treat hyperthyroidism D. I132 Comments Iodine 131 acts by giving beta radiation mainly, also emits gamma rays Half life is 8.04 days Oral Dose 100 to 200 mcui Useful in follicular carcinoma and papillary carcinoma Tips Read the half life of and the particles emitted from various radioactive elements. 253. Which one of the following radioisotopes is commonly used as a source for external beam radiotherapy in the treatment of cancer patients: A. Strontium-89. B. Radium-226. C. Cobalt-59. D. Cobalt-60. Answer: D (Cobalt-60) Ref: SARP-SARP 6th edn, 143; PARAS - PARAS 4th edn, 125 Quality: Spotter Status: Repeat QTDF: All books Discussion External beam radiotherapy or teletherapy is done usually with Co 60 and also with 4Mv-Linear accelerator. Explanation A. Strontium-89 is used in brachytherapy. B. Radium-226 is used in brachytherapy. C. Cobalt-59 is not used predominantly in teletherapy. D. Cobalt-60 is the common agent used for teletherapy. 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