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J ,@ l h ,@ l VX=X=X4X ,@ l ,@ l ,@ l ,@ l hd ZProviding services for unmarried mother 12. Teaching home economics and nutrition 13. Providing adoption services Explanation A. Screening for cervical cancer is done. B. Providing services for unmarried mothers is done. C. Screening for HIV infection is not done. D. Providing adoption services is done. Comments Straight out of Park. Tips Prepare a mnemonic yourself. 271. Elements of primary health care include all of the following, except: A. Adequate supply of safe water and basic sanitation. B. Providing essential drugs. C. Sound referral system. D. Health education. Answer: C (Sound referral system) Ref: Park 16th edn, 632; Park 17th edn, 650 Quality: Reader Status: New QTDF: Park Discussion Elements of Primary Health Care Although specific services provided will vary in different countries and communities, the Alma - Ata Declaration has outlined 8 essential components of Primary Health Care. 1. Education concerning prevailing health problems and the methods of preventing and controlling them 2. Promotion of food supply and proper nutrition 3. An adequate supply of safe water and basic sanitation 4. Maternal and child health care, including family planning 5. Immunisation against major infectious diseases 6. Prevention and control of locally endemic diseases 7. Appropriate treatment of common diseases and injuries 8. Provision of essential drugs. Explanation A. Adequate supply of safe water and basic sanitation is an element of primary care. B. Providing essential drugs is an element of primary care. C. Sound referral system is not an element of primary care. D. Health education is an element of primary care. Comments A question straight from Park. 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Wings Handicaps, Behavior and Skills (HBS) Schedule is the Most important epidemiological tool used for assessing disability in children C. Binet and Simon IQ tests are used for testing IQ. D. Physical Quality of Life Index (PQLI) consists of 3 indicators Infant Mortality rate Life expectancy at age one Literacy Comments Straight from Park Tips Of late more questions are asked from Park from hitherto unexplored areas 270. Scope of family planning services include all of the following except: A. Screening for cervical cancer. B. Providing services for unmarried mothers. C. Screening for HIV infection. D. Providing adoption services. Answer: C (Screening for HIV infection) Ref: Park 17th edn, 335 & 16th edn, 329 Quality: Reader Status: Repeat QTDF: Park Discussion The scope of family planning services includes - 1. Proper spacing & limitation of births 2. Advice on sterility 3. Education for parenthood 4. Sex education 5. 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Only BCG. B. BCG, DPT-1, OPV-1. C. DPT-1, OPV-1, Measles. D. BCG, DPT-1, OpV-1, Measles. Answer: D (BCG, DPT-1, OpV-1, Measles) Ref: Park 16th edn, 148; Park 17th edn, 150 Quality: Thinker Status: Repeat QTDF: ?? Discussion Park 16th Edition Page 148: Direct BCG vaccination has been adopted in India BCG can be given with oral polio Xh5+Xh5#Xh4#Xh4#Xh/#XhCXGcBCG can be given with DPT, but at different arms Park 16th Edition Page 120: Measles can be combined with mumps and rubella Nelson 15th Edition Chapter 247: It is not necessary to restart an interrupted schedule from the beginning or to add an extra dose. Unimmunised infants 2-14 months of age should be given the same sequence of immunisations and dose intervals recommended for young infants. However, only a single dose of a conjugated Hib vaccine is recommended for those older than 15 months. When an older unimmunised child is seen in the family, the adequacy of follow-up is doubtful. The simultaneous administration of DTP, OPV, and MMR is reasonable in these circumstances. Explanation A. We cannot stop with giving only BCG, as it is clearly given in Park that BCG can be combined with DPT and OPV. B. BCG, DPT-1, OPV-1 can be given. C. DPT-1, OPV-1, Measles can be given. D. BCG, DPT-1, OPV-1, Measles can be given and is the most beneficial. Comments A question that has been repeated and yet we dont have a concrete reference. Anyhow a few points are worth mentioning: Choice D has been taken as the most appropriate answer as there is no reference that BCG should not be given with measles and module given for medical officers under RCH also supports this. However, if there be any reference that contradicates simultaneous administration of BCG and Measles, then we have to go for choice C. Tips Search for a reference 257. Leprosy is considered a public health problem if the prevalence of leprosy is more than: A. 1 per 10,000 B. 2 per 10,000 C. 5 per 10,000 D. 10 per 10,000 Answer: A (1 per 10,000) Ref: Park 17th edn, 247, 311 & 16th edn, 242 ,307 Quality: Spotter Status: Repeat QTDF: Park Discussion Prevalence of one case per ten thousand populations indicates a potential public health problem. Explanation Self Explanatory Comments Prevalence rate is used for case finding strategy: Prevalence < 1/1000 Contact survey Prevalence 1/1000 or higher Group survey Prevalence 10/1000 or more Mass surveys Tips As always, no question paper is complete without a question in leprosy Of late the trend has been to ask questions in reactions and types of leprosy. 258. In the management of leprosy, Lepromin test is most useful for: A. Herd immunity. B. Prognosis. C. Treatment. D. Epidemiological investigations. Answer: B (Prognosis) Ref: Park 16th edn, 244; Park 17th edn, 247; Ananthanarayanan Quality: Spotter Status: Repeat QTDF: Park Discussion Lepromin test is an intradermal test for cell mediated immunity. It is of two types: Early (Fernandez reaction) read at 48 hours. Late (Mitbuda reaction) read at 21 days. It is not a diagnostic test, but it is of value in: Evaluating the immune status (CMI) of leprosy patients. Confirming the results of classifications of cases of leprosy on clinical and bacteriological grounds. Estimating the prognosis in cases of leprosy of all types. It is strongly positive in tuberculoid type and negative in lepromatous type. Explanation A. Since you are doing a test on a individual herd immunity cannot be found. B. Lepromin test is most useful for prognosis. C. Lepromin test is not used for treatment. D. Lepromin test can be used for epidemiological investigations. Comments The recent tests are LTT and LMT (Lymphocyte transforrnation test and Lymphocyte migration test). Tips Mnemonic Early - Fernandez : Late - Mitsuda (EFLM - consecutive alphabets) 259. For controlling an outbreak of cholera, all of the following measures are recommended, except: A. Mass chemoprophylaxis. B. Proper disposal of excreta. C. Chlorination of water. D. Early detection and management of cases. Answer: A (Mass chemoprophylaxis) Ref: Park 17th edn, 171,173 & 16th edn, 170 Quality: Reader Status: Repeat QTDF: Park Discussion Sanitation measures for control of cholera are: 1. Water control 2. Excreta disposal 3. Food sanitation 4. Disinfection Explanation A. Mass chemoprophylaxis is not needed. B. Proper disposal of excreta is done. C. Chlorination of water is done. D. Early detection and management of cases is done. Comments Chemoprophylaxis is, however, advised for household contacts. Tips Cholera is an extremely important topic. Read the compositions of ORS and the assessment of dehydaration and treatment plan of ADD and drugs used. 260. A child aged 24 months was brought to the Primary Health Centre with complaints of cough and fever for the past 2 days. On examination, the child weighed 11 kg. Respiratory rate was 38 per minute, chest indrawing was present. The most appropriate line of management for this patient is: A. Classify as pneumonia and refer urgently to secondary level hospital. B. Classify as pneumonia, start antibiotic and advise to report after 2 days. C. Classify as severe pneumonia, start antibiotics and refer urgently. D. Classify as severe pneumonia and refer urgently. Answer: C (Classify as severe pneumonia, start antibiotics and refer urgently) Ref: Park 17th edn, 136 & 16th edn, 135; OP Ghai 5th edn, 350 Quality: Reader Status: Repeat QTDF: Park Discussion See the tables in Park. Explanation Self Explanatory Comments Make sure that you know the criteria for fast breathing in various age groups. Tips Management of ARI and ADD are important from Exam as well as practical point of view. 261. The following statements about meningococcal meningitis are true, except: A. The source of infection is mainly clinical cases. B. The disease is more common in dry and cold months of the year. C. Chemoprophylaxis of close contacts of cases is recommended. D. The vaccine is not effective in children below 2 years of age. Answer: A (The source of infection is mainly clinical cases) Ref: Park 16th edn, 131; Park 17th edn, 132 Quality: Reader Status: Repeat QTDF: Park Discussion The organism is found in the nasopharynx of cases and carriers. Carriers are most important source of infection. The mean duration of temporary carriers is about 10 months and carriers rate may go up to 80% in epidemics. Clinical cases present only a negligible source of infection. 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You yourself know the important areas. And one more thing is that a new out of Park question is difficult for every one. But if you leave a few regular questions, you are out of the race. 254. The response which is graded by an observer on an agree or disagree continuum is based on: A. Visual analog scale. B. Guttman scale. C. Likert scale. D. Adjectival scale. Answer: C (Likert Scale) Ref:http://www.ndhcri.org/pain/Tools Visual_Analog_Pain_Scale.pdf; http://trochim.human.cornell.edu/kb/scalgutt.htm; http://trochim.human.cornell.edu/kb/scallik.htm; http://acl.ldc.upenn.edu/P/P93/P93-1023.pdf Quality: Thinker Status: New Question QTDF: Some book for Statisticians Discussion Visual analog scale The worst imaginable pain | | | | | No pain Instructions: Show and read the pain scale to the patient. Explain to the patient to place a mark along the line to indicate their current pain level. Wait for a verbal reply or for the patient to mark their current level of pain. Repeat the directions if the patient is having difficulty; use words other than pain: aching, cramping, sore, uncomfortable, stiff, dull, pressure, burning, shooting. If the patient does not like it or understand it, switch to another pain rating scale. Always use the same scale for each follow-up assessment. Document the scale used as the visual analog scale. More at http://www.ndhcri.org/pain/Tools/Visual_Analog_Pain_Scale.pdf Guttman Scale Guttman scaling is also sometimes known as cumulative scaling or scalogram analysis. The purpose of Guttman scaling is to establish a one-dimensional continuum for a concept you wish to measure. More at http://trochim.human.cornell.edu/kb/scalgutt.htm Likert Scale Youre now ready to use your Likert scale. Each respondent is asked to rate each item on some response scale. For instance, they could rate each item on a 1-to-5 response scale where: 1. = strongly disagree 2. = disagree 3. = undecided 4. = agree 5. = strongly agree There are a variety of possible response scales (1-to-7, 1-to-9, 0-to-4). All of these odd-numbered scales have a middle value is often labelled neutral or undecided. It is also possible to use a forced-choice response scale with an even number of responses and no middle neutral or undecided choice. In this situation, the respondent is forced to decide whether they lean more towards the agree or disagree end of the scale for each item. More at http://trochim.human.cornell.edu/kb/scallik.htm Adjectival Scale A linguistic scale is a set of words, of the same grammatical category, which can be ordered by their semantic strength or degree of informativeness (Levinson, 1983). For example, lukewarm, warm, and hot fall along a single adjectival scale since they indicate a variation in the intensity of temperature of the modified noun. In the case of adjectives, the above definition is commonly relaxed to replace the total order among the elements of the scale by a partial one, so that the elements of the scale may be partitioned into two groups (sub-scales), within each of which the order is total. The two sub-groups correspond to positive and negative degrees of the common property that the scale describes. For example, the set of adjectives (cold, lukewarm, warm, hot) are normally considered part of one scale, even though no direct ordering of semantic strength exists between cold and hot. More at http://acl.ldc.upenn.edu/P/P93/P93-1023.pdf Explanation A. Visual analog scale is often used in anaesthesia. B. Guttman scale is a measurement scale. C. Likert scale is an ordinal scale used in behavioural sciences and psychiatry. D. Adjectival scale can be used for a whole lot of purposes (including remarking about this book). Comments In the past, questions like these were forgotten (or the choices forgotten) and we had no opportunity to analyse these. But now, since the question papers are given out, questions like these pop out. Tips If you get a question like this; dont panic; dont think too long and waste your precious time (40 seconds for each question in AIPG Exam). Most will not attend this question and these questions will not be a decider. 255. Denominator while calculating the secondary attack rate includes: A. All the people living in next fifty houses. B. All the close contacts. C. All susceptible amongst close contact. D. All susceptible in the whole village. Answer: C (All susceptible amongst close contact) Ref: Park 16th edn, 87; Park 17th edn, 88 Quality: Spotter Status: Repeat QTDF: Park Discussion Secondary attack rate = (Number of exposed persons developing the disease within the range of incubation period/Total number of exposed susceptible contacts) 100 If susceptible contacts cannot be easily identified, the denominator can be taken as exposed contacts. Explanation Self-Explanatory Comments Secondary attack rate is more useful in diseases like measles and smallpox and not useful in diseases like influenza. Tips Study all the formulae in Park. Questions have been asked from virtually all of them. 256. In one single visit, a 9 month-old, unimmunised child can be given the following vaccination: A. Only BCG. B. BCG, DPT-1, OPV-1. C. DPT-1, OPV-1, Measles. D. BCG, DPT-1, OpV-1, Measles. Answer: D (BCG, DPT-1, OpV-1, Measles) Ref: Park 16th edn, 148; Park 17th edn, 150 Quality: Thinker Status: Repeat QTDF: ?? 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'\P-kDlGáD*w-kDLD*w-k '\P-kDlGáD*w-kDLD*w-kH!0߸pP0PP 5/c0񄋋D_-kD'|x%A\Pb0񄋋D_-kD'|x%A\Pb0Pp0PP 60 0񄋋D_-kD'|x%A\Pb` D_-kD'|x%A\Pb0߸0߸pP0PP 8dIZGdn and 500 mcg of folic acid are given through antenatal Vaccine is contraindicated in pregnant women. Chemoprophylaxis of close contacts is by Rifampicin 600 mg twice a day for 2 days for adults. Mass chemoprophylaxis is to be restricted to closed and supervised families. Incidence is higher in overcrowding and in low socio economic groups living under poor housing conditions. Explanation A. The source of infection is mainly carriers. B. The disease is more common in dry and cold months of the year. C. Chemoprophylaxis of close contacts of cases is recommended. D. The vaccine is not effective in children below 2 years of age. Comments Mass chemoprophylaxis is of use in meningococcal meningitis, but not in cholera (Question 259). Tips Chemoprophylaxis is given for [PID(MC)2 1. Plague 2. Influenza 3. Diphtheria 4. Meningococcal meningitis 5. Malaria 6. Cholera 7. Conjunctivitis 262. Class II exposure in animal bites includes the following: A. Scratches without oozing of blood. B. Licks on a fresh wound. C. Scratch with oozing of blood on palm. D. Bites from wild animals. Answer: B (Licks on a fresh wound) Ref: Park 16th edn, 209; Park 17th edn, 212 Quality: Reader Status: Repeat QTDF: Park Discussion Classification of exposures: Class I (Slight risk) Licks on healthy unbroken skin Consumption of unboiled milk of suspected animal Scratches without oozing of blood Class II (Moderate risk) Licks on fresh cuts Scratches with oozing of blood All bites except those on head, neck, face, palm and fingers Minor wounds less than 5 in number Class III (Severe risk) All bites or scratches with oozing of blood on head, neck, face, palm and fingers Lacerated wounds on any part of the body Multiple wounds 5 or more in number Bites from wild animals Explanation A. Scratches without oozing of blood is Class I. B. Licks on a fresh wound is Class II. C. Scratch with oozing of blood on palm is Class III. D. Bites from wild animals is Class III. Comments A straight forward question. Tips Read the vaccine schedules. 263. The organism most commonly causing genital filariasis in most parts of Bihar and Eastern U.P. is: A. Wuchereria bancrofti. B. Brugia malayi. C. Onchocerca volvulus. D. Dirofilaria. Answer: A (Wuchereria bancrofti) Ref: Park 17th edn, 204 & 16th edn, 201; Harrison 15th edn, 1237 Quality: Reader Status: Repeat QTDF: Park Discussion The Brugian filariasis is generally similar to Bancroftian filariasis, but strangely the genitalia are rarely involved. Explanation A. Wuchereria bancrofti is the leading cause. B. Brugia malayi rarely invoves genitalia. C. Onchocerca volvulus (onchocerciasis, river blindness) is a major cause of blindness in West Africa and Central America. The parasite is introduced into humans by blackflies of the genus Simulium, which breed in rapidly running water; people who live or work near waterways are thus most likely to be infected. D. Humans may be infected with three types of animal filariae. Dirofilaria immitis, the heartworm, is found on all continents and is a common parasite of dogs in many parts of the United States. D. tenuis, Brugia beaveri, and other unclassified Brugia spp. have also been reported to infect humans. These worms may be introduced into humans by the bite of mosquitoes containing 3rd-stage larvae. The organisms, however, do not undergo normal development in the human host. D. immitis are trapped in the lung parenchyma after migrating for several months in the subcutaneous tissues. The pulmonary response consists of granulomas with eosinophils, neutrophils, and tissue necrosis. Most human infections with D. immitis are discovered incidentally when the chest roentgenogram reveals a solitary pulmonary nodule3 cm in diameter. Definitive diagnosis and cure depend on surgical excision and identification of the nematode within the surrounding granulomatous response. D. tenuis does not leave the subcutaneous tissues, while B. beaveri eventually localises to superficial lymph nodes. D. tenuis and B. beaveri infections present as painful, rubbery 1-to 5-cm diameter nodules in the skin of the trunk, extremities, and orbit. Patients often report having been engaged in activities suggestive of exposure to infected mosquitoes, such as working in swampy areas. Diagnosis and management of these infections are similar to those of D. immitis. Comments Questions are repeated from filariasis, mosquitoes, the relevant and related programmes and the treatment. Tips Read filaria from Panicker and Chaterjee. The classification in Chaterjee will help you solve most of the Spotter Questions. 264. SAFE strategy has been developed for the control of: A. Onchocerciasis. B. Trachoma. C. Refractive error. D. Ocular trauma. Answer: B (Trachoma) Ref: Nema 4th edn, 118 Quality: Spotter Status: New QTDF: Nema Discussion International trachoma initiative sponsors a programme called SAFE to control Trachoma Surgery, Antibiotics, Facewash Environmental change Explanation Self Explanatory Comments Be aware of the latest facts. Tips Trachoma is an important topic and question can come from staging, complication, and management. 265. The commonest cause of low vision in India is: A. Uncorrected refractive errors. B. Cataract. C. Glaucoma. D. Squint. Answer: A (Uncorrected refractive errors) Ref: Pradeep Sharma 1st edn, 338 to 340 (causes of Low Vision); Nema 4th edn, 399 (Causes for Blindness); Park 16th edn, 301 (Causes for Blindness) Quality: Spotter Status: Repeat (with change) QTDF: ?? Discussion Causes of low vision are: Refractive errors 14.2 % Cataract 7.68 % Trachoma 4.02 % Vitamin A deficiency 1.32 % Central corneal opacity 0.73 % Glaucoma 0.07 % Causes of blindness Cataract 80.10 % Refractive errors 7.35 % Aphakia 4.67 % Glaucoma 1.70 % Corneal opacities 1.52 % Trachoma 0.35 % Others 4.25 % Explanation Self Explanatory Comments Refractive error causes low vision on 100% of cases. Tips This is an often repeated question. Make sure you correctly interpret what is asked in the question. 266. Elemental iron and folic acid contest of iron and folic acid adult tablets supplied under the National Programme for Anaemia Prophylaxis are: A. 60 mg of elemental iron and 250 micrograms of folic acid. B. 100 mg of elemental iron and 500 micrograms of folic acid. C. 120 mg of elemental iron and 750 micrograms of folic acid. D. 200 mg of elemental iron and 1000 micrograms of folic acid. Answer: B (100 mg of elemental iron and 500 micrograms of folic acid) Ref: Park 17th edn, 363, 439; Park 16th edn, 356 gives answer as 60 mg of Iron and 500 mcg of Folic Acid Quality: Spotter Status: Repeat Question with new choices QTDF: Park, 17th Edition Discussion As anaemia is the main culprit behind premature births, postpartum haemorrhage, puerperal sepsis, and thromboembolic phenomena in the mother, the government of India has initiated a programme in which 100 mg of elemental iron and 500 mcg of folic acid are given through antenatal clinics, PHCs and their subcentres. Please note that we have to give 500 mcg of folic acid. Explanation A. 60 mg of elemental iron and 250 micrograms of folic acid was never given. instead 60 mg of iron and 500 mcg of folic acid was once given. B. 100 mg of elemental iron and 500 micrograms of folic acid is given now. C. 120 mg of elemental iron and 750 micrograms of folic acid is not the correct dose. D. 200 mg of elemental iron and 1000 micrograms of folic acid is not the correct dose. Comments dG ,(xKdd x(xKdd# x(xKdd x(xKdd (xKdd# (xKdd ,(xKdd (xKdd ,(xKdd (xKdd ,(xKddO (xKdd ,(xKddV (xKdd (xKddSh<(xKddd6X(xKdddCX(xKdddCX(xKdddBCG can be given with DPT, but at different arms Park 16th Edition Page 120: Measles can be combined with mumps and rubella Nelson 15th Edition Chapter 247: It is not necessary to restart an interrupted schedule from the beginning or to add an extra dose. Unimmunised infants 2-14 months of age should be given the same sequence of immunisations and dose intervals recommended for young infants. However, only a single dose of a conjugated Hib vaccine is recommended for those older than 15 months. When an older unimmunised child is seen in the family, the adequacy of follow-up is doubtful. The simultaneous administration of DTP, OPV, and MMR is reasonable in these circumstances. Explanation A. We cannot stop with giving only BCG, as it is clearly given in Park that BCG can be combined with DPT and OPV. B. BCG, DPT-1, OPV-1 can be given. C. DPT-1, OPV-1, Measles can be given. D. BCG, DPT-1, OPV-1, Measles can be given and is the most beneficial. Comments A question that has been repeated and yet we dont have a concrete reference. Anyhow a few points are worth mentioning: Choice D has been taken as the most appropriate answer as there is no reference that BCG should not be given with measles and the module given for medical officers under RCH also supports this. However, if there be any reference that contradicates simultaneous administration of BCG and Measles, then we have to go for choice C. Tips Search for a reference. 257. Leprosy is considered a public health problem if the prevalence of leprosy is more than: A. 1 per 10,000 B. 2 per 10,000 C. 5 per 10,000 D. 10 per 10,000 Answer: A (1 per 10,000) Ref: Park 17th edn, 247, 311 & 16th edn, 242,307 Quality: Spotter Status: Repeat QTDF: Park Discussion Prevalence of one case per ten thousand populations indicates a potential public health problem. Explanation Self Explanatory Comments Prevalence rate is used for case finding strategy: Prevalence < 1/1000 Contact survey Prevalence 1/1000 or higher Group survey Prevalence 10/1000 or more Mass surveys Tips As always, no question paper is complete without a question in leprosy. Of late the trend has been to ask questions in reactions and types of leprosy. 258. In the management of leprosy, Lepromin test is most useful for: A. Herd immunity. B. Prognosis. C. Treatment. D. Epidemiological investigations. Answer: B (Prognosis) Ref: Park 16th edn, 244; Park 17th edn, 247; Ananthanarayanan Quality: Spotter Status: Repeat QTDF: Park Discussion Lepromin test is an intradermal test for cell mediated immunity. It is of two types: Early (Fernandez reaction) read at 48 hours. Late (Mitbuda reaction) read at 21 days. It is not a diagnostic test, but it is of value in: Evaluating the immune status (CMI) of leprosy patients. Confirming the results of classifications of cases of leprosy on clinical and bacteriological grounds. Estimating the prognosis in cases of leprosy of all types. It is strongly positive in tuberculoid type and negative in lepromatous type. Explanation A. Since you are doing a test on a individual, herd immunity cannot be found. B. Lepromin test is most useful for prognosis. C. Lepromin test is not used for treatment. D. Lepromin test can be used for epidemiological investigations. Comments The recent tests are LTT and LMT (Lymphocyte transforrnation test and Lymphocyte migration test). Tips Mnemonic Early - Fernandez : Late - Mitsuda (EFLM - consecutive alphabets) 259. For controlling an outbreak of cholera, all of the following measures are recommended, except: A. Mass chemoprophylaxis. B. Proper disposal of excreta. C. Chlorination of water. D. Early detection and management of cases. Answer: A (Mass chemoprophylaxis) Ref: Park 17th edn, 171,173 & 16th edn, 170 Quality: Reader Status: Repeat QTDF: Park Discussion Sanitation measures for control of cholera are: 1. Water control 2. Excreta disposal 3. Food sanitation 4. Disinfection Explanation A. Mass chemoprophylaxis is not needed. B. Proper disposal of excreta is done. C. Chlorination of water is done. D. Early detection and management of cases is done. Comments Chemoprophylaxis is, however, advised for household contacts. Tips Cholera is an extremely important topic. Read the compositions of ORS and the assessment of dehydaration and treatment plan of ADD and drugs used. 260. A child aged 24 months was brought to the Primary Health Centre with complaints of cough and fever for the past 2 days. On examination, the child weighed 11 kg. Respiratory rate was 38 per minute, chest indrawing was present. The most appropriate line of management for this patient is: A. Classify as pneumonia and refer urgently to secondary level hospital. B. Classify as pneumonia, start antibiotic and advise to report after 2 days. C. Classify as severe pneumonia, start antibiotics and refer urgently. D. Classify as severe pneumonia and refer urgently. Answer: C (Classify as severe pneumonia, start antibiotics and refer urgently) Ref: Park 17th edn, 136 & 16th edn, 135; OP Ghai 5th edn, 350 Quality: Reader Status: Repeat QTDF: Park Discussion See the tables in Park. Explanation Self Explanatory Comments Make sure that you know the criteria for fast breathing in various age groups. Tips Management of ARI and ADD are important from Exam as well as practical point of view. 261. The following statements about meningococcal meningitis are true, except: A. The source of infection is mainly clinical cases. B. The disease is more common in dry and cold months of the year. C. Chemoprophylaxis of close contacts of cases is recommended. D. The vaccine is not effective in children below 2 years of age. Answer: A (The source of infection is mainly clinical cases) Ref: Park 16th edn, 131; Park 17th edn, 132 Quality: Reader Status: Repeat QTDF: Park Discussion The organism is found in the nasopharynx of cases and carriers. Carriers are most important source of infection. The mean duration of temporary carriers is about 10 months and carriers rate may go up to 80% in epidemics. Clinical cases present only a negligible source of infection. 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no=ZGd ZGd=ZGd ZGdJZGdZGdZGdZGd"ZGdZGdZGd ZGdtZGd ZGdZGdQZGd9ZGdZGdHZGdZGdSZGdZGdUZGd ZGd*ZGdZGdZGdZGdZGd*ZGdZGd*ZGdZGd)ZGdZGd*ZGd ZGd+ZGdZGdZGdZGd ZGdZGdZGdZGdZGd ZGd ZGd ZGdZGd ZGd8ZGdZGdWZGdZGd<ZGdIZGdZGd?ZGdZGd3ZGdZGdNZGd ZGdKZGdZGdZGdCZGdZGdZGdZGdZGd<<GdZGdZGd ZGdZGdZGdZGdZGdZGdZGd ZGdZGd ZGd1ZGd0ZGd ZGdZGdeZGdZGd`ZGdZGdGZGdZGdiZGd ZGd@ZGd$ZGd2ZGd&ZGdZGd\ZGdZZGdZGd(ZGdZGd8ZGdZGdZGdZGd&ZGd ZGd8ZGdZGdZGdZGd5ZGdZGdZGdZGd%ZGd ZGdIZGd*@,:@;@4ABD C. 120 mg of elemental iron and 750 micrograms of folic acid is not the correct dose. D. 200 mg of elemental iron and 1000 micrograms of folic acid is not the correct dose. Comments CX(xKddd ,(xKdd5 ,(xKdd x(xKdd x(xKdd x(xKdd (xKdd# (xKdd ,(xKddCh(xKdddh(xKdddh(xKddd1h(xKdddah(xKdddPh(xKdddph(xKddd ,(xKdd0X(xKdddCX(xKdddCX(xKdddCX(xKddd ,(xKdd` (xKdd ,(xKdd( (xKddph(xKddd (xKddBh<(xKdddX(xKddd ,(xKdd ,(xKdd x(xKdd x(xKdd x(xKdd (xKdd# (xKdd ,(xKdd (xKddh(xKddd"(xKddd5(xKddd%(xKdddh(xKddd(xKddd"(xKdddA(xKddd&(xKdddh(xKdddU(xKddd,(xKddd'(xKddd(xKddd ,(xKddX(xKddd ,(xKdd (xKdd ,(xKdd (xKdd (xKddlh<(xKdddX(xKdddX(xKdddX(xKdddX(xKddd ,(xKdd ,(xKdd x(xKdd# x(xKdd x(xKdd (xKdd# (xKdd ,(xKddx (xKdd ,(xKdd/X(xKddd,X(xKddd<X(xKdddAX(xKddd(xKddd=(xKddd(xKddd ,(xKddk (xKdd ,(xKdd (xKdd (xKdd;h<(xKdddj \ '\P-kDlGáD*w-kDLD*w-k '\P-kDlGáD*w-kDLD*w-kH!0߸pP0PP  '\P-kDlGáD*w-kDLD*w-k '\P-kDlGáD*w-kDLD*w-kH!0Pp0PP  3un '\P-kDlGáD*w-kDLD*w-k '\P-kDlGáD*w-kDLD*w-kH!0߸pP0PP  0񄋋D_-kD'|x%A\Pb '\P-kDlGáD*w-kDLD*w-kH!0Pp0PP  0 '\P-kDlGáD*w-kDLD*w-k '\P-kDlGáD*w-kDLD*w-kH!0߸pP0PP  0񄋋D_-kD'|x%A\Pb '\P-kDlGáD*w-kDLD*w-kH!0Pp0PP  uS n '\P-kDlGáD*w-kDLD*w-k '\P-kDlGáD*w-kDLD*w-kH!0߸pP0PP "0񄋋D_-kD'|x%A\Pb '\P-kDlGáD*w-kDLD*w-kH!0Pp0PP `? '\P-kDlGáD*w-kDLD*w-k '\P-kDlGáD*w-kDLD*w-kH!0߸pP0PP 4&{0񄋋D_-kD'|x%A\Pb '\P-kDlGáD*w-kDLD*w-kH!0Pp0PP RX,@ l L,@ l ,@ l ,@ l D,@ l ,@ l ,@ l ,@ l rh|chmxh]j ,@ l iXX ,@ l @,@ l |,@ l \,@ l ZhXF,@ l ,@ l ,@ l ,@ l m,@ l ,@ l ,@ l ,@ l A question from Park 17th Edition. (In older editions, it is given as 60 mg of iron but nevertheless the dose of folic acid is 500 mcg and so you have to choose only choice B even if you go by the book. Note that oral iron in slightly increased doses is not toxic whereas folic acid is essential). Tips Questions on iron metabolism and anaemia question can pop up from any subject from physiology to OG and are often repeated and can be easily answered. 267. Elemental iron and folic acid contents of paediatric iron-folic acid tablets supplied under Rural Child Health (RCH) Programme are: A. 20 mg iron and 100 micrograms folic acid. B. 40 mg iron and 100 micrograms folic acid. C. 40 mg iron and 50 micrograms folic acid. D. 60 mg iron and 100 micrograms folic acid. Answer: A (20 mg iron and 100 micrograms folic acid) Ref: Park 16th edn, 432; Park 17th edn, 439 Quality: Spotter Status: Repeat QTDF: Park Discussion In children (1-12 years), daily supplementation based on requirement of iron and folic acid is done to prevent mild and moderate cases of anaemia. Each paediatric tablet contains 20 mg of elemental iron (60 mg of ferrous sulphate) and 100 mcg (0.1 mg) of folic acid. Explanation Self Explanatory Comments A question that is being repeated for a long long time. Tips Nutrition is an extremely important topic, both from SPM and paediatric point of view. 268. The protein efficiency ratio (PER) is defined as: A. The gain in weight of young animals per unit weight of protein consumed. B. The product of digestibility coefficient and biological value. C. The percentage of protein absorbed into the blood. D. The percentage of nitrogen absorbed from the protein absorbed from the diet. Answer: A (The gain in weight of young animals per unit weight of protein consumed) Ref: Park 17th edn, 432; Textbook of Medical Biochemistry 4th edn, Chaterjee and Shinde 702 Quality: Reader Status: New QTDF: Park Discussion Protein energy ratio is defined as the ratio of the weight increased in grams to the gms of proteins consumed. Protein efficiency ratio = Weight increase in gms Gms of protein consumed Biological value is defined as the percentage of absorbed nitrogen that is retained in the body Biological value (BV) = Nitrogen retained 100 Nitrogen absorbed Net protein utlilisation (NPU) is defined as the percentage of nitrogen in the food, that is retained by the body NPU = Nitrogen retained 100 Nitrogen present in the food NPU = Digestibility coefficient Biological Value (BV) 100 Explanation A. The gain in weight of young animals per unit weight of protein consumed is protein efficiency ratio. B. The product of digestibility coefficient and biological value is net protein utilisation 100. C. The percentage of protein absorbed into the blood is biological value. D. The percentage of nitrogen absorbed from the protein absorbed from the diet is net protein utilisation. Comments Other specialised procedures of nutritional assessment include: 1. Bioelectric impedance analysis. 2. Energy expenditure (Harris benedict equation) 3. Creatinine excretion in 24 hours. Tips The various graddings of protein energy malnutrition are given well in achar's paediatrics. 269. Most important epidemiological tool used for assessing disability in children is: A. Activities of daily living (ADL) scale. B. Wings handicaps' behaviour and skills (HBS) schedule. C. Binet and simon IQ tests. D. Physical quality of life index (PQLI) Answer: B (Wings handicaps' behaviour and skills (HBS) schedule) Ref: Park 16th edn, 462; Park 17th edn, 469 Quality: ReaderYou have to read the nook and corner of Park Status: New QTDF: Park (Yes !!! It is given in Park) Discussion There have been many attempts to measure or record in standardised forms, the aspects of behaviour, psychological function and social performance. One of the most important is Wings comprehensive handicaps' behaviour and skills (HBS) schedule which has been used in epidemiological studies to access the total child population. In the 1970s, for purposes of their research, Wing and Gould (1978) designed the first interview schedule that was intended to elicit from informants, in systematic fashion, all the details concerning history and present clinical pictures needed to make a diagnosis of typical autism. This was called the handicaps' behaviour and skills (HBS) schedule. As a result of using this schedule in research, Wing and Gould (1979) came to realise that there was a whole spectrum of disorders that overlap with typical autism. These disorders all have in common a triad of impairments of social interaction, communication and imagination, and a narrow, repetitive pattern of activities. Explanation A. Activities of daily living (ADL) scale: ADL : Survey based on 6 criteria Bathing (sponge bath, tub bath, or shower) Receives either no assistance or assistance in bathing only one part of body. Dressing: Gets clothes and dresses without any assistance except for tying shoes. Toileting: Goes to toilet room, uses toilet, arranges clothes, and returns without any assistance (may use cane or walker for support and may use bedpan/urinal at night). Transferring: Moves in and out of bed and chair without assistance (may use cane or walker). Continence: Controls bowel and bladder completely by self (without occasional accidents). Feeding: Feeds self without assistance (except for help with cutting meat or buttering bread) total ADL score: (Number of yes answers, out of possible 6.) Each criteria is graded on level of dependence: Performs independently Performs with assistance Unable to perform (assigned 1 point each) Interpretation Level of ADL dependence graded via score Independent in ADLs suggested by score of 0 to 1 Dependence in ADLs increases as score approaches 6 ADL used mainly in geriatrics, especially Alzheimers disease B. Wings Handicaps' behaviour and skills (HBS) schedule is the most important epidemiological tool used for assessing disability in children. C. Binet and simon IQ tests are used for testing IQ. D. Physical quality of life index (PQLI) consists of 3 indicators Infant mortality rate Life expectancy at age one Literacy Comments Straight from Park Tips Of late more questions are asked from Park from hitherto unexplored areas. 270. Scope of family planning services include all of the following, except: A. Screening for cervical cancer. B. Providing services for unmarried mothers. C. Screening for HIV infection. D. Providing adoption services. Answer: C (Screening for HIV infection) Ref: Park 17th edn, 335 & 16th edn, 329 Quality: Reader Status: Repeat QTDF: Park Discussion The scope of family planning services includes: 1. Proper spacing and limitation of births 2. Advice on sterility 3. Education for parenthood 4. Sex education 5. Screening for pathological conditions related to reproductive system, e.g. cervical cancer 6. Genetic counselling 7. Premarital consultation and examination 8. Pregnancy test 9. Marriage counselling 10. Preparation of couples for arrival of their 1st child 11. Id' '\P-kDlGáD*w-kDLD*w-k '\P-kDlGáD*w-kDLD*w-kH!0߸pP0PP $l0񄋋D_-kD'|x%A\Pb '\P-kDlGáD*w-kDLD*w-kH!0Pp0PP 2+ v '\P-kDlGáD*w-kDLD*w-k '\P-kDlGáD*w-kDLD*w-kH!0߸pP0PP 3-r$un;0񄋋D_-kD'|x%A\Pb '\P-kDlGáD*w-kDLD*w-kH!0Pp0PP 4. 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(In older editions, it is given as 60 mg of iron but nevertheless the dose of folic acid is 500 mcg and so you have to choose only choice B even if you go by the book. Note that oral iron in slightly increased doses is not toxic whereas folic acid is essential). Tips Questions on iron metabolism and anaemia question can pop up from any subject from physiology to OG and are often repeated and can be easily answered. 267. Elemental iron and folic acid contents of paediatric iron-folic acid tablets supplied under Rural Child Health (RCH) Programme are: A. 20 mg iron and 100 micrograms folic acid. B. 40 mg iron and 100 micrograms folic acid. C. 40 mg iron and 50 micrograms folic acid. D. 60 mg iron and 100 micrograms folic acid. Answer: A (20 mg iron and 100 micrograms folic acid) Ref: Park 16th edn, 432; Park 17th edn, 439 Quality: Spotter Status: Repeat QTDF: Park Discussion In children (1-12 years), daily supplementation based on requirement of iron and folic acid is done to prevent mild and moderate cases of anaemia. Each paediatric tablet contains 20 mg of elemental iron (60 mg of ferrous sulphate) and 100 mcg (0.1 mg) of folic acid. Explanation Self Explanatory Comments A question that is being repeated for a long long time. Tips Nutrition is an extremely important topic, both from SPM and paediatric point of view. 268. The protein efficiency ratio (PER) is defined as: A. The gain in weight of young animals per unit weight of protein consumed. B. The product of digestibility coefficient and biological value. C. The percentage of protein absorbed into the blood. D. The percentage of nitrogen absorbed from the protein absorbed from the diet. Answer: A (The gain in weight of young animals per unit weight of protein consumed) Ref: Park 17th edn, 432; Textbook of Medical Biochemistry 4th edn, Chaterjee and Shinde 702 Quality: Reader Status: New QTDF: Park Discussion Protein energy ratio is defined as the ratio of the weight increased in grams to the gms of proteins consumed. Protein efficiency ratio = Weight increase in gms Gms of protein consumed Biological value is defined as the percentage of absorbed nitrogen that is retained in the body Biological value (BV) = Nitrogen retained 100 Nitrogen absorbed Net protein utlilisation (NPU) is defined as the percentage of nitrogen in the food, that is retained by the body NPU = Nitrogen retained 100 Nitrogen present in the food NPU = Digestibility coefficient Biological Value (BV) 100 Explanation A. The gain in weight of young animals per unit weight of protein consumed is protein efficiency ratio. B. The product of digestibility coefficient and biological value is net protein utilisation 100. C. The percentage of protein absorbed into the blood is biological value. D. The percentage of nitrogen absorbed from the protein absorbed from the diet is net protein utilisation. Comments Other specialised procedures of nutritional assessment include: 1. Bioelectric impedance analysis. 2. Energy expenditure (Harris benedict equation) 3. Creatinine excretion in 24 hours. Tips The various graddings of protein energy malnutrition are given well in achar's paediatrics. 269. Most important epidemiological tool used for assessing disability in children is: A. Activities of daily living (ADL) scale. B. Wings handicaps, behaviour and skills (HBS) schedule. C. Binet and simon IQ tests. D. Physical quality of life index (PQLI) Answer: B (Wings handicaps, behaviour and skills (HBS) schedule) Ref: Park 16th edn, 462; Park 17th edn, 469 Quality: ReaderYou have to read the nook and corner of Park Status: New QTDF: Park (Yes !!! It is given in Park) Discussion There have been many attempts to measure or record in standardised forms, the aspects of behaviour, psychological function and social performance. One of the most important is Wings comprehensive handicaps, behaviour and skills (HBS) schedule which has been used in epidemiological studies to access the total child population. In the 1970s, for purposes of their research, Wing and Gould (1978) designed the first interview schedule that was intended to elicit from informants, in systematic fashion, all the details concerning history and present clinical pictures needed to make a diagnosis of typical autism. This was called the handicaps behaviour and skills (HBS) schedule. As a result of using this schedule in research, Wing and Gould (1979) came to realise that there was a whole spectrum of disorders that overlap with typical autism. These disorders all have in common a triad of impairments of social interaction, communication and imagination, and a narrow, repetitive pattern of activities. Explanation A. Activities of daily living (ADL) scale: ADL : Survey based on 6 criteria Bathing (sponge bath, tub bath, or shower) Receives either no assistance or assistance in bathing only one part of body. Dressing: Gets clothes and dresses without any assistance except for tying shoes. Toileting: Goes to toilet room, uses toilet, arranges clothes, and returns without any assistance (may use cane or walker for support and may use bedpan/urinal at night). Transferring: Moves in and out of bed and chair without assistance (may use cane or walker). Continence: Controls bowel and bladder completely by self (without occasional accidents). Feeding: Feeds self without assistance (except for help with cutting meat or buttering bread) total ADL score: (Number of yes answers, out of possible 6.) Each criteria is graded on level of dependence: Performs independently Performs with assistance Unable to perform (assigned 1 point each) Interpretation Level of ADL dependence graded via score Independent in ADLs suggested by score of 0 to 1 Dependence in ADLs increases as score approaches 6 ADL used mainly in geriatrics, especially Alzheimers disease B. Wings Handicaps', behaviour and skills (HBS) schedule is the most important epidemiological tool used for assessing disability in children. C. Binet and simon IQ tests are used for testing IQ. D. Physical quality of life index (PQLI) consists of 3 indicators Infant mortality rate Life expectancy at age one Literacy Comments Straight from Park Tips Of late more questions are asked from Park from hitherto unexplored areas. 270. Scope of family planning services include all of the following, except: A. Screening for cervical cancer. B. Providing services for unmarried mothers. C. Screening for HIV infection. D. Providing adoption services. Answer: C (Screening for HIV infection) Ref: Park 17th edn, 335 & 16th edn, 329 Quality: Reader Status: Repeat QTDF: Park Discussion The scope of family planning services includes: 1. Proper spacing and limitation of births 2. Advice on sterility 3. Education for parenthood 4. Sex education 5. Screening for pathological conditions related to reproductive system, e.g. cervical cancer 6. Genetic counselling 7. Premarital consultation and examination 8. Pregnancy test 9. Marriage counselling 10. Preparation of couples for arrival of their 1st child 11. 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J T *d  >CcC,cC, c+C, c:#,CWcC,cC,c&C,1 cC,@BcC,@BcC,'Cb @B, C@B, CcC,cC,wcC,.caD3CXca: CXcaN CX caD CX)ca0CXecc, C@BcC,@BcC,C0@@,CC@B, C@B,!Cs cc, cBC@ cc, c c@ Ccc,Ccc, Ccc,Ccc, Cbcc, Ccc, c1C@ CCcC,C c c,c@ Cl cc, c@ CCc C,cC,c C, Cc C,5cC,GcC,CChCCC 52. 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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(In older editions it is given as 60 mg of Iron but nevertheless the dose of Folic Acid is 500 mcg and so you have to choose only choice 2 even if you go by the book. Note that oral Iron is slightly increased doses is not toxic where as Folic Acid is essential) Tips Questions on Iron Metabolism and Anaemia Question can pop up from Any subject from Physiology to OG and are often repeated and can be easily answered 267. Elemental iron and folic acid contents of pediatric iron-folic acid tablets supplied under Rural child Health (RCH) Program are: A. 20 mg iron & 100 micrograms folic acid. B. 40 mg iron & 100 micrograms folic acid. C. 40 mg iron & 50 micrograms folic acid. D. 60 mg iron & 100 micrograms folic acid. Answer: A (20 mg iron & 100 micrograms folic acid) Ref: Park 16th edn, 432; Park 17th edn, 439 Quality: Spotter Status: Repeat QTDF: Park Discussion In children (1-12 years) daily supplementation based on requirement of iron and folic acid is done to prevent mild and moderate cases of anemia. Each pediatric tablet contains 20 mg of elemental iron (60 mg of ferrous sulphate) and 100mcg (0.1 mg) of folic acid. Explanation Self Explanatory Comments A question that is being repeated for a long long time Tips Nutrition is an extremely important topic, both from SPM and Paediatric Point of View 268. The Protein Efficiency Ratio (PER) is defined as: A. The gain in weight of young animals per unit weight of protein-consumed. B. The product of digestibility coefficient and biological value. C. The percentage of protein absorbed into the blood. D. The percentage of nitrogen absorbed from the protein absorbed from the diet. Answer: A (The gain in weight of young animals per unit weight of protein-consumed) Ref: Park 17th edn, 432; Textbook of Medical Biochemistry 4th edn, Chaterjee and Shinde 702 Quality: Reader Status: New QTDF: Park Discussion Protein Energy Ratio is defined as the Ration of the weight increased in grams to the gms of proteins consumed u Protein efficiency ratio = Weight increase in gms Gms of protein consumed Biological value is defined as the percentage of absorbed nitrogen that is retained in the body u Biological value (B.V.) = Nitrogen retained X 100 Nitrogen absorbed Net protein utlilization (NPU) is defined as the percentage of nitrogen in the food, that is retained by the body u NPU = Nitrogen retained x 100 Nitrogen present in the food u NPU = Digestibility coefficient X Biological Value (B.V.) 100 Explanation A. The gain in weight of young animals per unit weight of protein-consumed is Protein Efficiency Ratio. B. The product of digestibility coefficient and biological value is Net Protein Utilisation x 100. C. The percentage of protein absorbed into the blood is Biological Value. D. The percentage of nitrogen absorbed from the protein absorbed from the diet is Net Protein Utilisation. Comments Tips Question. 269. Most important epidemiological tool used for assessing disability in children is: 1.Activities of Daily living (ADL) scale. 2.Wings Handicaps, Behavior and Skills (HBS) Schedule. 3.Binet and Simon IQ tests. 4.Physical Quality of Life Index (PQLI) Answer: 2.Wings Handicaps, Behavior and Skills (HBS) Schedule. Ref: Park 16th Edition Page 462 Park 17th Edition Page 469 Quality: Reader - You have to read the nook and corner of Park Status: New QTDF: Park (Yes !!! It is given in Park) Discussion There have been many attempts to measure or record in standardized forms, the aspects of behaviour, psychological function and social performance. One of the most important is Wings comprehensive Handicaps Behaviour and Skills (HBS) schedule which has been used in epidemiological studies to access the total child population In the 1970s, for purposes of their research, Wing and Gould (1978) designed the first interview schedule that was intended to elicit from informants, in systematic fashion, all the details concerning history and present clinical pictures needed to make a diagnosis of typical autism. This was called the Handicaps Behaviour and Skills (HBS) schedule. As a result of using this schedule in research, Wing and Gould (1979) came to realise that there was a whole spectrum of disorders that overlap with typical autism. These disorders all have in common a triad of impairments of social interaction, communication and imagination, and a narrow, repetitive pattern of activities. Explanation 1.Activities of Daily living (ADL) scale. ADL : Survey Based on 6 criteria u Bathing (sponge bath, tub bath, or shower) Receives either no assistance or assistance in bathing only one part of body u Dressing - Gets clothes and dresses without any assistance except for tying shoes. u Toileting - Goes to toilet room, uses toilet, arranges clothes, and returns without any assistance (may use cane or walker for support and may use bedpan/urinal at night u Transferring - Moves in and out of bed and chair without assistance (may use can or walker). u Continence - Controls bowel and bladder completely by self (without occasional accidents). u Feeding - Feeds self without assistance (except for help with cutting meat or buttering bread). TOTAL ADL SCORE: (Number of yes answers, out of possible 6.) Each criteria is graded on level of dependence u Performs independently u Performs with assistance u Unable to perform (assigned 1 point each) Interpretation u Level of ADL Dependence graded via score u Independent in ADLs suggested by score of 0 to 1 u Dependence in ADLs increases as score approaches 6 ADL used mainly in Geriatrics, especially Alzheimers disease 2.Wings Handicaps, Behavior and Skills (HBS) Schedule is the Most important epidemiological tool used for assessing disability in children 3.Binet and Simon IQ tests are used for testing IQ. 4.Physical Quality of Life Index (PQLI) consists of 3 indicators Infant Mortality rate Life expectancy at age one Literacy Comments Straight from Park Tips Of late more questions are asked from Park from hitherto unexplored areas Question. 270. Scope of family planning services include all of the following except: 1.Screening for cervical cancer. 2.Providing services for unmarried mothers. 3.Screening for HIV infection. 4.Providing adoption services. Answer 3.Screening for HIV infection. Ref: Park 17th Edition Page 335 & 16th Edition Page 329 Quality: Reader Status: Repeat QTDF: Park Discussion The scope of family planning services includes - 1. Proper spacing & limitation of births 2. Advice on sterility 3. Education for parenthood 4. Sex education 5. Screening for pathological conditions related to reproductive system e.g. cervical cancer 6. Genetic counseling 7. Premarital consultation & examination 8. Pregnancy test 9. Marriage counseling 10. Preparation of couples for arrival of their 1st child 11. 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