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Ureteroscopic retrieval. Answer: D (Ureteroscopic retrieval) Ref: Bailey & Love 23rd edn, 1189 Quality: Reader Status: Repeat QTDF: Bailey Discussion Methods for removal are: Ureteroscopic Removal Small stone Stone in lower part of ureter within 5-6 cm of ureteric orifice Extracorporal Shock Wave Lithotripsy Proximal stones Midureter stones are pushed up and then exposed to shock waves Stones less than 2 to 2.5 cm Percutaneous Nephrolithotripsy For proximal ureteral calculi Stones more than 2.5 cm Stones that are resistant to shock wave Open Urethrolithotomy For long-standing cases Explanation Self Explanatory Comments Regular Question Tips Indications for stone removal (Mnemonic POLICE) PassiveStone is stationary ObstructionCausing obstruction LargeStone too large to pass Infection ColicRepeated attacks of colic EnlargingStone is increasing in size 293. A 65-year-old male smoker presents with gross total painless haematuria. The most likely diagnosis is: A. Carcinoma urinary bladder. B. Benign prostatic hyperplasia. C. Carcinoma prostate. D. Cystolithiasis. Answer: A (Carcinoma urinary bladder) Ref: Bailey & Love 23rd edn, 1229 Quality: Reader Status: Repeat QTDF: Bailey Discussion Painless haematuria is Ca bladder unless proved otherwise. In this patient, the other findings favouring the diagnosis are: 65 years Male Smoker Explanation Self Explanatory Comments About bladder carcinoma MC typeTransitional cell carcinoma From urachusAdenocarcinoma Due to schistosomiasisSquamous cell carcinoma Tips Please read the predisposing factors. 294. Semen analysis of a young man who presented with primary infertility revealed low volume, fructose negative ejaculate with azoospermia. Which of the following is the most useful imaging modality to evaluate the cause of his infertility? A. Colour duplex ultrasonography of the scrotum. B. Transrectal ultrasonography. C. Retrograde urethrography. D. Spermatic venography. Answer: B (Transrectal ultrasonography) Ref: Sabiston 15th edn, 1556; Oxford Textbook of Surgery Quality: Thinker Status: New QTDF: Sabiston /Oxford Discussion Physical examination of the infertile male should include careful examination of the genitalia, particularly to ensure the testes are of normal size and consistency, the epididymides and vasa are present, and tZdZ\ /C/l@ m|.@x5.--z00%%($(   @     @    /@ @   e @ +   : @ [ @ @          +@    @&111@C,cC,cC,cC,CP L(@f0PK :fand ventilator circuit disconnections, and ensurh- ,@ l 6X5XiXX ,@ l ,@ l UhXEXXEXXZdZdZdNZdZdJZdZdcaused by a variety of microorganisms, including mycobacteria; and is common in northern Nigeria. D. Meleneys gangrene or Meleneys ulcer or progressive bacterial synergistic gangrene is an undermining ulcer of the skin and subcutaneous tissues, usually following an operation, caused by a synergistic interaction between microaerophilic nonhaemolytic streptococci and aerobic haemolytic staphylococci. Comments This a reflex question for anyone who has attended his ward posting regularly. Tips Questions like these being asked in All India make us suggest you to read (at least the important topics in) the Clinical Das once before going to the exam. 277. The best treatment for cystic hygroma is: ZdZd`ZdZdHZd ZdFZdZdhZd ZdZdZd8ZdcZdZdZdZdZdZdZdZd Zd Zd9ZdZd ZdZdZdZd Zd Zd-ZdZd22d@Fd22dFd22dFd22dHFdZd22dZdZdZdZdZdZdZdZd Zd,ZdZdXZdfZdZdZd ZdZd ZdZdZd Zd ZdMZdZd ZdZdZdZd Zd Zd9Zd ZdZd Zd(Zd22d-Pd22dPdPdPd PdtPd PdPd22dZd2Zd_Zd ZdZdZdZdZdZdRisk factors for cholangiocarcinoma are: 1. Chronic hepatobiliary parasitic infectionsLiver flukes 2. Congenital anomalies with ectatic ductsCholedochocyst /Carolies disease 3. Polycystic liver 4. Congenital hepatic fibrosis 5. Sclerosing cholangitis 6. Chronic ulcerative colitis 7. Occupational exposure Explanation Self-Explanatory Comments Cholelithiasis is not a risk factor. Tips Some books simply say that 'parasitic diseases lead to cholangiocarcinoma and obviously it refers to the fluke. Choices B, C and D are given in almost all books. 290. Strong correlation with colorectal cancer is seen in: A. Peutz-Jeghers polyp. B. Familial polyposis coli. C. Juvenile polyposis. D. Hyperplastic polyp. Answer: B (Familial polyposis coli) Ref: Harrisons, 15th edn, 582 Quality: Spotter Status: Repeat QTDF: All books Discussion Dominantly inherited colon cancer is sometimes associated with familial polyposis, which is usually due to mutations in the adenomatous polyposis coli (APC) tumour suppressor gene on chromosome 5. Hereditable (Autosomal dominant) gastrointestinal polyposis syndromes Syndrome Distribution Histologic type Malignant Associated lesions of Polyp Potential Familial Large Adenoma Common None adenomatous intestine polyposis Gardners Large and Adenoma Common Osteomas, fibromas, syndrome small intestine lipomas, epidermoid cysts, ampullary cancers, congenital hypertrophy of retinal pigment epithelium Turcots Large Adenoma Common Brain tumours syndrome intestine Nonpolyposis Large Adenoma Common Endometrial and syndrome intestine ovarian tumours (Lynch's (often syndrome) proximal) Peutz-Jeghers Small and Hamartoma Rare Mucocutaneous syndrome large pigmentation; tumours intestines, of the ovary, breast, stomach pancreas, endometrium Juvenile Large and Hamartoma, Rare Various congenital polyposis small rarely progressing abnormalities intestines, to adenoma stomach Explanation A. Peutz-Jeghers polyp is rarely malignant. B. Familial polyposis coli is premalignant. C. Juvenile polyposis rarely progresses to adenoma. D. Hyperplastic polyp is usually not premalignant. Comments Most colorectal cancers, regardless of aetiology, arise from adenomatous polyps. A polyp is a grossly visible protrusion from the mucosal surface and may be classified pathologically as a non-neoplastic hamartoma (juvenile polyp), a hyperplastic mucosal proliferation (hyperplastic polyp), or an adenomatous polyp. Only adenomas are clearly premalignant, and only a minority of such lesions ever develop into cancer. Tips Occasionally, patients with Gardners syndrome develop premalignant adenomas in the small bowel; such lesions are generally in the duodenum. Multiple polypoid tumours may occur throughout the small bowel (and occasionally the stomach and colorectum) in the Peutz-Jeghers syndrome. 291. A 50-year-old male working as a hotel cook, has four dependent family members. He has been diagnosed with an early stage squamous cell cancer of anal canal. He has more than 60% chances of cure. The best treatment option is: A. Abdomino-perineal resection. B. Combined surgery and radiotherapy. C. Combined chemotherapy and radiotherapy. D. Chemotherapy alone. Answer: C (Combined chemotherapy and radiotherapy) Ref: Bailey and Love 23rd edn, 1141 Quality: Reader Status: Repeat QTDF: Bailey Discussion Tumours arising in the anal canal or in the transitional zone that have a: squamous, basaloid, cloacogenic, or mucoepidermoid epithelium share a similar clinical presentation, response to treatment, and prognosis and are considered collectively. They typically present as: a mass, sometimes with bleeding and pruritus. At the time of diagnosis, 50% are less than 3 cm in size, and the rest are larger. Nearly a quarter are superficial or in situ. In the past, treatment modalities included either surgery alone or radiation alone. Patients with: tumours confined to epithelial or subepithelial tissue have been 3 treated by local excision, and patients with more advanced lesions 3 by abdominoperineal resection. for superficial, early-stage lesions, 3 local excision alone remains a good option. Patients with lesions greater than 2 cm with any suggestion of fixation or sphincter involvement on digital examination or anal ultrasonography should not be treated by local excision. 3 Thus, the majority of patients who are not candidates for local excision are best treated by combined chemotherapy and radiation therapy. Explanation We see that for superficial lesions, local excision alone suffice, but since that is not given as one of the choices, we go for chemoradiation as the answer. Comments The introduction of multimodality therapy, combining radiation and chemotherapy, promised to preserve continence, avoid colostomy, and offer similar survival advantages. Tips External irradiation: 3000 cGy to primary tumour and pelvic and inguinal nodes. Start day 1 (200 cGy/day) Systemic chemotherapy: 5-fluorouracil: 1000 mg/sq m for 24 hours as a continuous infusion for 4 days. Start day 1. Mitomycin C: 15 mg/sq m intravenous bolus. Day 1 only. 5-fluorouracil: Repeat 4-day infusion. Start day 28. 292. A 10-mm calculus in the right lower ureter associated with proximal hydrouretero-nephrosis is best treated with: A. 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It is also called neurogenic ulcer, neuropathic ulcer or penetrating ulcer. It occurs in heel and ball of the foot in ambulatory patients and buttocks and back in non-ambulatory patients. Explanation A. Tropical ulcer or tropical sore is the lesion occurring in cutaneous leishmaniasis, tropical phagedenic ulceration caused by a variety of microorganisms, including mycobacteria; and is common in northern Nigeria. B. Bed sore comes under the category of trophic ulcer. C. Venous ulcer is caused by the stagnation due to varicose veins. D. Post-thrombotic ulcer is venous ulcer. Comments A simple, unexpected question. Tips Bed sore is a chronic ulcer that appears in pressure areas in debilitated patients confined to bed or otherwise immobilised, due to a circulatory defect from the enhanced tissue pressure in high-contact areas, often occurring over a bony prominence (for example, sacral decubitus). 276. Marjolins ulcer is a: A. Malignant ulcer found on the scar of burn. B. Malignant ulcer found on infected foot. C. Tropic ulcer. D. Meleneys gangrene. Answer: A (Malignant ulcer found on the scar of burn) Ref: Bailey & Love 23rd edn, 180; Short Cases in Surgery by S. Das 2nd edn, 28; Schwartz 7th edn, 257 Quality: Spotter Final MBBS Status: Repeat QTDF: Bailey Discussion Marjolins ulcer is a squamous cell carcinoma rising from a scar or ulcer. The scar that commonly is transformed to a Marjolins ulcer is the scar of burns and the ulcer is the chronic venous ulcer. The previous inflammation destroys the cutaneous nerves and lymphatics and to a certain extent the blood vessels. The carcinoma is, therefore, slow growing, painless and rarely there is metastasis. Explanation A. Malignant ulcer found on the scar of burn is the classical Marjolin's ulcer. B. Malignant ulcer is also found on infected foot and is usually squamous cell carcinoma. C. Tropic ulcer or tropical sore is the lesion occurring in cutaneous leishmaniasis, tropical phagedenic ulceration caused by a variety of microorganisms, including mycobacteria; and is common in northern Nigeria. D. Meleneys gangrene or Meleneys ulcer or progressive bacterial synergistic gangrene is an undermining ulcer of the skin and subcutaneous tissues, usually following an operation, caused by a synergistic interaction between microaerophilic nonhaemolytic streptococci and aerobic haemolytic staphylococci. Comments This a reflex question for anyone who has attended his ward posting regularly. Tips Questions like these being asked in All India make us suggest you to read (at least the important topics in) the Clinical Das once before going to the exam. 277. The best treatment for cystic hygroma is: GdZGd shock wavesZdCZdZdZdZdZdZdZdZd ZdZdZdZd ZdZdZdZd Zd ZdZd ZdZd Zd+ZdZdkZd6Zd ZdZd ZdZdZdZdZd ZdZdWZdZd ZdZdZdZd Zd ZdZdZd)ZdZd6ZdZdZdZd-Zd ZdfZdZdZd+ZdZdZdZdZdZdZdZd ZdZdbZdZdZdZdZdZd Zd Zd/ZdZdZdZdsZdZd1ZdZdZdZdgZdZd$ZdZd$ZdZdZdZd#ZdZdZdZdjZdZd!ZdZdUZd Zd]ZdZdZdZdLZdZd,@ l ,@ l ,@ l y tu2X ,@ l f,@ l ,@ l ,@ l 'hQX2,@ l hyh ,@ l YX,@ l ,@ l ,@ l hXXXX,@ l ,@ l ,@ l ",@ l -kDL+,@ l EhJ:h]MBUhB,@ l ,@ l Er:YAG Laser. The erbium laseraser thermal arterial recanalizationh- ,@ l 6X5XhXX ,@ l ,@ l ,@ l ,@ l UhXEXX Bilateral hydroureteronephrosis. BA@@!A@BCDFWhen we trace the source of question. Principles of Surgery (Schwartz) 3 Ulcers (Short Cases Das) 2 Swelling (Short Cases Das) 1 Arteries (Short Cases Das) 3 Veins (Short Cases Das) 1 Thyroid (Pathology and Medicine) 3 GIT (Path, Medicine and Paed) 5 Liver (Path, Medicine and Paed) 2 Urology (Schwartz, Sabiston, OTS) 9 Of the 29 Questions Bailey was not required for any of the questions. Short Cases in Surgery by Das emerged as a surprise Question Bank. This is a small book and most of the topics that are dealt there are dealt in detail. Though Questions are not being directly asked from Bailey now-a-days. With Short cases Das and Bailey you can attempt most of the questions if your knowledge in path and medicine are good. 272. One unit of fresh blood raises the Hb% concentration by: A. 0.1 gm% B. 1 gm% C. 2 gm% D. 2 gm% Answer: B (1 gm%) Ref: Washingtons Manual of Surgery; Also found in; PARAS - PARAS 4th edn, 30; SARP - SARP 6th edn, 129; Sure Success in PG Entrance 1st edn, 79 Quality: Spotter Status: New QTDF: Sabiston Discussion In India, l unit of blood = 350 ml (301 ml of blood + 49 ml of anticoagulant) while in western countries one unit contains 450 ml (out of which 63 ml is anticoagulant). One unit of blood raises the Hb by 0.8 g% in India while in western countries by 1 g%. Explanation Self-Explanatory Comments Given in Sabiston and other Surgery books. Tips There is another formula for calculating iron requirement in anaemia. Please be prepared with that also. 273. Early stage of trauma is characterised by: A. Catabolism B. Anabolism C. Glycogenesis. D. Gluconeogenesis. Answer: A (Catabolism) Ref: Harper; Bailey and Love 23rd edn, 65; Sabiston, 19; Schwartzes 17th edn, 233, 80 Quality: Spotter Status: New QTDF: Schwartz Discussion In the early stage it is the catabolic processes like gycogenolysis which happen. Gluconeogenesis starts only after glycogenolysis which itself is catabolism. Explanation A. Catabolism (glycogenolysis) starts first B. Anabolism occurs when the body is in a well-fed state C. Glycogenesis is anabolism. D. Gluconeogenesis occurs after glycogenolysis. Comments Adequate nutrition is a daily concern in any postoperative patient; in the context of ARF, it assumes even greater importance. Acute uraemia is a catabolic condition. The postoperative or trauma patient who cannot eat is also catabolic. Tissue catabolism in these patients releases potassium, acids, water, phosphorus, and nitrogenous products into the ECF. Tips Beware of the word early. 274. A 64-year-old hypertensive obese female was undergoing surgery for fracture femur under general anaesthesia. Intra-operatively her end-tidal carbon dioxide decreased to 20 from 40 mmHg. followed by hypotension and oxygen saturation of 85%. What could be the most probable cause? A. Fat embolism. B. Hypovolaemia. C. Bronchospasm. D. Myocardial infarction. Answer: A (Fat embolism) Ref: Sabiston Chapter 11 Anaesthesia; Oxford Textbook of Surgery Chapter 5.1 Respiratory Problems Quality: Reader Status: Repeat QTDF: Sabiston Discussion Capnometry provides measurement of end-tidal CO2 and display of exhaled CO2 waveforms (capnography). The most commonly used capnometers continuously withdraw a small (150 ml/min) sample of gas distally to the Y-piece connector of the breathing circuit. Modifications to face-masks, nasal airways, and nasal cannulas have been designed to facilitate capnography in the awake patient, enabling the capnograph to serve as an apnoea monitor. The CO2 tension recorded at end-expiration (end-tidal CO2) reflects the PCO2; in the alveolar gas, which in normal circumstances is slightly lower (2-4 mmHg) than the arterial PCO2. A higher arterial to end-tidal PCO2; gradient reflects an increase in VD/VT A sudden fall in the end-tidal PCO2 may be due to an acute decrease in cardiac output, to pulmonary embolism or to air embolism. Useful applications of capnometry in the operating room include: 1. Detection of accidental oesophageal intubation by absence of a CO2 waveform, 2. Inadequate ventilation, 3. Disconnection of a component of the breathing system, 4. CO2 rebreathing from an exhausted CO2 absorber or a malfunctioning valve. 5. Capnometry may allow early detection of air embolism during sitting craniotomy, spinal fusion or hip surgery, by a sudden decrease of end-tidal CO2. 6. Decrease of end-tidal CO2 secondary to a decreased cardiac output or to sampling of gas lower in CO2, which diffuses into the alveoli from the pulmonary capillaries. 7. Capnography may be useful in the intensive care unit in mechanically ventilated patients, where the adequacy of ventilation in response to physiological or mechanical changes may be assessed immediately. 8. End-tidal carbon dioxide measurement (capnography) gives valuable information on the effectiveness of ventilation as well as certain disease states, such as chronic obstructive pulmonary disease and pulmonary embolism. 9. It is very important and sensitive tool for monitoring in anaesthesia. ETCO2 decreases suddenly in pulmonary embolism by fat, air or thrombus. Explanation A. Fat embolism is the correct answer as the end-tidal CO2 and oxygen saturation decreases. B. Hypovolaemia will cause hypotension, but end-tidal CO2 and oxygen saturation will not decrease. C. Bronchospasm will not cause hypotension. D. Myocardial infarction will cause hypotension as well as hypoxia, but end-tidal CO2 is rarely affected. Comments Remember that the surgery is for fracture femur. Tips Capnographs monitor spontaneously breathing patients ventilatory status, warn of airway leaks and ventilator circuit disconnections, and ensure proper endotracheal tube placement. 275. Bedsore is an example of: A. Tropical ulcer. B. Trophic ulcer. C. Venous ulcer. D. Post-thrombotic ulcer. Answer: B (Trophic ulcer) Ref: Bailey & Love,23rd edn, 158 & 220; Short Cases in Surgery by S. Das 2nd edn, 46 Quality: Spotter - Final MBBS Status: Unexpectedly new !! 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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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