The Correct option is E
Papillary necrosis is complication of pyelonephritis.
Kidney stones formation or urolithiasis is comprised of calcium carbonate crystals in the presence of hypercalciuria and a common complication is chronic pyelonephritis.

The Correct option is B
Fanconi Syndrome (Toni-Debre-Fanconi Syndrome)
Fanconi syndrome is a generalized disorder of the PT. The defect can lead to glycosuria, aminoaciduria, phosphaturia, bicarbonaturia and excessive urinary loss of K+, Na+, Ca++, Mg++, uric acid and other organic acids.
It appears that the common denominator in most of the inherited forms is that a toxin builds up in the tubular cells (e.g. cystinosis--cystine in lysosomes, Wilson’s disease-copper). In the idiopathic forms, the presumed tubular toxin is unknown. Because of the number of different transport mechanisms involved in Fanconi syndrome, it is likely that individual transporters themselves are affected. It is speculated that a generalized membrane defect exists (permeability theory), or alternatively, there is a defect in intracellular energy production or utilization (energy theory). In experimentally induced Fanconi syndrome (maleic acid), decreased intracellular ATP has been noted.

The Correct option is B
Renal Carcinoma
Renal Cell Carcinoma – hypernephroma/Grawitz tumourArises from proximal renal tubular epithelium
Epidemiology
90% renal cancersMean age 55 years, male: female is 2:115% those on renal dialysis develop renal cell carcinoma
Clinical features
50% incidental findings during abdominal imaging for other symptoms
Haematuria, loin pain, abdominal mass, anorexia, malaise, weigh loss and PUO may all occur

The Correct option is C
Minimal change disease
Is a commonest cause of nephrotic syndrome in children in whom this disease occur frequently. Despite massive proteinuria, the renal function remains normal. Over 90% of patients are corticosteroid sensitive while small numbers of patients are corticosteroid dependent or resistant. The later can be treated by immunosuppressive agents. The disease is characterized by normal appearing glomeruli on light and immunofluorescence microscopy and the only abnormality detected is effacement of epithelial cell foot processes which is identified on electron microscopy only. No immune-complexes are identified and so the disease is not an immune complex in origin but several associated features suggests immune mediation. The current hypothesis is that the cell-mediated immunity seems to play an important role where T-lymphocytes are said to produce vascular permeability factor which is responsible for massive proteinuria.

The Correct option is A
IgA NEPHROPATHY
General: a.k.a Berger Disease. Causes: Nephrotic syndrome
Epidemiology/At risk individuals: Most common type of GN worldwide, occurs 1-2 days after URTI/GIT infections in patients
Clinical features / course: There is an acquired or genetic defect in regulating production of IgA antibodies. After URTI / GIT infection, too much IgA is produced à forms immune complexes à trapped in mesangium à elicit alternate complement pathway à injury. Proteinuria + haematuria (Nephrotic syndrome). Progress to ESRF in 25-50% of patients.

The Correct option is C
“Extrahepatic bile duct obstruction” is a blockage of the biliary tree at the level of the extrahepatic or common bile duct or at the level of the liver bile ducts (may involve one, several, or all ducts, depending on the disorder) that results in the flow of bile being decreased or stopped (known as “cholestasis”)
CAUSES
· Associated with diverse disorders
· Presence of hard, solid material in the bile duct or gall bladder (known as “cholelithiasis”)

The Correct option is A
Explanation:
Primary biliary cirrhosis (PBC)
first stage- destructive inflammatory lesions of multiple interlobar and septal small bile ducts characterized by granulomatous inflammation accompanied by dense mixed infiltrate in portal tracts
progressive lesion- global involvement of hepatic portal tracts with secondary obstructive changes and eventually with development of cirrhosis
end stage- indistinguishable from other forms of cirrhosis

The Correct option is E
Explanation:
Chronic active hepatitis- more progressive liver destruction
Micro: severe portal and periportal infiltrates of lymphocytes, plasma cells and macrophages, active destruction of hepatocytes in the vicinity of portal tracts- so-called piecemeal necroses, fibrosis and cirrhosis it is getting to be evident now that both forms are related may overlap

The Correct option is B
Explanation:
Patients with unconjugated hyperbilirubinemia should be examined for evidence of hemolysis. This includes reticulocyte count, examination of a peripheral smear, serum level of lactic dehydrogenase, and haptoglobin levels. The diagnosis of exclusion for unconjugated hyperbilirubinemia is Gilbert’s disease, which is a benign disease of a partial defect in the enzyme uridine diphosphoglucuronyl transferase (UDPGT), characterized by mild, chronic, and intermittent unconjugated hyperbilirubinemia.

The correct answer is E
More sedative TCA are more appropriate in agitated and anxious patients. These include for example amitriptylin, imipramine and clopramine.

The correct answer is B
Activating TCA are useful in withdrawn and apathetic patients. This group involves nortriptyline, norimipramine and others. Viloxazine belongs to the 2nd generation.

The correct answer is B
TCA are readily absorbed from the GIT. Protein binding is high. They undergo presystemic hepatic metabolism: demethylation, ring hydroxylation and then conjugation.

The Correct option is B
Inhibition of H1 receptors results in sedation, increased appetite and weight gain.

All the options are correct
All effects mentioned above are due to antidepressant treatment (overdose).

The correct option is C
Selegilin belongs to MAOI -B. Other responses are true.

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The Correct option is C
Hallucinations, delusions, feelings of external control and thought disorders are positive symptoms of schizophrenia. Apathy and withdrawal are negative symptoms of schizophrenia. All these symptoms can be treated using neuroleptics. (Schizophrenia is psychosis). Tremor and muscle rigidity are not symptoms characterising psychosis. They can be signs of a Parkinsonian syndrome-an adverse effect of neuroleptics.

The Correct option is D
Phenothiazines are chlorpromazine and promazine. Haloperidol belongs to butyrophenones, flupenthixol to thioxanthenes, fluspirilen to diphenylbutylpiperidines.

The Correct option is C
Phenothiazines are used for treatment of schizophrenia, mania and delirium, aggressive and violent behavior, premedication and neuroleptanalgesia. Malignant syndrome is an adverse effect of phenothiazines.

The Correct option is B
Those are symptoms of acute akathisia, the most common movement disturbances caused by antipsychotics. Note that akathisia is an important cause of poor compliance.

The Correct option is C
Malignant neuroleptic syndrome is potentially fatal complication. Its clinical features are rigidity, hyperpyrexia, stupor or coma, and autonomic disorders. It responds to treatment with dantrolene (an intracellular Ca 2 antagonist).

The Correct option is B
Pre-existing epilepsy may be aggravated

The Correct Option is D
No use in motion sickness but is active against drug-induced nausea. Is useful for treatment of hiccough and vestibular disorders. Alcoholism is contraindicated for use of neuroleptics.

The Correct option is B
Thioridazine : moderately sedating, much antimuscarinic action, little extrapyramidal effect, useful for outpatient, with piperidine side chain in the structure

The correct option is C
Perphenazine and prochlorperazine: piperazine side chain in the structure, little sedating, little antimuscarinic action, high extrapyramidal effect, useful for in-patients.

The Correct option is B
Butyrophenones are less sedating, less hypotensive, less antimuscarinic, have more extrapyramidal toxicity. Like phenothiazines are contraindicated in epilepsy.

The Correct option is C
Antidepressants involve thymoleptics and MAOI.

The Correct option is A
Thymoleptics involve TCA, 2nd generation and SSRI.

The correct option is B
The main mechanism is inhibition of reuptake of amines by nerve terminals.

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The Correct option is A
Depression results from functionally deficient monoaminergic ( norepinephrine and/or 5-HT transmission) in the CNS. 5-HT =5-hydroxytryptamine = serotonin.

The Correct option is B
Depression is alleviated after 2-3 weeks because of pre-existing up regulation of postsynaptic receptors.

The Correct option is D
TCA affects histamine, muscarinic and 5-HT receptors. Note that antimuscarinic effects are especially responsible for various troublesome adverse effects.

The correct option is E
The antimuscarinic effects are: dry mouth, blurred vision and aggravation of narrow-angle glaucoma, constipation, tachycardia and bronchodilation.

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The Correct option is B
Pimozide can potentiate arrhythmic toxicity of cardioactive drugs, is long- acting, serious arrhythmias have been associated with its administration,an ECG must be taken before, should be avoided in children.

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The Correct Option is D
Clozapine can be effective in up to 60% who have not responded to other drugs. Increases risk of cardiac arrhythmias. Is effective against negative as well as positive symptoms of schizophrenia. Induces neutropenia or agranulocytosis. Blood monitoring is mandatory.

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The Correct option is C
Parkinsonian syndrome results from the dopamine receptors blockade in the nigrostriatal area though anticholinergic effects may restore ACH/D balance and compensate.
Related articles
Test your memory (slideshare.net)ADHD brain chemistry clue found - Article (untreatableonline.com)

The Correct option is A
Hepatocellular Adenoma:
Histologically these tumors compromise of only hepatocytes without hyperplasia of the bile ducts.These are truly benign tumors of the liver with a very small risk of malignancy. These tumors also show a tendency to regress spontaneously after a period of time.Etiology wise these are usually seen in women on prolonged oral contraceptives and might also be seen in people abusing anabolic steroids.Characterized by yellow-tan nodules with sheets and cords of hepatocyte-like cells. This tumor is hard to differentiate from well-differentiated hepatocellular carcinoma. However unlike carcinomas, these are not associated with chronic liver disease.This tumor has a tendency to rupture leading to intra-peritoneal hemorrhage that may be massive and life threatening. Therefore, it is usually excised.

The Correct option is E
Most gallstones are composed of precipitated cholesterol, which is supersaturated in the bile of most humans. Gallstones need not always be compromised of Cholesterol and may be composed of precipitated unconjugated bilirubin in a minority of cases.
Such gallstones are termed as pigmented gallstones as these are usually dark/black in colour. In addition there might be precipitation of Calcium, forming a complex with bilirubin to form insoluble calcium bilirubinate. These are generally radio-opaque and are among the only gallstones detected by an X-Ray.

The correct option is A
Long treatment with major tranquillisers leads to up regulation (an increase in both density and sensitivity of dopamine receptors), a Parkinsonian syndrome. Major tranquillisers tend to be anti-nauseogenic.

The Correct Answer is B
Effects of chlorpromazine: profoundly sedating, moderately antimuscarinic, moderately extrapyramidal. Anti-emetic effect. Can decrease body temperature.

The Correct option is A
Chlorpromazine was the first to be used in man. It belongs to the group known as phenothiazines. May promote a Parkinsonian syndrome. Can be given orally, rectally or by injection but is irritant to tissue- is therefore given by deep i.m. injection - not repeated at the same site. Cannot be prescribed to out-patients.

The Correct option is D
Neuroleptics= antipsychotics= major tranquillizers

The Correct option is C.
Chlorpromazine does not inhibit nicotinic receptors. Anti-muscarinic effects are responsible for troublesome adverse effects.

Anaemia is a state in which the number of red blood cells or the haemoglobin in them is below normal. When you’re anaemic, your body produces too few healthy red blood cells, loses too many of them or destroys them faster than they can be replaced. As a result, your blood is low on red blood cells to carry oxygen to your tissues - leaving you fatigued.
If you have anaemia, people may say you have tired blood. That’s because anaemia - a condition in which there aren’t enough healthy red blood cells to carry adequate oxygen to your tissues - can make you feel tired. Many types of anaemia exist, each with its own cause. Anaemia can be caused by an iron or vitamin deficiency, blood loss, a chronic illness, or a genetic or acquired defect or disease. It may also be a side effect of a medication. Anaemia can be temporary or chronic. It can range from mild to severe. Women and people with chronic diseases are at increased risk of the condition. Although anaemia is common, it sometimes can be a complex problem to diagnose and treat because of its many causes. If you suspect you may have anaemia, it’s important to pursue a diagnosis and treatment. Anaemia can signal certain illnesses. Left untreated, it can lead to complications, such as a heart rhythm irregularity. Treatments for anaemia range from taking vitamin and iron supplements to undergoing serious medical procedures.

The Correct option is B
Reliever drugs in asthma:
beta2 agonists, e.g. salbutamol (short acting)are indicated for the immediate relief of the symptoms of acute attackscan be used as needed
Preventer drugs in asthma:
inhaled corticosteroids, e.g. budesonide and beclomethasonemust be used twice daily, even when the patient feels wellInitiate treatment with twice the maintenance dose for 1–2 weeks until control is achieved. Nedocromil is another anti-inflammatory that inhibitsneural reflexes to irritants, exercise, cold. All in all, Nedocromil reduces bronchial reactivity. It is used as a prophylactic against exercise-induced and allergen-induced asthma.Nedocromil is very safe to use.

The Correct option is C

The Correct option is E
Terbutaline is a short acting beta- agonist.
Epinephrine and terbutaline are adrenergic agents that can be given subcutaneously to patients with acute severe asthma.
The dose of subcutaneous epinephrine (concentration of 1:1000) is 0.01 mg/kg divided into 3 doses of approximately 0.3 mg given at 20-minute intervals.
The nonselective adrenergic properties of epinephrine may cause an increase in heart rate, myocardial irritability, and increased oxygen demand. But its use (even in patients >35 years of age) is well-tolerated. Terbutaline is given in a dose of 0.25 mg subcutaneously and can be repeated in 30 to 60 minutes.

The Correct option is D
Although most people with mitral valve prolapse never have problems, complications can occur. Complications tend to occur in middle-aged or older adults.
Mitral valve regurgitation.Heart valve infection (endocarditis).Heart rhythm problems (arrhythmias)cerebrovascular ischemic events

The Correct option is C
Causes of cor pulmonlae include:
Severe, chronic obstructive lung disease, such as emphysema, recurrent pneumonia, bronchiectasis, silicosis, lung cancer, tuberculosis or collagen diseases. Small blood clots that travel to the lung from another body site (usually a deep vein in the calf of the leg) and obstruct lung blood vessels. Primary diseases of the heart, including rheumatic heart disease and congenital heart disease.

The Correct Answer is B
Sudden cardiac death (SCD) is an unexpected death due to cardiac causes occurring in a short time period (generally within 1 h of symptom onset) in a person with known or unknown cardiac disease in whom no previously diagnosed fatal condition is apparent. Most cases of SCD are related to cardiac arrhythmias. Approximately half of all cardiac deaths can be classified as SCDs. SCD occurs as the first expression of cardiac disease in many individuals presenting as out-of-hospital patients with cardiac arrest. According to the American Heart Association, more than 680 people experience sudden death each day in the United States. That is over 350,000 each year.

The Correct option is D
Ischemia refers to a lack of oxygen due to inadequate perfusion. Ischemic heart disease is a condition of diverse etiologies, all having in common an imbalance between oxygen supply and demand.
When all age groups are considered, ischemic heart disease is the most common cause of death not only in men but also in women. Approximately 25 percent of patients who survive acute myocardial infarction may not reach medical attention, and these patients carry the same adverse prognosis as those who present with the classic clinical syndrome. Sudden death may be unheralded and is a common presenting manifestation of ischemic heart disease. Patients can also present with cardiomegaly and heart failure secondary to ischemic damage of the left ventricular myocardium that caused no symptoms prior to the development of heart failure; this condition is referred to as ischemic cardiomyopathy. In contrast to the asymptomatic phase of ischemic heart disease, the symptomatic phase is characterized by chest discomfort due to either angina pectoris or acute myocardial infarction.

The Correct option is B
Characteristics of Left-Sided Heart Failure
Hypertrophy and dilation (except in mitral valve or other obstructions) 2° atrial enlargement and fibrillation Pulmonary congestion and edema: respiratory problems (ie dyspnea, SOB); left side of heart backs up into the lungs ¯Renal perfusion --> renin-angiotensin-aldosterone activation & prerenal azotemia (abn inc in urea and nitrogenous substances in blood plasma) Hypoxic encephalopathy

The Correct option is C
Syphilitic (Luetic) aneurysms
Occurs exclusively in late tertiary syphilis. Almost always occur in the thoracic aorta and aortic arch. When luetic aortitis involves the aortic valve ring, the ring dilates causing aortic valvular insufficiency. Since the organisms lodge in the vasa vasorum of the aorta, there is an obliterative endarteritis of these vessels rimmed by an infiltrate of lymphocytes and plasma cells. With the subsequent inflammation there is destruction of elastic fibers within the aortic wall and scar formation. As the scars contract, the aortic intima is retracted leading to wrinkling or the "tree-barking" change of the intima.

The Correct option is C
Perhaps the most important study ever done to reveal the relation of the risk factors to diseases due to atherosclerosis is that of Framingham that started in the early 1950’s. This, and later other studies, clearly showed that the following major modifiable risk factors are causaly related to atherosclerosis and its clinical sequelae: SmokingHigh blood cholesterolHypertensionDiabetes mellitusInactivity/obesity In addition, there are also four unmodifiable risk factors for atherosclerosis, namely:
AgeMale sex (or postmenopausal status)Family history of vascular diseasePersonal history of symptomatic vascular disease is another major risk for repeat events.

The Correct option is C
Ulcers are defects in the gastrointestinal mucosa that penetrate the muscularis mucosae.
A common disease（10% individuals）The most common Peptic Ulcers: Duodenal Ulcer & Gastric UlcerDU＞GU，about 3：1Causes Helicobacter Pylori（Hp）Acid & PepticNonsteroidal anti-inflammatory drugs（NSAIDs）Genetic factorsAbnormal motor functionStress and psychologic factorsOthers：smoking,food and drink,infection of virus.

The Correct option is C
Remember the ABCD of critical care. This patient has collapsed. Immediate priority would be to resuscitate the patient first while looking for the contributing cause.

The Correct option is C
A high proportion of patients with colon cancer have a Family History of the disease. A history of colon Ca in 1st degree relatives is an important predictor. Even many "sporadic" polyps and cancers may have a genetic basis.
Clinical manifestations:
Rt colon: (occult)
Slow bleeding leading to anemia. Obstructions are infrequent. May some day find large mass.
Left colon:
Narrower diam —> obstruction w/abdominal pain/cramping,Hematochezianarrowing of stool caliber. Much more symptomatic. 3/4 of these cancers occur in the distal path.

The Correct option is B

The Correct option is C
Vitamin K metabolism in the bowel can decrease because you are destroying the normal flora in the GI tract that synthesize vitamin K when one of the antibiotics that interfere with the normal flora of the gut .

The Correct option is C
Vitamin E is a fat-soluble vitamin that is gaining considerable attention due to its antioxidant properties. The main role of Vitamin E in the body is to protect the cells from reactive oxygen species (ROS). Oxygen, when unpaired in the body, is unstable and damaging therefore known as ROS. Antioxidants are a safeguard by giving up hydrogen molecules to stabilize the free oxygen. This is a process that inactivates the oxygen molecule from causing serious damage. It is suggested that ROS contribute to the hardening and clogging of the heart artery walls by reacting with low-density lipoproteins (LDL). This clogging and hardening can lead to stroke, heart attack, kidney damage and even death.

The Correct option is E
Toxicities associated with Vitamin C
Linus Pauling recommended taking about 10g/day for the common cold (although it probably cut down the course from 7 days to 6.5 days. “Is that significant? Who knows. If it works for some people, great”.10g/day though is a lot. You can get nausea and diarrhea with that amount of vitamin C. You can also get stones in the bladder. Vitamin C will also acidify urine and cause a sickle cell crisisPatients with glucose-6-phosphate dehydrogenase (G6PD) deficiency tend to show hemolysis with large dose of vitamin c. How does this happen?G6PD is needed to produce NADPH. NADPH then will reduce glutathione from GS-SG state to GSH, GSH. This reduced state of glutathione is necessary for the membrane integrity of RBC.Massive doses of vitamin C will induce a large amount of enzyme to chew up the vitamin. Then, if you go cold turkey and stop the vitamin C intake, now all of a sudden, you have this large quantity of enzymes that will chew up every last molecule of vitamin C, thus inducing scurvy.

The Correct option is B
For B12 deficiency, parenteral administration of B12 is usually recommended. The duration of treatment is not as standardized as in case of iron deficiency anemia. Six to eight weeks treatment is usually described as sufficient. Decrease in MCV, reticulocytosis, and improvement in platelet and neutrophil counts are observed within few days.

The Correct option is C
Diphyllobothrium Latum (“fish tapeworm”)
-most infections asymptomatic -occasionally epigastric pain, abdominal cramping, n/v, and weight loss
-may have low serum levels of vitamin B12, presumably because of the competition between the host and the worm for dietary vitamin B12
-small percentage develop clinical signs of vitamin B12 deficiency (megaloblastic anemia, neurologic manifestations: numbness, paresthesia, loss of vibration sense)

The Correct option is E
Naloxone has been shown to reverse alcohol-induced respiratory depression and coma.

The Correct option is C
Vitamin B12 is stored in the Liver. Stores may last for up to 6 months.

The Correct option is A

The Correct option is A
Hydralazine: May decrease the effect of pyridoxine
Isoniazid: May decrease the effect of pyridoxine
Levodopa: Pyridoxine may decrease the effect of levodopa

The Correct option is C
Pellagra is caused by a deficiency of the B vitamin niacin in the diet. Niacin refers to both nicotinic acid and nicotinamide. Nicotinamide is a component of two coenzymes, nicotinamide-adenine dinucleotide (NAD) and nicotinamide-adenine trinucleotide (NADP). These coenzymes are involved in oxidation-reduction reactions and are essential for metabolic processes in each cell in the body. A deficiency in niacin decreases the cellular function throughout the body. One symptom of niacin deficiency is diarrhea, which is one of the four D’s of pellagra-diarrhea, dermatitis, dementia, and death.

The Correct option is B
FMN and FAD. Like NAD/NADP, these coenzymes are usually bound non-covalently by their enzymes. (Occasional exceptions do occur). FMN is flavin mononucleotide (= riboflavin phosphate) and FAD is flavin adenine dinucleotide. FAD is FMN linked via a phosphate to AMP.
Riboflavin functions as the precursor for flavin mononucleotide (FMN) and flavin adenine dinucleotide (FAD).
Riboflavin deficiency can develop in patients with sever liver disease, diabetes mellitus, and achlorhydria.

The Correct option is C
Toxicity
Vitamin A -HA, dizziness, blurred vision, clumsiness, birth defects, Vitamin D-Constipation, weakness, anorexia, weight loss, confusion B3-Niacin-Flushing, redness of skin, B6-pyridoxine-Numbness, paresthesia, ataxia Vitamin C-kidney stones Folate-can mask B12 deficiency

The Correct option is A
The Cardiovascular manifestations of beriberi most commonly encountered are dyspnea and palpitation on exertion, tachycardia and edema. The heart is generally enlarged both to the right and to the left. Systolic murmurs are common. Basilar pulmonary rales are frequent.
The important points in establishing the diagnosis of cardiovascular disease dependent on deficiency of Vitamin B1 are, in addition to those points already presented, the presence of other manifestations of Vitamin B1 deficiency, such as polyneuritis, or of deficiencies of other portions of the B complex, such as glossitis and pellagrous skin changes. Indeed it is rare to observe ‘beriberi heart’ without at least minimal signs of polyneuritis; the history of dietary inadequacy or of conditioning factors which lead to Vitamin B1 deficiency in spite of an apparently normal diet; the disappearance of signs and symptoms following adequate B1 therapy.

The Correct option is A
H. pylori is accepted as an etiologic factor in duodenal ulcers, peptic ulcer disease, gastric carcinoma, and primary B-cell gastric lymphoma.

The Correct option is B
Gastric carcinoma -accounts for over 90% of malignant tumors of the stomach
geographic differences in the incidence- 10 times higher in Japan than in the U.S. for example- environmental factors play roleprecancerous lesions for gastric carcinoma include: chronic atrophic gastritis with dysplasia- its association with PA adenomatous polyps with dysplasia chronic peptic ulcers
Grossly:-
early cancer- =gastric carcinoma restricted to the mucosa and submucosarecognized in Japan- diagnosis by endoscopic examination and biopsyadvanced gastric cancer- =gastric carcinoma that invades the gastric wall-presents as- endoscopic gross morphology: fungating mass that protrudes into the lumen- polypoid as a malignant ulceration with raised edges as an ulcer resembling the peptic ulcer as a diffusely infiltrating lesion that causes diffuse thickening of the gastric wall

The Correct Option is D
It is important to make sure that the diarrhea is not inflammatory and is non- bloody and that there is a low suspicion for Salmonella gastroenteritis, C. difficile or enterohemorrhagic E. coli.

The Correct option is C

The Correct option is E
Thiamin is used to help release energy from carbohydratesMajor sources of thiamin include pork, products, whole grains, ready-to-eat breakfast cereals, enriched grains, green beans, milk, orange, juice, organ meats, peanuts, and dried beans, and seedsThiamine is commonly known as the "nerve vitamin".
Deficiency in thiamine causes beriberi, which is characterized by muscular weakness, swelling of the heart, and leg cramps and may, in severe cases, lead to heart failure and death.

The Correct option is E
Vitamin A deficiency (VAD) causes ocular manifestations, ranging from night blindness to xerophthalmia, resulting in blindness in severe cases. Vitamin A deficiency causes impaired immunity and is responsible for increased overall childhood mortality especially due to various infectious diseases, of which measles, acute respiratory infections, and diarrhoea are the most important ones.
Vitamin A is found in liver, fish , fish oils, fortified milk and yogurt and eggsProvitamin A carotenoids mentioned before are mainly found in dark green and yellow-orange vegetables and some fruitsCarrots, spinach, and other greens, winter squash, sweet potatoes, broccoli, mangoes, cantaloupe, peaches and apricots are examples of such sources

The Correct option is E
Vitamin K deficiency leads to bleeding tendencies due to deficiency of Vit.K dependent clotting factors. Reproductive problems arise with deficiency of Vitamin E.

The Correct option is D
Both vitamin B12 and folate deficiency cause an identical megaloblastic anemia

The Correct option is A

The Correct option is B
Barbiturates (eg, phenobarbital), methotrexate, nitrofurantoin, phenytoin, primidone, or pyrimethamine decrease the effectiveness of folic acid, leading to folic acid defieciency and anemia.

The Correct option is A

The Correct option is D

The Correct option is E
In a typical case of acute HBV infection, you can detect the surface antigen (HBsAg) early in time – the incubation period is 4-12 weeks – this is one of the events that happens early. HBsAg appears early in the serum, peaks, then DISAPPEARS. Can detect in some patients the E antigen (unreliable marker – not all patients have this during this phase) – appears about the same time, peaks and disappears about the same time as HBsAg. You don’t get the core antigen in the serum (stays in the hepatocytes).

The Correct option is D

The Correct option is e

The Correct option is D

The Correct option is D

The Correct option is A
Wilsons disease: occurs in children. Combination of liver disease (elevated AST/ALT), CNS problems (tremor, choreiform movements), and Kayser-Fleishcer ring of the cornea. Affects GP and Putamen.
Patient will have elevated copper in their blood and urine and decreased ceruplasmin (copper binding protein).

The Correct option is D

The Correct option is B
Primary hemochromatosis is an autosomal recessive inherited disorder, resulting in progressive iron absorption through the gastrointestinal tract with accumulation of iron in a variety of organs, including the liver. Without treatment, the disorder leads to cirrhosis and hepatic failure. With involvement of other organs, patients can also develop cardiac failure and various endocrine insufficiency states.

The Correct option is A
Wilson's disease, or hepatolenticular degeneration, is an autosomal recessive disorders of copper (Cu) metabolism characterised by an inability of the liver to excrete Cu into bile and to incorporate Cu into ceruloplasmin.
Clinically, Wilson's disease is characterised by neurologic, psychiatric and/or hepatic abnormalities. Movement disorders associated with Wilson's disease often take the form of action tremor, focal dystonia, rigidity, slowed movements and characteristic speech disorders. The psychiatric profile of Wilson's disease includes disturbances such as anxiety, irritability, and alteration in personality, forgetfulness, depression, mania, and rapid mood swings.

The Correct option is B
Primary sclerosing cholangitis:
Rare disease characterised by chronic inflammation and fibrosis around bile ducts – diagnosis made by cholangiography and biopsy used to confirm or determine degree of liver damage.
Often associated with inflammatory bowel diseaseAssociation with development of cholangiocarcinoma
Close resemblance to type I auto-immune hepatitis

The Correct option is A
Primary biliary cirrhosis :
Signs of portal hypertension: hepatomegaly, splenomegaly, variceal bleeds, ascites Signs of cholestasis: pigmentation, gallstones, steatorrhoea, pruritis, jaundice Abdominal pain Osteoporosis (important co-existing problem; steroids contra-indicated as can exacerbate this) Associated with other auto-immune diseases: e.g. Sjogren's syndrome; thyroid auto-immunity; SLE; scleroderma; rheumatoid arthritis; CREST; dermatomyositis; renal tubular acidosis

The Correct option is E
Some people remain healthy for years but then as adults develop breathing difficulties due to emphysema. Alpha1 antitrypsin deficiency-related (AAT) emphysema is caused by the inherited deficiency of a protein called alpha1-antitrypsin (AAT) or alpha1-protease inhibitor. AAT, produced by the liver, is a "lung protector." In the absence of AAT, emphysema is almost inevitable. It is responsible for 5% or less of the emphysema in the United States.Symptoms of AAT deficiency emphysema usually begin between 32 and 41 years of age and include shortness of breath and decreased exercise capacity. Smoking significantly increases the severity of emphysema in AAT-deficient individuals.

The Correct option is D
The hepatitis B virus itself does not directly cause damage to the liver. Rather, the body's immune (protective) response to the virus (a foreign material) paradoxically causes the damage.
An acute hepatitis B viral infection can lead to recovery (the usual outcome), to acute liver failure (rarely), and sometimes to chronic infection.
The chronic infection can result in a healthy carrier state (in which the affected person harbors the virus but remains healthy) or progress to cirrhosis (sever scarring, or fibrosis, of the liver) and its complications, including liver cancer.

The Correct option is D
Hepatitis B is an infectious liver disease that is caused by the hepatitis B virus. This virus is spread when blood or other body fluids from an infected person enters the body of a non-infected person—for example, from an infected mother to her baby during birth. Overall, infants born to infected women have a 4% chance of being infected with hepatitis B at birth.

The Correct option is B
Refer Here

The Correct option is D
Small Cell Carcinoma: highly malignant tumor has a distinctive cell type...the epithelial cells are generally small, have little cytoplasm, and are small, round, and oval and, lack nucleoli...
A high mitotic rate is characteristic, with an average of 60 to 70 mitoses per 10 high-power fields. Necrosis is frequent and extensive. Basophilic nuclear staining of vascular walls by DNA from necrotic tumor cells (the Azzopardi effect) is common in necrotic areas. Although there is no absolute measure for the size of the tumor cells, a useful rule of thumb in small cell carcinoma is the diameter of three small lymphocytes.

The Correct option is D

The Correct option is E

The Correct option is B

The Correct option is D
Leukoplakia is a clinical term that does not connote any specific histologic tissue alteration. Although leukoplakia has been overemphasized in its relationship to cancer, the etiology of any white lesion should be determined or monitored. The causes of leukoplakia are varied and include both intrinsic and extrinsic factors. Extrinsic factors include: tobacco, alcohol, and actinic radiation. Intrinsic factors include: vitamin deficiencies, immunodeficiencies, and genetic predisposition. A classic study by Waldron et al. revealed that 80% of these lesions showed benign changes such as hyperkeratosis, thickening of the epithelium (acanthosis) without any evidence of epithelial dysplasia (a pre-cancerous condition), a male predilection, and occurred mainly in patients in 50-70 years of age.

The Correct option is C

The Correct option is C
CK–MB levels, along with total CK, are tested in persons who have chest pain to diagnose whether they have had a heart attack. Since a high total CK could indicate damage to either the heart or other muscles, CK–MB helps to distinguish between these two sources.
The CK and CK index (a calculated parameter that evaluates the amount of CK-MB relative to the amount of total CK) rapidly rise together in a time course consistent with acute myocardial infarction (AMI).

The Correct option is C

The Correct option is E
Management of Iron overdose:
1. Decontamination: Iron is well known to form drug concretions (pharmacobezoar) and/or become adherent to the gastric wall due to its corrosive effect. Activated charcoal is not effective.
whole bowel irrigationgastroscopic removalgastrotomy
X-ray review following decontamination procedures should be performed to ensure removal of drug from the GIT.
2. Antidote: Desferrioxamine , 15mg/kg/hour - up to 80mg/kg/day in first day…

The Correct Option is B
The most common complication of iron supplementation includes constipation, and patients should be counselled to increase water intake. Other side effects include nausea, epigastric tenderness, or vomiting.

The Correct option is A
The most appropriate form of oral iron therapy is one containing iron salts such as ferrous fumarate, ferrous sulfate, or ferrous gluconate. The recommended daily dose is between 150-200mg of elemental iron daily. No evidence suggests that one preparation is more effective for the treatment of iron deficiency.
Ferrous sulfate at 325 mg TID contains 195 mg of elemental iron. Absorption of iron is best when taken on an empty stomach. This regimen should increase hemoglobin 2 g/dL over the next three weeks.

The Correct option is A

The Correct option is A
Hypochromic Microcytic anemia
RBC's – smaller, ↑ zone of central pallor.Hypochromic = ↓ Hb in each RBCMicrocytic = ↓ size of each RBCalso, RBC’s ↑ anisocytosis (variation in size) and ↑ poikilocytosis (variation in shape).most common cause: Iron Deficiencymost common nutritional deficiency: ↓ dietary ironmost at risk: children and women in reproductive years (from menstrual blood loss and from pregnancy)

The Correct option is D
Neurological symptoms are more commonly associated with folic acid and vitamin B12 deficiency, rather than with Iron deficiency anemia.

The Correct option is E
Causes of Mitral regurgitation include:
Acute rheumatic heart diseaseMVP
Ischemia is responsible for 3-25% of mitral regurgitation.Mitral annular calcification
Left ventricular dilatation and heart failure
Tendineae rupture can be due to endocarditis, myocardial infarction, or trauma.Papillary muscle dysfunction usually is caused by infarction.Other causes include the following:Ehlers-Danlos syndromeMarfan syndromeOsteogenesis imperfectaSystemic lupus erythematosus (SLE)Reference: Mitral Regurgitation;Daniel DiSandro

The Correct option is C
The small verrucous vegetations seen along the closure line of this mitral valve are associated with acute rheumatic fever. These warty vegetations average only a few millimeters and form along the line of valve closure over areas of endocardial inflammation. Such verrucae are too small to cause serious cardiac problems.

The Correct option is C

The Correct option is C
Syphilitic aneurysms are due to inflammation of Aortic vasa vasorum. The most common sites of arterial involvement are the ascending aorta, the aortic arch and the pulmonary artery.
Syphilis aortitis is characterized by peri-aortic and meso-aortic inflammation with perivascular cuffing of lymphocytes around the vasa vasorum. Obstruction of the vasa vasorum follows, resulting in nutritional impairment of the medial coat together with degeneration of the muscle fibres. Aneurysmal dilatation eventually ensues as a result of weakening of the medial layer. Syphilitic aneurysms are either fusiform or saccular and may attain great size and compress

The Correct option is B
Protruding atherosclerotic lesions in the thoracic aorta, often with superimposed mobile thrombi, are an important cause of embolic disease. During the last 6 years, the increasing use of transesophageal echocardiography has shown that atherosclerotic plaque in the thoracic aorta is a source of otherwise unexplained embolic events, including stroke, transient ischemic attack, and peripheral emboli.
An additional, different clinical picture-the classic atheroemboli syndrome-is associated with aortic atherosclerosis. This well-described syndrome consists of renal insufficiency, skin lesions, blue toes, and multisystem findings caused by embolic phenomena. It can occur spontaneously but frequently results from arterial manipulation, such as cardiac catheterization and aortotomy during coronary artery bypass surgery.

Pharmacology
1. Which of the following can be given with OCP
a. Mebendazole,
b. Amoxycillin,
c. Phenytoin,
d. Rifampin
2. Mode of action of vigabatrin is
a. Inhibitor of GABA transaminase increasing GABA conc,
b. Suppress Na+ current channels,
c. Inhibit T type Ca 2+ channel,
d. None
3. Mode of action of baclofen is