The correct answer is A

The innervation of the parotid involves the preganglionic parasympathetic portion of the gland, beginning in the inferior salivatory nucleus and passing via the glossopharyngeal nerve, the tympanic plexus, and the lesser petrosal nerve to the oticganglion.

The postganglionic fibers travel along the auriculotemporal nerve and into the parotid gland, where they control glandular secretions.

Preganglionic sympathetic fibers originate in the first and second thoracic segments and synapse in the cervical sympathetic ganglia. Postganglionic sympathetic fibers travel along the external carotid artery to the superficial temporal artery and the transverse facial artery and terminate in the sweat glands.

The correct answer is C

Hind-milk has the highest concentration of fat and is released after several minutes of nursing. It is similar in consistency to cream and will have a soporific (sleepy) effect on your baby. Hind-milk is important for your baby to feel satisfied and to gain adequate weight.

The correct answer is D

When used as an antagonist to nondepolarizing muscle relaxants, adequate recovery of voluntary respiration and neuromuscular transmission must be obtained prior to discontinuation of respiratory assistance, and there should be continuous patient observation. Satisfactory recovery may be judged by adequacy of skeletal muscle tone, respiratory measurements, and by observation of the response to peripheral nerve stimulation. A patent airway should be maintained and manual or mechanical ventilation should be continued until complete recovery of normal respiration is assured.

Head-lift for 5 s has been used clinically for the assessment of residual block.

The correct answer is B

Perivalvular abscesses are seen in about 30% of patients with bacterial endocarditis. It is important to detect these lesions, because they indicate advanced disease that has a poor prognosis and thus necessitates aggressive medical management and sometimes surgery. Transesophageal echocardiography (TEE) is the method of choice for detecting infective endocarditis of both native and prosthetic cardiac valves. This technique also aids in the detection of complications, such as perivalvular abscesses and pseudoaneurysms, with good sensitivity (80%–87%) and specificity (95%–98%)

The correct answer is B


Gastrointestinal lymphomas typically present with nonspecific signs and symptoms attributable to the site of involvement.

Primary gastric lymphoma accounts for 3 percent of gastric neoplasms and 10 percent of lymphomas. The stomach is the most common extranodal site of lymphoma and is also the most common site of gastrointestinal lymphoma

• Stomach — 75 percent
• Small bowel (including duodenum) — 9 percent
• Ileo-cecal region — 7 percent
• More than one GI site — 6 percent
• Rectum — 2 percent
• Diffuse colonic involvement — 1 percent

The correct answer is C

Hyperplastic arteriolosclerosis is commonly associated with malignant HTN. With ongoing injury, the vascular walls hypertrophy due to hyperplasia of SMCs and sometimes this occurs along with necrosis of the vessel wall. There is a characterisitic “onion-skin” appearance of the vessel wall.


Hyaline Arteriolosclerosis: The lesions are characterized by glassy thickening of arterial and arteriolar walls. Hyaline arteriolosclerosis is seen in elderly patients, with or without hypertension or diabetes, and in patients with long-standing diabetes but the lesions are most common and most severe in hypertensive patients.

The correct answer is D

Photopsia is the presence of perceived flashes of light. It is most commonly associated with posterior vitreous detachment, migraine with aura, migraine aura without headache and retinal break or detachment.

The correct answer is B


At birth a child has an average head circumference of around 35 cms. This increases at the rate of 1.4 cms per month for first four months.

This child has macrocephaly...

Microcephaly may occur in neonates with central nervous system toxoplasmosis infection but macrocephaly due to hydrocephalus as a result of aqueductal stenosis may also occur.

The correct answer is C

Blood supply of Stomach

• left gastric artery from celiac trunk
  
• splenic artery and left gastroepiploic artery
  
• common hepatic artery through the right gastroepiploic artery and gastroduodenal artery

The correct answer is D


LMN paralysis of CN VII

• 
  

• Bell's Palsy is a LMN paralysis in which there is an abolition of both voluntary and reflex movements of the facial muscles. On the ipsilateral side the face is masklike and the forehead immobile

• corneal sensitivity remains (CN V) but the patient is unable to blink or close the eyelid.

• lacrimation on the lesion side may be impaired (greater petrosal nerve)

• there may be a reduction of saliva (chorda tympani nerve)

• taste is lost on the ipsilateral anterior 2/3 of the tongue (chorda tympani)

• ear pain

• there can be an increased acuity to sound (hyperacusis) due to paralysis of the stapedius muscle

• when a lesion occurs at the location where VII emerges from the pons, as the patient opens his mouth, his eyes close (jaw-winking phenomenon)

The correct answer is B


Assessment of of age if Fetus is important in Cases of (Medico-legal Aspect) Criminal Abortion, Infanticide, Still-Born or Dead Born Baby, Fabricated Abortion, Marriage, Divorce, Adoption, Inheritance etc.

At the end of Ninth Month

*Length is about 45 cm
*Weight is about 2.5 Kg to 3 Kg
*Scalp hair is dark and 4cms long
*Meconeum is seen at the end of large intestine
*Ossification center are usually present in the lower end of femur, in Cuboid and Capitate bone

The correct answer is B

Cytochrome oxidase (complex IV) carries out the following irreversible reaction:
O2 + 4 H+ + 4 e- ---> 2 H2O

Cyanide Blocks cytochrome oxidase (complex 4) and prevents both coupled and uncoupled respiration with all substrates, including NADH, succinate and ascorbate + TMPD.

The correct answer is C

Von Willebrand Factor (vWF) is a heterogeneous multimeric glycoprotein which is produced by endothelial cells and megakaryocytes. The molecular weight varies from 400 kD to 20,000 kD. In platelets, vWF is stored in the alpha-granules. In endothelial cells vWF is stored in so-called Weibel-Palade bodies. The normal function of vWF is to stabilize factor VIII, as well as to be a carrier protein of factor VIII. Large vWF multimers also stabilise platelet adhesion to the subendothelial matrix in case of tissue injury.

The correct answer is A

PNEUMOCYSTIS

Pathogenesis:

• P. carinii is a low virulence fungus commonly found in lungs in humans and other mammals.
• Infects host via inhalation of the organism in its trophic form.
• Usually infection occurs in those HIV infected patients with CD4+ counts below 200/mm3, since CD4 + lymphocyte activation of macrophages is critical in host defense.
• Fungus cannot be targeted with usual antifungal agents.

Clinical characteristics:

• Shortness of breath, fever and nonproductive cough.
• Tachypnea and tachycardia characterize an acute ill patient. Alar flaring, intercostal reaction with radiographic findings of bilateral diffuse infiltrates are present.
• The most common finding is hypoxia.
• Extrapulmonary pheumocystosis may occur in cases of advanced HIV infection with involvement of liver, spleen, lymph nodes, GI tract, eyes, thyroid and adrenals.

Diagnostic work-up:

• From identification of organism in respiratory secretions or tissue sections of severely immunocompromised individuals with respiratory symptoms.
• Immunofluerescence is the most widely used technique, while demonstration of P. carinii antigen in serological test and DNA in tissue specimens are of high specificity and sensitivity.

Treatment:

• Key is early diagnosis. Mechanical ventilation along with Trimethoprin-sulfamethoxazole may reduce mortality from 80% -90% to 50%.
• TMP-SMX inhibits folic acid synthesis is relatively inexpensiveavailable in oral and parenteral forms is well tolerated and the drug of choice. Usual IV doses 15-20 mg/kg/day.
• Alternative agents Dapsone 100mg/day PO alone or in combonation with TMP-SMX.
• In patients with AIDS and CD4+ count below 200/mm3, oral candidiasis, unexplained fever of >100 F for more than 2 weeks, or recovered from previous episode of P. carinii pneunitis chemoprophylaxis is recommended and continued for life.

The correct answer is D


Myositis ossificans is a benign, ossifying soft-tissue lesion typically occurring within skeletal muscle. Patients are usually adolescents and young adults; myositis ossificans is rare in children under 10 years of age. The most frequent symptoms and signs are pain and tenderness with a soft tissue mass. Approximately 80% of cases arise in the large muscles of the extremities.

Myositis ossificans traumatica (latinized name) is produced as an insult (crushing injury) to muscle against bone. A hematoma (bloody mass) is formed against the periosteum and subsequently calcification and ossification occurs.

The correct answer is C

The depersonalisation in severe depression culminates in the so-called nihilistic delusions or the Cotard-Syndrome, formerly aptly called „melancholia anaesthetica“. The patients do not sense their body any more; taste, smell, even the sense of warmth or pain are gone, everything seems dead. This makes them conclude that they have already died and ought to be buried. They may even deny their own existence or the existence of the world.

The correct answer is C

Duodenal Ulcer

1. characteristics: mostly occurs in 40-65 yo, M:F = 2:1, more than twice as common as gastric ulcers, bleed 4x as often as gastric ulcers, 25% of total UGI bleeds
2. etiology
1. most (95%) due to H. Pylori
2. increased gastric acid production
3. environmental factors – smoking, NSAIDs
3. risk factors: male, smoking, aspirin/NSAID use, uremia, Zollinger-Ellison syndrome, H. pylori infection, trauma, burn injury

4. sx: epigastric pain (burning or aching, several hrs after meal, initially relieved by food, milk, or antacids), back pain, N/V, anorexia, decreased appetite
5. signs: tenderness in epigastric area (possibly), guaiac-positive stool, melena, hematochezia, hematemesis
6. ddx: acute abdomen, pancreatitis, cholecystitis, all causes of UGI bleeding, Zollinger-Ellison syndrome, gastritis, MI, gastric ulcer
7. diagnose with H&P, EGD, UGI series (if not actively bleeding), urea breath test, H. pylori serology

a. with EGD, visible vessel in ulcer crater a/w 90% rebleed rate

8. location

1. majority within 2 cm of pylorus in duodenal bulb
2. posterior – more likely to bleed b/c erodes into gastroduodenal artery
3. anterior – most likely to perforate (see free air under diaphragm on upright AXR)

9. medical tx
1. Antacids (Mg, Al, Ca): control gastric pH, promote healing
2. H2 receptor blockers: usually heal ulcers in 4-6 wks
3. Sucralfate: coats ulcer
4. Proton pump inhibitors (omeprazole): decrease acid production; used for refractory ulcers and ulcers a/w Zollinger-Ellison syndrome
5. Prostaglandins: provide mucosal protection
6. Bismuth
7. Antibiotics: triple therapy for H. pylori (see above)
10. surgical tx
1. indications: I HOP

I = Intractability

H = Hemorrhage (massive or relentless)

Note: exsanguination is the most common cause of death from a duodenal ulcer

O = Obstruction (gastric outlet obstruction)

P = Perforation

2. goal: decrease gastric acid secretion and fix IHOP
3. options for Intractability

1. highly selective vagotomy (preserves pyloric branches, operation of choice b/c only 0.5% mortality, but increased recurrence, 10-25%)
2. vagotomy and pyloroplasty (0.5-1% mortality, 10-12% recurrence)
3. vagotomy and antrectomy Billroth I or II (1-2% mortality, 1-2% recurrence) (see Surg Recall p.235 for Billroth I, II explanations)

4. for Hemorrhage, open duodenum through pylorus, oversew bleeding vessel, perform vagotomy and pyloroplasty
5. options for Obstruction

1. truncal vagotomy, antrectomy, and gastroduodenostomy (Billroth I) or gastrojejunostomy (Billroth II)
2. truncal vagotomy and drainage procedure (gastrojejunostomy)

6. options for Perforation

1. Graham patch for poor candidates, shock, or prolonged perforation (Graham patch is a piece of omentum incorporated into the suture closure of a perforation)
2. truncal vagotomy and pyloroplasty, incorporating ulcer
3. Graham patch and highly selective vagotomy
4. truncal vagotomy and antrectomy

11. complications
1. early

1. hemorrhage (may need to reoperate)
2. gastric retention from vagotomy
3. duodenal stump leakage with Bilroth II (must usually reoperate)

2. late

1. dumping: ealy dumping: uncontrolled emptying of hypertonic fluid from intravascular space to intraluminal space, leading to intravascular volume depletion and diarrhea; late dumping: rapid absorption of glucose due to improper gastric emptying, leads to large insulin increase – over-correction of blood glucose leads to transient hypoglycemia approx. 3 hrs after meal

2. diarrhea (tx with Lomotil, Kaopectate, Imodium)

3. reflux gastritis (convert Billroth I/II to gastrojejunostomy)

4. gallstones
5. weight loss
6. iron/vit B-12 deficiency due to decreased intrinsic factor secretion (tx with supplementation)

The correct answer is A

TRIAGE TAG Color Code Priorities

1. RED--- Immediate
1. Serious but salvageable, with life-threatening injuries. Severe burns, bleeding, impaired breathing and internal injuries.
2. Red Tagged patients are transported first from Casualty Collection Area.
3. Examples of Injuries:
1. Witnessed Cardiac Arrest
2. Uncorrected Respiratory Problems (not Minor Distress)
3. Severe Bleeding and Shock
4. Open Chest and Abdominal Injuries
5. Major Fractures and Burns (Full Thickness/ Airway)
6. Unconscious Patients
7. Severe Medical Problems (Heart Attack, Poisoning)
8. Injured Co-workers and Severe Emotional Disorders

2. YELLOW--- Moderate
1. Moderate to serious injuries. Victims with potentially serious injuries such as long bone fractures and moderate bleeding are assigned here.
2. Yellow tagged patients are transported immediately after Red Tag and may be transported with a green tag patient.
3. Examples of Injuries:
1. Severe Burns not affecting the airway
2. Spinal Injuries
3. Moderate Blood Loss
4. Head Injuries

3. GREEN--- Minor
1. “Walking Wounded” and minor injuries. Patient is not seriously injured.
2. Delayed treatment and transport
3. Example of Injuries:
1. Minor Injuries- Cuts and Abrasions
2. Minor Fractures
3. Mortal Injuries where death appears imminent

4. BLACK--- Deceased
1. Victims who are found to be obviously deceased with no vital signs or obviously fatal injuries.
2. Transport arrangements are made with Coroner.
3. Patients should not be moved by EMS Personnel, as they are part of the crime scene.

5. WHITE--- Non-Injured
1. For patient accountability
2. Person was involved in the incident but is not injured.
3. Transportation will occur when available and by mass transit capabilities.

The correct answer is B

• Chlamydiae are very small bacteria which have to live intracellularly.
• They were originally considered to be viruses, but it is now known that they contain both DNA and RNA and are structurally related to Gram-negative bacteria.
• Several species are known in the genus Chlamydia: C. psittaci, the pathogen of psittacosis; C. pneumoniae (the old TWAR), pathogen of atypical pneumonia; and C. trachomatis, which has many serotypes.
• Serotypes A, B, Ba, and C cause trachoma. Serotypes D to K cause inclusion conjunctivitis in the newborn (“paratrachoma”), Reiter’s syndrome, non-gonococcal urethritis, epididymitis, cervicitis and P.I.D. (pelvic inflammatory disease). Neonatal conjunctivitis and pneumonia can be caused in the newborn by these bacteria. Serotypes L1 and L2 cause the sexually-transmitted disease lymphogranuloma venereum. L3 causes pneumonia in mice.
• C. trachomatis is considered to be responsible for 20% of the pharyngitis symptoms in adults.

The correct answer is D


A-alpha fibers - the largest myelinated fibers, range in diameter from 7-16 microns,conduction velocity from 70-120m/s, encoded for the transmission of muscle spindle and tendon organ afferents

A-beta fibers - responsible for sensibility of touch, diameter from 6-8 microns, conduction velocity 30-70 m/s.

A-delta fibers - transmit stimuli encoded for temperature and fast or first pain, smallest myelinated, diameter 2.5-4 microns, conduction velocity 12-30 m/s

Unmyelinated C fibers - transmit stimuli encoded for slow or second pain, temperature, efferent sympathetic fibers, conduction velocity 0.5-2 m/s.

The correct answer is B


Traumatic Cataract

• Unilateral
• Rosette-shaped
• Can be lamellar

• Vossius' ring is a traumatic deposit of iris pigment epithelium on the anterior lens capsule and usually fades with time.

The correct answer is A

DRUG INDUCED SLE

• Most common drug is procainamide, which induces ANA in 50-75% of individuals within a few month

• 20% of these patients develop a clinical drug induced lupus, which may consist of polyarthralgias, systemic symptoms, anemia, leukopenia, thrombocytopenia, rheumatoid factors, false positive VDRL and positive coombs test.

• Hydralazine is another common drug that induces ANA in 25-30% of patients and lupus like symptoms in 10% of patients.

• The major serological differences between drug induced lupus and non-drug induced lupus is that antihistone bodies are more common in drug induced lupus while it is very rare to find anti double stranded antibodies on Smith antigen in drug induced lupus.

• Identical to SLE except when take the drug away, patient gets better (duh)

• Linkage with HLA-DR4

The correct answer is B

Sump syndrome: -

A complication of side-to-side choledocho-duodenostomy, in which the lower end of the CBD

At times acts as a diverticulum, resulting in stasis, trapping of food particles, and infection.

Often the same symptoms that are present before the operation recur or postoperative symptoms such as: Colicky pain, bloating, nausea, and vomiting occur. There is pain on palpation of the RUQ and sometimes jaundice.

The correct answer is A

A Bennett's fracture is an intra-articular fracture of the proximal end (base) of the thumb metacarpal. The resulting bone fragment is held by the intermetacarpal ligament. The base of the metacarpal is displaced laterally by the pull of the abductor pollicis longus

The correct answer is A

Malnutrition is any physical condition resulting either from an inappropriate or inadequate diet, such as a diet that either provides too much or too little of necessary nutrients, or from a physical inability to absorb or metabolise nutrients.

Complications

（1） Anemia

（2） Vitamins deficiency

（3） Infections

（4） Spontaneous hypoglycemia

（5） Disorder of water and electrolyte

The correct answer is A


The activities of glucose-6-phosphatase (G6Pase), fructose-1,6-bis-phosphatase(FDPase), pyruvate carboxylase (PC) and phosphoenolpyruvate carboxykinase (PEPCK), the key gluconeogenic enzymes, increase markedly, indicating compensatory gluconeogenesis.

The correct answer is D

Meckel's diverticulum is the most common congenital anomaly of the gastrointestinal tract, affecting about 2% of the population. Meckel's diverticulum affects the distal ileum and represents the remnants of the proximal end of the embryologic yolk stalk (i.e., the omphalomesenteric or vitelline duct) which normally obliterates completely by the 8th week of gestation.

The correct answer is B


Section 83 of the Indian Penal Code, according to which, nothing is an offence which is done by a child above seven years of age and under 12 years, who has not attained sufficient maturity of understanding to judge the nature and consequences of his conduct on that occasion.

It may be noted that children below the age of seven years are deemed to be incapable of criminal offence as per section 82 of the Indian Penal Code.

The correct answer is D

The Hepatitis C virus (HCV) is a small (50 nm in size), enveloped, single-stranded, positive sense RNA virus in the family Flaviviridae.

The correct answer is C

Arthus reaction demonstrated by Maurice Arthus in 1903.

1. Artificially induced in laboratory.

2. Induced localized inflammatory skin reaction in previously sensitized rabbit (to horse serum) by intradermal injection of cognate Antigen.

Inflammation grossly visible after several hours

a. Longer time than Type I, but shorter than Type IV. Classified as immediate because responsible antibodies can be passively transferred via serum.

b. Ag-Ab complexes form and adhere to vascular endothelium; complement system activated and some of its chemotactic intermediates attract neutrophils to site. Anaphylatoxins degranulate mast cells with resultant release of histamine that causes constriction of arterioles and retards blood supply to area. Platelets stimulated by the immune complex initiate the coagulation cascade, resulting in fibrin deposits. Eventually vessels become clogged with thrombin and accumulated cells, causing an exudate into the surrounding tissue (edema). Deprivation of blood supply to area results in ischemic necrosis.

c. Only precipitating (multivalent) antibodies can elicit the Arthus reaction (mainly IgG). Relatively large amounts of antigen required.

d. Reverse passive Arthus possible (Ab from sensitized animal injected intradermally, Ag IV or at site).

The correct answer is D


Cholecalciferol is Vitamin D

Vitamin D is very important to the health of bone. 1,25- dihydroxy-D3 stimulates the production of a protein in the digestive system called calbindin. Calbindin allows the body to absorb calcium from the digestive system into the blood stream.

The correct answer is A

VASCULAR (ARTERIOLAR) CONTROL

Mainly via the sympathetic nervous system: tonic discharge of sympathetic nerves enhances the basal tone of the arterioles (via neurally released noradrenaline, NAd). There is, with a few notable exceptions, little parasympathetic innervation of arterioles.

Change in this the sympathetic discharge rate either vasoconstricts or vasodilates arterioles:

↑ sympath. activity → arteriolar vasoconstriction

↓ sympath. activity → arteriolar vasodilatation

This forms part of reflex control of the CVS to regulate MAP.

Because adrenergic influences are mediated by α-adrenoceptors in the VSM (controls TPR), and β-adrenoceptors in the heart (controls CO), selective α or β blockers can be used to block one or the other.

The correct answer is A

Creatinine kinase (CK) is an enzyme, found primarily in muscle and brain tissue, which exists as three dimeric isoenzymes — CKMM (CK-3), CK-MB (CK-2), and CK-BB (CK-1) — built from subunits designated M and B.

The CK-MB isoenzyme, which has a molecular mass of approximately 87,000 daltons, accounts for 5 to 50% of total CK activity in myocardium.

In skeletal muscle, by contrast, it normally accounts for just 1% or less, CK-MM being the dominant form, though the percentage can be as high as 10% in conditions reflecting skeletal muscle injury and regeneration (e.g. severe exercise, muscular dystrophy, polymyositis).

The correct answer is A


A standard dose of 5 Tuberculin units (0.1 mL)is injected intradermally (into the skin) and read 48 to 72 hours later. A person who has been exposed to the bacteria is expected to mount an immune response in the skin containing the bacterial proteins.

The reaction is read by measuring the diameter of induration (palpable raised hardened area) across the forearm (perpendicular to the long axis) in millimeters. No induration should be recorded as "0 mm". Erythema (redness) should not be measured.

If a person has had a history of a positive tuberculin skin test, another skin test is not needed.

The correct answer is B


Histrionic Personality Disorder

Pervasive pattern of excessive emotionality, attention-seeking as demonstrated by at least 5 of:

1. uncomfortable if not the center of attention
2. inappropriately seductive
3. rapid, shallow expression of emotion
4. use of appearance to draw attention
5. impressionistic speech style
6. expressions of emotions exaggerated
7. unable to delay gratification
8. considers relationships more intimate than they are

Prevalence: 2-3% general population. Male: Female, slightly more female (as in general population); gay persona, “macho” stance. 10-15% psych outpatients.

Etiology: usually an over sexualized, over stimulated, “special” child; NOT always frankly abused.

Differential: hypomania, brain tumor/infarct (Klüver-Bucy), culture, adaptation/manipulation.

Comorbidity: late phase depression, Somatization, substance problems, other PD.

The correct answer is C

Perthe's test - Checks competence of the venous valves of lower extremities.


# Release a bit of tourniquet, but pt raises up and down on toes after releasing.
# If perforating calf veins have competent valves, calf pump will function, making varicosities less tense.

The correct answer is C

Like all antiarrhythmic drugs, amiodarone can aggravate arrhythmia; this is reported in 3% to 5% of patients.However, because of the long time course of drug action, it may be difficult to distinguish between the natural history of the underlying cardiac disease and the arrhythmia and a drug-related aggravation of arrhythmia. Although amiodarone markedly prolongs the QT interval, torsade de pointes is an infrequent complication and is most often reported in association with hypokalemia or with concomitant therapy using a class IA drug, especially quinidine.

The correct answer is B

Congenital Adrenal Hyperplasia (CAH)

• genetic disorder which involves deficiency in one of enzymes required in steroid hormone synthesis
• in enzyme defects associated with cortisol deficiency, hyperplasia of adrenal gland may occur due to excessive stimulation by ACTH
• when enzyme deficiency leads to virilisation of affected females (masculinisation of ext genitalia) disorder sometimes referred to as adreno-genital syndrome

• wolffian duct development consistently absent in virilised females, who, therefore, have normal internal sex organs
• why development is not stimulated by excess androgen is not understood, but high local concentrations created by testes may be required

The most common block is the 21 Hydroxylase block, which accounts for more than 90% of all CAH cases. The steroid that accumulates is 17 Hydroxy progesterone. This is an easy diagnostic test to do in the newborn period. The blood spot, which is taken at 5 days, can be tested for 17 Hydroxy-progesterone.

The correct answer is B

Toxic shock syndrome (TSS) is an illness marked by acute onset of fever, hypotension, rash, desquamation and failure of multiple organ systems. It is caused by a bacterial infection, predominantly Staphylococcus aureus, but also commonly caused by group A Streptococcus. Cases of TSS caused by other genera of bacteria (e.g. Clostridium sp.) have been reported as well.

Toxic shock syndrome is best known for its association with tampon use (menstrual toxic shock syndrome); however, there are many other causes of infection.

Transmission of staphylococcal TSS requires colonization with the bacteria, usually on a fomite placed inside the body or directly as in the case of burn patients whose wounds are susceptible to infection.

Toxic shock syndrome can be treated with antibiotics; antibiotic prophylaxis has been shown to be effective in high-risk burn patients

The correct answer is C


24-hr pH Monitoring

• Registers the amount and frequency of acid in the esophagus and allows correlation with symptoms such as heartburn and pain. A probe is placed into the esophagus which records the acid level in both the esophagus and stomach for a full 24 hours.
• This is the most accurate method of detecting reflux and GERD
  

The correct answer is D

Urethral stricture is the most common complication of transurethral resection of prostate, occurring in up to 29 per cent of cases.

The correct answer is C


Thymoma is not uncommon in adults, and accounts for 12% of all primary mediastinal masses. The average age at onset is the fifth decade of life and the disease is rare in children. It is the commonest tumor of the anterior mediastinum and is locally invasive in 30-50% of cases.

Thymoma involves mainly the anterior mediastinum and may rarely arise from thymic rests which are not infrequently encountered in the pericardium.

The correct answer is B

The correct answer is C



A fracture of the lower humerus besides leaving a valgus deformity, may cause the opposite or a cubitus varus. This is known colloquilly as a gunstock deformity. It may require a osteotomy of the lower humerus to correct this in the future.

The correct answer is D

MRSA is a germ that can cause Staph infection. It is resistant to most antibiotics including methicillin, the longtime drug of choice for treating many common Staph infections.

The antibiotic vancomycin is given intravenously for MRSA infections.

The correct answer is d

Erb-Duchene paralysis: Waiters Tip

C5,6

• Nerve to Subcavius (ST)
• Suprascapular (ST)
• Lower Subscapular (PC)
• Upper Subscapular (PC)
• Axillary

The correct answer is B

Endoscopic features of Crohn’s disease include: aphthous ulcers, irregular punched-out or longitudinal “serpiginous” ulcers, pseudopolyps, inflammatory polyps, “cobblestone” appearance of the mucosa, strictures, and fistula. Pathologic features of Crohn’s disease (based on biopsy specimens) include many of the same findings as with ulcerative colitis, but the inflammation is transmural, goblet cells and mucin are usually preserved, and granulomas may be present. A granuloma is pathognomonic for Crohn’s disease, but is only present in 50% of cases and its absence does not exclude the diagnosis of Crohn’s disease.

The endoscopic appearance in ulcerative colitis is likened to “wet sandpaper.” Deep, large ulcers (macro-ulceration) of the mucosa may be present in severe ulcerative colitis, but in the majority of people with ulcerative colitis, endoscopically apparent ulcers are usually not seen (in contrast to Crohn’s disease).

The correct answer is C

Multiple Myeloma

Key clinical features

1. 75% of patients are between 50-70 yoa and 2:1 male preponderance
2. LB Pain is the cardinal initial symptom relieved with bedrest and aggravated with weight. With sciatica
3. Bacterial infections occur in 10% of cases most respiratory in nature.
4. Pathological fracture is common complication

Key radiologic findings

1. Bone Scans are cold
2. Gross osteoporosis may be the only early sign
3. Punched lesions are the radiologic hallmark of myeloma
4. Vertebra plana or wrinkled vertebra is characteristic.
5. Raindrop skull (lytic myeloma defects) and pedicle sign of myeloma (preservation of pedicles) occur.
6. “Moth Eaten,” Permeative lesions
7. Foggy cortical – Medullary border

Key laboratory features

1. 40% show Bence Jones’ proteinuria.
2. Immnoglobulin Electrophoresis – to Elevation of IgG
3. May have infections due to decreased WBCs
4. Normocytic, normochromic anemia

Well-defined osteolytic areas are visible in the bone of the calvaria (classical 'raindrop' lesions) (arrows).

The correct answer is D


Atopic Dermatitis

• 10% of kids in industrialized nations - incidence rapidly increasing
• Onset almost always in infancy, and 60-70% will continue to have some manifestations throughout life
• A large % will develop other atopic diseases and many have family history of atopy

Clinical Findings

• Severe pruritis, interferes with sleep. Dbn varies with age
  
• 3 mo: scalp, face, extensor surfaces, i.e. where they can rub (diaper spared)
  
• 2 yrs: flexural involvement, neck, antecubital and popliteal fossa, periorbital area, and hands/feet - leading to more chronic lichenification
  
• Adults: similar, including hands, nipple, periorbital
• Associated features include dry skin
  
• ichthyosis vulgaris - auto-dom
  
• abn keratinazation
  
• keratosis pilaris - rough follicular pustules on posterolateral aspects of arms, thighs
  
• pityriasis alba - poorly circumscribed hypopigmented macules
  
• Dennie-Morgan fold - in eyelid, from rubbing
  
• Increased risk for Staph aureus, viral, and fungal infections (impaired cell-med immunity)

Pathogenesis

• Uncertain, likely to be polygenic
• Linked mutations involve genes that regulate the immune response
• A TH2 dominated disease with increased amounts of IL4, 5, 10 in the skin and blood. Accopanied by increased amounts of IgE and eosinophilia.

Treatment

1. Moisturize the skin
2. Control itching -antihistamines
3. Decrease inflammation -topical glucocorticoids

Pts w/ severe disease require systemic immunosuppression

The correct answer is D

Rigler's sign, also known as the double wall sign, is seen on an x-ray of the abdomen when air is present on both sides of the intestine; a Rigler's sign is present when air is present on the inside (lumenal side) and the outside (peritoneal side).

The correct answer is C

Temperature is the first sensation that is lost. Patients cannot sense extremes of hot or cold. The next sensation lost is light touch, then pain, and finally deep pressure. These losses are especially apparent in the hands and feet; therefore, the chief complaint may be a burn or ulcer in an anesthetic extremity.

The correct answer is C

Carbon Dioxide Transport

• Carbon dioxide is transported in the blood in three forms
• Dissolved in plasma – 7 to 10%
• Chemically bound to hemoglobin – 20% is carried in RBCs as carbaminohemoglobin
• Bicarbonate ion in plasma – 70% is transported as bicarbonate (HCO3–)

The correct answer is A

Signs Of Cerebellar Disease

• gait ataxia
• disturbed stance
• limb dysmetria
• limb dysynergia
• kinetic (intention) tremors
• dysarthria
• past-pointing
• excessive rebound
• impaired check
• dysdiadochokinesis
• head tilt or titubation
• hypotonia
• nystagmus
• ocular dysmetria or ocular dysynergia
• gaze palsies

The correct answer is D

APGAR SCORE: a composite measure of the physical health of an infant, assessed at one and five minutes after birth, and used to predict the infant’s chances of survival. Five easily identifiable characteristics of the baby are assessed on a scale of 0 to 2, with 2 being optimum: heart rate, respiratory effort, muscle tone, reflex irritability, and color. The Apgar score is the sum of these scores, with a score of 7 or higher indicating that the infant is in good physical condition, and a score of 10 being perfect.

Factors affecting apgar score:

• Prematurity
• Drugs-sedatives,narcotics,mgso4
• A/c cerebral trauma
• Precipitate labor
Cong. Myopathy
• 
  
• Cong. Neuropathy
• Spinal cord trauma
• CNS anomaly
Lungs-diaphragmatic hernia
• 
  
• Airway-choanal atresia
• Cong. Pneumonia (GBS)

• Maternal acidosis
• High fetal catecholamine levels
• Some full term infants

The correct answer is A


The commonest cause of severe acute pancreatitis is blockage of the pancreatic duct by gallstones. This can sometimes occur even if the gallbladder has been previously removed. When triggered by excessive alcohol consumption, acute pancreatitis usually resolves itself with rest and abstinence from drinking.

The correct answer is A

WHO has defined perinatal asphyxia as a “failure to initiate and sustain breathing at birth”.

Moderate Birth asphyxia was defined as “Slow gasping breathing or an Apgar score of 4-6 at 1 minute of age.

Severe Birth asphyxia was defined as no breathing or an Apgar Score of 0-3 at 1 minute of age.

The correct answer is B

Meckel's diverticulum is a true diverticulum containing all layers of the intestinal wall, usually arising from the antimesenteric border of the ileum 45–90 cm. proximal to the ileocecal valve. It is a vestige of the omphalomesenteric or vitelline duct, which usually undergoes complete obliteration during the seventh week of gestation. Autopsy studies have estimated the incidence of Meckel's diverticulum to be 1% to 2% with men being more commonly affected than women by a ratio of 2:1. Gastric mucosa is present in 50% of all Meckel's diverticula, but in over 75% of symptomatic individuals.

The correct answer is B

New spongy bone is laid down around the footplate of the stapes which impedes its ability to move freely in the oval window. This causes a conductive deafness which gets worse as the disease process develops.

Examination is normally normal although in very active disease it may be possible to see a pink hue to the drum, from very vascular spongy bone deposits on the medial wall of the middle ear. (Schwarze's sign).

The correct answer is C

Antistreptolysin O antibodies will be raised after infection with streptococci. Levels greater than 200 units per millilitre are considered significant (although cut off levels will vary between laboratory undertaking the test).

Measurement can be useful diagnostically if recent infection with streptococci is known to be important in aetiology. Diseases include:

• rheumatic fever
• post streptococcal glomerulonephritis
• scarlet fever
• erysipelas

The correct answer is A

Goodpasture syndrome (antiglomerular basement membrane disease)

Ña. The cause is antibodies (antiglomerular basement membrane antibodies) directed against antigens in glomerular and pulmonary alveolar basement membranes.

Ñb. Fluorescent antibody studies for IgG demonstrate linear immunofluorescence.

c. Clinical manifestations include:

Ñ(1) Nephritic syndrome

Ñ(2) Pneumonitis with hemoptysis (hemorrhagic pneumonitis)

(3) Peak incidence in men in their mid-20s

(4) RPGN crescentic morphology with linear immunofluorescence

The correct answer is D

Ewing’s sarcoma

• Is a primitive primary malignant tumor of bone it is composed of tumor cells derived from the connective tissue framework of bone marrow

1. 7% of all primary bone tumors. 4^th m/c primary malignant bone tumor behind (multiple myeloma, osteosarcoma, and chondrosarcoma).
2. 10-25 years of age

2. Key clinical features
1. Mimics: Infection; systemic signs of slight fever, secondary anemia leukocytosis, and increase ESR
2. Affects long tubular bones of the Lower extremity.

3. Key radiologic features
1. Saucerization: Cortical saucerization is a characteristic sign. This irregular defect effaces the outside of the bone occasionally, exhibiting a marginal scalloping effect.
   
2. Classic presentation is a diaphyseal permeative lesion with a delicate onion skin or peel periosteal response.
3. The most common primary malignant bone tumor to metastasize to bone

The correct answer is C


In judicial hanging the posterior arch of the axis is snapped clean off and remains fixed to the third vertebra, while the atlas, the Odontoid process, and the anterior arch of the axis remain fixed to skull.

Schneider and colleagues first introduced the term hangman fracture into the modern medical lexicon in 1965 when they described eight patients who sustained bilateral fractures through the neural arch of the axis, with or without dislocation of the body of the axis from that of the third cervical vertebra. According to these authors, "This type of fracture-dislocation occurs in modern judicial hanging and in some instances of traffic accidents".

Most likely, the forces involved in judicial hanging are much greater than those sustained by many motor vehicle accident victims, and the spinal disruption between C2 and C3 caused by judicial hanging is considerably greater.

The correct answer is C

Plummer-Vinson syndrome: hypopharyngeal web + iron-deficiency anemia in middle-aged women. This syndrome occurs most commonly in individuals of Scandinavian descent and is characterized by esophageal webs, iron deficiency anemia, dysphagia, achlorhydria, atrophic gastritis, hiatal hernia, and increased risk of cancer. Dysphagia improves in the Plummer-Vinson syndrome with iron therapy, though the webs remain.

The correct answer is B

Primary biliary cirrhosis (PBC) is a disease characterized by inflammatory destruction of the small bile ducts within the liver. PBC eventually leads to cirrhosis of the liver.

Most patients with PBC present with pruritus (itching). After pruritus, jaundice (yellow skin caused by bilirubin retention) is the most common presenting symptom.

The correct answer is B

A drug normally used to fight tuberculosis, isoniazid (INH) with pyridoxine, is also helpful in controlling severe gross tremors which are posture related. Unfortunately, large doses of isoniazid are needed to be effective, and this can result in liver toxicity. Given the danger, this medication should only be used in extreme cases, and liver function must be evaluated regularly.

Four patients with disabling action tremor in the setting of MS were treated with isoniazid (800 to 1200 mg per day). All patients showed significant improvement of the tremor, allowing more functional use of their extremities. To the best of our knowledge, this is the only medical treatment for this type of tremor.

Ref: Treatment of action tremor in multiple sclerosis with isoniazid;A. F. Sabra, M. Hallett, L. Sudarsky and W. Mullally ; American Academy of Neurology ;NEUROLOGY 1982;32:912

The correct answer is D

The combination of amphotericin B and intralipid should not be given to patients

• Intralipid does not decrease the renal toxicity and subjective side effects associated with intravenous amphotericin B at a dose of 0.75mg/kg/day in neutropenic cancer patients
• Use of amphotericin B in intralipid 20% can be associated with transient pulmonary toxicity, possibly related to fat overload
• On the basis of published data, amphotericin B and intralipid 20% should be regarded as chemically incompatible

The correct answer is B


The immune system of mammals makes receptor proteins (antibodies) to substances that are foreign (i.e. not part of the body), each antibody being specific to a given substance. Antibodies are of several types, IgG for instance being involved in protection against viral diseases after vaccination whereas IgE, involved in atopic individuals, is particularly concerned with protection against parasites.

The correct answer is C

Tetanus spores infect women and children through unsafe or unclean deliveries, accounting for an estimated 5% of maternal deaths and 14% of neonatal deaths.Tetanus toxoid vaccines can prevent infections and save the lives of mothers and infants alike. Pregnant women should receive at least two doses of tetanus toxoid, which provide one to three years of protection.

The correct answer is B

Fleischer rings are pigmented rings in the peripheral cornea, resulting from iron deposition in basal epithelial cells. They are usually yellowish to dark-brown, and may be complete or broken.

Fleischer rings are indicative of keratoconus, a degenerative corneal condition that causes the cornea to thin and change to a conic shape.

The correct answer is C


Pericarditis, which is an inflammation of the membrane enveloping the heart, is the most frequent manifestation of cardiac lupus. The inflammation can cause the build up of fluid into the pericardial sac surrounding the heart and cause compression of the heart.

The correct answer is B


The spondyloarthropathies are a family of interrelated, but heterogeneous, conditions. There can be a marked overlap between the different conditions. All of these conditions are associated to a greater or lesser extent with the HLA B27 antigen. The diseases included in this group are ankylosing spondylitis, Reiter’s syndrome, reactive arthritis, psoriatic arthritis, and the enteropathic arthritis associated with inflammatory bowel disease.

Disease classified under the spondyloarthropathies

• Ankylosing spondylitis (AS)
• Reiter’s syndrome / Reactive arthritis
• Enteropathic arthritis (Crohn’s disease, ulcerative colitis)
• Psoriatic arthritis

Although the precise etiology is unknown, there is a strong association between this group of diseases and the HLA-B27 antigen. HLA-B27 forms part of the class I antigens of the major histocompatibility complex (MHC) and is expressed on the surface of many cell types. This supports the view that these diseases are due to a genetically determined immune response to environmental factors.

One hypothesis is that an immune response is triggered by an infection in the gastrointestinal or genitourinary tracts. Some Chlamydia, Salmonella and Yersinia antigens can be found in the synovial fluid of patients who had infections with these pathogens. Some peptide fragments from these bacteria possibly bind to the HLA-B27 antigen and are presented to the T-cells, thus triggering an autoimmune response.

An alternative hypothesis suggests an autoimmune reaction to self-antigens, because of mimicry between fragments of the infecting microorganisms and host tissue i.e. antigenic fragments between fragments of bacteria and self-antigens. These infecting organisms may be Gram negative bacteria, such as Klebsiella which have been shown to possess antigens that resemble the HLA-B27 antigen. They may give rise to antibodies that crossreact and bind to HLA-B27 positive cells resulting in disease manifestations.

The correct answer is D

The correct answer is B

For India, the National Family Health Survey of 1992-93 was the first to provide a national-level estimate of 437 maternal deaths per 100,000 births for the two-year period preceding the survey (International Institute for Population Sciences, 1995).

To fill the data gap, in recent times, the potential of the Sample Registration System - a dual record system for collecting data on births and deaths - for estimating maternal mortality has also been explored. The source has recorded a maternal mortality rate of 408 and 407 for 1997 and 1998, respectively (India, Registrar General, 1999 and 2000).

The correct answer is C

In March 2003, a Chinese-American businessman died in Vietnam from a severe flu-like illness. Soon after, reports of a new disease, then termed "atypical pneumonia," made headlines around the world.

The first cases of SARS probably arose in November 2002 in Foshan City, located in the Guangdong Province of China. The Chinese government did not publicize the outbreak right away, however. In February 2003, the Chinese Ministry of Health reported 305 cases, with five fatalities, of a disease that quickly deteriorated the patient's health and evolved to respiratory failure. About one third of those affected were health care providers.

SARS first gained attention outside of China in March 2003, when Dr. Carlo Urbani, a WHO official based in Vietnam, reported several cases of "atypical pneumonia" at the hospital where he worked. The first of these cases was the Chinese-American businessman. Following these reports, the WHO was finally able to trace the disease and account for its spread across so many countries. On March 29, Dr. Urbani himself died of SARS.

The correct answer is B

According to the Population Reference Bureau's 2000 World Data Sheets, life expectancy at birth for Indians is between 60 and 61 years. This was also confirmed by the most recent Census of India in 2001. Only 4% of our population is over the age of 65.

Country:	INDIA
Population:	1,065,462,000 (2003)
Capital City:	New Delhi
National Language:	Hindi
Per capita income:	US$ 530/year (2003)
Country:	INDIA
Life expectancy:	64 years (2003)
Access to safe water:	86% (2002)
Under 5 Mortality Rate:	87/1,000 live births (2003)

The correct answer is C

Alexia - pure word blindness

• results from damage to left occipital cortex and corpus callosum caused by a stroke.
• here the right visual field is lost because this projects onto the left visual cortex.

The correct answer is D

The gastrinoma syndrome, or Zollinger-Ellison syndrome, has traditionally been associated with a severe, fulminant ulcer diathesis, often with multiple ulcers, and ulcers in unusual locations such as the post-bulbar region of the duodenum and proximal jejunum.

However, with increasing recognition of this syndrome, as well as the availability of a radioimmunoassay for serum gastrin, most patient's with gastrinoma now present with either milder forms of peptic ulcer disease, or with secretory diarrhea.

The syndrome can exist in multiple forms, including benign sporadic, malignant metastatic, and as part of the MEN-I syndrome.

Approximately 66% of gastrinomas are sporadic. Sporadic tumors are reported to be malignant in approximately 40-85% of cases. Sporadic gastrinomas occur primarily in the gastrinoma triangle, defined as the confluence of the cystic and common bile duct superiorly, the second and third portions of the duodenum inferiorly, and the neck and body of the pancreas medially.

Although they can occur in the pancreas, the duodenum has been shown to be the most common site of gastrinomas, based on the pioneering work of Debas and colleagues, Thompson and colleagues, and others. Duodenal wall gastrinomas have been identified in 43-77% of patients.

The correct answer is D

Alcohol is responsible for about 30% of all cases of acute pancreatitis. The amount of alcohol required to induce clinically acute pancreatitis is controversial. Sarles suggests that an average intake of 80g of alcohol needs to be taken daily for 5 to 15 years before 1st attack. Acute attacks may occur with lesser, intermittent consumption (ie weekend binging).

Gallstones are the leading cause of acute pancreatitis in most series (30-60%), however only 3-8% of patients with symptomatic cholethiasis will develop acute pancreatitis.

The cause of AP in about 1.3-3.8% of cases. Hyperlipidaemia types 1,4 or 5 cause pancreatitis; is generally associated with serum triglyceride levels > 1000mg/dl.

The correct answer is B

Chlorination status of water is confirmed by carrying out Ortho Toluidine test where in 1 ml sample of drinking water a drop of Ortho Toluidine reagent is added and after 10 seconds the yellowish coloration is compared with the standard colored plates of choloscope for the presence of free chlorine.

The correct answer is B

The National Programme of Nutritional Support for Primary Education (i.e. the national
“mid-day meal scheme”) was initiated in 1995. By 2001 a few states were providing cooked meals, but most were only giving monthly “dry rations” of foodgrain to school children. The number of states providing cooked meals rose sharply from early 2002 onwards, after a Supreme Court order (dated 28 November 2001) directed all State Governments to introduce cooked mid-day meals in primary schools.

The Programme guidelines have also been revised in September, 06 wherein the nutritional norms were raised from the existing 300 calories and 8-12 grams of proteins to minimum 450 calories and 12 grams. of proteins.

From the allowances recommended by the Indian Council of Medical Research (ICMR) for children in the age range 6 to 10 years, one third of the daily requirements are computed as the nutrients and calories to be supplied by the school lunch.

The correct answer is B

The correct answer is D

Aqueous flare - The release of protein following breakdown of the blood-aqueous barrier renders the aqueous no longer optically clear. The path of a light shone across the anterior chamber is defined in the aqueous. A sharp focussed beam and careful observation are needed. Aqueous flare is usually transient.

To see aqueous flare an intense and focal light source must be held close (1 cm) to the corneal surface. A direct ophthalmoscope set at its smallest circular aperture of white light, and to its highest light intensity, works best (a pen light is inadequate for this procedure). Aqueous flare is present if the light beam is visible in the anterior chamber.

The correct answer is D


Pseudomonas aeruginosa is the predominant pathogen associated with otitis externa. Occasionally P. aeruginosa may penetrate the epithelium of the floor of the external auditory canal & invade the underlying soft tissue, cartilage & cortical bone. This condition is called malignant otitis externa & occurs predominately in elderly diabetics. Virtually all cases of malignant otitis externa are caused by P. aeruginosa.

The correct answer is C

Gross negligence recognised as 'criminal negligence' is deemed as an offence, though criminal intention may not be present. Section 304-A of IPC deals with causing death by any rash or negligent act and prescribes a punishment of imprisonment of either description for a term which may extend to two years or with fine or with both.

The correct answer is A

Poisons may exert a twofold action. This may be either local, or remote, or both local and remote.

The local action of a poison is usually one of corrosion, inflammation, or a direct effect upon the sensory or motor nerves.

The remote actions of poisons are usually of a specific character, though some writers group the remote effects of poisons under two heads, and speak of the common and the specific remote effects of a poison.. The local action of a poison of the corrosive class is usually so well marked and obvious that the fact of the administration of a poison of this class is generally unmistakable.

The symptoms produced by the mineral acids and the alkalies are almost altogether referable to local action; but some corrosive poisons, such as carbolic acid, produce, besides a local action, remote and specific constitutional effects.

The correct answer is A


Copper is a cofactor for lysyl oxidase, the enzyme that forms cross-links between collagen in connective tissue.

The correct answer is B

The anterior spinal nerve roots contain only motor fibres and posterior roots only sensory fibres.

Charles Bell's work of 1811 Contains the first reference to experimental work on the motor functions the ventral spinal nerve without, however, establishing the sensory functions of the dorsal roots.

In 1822 Magendie definitively discovered that the anterior root is motor and that the dorsal root is sensory. Magendie announced that "section of the dorsal root abolishes sensation, section of ventral roots abolishes motor activity, and section of both roots abolishes both sensation and motor activity". This discovery has been called "the most momentous single discovery in physiology after Harvey". In the same volume of Journal de physiologie expérimentale et de pathologie, Magendie gave experimental proof of the Bell-Magendie law.

Magendie proved Bell’s law by severing the anterior and posterior roots of spinal nerves in a litter of puppies. Stimulation of the posterior roots caused pain.

The correct answer is B

Antibody-mediated immunity is active when the person synthesizes his own antibody; it is passive when another person or animal synthesizes the antibody and it is subsequently injected into the person receiving the passive immunization.

Cell-mediated immunity is active when the person's own T-cells are stimulated or adoptive when the source of stimulated T-cells is another person.

Adoptive immunization is rarely used with humans because the recipient will reject the cells unless they are histocompatible (genetically identical, e.g. from an identical twin).

Innate immunity is present from birth and is independent of the life experiences of the person, whereas acquired immunity arises only after an infection or immunization and hence is acquired during life.

The correct answer is C


CHOLESTEROL: Cholesterol is a fat-like substance found in all foods of animal origin (meat, poultry, fish, and dairy products) but not in food from plants. It is also produced by the liver. Cholesterol is a normal component of the blood and is needed for nerves, cell walls, and hormones. However, too much cholesterol can build up in arteries leading to heart disease, stroke, hypertension, and atherosclerosis. Cholesterol is transported in the blood in several forms - two important forms are high-density lipoprotein (HDL) and low-density lipoprotein (LDL). Levels are dependent upon age, diet, heredity and exercise.

LIPOPROTEIN: A combination of a lipid (fat) and a protein. Because fat and water don’t mix, cholesterol must be carried in the blood by protein capsules.

LDL CHOLESTEROL (Low Density Lipoprotein): This is the form of cholesterol often termed “the bad cholesterol.” It tends to build up on blood vessel walls, increasing the risk of heart disease.

HDL CHOLESTEROL (High Density Lipoprotein): HDL cholesterol, often termed “the good cholesterol,” appears to remove cholesterol from the body. Large amounts of HDL cholesterol are associated with a decreased risk of heart disease.

TOTAL CHOLESTEROL/ HDL RATIO: This value is used to predict heart disease risk.

TRIGLYCERIDE: The form of fat in the body's fat deposits. It forms when we eat more than we burn off. Triglycerides are a source of stored energy and can be imported through the blood. The role of high blood triglycerides in heart disease is unclear. However, for some people high triglycerides are a risk factor similar to high cholesterol. In this test, it is used to calculate LDL levels, as LDL values are difficult to measure directly.

The correct answer is D


FTA-ABS stands for fluorescent treponemal antibody absorbed, a blood serum screening test for syphilis designed to demonstrate the presence or absence of specific antibodies directed against the organism (Treponema pallidum) responsible for syphilis.

The correct answer is C

The cardinal clinical features of cerebellar disease are ataxia, dyssynergia, and dysmetria. Ataxia of gait is typified by unsteadiness with a wide base, body sway, and an inability to walk on tandem (heel to toe). Dyssynergia refers to a decomposition of movement instead of a smooth, continuous movement; it is associated with a tendency to miss a target and worsens when approaching the target. Dyssynergia is frequently accompanied by dysmetria (the misjudging of distance), with its characteristic overshooting and undershooting of a target.

The correct answer is A

Ergometrine is an amine ergot alkaloid that stimulates contractions of uterine and vascular smooth muscle.

The correct answer is A

Aztreonam (Azactam)

• Synthetic
• Primarily active against aerobic gram-negative bacteria (E. coli, Klebsiella, Pseudomonas)
• Bactericidal
• Used for severe systemic infections and UTIs