Q.Most common cause of renal artery stenosis is YOUNG patients less than 50yrsa)DM
b)Atherosclerosis
c)HTN
d) Fibromuscular dysplasis
Answer:d) Fibromuscular dysplasis
Review: Renal artery stenosis is a narrowing or blockage of the artery that supplies blood to the kidney. It is caused by atherosclerosis, fibromuscular dysplasia of the renal artery wall, or scar formation in the artery.
Renal artery stenosis is caused when atheroembolic renal disease results in narrowing of the renal artery. Fibromuscular disease, a condition more common in young women in which fibrous tissue grows in the wall of the renal artery and narrows it, is a second cause. It may also be caused when scar tissue forms in the renal artery after acute arterial obstruction or traumatic injury to the kidney.
Renal artery stenosis often causes hypertension (high blood pressure) with no other signs of its presence, and it is usually discovered in investigation for the cause of hypertension that is difficult to control. Renal artery stenosis is, in fact, among the most common causes of secondary (caused by another condition) hypertension. The disorder may also be discovered when a bruit (loud whooshing sound) over the kidney is noted on examination with a stethoscope (auscultation).
In the elderly, renal artery stenosis is most commonly associated with atherosclerotic disorders, including atherosclerotic heart disease. Atherosclerotic plaque deposits within the renal artery and causes it to become stenosed (narrowed).
Fibromuscular dysplasia is a congenital disorder involving thickening of the arterial wall and is a cause of renal artery stenosis in younger adults, particularly women 20-40 years old.
Renal artery stenosis may cause chronic renal failure if it affects both renal arteries or if the high blood pressure associated with this condition is prolonged or severe.
Q.Life span of Cu-380A in years
a)2
b)1
c)5
d) 10
Answer:c) 5 years
Review: Tcu-380A device has approved life span of only 5 years but effective life is atleast 10 years. The Tcu-380A is now the most widely available used IUD distributed in more than 70 countries and one of the most effective methods of contraception ever developed (Schmidt et al, 1994).
Types
Unmedicated or inert
Medicated - copper bearing or hormone releasing
The majority of the IUDs now widely used are copper bearing
Progressing from stones in camels to insert devices, researchers have developed the second and third generation of medicated IUDs which are highly effective, long lasting, have fewer side effects than earlier models.
Actually the first modern IUDs, the Lippes Loop and the Margulies Spiral appeared in the early 1960s. They were made of polyethylene, biologically inert plastic (Zipper et al 1969). The first generation of copper IUDs, which included the Cu-7, the Tcu-200 and the Multiload-250, carried copper wire with a surface area of 200 to 250 mm2. it was thought that these IUDs would have to be replaced every few years therefore newer IUDs were developed including the Tcu-380A, the Tcu-220C, the Nova T, the Multiload-375 and others. IUDs that release a hormone in the uterus were developed in the 1970s (Luukkainen 1994). A smaller, lightweight and flexible T-shaped copper IUD, the Cu-SAFE 300, which can be inserted without a plunger and is designed to move towards the uterine fundus when the uterus contracts (Vankets et al 1995) is also being marketed. Others are frameless IUDs consisting of six copper sleeves on a surgical nylon thread called the FlexiGard 330, Gynefix TM, or Cufix PP 330 (Vankets et al, 1995, WHO 1995).
The hormone releasing LNG-20 IUD may be even more effective than copper IUDs. Also it reduces menstrual bleeding, while copper IUDs may increase it (Luukkainen and Trivonen 1995). The Progestasert which has been marketed since 1976, contains 38 mg of progesterone released at a rate to 65mg per day for one year. The LNG-20 IUD contains 52 mg of levonorgesterel released at a rate if 20 mg per day and lasts at least five years.
The other major types of unmedicated IUDs are flexible stainless steel rings (either round or of the shape of the uterine cavity and made with a single or double coil). These ring have been widely used in China but not elsewhere.
Mechanism of Action:
The precise mechanism of action of copper IUDs is still not certain, probably affect ova and sperm in various ways, most likely the primary action is altering the function or survival of sperms and ova before they can meet (Croxatto et al 1994). They stimulate a pronounced inflammatory reaction or foreign body response in the uterus. The concentration of various types of white blood cells postaglandins and enzymes in uterine- tubal fluids increases markedly (Sagiroglu 1971, WHO 1987). These changes may interfere with transport of sperms in the genital tract and may damage sperms and ova so that fertilization is impossible (WHO 1987). It has been reported that fewer sperms are found in the fallopian tubes in IUD users than in nonusers. Various types of white blood cells probably consume or damage many sperms in the uterus (Sagiroglu 1971). However, the LNG-20 IUD, although also prevent sperm and ova from joining, has a primarily hormonal mode of action, probably working chiefly by thickening cervical mucus so that sperms cannot pass through it (Luukkainon and Toivonen 1995). Prevention of implantation as a result of biochemical and histological changes in the endometrium as a result of biochemical and histological changes in the endometrium play only a minor role, specially in case of Cu ebaring or progesterone releasing IUDs.
Progesterone releasing IUD exerts no protective effect against ectopic pregnancy. Progesterone decreases tubal motility and this may be the reson for the progesterone releasing IUD failing to reduce the frequency of ectopic pregnancies. Rate of ectopic pregnancy with Levonogestrel releasing IUD is very low 0.02/100 women after 5 years of use (WHO 1997).
Q. Most common causee of Nephrotic syndrome in Adults:
- FSGN
- MPGN
- MCD
Answer: ?
Review:
Minimal change disease: The most common cause (80%) of nephrotic syndrome in children. It is so called because on renal biopsy there is no change on light microscopy, only electron microscopy reveals fusion of foot processes.
Membranous glomerulonephritis: The most common primary renal cause of nephrotic syndrome in adults in developing countries
Focal glomerulosclerosis — Focal glomerulosclerosis (FGS) is the most common cause of the nephrotic syndrome in adults, accounting for 35 percent of all cases and over 50 percent of cases among blacks in western countries. FGS can present as a primary syndrome (primary FGS) or may be associated with other conditions (secondary FGS).
FGS is characterized on renal biopsy by the presence in some but not all glomeruli (hence the name focal) of collapse and scarring. The cause of primary disease is unknown, although a few cases appear to result from a genetic defect.
There is a subtype of FGS called collapsing FGS, which most often occurs in blacks. This disorder was first described in HIV-infected patients, but can occur in those without HIV infection.
Which among the following mycobacteria does not produce pigment when grown In light or dark?
- M. avium intracellulare complex
- M. xenopi
- M. scrofulaceum
- M.marinum
Answer:
M. avium intracellulare complex
Review:
A Quick Review of the Mycobacteria
All Mycobacteria share the following characteristics:
They are nonmotile, slim rod shaped organisms, 1-10 µm long.
They are obligate aerobes.
They grow very slowly when compared with conventional bacterial such as E. coli. They contain mycolic acid, a rare acid that is otherwise only found in Nocardia and Corynebacterium.
They stain Acid-fast with the Ziehl-Neelson stain.
A Quick Review of M. tuberculosis:
M. tuberculosis is a slender (1-4µm), unencapsulated, strongly acid-fast rod that frequently shows irregular beadingdue to vacuoles and polyphosphate content.
- M. tuberculosis has doubling time of 18 hours.
- M. tuberculosis multiplies intracellularly in phagosome and prevents phagolysosome fusion.
- M. tuberculosis produces large amounts of niacin, however, drug resistant strains can no longer do this.
- M. tuberculosis makes a heat sensitive catalase, unless it is INH resistant.
- M. tuberculosis reduces nitrate. (M. bovis does this too.)
- M. tuberculosis is virulent for Guinea pigs.
The virulence factors of M. tuberculosis include:
Waxes D, a heterogeneous group of peptidoglycolipids in cell wall with adjuvant activity.
Cord factor (Trehalose 6,6 dimycolate) which is a poorly understood determinant of pathogenicity that does manybad things in vitro.
Sulfatides which seem to be involved in the inhibition of phagolysomal fusion.
A Quick Review of the Nontuberculous Mycobacteria
The Nontuberculous Mycobacteria are soil and water organisms
The Nontuberculous Mycobacteria are noncommunicable. (i.e., There is no person to person spread.)
The Nontuberculous Mycobacteria prevents phagosome-lysosome fusion.
Disease usually develops in setting or trama/surgical disruption or immunosuppression.
The Nontuberculous Mycobacteria do not infect guinea pigs.
As a group, the Nontuberculous Mycobacteria are INH resistant. (M. kansasii is the exception to this rule.)
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Runyon Classification System of the Atypical Mycobacteria Runyon I Grown in the Dark.
Runyon I:
Members of Runyon I are slow growing.
Members of Runyon I produce a yellow-orange pigment when exposed to light.
A Few Interesting Facts About Runyon I Organisms:
M. kansasii
- On acid fast stain, M. kansasii appears as a long, banded, beaded, "barber pole", yellow bacillus due to beta carotene crystals.
- Some nonpathogenic strains of M. kansasii are catalase negative.
- M. kansasii reduces nitrate like M. tuberculosis.
- M. kansasii causes a lung disease that clinically resembles TB, especially in those with preexisting lung conditions such as COPD.
- Also males are affected more than females.
M.marinum
- Exposed to Light M. marinum causes swimming pool granulomas, and abscesses (fish fancier’s finger).
- Because M. marinum likes to grow at a lower than core body temperature, it causes disease at the site of abrasions.
- M. marinum inhabits both fresh and salt water, and infects a lot of marine organisms
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Runyon II:
Members of Runyon II are slow growing.
Members of Runyon II produce yellow-orange pigment in light or dark.
Few Interesting Facts About Runyon II Organisms:
M. scrofulaceum
- M. scrofulaceum produces scrofula, a granulomatous cervical adenitis, usually in children.
- M. scrofulaceum enters through the oral pharynx and draining lymph nodes.
M. xenopi
- M. xenopi grows poorly at 37oC, but prefers temperatures of 42oC- 45oC.
- M. xenopi is isolated from water, hot and cold taps, and granulomatous lesions in swine
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Runyon III
Members of Runyon III are slow growing
Members of Runyon III do not produce pigment.
A Few Interesting Facts About Runyon III Organisms:
M. avium intracellulare complex
M. avium intracellulare complex is often called MAC.
M. avium intracellulare complex is most common NTM infection in AIDS.
M. avium intracellulare complex causes:
- In middle-aged smokers with COPD or bronchiestasis, MAC can cause cough, weight loss, upperlobe x-ray changes, and cavities - all similar to TB.
- Patients with brochiectasis from old TB or cystic fibrosis can develop infiltrates from MAC infection inthe diseased lung areas.
- Non-smoking women over 50 who have a persistent cough and interstitial changes in their right middle lobe or lingula can have MAC infection.
The key to diagnosis is thinking to send sputum for AFB smear and culture. Whereas it used to be thought that these women were simply colonized with MAC, it is nowrealized that 20% will die within 5 years unless treatment is given.
- Scrofula, most common cause of cervical lymphadenitis in children. It must be treated by excision. M. avium intracellulare complex is highly drug resistant.
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Runyon IV:
Members of Runyon IV are rapid growing.
They produce colonies in less than 5 days.
Members of Runyon IV do not produce pigment.
The production of arylsulfatase is used to distinguish the clinically significant rapid growers.
Members of Runyon IV have a positive test for iron uptake test
Few Interesting Facts About Runyon IV Organisms:
M. chelonei and M. fortuitum
M. chelonei and M. fortuitum cause infections in the immunocompromised (although disseminated-DZ is rare), and those with prosthetic implants.
Sometimes, M. chelonei and M. fortuitum infections can be traced to contaminated operating equipment (e.g., mammoplasty).
Areas infected by M. chelonei and M. fortuitum include soft tissue, lungs, bone, the CNS, and the eye (keratitis).
M. fortuitum reduces nitrate like M. tuberculosis
11. Hypertrophic pulmonary osteoarthropathy is seen in
- Scc lung
- Anaplastic ca lung
- Adeno ca lung
Answer:
Adeno ca lung
"Symmetrical osteitis of the four limbs, chiefly localized to the phalanges and the terminal epiphyses of the long bones of the forearm and leg, sometimes extending to the proximal ends of the limbs and the flat bones, and accompanied by dorsal kyphosis and joint involvement. It is often secondary to chronic conditions of the lungs and heart. (Dorland, 27th ed)"
Hypertrophic pulmonary osteoarthropathy is a rare disorder that is associated with severe clubbing.
This disorder is characterised by:
- Subperiosteal new bone formation at the distal ends of long bones, metatarsals, metacarpals and proximal phalanges
- Symmetrical arthropathy of adjacent joints
- Clubbing of the fingers
- Gynaecomastia
- The patient may complain of dull aching and sometimes swelling of the wrist and ankles.
Paraneoplastic syndromes:
Gynecomastia - most commonly with large-cell
Hypercalcemia - most commonly with squamous cell
Hypertrophic pulmonary osteoarthropathy - presents as bilateral pain and tenderness in the legs, especially over the tibias.
Bone scan positive.
X-rays show elevated periosteum without cortical involvement. - most commonly with adenocarcinoma (secondary to PTHrp)
Clubbing of digits
Syndromes according to tumor location:
Pancoast syndrome (superior sulcus tumor) - lower brachial plexopathy,
Horner's syndrome,
shoulder/ulnar distribution of pain.
Horner's syndrome - enophthalmos, ptosis, miosis, ipsilateral loss of sweating, hoarseness due to recurrent laryngeal nerve involvement
Second primary: Patients treated for upper aerodigestive tract tumors (lung, H&N, esophagus) have a 3%/year risk of developing a subsequent cancer.
Wickham striae is seen in
1.Lichen planus
2. Psoriasis
3. Dermatophytic Infections
4. Eczema
Answer: Lichen planus shows Wickham striae (white, fine, reticular scales).
Lichen planus facts
- about one in 50 people affected
- ages 30 to 60
- women slightly more than men
- children or older people rarely affected
- cause unknown - not infectious
- often mistaken for other skin conditions
- flat-topped, pink-purple spots with a shiny surface that reflect light
- appear in groups or along the line of an injury
- irregular white streaks seen - Wickham's striae
- can cause mouth ulcers, hair-loss, nail damage
10) yellow coloured crusts are seen in
Impetigo
Well thats the answer...
Impetigo, a contagious skin infection that usually produces blisters or sores on the face and hands, is one of the most common skin infections among kids.
It is generally caused by one of two bacteria: group A streptococcus or staphylococcus aureus. Impetigo usually affects preschool and school-age children, especially in the summer months. A child may be more likely to develop impetigo if the skin has already been irritated or injured by other skin problems, such as eczema, poison ivy, insect bites, or a skin allergy to soap or makeup.
Good hygiene can help prevent impetigo, which often develops when there is a sore or a rash that has been scratched repetitively (for example, poison ivy can get infected and turn into impetigo). Impetigo is typically treated with antibiotics.
Signs and Symptoms
Impetigo may affect skin anywhere on the body but commonly occurs around the nose and mouth, hands, and forearms.
When impetigo is caused by group A streptococcus, it begins as tiny blisters. These blisters eventually burst and leave small wet patches of red skin that may weep fluid. Gradually, a tan or yellowish-brown crust covers the affected area, making it look like it has been coated with honey or brown sugar.
Impetigo that is caused by staphylococcus aureus triggers larger fluid-containing blisters that appear clear, then cloudy. These blisters are more likely to stay intact longer on the skin without bursting.
Contagiousness
Impetigo may itch and can be spread by scratching. Kids can spread the infection by scratching it and then touching other parts of the body.
Impetigo is contagious and can spread to anyone who comes into contact with infected skin or other items, such as clothing, towels, and bed linens, that have been touched by infected skin.
9) strep viridans causes
1. erysipelas
2. endocarditis
3. impetigo
Answer : Endocarditis
Many bacteria can cause endocarditis, but an organism commonly found in the mouth, Streptococcus viridans, is responsible for approximately half of all bacterial endocarditis. Other common organisms include Staphylococcus and Group D streptococcus. Less common organisms include Pseudomonas, Serratia, Candida, and many others
8 ) ultras sonic feature of impending fetal death
• Brady cardia
• Altered fetal tone
.Absent fetal respiration
Answer: Bradycardia?
Fetal Monitoring
Monitoring consists of measuring uterine contractions with a tocometer, fetal HR with a Doppler transducer, and fetal movement and tone with ultrasonography. Together, these measurements yield a good indication of fetal health. Preoperative ultrasonography can also approximate gestational age when an accurate history cannot be obtained. Gestational age plays a pivotal role in all surgical decision making for a pregnant patient.
The fetal HR is routinely measured both preoperatively and postoperatively. Though the fetal HR can be heard 14 weeks after conception, it serves as an indicator of fetal oxygenation only after week 26. Specific fetal HR abnormalities—absence of variability, late or variable decelerations, and bradycardia—are predictive of impending fetal hypoxia, physical damage, or death. In the absence of these extreme (and hence obvious) fetalHR patterns, interpretation of fetal tracings can be complex. There are no conclusive data to suggest that any single monitoring technique reflects fetal outcome.Optimization of maternal physiologic status is more important than any mode of fetal monitoring.
