Pg Blazer - Online Test Series - Weekly Test 4

The fat globules released from the bone marrow (due to trauma / orthopedic procedures) are deposited in the pulmonary capillary bed. This causes ischemia and inflammation. The symptoms appear 12-72 hours after the trauma. Initial symptoms are tachycardia and tachypnoea. There may be high spiking fever and non palpable petichae, especially over upper body. Neurological symptoms like agitation, delirium, stupor and coma can occur. (The fat globules may cross the pulmonary circulation via arteriovenous connections).

Renin is an enzyme that plays a crucial role in regulating blood pressure and fluid balance in the body. It is primarily secreted by the juxtaglomerular apparatus, which is located in the kidney. The juxtaglomerular apparatus consists of specialized cells in the walls of the afferent arterioles that supply blood to the glomerulus. When there is a decrease in blood pressure or a decrease in sodium levels, the juxtaglomerular cells release renin into the bloodstream. Renin then acts on angiotensinogen to produce angiotensin I, which is further converted to angiotensin II. Angiotensin II causes vasoconstriction and stimulates the release of aldosterone, leading to increased blood pressure and fluid retention. Therefore, the juxtaglomerular apparatus is responsible for the secretion of renin.

Imperforate hymen prevents drainage of menstrual blood which accumulates in the vagina producing hematocolpos. This is seen as the tense bulge.

Some drugs causing gynaecomastia:

Reserpine
Cemetidine
Spironolactone
Ketoconazole
Digitalis
INH
Methyldopa
Phenytoin
Flutamide

Dobutamine is a synthetic / exogenous catecholamine.

Mnemonic for causes of avascular necrosis other than fracture – SCLERA
S – Steroids
C – Caisson’s disease
LE – Lupus Erythematosus
R – Radiation
A – Alcohol

The treatment of choice for glue ear is myringotomy with ventilation tube insertion. Glue ear, also known as otitis media with effusion, is a condition where fluid accumulates in the middle ear. Myringotomy involves making a small incision in the eardrum to drain the fluid, and ventilation tube insertion involves placing a small tube in the incision to keep it open and allow for continued drainage. This procedure helps to relieve symptoms and restore normal hearing. Conservative treatment with analgesics and antibiotics may be used in some cases, but myringotomy with ventilation tube insertion is the preferred option for persistent or severe cases of glue ear.

Fine Needle Aspiration Cytology (FNAC) is not performed as a diagnostic procedure for pheochromocytoma. Pheochromocytoma is a rare tumor that develops in the adrenal glands and produces excessive amounts of adrenaline and noradrenaline. CT scan and MRI are imaging techniques used to visualize the tumor and assess its size and location. MIBG scan is a nuclear medicine test that helps in identifying and locating pheochromocytoma. However, FNAC, which involves extracting cells from the tumor using a thin needle for microscopic examination, is not commonly used for diagnosing pheochromocytoma due to the risk of triggering a sudden release of hormones during the procedure.

Filgrastim is a granulocyte colony-stimulating factor (G-CSF) analog used to stimulate the proliferation and differentiation of granulocytes.

The pregnancy should be best terminated at 37 completed weeks because this is considered full term and reduces the risk of complications associated with preterm birth. Additionally, the patient has pregnancy-induced hypertension, which increases the risk of complications such as preeclampsia. Terminating the pregnancy at 37 weeks allows for adequate fetal development while minimizing the risk to both the mother and baby.

Cu-T 380A is the correct answer because it is an intrauterine contraceptive device (IUCD) that can act for 10 years. The "Cu" in the name stands for copper, which is the active ingredient in the device that prevents pregnancy. The number "380" indicates the amount of copper in the device (380 mm2), which is higher compared to other IUCDs. This increased copper content allows Cu-T 380A to provide long-term contraception for up to 10 years.

Angioneurotic edema is the most probable diagnosis for a man who takes peanuts and develops symptoms such as stridor, neck swelling, tongue swelling, and hoarseness of voice. Angioneurotic edema is a condition characterized by sudden swelling of the skin, mucosa, and submucosal tissues. In this case, the symptoms are likely due to an allergic reaction to peanuts, causing swelling in the airway and vocal cords, leading to the symptoms mentioned. Foreign body bronchus, parapharyngeal abscess, and foreign body larynx are less likely diagnoses in this scenario.

External hemorrhoids below the dentate line are painful because they are located in an area where there are more pain receptors. Ligation is done as management to cut off the blood supply to the hemorrhoid and cause it to shrink. Skin tag is not seen in these cases because the hemorrhoid is located below the dentate line. These hemorrhoids may turn malignant, meaning they have the potential to develop into cancerous cells.

The common carotid artery divides at the level of the superior border of the thyroid cartilage. The superior border of the thyroid cartilage is located at the level of the C3 vertebrae. This is an important anatomical landmark for surgeons and healthcare professionals when locating and accessing the carotid artery for procedures or assessments.

Caudal regression is the most specific anomaly in a child born to a diabetic mother.

Common causes of urethral discharge in a young male are gonococcus and chlamydia. But in this case, no organisms were found in the pus cells. This indicates that the cause is probably not gonococcus. So in order to check for presence of chlamydia, we have to use cell culture methods such as Mc coy cells.

Ataxia telangiectasia is a genetic disorder that affects the immune system and causes progressive damage to various organs, including the breasts. This condition increases the risk of developing certain types of cancer, including breast cancer. Therefore, individuals with ataxia telangiectasia have a higher risk of developing breast cancer compared to the general population. Therefore, the least risk of CA breast is seen in Ataxia telangiectasia.

The half and half nail sign, seen in uremia, is characterized by a distinct color change in the nails. The proximal half of the nail appears pale or white, while the distal half appears pink or red. This is due to increased capillary density at the distal half of the nails, leading to increased blood flow and a reddish color. It is not caused by melanin deposition, hypoproteinemia, or circulating toxins.

The patient's history of a road traffic accident (RTA) and the presence of blood at the external urethral meatus suggests a possible urethral injury. The fact that the patient has not passed urine and has a palpable bladder indicates urinary retention, which is commonly seen in cases of urethral injury. The other options, such as rupture bladder and urethral injury with extravasation of urine in the retroperitoneum, may also cause similar symptoms, but the presence of blood at the urethral meatus makes urethral injury the most likely diagnosis. Anuria due to hypovolemia is less likely as it does not explain the presence of blood at the urethral meatus.

Most common substance abuse in India – Tobacco (see statistics below)
Most common substance abuse in the world – ?? Probably tobacco (According to WHO statistics, there is an estimated 1.1 billion tobacco users in the world – corresponds to 1/3 of people above 15 years of age)
Most common illicit substance abuse in India – Cannabis (see statistics below)
Most common illicit substance abuse in the world – Cannabis (see statistics below)

National Household Survey of Drug and Alcohol Abuse in India - Estimated users: (2001)

Tobacco – 162 million
Alcohol – 62 million
Cannabis – 9 million
Opiates – 2.5 lakh

Cannabis is by far the most widely cultivated, trafficked and abused illicit drug. About 147 million people, 2.5% of the world population, consume cannabis (annual prevalence) compared with 0.2% consuming cocaine and 0.2% consuming opiates.


References :
Substance use disorder, Manual for physicians – published by National Drug Dependance Treatment Centre, AIIMS

Basic emergency obstetric services
Parenteral oxytocics
Antibiotics and anticonvulsants
Assisted deliveries
Manual extraction of the placenta
Removal of retained products

Comprehensive emergency obstetric services
basic services plus
Caesarean sections
Blood transfusions

Ref: WHO Bulletin (http://www.who.int/bulletin/volumes/87/1/07-047076/en/index.html)

The best method to monitor intracranial pressure is through an intraventricular catheter. This type of catheter is inserted into the ventricles of the brain, allowing for direct measurement of the pressure inside the skull. This method is considered more accurate and reliable compared to other options such as subarachnoid bolt, intraparenchymal catheter, or epidural catheter.

Glutamine is the correct answer because it is an amino acid that is known to produce ammonia in the kidney. The kidney plays a crucial role in eliminating waste products from the body, including ammonia. Glutamine is converted into ammonia in the kidney through a process called deamination. This ammonia is then excreted in the urine. Therefore, glutamine is involved in the production of ammonia in the kidney.

When the confidence level of a test is increased, it means that the threshold for determining significance is raised. This means that it becomes harder for a value to be considered significant. Therefore, a previously insignificant value may become significant when the confidence level is increased. This is because the higher threshold requires stronger evidence for a value to be considered significant.

Kawasaki disease - the child does not have the classical features like non purulent conjunctivitis and cervical adenopathy
Infectious mononucleosis - Usually occurs in adolescents and adults. EBV infection is usually asymptomatic in children.

Embryo implantation typically occurs around 7-9 days after ovulation. During this time, the fertilized egg travels through the fallopian tubes and into the uterus where it attaches to the uterine lining. This process is essential for pregnancy to occur as it allows the embryo to receive nutrients and oxygen from the mother's body. Implantation can sometimes cause mild cramping or spotting, and it marks the beginning of the pregnancy journey.

Atkin's diet is a carbohydrate restricted low calorie diet. This means that the diet focuses on reducing the intake of carbohydrates, such as bread, pasta, and sugar, while also limiting overall calorie consumption. The goal of this diet is to promote weight loss by forcing the body to burn fat for energy instead of carbohydrates. By restricting carbohydrates, the body enters a state of ketosis, where it starts breaking down fat for fuel. This can lead to rapid weight loss, but it is important to note that this diet may not be suitable for everyone and should be done under the guidance of a healthcare professional.

In isometric exercise, all variables except systemic vascular resistance are increased. Isometric exercise refers to a type of exercise where the muscle length remains constant while the muscle contracts. During isometric exercise, the heart rate, cardiac output, and mean arterial pressure all increase due to increased demand for oxygen and nutrients by the muscles. However, systemic vascular resistance, which is the resistance to blood flow in the systemic circulation, does not increase during isometric exercise. This is because the blood vessels do not constrict or narrow during this type of exercise, leading to a relatively constant resistance.

Reducing occurrence of polio by immunization - Specific protection
Arranging for schooling of child suffering from PRPP (post polio residual paralysis) - Rehabilitation
Resting affected limbs in neutral position - Disability limitation
Providing calipers for walking - Rehabilitation

Bone marrow aplasia is a condition characterized by the failure of the bone marrow to produce enough blood cells. Methicillin is a type of antibiotic and it does not cause bone marrow aplasia. Therefore, bone marrow aplasia is not seen with methicillin.

Tumor necrosis factor-alpha (TNF-alpha) is the main cytokine involved in erythema nodosum leprosum (ENL) reaction. TNF-alpha is a pro-inflammatory cytokine that plays a crucial role in the immune response. It is produced by various immune cells, including macrophages, and is involved in the recruitment and activation of other immune cells. In ENL, an immune-mediated complication of leprosy, TNF-alpha is thought to contribute to the inflammation and tissue damage observed in the skin and other organs. Therefore, TNF-alpha is considered the main cytokine involved in ENL.

The Paneth cell is the correct answer because it is the only cell among the options that does not migrate from the base of the crypt to the ends of the villi. Paneth cells are located at the base of the intestinal crypts and secrete antimicrobial substances to protect the intestinal stem cells. They stay in this location and do not migrate along the villi like enterocytes, endocrine cells, and goblet cells.

MRI is the investigation of choice for Perthe’s disease

The correct answer is "Good oral hygiene." Nasotracheal intubation refers to the insertion of a breathing tube through the nose and into the trachea. One of the merits of this procedure is that it promotes good oral hygiene. Since the tube bypasses the mouth, there is less chance of contamination from oral bacteria, reducing the risk of infection. Additionally, maintaining good oral hygiene is important for overall health and can help prevent complications such as pneumonia.

Agar has no nutrient properties. Chocolate medium is an enriched media. Addition of selective substances in a liquid medium is called enrichment media.

Beta blockers inhibit the vasodilatation in the erectile tissue and arteries of the penis.

In PCOS, the androgen levels are very high. This prevents atresia of developing follicles. These form cysts of size 2-9mm size in the periphery of the ovary in a necklace pattern.

Components of of ReSoMal:
Glucose 125 mmol/l
Sodium 45 mmol/l
Potassium 40 mmol/l
Chloride 70 mmol/l
Magnesium 3 mmol/l
Zinc 0.3 mmol/l
Copper 0.045 mmol/l
Citrate 7 mmol/l

The renal angle is the angle between the 12th rib and the lateral border of the sacrospinalis muscle.

The juxtaglomerular apparatus lies in relation to the glomerulus.

X-ray crystallography is a technique used to determine the three-dimensional structure of molecules. It involves shining X-rays onto a crystal of the molecule and analyzing the resulting diffraction pattern. In the case of amyloidosis, X-ray crystallography can be used to visualize the arrangement of beta pleated sheets, which are characteristic of amyloid fibrils. This technique allows for the detailed examination of the molecular structure and can provide valuable insights into the formation and progression of amyloidosis.

Daily recommended intake of potassium is 1-2mEq/kg.

Hemoglobin electrophoresis is a technique used to separate and identify different types of hemoglobin based on their charge. Hemoglobin molecules have different charges due to variations in their amino acid composition. When an electric current is applied, the hemoglobin molecules move towards the oppositely charged electrode at different rates, allowing for their separation and identification. Therefore, the correct answer is charge.

The most common site of histiocytosis is the bone. Histiocytosis is a group of rare disorders characterized by the abnormal accumulation of immune cells called histiocytes. In histiocytosis, these histiocytes can accumulate in various organs and tissues, but the bone is the most commonly affected site. This can lead to symptoms such as bone pain, fractures, and deformities. Other organs, such as the skin, lung, and liver, can also be involved in histiocytosis, but bone involvement is the most frequent.

Primary tumours producing osteolytic metastasis:
Kidney
Lung
Thyroid
GIT
Breast

The correct answer is APC gene. Familial polyposis coli (FPC) is a genetic condition characterized by the development of multiple polyps in the colon. The APC (adenomatous polyposis coli) gene is associated with FPC and is responsible for regulating cell growth and division. Screening for FPC involves genetic testing to identify mutations in the APC gene. This can help determine the risk of developing FPC and guide further management and surveillance strategies for affected individuals and their family members.

The presence of bluish green cadaveric lividity suggests hydrogen sulphide poisoning as the most likely cause of death. Hydrogen sulphide is a toxic gas that can be produced by the decomposition of organic matter, such as a dead body. Inhalation of this gas can lead to poisoning, causing symptoms such as respiratory distress and cardiac arrest. The bluish green color of the cadaveric lividity is consistent with the effects of hydrogen sulphide on the body.

Down's syndrome, also known as trisomy 21, is a genetic disorder caused by the presence of an extra copy of chromosome 21. It is associated with various physical and intellectual disabilities. While hypothyroidism, ventricular septal defect, and Brushfield's spots are commonly seen in individuals with Down's syndrome, undescended testis is not typically associated with this condition. Undescended testis refers to the condition where one or both testicles do not descend into the scrotum. This condition is not directly related to Down's syndrome and is more commonly seen in premature babies or those with certain hormonal imbalances.

Natural killer cells are a type of white blood cell that plays a crucial role in the immune system's defense against cancer and viral infections. They are able to recognize and attack cells that are not able to express MHC 1 molecules. MHC 1 molecules are proteins found on the surface of most cells in the body, and they play a key role in presenting antigens to the immune system. Cells that are not able to express MHC 1 molecules may be infected with a virus or have undergone a transformation, making them targets for natural killer cell-mediated destruction.

Increased transferrin saturation is the earliest phenotypic manifestation of idiopathic hereditary hemochromatosis. This condition is characterized by the body's inability to regulate iron absorption, leading to excessive iron accumulation in various organs. Transferrin saturation refers to the percentage of iron-binding sites on transferrin that are occupied by iron. In individuals with hereditary hemochromatosis, transferrin saturation is typically elevated before other symptoms or laboratory abnormalities, such as elevated serum ferritin levels or slate grey pigmentation of the skin, become apparent.