True about nitric oxide

True about nitric oxide 

a. Formed from L-Arginine by NO synthase 
b. Causes vasodilation in all vessels 
c. Used in portal hypertension 
d. Interacts with Hb 
e. Used in erectile dysfunction

Ans. (B) Dilates pulmonary arteries; (B) Least systemic effects; (E) Better ventilation perfusion match

•Nitric oxide (NO) is a colorless, odorless gas that is used extensively in inhaled form. It is mainly used extensively in inhaled form for its selective pulmonary vasodilator property.

• Inhaled NO diffuses rapidly across the alveolar-capillary membrane into the subjacent smooth muscle of pulmonary vessels to activate soluble Guanylate Cyclase. Increased intracellular concentration of cGMPrelaxes smooth muscls.

• Indications: used mainly fOr its selective pulmonary vasodilator property & consequent intrapulmonary distribution of ventilation & blood flow (V/Q distribution) & thus improves partial pressure of Oxygen in ystemic arterial blood (Pa02).

Used in:

- Pulmonary hypertension

- Treatment of pulmonary hypertension & hypoxia following cardio pulmonary bypass or use of ventricular assist devices, for mitral valve replacement, coronary artey bypass grafting, Heart & Lung transplant & Pulmonary embolism. 

- Asthma, COPD, & bronchitis

- One lung ventilation to reduce the shunt fraction

- Sickle cell disease.

- Prevention of chronic lung disease in newborn.

- Ischemia reperfusion injury.

- ARDS by producing selective pulmonary vasodilatation, pulmonary capillary pressure is reduced, which decreases pulmonary transvascular Albumin flux & thus improves Oxygenation.

Toxicity of NO:

- Production of N02 & Methemoglobinemia

- Rebound pulmonary hypertension following sudden withdrawal.

- LV filling pressure & worsening pulmonary edema in patients with CHF.

• Other side effect of treatment is the coagulation disorders by inhibition of platelet aggregation 

Brain fingerprinting

Brain fingerprinting: 

a. Used lie-detector 
b. Used by EEG on lead 
c. Used for quantitative measurement of sulci, gyri 
d. Used by DNA
e. Used to study parts of brain

Ans (B) Used by EEG on lead

Brain fingerprinting is a technique that measures recognition of familiar stimuli by measuring electrical responses to words, phrases, or pictures that are presented on a computer screen. 

Most common presentation of Neuroblastoma in children

The most common presentation of neuroblastoma in children is: 

A. Lytic lesion in the skull with suture diaschisis
B. Lung metastasis 
C. Renal invasion 
D. Secondaries in the brain

Ans. A. [Lytic lesion in the skull with suture diathesis]

Neuroblastoma - Tumor metastasize very early to bone lymph nodes, liver, subcutaneous tissue and the bone marrow metastasis may be the first manifestation of the tumor

•Orbital proptosis, ° spinal cord compression or fever and bone pain may be the earliest     manifestations

•The most common symptom is pain from primary or metastatic. 

• Neuroblastoma is the most common abdominal tumor to demonstrate cetciticetions" 50%. Prior to chemotherapy

•Most neuroblastoma are radiosensitive and respond to 3000 cGY or less of radiation

•Infiltration of the sutures - translucencies in skull vault and 'sun ray' spiculation a reaction to sub pericranial deposits. .

TRUE about Tetralogy of Fallot

Which of the following is TRUE about Tetralogy of Fallot? 

A. Cyanosis is often present in the first few days of life. 
B. There is a right sided aortic arch in about 50% of cases. 
C. The murmur becomes softer during a cyanotic spell as flow through the pulmonary valve is increased. 
D. There is an association with DiGeorge syndrome

Ans. D. There is an association with DiGeorge syndrome.

Tetralogy of Fallot is the most common congenital cyanotic heart condition. It may present with cyanosis in the first few- of life, though this is rare. Usually it presents as a murmur detected in first few months of life or as hypercyanotic in late infancy. A hot bath will increase cyanosis, as the vasodilatation results in a decrease in the peripheralvascular resistance, and so flow through the pulmonary artery decreases, and cyanosis increases. During a cyanotic spell the decreased not increase.  flow through the pulmonary artery results in the murmur becoming softer or inaudible. There is a right sided aortic arch in about 30% of cases

Neonatal thymectomy

Neonatal thymectomy leads to 

A. Depletion of lymph nodes 
B. Depletion of para cortical areas of the lymph node 
C. increased IgM level 
D. Increased production of lymphocytes by the bone narrow

Ans. B.  [Depletion of paracortical area of the lymph nodes]

•  The primary function of the thymus is the production of the thymic lymphocytes, if is the major site for lymphocyte proliferation in the body.

• The importance of the thymus in lymphocytes proliferation and development of CMI is evident from the lymphopenia, deficient graft rejection and so called "runt disease" seen in neonatallythymectomized mice, Deficient CMI is also seen in congenital aplasia of the thymus in human beings Di George syndrome and in mice 'nude mice'.  Lymphoid follicles are usually present but lymph node paracortical area and thymus - Dependent regions of spleen show variable degrees of depletion 

Sentinel surveillance

Sentinel surveillance indicates: 

A. Identifying the missing cases 
B. Identifying high risk groups 
C. Surveillance of water pollution 
D. SurveilJance of environmental

Ans. A. Identifying the missing eases

Sentinel surveillance

A method for identifying the missing cases and thereby supplementing the notified cases is required. This is known as sentinel surveillance.’ The advantages of such a system are that the reporting biases are minimized, and feedback of information to the provider is simplified.

Finally, these sentinel sites could be developed into a notification system for providing more detailed information, which, in some settings, may be less costly than developing and maintaining an ongoing notification system. 

Features of Edwards' Syndrome

All of the following are features of Edwards' syndrome except? 

A. Mcntal retardation 
B. Stunting of growth 
C. Hypotonia 
D. Congenital disease

Ans. C. Hypotonia.

Trisomy 18, also called Edwards syndrome, is a chromosomal condition associated with abnormalities in many parts of the body. Individuals with trisomy 18 often have slow growth before birth intrauterine growth retardation.  and a low birth weight. Affected individuals may have heart defects and abnormalities of other organs that develop before birth. Other features of trisomy 18 include a small, abnormally shaped head; a small jaw and mouth; and clenched fists with overlapping fingers. Due to the presence of several life-threatening medical problems, many individuals with trisomy 18 die before birth or within their first month.

After down’s syndrome, Edward’s syndrome is the next common trisomy among live births. Hypertonia is seen instead of hypotonia.

A newborn has a fever of 103°F. Blood culture grows gram-positive cocci in chains.

A newborn has a fever of 103°F. Blood culture grows gram-positive cocci in chains. This is most likely to be which of the following? 

A. GroupA Streptococci Streptococcus pyogenes. 
B. Group B Streptococci Streptococcus agalactiae. 
C. Salmonella species 
D. Streptococcus pneumoniae

Ans. B. Group B Streptococci Streptococcus agalactiae. 

•Most human infections caused by Streptococci involve the group A organisms Streptococcus pyogenes. .

•The group B Streptococci are members of the female genital tract and are important causes of neonatal sepsis and meningitis.

•They are usually beta-hemolytic similar to group A. , hydrolyze hippurate and give a positive response in the so-called CAMP test Christie, Atkins, Munch-Peterson. .

•Detection of the infection and prompt antimicrobial treatment is necessary because the infections may become life-threatening.

•Streptococcus pneumoniae organisms are important in meningitis cases in young children, but are more frequently seen as diplococci forms rather than long chains. 

Test for assessing hearing deficits in infants older than 6 months

What is the best test for assessing hearing deficits in infants older than 6 months of age? 

A. Automated auditory brain stem response AABR. , 

B. Transient evoked otoacoustic emissions TEOAE. , 

C. Distortion product otoacoustic emissions DPOAE. 

D. Visual reinforcement audiometry VRA.

Ans. D. Visual reinforcement audiometry VRA. 

Visual reinforcement audiometry VRA.  is a test that allows an audiologist to assess hearing in infants and toddlers too young for normal tests. VRA relies on behavioral conditioning to train very young kids to respond to sounds.It is designed for children aged 6 months to around 2 to 3 years old.

Metabolization of arginine

Which of the following metabolizes arginine? 

A. Mycoplasma pneumoniae 
B. Mycoplasmagenitalium
C. Mycoplasma homilies 
D. Ureaplasma urealyticum.

Ans. C. Mycoplasma homilies

Mechanisms of Pathogenicity

•Adherence of mycoplasmas to the surface of the host cell is necessary for colonization and infection. Some pathogenic mycoplasmas are flask-shaped, with specialized tips that enhance adherence.

•M. pneumoniae adheres via a network of interactive adhesins and accessory proteins and produces hydrogen peroxide, which may cause injury to host cells.

•M. pneumoniae may evoke IgM autoantibodies that agglutinate human erythrocytes at 4°C. These cold agglutinins can cause anemia and other complications.

• M. hominis metabolizes arginine, with the production of potentially cytotoxic amounts of ammonia. Ureap/asmas have been laced in a separate genus because of their unique urease activity; the metabolism of urea a/so produces ammonia. 

Med01 Participants MCQs and Ans

A patient with necrotizing pancreatitis undergoes CT guided aspiration, which results in growth of E-coli on culture. The most appropriate treatment is: 

A. Culture appropriate antibiotic therapy
B. ERCP with sphincterotomy
C. CT guided placement of drain(s)
D. Exploratory laparotomy

The answer is D. Exploratory laparotomy

The presence of secondary pancreatic infection suspected in patients whose systemic inflammatory response (fever, WBC count or organ dysfunction) fails to resolve, CT-guided aspiration of fluid from pancreatic bed for performance of Gram's stain & culture analysis is of critical importance. A positive is Gram's stain or culture or identification of gas within pancreas on CT-scan, mandate operative intervention. 

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Thiopentone does not cause:

A. Fall in intracranial tension 

B. Decreases oxygen consumption of brain 

C. Decreases metabolic rate of brain 

D. Decreases stage 2 of sleep

The ans. is .D.

Thiopentone decreases oxygen consumption, metabolic rate and ICT. That is why it is agent of choice for cerebral protection. On sleep it increases stage 2 and decreases stage 3, 4 and REM.

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Which of the following sugars is absorbed from the small intestine by facilitated diffusion?

A. Glucose

B. Galactose

C. Fructose

D. Sucrose

The answer is C.

Facilitated diffusion is the major transport route for fructose. The duodenum and jejunum are the principal sites of carbohydrate absorption in humans. Digestion of carbohydrates is accomplished by amylase and brush border enzymes and results in a mixture of glucose, fructose, and galactose. A common sodium-dependent secondary active transporter absorbs glucose and galactose. Sucrose and lactose are disaccharides that break down into glucose and fructose, and glucose and galactose, respectively. 

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Most Commons and Various Bodies list asked in various exams

Various Bodies list asked in various exam

*Michaelis Gutmann bodies-Malakoplakia
*Verocay bodies- Neurilemmoma
*Civatte ( colloid ) bodies- Lichen Planus
*Hireno bodies- Alzhiemer's disease
*Cell Exner bodies- Granulosa Cell Tumour
*Russell's bodies ( cytoplasmic inclusions )- Multiple Myeloma
*Moot bodies- Multiple Myeloma
*Aschoff bodies- Rheumatic Fever ( acute Stage )
*Torres bodies- Yellow Fever
*Gamma Gandy bodies- Sickle call Anaemia & Congestive Splenomegaly
*Negri bodies- Rabies
*Asteroid bodies- Sporotrichosis
*Odland bodies- Keratinosome
*Mooser bodies- Endemic Typhus
*Heinz bodies- G 6 P D Deficiency
*Zebra bodies- Metachromatic Leukodystrophy
*Lewy bodies- Parkinsonism
*Sandstorm bodies- Parathyroid Gland
*Harting Bodies- Calcospheritis ( in cerebral capillaries )
*Dhole bodies- Myelodysplasia
*Henderson Peterson bodies- Molluscum Contagiosum
*Citron bodies- Clostridium welchi infection
*Bollinger bodies- Fowlpox infection
*Parchon bodies- Small Pox infection
*Sclerotic bodies- Chromoblastomycosis
*Guarnieri bodies- Vaccinia virus ( inclusion bodies )
*Councilman bodies- Acute Hepatitis B
*Leishman Donovan bodies- Kala Azar
*Schaurman bodies- Sarcoidosis
*Virchow Hassall's bodies- Thymus
*Halberstaedter-Prowazek's bodies- Trachoma
*Weibal-Palade bodies- EM finding in Tumour Of Vascular Origin
*Rokitansky bodies- Teratoma
*Schiller Duval bodies- Endodermal Sinus Tumour ( Yolk Sac T. )
*Levinthal-Cole Lillie (LCL) Bodies- Psitticosis
*Coccoid X bodies- Psitticosis
*Balbiani'S bodies- Yolk nucleus
*Bamboo Bodies- Asbestosis
*Ferruginous bodies- Asbestosis
*Mallory bodies- Alcoholic Hepatitis
*Chromatid bodies- Entamoeba histolytica precyst
*Donnes bodies- Colostrum carpuscles
*Ross bodies- Syphillis
*Winkler bodies- Syphillis
*Rushton bodies- Odantogenic cyst
*Herring bodies- Neurohypophysis
*Pick bodies- Pick's disease
*Oken's bodies- Mesonephros
*Reilly bodies- Hurler's Syndrome
*Cystoid bodies- in Degenerated Retinal Nerve Fiber ( seen in cotton wool spot )
*Body of ARANTIUS- Aortic Valve Nodule

Pom’s sign

Pom’s sign is seen in infection with? 

A. Brucella 
B. Tuberculosis 
C. Pseudomonas 
D. Coxiella

Ans. A.

Brucellosis is a bacterial zoonosis transmitted directly or indirectly to humans from infected animals, predominantly domesticated ruminants and swine. The disease is known colloquially as undulant fever because of its remittent character. Brucellosis almost invariably causes fever, which may be associated with profuse sweats, especially at night. In endemic areas, brucellosis may be difficult to distinguish from the many other causes of fever.

Radiology of the Spine: Differentiation of Brucellosis from Tuberculosis

	Brucellosis	Tuberculosis
Site	Lumbar and others	Dorsolumbar
Vertebrae	Multiple or contiguous	Contiguous
Diskitis	Late	Early
Body	Intact until late	Morphology lost early
Canal compression	Rare	Common
Epiphysitis	Anterosuperior Pom's sign.	General: upper and lower disk regions, central, subperiosteal
Osteophyte	Anterolateral parrot beak.	Unusual
Deformity	Wedging uncommon	Anterior wedge, gibbus
Recovery	Sclerosis, whole body	Variable
Paravertebral abscess	Small, well-localized	Common and discrete loss, transverse process
Psoas abscess	Rare	More likely

Serologic diagnosis of infections Mononucleosis

Which statement regarding serologic diagnosis of infections mononucleosis is correct? 

A. A heterophile. antibody is formed that reacts with the membrane protein of EBV. 
B. A heterophile antibody is formed that agglutinates sheep or horse red blood cells. 
C. A heterophile antigen occurs that cross-reacts with atypical lymphocytes. 
D. A heterophile antigen occurs following infection with both EBV and CMV

Ans. B. A heterophile antibody is formed that agglutinates sheep or horse red blood cells.

A nonspecific heterophile agglutination test Monospot test.  is commercially available and can be used to diagnose EBV infectious mononucleosis within a week to months of infection. Infectious mononucleosis-like infection caused by CMV is heterophile negative.

Laboratory diagnosis of vaginal trichomoniasis

Laboratory diagnosis of vaginal trichomoniasis is ‘most commonly made by; 

A. identifying cyst stages in an iodine stained preparation of vaginal secretion. 

B. Finding trophozoites in a saline wet mount of vaginal discharge. 
C. Using an acid-fast stain to highlight the parasite. 
D. Staining a thin blood smear with common blood stains

Ans. B. Finding trophozoites in a saline wet mount of vaginal discharge.

Trophozoites are usually visible in saline mounts of vaginal scrapings.

Cysts are not present in the T. vaginalis life cycle, and iodine is used primarily to observe cysts of intestinalprotozoa. Acid-fast stains are used to search for oocysts of coccidian intestinal parasites, such as Cryptosporidium and Cyclospora. Thin blood smears are used to diagnose malaria. 

PGIMER MCQs | Surgical causes of Hypercalcemia

Surgical causes of hypercalcemia:

a. Hyperparathyroidism 
b. MEN 
c. Hyperthyroidism 
d. Sarcoidosis 
e. Pheochromocytoma

Ans (A) Hyperparathyroidism , (B) MEN , (C) Hyperthyroidism , (E) Pheochromocytoma

• There are three basic pathophysiologic mechanisms of hypercalcemia

- ↑Ca2 absorption form GIT e.g. milk alkali syndrome vit. D intoxication.

- ↑ed renal excretion of Ca2 e.g. Renal failure

- ted bone resorption e.g. tPTH, malignancy, hyperthyroidism etc.

• Surgical causes of ↑Ca2

- Parathyroid adenomas

-MEN

- Pheochromocytoma

- Malignancies e g breast Lung kidney Ca,

- Thyrotoxicosis 

PGIMER entrance Preparations | Common between B & T cells

Common between B & T cells: 

a. Origin from same cell lineage 
b. Site differentiation 
c. Antigenic marker different 
d. Both humoral & cellular immunity 
e. Further differentiation seen.

Ans. (A) Origin from same cell lineage; (E) Further differentiation is seen;

• Both T and B cell origin from the same cell-line in the marrow.

• There was furthur differentiation is seen both in the T and B-lymphocytes.

• The most clear-cut differentiation between T and B cells is their surface marker. 

Clincal Case of Intermittent chest pain and palpitation

A 30 year old female presented with complaints of progressive breathlessness since 6 months. There was history of intermittent chest pain and palpitation. On examination her HR was 88/min and BP was 140/80 mm of Hg and a late systolic murmur with midsystolic click at cardiac apex. Pathological examination of the heart is most likely to show which of the following in this patient? 

A. Fatty replacement of the ventricle with thinning of the RV free wall 

B. Hooding of the mitral valve leaflets with myxomatous degeneration 
C. Ischemia of the papillary muscles 
D. Elongated and ruptured chordae tendineae

Ans. B. Hoodingof the mitral valve leaflets with myxomatous degeneration.

Myxomatous degeneration of the mitral valve with hooding and prolapse of the posterior mitral leaflet into the left atrium is characteristic of mitral valve prolapse.

Prolapsing ,billowing.  mitral valve:-

This is also known as Barlow's syndrome or floppy mitral valve. It is due to excessively large mitral valve leaflets, an enlarged mitral annulus, abnormally long chordae or disordered papillary muscle contraction. Histology may demonstrate myxomatousdegeneration of the mitral valve leaflets. It is more commonly seen in young women than inmen or older women and it has a familial incidence.  Its cause is unknown but it is associated with Marfan'ssyndrome, thyrotoxicosis, rheumatic or ischaemic heart disease. It also occurs in association with atrial septal defect and as part of hypertrophic cardiomyopathy. Mild mitral valve prolapse is so common that it should be regarded as a normal variant.

Pathophysiology - During ventricular systole, a mitral valve leaflet most commonly the posterior leaflet.  prolapses into the left atrium. This may result in abnormal ventricular contraction, papillary muscle strain and some mitral regurgitation. Usually.the syndrome is not haemodynamically serious. Thromboembolism occurs. 

Symptoms:  Atypical chest pain is the most common symptom. Usually the pain is left submammary and stabbing in quality. - Sometimes it is substernal, aching and severe. Rarely it is similar to typical angina pectoris. Palpitations may be experienced because of the abnormal ventricular contraction or because of the atrial and ventricular arrhythmias that are commonly associated with mitral valve prolapse.  Sudden cardiac death due to fatal ventricular arrhythmias is a very rare but recognized complication.

Signs  The most common sign is a mid-systolic click, which is produced by the sudden prolapse of the valve and the tensing of the chordae tendineae that occurs during systole. This may be followed by a late systolic murmur owing to some regurgitation. With more regurgitation, the murmur becomes pansystolic mitral regurgitation. 

Diagnosing Trisomy-21 during Second Trimester of Pregnancy

The best way of diagnosing Trisomy-21 during second trimester of pregnancy is: 

A. Triple marker estimation 
B. Nuchalskin fold thickness measurement 
C. Chorionic Villus Sampling 
D. Amniocentesis

Ans. D.  Amniocentesis

Prenatal diagnosis of Downs Syndrome.

Risk of having a fetus affected by Downs syndrome at an advanced maternal age >35 years.  is well known.

USG and biochemical markers are being used to calculate the risk and predict outcomes. Fetal blood sampling and tissue sampling being invasive can be performed only in very selected cases.

Currently second trimester USG scanning has been shown to detect up to 60% ofDS fetuses.

The following findings on USG are useful:

1. Nuchal skin thickness measured on an axial view where the cavumseptipellucidi. , cerebral pedicles, cerebellar

hemispheres and cisterna magna are seen. A cut off of 6 mm is significant.

2. Choroid plexus cysts

3. Cardiac defects are noted in 50% children with DS.

4. Abdominal findings namely duodenal atresia, omphalocoele, pylectasis ascites, two vessel umbilical cord, a single umbilical artery, echogenic bowel, should be seen. Duodenal atresia can be diagnosed as early as 14 weeks on a USG.

5.Femur, humerus length is a possible marker of underlying trisomy 21.

Ratio of biparietal diameter to femur length and humerus length with expected length are good predictors with sensitivity of 37% and specificity of 47%.

6.Clinodactyhy, hypoplastic mid phalanx in the fifth finger, increased gap between 1 st and 2nd toe can be detected.