Hypocalcemia is characterized by all of the following features except:
1. Numbness and tingling of circumoral region.
2. Hyperactive tendon reflexes.
3. Shortening of Q-T interval in ECG.
4. Carpopedal spasm.
--------------------------------------------------------------------
Answer
3. Shortening of Q-T interval in ECG.
Reference
Harrison 15th Edition Chapter 341 and 340
Discussion
A decrease in the concentration of free calcium ions in plasma results in
* increased neuromuscular irritability and tetany.
* This syndrome is characterized by peripheral and perioral paresthesia,
* carpal spasm, pedal spasm,
* anxiety, seizures,
* bronchospasm, laryngospasm,
* Chvostek's sign, Trousseau's sign, and
* Erb's sign, and
* lengthening of the QT interval of the electrocardiogram.
* In infants tetany may be manifested only by irritability and lethargy.
* The level of calcium ions that determines which features of tetany will be manifested varies among individuals. Tetany is also influenced by other components of the ECF; e.g., hypomagnesemia and alkalosis lower whereas hypokalemia and acidosis raise the threshold for tetany.
Explanation
1. Numbness and tingling of circumoral region is present.
2. Hyperactive tendon reflexes is present. This is the basis of asking the patients to hyperventilate when we are not able to elicit a reflex. Hyperventilation causes Alkalosis which causes tetany
3. of Q-T interval in ECG is prolonged.
4. Carpopedal spasm is present.
Comments
Increases in total serum calcium concentration are usually accompanied by increases in free calcium levels and may be associated with
* anorexia, nausea, vomiting,
* constipation,
* hypotonia,
* depression, and occasionally lethargy and coma.
* Persistent hypercalcemia, especially when accompanied by normal or elevated levels of serum phosphate, may cause
o ectopic deposition of a solid phase of calcium and phosphate in
+ walls of blood vessels,
+ connective tissue about the joints,
+ gastric mucosa,
+ cornea, and
+ renal parenchyma.
o Hypercalcemia per se alters renal function in addition to the pathologic effects of calcium phosphate deposition.
Tips
One formula that approximates the amount of calcium bound to protein is
% of Protein bound Calcium = 0.8 x albumin (g/L) + 0.2 x globulin(g/L) + 3
A simplified correction is The correction is to add 1 mg/dL to the serum calcium level for every 1 g/dL by which the serum albumin level is below 4.0 g/dL. If the serum calcium level, for example, is 7.8 mg/dL (a subnormal value) and the serum albumin level is only 3.0 g/dL, then the stated serum calcium level is corrected by adding 1 mg/dL; the corrected value of 8.8 mg/dL is within the normal range.
----------------------------------------------------------------------------------------
A primigravida in 2nd stage of labour for past 1hr,with the fetus in left occipito transverse position at station +++1.The best way to manage would be :
a)apply vacuum
b)apply forceps
c)watchful expectancy
d)emergency LSCS
------------------------------------------------------
answer is a --------
Reference:Dutta pg 398
Discussion:
This is a case of transverse arrest.
The head is still at +1(what is +++1???),that means it still has not crossed the ischial spines.
She is in 2nd stage,that means cervix is fully dilated;
So overall we have a case of primi with full dilatation of cervix,in active labour pains but the head not descending;
and 1 hour has passed already;
with PV findings telling us fetus is in occipito transverse position.
Dutta says,
In deep transverse arrest,the head is deep into the cavity;
the saggital suture is placed in the transverse bispinous diameter &
there is no progress in descent of the head even after ½-1hr following full dilatation of the cervix.
Dutta further says,
the pelvis should be assessed and
if,pelvis is adequately spacious &
fetus of normal size(not BIG baby) &
fetal conditions adequate for a vaginal delivery, ventouse is ideal in these cases.
Since,nothing is mentioned about inadequacy of the pelvis,nor the mention about fetal distress,
I take that these things are normal(& the main concern being,why the labour isn’t progressing inspite of normality of every other thing!!!)
Explanation:
a)apply vacuum :ideal for this case;correct choice!
b)apply forceps : applied only after manual rotation is done.
c)watchful expectancy : DTA cases wont deliver spontaneously;and we have already waited for 1 hour!!!
d)emergency LSCS : undertaken when pelvis is inadequate
Correct choice: (a) apply vacuum
------------------------------------------------------------------------------------
A one-year-old child having leucocoria was detected to be having a unilateral, large retinoblastoma filling half the globe. Current therapy would involve:
1. Enucleation.
2. Chemotherapy followed by local dyes.
3. Direct Laser ablation using photo dynamic cryotherapy.
4. Scleral radiotherapy followed by chemotherapy.
Answer
1. Enucleation.
Reference
SKBasak 2nd Edition Page 258
Kanski 4th Edition Page 341
Parson 19th Edition Page 400
Status
Spotter
QTDF
Repeat
Discussion
Enucleation is indicated in unilateral and bilateral Retinoblastomas involving more than half of the globe
Explanation
1. Enucleation is done as the Retinoblastoma is filling half the globe.
2. Chemotherapy followed by local dyes will not be effective.
3. Direct Laser ablation using photodynamic cryotherapy will not be effective.
4. Scleral radiotherapy followed by chemotherapy will not be effective.
Comments
Two questions have been asked about Retinoblastoma. (the other is given in Pathology) Another theme couple
Tips
Management of Tumours of Eye with regard to the size
· Small Tumours
o Laser Photocoagulation or transpupillary thermotherapy
o Cryotherapy
· Medium Tumours
o Brachytherapy : Tumour less than 12 mm in diameter and less than 6 mm in thickness
o Chemotherapy with Carboplastin, Vincristine, Etoposide
o External Beam Irradiation
· Large Tumours
o Enucleation
o Chemotherapy
---------------------------------------------------------------------------------------------
Q. posterior fontanelles ossify at the the age of
a. 1 year
b. 2 years------------------------
c. 3 years
d. 4 years
-----------------------------------------------------------
ref :chaurasia 3rd edn pg: no 309
Anterior F by 18 month of life
Posterior F & Sphenoidal F b/w the 2nd & 3rd month
Mastoid F by 12th month
The posterior fontanelle is usually gone by four months and the anterior fontanelle by about 15 months, although it may still be seen on x-rays until two years of age.
( go to the web page http://www.bbc.co.uk/health/ask_the_doctor/babysoftspot.shtml )
-------------------------------------------------------------------
Q.In Pregnancy which vaccine is not given:
a. Influenza
b. Rubella
c. Yellow fever
d. Polio
----------------------------------------------------------------------
answer is b.
vaccines C / I in pregnancy : MMRV---------------MUMPS , MEASLES , RUBELLA & VARICELLA
TETANUS & DIPHTHERIOD TOXOID are SAFE in p'cy
INACTIVATED VACCINES SAFE in p'cy : HIP , HBV ,H.INFLUENZA , PNEUMOCOCCAL
LIVE VACCINES which can b given in p'cy : POLIO & YELLOW FEVER
--------------------------------------------------------------------------
QUESTION.
An alcoholic is brought to the Emergency OPD with the complaint of irrelevant talking. He had stopped using alcohol three days back. On examination, he is found to be disoriented to time, place and person. He also has visual illusions and hallucinations. ‘There is no history of head injury. The most likely diagnosis is:
1. Dementia praecox.
2. Delirium tremens.
3. Schizophrenia.
4. Korsakoff’s psychosis.
Answer
2. Delirium tremens.
Reference
A Short Textbook of Psychiatry by Ahuja 4 ed Page 36
Discussion
Please go through the Discussion on Delirium Tremens. You will find that all the features mentioned in the Question are there as features of Alcohol Withdrawal and to add to the clue is the fact that the patient is an known alcoholic and he has stopped taking alcohol for the past 3 days
Explanation
1. Dementia praecox is the old name of Schizophrenia.
2. Delirium tremens is the correct answer as explained above.
3. A patient of Schizophrenia will not be disoriented to time place and person.
4. Korsakoff’s psychosis occurs after USING ALCOHOL and not after abstaining from Alcohol.
-----------------------------------------------------------------------------
landmark in usg testes is?
1 testicular artery
2. rete
3. tunica albuginea
4.mediastinum
-------------------------------------------
answer is 4
Ultrasonography is being used with increased frequency in the evaluation of the infertile male. Minimally invasive and non-invasive sonographic procedure have become a readily available tools for the diagnosis of many disorders of male reproductive tract and largely replaced previous "gold standard" radiological procedures.
Sonographic evaluation is dependent on operator experience and the knowledge of the disease process. It is very important to know normal ultrasound Anatomy of male reproductive tract.
In most instances testis is seen as a homogenous structure with a salt-and pepper texture. In the adult it measures approximately 3.5cm in length and 2-3 cm in diameter.
The mediastinum testis is seen as a very echogenic linear structure in the peripheral postero-superioir portion of the testis. The head of the epididymis has a triangular or pyramidal shape and an echogenicity similar to the testis. It ranges in size from 7 to 15 mm and seen in the superior pole of the testis. The body of the epididymis is less echogenic than the head or adjacent testis. Normally epididymis will not have readily demonstrable color flow and the presence of flow may indicate an inflammation. Sometimes appendix testis and appendix epididymis may be seen.
Scrotal ultrasound is employed for the evaluation of testicular size, intra-and extratesticular masses. Most intratesticular lesions in the age group concerned about fertility are malignant, benign lesions such as microlithiasis, intratesticular cyst, old hematoma may be found. Examination of the epididymis is helpful for the diagnosis of epididymal cyst or spermatocele. They are usually hypoechoic and circumscribed with good through transmission and posterior wall enhancement. In certain situation spermatocele may become obstructive and cause azoospermia.
The hydrocele, fluid filled tunica vaginalis sac surrounding testis, is easily diagnosed with an ultrasound. Hydrocele may be associated with testicular tumor or epididymal obstruction as a consequence of epididymitis.
One of the principal applications of scrotal ultrasound in infertility is the diagnosis of varicocele. Although the presence and grade of varicocele is traditionally determined by physical examination, ultrasound may additionally detect subclinical varicocele.
The diagnosis of a varicocele with scrotal sonography include standard measurement of venous diameter and color flow Doppler study which allows to determine the direction and magnitude of venous blood flow. The values used to define a positive exam have varied considerably in the literature. The presence of a subclinical varicocele may be confirmed if the largest scrotal vein is greater than 3 mm (with or without Valsalva, number of veins increased (>3), the largest vein is 2-3 mm with reflux or 2mm at rest with increase in diameter >0.5 mm with Valsalva.
-----------------------------------------------------------------
Ligation of anterior division of internal iliac artery stops intractable pelvic haemorrhage because of :
a-Lack of collateral circulation
b-Shuting off of blood flow
c-Decrease in arterial pulse pressure
d-Increased capillary clotting
-------------------------------------------------------------
answer cud be ---- c ( 80% ) or b ( 60 % )
i donot know the answer but i searched on the internet and found the following lines
Internal iliac artery supplies the pelvic viscera. Bilateral ligation
of the internal iliac arteries is a safe, rapid and very effective
method of controlling bleeding from genital tract. It is also
helpful in massive broad ligament hematoma, in torn vessels
retracted within the broad ligament, and even in postoperative
hemorrhage after abdominal or vaginal hysterectomy where
no definitive bleeding point is detectable. Bilateral ligation of
internal iliac arteries is also helpful in controlling atonic
postpartum hemorrhage. Following ligation of internal iliac
artery, there is a reduction of 85% in pulse pressure and
48% in the blood flow in the arteries distal to the ligation 1.
Thereby the arterial pressure approaches the venous pressure
and is rendered more amenable to hemostasis by a simple
clot formation.
go to the web address --- http://medind.nic.in/jaq/t05/i2/jaqt05i2p144.pdf
--------------------------------------------------------------------
which element should not given in TPN in obstructive jaundic
a) Zinc.......a???
b) Chromium
c) Copper
d) selenium
-------------------------------------------------
copper
--------------------------------------
Q. Due to bony support, the most stable position of the ankle joint is:
a. inversion
b. Plantar flexion
c. Eversion
d. Dorsiflexion
--------------------------------------------------------
answer is d
Dorsiflexion is more stable than plantarflexion. The talus is stabilized due to the wider anterior side of the trochlea being immobilized by the tibial articulation. In plantarflexion, the skinnier posterior side is articulating more and so more movement is possible since it does not completely fill the space allowed the anterior side.
-----------------------------------------------------------------------
Village health Guide concept was given by
a. Kartar Singh
b. Srivastav
c. Chadha
d. Jungalwala
-------------------------------------------------------------------
answer is b
VHG SCHEME was started on 2 nov 1977 on recommendation of shrivastava committee.
--------------------------------------------------------------------
Q-in sitting position horizontal semicircular canal...
.....is made vertical in otoscopic examination when head is tilted....
a.30 deg.forward
b.30 deg. backward
c.60 deg backward
d.60 deg forward
--------------------------------------------------
ans is D- 60 degree backward refer dhingra pg no 48
in supine position it is 30 degree forward to make it vertical
------------------------------------------------------------
which of the following medicines given along ciproflox increse cns toxicity of it
doxycycline
aspirin
phenylbutazone
imipramine
-------------------------------------------------------
ans: aspirin.
HARRISON SAYS:
flouroquinolones show increased neurotoxicity when coadministered with NSAIDS.
concurrent administration of NSAID's may potentiate the CNS stimulant effects of the quinolones, with seizures reported in patients receiving enoxacin and fenbufen
ref - Goodman & Gilman, 9th ed, pg no - 1068
phenylbutazone &aspirin both r nsaids &increase d neurotoxicity when given alongwith quinolones.seizures have been reported in childrens.
---------------------------------------------------------------------------
what is the investigation of choice for
3. A 35-year-old mechanic has recurrent epileptiform attacks. He has no history of trauma.
4. An 18-year-old student is brought to the Accident and Emergency department by ambulance having been flung off his bicycle in a road traffic accident upon arrival, he is noted to have deterioration in consciousness.
5. A 32-year-old boxer presents with headache, drowsiness, seizures, and a rising blood pressure.
Options:
A. Blood cultures
B. Blood glucose
C. Lumbar puncture
D. Computed tomography (CT) scan of head
E. Mantoux test
F. Electro-encephalogram
G. Full blood count (FBC)
H. Chest x-ray
I. Urea and electrolytes
J. Blood alcohol level
K. Toxicology
L. Skull x-ray
------------------------------------------------------------------------
CT remains the investigation for the diagnosis and management of many central nervous system diseases. MRI is superior in the posterior fossa and parasellar region and for the assessment in multiple sclerosis, epilepsy and tumours. CT is superior to MRI in the assessment of head injury. Indications for CT imaging, CTangiography, and CT venography include:
1. Cranial
* Acute stroke: CT scan as soon as possible and within 48 hours to rule out haemorrhage. CT scanning is reliable in excluding primary intracerebral haemorrhage as a cause of acute stroke, provided it is performed within about a week of onset. A CT scan is particularly important in those patients who are being evaluated for thrombolysis or carotid endarterectomy. The CT signs of ischaemia are more subtle and detection of acute infarction is variable depending on the timing of the examination. The area of infarction matures over the first week or more with the development of progressively better defined low attenuation and loss of volume in the damaged area.
* Transient ischaemic attack: Can help to distinguish infarction from haemorrhage and also differentiate from other causes such as extracerebral haemorrhage or glioma.
* Acute subarachnoid haemorrhage: CT will provide evidence of subarachnoid haemorrhage in [snip]% of cases if performed within 48 hours. CT is indicated in acute headache with focal neurological signs, nausea, vomiting or Glasgow Coma Scale below 14. MRI is better for inflammatory causes of acute headache.
* Acute head injury: CT Head in every severe head injury (Glasgow Coma Scale 8 or below) and every moderate head injury (Glasgow Coma Scale 9-13). The role of CT scanning in mild head injury is controversial.
* Space occupying lesions: suspected tumour or mass, e.g. cerebral abscess. MRI is more sensitive for early tumours and posterior fossa lesions but CT is usually adequate for supratentorial lesions. MRI may miss calcification.
* Suspected hydrocephalus or shunt revision. MRI may be more appropriate for children. Ultrasound is first choice for infants.
* Chronic headache. CT or MRI are not usually useful if there are no focal neurological signs but are more likely to detect an abnormality if there is:
o recent onset and a progressive worsening of symptoms and frequency or a change in their pattern
o association with the onset of epilepsy (especially focal epilepsy)
o change in personality
o associated dizziness, lack of coordination, tingling or numbness
o history of recent head injury, or falls (to exclude subdural haemorrhage)
* Intracranial infection: To exclude raised intracranial pressure prior to lumbar puncture (but only if there is considered to be a high risk of coning). In cases of childhood bacterial meningitis, CT is accurate in the diagnosis of intracranial complications of bacterial meningitis and is indicated mainly in children with persistent neurological dysfunction such as complex seizure disorder, and is of little value in children with prolonged fever alone3.
* Detection or evaluation of calcification: For example, the radiological hallmark of an oligodendroglioma is calcification, which is best detected on CT scanning. Calcification may be invisible on MRI
* Other: mental status change, increased intracranial pressure, headache, acute neurological deficits, congenital lesions (e.g. craniosynotosis, macrocephaly, and microcephaly), evaluation of patients with psychiatric disorders and brain herniation. In the assessment of psychosis, CT scan should be reserved for those with recent onset, rapid unexplained deterioration, focal neurological signs, recent head injury before onset or if there has been urinary incontinence or gait disturbance early in the illness.
* Secondary indications (e.g. when access to MRI is not available): diplopia, cranial nerve dysfunction, seizures, apnoea, syncope, ataxia, suspicion of neurodegenerative disease, developmental delay, neuroendocrine dysfunction, encephalitis, vascular occlusive disease or vasculitis (including use of CT angiography and/or venography), aneurysm, cortical dysplasia, and migration anomalies.
2. Extracranial
* Middle or inner ear symptoms, including vertigo. If felt necessary following specialist assessment. MRI is much better, especially for acoustic neuromas.
* Sinus disease if there has been failure of maximal medical treatment, complications, e.g. orbital cellulitis or suspicion of malignancy.
* Congenital anomalies, benign and malignant neoplasms, trauma4, vascular malformations, evaluation of palpable masses, planning and follow-up of radiotherapy
* Orbital lesions, including eye trauma in which there may be an associated facial fracture. Ultrasound may be appropriate for intraocular lesions. CT scan may also be indicated for strong suspicion of an intraocular foreign body that has not been shown on x-ray.
* Fractures of the temporal bone, skull, and face.
* Evaluation of the skull base including primary and secondary bone lesions
* Cranio-maxillo-facial surgery: The CT scan delineates lesions in the oral and maxillofacial complex to aid in planning surgical treatment. CT-based 3D models allow precise preoperative diagnosis and operation planning5
* Secondary indications (e.g. when access to MRI is not available): Evaluation of lesions involving the orbit, larynx, pharynx, oral cavity and soft tissue spaces of the face
----------------------------------------------------------------------------------------
most common cause of O-P position of fetal head during labour is
a]maternal obesity
b]deflexion of fetal head
c]multiparity
d]android pelvis
---------------------------------------------------
ans. is "b" OR "d"
dutta clearly writes:
In more than 50% cases OP position is associated with either anthropoid pelvis or android pelvis.
But since the question is "during labour" .......i think that the answer shud be deflexed head.---- ( check and u decide or send me any reference . post comment )
-----------------------------------------------------------------------------
Subscribe to:
Post Comments (Atom)
No comments:
Post a Comment