110 - miscellaneous 5 bits

Q. Factors leading to raised intraocular pressure following cataract extraction :
a. Vitreous touch syndrome
b. Use of alpha chymotrysin
c. Choroidal detachment
d. Epithelial ingrowth
e. Residual lens cortex

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answer is d

a. Vitreous touch syndrome

no:
its a latec omplication of ICCE
devlpt of corneal odema d/t endothelial cell damage caused by vitreous touch
prolonged vitreous touch may ultimately end in [bleep] keratopathy
vitreous touch + ------- keratopathy + CME = IRVINE GASS SYND

b. Use of alpha chymotrysin

no

c. Choroidal detachment

no:
ciliochoroidal detatchment presents as a convex brownish mass in the involved quadrant with shallow AC
cured within 4days with pressure bandage + oral acetazolamide
if persists : suprachoroidal drainage + inj of air in the AC

d. Epithelial ingrowth

yes:
rarely conjuctival epithelial cells may invade the AC thru a defect in the incision
this epi memb slowly grows & lines the bac of cornea & trabecular meshwork leading to intractable glaucoma

e. Residual lens cortex

no:
it leads to after cataract

ref : pg no: 209 , khurana

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Albumin contributes the maximum to oncotic pressure because it has:

[a]high mol wt,low concn
[b]low mol wt,low concn
[c]high mol wt,high concn
[d]low mol wt ,high concn

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ans is d . LMW--abt 69000--- and high concentration .

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Barium enema shows

Pipe Stem appearance in --- ULCERATIVE COLITIS ---------------------- ( In longstanding chronically active VC there is loss of haustral folds and the whole affected colon becomes narrowed, shortened and featureless ("pipe-stem" colon; ).

Hose pipe appearance in --- CROHN'S DISEASE --------------------------( Crohn's disease most commonly affects young adults with a peak incidence at 20-30. Three principal macroscopic patterns are recognized. The first, ulceration of the mucosa can predominate. Initially, these are tiny pinpoint lesions (aphthous ulcers). Later, the ulcers become serpiginous and discontinuous. Secondly, strictures can develop which may be long or short, single or multiple. The classical type is a single "hose pipe" stricture of the terminal ilium. Third, the classic "cobblestone" appearance of the mucosa is caused by mucosal edema with intervening crevices or fissure formation.

Lead pipe appearance in --- ULCERATIVE COLITIS ------------( Barium enema examination demonstrates loss of haustral folds in the entire descending
colon with small ulcerations suggested. The colon has a "lead-pipe" appearance.
The distribution and appearance are suggestive of ulcerative colitis. )

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MEXICAN HAT SIGN - feature of polyps of colon . (barium )

BOWLERS HAT SIGN - feature of both diverticulae and polyps of the colon .( barium )

DOUBLE HALO or TARGET SIGN - ischemic colitis - indicates inflammation ( THUMB SIGN ALSO SEEN IN ISCHEMIC COLITIS ) ( THUMB SIGN IS ALSO SEEN IN ACUTE EPIGLOTTITIS )

STRIPE SIGN - Metastases to the colon
Metastasis to the colon can occur by direct invasion from contiguous organs, by spread along the mesentery or its lymphatics, by intraperitoneal seeding or less commonly by haematogenous embolisation. Typically serosal involvement leads to a mass effect on the bowel, fixation, angulation, traction changes with tethering and spiculation and narrowing . En face, pleating of transverse folds which do not completely traverse the lumen, gives rise to a "stripe sign" due to tethering.

DRAPE SIGN - Mucosal changes that are seen in acute diverticulitis include the "drape sign" - the bending of adjacent diverticula around a presumed pericolic abscess and multiple crowded transverse pleat-like folds which may be deformed into a crumpled pattern.

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Lisfranc ligament diagonally connects the 1st (medial) cuneiform with the base of the 2nd metatarsal

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QUESTION.
A 20- year-old man has presented with increased alcohol consumption and sexual indulgence, irritability, lack of sleep, and not feeling fatigued even on prolonged periods of activity. All these changes have been present for 3 weeks. The most likely diagnosis is:

1. Alcohol dependence.
2. Schizophrenia.
3. Mania.
4. Impulsive control disorder.



Answer
3. Mania.

Reference
A Short Textbook of Psychiatry by Ahuja 4 ed Page 65

Discussion
Features of Manic Episodes (at least for 1 week) include
1. Elevated, Expansive or Irritable Mood

Stages Mood
Euphoria Mild Elevation of Mood Psychological Well being Hypomania Stage I
Elation Moderate Elevation of Mood Increased psychomotor activity Classical Mania Stage II
Exaltation Severe Elevation of Mood Intense Elation with Delusion of Grandeur Severe Mania Stage III
Ecstasy Very Severe Elevation of Mood Intense sense of Rapture Delirious or Stuporous Mania Stage IV

2. Psychomotor Activity
a. Overactiveness and Restlessness
b. Activity is Goal Oriented
c. Patient is “on the go”
3. Speech and thought
a. More talkative, Describes thoughts racing in Mind, develops pressure of speech, uses playful language with puning, rhyming, joking and teasing
b. Flight of Ideas
4. Goal – directed Activity
a. Ability to function is better.
b. Many artists and writers contribute significantly
5. Other features
a. Sleep reduced
b. Insight Absent
c. Mood Incongruent psychotics features may be present
6. Absence of Underlying Organic Cause

Explanation
1. Other than that he takes Alcohol, no other feature supports Alcohol dependence.
2. Schizophrenia rarely presents like this.
3. Mania is the correct diagnosis for this patient. We can see that all the features that are seen in this patient are the ones seen in Mania
4. Impulsive control disorder does not present like this. Please look at the other question for Impulse control disorders

Tips
Mania and Depression along with Schizophrenia, Delusion, Hallucination, Drug dependence are the common topics from which you will get questions and these question will be answered by the majority and if you leave a question in these topics, you may be left out in the race.

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1. A 29 yr old male tells that people are telling him to go and kill the prime minister. He says that they don't let him think and that they control his thoughts.

A. Schizophrenia

Quote:
2. A young lady is afraid to go out of her house. Whenever she goes out she rushes back home panicking and closes all the doors and windows.

E. Agoraphobia-Agoraphobia is an anxiety disorder precipitated by the fear of having a panic attack in a setting from which there is no easy means of escape. As a result, sufferers of agoraphobia may avoid public and/or unfamiliar places. In severe cases, the sufferer may become confined to their home, experiencing difficulty traveling from this "safe place."


Quote:
3. A 45 yr old man comes rushing to your clinic and asks you close your clinic and go home as he says that the world is going to come to an end.

---------- THIS IS A NILHILISTIC DELUSION.


Quote:
4. A 35 yr old man does not sleep in the night. He repeatedly gets up and checks whether all the doors and windows are locked again and again

L. Obsessive- Compulsive disorder


Quote:
5. A 38 yr old man has lost appetite and always sits alone and keeps thinking about the accident that happened a year ago in which his wife was killed. He is not regular to his office and avoids socializing

C. Post-traumatic stress disorder

Options
A. Schizophrenia
B. Depression
C. Post-traumatic stress disorder
D. Anxiety neurosis
E. Agoraphobia
F. Panic attack
G. Hysteria
H. Munchausen's syndrome
I. Paranoid state
J. Anorexia nervosa
K. Bulimia
L. Obsessive- Compulsive disorder

see page 2543 harrison 15th edi table 385 1

diagnostic creteria of panic attack

a discrete period of intense fear or discomfor, in which four or more of the follwoing symptoms developed abruptly and reached a peak within 10 min

1.sweating
2.palpitations,pounding heart or acclelerated heart
3.termbling or shaking
4.sensation of shortness of breath
5.feeling of chocking
6.chest pain
7.nausea or abdominal distress
8.feeling dizzy,unsteady,lightheaded or faint
9.disrelization(feeling of unreality) or depersonalization
10.fear of losing control or going crazy
11.fear of dying
12.paraesthesia
13.chills or hot flushes

4 out of this is necessary to diagnose a panic attack .

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Which of the following is the most reliable method of estimating blood alcohol level?
A) Cavett's test
B) Breath alcohol analyzer
C) Gas liquid chromatography-----------
D) Thin layer chromatography

the answer is c.

The books say that

Most Specific test is Gas Liquid.......(Qualitative)
Cavett test is Titration (Quantitative)

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Blood Alcohol Level(B.A.C)can be estimated by
a) Microdiffusion Technique
b) Electrochemical method This can be done in Casuality

But in Forensic toxicology labs in India the most common method used to estimate BAC is
Gas Chromatography or immunossay,only drawback is the results take a longer time.

Cavett test is a macro method involves aeration + distillation or diffusion under low pressure to determine alcohol in blood where Potassium dichromate is used, which oxidise alcohol to acetic acid. Each ml of dichromate solution reduced=0.575 mg of alcohol. Modified Kozelka & Hine test is a micro method for determining blood alcohol
Explanation
1. Cavett's test is for estimating the blood alcohol level.
2. Breath alcohol analyzer is just a screening test & is NOT admissible in court but is very helpful only for the police. It shows whether the person behind the wheels is under the influence of alcohol or not. In India the usual ones are chemical breath analysers in which alcohol reacts with an oxidising agent 2 produce a colour change which is proportional to the amount of alcohol. In Western nations, electronic breath analysers which can do a quantitative alcohol analysis complete with print out results are available and these are accepted in courts.
3. Gas liquid chromatography is a type of partition chromatography to estimate alcohol which is sensitive, resonably specific & satisfied even with a microlitre of sample. Its very useful in deaths due to poisonous liquor. But it is not appropriate for measuring the level
4. Thin layer chromatography is another type of liquid-liquid partition chromatography and is mainly used for separation of mixtures of aminoacids and peptides. It’s not been mentioned in alcohol estimation.


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Question 8 : Coracoid process of scapula gives attachment to all of the following muscles, EXCEPT ::
a) Pectoralis minor
b) Short head of Biceps brachii
c) Long head of Biceps brachii--------------------------
d) Coracobrachialis

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-Pectoralis Minor insertion lies at coracoid process

2 Muscles Originate from its tip

1. Short head of Biceps and
2. Coracobrachialis (Coraco + Brachialis )

so except long head of biceps the coracoid process gives attachment to the remaining three .

The long head of Biceps originates from the Supra Glenoid Tubercle
The long head of Triceps originates from the Infra Glenoid Tubercle

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Q - muscles attached at the greater tuberoisity of the humerus like this: LADY BETWEEN TWO MAJORS

lattisumus dorsi,

pectoralis major

and bicipital tendon,

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Q-Serologic markers of acute Hepatitis B infection-

HBsAg + HBeAg-------------------
HBsAg+ Core Ab
HBs Ag
HBcAg

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answer is a .

A/c Infection
HBsAg
HBeAg
HBcAb IgM
HBV-DNA

Window Period
HBcAb IgM


Prior Infection
HBcAb IgG
HBsAb IgG

but if its mentioned that core antibody is IgM then that will be the answer.

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drugs and their side effects

6. Cimetidine.
Ans . Impotence

7. Cyclophosphamide.
Ans. Haemorrhagic cystitis

8. Diamorphine.
Ans. Constipation

9. Amoxicillin.
Ans. steven johnson's syndrome

10. Oral contraceptive pill
Ans. Deep vein thrombosis

11- ampicillin causes Pseudomembranous enterocolitis

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side effects of antipsychotics

clozapine--------- Agranulocytosis

lithium--------------Thyroid function disturbance

diazepam---------- Addiction

haloperidol & chlorpromazine------------Extra-pyramidal side-effects

lithium---------------Polyuria (up to 12 litres/day), polydipsia and
nocturia. Serum glucose is normal.

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Antipsychotic drugs are also known as ‘neuroleptics' and (misleadingly) as ‘major tranquillisers'

Side-effects
Extrapyramidal symptoms are the most troublesome. They occur most frequently with the piperazine phenothiazines (fluphenazine, perphenazine, prochlorperazine, and trifluoperazine), the butyrophenones (benperidol and haloperidol), and the depot preparations.

Classification of antipsychotics
The phenothiazine derivatives can be divided into 3 main groups.

Group 1: chlorpromazine, levomepromazine (methotrimeprazine), and promazine, generally characterised by pronounced sedative effects and moderate antimuscarinic and extrapyramidal side-effects.

Group 2: pericyazine and pipotiazine, generally characterised by moderate sedative effects, marked antimuscarinic effects, but fewer extrapyramidal side-effects than groups 1 or 3.

Group 3: fluphenazine, perphenazine, prochlorperazine, and trifluoperazine, generally characterised by fewer sedative effects, fewer antimuscarinic effects, but more pronounced extrapyramidal side-effects than groups 1 and 2.


Drugs of other chemical groups tend to resemble the phenothiazines of group 3. They include the butyrophenones (benperidol and haloperidol); diphenylbutylpiperidines (pimozide); thioxanthenes (flupentixol and zuclopenthixol); and the substituted benzamides (sulpiride).

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Most common surgically treatable cuse of male infertility is
a)cryptorchidism
b)epididymitis
c)varicocele
d)stricture urethra

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answer is d ( baily 24th
there is little evidence that varicocelectomy improves seman quality or rate of conception )

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Ranula is

a.Retension cyst of sublingual gland
b.Retension cyst of submandibular gland
c.Extravasation cyst of sublingual gland----------------------?
d.extravasation cyst of submandibular gland.

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answer is a

ranula is retention cyst of sublingual gland

now why not extravasation cyst as most of the mucoceles are?
as histologically retention cysts have epithelial lining as in ranula while extravasation cysts don't have epithelial lining instead are lined by connective tissue and fibroblasts.

C is the answer I hope the source is authentic
"Ranula, or “little frog,” is the term given to mucoceles located within the floor of the mouth. This variety of mucocele is typically larger and caused by extravasation of mucin from the sublingual gland, or less commonly the submandibular duct(in a PGI style question d would be answer as well) or minor salivary glands in the floor of the mouth"
Otolaryngo. Clinics of North America
Vol. 40 • Number 1 • Feb. 2007

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What is GOLD criteria?

its for COPD.

0=AT RISK BUT NORMAL

1=MILD------------------ -------------------------FEV1/FVC<0.7,>80%
2A=MODERATE "--------------------------- FEV1-50 TO 80%
3 =SEVERE " ,-------------------------------- FEV1 - 30 TO 50%
4 =VERY SEV. " ,---------------------------- FEV1 - <30%>

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"Girl b/w the two Sardars" on the medial surface of the upper end of Tibia i.e
Gracilis between Sartorius and semitendinosus.

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