whats collip`s hormone is
a) cortisol
b)insulin
c)thyroxine
d)parathormone
e)growth hormone
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Its Parathormone
Dosage of Parathormone is expressed in Collip Units
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figure of 8 is usually seen in?
endocardial fibroelastosis
ebstein's anamoly
total anomalous venous drainage----------------
trilocular heart
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on x ray, in TAPVC, there is lt. brachiocephalic V. superiorly, SVC on the right, vertical V on the left, giving a cardiac shadow that resembles snoman or figure of 8...
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LADD'S BAND IS SEEN IN:
1.STOMACH.
2.ILEUM.
3.JEJUNUM.
4.DEODENUM.
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answer is duodenum.
A Ladd's band is a peritoneal band which stretches from the caecum to the subhepatic region. ladd bands is a cause of duodenal obstruction...
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normal arterial blood gas values
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all values from harri 16th:
partial pressure of CO2 in arterial blood (PaCO2)----4.7-5.9kPA /35-45mmHg.
partial pressure of oxygen in arterial blood(PaO2)----11-13kPa / 80 -100mmHg.
pHof blood --- 7.38- 7.44.-----lab
HCO3 ---- 21 -28mmol/L / 21 - 30 meq /L.
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pH of blood: 7.35 to 7.45 (please follow this value as this is the standard for all India questions-Mudit Khanna,Amit Ashish,CMDT,and many other books)
HCO3- = 22 to 28 mEq/L...(now many books differ on this but I have been using this since long time.)
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Q.Lepold manoeuver is done for :
1.Delivary of afterhead
2.Midcavity forceps application
3.External podalic version
4.Examination of abdomen
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answer is 4 .
Leopold's maneuvers
four maneuver's employed to determine fetal position:
1) determination of what is in the fundus;
2) evaluation of the fetal back and extremities;
3) palpation of the presenting part above the symphysis;
4) determination of the direction and degree of flexion of the head.
Abdominal Palpation—Leopold’s Maneuvers.
In order to obtain satisfactory results, the examination should be conducted systematically employing the four maneuvers suggested by Leopold and Sporlin (1894). The mother should be supine and comfortably positioned with her abdomen bared. During the first three maneuvers, the examiner stands at the side of the bed that is most convenient and faces the patient; the examiner reverses this position and faces her feet for the last maneuver.
First Maneuver
First Maneuver. -determination of what is in the fundus
After outlining the contour of the uterus and ascertaining how nearly the fundus approaches the xiphoid cartilage, the examiner gently palpates the fundus with the tips of the fingers of both hands in order to define which fetal pole is present in the fundus. The fetal breech gives the sensation of a large, nodular body, whereas the head feels hard and round and is more freely movable and ballottable.
Second Maneuver
Second Maneuver. - evaluation of the fetal back and extremities
After the determination of the pole of the fetus that lies in the fundus, the palms of the examiner’s hands are placed on either side of the abdomen, and gentle but deep pressure is exerted. On one side, a hard, resistant structure is felt, the back; and on the other, numerous small, irregular and mobile parts are felt, the fetal extremities. In pregnant women with thin abdominal walls, the fetal extremities can often be differentiated, but in heavier women, only these irregular nodulations may be felt. In the presence of obesity or considerable amnionic fluid, the back is felt more easily by exerting deep pressure with one hand while counter-palpating with the other. By next noting whether the back is directed anteriorly, transversely, or posteriorly, a more accurate picture of the orientation of the fetus is obtained.
Third Maneuver-palpation of the presenting part above the symphysis
Third Maneuver. Employing the thumb and fingers of one hand, the examiner grasps the lower portion of the maternal abdomen, just above the symphysis pubis. If the presenting part is not engaged, a movable body will be felt, usually the fetal head. The differentiation between head and breech is made as in the first maneuver. If the presenting part is not engaged, all that remains to be defined is the attitude of the head. If by careful palpation it can be shown that the cephalic prominence is on the same side as the small parts, the head must be flexed, and therefore the vertex is the presenting part. When the cephalic prominence of the fetus is on the same side as the back, the head must be extended. If the presenting part is deeply engaged, however, the findings from this maneuver are simply indicative of the fact that the lower pole of the fetus is fixed in the pelvis; the details are then defined by the last (fourth) maneuver.
Fourth Maneuver-determination of the direction and degree of flexion of the head.
Fourth Maneuver. The examiner faces the mother’s feet and, with the tips of the first three fingers of each hand, exerts deep pressure in the direction of the axis of the pelvic inlet. If the head presents, one hand is arrested sooner than the other by a rounded body, the cephalic prominence, while the other hand descends more deeply into the pelvis. In vertex presentations, the prominence is on the same side as the small parts; and in face presentations, on the same side as the back. The ease with which the prominence is felt is indicative of the extent to which descent has occurred. In many instances, when the fetal head has descended into the pelvis, the anterior shoulder of the fetus may be differentiated readily by the third maneuver. In breech presentations, the information obtained from this maneuver is less precise.
Abdominal palpation can be performed throughout the latter months of pregnancy and during and between the contractions of labor. The findings provide information about the presentation and position of the fetus and the extent to which the presenting part has descended into the pelvis. For example, so long as the cephalic prominence is readily palpable, the vertex has not descended to the level of the ischial spines. The degree of cephalopelvic disproportion, moreover, can be gauged by evaluating the extent to which the anterior portion of the fetal head overrides the mother’s symphysis pubis. With experience, it is possible to estimate the size of the fetus, and even to map out the presentation of the second fetus in a twin gestation. Experienced clinicians have been reported to accurately identify fetal malpresentation using Leopold’s maneuvers with a high sensitivity (88 percent), specificity (94 percent), positive predictive value (74 percent), and negative predictive value (97 percent) (Lydon-Rochelle and colleagues, 1993).
During labor, palpation also may provide information about the lower uterine segment. When there is obstruction to the passage of the fetus, a pathological retraction ring sometimes may be felt as a transverse or oblique ridge extending across the lower portion of the uterus . Even in normal cases, the contracting body of the uterus and the passive lower uterine segment may be distinguished by palpation. During a contraction, the upper portion of the uterus is firm or hard, whereas the lower segment feels elastic or almost fluctuant.
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In neonate, the appearance of external genitalia may not correspond with genotype in the presence of:
a. adrenogenital syndrome TRUE
b. testicular feminization syndrome TRUE
c. renal agenesis ( potter sundrome) FALSE
d. trisomy 21 ...FALSE
e. severe hypospadias ...TRUE
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a. adrenogenital syndrome T .......THERE IS DEFICIENCY OF CORTISOL AND ALDOSTERONE AND INCREASE IN ANDROGENS.......THE NEWBORN FEMALE IS MASCULINISED......PAGE 123 TIM CHARD
b. testicular feminization syndrome T .......
Testicular feminization syndrome: Now more appropriately called the complete androgen insensitivity syndrome, this is a genetic disorder that makes XY fetuses insensitive (unresponsive) to androgens (male hormones). Instead, they are born looking externally like normal girls. Internally, there is a short blind-pouch vagina and no uterus, fallopian tubes or ovaries. There are testes in the abdomen or the inguinal canal
c. renal agenesis ( potter syndrome) F---in Potter's syndrome,
In males there will be absence of vas deferens and seminal vesicals and in females there will be absence of vagina and the uterus. as per q they are asking about external genitilia and genotype which corresponds in potters syndrome although there may be agenesis of internal structures.
d. trisomy 21 ...F
e. severe hypospadias ...T .....
Hypospadias is a birth defect found in boys in which the urinary tract opening is not at the tip of the penis. Bending of the penis on erection may be associated and is known as chordee
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Risk of development of chorio carcinoma is maximum after:
1. Spontaneous abortion
2.H.Mole
3.Full term pregnancy
4.Pre-term pregnancy
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answer is 2
significantly higher risk:
Risk for the development of a hydatidiform or invasive mole or choriocarcinoma include:
a prior mole (30 times the risk)
maternal age greater than 40 years (5 times) or less than 20 years (1.5 times)
a previous spontaneous abortion (twice the risk)
At slightly lower risk:
Eating a diet high in vitamin A and having one or more children without having a previous abortion is statistically correlated with a lower than average risk of developing a complete mole.
Choriocarcinoma most frequently follows a previous complete hydatidiform mole (50%), though 25% may follow a normal pregnancy or spontaneous abortion.
according toOHCS(oxford series of clinical secialities)
50% of choriocarcinoma follows a benign mole
20%follow abortions
10% follow normal pregnancy.
so ans here is H.MOLE
between one half & 2/3rds of malignant GTDs follow evacuation of a complete or partial mole.in that 50-70% are invasive moles & 30-50% are chorioca.PSST can follow any pregnancy event.
chorioca is 1000 times more likely to follow a mole than normal pregnancy.the risk is much higher with a complete mole than a partialmole.
ref:COG vol46, number3,547-554
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wht is albert regime for diabetics on insulin?
when u donot exactly know the RBS levels and involves giving 8 units of plain insulin to the diabetic with 5% DNS..
Alberti & Thomas regime of insulin dosing schedule for diabetic patients when due to slow lab works near real time blood sugar levels, unlike today, were not possible.
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what is ondine curse ?
ondine curse is SLEEP APNOEA SYNDROME..
details abt the same are---
Apnea (literally, "without breath") is the term used when someone stops breathing for very short periods of time, usually 10 to 20 seconds. It's termed "obstructive" when respiratory efforts continue, such as movements of the chest. It's termed "central" when all respiratory effort stops. There is also a mixed version. In children, sleep apnea is almost always obstructive. During the apneic episode, the child will have decreased oxygenation of the blood.
Symptoms of Obstructive Sleep Apnea (OSA) are: snoring, restless/disturbed sleep, frequent partial or total wakenings and daytime mouth breathing. Some children with OSA have odd sleep positions, often with their neck bent backwards, or even in a sitting position. Some children with OSA sweat profusely during sleep. In adults, there is an association of obesity, but that's not a common association in children. Some children will have daytime grumpiness or sleepiness, but it's not common. Some children may have noisy swallowing as well.
Children with Down syndrome (DS) are certainly at risk for OSA. In 1991, one study showed 45% had OSA. This can be caused by several different factors present in DS: the flattened midface, narrowed nasopharyngeal area, low tone of the muscles of the upper airway and enlarged adenoids and/or tonsils.
Why is this important? Well, first, there's the obvious problem of the child not getting enough quality sleep and the behavioral effects that brings. Second, I've mentioned above that during sleep apnea, the oxygenation of the blood decreases. It has been shown that in children with DS and heart disease this low oxygenation causes an increase in the blood pressure in the lungs as the body tries to get more oxygen. This "pulmonary hypertension" can cause the right side of the heart to become enlarged and other cardiac complications can follow. The incidence of death due to OSA is unknown.
If you're unsure if your child has OSA, the way to test is through a sleep study, also called polysomnography. This test is performed overnight in a hospital (though some doctors will do "nap somnography") and consists of continuous monitoring of the oxygen in the blood, as well as monitoring chest wall movements (to assess respiratory efforts) and the flow of air through the nose. Some doctors also measure carbon dioxide in the blood or exhaled air. This is usually performed by otolaryngologists or neonatologists.
The treatment of OSA is usually removal of adenoids and/or tonsils. Various studies have been done on children with DS, and this appears to relieve OSA in most cases. However, it has been estimated that 30 to 40% of children with DS and OSA develop recurrent or persistant OSA even after removal of the tonsils and adenoids. There are several different reasons for this, including a large tongue, blockage of the airway by movement of the tongue during sleep, low muscle tone of the area of the airway just below the throat, and regrowth of the adenoids. When there is some concern regarding the effectiveness of the initial surgery, then post-surgical polysomnography is needed to document the OSA. Some centers are now using a type of MRI that takes sequential pictures of the airway while the child or adult is asleep to evaluate possible causes for persistant or recurrent OSA, and basing further surgery on those results;
In adults and children in whom surgical treatment has failed or was not indicated, one therapy is "continuous positive airway pressure," or CPAP. This is administered by a nasal mask or tube during sleep. The tube/mask administers air with an amount of pressure designed to keep the airway open.
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following are true about bupivacaine except
a. 0.25 percent is effective for sensory block
b. must never be injected into vein-- ( cardiotoxicity )
c. it produces methaemoglobinemia
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answer is c .
a) true. but so does 0.5 and 1% bupivacaine. widely used minimal concentration is 0.125%
b) false. bupivacaine may be used for IVRA ( intravenous regional anaesthesia ) but not recommended over lidocaine. bupivacaine has greater cardiotoxicity and does not offer any advantage over lidocaine. the analgesia duration in IVRA is linked to the isolated limb circulation rather than the duration of action of the LA
c) false. methaemoglobinaemia is caused by prilocaine
by an anaesthetist - Actually we give at RIVA ( regional IV anesthesia)
bupiv. IV. But we check it that there is no blood stream . Because we can cause a cardiac collaps state( with such a dose) We deflate turniquet gradually also at the end of surgery.
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1. Regarding the embryology of the thyroid gland:
A. the thyroid develops from ventral pharyngeal gut endoderm. T
B. this development occurs in the 4th week of intrauterine life. T
C. the embryonic thyroid descends from the foramen caecum, situated in the anterior part of the tongue. F
D. The thyroid usually reaches the front of the trachea by the 5th month of intrauterine life. F
E. the thyroglossal duct is originally a hollow tube running from foramen caecum to pharynx. F
F. thyroglossal duct tissue normally becomes solid and remains uncanalised after transit of the thyroid. F
G. The pyramidal lobe of the thyroid represents part of the thyroglossal duct. T
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The foramen caecum is described as being in the posterior part of the tongue; although, strictly speaking, it marks the junction of the anterior 2/3 and posterior 1/3. The thyroid begins its development in the 1st month, and completes its descent to (usually) the front of the trachea by the end of the 2nd month IUL. The hollow thyroglossal duct does become solid after transit of the thryoid, but then usually breaks apart and disappears shortly after. In addition to the commonly found pyramidal lobe, any remnant ductal epithelium from the thyroglossal duct could potentially give rise to a thyroglossal cyst.
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3. The lateral thyroid anlagen:
A. are part of the parathyroid gland. F
B. arise from the 4th pharyngeal pouch. T
C. fuse to the posterior and medial aspect of the main gland. T
D. correspond to the ultimobranchial bodies. T
E. contain parafollicular cells which produce parathyroid hormone. F
F. can give rise to medullary carcinoma. T
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The lateral thyroid anlagen correspond to the ultimobranchial bodies, and contain the parafollicular cells (C cells) which produce the hormone calcitonin. These anlagen comprise only 1% of the thyroid, but are the cells that may give rise to medullary thyroid carcinoma.
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4. Regarding the vascular supply to the thyroid gland:
A. It comes primarily from the superior and inferior thyroid arteries. T
B. The origin of the inferior thyroid artery is more constant than the superior. F
C. Small branches from the laryngeal and tracheo-oesophageal arteries also supply thyroid tissue. T(Throid also receives blood supply from tracheal and oesophagesl vessels.
Significance is even if u ligate both superior and inferior thyroid arteries thyroid will survive. )
D. When the thyroidea ima artery is present, it contributes significantly to arterial supply. F
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The superior thyroid artery is the first branch of the external carotid;
the variable inferior thyroid usually arises from the thyrocervical trunk.
The thryoidea ima is present in 10%,
but is not a significant source of supply.
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2. The following statements pertain to the Sistrunk operation.
A. This procedure is performed to excise a thyroglossal cyst. T
B. It is a simple excisional operation. F
C. The thyroglossal duct always passes anterior to the hyoid bone. F
D. A lingual thyroid must always be removed when a thyroglossal cyst is excised. F
E. The excision tract for a thyroglossal cyst passes through the mylohyoid muscle. T
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lichen planus
REMEMBER 5 'P's
plane,
purple,
polygonal,
pruritic,
papule,
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In paediatrics, the relationship between (classical) onset of rash and day of fever can be memorized as below:
V"ery "S"ick "P"atient "M"ust "T"ake "No" "E"xercise
Day 1 of fever: "v"aricella zoster
Day 2 of fever: "s"carlet fever
Day 3 of fever: small"p"ox
Day 4 of fever: "m"easles
Day 5 of fever: "t"yphus
Day 6 of fever: "no" related disease
Day 7 of fever: "e"nteric fever
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Exit of branches of trigeminal nerve from the skull
Standing Room Only
V1 -Superior orbital fissure,
V2 -foramen Rotundum,
V3 -foramen Ovale
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INNERVATION OF PENIS
Parasympathetic puts it up; sympathetic spurts it out
Point , Shoot, Score! (erection, emmision ,ejaculation) Parasympathetic, Sympathetic , Somatomotor
"S2, 3, 4 keep the penis off the floor" Innervation of the penis by branches of the pudental nerve, derived from spinal cord levels S2-4
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order of nerves that pass through the superior orbital fissure
Lazy French Tourists Lie Naked in Anticipation
(Lacrimal, Frontal, Trochlear, Lateral, Nosociliary, Internal,
Abducens)
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