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Correct Answer - C
Answer- C. Manometry
H/O of dysphagia with more to liquids than solids suggests achalasia cardia.
In all other obstructive causes of esophagus, dysphagia for solids is seen first Manometry is used for diagnosis.
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Correct Answer - D
Ans. is 'd' i.e., Left Anterior Fascicular Block
Left Anterior Fascicular Block is a partial block in the left bundle
system and does not prolong the QRS duration significantly. Typically the QRS duration is slightly prolonged and remains between 0.10 to 0.12 seconds.
...Major causes of a wide ORS complex
Intrinsic intraventricular conduction delay
o Left bundle branch block
and variants Right bundle branch block and variants
o Other nonspecific IVCD
patterns
..Extrinsic intraventricular conduction delay
Hyperkalemia
Drug-induced - type 1 antiarrhythmic drugs and related sodium channel blocking agents (eg, tricyclic antidepressants and
phenothiazines) Ventricular beat o Premature
o Escape Paced
Ventricular preexcitation
Wolff Parkinson-White (WPW) pattern and variants
Factitious
ECG unintentionally recorded at fast paper speeds (50 or 100 mm/s
..Wide QRS complex tachyarrhythmias
Ventricular tachycardia
Supraventricular tachycardia or atrial fibrillation or flutter with
aberrant intraventricular conduction due to:
Bundle branch block
Atrioventricular bypass tract (preexcitation syndromes with
orthodromic conduction
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Correct Answer - D
Answer is D (Propylthiouracil):
Propylthiouracil (PTU) is not associated with an increased risk of congenital malformations and is considered the drug of choice for
treating hyperthyroidism is Pregnancy. .
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Correct Answer - A
Ans. is 'a' i.e., CSOM
Clinical features of CSOM
Profuse mucopurulant discharge which is not foul smelling, i.e., non
foul smelling discharge .
Hearing loss (conductive type). If sensorineural component also
occurs (i.e., mixed type), it arouses the suspician of toxic deafness.
Sometimes, patient reports a paradoxical effect, i.e., hears better in the presence of discharge than when the ear is dry. This is due to
round window shielding effect produced by discharge which helps to maintain phase differential.
There is no pain, if it occurs it is due to associated otitis externa not due to otitis media.
Since the infected area is open at both ends, discharge does not
accumulate in the middle ear cavity.
Ossicular chain is mostly uninvolved, if involved only long process of incus.
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Correct Answer - B
Ans. is
'b' i.e., Antibiotics [Ref Conquering Otitis media by Charles Bluestone p. 95]
Retraction pocket
It must be treated by an otolaryngologist.
1) Antibiotics
A mild retraction pocket that is present in a fluid - filled middle ear
can first be treated with antibiotics.
2) Tympanostomy
If antibiotics does not work, a tympanostomy tube is usually
inserted, and in most cases, the eardrum will return to normal.
If the retraction pocket is very deep, a tube should be inserted,
bypassing the antibiotic treatment.
3) Surgical excision
If the retraction pocket still does not go away, the deformed eardrum should be operated on to prevent a cholesteatoma from developing.
Once a cholesteatoma develops, surgery is the only way to remove
it.
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Correct Answer - D
Answer. D. Right ventricle
Mitral stenosis is associated with right ventricular hypertrophy.
Left ventricular diastolic pressure is normal in isolated MS.
Mitral stenosis : Features
left atrial pressure is increased
pulmonary arterial pressure is increased
Increased right ventricular afterload impedes the emptying of this
chamber and Right ventricular end diastolic pressure and volume
increase.
Right ventricular hypertrophy occurs.
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Correct Answer - D
Ans. is 'd' i.e., Expiratory stridor
Laryngomalacia
It is the most common congenital abnormality of the larynx.
Laryngomalacia is the most frequent cause of stridor or noisy
breathing in infants. It occurs as a result of a floppy portion of the
larynx (in supraglottic larynx) that has not yet developed the strength
to provide rigid support to the airway. During inspiration negative
pressure is created through larynx, which results in a collapse of
these structures into the airway and a narrower breathing passage.
Partial obstruction is the source of the noise with breathing (stridor),
and sometimes cyanosis.
The hallmark sign includes intermittent stridor mostly in inspiration.
It is usually more prominent when the infant is lying on his/her back
(supine position, crying, feeding, excited or has a cold. Stridor gets
relieved on placing the patient in prone position. This is usually first
noticed in the first few weeks of life.
It may worsen over the first few months and become louder. This is because as the baby grows, inspiratory force is greater, which
causes greater collapse of the laryngeal structures into the airway.
This is usually worst at 3-6 months and then gradually improves as
the rigidity of the cartilage improves.
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Correct Answer - A
Answer: A 10/ 24 or more red cell products in hours.
Various definitions of massive blood transfusion (MBT) have been
published in the medical literature such as:
Replacement of one entire blood volume within 24 h
Transfusion of >10 units of packed red blood cells (PRBCs) in 24 h
Transfusion of >4 units of PRBCs in 1 h when on-going need is
foreseeable
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Correct Answer - B
Ans. is 'b' i.e., Bony labyrinth
Otosclerosis is a primary disease of the bony labyrinth.
There is abnormal bone growth that causes hearing loss.
There is altered bone remodeling.
Normally, the typical human otic capsule remodeling rate is
extremely low.
In otosclerosis, normal inhibition of bone remodeling is lost resulting
in foci of bone remodeling.
When remodeled bone bridges the stapediovestibular joint, it fixates
the joint and impedes sound transmission manifested as conductive hearing loss.
The most common site of disease is promontory in the region of the
anterior margin of oval window, and in advanced cases the stapes
become ankylosed in position by a mass of new spongy bone.
Other sites, which may be involved, are round window area,
stapedial footplate, internal auditory canal, and semicircular canal
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Correct Answer - D
Ans. is 'd' i.e., Superior laryngeal nerve palsy
Tracheostomy
A tracheostomy is a surgical procedure to create an opening through the neck into the anterior wall of trachea.
A tube is usually placed through this opening to provide an airway
and to remove secretions from the lungs. The tube is
called tracheostomy tube
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Correct Answer - A
Answer- A. Tumor lysis
MHC class I molecules are present on all nucleated cells, all virusinfected cells can be detected and eliminated by CD8+Cytotoxic T
lymphocytes.
MHC class I is responsible for graft rejection and cell-mediated
cytolysis of viral infected or tumor cells.
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Correct Answer - A
Answer: A. 5.5cm
*Operative repair of the aneurysm with the insertion of a prosthetic graft or endovascular placement of aortic stent graft is indicated for:
Abdominal aortic aneurysms of any size that are expanding rapidly
or are associated with symptoms.
For asymptomatic aneurysms, abdominal aortic aneurysm repair is indicated if the diameter is >5.5 cm.
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Correct Answer - A
Answer- A. Alport syndrome
Basketweave appearance of glomerular basement membrane on Electron Microscopy is seen in Alport's syndrome.
In Alport's Syndrome, the glomerular basement membrane shows irregular thinning and thickening with a lamellated basket-weave appearance in the thickened area due to extensive remodeling and injury of the basement membrane.
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Correct Answer - D
Ans. is 'd' i.e., Vitamin B12 deficiency
Anemia along with involvement of posterior column is characteristic
of subacute combined degeneration of spinal cord caused by vitamin
B12 deficiency
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Correct Answer - C
Ans. is 'c' i.e., I-V
Radical neck dissection
During radical neck dissection, following are removed.
a. Lymph nodes of submental, submandibular, upper, middle and lower jugular, and lateral (posterior) triangle regions, i.e. Level I to V along with its fibrofatty tissue.
b. Sternomastoid muscle.
c. Internal jugular vein.
d. Spinal accessory nerve.
e. Submandibular salivary gland.
f. Tail of the parotid.
g. Omohyoid muscle.
Following structures are saved -
Carotid artery Brachial plexus, phrenic nerve, vagus nerve, cervical sympathetic chain, marginal mandibular branch of facial, lingual and hypoglosal nerve.
Modified neck dissection
It is similar to radical neck dissection but with preservation of one or more following structures -
1. Spinal accessory nerve
2.Internal jugular vein
3. Sternocleidomastoid muscle
Thus, both radical neck dissection and modified radical neck
dissection remove level Ito V neck nodes.
Different levels of neck nodes heve been explained in previous
sessions.
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Correct Answer - A
Ans. is 'a' i.e., Keratin debris
Cholesteatoma
Destructive or expanding growth in the middle ear or mastoid
process
The term cholesteatoma is a misnomer, because it neither contains cholesterol crystals nor is it a tumor to merit the suffix `oma'.
Cholesteatoma has the property to destroy bone. It may cause
destruction of ear ossicles, erosion of bony labyrinth, canal of facial
nerve, sinus plate or tegmen tympani and thus cause several
complications. Bone destruction by cholesteatoma has been
attributed to various proteolytic enzymes liberated by osteoclasts
and mononuclear inflammatory cells, seen in association with
cholesteatoma.
Cholesteatoma consists of two parts : ?
i) Matrix : - Made up of keratinizing squamous epithelium.
ii) Keratin debris (central white mass) : - Produced by the matrix.
Therefore, cholesteatoma also referred to as epidermosisor
keratoma.
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Correct Answer - A
Answer- A. Hemolysis
Hemolysis and hyperbilirubinemia
Increased destruction of erythrocytes leads to increased bilirubin turnover and unconjugated hyperbilirubinemia; the hyperbilirubinemia is usually modest in the presence of normal liver function.
Therefore, hemolysis alone cannot result in a sustained
hyperbilirubinemia of more than -68 umol/L (4 mg/dL).
When hemolysis is the only abnormality in an otherwise healthy individual, the result is a purely unconjugated hyperbilirubinemia.
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Correct Answer - C
Answer- C. 1000 ml bolus then regulated by clinical indicators
Fluid resuscitation begins with 1000 ml bolus of RL for adult and 20 ml/kg for a child.
Response to therapy is monitored by clinical indicators as blood pressure, skin perfusion, urinary output and mental status.
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Correct Answer - A
Ans. is. A. Glottic Ca is the most common
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Correct Answer - C
Ans. is 'c' i.e. mitotic rate
Grading of breast cancer
o Presently, most methods for grading use the previously cited
three-tiered systems for describing tumor structure in terms of tubule
formation, nuclear grade and mitotic count, with the latter usually expressed as the number of mitosis per 10 high- magnification field.
o Each element is scored on a scale from 1 to 3 according to criteria of the specific grading system, and the final grade is determined by the sum of mitosis.
o Totals of 3 to 5 indicate a well-differentiated or low-grade tumor; 6
to 7, a moderately differentiated or intermediate-grade tumor; and 8
to 9 , a poorly differentiated or high-grade tumor.
o This method of scoring is known as the Nottingham combined
histologic grade of Elston-Ellis modification of the Scarff-BloomRichardson grading system, often reported as a modified ScaffBloom-Richardson grade.
Modified Bloom-Richarson histological grading Tubule formation
o Score 1 :- >75% of tumor has tubules
Score 2 :- 10-75% of tumor has tubules
o Score 3 :- < 10% of tumor has tubules
Nuclear size ( nuclear polymorphism)
o Score 1 :- tumor nuclei similar to normal duo Score 1 :- tumor nuclei similar to normal duct nuclei (2-3 x RBC)
Score 2 :- Intermediate size nuclei
Score 3 :- very large nuclei, usually vesicular with prominent nucleoli
Mitotic count
o Score 1 :- 0-7 mitosis o Score 2 :- 8-14 mitosis o Score 3 :- > 15
mitosis
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Correct Answer - B
Answer- B. Type II
Bismuth - Corlette classification is used to classify
cholangiocarcinoma
Type I - Common hepatic duct involvement.
Type II - CHD + bifurcation/confluence of hepatic ducts. Type III- a) Extension to right secondary intrahepatic duct.
b) Extension to left
secondary intrahepatic duct.
Type IV - Involving both right and left secondary intrahepatic ducts.
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