89187
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Correct Answer - B
Ans, B. Preovulatory
The testing of tubal patency and detecting tubal pathology are done
in pre-ovulatory phase of the menstrual cycle.
If performed in the post-ovulatory period, insufflation might disturb
an implanted or fertilized ovum and may also cause pelvic endometriosis.
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Capnography In Nutshell
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Correct Answer - A
The answer is A (Increased amplitude of QRS complex):
Athletic Heart Syndrome
Athletic Heart Syndrome is a benign condition consisting of
physiologic adaptations to the increased cardiac workload of
exercise in trained athletes.
It represents a constellation of clinical findings that are the result of normal physiologic adaptation to strenuous physical activity.
In response to the increased physical demand, the left ventricles
dilate and wall thickness increases. The mass to volume ratio,
however, does not change.
Physical examination
Decreased body fat and increased muscle mass (generally very
physically fit)
Pulse slow and often irregular (sinus bradycardia or bradycardia with first-and second-degree blocks)
Grade I or II mid-systolic murmurs (benign functional ejection
murmur resolves with Valsalva maneuver) Third and fourth heart sounds very common (benign filling sounds)
Blood pressure typically remains normal Electrocardiogram rhythm
Rhythm
- Sinus bradycardia of 40 to 55 beats /min while at restSinus pauses of more than 2.0 seconds due to increased vagal
tone
- Wandering atrial pacemaker found only in dynamic athletes
- First degree atrioventricular block present only at rest; P-R interval
normalizes with exercise
- Second degree atrioventricular block present only at rest: Mobitz I
(wenckebach block) common in marathon runners; Mobitz II rare in
athlete's heart.
Voltage: TORS voltage (Amplitude)
- Left ventricular hypertrophy found in 85% of Olympic marathon
runners
- Right ventricular hypertrophy common in dynamic athletes but
rarely seen in sedentary controls and static athletes sedentary
control and static athletes
Repolarization
- S-T segment elevation with peaked T waves normalizes with
exertion
- S-T segment depression may be rarely found in athletes
T-wave inversion in lateral leads associated with interventricular
septal hypertrophy in static athletes (can be a normal finding in
dynamic athletes)
Chest radiography
- The heart is globular in appearance, particularly in endurance
athletes.
- Cardiomegaly (cardiothoracic ratio >0.50)
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Correct Answer - D
Ans. is 'd' i.e., Facial nerve injury [Ref Schlemmer KD, Naidoo
SK. Complicated sinusitis in a developing country, a
retrospective review. Int J Pediatr Otorhinolaryngol. 2013 May
17]
Complication of Maxillary sinus lavage and insufflation
Complications of nonendoscopic drainage procedures can be minor
or severe.
The most common complication is failure to enter the sinus because
of improper positioning of the trocar, incomplete penetration of the sinus mucosa, or the presence of a hypoplastic antrum.
Epistaxis may occur because of laceration of the nasal mucosa or
preexisting coagulopathies necessitating packing.
Severe complications include orbital injury, air embolism, and death secondary to injection of air into the sinus
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Correct Answer - A
Ans. A. MCA doppler peak systolic volume
Doppler ultrasound: Serial Doppler study of the middle cerebral
artery (MCA)-peak systolic velocity (PSV) is the mainstay to assess
fetal anemia. A value >1.5 multiples of the median (MOMs) for the
corresponding gestational age, predicts moderate to severe fetal
anemia.
This value (between 24 weeks and 35 weeks of gestation), is an
indication for cordocentesis and fetal transfusion
Most centers have replaced serial amniocentesis with serial MCA
Doppler studies.
Ref. OBstetrics Dutta ed. 8th pg. 391
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A 60 years old man comes to the emergency department because of severe abdominal pain and nausea. The patient also has a history of corrective spine surgery done for his scoliosis. He also complaints of postoperative weight loss. The CT scan shows the following interpretation. The most likely cause of this condition is due to which of the following artery?
A. Inferior mesenteric artery
B. Superior mesenteric artery
C. Coeliac artery
D. Median sacral artery
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Ans. C. Loeffler’s Serum Slope
Volutin granules are poly-metaphosphate, an intracytoplasmic storage form of complexed inorganic polyphosphate, the production of which is used as one of the identifying criteria when attempting to isolate Corynebacterium diphtheriae on Löffler's medium.
In Diphtheria, the most frequent cause of death is airway obstruction or suffocation following aspiration or due to pseudo membrane. Cervical edema and cervical lymphadenopathy from diphtheria infection produce a bull's neck appearance in this child.
Diphtheria-causing bacteria may produce a toxin. This toxin damages tissue in the immediate area of infection — usually, the nose and throat. At that site, the infection produces a tough, gray-colored membrane composed of dead cells, bacteria and other substances. This membrane can obstruct breathing.
Volutin granules can also be possessed by:
Corynebacterium xerosis
Gardnerella vaginalis
Spirillum
Few Mycobacterium species
Enterobacter aerogene
Reference: Jawetz Melnick & Adelbergs Medical Microbiology, 27th Edition, Page No. 191
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A 2-year-old child was brought to the pediatrics OPD with complaints of enlarging scalp mass since 3months. On detail history taking, history of trauma to head 5-6 months back was revealed. After thorough clinical examination, the pediatrician adviced NCCT brain. The NCCT brain showed lytic calvarial lesion in right temporal bone with scalloped edges in which encephalomalacic cerebral tissue invaginated. What could be the possible diagnosis?
A. Leptomeningeal cyst/ growing skull fracture
B. Encephalocele
C. Eosinophilic granuloma
D. None of the above
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During a routine visit, a 68-year-old woman complains of 3 months of fatigue, abdominal fullness, and bilateral axillary adenopathy. On physical examination, vital signs are normal, and she has bilateral palpable axillary and cervical adenopathy and an enlarged spleen. A complete blood count is notable for a white cell count of 88,000 with 99% lymphocytes. A peripheral smear is shown in Image. Which of the following is the most likely diagnosis?
A. Acute lymphoblastic leukemia
B. Acute myelogenous leukemia
C. Chronic lymphocytic lymphoma
D. Hairy cell leukemia
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Correct Answer - C
Answer is C (Constrictive pericarditis)
Kussmaul's sign is classically described in association with
Constrictive Pericarditis.
Kussmaul's sign refers to paradoxical elevation of JVP/CVP during inspiration (In healthy persons venous pressure falls during inspiration because pressures in the right heart decrease as intrathoracic pressures fall)
The Kussmaul's sign is classically
described in association with Constrictive pericarditis. Kussmaul's sign is however also seen in association with Right Ventricular Infarction, Restrictive Cardiomyopathy, Pulmonary Embolism and Advanced Systolic Severe Heart Failure
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A 61-year-old woman has experienced increasing malaise and bouts of abdominal pain for the past 5 years. On physical examination, she has a blood pressure of 150/95 mm Hg. On auscultation, a midsystolic click is heard over the mitral area. Bilateral abdominal masses are palpable. An abdominal ultrasound shows enlarged kidneys with the representative gross appearance shown in the figure. Which of the following extrarenal conditions is she most likely to have?
A. Berry aneurysm
B. Coagulopathy
C. Hepatic cirrhosis
D. Pulmonary fibrosis
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Correct Answer - B
Ans.B.TB pelvis with Tubo ovarian mass
The tubercles burst to pour the caseous material inside the lumen
producing tubercular pyosalpinx, which may adhere to the ovaries
and the surrounding structures.
Often the infection spreads outwards producing peri salpingitis with exudation, causing dense adhesions with the surrounding structures tubercular tubo-ovarian mass.
Clinical diagnostic features:
Weakness, low-grade fever, anorexia, anemia or night sweats may be present.
Infertility: It may be primary or secondary
Chronic pelvic pain
Vaginal discharge— postcoital bleeding or a blood-stained
discharge.
Constitutional symptoms such as loss of weight, malaise, anorexia,pyrexia, and anemia are present in the acute phase of the disease.
Menstrual abnormality: In about 50 percent, the menstrual function is
normal.
Presence of pelvic mass with nodules in the pouch of Douglas
palpable
Ref. Gynaecology Dutta ed. 6th Page no. 139-142
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Ans. A. Leptomeningeal cyst/ growing skull fracture
Growing skull fracture occurs secondary to trauma in 0.5% of skull fractures and in children <3years age.
There will be encephalomalacic brain tissue invaginating through skull defect.
It occurs due to Dural tear during trauma and herniation of leptomeninges and cerebral parenchyma which prevents of union of skull fracture. Later the defect goes on enlarging in size.
Encephalocele is herniation of brain parenchyma through calvarial defect and presents since birth
Eosinophilic granuloma has geographic lytic lesion with bevelled edges but no brain tissue invagination.
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Ans. C. Chronic lymphocytic lymphoma
The peripheral smear shows increased numbers of small, well-differentiated, normal-appearing lymphocytes characteristic of chronic lymphocytic leukemia, the most common leukemia or lymphoma in adults.
Common presenting complaints typically include fatigue, frequent infections, new lymphadenopathy, and abdominal complaints relating to splenomegaly.
Hairy cell leukemia is a rare disease that presents predominantly in older men. Typical presentation involves pancytopenia, although occasional patients will have a leukemic presentation.
Splenomegaly is usual. The malignant cells appear to have “hairy” projections on light and electron microscopy.
Patients with this disorder are prone to unusual infections, including infection by Mycobacterium avium intracellulare, and to vasculitic syndromes.
Hairy cell leukemia is responsive to chemotherapy with cladribine with clinical complete remissions in the majority of patients and frequent long-term disease-free survival.
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