Chromosome 16

CHROMOSOME 16 :

• ADPKD (PKD 1)
• Alpha thallesemia
• Pseudoxanthoma elasticum
• Tomm Harsfall protein's gene (UMOD)

Note: 

Beta Thallesemia - Chromosome 11

Alpha thallesemia - Chromosome 16


ADPKD

• Chromosome 16 ( Gene - PKD 1 ) (85% of cases) 
• Chromosome 4 (Gene - PKD 2 ) 

ARPKD - Chromosome 6 ( Gene - PKHD 1 )

---

Chromosome 15

CHROMOSOME 15 :

• Albinism
• Angelman syndrome (Maternal deletion or Paternal Disomy)
• Prader willi syndrome (Paternal Deletion or Maternal Disomy)
• Tay Sachs disease.
• Marfan syndrome.
• Bloom syndrome. 

Point to note : 

Fibrillin gene 1 (FBN 1) - On chromosome 15 - Marfan's Syndrome.

Fibrillin gene 2 (FBN 2) - On chromosome 5 - Beals syndrome

---

Mnemonic :
Its usually confusing to remember Prader willi and Angelman , deletion or disomy , maternal or paternal.

So here is the way

Prader Willi -- is Paternal Deletion (or maternal uniparental disomy) and Angelman's is vice-a-versa.

---

Chromosome 14

CHROMOSOME 14 :

• Alpha 1 antitrypsin deficiency
• Familial HOCM
• Krabbe disease
• Niemann pick type C (NPC2 gene) (5% cases of type C)

Note: 

Niemann pick disease

Type A - Chromosome 11

Type B - Chromosome 11

Type C 

• NPC1 - Chromosome 18
• NPC2 - Chromosome 14

Approximately 95% of Niemann–Pick Type C cases are caused by genetic mutations in the NPC1 gene, referred to as type C1;

5% are caused by mutations in the NPC2 gene, referred to as type C2.

Chromosome 12 & 13

CHROMOSOME 12 :

• Phenylketonuria (q)
• Holt Oram syndrome
• vWF

CHROMOSOME 13 :

• Wilson disease 
• Retinoblastoma 
• Osteosarcoma 
• BRCA 2
• Patau Syndrome (Trisomy)

Note :

BRCA 1 - Chromosome 17

BRCA 2 - Chromosome 13

Chromosome 10 & 11

CHROMOSOME 10 :

• RET protoncogene
• MEN 2

Note : 

MEN 1 - Chromosome 11

MEN 2 - Chromosome 10

CHROMOSOME 11 :

• Sickle cell dis.
• Wilms tumour 
• Ataxia telangiectasia
• Beta thallesemia
• MEN 1
• Human insulin gene.
• PTH gene
• Niemann pick disease (Type A & B )
• Folate Receptor genes

Note:
Alpha thallesemia - Chromosome 16
Beta thallesmia - Chromosome 11

Folate Receptor genes (FOLR 1 adult , FOLR 2 fetal , FOLR 3 ) are mapped on Chromosome 11
Reduced folate carrier (SLC19A1) (Folate Transporter) - Chromosome 21.



Human Insulin gene - Chromosome 11
Insulin Receptor gene - Chromosome 19

---

Chromosome 9

CHROMOSOME 9 : 

• ABO blood group antigens
• Friedreich's ataxia (its a GAA repeat)

Gorlin syndrome can also be associated with 9q22.3 microdeletion

Propofol

---

Propofol = 2,6- diisopropyl phenol

1% / 2% emulsion in a lipid vehicle containing soybean oil, egg lecithin, and glycerol.

therefore - bacterial growth (thus discard after 6hrs)
Only IV use.

Pain on injection which can be decreased by :

1. injecting in larger vein.
2. Mixing with lignocaine
3. by cooling propofol

Other points:

• Recovery is rapid and clear (Therefore DOC for Day Care Surgery)

• Hepatic and Extrahepatic (Lungs) clearance.

• Decrease BP and Decrease Heart rate ( propofol blunts carotid body receptor response & hence no compensatory increase in heart rate)

• Causes maximum depression of upper airway reflexes (therefore DOC - for LMA insertion)

• Antiemitic & Antipruritic

• No anticonvulsant.

• Decrease IOP.(intraoccular pressure)

• AntiOxidant

• DOC in hepatic disease/Liver transplant (because it can be metabolized extrahepatic too.)

• Potentiates NMDR and fentanyl.

• DOC in Acute intermittent porphyria (here Thiopentone is Contraindicated)

---

Propofol Infusion syndrome :

Triad of

• Metabolic Acidosis
• Skeletal Myopathy
• Acute Cardiomyopathy

On prolonged infusion (>48hrs) of high dose in child.

Occurs due to failure of metabolism of free fatty acids.

---

Etomidate

---

Etomidate :

• dissolved in propylene glycol

• only IV injection

• Most Cardiostable 

• Slight decrease in BP

• Maximum incidence of post op Nausea and Vomiting.

• lacks Analgesic property.

• Causes AdrenoCortical depression - therefore inhibit steroid - therefore mortality - thus Withdrawn.

---

Ketamine

---

Ketamine (Phencyclidine derivative):

Dissociative anaesthesia i.e dissociates thalamus from limbic system.

Metabolized in Liver to Nor-Ketamine (this also has anaesthetic potency)

CVS : 

• Increase HR, BP and Cardiac Output. (Therefore DOC for Hypovolumic shock patients)
• Myocardial O2 demand increases -- therefore avoid in Ishaemic heart disease , Hypertention and aortic aneurysm.

Respiratory system : 

• Minimal effect
• Potent Bronchodialator (therefore agent of choice in Asthma)
• Maintain upper airway reflex (therefore DOC for Full stomach patients)
• increases salivation (thus Anticholinergics are given to reduce this)

CNS :

• Increase cerebral O2 consumption (therefore contraindicated in Space occupying lesion and Head injury)
• Increases ICT
• causes hallucinations (decreased by BZDs)
• causes increase in IntraOccular Pressure (therefore Contraindicated in Glaucoma patients)
• NDMR are potentiated by ketamine.

Strongly analgesic. Therefore - Other uses:

• Field Anaesthesia
• Short surgical procedures
• Burn dressings

---

Blue Colour : USE

Red Colour : NOT

---

GABA & 5HT

BZD vs Barbiturates

---

BZD	Barbiturates
1.       GABA facilitator	GABA mimetic
2.       DRC- flat	Steep
3.       No drug interaction	Enzyme Inducer
4.       Specific antagonist – Flumazenil	Not (therefore do alkaline diuresis in case of poisioning)
5.       Less Respiratory depression	More

---

Benzodiazepines

---

Benzodiazepine 

Barbiturates produce their pharmacological effects by increasing the duration of chloride ion channel opening at the GABA_A eceptor (pharmacodynamics: This increases the efficacy of GABA), 

whereas 

Benzodiazepines increase the frequency of the chloride ion channel opening at the GABA_A receptor (pharmacodynamics: This increases the potency of GABA).

Diazepam : Oil based , IM painful

Midazolam : Water Soluble , can be used as Anticonvulsant

                      It is the 1st drug to decrease seizures in ICU.

Awakening due to redistribution.

CVS : Minimal CVS depression.

Respiratory syatem : decrease Ventilatory response to CO2

• Diazepam : Retrograde Amnesia

• Midazolam : Anterograde Amnesia

They decrease MAC by 30%

---

Methohexitol

---

Methohexitol ( is a barbiturate derivative)

 MOA : binds to a distinct site which is associated with Cl− ionophores at GABA_A receptors and increases the length of time which the Cl− ionopores are open, thus causing an inhibitory effect.

Important points :

• Drug of Choice (DOC) for ECT

• It is a ProConvulsant

---

Tennis Elbow

Tennis Elbow = Lateral epicondylitis
Tennis elbow occurs in the lateral side of the elbow region, but more specifically it occurs at the common extensor tendon that originates from the lateral epicondyle.

Non-inflammatory, chronic degenerative changes of the origin of the extensor carpi radialis brevis (ECRB) muscle are identified in surgical pathology specimens.

Investigation of Choice : Cozen's test

Positive if a resisted wrist extension triggers pain to the patient.

Golfer's Elbow : Medial Epicondylitis

---

Sir Sachin Ramesh Tendulkar suffered from "Tennis Elbow" in 2004.

http://www.hindu.com/mp/2006/11/25/stories/2006112501900400.htm

He announced his retirement from ODIs today. We will miss you " Sir ".
23rd Dec 2012

Thiopentone

---

Thiopentone = Sodium Thiopental
Thiopental, a barbiturate, is used for the induction of anesthesia

First used in 1934 by Lundy' and Waters

Yellow amorphous powder.

pH 10.5 - 11 , therefore not to be given with Normal Saline & RL

Dose - 3-5mg/kg ;  Route: IV

Adequate induction dose will cause loss of eyelash reflex.

Used in concentration of 2.5%

Given Commonly at outer aspect of forearm (Never in anticubital fossa)

If Concentration >2.5%

• Pain on injection
• Venous thrombosis

Mechanism of action :

• depress RAS
• binds at a distinct binding site associated with a Cl- ionopore at the GABA_A  receptor, increasing the duration of time for which the Cl- ionopore is open. The post-synaptic inhibitory effect of GABA in the thalamus is, therefore, prolonged.

Duration of action 

• Determined by redistribution (not by elemination)
• Patient looses consciousness in 30 sec and regains in 20 min.
• With repeated doses - duration depends on elimination (Metabolized in Liver)

Systemic effects:

• Decrease BP (Compensatory increase in Heart Rate)
• Decreased response to hypoxia & hypercarbia.
• Apnea (Treat with Positive pressure resp. -  IPPV)
• Decrease Tidal Volume and Respiratory Rate 
• Can cause bronchospasm & laryngospasm
• Decreases Cerebral blood flow
• Decreases Cerebral O2 consumption ( Therefore Cerebroprotective ; DOC - in Head Injury )
• Lowers threshold for pain ( it is AntiAnalgesic)
• Does not cause Muscle relaxation
• Powerful anticonvulsant (refractory seizures can respond to it)
• Decreases Renal blood flow and GFR
• Crosses Placenta and has some antithyroid activity.

It is Microsomal enzyme inducer.

Induction of hepatic enzymes increase the rate of metabolism.

Contraindications:

Acute Intermittent Porphyria and Variegate Porphyria

Can be used in Porphyria Cutaneous Tarda

---

In case of inadvertent intra-arterial injection (eg: if in anticubital fossa)

• pain , 
• blanching hand , 
• absent radial pulse , 
• Secondary thrombosis

Treatment - 

• Stop injection & Leave the needle in situ (most important)
• Flush with saline
• Give Vasodialator
• Brachial or stellate ganglion block
• Anticoagulant

---

Limb Buds

Lower limb buds bulge from the lateral aspect of which segments of the trunk ?

a. C5-T1

b. T7-L2

c. L1-S5

d. L2-S2

ANSWER:

Ans: D
The upper and lower limbs develop from limb buds that arise from the lateral body wall during the 4th and 5th weeks, respectively.
Upper limb -> C5 - T1 segments.
During the 5th week, lower limb buds bulge from the lateral aspect of the L2 - S2 segments of the trunk.
Also, during the seventh week of gestation the limbs rotate in opposite directions. The upper limb rotates 90◦ laterally, so that the extensor muscles lie on the lateral and posterior surface and the thumbs lie laterally, whereas the lower limb rotates approximately 90◦ medially, placing the extensor muscles on the anterior surface and the big toe medially.

Chromosome 7 & 8

---

CHROMOSOME 7 :

• Cystic fibrosis
• Type 2 MODY

CHROMOSOME 8 :

• Osteoporosis
• Hereditary Spherocytosis (AD)

Note :

Type 1 MODY - Chromosome 20

---

Chromosome 6

CHROMOSOME 6 :

• MHC Complex (p)-short arm
• ARPKD
• Hemochromatosis
• Cleidocranial dystosis 

Remember :

ADPKD - Chromosome 16 ( Gene - PKD 1 ) (85% of cases)
                 Chromosome 4 (Gene - PKD 2 )

ARPKD - Chromosome 6 ( Gene - PKHD 1 )

“ Crazy Paving ” appearance on HRCT

---

Q. “ Crazy Paving ” appearance on HRCT can be seen in

a. Alveolar Proteinosis

b. Pneumocystis jiroveci pneumonia

c. acute respiratory distress syndrome [ARDS]

d. All of the above.

ANSWER:

Ans: D
Although initially described as typical of alveolar proteinosis, this appearance is nonspecific and may be seen in a variety of
acute lung diseases (e.g., edema, hemorrhage, Pneumocystis jiroveci pneumonia, and acute respiratory distress syndrome [ARDS])
or chronic lung diseases (alveolar proteinosis, exogenous lipoid pneumonia).

---

Chromosome 5

---

CHROMOSOME 5 :

• FAP (APC gene) 
• Beals syndrome = Congenital Contractual Arachnodactyly (FBN 2)
• Treacher collins syndrome
• Cri du chat syndrome (5p deletion)

Point to note :

Fibrillin gene 1 (FBN 1) - On chromosome 15 - Marfan's Syndrome.

Fibrillin gene 2 (FBN 2) - On chromosome 5 - Beals syndrome

---

Biphasic pattern on histology

“ Biphasic pattern” on histology is seen in which tumor:
a. Rhabdomyosarcoma
b. Synovial cell sarcoma
c. Osteosarcoma
d. Neurofibroma

ANSWER:

Correct Ans : B

Other biphasic tumors are Epithelioid sarcoma, Mesothelioma
Triphasic tumor is Wilms' tumor

Lets see why most people think osteosarcoma here--
Osteosarcoma shows Biphasic Pattern of "INCIDENCE" , its not the histology.
A biphasic pattern of incidence of osteosarcoma has been observed; peaks have been noted among adolescents (rapid growth of long bones) and in the elderly (secondary tumors arising in association with Paget disease or within previously irradiated tissue).

FB Page MCQs (61-70)

61. Leucocytosis is seen in all except:
a. Brucellosis
b. Acute MI
c. Tyhoid
d. Diphtheria

62. Which of the following disorders has been shown to be genetically transmitted by single autosomal dominant genes :
a. Cataconic schizophrenia
b. Phenyl keronuria
c. Cretzfeldt-Jakob’s disease
d. Huntington’s disease

63. More sensitive indicator of thyroid insufficiency?
A) serumTSH
B ) serumT3
C) serumT4
D) serum iodine

64. Brushfield spots can be seen in?
a) lowe's syndrome
b) down's syndrome
c) patau syndrome
d) turner's syndrome

65. Bronze diabetes occurs due to overload of?
a) copper
b) iron
c) carotene
d) arsenic.

66. Salaam spells are seen in
a) infantile spasms
b) rolandic seizures
c) gtcs
d) absence seizure

67. Tomcat urine odor is seen in:
a)glutaric acidemia
b)isovaleric acidemia
c)phenyl ketonuria
d)multiple carboxylase deficiency

68. Gingival biopsy is useful in the diagnosis of :
a. Sarcoidosis
b. Amyloidosis
c. Histoplasmosis
d. Scury

69. “ Biphasic pattern” on histology is seen in which tumor:
a. Rhabdomyosarcoma
b. Synovial cell sarcoma
c. Osteosarcoma
d. Neurofibroma

70. The most important function of epitheliod cells in tuberculosis is :
a. Phagocytosis
b. Secretory
c. Antigenic
d. Healing

ANSWERS 61-70 :

61c , 62d , 63a , 64b , 65b , 66a , 67d , 68b , 69b , 70d

Chromosome 4

CHROMOSOME 4 :

• Huntington chorea
• Parkinsonism 
• Achondroplasia
• ADPKD (Gene - PKD 2 )

Remember :

ADPKD - Chromosome 16 ( Gene - PKD 1 ) (85% of cases)
                 Chromosome 4 (Gene - PKD 2 )

ARPKD - Chromosome 6 ( Gene - PKHD 1 )

Muscle that Extend the index finger

 MCQ 43 @ MN FB page

Q. Muscle that can extend the index finger at interphalangeal joint include all except ?

a. The first dorsal inerosseous

b. The first lumberical

c. The second palmar interosseous

d. Extensor carpi radialis longus.

Wrongly answered at various places as option C.

Option C is NOT the answer here.

We had already answered this with proper explanation on our facebook notes.

On request of our readers - we are reposting the question with explanation here.

ANSWER:

Ans: D

Explanation from Gray's Anatomy -- Compiled and edited by DrShiviMudgal (Director/Admin @MedicoNotebook)

The interossei are muscles between and attached to the metacarpals.

They insert into the proximal phalanx of each digit and into the extensor hood and are divided into two groups, the dorsal interossei and the palmar interossei. All of the interossei are innervated by the deep branch of the ulnar nerve. Collectively, the interossei abduct and adduct the digits and contribute to the complex flexion and extension movements generated by the extensor hoods.

 Dorsal interossei

 Dorsal interossei are the most dorsally situated of all of the intrinsic muscles and can be palpated through the skin on the dorsal aspect of the hand (Fig. 7.99). There are four bipennate dorsal interosseous muscles between, and attached to, the shafts of adjacent metacarpal bones (Fig. 7.99). Each muscle inserts both into the base of the proximal phalanx and into the extensor hood of its related digit.

The tendons of the dorsal interossei pass dorsal to the deep transverse metacarpal ligaments:

• the first dorsal interosseous muscle is the largest and inserts into the lateral side of theindex finger;
• the second and third dorsal interossei insert into the lateral and medial sides, respectively, of the middle finger;
• the fourth dorsal interosseous muscle inserts into the medial side of the ring finger. 

Palmar interossei

The first palmar interosseous muscle originates from the medial side of the palmar surface of metacarpal I and inserts into both the base of the proximal phalanx of the thumb and into the extensor hood. A sesamoid bone often occurs in the tendon attached to the base of the phalanx.

The second palmar interosseous muscle originates from the medial surface of metacarpal II and inserts into the medial side of the dorsal expansion of the index finger.

The third and fourth palmar interossei originate from the lateral surfaces of metacarpals IV and V and insert into the lateral sides of the respective dorsal hoods.

 Like the tendons of the dorsal interossei, the tendons of the palmar interossei pass dorsal to the deep transverse metacarpal ligaments.

The palmar interossei adduct the thumb, index, ring, and little fingers with respect to a long axis through the middle finger. The movements occur at the metacarpophalangeal joints. Because the muscles insert into the dorsal hoods, they also produce complex flexion and extension movements of the digits

Extensor carpi radialis longus -- Extends and abducts the wrist

Extensor indicis -- Extends index finger

Chromosome 2 & 3

---

CHROMOSOME 2 :

• HNPCC (MSH 2)
• Cysteinuria

CHROMOSOME 3 :

• HNPCC (MLH 1) 
• VHL
• Alkaptonuria

The majority of HNPCC ( hereditary non-polyposis colorectal cancer ) is caused by mutations in one of several mismatch-repair genes:

MSH2, MSH6, and PMS1 on chromosome 2, 

MLH1 on chromosome 3, 

MSH3 on chromosome 5, and 

PMS2 on chromosome 7. 

MSH2 and MLH1 account for the majority of mutations in HNPCC families.

---

MedicoNotebook - Founder : DrShiviMudgal , Co-Founder : DrAyushGoel

Chromosome 1

---

CHROMOSOME 1 :

• Rh system 

• Neuroblastoma

• NPHS 2 (podocin)

• Primary open angle glaucoma (MYOC gene coding myocilin protein) 

Note :

NPHS 1 - Chromosome 19

NPHS 2 - Chromosome 1

---

IV Anaesthetic agents

---

---

Determining ET Tube placement

---

Verification / Confirmation of ET tube placement :

1. Auscultation : Left Base

2. Chest rise and fall

3. Xray – for PVC tube

4. End Tidal CO2 slope (Capnography) –  Best for single lumen tube

                                                                     Surest sign of intubation

5. Bronchoscopy – Best for double lumen tube.

---

ET tubes

---

ET tubes

Red Rubber	PVC
Reusable	Disposable
Expensive	Cheaper
Higher tendency to kink	Lesser tendency to kink
Low Volume High Pressure Cuff	High Volume Low Pressure Cuff
Radiolucent	Radio-opaque line (for X-ray detection).
Kept for short duration hence less sore throat	Kept for long duration hence more incidence of sore throat
Increased chance of injury
	Murphy eye + (allows ventilation in the event of obstruction of the end of the tube.)
	Transparent

In Child : Uncuffed tubes are used.

MC Size : 

• Adult Male  8 & 8.5
• Adult Female 7.5 & 8

Other Tubes :

1.      RAE Tube - for cleft lip & palate

2.      Spiral embedded tube / flexometallic tube / armored tube – 

• For head and neck surgeries
• Spine surgeries
• Surgeries in Prone position.

3.      Robert shaw and carlin's tube (double lumen) – for cardiothoracic surgeries (here only single lung ventilation.)

4.      Cole Tube – in Children 

Narrowest part of Child's airway : Subglottic.

Narrowest part of Adult's airway : Glottic Opening.

MC cause of hypoxia in single lung ventilation : Malpositioning of tube.

---

MN FB MCQs (51-60)

51. A patient with pneumonia for 5 days is admitted to the hospital. He suddenly ceases to recognize the doctor and staff. He thinks that he is in jail and complains of scorpions attacking him. He is in an altered sensorium. This condition is most likely:
A. Acute delirium
B. Acute schizophrenia
C. Acute dementia
D. Acute paranoia


52. A 32 years old male presents with abdominal pain and vomiting. He also complains of some psychiatric symptoms and visual hallucinations. Most likely diagnosis is:
A. Intermittent Porphyria
B. Hypothyroidism
C. Hyperthyroidism
D. Hysteria


53. A person missing from home, is found wandering purposefully. He is well groomed, and denies of having amnesia. Most likely diagnosis is:
A. Dissociative fugue
B. Dissociative amnesia
C. Schizophrenia
D. Dementia


54. Bilirubin is secreted by:
A. Bile salts
B. Bile pigment
C. Secretin
D. CCK


55. Most important stimulant for bile secretion is:
A. Cholecystokinin
B. Secretin
C. Bile acid
D. Bile salts


56. Gall bladder contraction is stimulated by:
A. Gastrin
B. Secretin
C. Vagus
D. Cholecystokinin


57. On CXR, all are true except. ?
a.Normally there is less than 5 mm of soft tissue lateral to anterior segment bronchus of upper lobe.
b.Anterior segment bronchus of upper lobe is seen as a ring adjacent to upper hilum.
c.Air can be identified within the proximal bronchi but normal bronchial walls are only seen end-on.
d.In 80 % of subjects the left hilum is higher than the right and in 20 % they are at same level.


58. Which headache is commonest among the following :
a. Migraine
b. Cluster
c. Idiopathic stabbing
d. Exertional


59. All of the following are features of prematurity in a neonate, except:
A. No creases on sole.
B. Abundant lanugo.
C. Thick ear cartilage.
D. Empty scrotum.


60. A normally developing 10 month old child should be able to do all of the following except :
a. Stand alone.
b. Play peek a boo.
c. Pick up a pellet with thumb and index finger.
d. Build a tower of 3-4 cubes.

ANSWERS 51-60:

51a , 52a , 53a , 54a , 55d , 56d , 57d , 58a , 59c , 60d

FB Page MCQs (41-50)

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41. Which one of the following arteries pierce the oblique popliteal ligament of the knee joint:
a. Medial superior genicular artery
b. Lateral superior genicular artery
c. Middle genicular artery
d. Posterior tibial artery.

42. The following structures are attached to the greater tuberosity of the humerus except ?
a. Supraspinatus muscle
b. The coracohumeral ligament
c. Teres minor muscle
d. Subscapularis muscle

43. Muscle that can extend the index finger at the interphalangeal joint include all except ?
a. The first dorsal inerosseous
b. The first lumberical
c. The second palmar interosseous
d. Extensor carp radialis longus

44. Ulnar nerve injury at wrist spares which muscle :
a. Opponens possicis
b. Palmar interossei
c. Dorsal interossei
d. Adductor pollicis

45. The rectus sheath contains all of the following except:
a. Pyramidalis muscle
b. Genitofemoral nerve
c. Inferior epigastric
d. Superior epigastric vessels

46. Alderman’s nerve is a branch of :
a. Superior cervical ganglion
b. Inferior cervical ganglion
c. Auricular branch of vagus nerve
d. None of these

47. Major component of Soda lime is ?
a. Calcium hydroxide
b. Sodium hydroxide
c. Potasium hydroxide
d. Barium hydroxide.

48. Metalloproteins help in jaundice by the following mechanism:
A. Increased glucoronyl transferase activity
B. Inhibit heme oxygenase
C. Decrease RBC lysis
D. Increase Y and Z receptors

49. After 5 days of fasting, a man undergoes oral GTT. True is all except:
A. Growth hormone levels are increased
B. Increased glucose tolerance
C. Decreased insulin levels
D. Glucagon levels are increased

50. Albumin contributes the maximum to oncotic pressure because it has:
A. High molecular weight, low concentration
B. Low molecular weight, low concentration
C. High molecular weight, high concentration
D. Low molecular weight, high concentration

ANSWERS 41-50 :

41c , 42d , 43d , 44d , 45b , 46c , 47a , 48b , 49b , 50d

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FB Page MCQs (31-40)

---

31. The following substances are cell inclusions except ?
(A) Melanin
(B) Glycogen
(C) Lipids
(D) Centrosome

32. Rule of nine to estimate surface area of a burnt patient was introduced by –
a) Mortiz kaposi
b) Alexander wallace
c) Joseph lister
d) Thomas Barclay

33. In 3″ degree burns, all are seen except -
a)Vesicles are absent
b)Painful
c)Leathery skin
d)Reddish due to Hb infiltration

34. All are components of black gun powder blister except:
a. Sulphur
b. Charcoal
c. Potassium nitrate
d. Lead peroxide

35. When a group of muscles of a dead body were in state of strong contratction
immediately prior to death and remain so even after death, the condition is termed as:
a. Gas stiffening
b. Rigor mortis
c. Cadveric spasm
d. Cold stiffening

36. Priapism occurs in :
a. Snake bite
b. Ratti poisoning
c. Catharide poising
d. Arsenic poisoning

37. In methyl alcohol poisoning there is CNS depression, cardiac depression and optic
nerve atrophy. These effect are produced due to :
a. Formaldehyde and formic acid
b. Aceldehyde
c. Pyridine
d. Acetic acid

38. Which of the following is a non-poisonous snake :
a. Viper
b. Krait
c. Sea snake
d. Rat snake

39. Brown–coloured urine is seen in the :
a. Nitric acid poisoning
b. Carbolic acid poisoning
c. Hydrochloric and poisoning
d. Sulphuric acid poisoning

40. A bullet fired from a gun is not released. It is ejected out with the subsequent shot. It is known as :
a. Dumbum bullet
b. Rocketing bullet
c. Richochet bullet
d. Tandam bullet

ANSWERS 31-40:

31d , 32b , 33b , 34d , 35c , 36c , 37a , 38d , 39a , 40d

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FB page MCQs (21-30)

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21. The age of a 15-year old female is best derermind by the rediograph of :
a. Lower end of Radius and Ulna
b. Upper end of humerus
c. Upper end of Radius and Ulna
d. Xiphisternum

22. Sodium fluoride is used for preservation :.
a. Urine
b. Blood
c. Alchohal
d. Carbonic acid

23. Maximum congestion is seen in :
a. Choking
b. Hanging
c. Strangulation
d. Drowning

24. In freshwater drowning the death occurs within 4-5 minutes of submersion due to
ventricular fibrillation . Which of the following reasons is responsible for this ?
a. Total asphyxia produced due to fresh water
b. Laryngospasm causing vagal inhibition
c. Haemoconcentration of blood caused by the osmotic pressure effect
d. Haemodilution, overloading of heart and haemolysis resulting in release of potassium

25. Bevelling of the skull is seen in the :
a. Brod end of the entry point in bullet injury
b. Narrow end of the entry point in bullet injury
c. Exit point of bullet
d. Depressed fracture of the skull

26. Which of the following is required forcrystallization and storage of thehormone insulin?
(A)Mn++
(B)Mg++
(C)Ca++
(D)Zn++

27. The digestive enzymes of cellularcompounds are confined to
(A)Lysosomes
(B) Ribosomes
(C)Peroxisomes
(D) Polysomes

28. Fatty acids can be transported into and out of cell membrane by
(A)Active transport
(B) Facilitated transport
(C)Diffusion
(D) Osmosis

29. Heat rupture is characterized by
a. irregular margin
b. regular margin
c. clotted blood
d. clotted blood vessel

30. Middle mediastinal nodes drain all except ?
a. Lungs
b. Bronchi
c. Right Heart
d. Visceral Pleura

ANSWERS 21-30 :

21c , 22c , 23c , 24d , 25c , 26d , 27a , 28b , 29a , 30c

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FB Page MCQs (11-20)

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11. Highest concentration of potassium is seen in:
a. Rectum
b. Pancreatic juice
c. Illeal secretions
d. Bile

12. Chest X-Ray taken in the position shown in image will be ? Click here for image
a. AP
b. PA
c. Left antero oblique (LAO)
d. Right antero oblique (RAO)

13. A positive Rumpel leede test is suggestive of
a. brucellosis
b. lyme's disease
c. rocky mountain fever
d. erysipelas

14. Which of the following is a proinflammatory mediator of shock?
A.interleukin-4
B.IL-6
C.IL-10
D.IL-13

15. A cognizable offence signifies :
a. Imprisonment upto 2 year
b. Imprisonment upto 5 year
c. Arrest without warrant
d. Fine upto Rs. 10,000

16. Which of the following section of IPC are concerned with dowry death :
a. 300`
b. 302
c. 304A
d. 304B

17. When extracellular k+ is increased from 4 meq to 10 meq what will happen?
a.RMP becomes more negative
b.increase in sodium conductance
c.increase in potassium conductance
d.Na-K ATP ase will be stopped

18. Muscle relaxant not metabolized in human body ?
a)pancuronium
b)doxacurium
c)vecuronium
d)rocuronium

19. Breur lockhart reflex is seen during ?
a)anal dilatation
b)gut resection
c)ocular muscle manipulation
d)bronchoscopy

20. MIESCHERS GRANULOMA is seen in histopathology of ?
1.erythema nodosum.
2.erythema induratum..
3.nodular vasculitis.
4.erythema marginatum

ANSWERS 11-20 :

11a , 12d , 13c , 14b , 15c , 16d , 17b , 18b , 19d , 20a

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FB page MCQs (1-10)

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1. Translocation t (2:8) (p12:q24) is associated with

A.CML
B.AML
C.T cell - ALL
D.Burkitt's Lymphoma

2. LUES MALIGNA is manifestation of
a)primary syphilis
b)secondary syphilis
c)tertiary syphilis
d)any stage

3. The finnish type of congenital nephrotic syndrome occurs due to genetic mutations affecting the following protein :-
a) podocin
b) alpha-actin
c) nephrin
d) cd2 activated protein

4. Most common cause of congenital nephrotic syndrome?
a.Denys-Drash syn
b.Finnish type of congenital NS
c.Nail patella syn
d.Frasier syn

5. 80yr asymptomatic man with total leucocyte count of 1lakh,with 80%lymphocytes, 20%PMC's. Most likely diagnosis:
1.HIV
2.CML
3.CLL
4.TB

6. Most common site of Morgagni Hernia?
A.Left anterior
B.Right posterior
C.Right anterior
D.Left posterior

7. Which anesthetic modality is to be avoided in sickle cell disease?
A. General anesthesia
B. Brachial plexus block
C. Intravenous regional anesthesia
D. Spinal anesthesia

8. The chances of having an unaffected baby, when both parents have achondroplasia, are:
A. 0%
B. 25%
C. 50%
D. 100%

9. Deoxygenated blood is not seen in
A. Pulmonary artery
B. Umbilical artery
C. Umbilical vein
D. Renal vein

10. All are seen in injury to common peroneal nerve except?
A. Loss of sensation over sole
B. Foot drop
C. Injury to neck of fibula
D. Loss of dorsiflexion of toe 

ANSWERS 1-10:

1d , 2b , 3c , 4b , 5c , 6c , 7c , 8b , 9c , 10a

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Osteotomy

Surgically cutting the bone with help of osteome.

1. Dwyer osteotomy -- CTEV
2. French osteotomy -- Supracondylar fracture of Humerus
3. Darrach osteotomy -- Made Lung deformity
4. High Tibial osteotomy -- Osteoarthritis Knee.

International Day of People with Disabilities (3 December)

International Day of People with Disability (December 3) is an international observance promoted by the United Nations since 1992.
The observance of the Day aims to promote an understanding of disability issues and mobilize support for the dignity, rights and well-being of persons with disabilities.
It also seeks to increase awareness of gains to be derived from the integration of persons with disabilities in every aspect of political, social, economic and cultural life.


2012 Theme : Removing barriers to create an inclusive and accessible society for all.

Gustilo and Anderson open fracture Classification

Open fractures +

I -- Wound < 1 cm with no extensive damage / contamination.

II -- Wound >1cm but <10cm with no extensive damage / contamination.

III -- Open fracture with extensive soft-tissue laceration, damage, or loss or an open segmental fracture.

      3 a. Soft tissue contamination but periosteum spared/intact
      3 b. Periosteum broken and bone is bare.
      3 c. associated with NeuroVascular damage.


All open fractures are Surgical emergencies.

T/t -- Damage control orthopedics

1. Thorough debridement
2. Fracture stabilization by external fixation
3. Delayed closure of wound.

World AIDS Day

1st  December 

In 2012, World AIDS Day is the 25th time that the day is being observed. The awareness day was first established by the World Health Organization, in 1988.

The Red Ribbon:

30 years after the first cases of HIV – the red ribbon is the universal symbol of awareness and support for those living with HIV. The red ribbon was the first ever ribbon symbol, inspiring later versions such as the pink ribbon for breast cancer awareness.

Laryngoscopes

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Laryngoscopes

Curved blade -- MacIntosh
Straight blade -- Miller's

Position -- Extension at Atlanto-Occipital joint.
                 Flexion at neck.
Barking dog / Sniffing the morning air position.

MC damage -- Upper Incisors


Complications:

Adults -- Hypertension , Tachycardia , Arrhythmias

Child -- Bradycardia (MCQ)

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Laryngeal mask airway (LMA)

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Laryngeal mask airway (LMA)

Advantages : 

1. No laryngoscopy or muscle relaxation required
2. Easy to insert

BUT
Does not prevent aspiration of gastric contents.


FAST TRAC / Intubating LMA -- for difficult intubation.

Pro-Seal LMA -- provides Controlled Ventilation. ( Therefore used in elective ventilation. )

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Sodalime

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Q. Major component of Sodalime is ?

a. Calcium hydroxide

b. Sodium hydroxide

c. Potasium hydroxide

d. Barium hydroxide.

ANSWER:

Ans: A (Calcium hydroxide)
Composition of Sodalime
94% Ca(OH)2
5% NaOH
1% KOH

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MedicoNotebook - Founder : DrShiviMudgal , Co-Founder : DrAyushGoel

Mapleson systems

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In 1954 Mapleson described and analyzed five different semiclosed anesthetic systems, and they are classically referred to as Mapleson systems

Type A - Magill's circuit
Best for Spontaneous Ventilation
Modified A - Lack's circuit

Mnemonic : SMAL

Type B & C - Obsolete

Type D - Bain's Circuit
Best for Controlled Ventilation
Modified D - Fenlon

Mnemonic : BCDF

Type E - k/a Ayre's T piece
Used in neonates

Type F - Jackson-Rees' modification of the Ayre's T-piece
Used in child < 6 year or < 20 Kg

E & F are Valveless

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Zeolite - Oxygen Concentrator

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Zeolites are microporous, aluminosilicate minerals commonly used as commercial adsorbents.

Ambient air is compressed, then passed through zeolite,

1. Aluminium hydroxide lattice -- adsorbs nitrogen, leaving a 95% oxygen mixture at the outlet.
2. Silica used to absorb Water Vapour.

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