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Jefferson fracture (MCQ)


MCQ 133

Q. Jefferson fracture is best viewed by ?

A. Swimmer's view
B. AP cervical spine view
C. Open mouth view
D. Lateral cervical spine view


ANSWER:
Answer : C , Open mouth odontoid view.
Jefferson fracture is burst fracture of atlas (C1) vertebra.

Swimmer's view is used to visualize C7/T1



For image - Click here

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Jefferson fracture



Jefferson fracture : Burst fracture of atlas (C1) vertebra.







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World No Tobacco Day


World No Tobacco Day (WNTD) is observed around the world every year on May 31. It is meant to encourage a 24-hour period of abstinence from all forms of tobacco consumption across the globe.

An ashtray with a rose, Logo of the World No Tobacco Day of the WHO



Image src: http://en.wikipedia.org/wiki/File:Bluete_in_Aschenbecher.jpg
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Weber fracture classification


MCQ 132

Q. Weber fracture classification is used for fracture involving :

a. Lateral malleolus

b. Medial malleolus

c. Tallus

d. Calcaneus


ANSWER:
Answer : A - Lateral malleolus

Weber A is distal to the level of ankle joint
Weber B means at the level of ankle joint
Weber C means proximal to the level of ankle joint.






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Centered Chest Xray film


MCQ 131

Q. In a well centered Chest Xray film , the clavicles are equidistant from vertebral spinous process at the level of ?

a. T1/2

b. T2/3

c. T3/4

d. T4/5


ANSWER:
Answer : D




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Confidence level


MCQ 129

Q1. When the confidence level of a test is increased which of the following will happen

a) No effect on significance

b) Previously insignificant value becomes significant

c) Previously significant value becomes insignificant

d) No change in hypothesis



ANSWER:
Ans : C
If we increase the CI limit , the level of significance i.e. LOS=100-CI will be less. In other words by increasing the CI we decrease the probability of rejecting null hypothesis by chance. So, if at 95% CI, the LOS was 5% or 0.05, so value of 0.04 will be significant but if we say at 99% CI, the LOS will be 1% or 0.01 so p value less than 0.01 will be significant only. So we can say that by increasing the CI, previously significant difference will become non significant.


MCQ 130

 Q2. When the confidence limit of a test is decreased which of the following will happen 

a) No effect on significance

b) Type I error will occur

c) Previously significant value becomes insignificant

d) No change in hypothesis


ANSWER:
Answere here is : B - Type I error will occur.
The area between two CI limit is Zone of acceptance of Null hypothesis ( Not significant result), and outside this limit is zone of rejection of null hypothesis ( Significant result). So, if we decrease the CI, the observation which was plotted in Zone of acceptance gets shifted to zone of rejection i.e. not significant results become significant.

Thus Option C is correct when the confidence limit is Increased.

Type I error is Rejection of Null hypothesis despite of it being true. It’s a very dangerous error and occurs if we decrease the CI limit.




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Golden pneumonia


MCQ 128

Q. Golden pneumonia is other name for ?

a. Klebsiella pneumonia

b. Staphylococcal pneumonia

c. Pneumococcal pneumonia

d. Lipoid pneumonia


ANSWER:
Answer : D - Lipoid pneumonia
It is caused due to aspiration of mineral oil which is used usually for chronic constipation.




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Mendelson's Syndrome


MCQ 127

Q. Mendelson's Syndrome was 1st described for ?

a. aspiration of gastric contents in women during parturition

b. aspiration of gastric contents in men during heavy weight lifting

c. aspiration of meconium in term baby

d. aspiration of meconium in preterm baby


ANSWER:
Answer : A , aspiration of gastric contents in women during parturition.
Though it is often used to include any cause of gastric content aspiration



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ESRD


MCQ 126

Q. End stage renal disease (ESRD) is considered at GFR value of ?

a. < 5 mL/min/1.73 m2.
b. < 15 mL/min/1.73 m2
c. < 30 mL/min/1.73 m2
d. < 60 mL/min/1.73 m2


ANSWER:
Answer : B , GFR  < 15 mL/min/1.73 m2
Also remember
According to the US National Kidney Foundation, chronic kidney disease (CKD) can be defined as a GFR < 60 mL/min/1.73 m2.




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Medical One Liners 181 - 190


181. Odor of urine for hypermethioninemia - boiled cabbage.
Also Cabbage odor - in Tyrosinaemia

182. Lead toxicity - Purely motor neuropathy.

183. Malnourished child is Sodium overloaded and Potassium depleted - hence use ReSoMal (Rehydration solution for malnourished)

 184. GFR of a newborn is 15 - 20ml/min/1.73m2
        At 3 months - it is 2/3 rd of Adult
        Adult Values at 2years age.

185. Newborn's renal tubular concentration capacity reaches adult value at 1year of age.

186. Best method of estimating creatinine is Enzyme assay.

187. Oliguria is important sign of Renal failure.
Causes of Non-Oliguric Renal failure - 
  1. In Newborns , 
  2. Aminoglycoside nephrotoxicity.

188. Total number of nephrons reaches adult value at 36 wks Intrauterine gestation. Thus after birth , there is only functional maturity.

189. In a child with CRF , if Acidosis and hyperphosphatemia is present , then these must be corrected first before introducing Growth hormone. (GH does not act if acidosis and increased Po4 are present)

190. Membranous glomerulonephritis has been associated with Renal vein thrombosis.

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Acute Renal Failure


Acute renal failure ( better termed as Acute kidney injury )

Markers :

  1. NGAL ( Neutrophil gelatinase associated lipocalin )
  2. IL-18
  3. KIM-1 ( Kidney injury molecule - 1 )
Can be :


  • Pre-Renal
  • Renal
  • Post-Renal

 Pre-Renal
(can have hyaline cast)

Renal
(granular cast)

Urine Na

<20 meq/l (or < 10 mmol/l)

 >40 meq/l (or > 20 mmol/l)

 Urine Osmol. 

 >500

 <300

 Blood urea / creatinine


 >20:1

 < 20 : 1

 Fractional excretion of Na %

 <1

 >1


MC cause of ARF in 

  • Newborn : Birth Asphyxia
  • Children ( 1 - 3yr ) : 1. HUS ; 2. ATN


MC Complications ( and their management ) :

  1. Fluid overload ( so restric fluids to 400ml/m2 - dextrose)
  2. Hyperkalemia ( so - Nebulize beta 2 agonist , IV -Na Bicarb , IV Insulin with dextrose , Resins , Haemodylasis , Ca Gluconate for cardiac stabilization )
  3. Hyponatremia -dilutional ( manage same as 1 )
  4. Dilutional anaemia ( so transfuse RBC )
  5. Increase phosphate , decrease calcium ( so Restrict phosphate, use phosphate binders )
  6. Metabolic acidosis ( so use Na Bicarb )



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CXR - Opacities denser than calcium


MCQ 125

Q. Discrete opacities denser than calcium are seen on Chest X-Ray and CT scan in ?

a. Silicosis
b. Sarcoidosis
c. Berylliosis
d. Stannosis


ANSWER:
Answer : D - Stannosis. It is caused by inhalation of tin oxide. Tin has a higher atomic number and hence results in denser opacities as compared to calcium.



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Alport Syndrome


Alport Syndrome

Mutation involving Alpha 5 domain of type 4 Collagen.
( Confuser : Alpha 3 domain of type 4 collagen is the antigen involved in Good pasture syndrome )

 Most commonly - X-Linked dominant

Triad :
  1. Sensorineural deafness
  2. Anterior Lenticonus (pathognomonic)
  3. Haemorrhagic nephritis

Electron microscopy is must for diagnosis.

GBM changes -  Striations / irregularities , splitting of lamina densa giving Basket weave appearance.


Treatment : Symptomatic

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Hematuria


Hematuria

Glomerular : 

  1. Acute glomerulonephritis
  2. Hypercalciuria
  3. MPGN
Points to remember - Dysmorphic RBC , Cola coloured urine , Painless , Proteinuria


Extra-Glomerular
  1. Stones
  2. Tumor
  3. Cystitis



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Schwartz method / equation for estimating GFR in children


Schwartz equation :

 GFR (mL/min/1.73 m2) = ( k × Height in cm) / Creatinine in mg/dL
Creatinine value depends on

  1. Method of calculation : Jaffe's reaction ; Enzyme assay (best) 
  2. Muscle mass
k is a constant that depends on age.



Thus GFR will depend on :

  1. Age
  2. Height
  3. Muscle mass
  4. Method of calculating creatinine.


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Cofactors - Coenzymes and Ions



Cofactors
  • Can be Ions or Coenzymes

They are required as / to increase catalysis.


Ions as well as coenzymes can be loosely or tightly bound.
  • Coenzymes bound loosely = Cosubstrate
  • Coenzyme bound tightly = Prosthetic group






Cofactor
Enzyme

PLP (from Vit B6 – Pyridoxine )

  1. Transaminase
  2. Cystathione Beta synthase (deficient in HCU 1)
  3. Kinurinase

THB 




Confuser :
Most people confuse Melatonin and Melanin here.
Remember THB is required for melaTonin.
3 Hydroxylases
1. Tyrosine H – produces DOPA
2. Tryptophan H – helps in production of Serotonin which later forms  Melatonin
3.Phenylalanine H – produces Tyrosine

Thus THB is required for synthesis of :
  • Catecholamines
  • Melatonine
  • Serotonin

Note :
 
Tyrosine  produces -
  1. Catecholamines (uses THB in 1st step for this)
  2. Thyroid hormones
  3. Melanin ( here Tyrosinase enzyme is used which requires Cu++ as cofactor)

Vit B12

Homocystein Methyl transferase = Methionine Synthetase ( deficient in HCU 2 )

Selenium (Se)

Glutathione peroxidase

Iron (Fe)

Cytochrome oxidase  , Peroxidase , catalase

Manganese (Mn)

Superoxide Dismutase
Arginase

Molybdenum (Mo)

Off topic MCQ point :
Most X-ray tubes use tungsten anode
But Mammography  uses molybdenum anodes. 

Xanthine Oxidase
Sulphide Oxidase
Dinitrogenase

Magnesium (Mg)

Kinases (Hexokinase , Pyruvate kinase)
Glucose 6 phosphatase

Copper (Cu)

Tyrosinase
Cytochrome Oxidase

TPP (from Vit B1)

Alpha ketoglutarate dehydrogenase

Zinc (Zn)

Alcohol dehydrogenase
Carbonic anhydrase


Another frequent MCQ - Biotin is used in Carboxylation reactions.

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Celiac disease


Celiac disease ( Coeliac disease )
  • Gluten sensitivity 
    Thus if wheat is introduced in diet , there can be -
    1. Chronic Diarrhoea
    2. Recurrent diarrhoea
    3. Abdominal distention
    4. Vomiting
    5. Anorexia
    6. Failure to thrive
  • Can be asymptomatic
  • Age group : 6 months - 24 months


MCQ point - HLA DQ2 , DQ8

MARSH Criteria 
  1. Disease of small intestine in which
    - Villous atrophy
    - Crypt hyperplasia
    - Transmural inflammation
  2. If restrict gluten - mucosa returns to normal
  3. If gluten challenge - mucosa goes back to original state

 Best Test :
  1. Anti Endomysial Antibody (Specificity 97 - 100%)
  2. Anti TTG (Tissue transglutaminase antibody )
Serum IgA levels are low

Treatment : Life long gluten restriction
i.e NO TO - Wheat , Barley and Rye.



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A Vision and A Solution - Can we devote 10 mins to solve the mystery ?


 INDIA 


Isnt it seen every year that medical students are confused which college/hospital to join ? Be it  DNB or MD/MS or Diploma ??

Just a simple solution. We all get some time to chat and use social networking platform for various purposes.

If everyone taking a seat , just pens down about the in and out of their respective college/instt/hosp. , then in ONE day a great deal of information can come out.

This vision just calls for 10 mins time of the person doing their respective course.

If anyone reading this feels that why should we bother , then please try to remember the time when you needed the same information. Your 10 mins can solve the problem of approx. 90,000 medical students in India every year.



This thought struck my mind as I got up at 3:15 AM because of a facebook message notification  on my mobile where a student asked " Sir , Is _______ hospital good "
Please comment if you feel you can/should help.


Author - DrAyushGoel
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Ligament of humphrey


MCQ 124

Q. Ligament of humphrey is also known as :

a. Anterior Cruciate Ligament

b. Anterior meniscofemoral ligament

c. Posterior Cruciate Ligament

d. Posterior meniscofemoral ligament

ANSWER:
Answer : B

Anterior meniscofemoral ligament = Ligament of humphrey

Posterior meniscofemoral ligament = Ligament of Wrisberg




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ORS - oral rehydration salts solution


 mmol/L of
 WHO ORS
 ReSoMal
 Low Osmolar ORS

Na

 90 

 45

75

K

 20

40 

20 

 Glucose

111 

125 

75 

 Cl-

 80

70 

65 

 Citrate
(increases shelf life)

10 

7 + Mg , Zn , Cu

10 


  • WHO ORS was based on cholera stools.
  • In Rotavirus - Na loss is 50 - 70 mmol/L
  • Malnourished children are Na overloaded and K depleted - hence ReSoMal is used.


Management of diarrhoea in child (along with ORS) - 

1. Probiotics are used in rotavirus infections :
  • give Saccharomyces boulardii and Lactobacillus rhamnosus
2. Zinc : 2 RDA (i.e 2 x 10 mg/day) during diarrhoea + 2 wks after diarrhoea subsides

3. Anti Secretory : Racecadotril- enkephalinase inhibitor


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Acute flaccid paralysis


Acute flaccid paralysis (AFP)

Age group : 0 - < 15 years

Provided pseudoparalysis is ruled out :
  1. Scurvy
  2. Osteomyelitis
  3. Syphilis
  4. Hypokalemia

Causes of AFP :

1. Paralytic poliomyelitis
  • Asymmetrical 
  • at onset of paralysis - high grade fever

2. Traumatic neuritis  : History of IM gluteal

3. Transverse myelitis : (Usually viral) Varicella

4. Guillain-Barré Syndrome - GBS (AIDP) 
  • follows C.Jejuni diarrhoea - 10 days later - GBS
    other - Mycoplasma
  • Ascending , Areflexic , Symmetrical paralysis
  • Proximal muscles affected 1st
  • CSF : Albumino-cytological dissociation (at the end of 2nd week) - MCQ
  • NCV : decreased , symmetrical demyelinating neuropathy
  • Treatment : Iv-Ig , Plasmapheresis


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Medical one liners 171 - 180


171. Coast of california sign is seen in neurofibromatosis.

172. Hyppocampus and amygdala are very sensitive to hypoxia. Therefore if exposed to hypoxia, they die after 30 mins.

173. Among causes of neonatal seizures, Late onset hypocalcemia has best prognosis.

174. Sweaty feet odor : Glutaric acidemia type II , Isovaleric acidemia.
(Isovaleric acidemia also Cheesy odor)

175. MC cause of pancreatic calcifications - Chronic alcoholic pancreatitis.

176. MC complication after lens extraction in PHPV is vitreous hemorrhage.

177. Adenocarcinomas do not calcify.

178. Forgotten muscle of rotator cuff - Subscapularis.

 179. Rett syndrome is characterized by Microcephaly.

180. Inferior border of orbit is formed by contribution from maxilla , palatine and zygomatic bones.


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Encephalitis (Most common causes and salient points)


Most common causes :

  • Sporadic encephalitis - Herpes 
  • Epidemic encephalitis - Arbovirus
  • Viral encephalitis - Enterovirus (also MC meningoencephalitis)
  • Brainstem encephalitis - Rabies 


Viral encephalitis : causes

  1. Enterovirus (80%)
  2. Arbovirus
  3. Herpes
  4. Mumps

HSV encephalitis :
  • MRI - Temporal lobe hyperintensities on T2 and Flair
  • CSF : haemorrhagic ; PCR for HSV
  • Treatment - Acyclovir


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Meningitis in child


Meningitis


  • 1st 2 months - E.Coli (MC)
  • 2months - 12 years - Pneumococcal and Neisseria.


95% Meningitis in child - affects 1month - 5years age group.



Condition
Organism

Defect of complement system C5-8 and properdin system

Meningococcus

Congenital / acquired defect across mucocutaneous barrier

Pneuococcal

T.Lymphocte defect

Listeria

Lumbosacral Myelomeningocele and Dermal sinus

Staphylococcus ; Enteric bacteria

Penetrating CNS trauma ; CSF shunt infection

Coagulase –ve Staph.

Recurrent meningitis in CSF leak patients

Pneumococcal



Investigation : 
85% cases have bacteremia
therefore -
1. Blood culture
2. CxR
3. Lumbar puncture - Increased ICT is absolute contraindication

  • Turbid grossly
  • Neutrophil leucocytosis
  • Protein (normal 50mg%) - raised
  • Sugar (normal 2/3 blood sugar) - decreased (permeability to glucose in meninges decreased ; increased anaerobic glycolysis in adjoining brain tissue)

Treatment : 
  • 3rd generation cephalosporins - ceftriaxone.
  • Pneumococci resistant to cephalosporins - Vancomycin


Complications :

  1. SIADH
  2. Sub-dural effusions
  3. Seizures
  4. Increased ICT
  5. Cerebral edema

MC Neurological sequelae : Deafness (Sensorineural) , because of labrynthitis.


  • Prevented by Dexamethasone (0.15mg/kg) 15-30 mins before antibiotics.



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