Most Typical presentation of the Oral Lesions of Tuberculosis

What is the most typical presentation of the oral lesions of tuberculosis?

a. Mucosal lesions with a cobblestone appearance 
b. Nonhealing ulcer
c. Mucositis 
d. Erythematous bullseye

The correct answer is B: The oral lesions of tuberculosis are thought to result from the presence of organisms brought into contact with the oral mucosa by sputum. A nonhealing ulcer, which is impossible to differentiate clinically from carcinoma, is the most common presentation in the mouth. Ulcers are most consistently present on the lateral borders of the tongue and may have a purulent center. Lymphadenopathy also may be present. Diagnosis is made by histologic examination and demonstration of organisms in the tissue.

Laparoscopic sterilization tubal occlusion

Which one of the following places will you select to hold laparoscopic sterilization tubal occlusion. camp? 

A. Village Community Centre 
B. School building of the locality 
C. Primary Health Centre 
D. Patients’ residences

Ans. C. Primary Health Centre

When fully staffed by 3 medical officers including one lady doctor and supporting personnel.  the PHC is expected to provide fairly comprehensive ‘essential heath care’ including family planning care. The medical officers are usually trained to provide MTP and sterilization services. The programme of insertion of copper T IUCD has been intensified. Laparoscopic services will be made more widely available at the PHC.

Each subcentre staffed by one male and one female health worker, provides the main thrust of the family planning programme. They are responsible for providing rudimentary health and MCH care; family planning motivation, supplies and services in spacing methods.

At village level, village health guides and trained dais are the Iyichpins of the family planning delivery system in India. Trained dais besides conducting safe deliveries in rural areas, also act as family planning counsellors and motivator’s, supplementing the delivery system. Village health guides also spread knowledge and information to the eligible couples and provide them with supplies of Nirodh and oral pills. 

Tuberculosis in HIV positive individual | MDS Preparations

Which statement is false regarding Tuberculosis in HIV positive individual

A. Frequent negative sputum smear. 
B. False negative tuberculin test result
C. Extra pulmonary tuberculosis more common. 
D. Cavitating lesions in lungs as shown by chest X-ray.

Ans. D.  Cavitating lesions in lungs as shown by chest X-ray.

In early part of HIV infection with high CD4 count, the clinical manifestations are more similar to non HIV TB patient. But in latter part of HIV infection when CD4 count is low, TB patient more commonly present with atypical features of pulmonary TB and also features of extra pulmonary TB. In X-ray chest- lower zone infiltration, bilateral interstitial infiltrate, mediastinal hilar lymph gland enlargement and nodular lesions are commonly seen. Cavitary lesion and upper zone infiltration are less common. Extra pulmonary TB are more common in HIV - TB Co infected patient. Sputum smear examination show negative for AFB because of less cavitation in HIV —TB co infected patients. False negative Tuberculin test result is due to decreased immune response in advance I-BY infection

‘Tracking’ of blood pressure | MDS Preparations 09818001730

The term ‘Tracking’ of blood pressure refers to- 

A. Pictoral representation of BP 
B. BP control with nifedipine
C. 24 hrs. BP monitoring 
D. Identifying children at risk of developing hypertension of future date.

Ans. D. Identifying children at risk of developing hypertension of future date.

Sol. ‘Tracking’ of blood pressure -If blood pressure levels of individuals were followed up over a period of years from early childhood to adult life, then those individuals whose pressure were initially high in the distribution, would probably continue in same ‘track’ as adult. This phenomenon called ‘tracking’. It is useful in identifying children and adolescent ‘at risk’ of developing hypertension at a future date. 

Socratic method of communication | MDS Preparations 9818001730

Which of the following is the Socratic method of communication

A. One way communication 
B. Two way communication 
C. Visual communication 
D. Non-verbal communication

Ans. B. Two way communication

Socratic Method is a two-way communication in which both the communicator and audience take part.

Didactic Method is a one-way communication which is flow of information from communicator to audience, without the active participation of the later.

Types of communications

One-way communication; Two-way communication; Verbal communication 

Heinz bodies | MDS Preparations 09818001730

Heinz bodies are found in all conditions except: 

A. α-thalassemia 
B. G6PD deficiency
C. Unstable hemoglobinopathy 
D. Lead poisoning

Ans: D. . Lead poisoning

•Denatured Hb is precipitated with RBCs in the form of inclusions known as Heinz bodies.

•Condition m which Heinz bodies found are:

1.Glucose-6-phosphate dehydrogenase deficiency this disorder produce no symptom unless the RBC subjected to oxidant injury e.g. primaquine and sulfonamide.

2. α-thalassemia.    

3. HbH disease A variant of a-thalassemia.

4. Unstable-Hb hemoglobinopathy.

•Congenital non-spherocytic haemolytic anaemia results because of unstable hemoglobinopathy.

• Lead poisoning: 90% of absorbed lead accumulate in metaphysis of bone and 10% accumulate in brain, liver, kidney and bone marrow.

- Effect of lead poisoning on haemopoietic system:-

•Microcytic hypochromic anaemia.

•Prominent basophilic stippling of erythrocytes.

Other condition in which basophilic stippling is seen are following:

- Aplastic anaemia

- Thalassemia

- Myelodysplasia

- Infection.

The causes of pulmonary edema

The causes of pulmonary edema include all except 

A. Increased negative pressure
B. Increased pulmonary arteriolar pressure
C. Increased pulmonary capillary permeability
D. Increased plasma colloid pressure

Ans. D) 

        Increased plasma colloid pressure: Causes of Increased interstitial fluid volume and edema

Increased filtration pressure:-

·         Arterial dilatation

·         Venular constriction

·         Increased venous pressure (heart failure, incompetent valves, venous obstruction, increased total ECF volume, effect of gravity, etc.)

·         Decreased osmotic pressure gradient across capillary

Limitation of inspiration by vagal lung inflation

Limitation of inspiration by vagal lung inflation signals is called the

A. Autonomic reflex 

B. Bainbridge reflex
C. Hering - Breur reflex 
D. Dynamic stretch reflex

Ans.  (c) Hering - Breur reflex

·         The shortening of inspiration produced by vagal afferent activity is mediated by slowly adapting receptors

·         So are the Hering - Breur reflexes

·         The Hering - Breur inflation reflex is an increase in the duration of expiration produced steady lung inflation, and the Hering – Breur deflation reflex is a decrease in the duration of expiration produced by marked deflation of the lung

·         Because the rapidly adapting receptors are stimulated by chemicals such as histamine, they have been called irritant receptors

None occurance as the blood passes through systemic capillaries

Which of the following does not occur as the blood passes through systemic capillaries?

A. Increased protein content 
B. Shift of Hemoglobin dissociation curve to left
C. Increased hematocrit 
D. Decreased pH

Ans. B

    In systemic capillaries, O2 is released (i.e., O2 dissociation curve shifted to right) and CO2 is acquired (CO2 dissociation curve shifted to left). In systemic capillaries, there is decrease in Ph and increase in hematocrit, protein content, H+, Cl- & HCO3- ion concentration.

Pom’s sign

Pom’s sign is seen in infection with? 

A. Brucella
B. Tuberculosis
C. Pseudomonas
D. Coxiella

Ans. A.

Brucellosis is a bacterial zoonosis transmitted directly or indirectly to humans from infected animals, predominantly domesticated ruminants and swine. The disease is known colloquially as undulant fever because of its remittent character. Brucellosis almost invariably causes fever, which may be associated with profuse sweats, especially at night. In endemic areas, brucellosis may be difficult to distinguish from the many other causes of fever.

Radiology of the Spine: Differentiation of Brucellosis from Tuberculosis

	Brucellosis	Tuberculosis
Site	Lumbar and others	Dorsolumbar
Vertebrae	Multiple or contiguous	Contiguous
Diskitis	Late	Early
Body	Intact until late	Morphology lost early
Canal compression	Rare	Common
Epiphysitis	Anterosuperior Pom's sign.	General: upper and lower disk regions, central, subperiosteal
Osteophyte	Anterolateral parrot beak.	Unusual
Deformity	Wedging uncommon	Anterior wedge, gibbus
Recovery	Sclerosis, whole body	Variable
Paravertebral abscess	Small, well-localized	Common and discrete loss, transverse process
Psoas abscess	Rare	More likely

Primary molar filled with a temporary restoration classification

According to WHO 1997 classification, a primary molar filled with a temporary restoration is classified as:

A. Sound tooth 
B. Filled but Decayed
C. Filled but non-decayed 
D. Decayed tooth.

Answer. (D) Decayed tooth.

• Page 190 of the text mentions that the def index, described by A.O.Gruebbell in 1944, as an equivalent index to DMF index for measuring the dental caries in primary dentition.

• The caries indices used in primary dentition are deft and defs index equivalent to DMFT & DMFS indices used in permanent dentition.

• The basic principles and rules for def index are same as that for DMF index.

Infant mortality rate

The ratio of number of deaths under one year of age to the total live births per 1000 live births per year is termed as:

A. Infant mortality rate. 
B. Child mortality rate.
C. Child morbidity rate. 
D. Life expectancy rate

Answer. A. Infant mortality rate

• Infant mortality rate is defined as the ratio of infant deaths registered in a given year to the total number of live births registered in the same year, usually expressed as a rate per 1000 live births.

• It is given by the formula-

Number of deaths of children less than 1 year of age in a year

IMR = ————————————————————————————— X l000

Number of births in the same year

Presence of maximum amount of fluoride

The maximum amount of fluoride is present in:

A. Tea 
B. Sea fish 
C. Pineapple 
D. Olive oil

Answer. A. Tea.

• Tea as the richest source of Fluoride, read the following discussion to draw your inference-

• Fluoride is rapidly released into Tea infusions, most of it within 5 to 10 minutes.

• The dried tea leaves contain 100 to 400 ppm fluoride depending on the brand.

• On an average, tea leaves contain about 98 ppm fluoride.

• The ingestion of fluoride by tea drinkers is in range from 0.04 to 2.7 mg/ day.

• Tea made from instant tea powder results in twice as much fluoride in the extract as in regular brewed tea

β-Oxidation of odd- chain fatty acids

β-Oxidation of odd- chain fatty acids produces:

A. Succinyl CoA 
B. Propionyl CoA
C. Acetyl CoA 
D. Malonyl CoA

Answer. B. Propionyl CoA .

In β-oxidation, “2” carbon atoms at a time are cleared from Acetyl-CoA molecules, starting at carboxyl end. The chain is broken between the β -2 and β -3 carbon atoms.

Hence the name β-oxidation.

Fatty acid with an odd no. of carbon atoms are oxidized by the pathway of β- Oxidation producing Acetyl CoA, until a three carbon atom molecule propionyl CoA molecule remains.

Post-Transcriptional modification of RNA

Which of the following is not a post-transcriptional modification of RNA?

A. Splicing 
B. 5- capping
C. 3'-poly adenylation 
D. Glycosylation

Answer. D. Glycosylation

Glycosylation has not been mentioned as a post-transitional modification of RNA.

5' - capping: Is required both for efficient translation initiation and protection of 5' - end of MRNA from attack by 5'-3' exonucleases.

3' - poly adenylatlon: Added to 3'-end of mRNA molecules in a post transcriptional processing step. This appears to protect the 3'-end of mRNA from 3' - 5' exo-nuclease attack.

Musicians nerve

Musicians nerve is

A. Radial 
B. Ulnar 
C. Median 
D. Musculoskeletal

Answer. B. Ulnar

- Cubital tumnel syndrome is seen in guitarists.

- A common problem among acoustic and electric guitar palyers, as well as other stringed instrument player, is the development of forearm pain, tingling and numbness, typically on the same side you fret the instrument. This type of repetitive injury is called cubital tunnel syndrome.

- Cubital tunnel syndrome typically involves pain and or abnormal sensations in the elbow area, along the inner side of the forearm.

- This syndrome usually only involves the ring and pinky fingers, since these fingers receive their nerve supply from the ulnar nerve.

”GoId standard” investigation for Acoustic Neuroma

”GoId standard” investigation for Acoustic Neuroma is? 

A. Contrast enhanced CT 
B. Contrast enhanced MRI
C. Evoked potential 
D. PET scan

Ans. B. Contrast enhanced MRI 

VESTIBULAR SCHWANNOMA

Tumors origination from cranial nerves account for 6-8 % of primary intracranial tumors and most are benign neoplasms arising from Schwan cell schwannomas; of the nerve sheaths; 

• Vestibular Schwannoma arises eccentrically from the sheath and compress the parent nerve rather than invading it; 

• It is the most common CP angle tumor, followed by meningioma and epidermoid cyst 

All cranial nerves except I and II, which are in fact white matter tracts of the cerebrum, have nerve sheaths, but schwannomas usually grow on the sensory nerves, most frequently from the superior vestibular division of vestibulocochlear nerve acoustic neuroma; and with decreasing frequency, from trigeminal, glossopharyngeal and lower cranial nerves; Pure motor cranial nerves rarely form schwannomas;

- Multiple cranial nerve schwannomas are found in neurofibromatosis type 2 and bilateral vestibular Schwannomas are pathognomonic sine qua non; of NF-2; Recently, NF-2 is called as MISME complex multiple inherited Schwannomas, Meningiomas and ependymomas;; Cranial nerve tumors almost invariably show marked contrast enhancement; 

-Acoustic vestibular; schwannomas .  neuromas; account for 80% of cerebellopontine lesions 

- Plain skull radiograph or conventional tomography shows widened internal auditory meatus IAM. ; 

- CECT shows enhancing mass in posterior fossa with widening of IAM; Although medium sized and large vestibular schwannomas may easily be detected by CECT, MRI is much more sensitive than CT in detection of small lesions;

- MRI is now the method of choice for the investigation of suspected vestibular schwannomas than can be diagnosed or excluded on high-resolution, thin section, T2 weighted fast spin-echo images of CP angles, capable of resolving the 7th and 8th nerves in detail; If the findings are equivocal, gadolinium-enhanced images can refuse or confirm the suspicion of a tumor, since it almost always shows marked enhancement; 

- Audiometry is often the initial diagnostic test; Unilateral pure-tone sensorineural hearing loss with disproportionate loss of speech is suggestive of a retrocochlear lesion; Auditory brain stem response detects 95% of tumors- a delay in the latency of the V wave of 0.2 msec or greater is considered abnormal;

-  MAGNETIC RESONANCE IMAGING WITH GADOLINIUM ENHANCEMENT is the GOLD STANDARD for diagnosing Acoustic neuromas.

Agatston’s score is used for ?

Agatston’s score is used in? 

A. Calcified lesion in CAD
B. Coma
C. Endocarditis
D. None of the above

Ans. A. Calcified lesion in CAD

Atherosclerotic plaques become progressively calcified over time, and coronary calcification in general increases with age. For this reason, methods for detecting coronary calcium have been developed as a measure of the presence of coronary atherosclerosis. These methods involve computed tomography CT.  applications that achieve rapid acquisition of images [ultrafast or electron beam EBCT.  and multidetector MDCT. ]. Coronary calcium detected by these imaging techniques is quantified using the Agatston score most commonly, which is based on the area and density of calcification. Although the diagnostic accuracy of this imaging method is high sensitivity, 90—94%; specificity, 95—97%; negative predictive value, 93—99%. , its prognostic utility and its role in the evaluative algorithm of patients with stable angina pectoris have not yet been defined. 

Investigation for detection of suspected pancreaticobiliary worms

Most worthwhile investigation for detection of suspected pancreaticobiliary worms is? 

A. Ultrasound 
B. CT
C. MRCP 
D. ERCP

Ans. D.
Most cases of ascariasis can be diagnosed by the microscopic detection of characteristic mamillated ascaris eggs 65 by 45 mm.  in fecal samples; Occasionally, patients present after passing an adult worm — identifiable by its large size and smooth cream-colored surface — in the stool or through the Mouth or nose; During the early transpulmonary migratory phase, when eosinophilic pneumonitis occurs, larvae can be found in sputum or gastric aspirates before
diagnostic eggs appear in the stool. The eosinophilia that is prominent during this early stage usually decreases to minimal levels in established infection. The large adult worms may be visualized, occasionally serendipitously, on contrast studies of the gastrointestinal tract. A plain abdominal film may reveal masses of worms in Gas-filled loops of bowel in patients with intestinal obstruction. Pancreaticobiliary worms can be detected by ultrasound and endoscopic retrograde Cholangio-pancreatography; the latter method also has been used to extract biliary ascaris worms.