Go Abdul Wahab & 100cm of ileal resection done.What will happen? A Decreased amount of bile salt absorption VV VW B Decrease fat absorption C Dec Vit B 12 absorption A>B>C #Brsphysio #SiyapaaAbdul Wahab most potent anabolic hormone a. testosterone VV VW b. dihydrotestosterone When asked only potent than B>A But when asked about anabolic potent That is A #Guyton #Siyapaa n fact, even a male who participates in very little sports activity but who nevertheless has a normal level of testosterone will have muscles that grow about 40 percent larger than those of a comparable female without the testosterone.Abdul Wahab & In 10 years old boy Thymus. A. Remains as Single Lobe B. Extends from inferior border of thyroid to 4thCervial.. vw Vv Ww C. Supplied by superior thyroid artery D. Supplied by RLN #Rjlast #Siyapaa nymus The thymus may appear to be a single organ, but sely applied to each other for much of their extent (Fig. 4.15). It is usually most prominent in children, gland. In front of it lic the sternohyoid and sternothyroid muscles, the manubrium and upper part of the body of the sternum and their adjacent costal cartilages. Behind it are the pericardium, the arch of the vorta with its three large branches, the left brachiocephalic vein and the trachea.Abdul Wahab about volkman's canal resembles harvesian canal vascular space VW V Ww has concentric lamella #Rjlast #Siyapaa Macroscopically, bone exists in two forms: compact and cancellous. Compact bone is hard ana dense, and resembles ivory. It occurs on the surface cortex of bones, being thicker in the shafts of long bones, and in the surface plates of flat bones. The collagen fibres in the mineralized matrix are arranged in layers, embedded in which are osteocytes. Most of these lamellae are arranged in concentric cylinders around vascular channels (Haversian canals), forming Haversian systems or osteons, which usunlly lie parallel to each other and to the Long axis of the bone, Haversian canals the medullary cavity and cach other by wansversely running Nolkinann’'steanals Cancellous bone consists of a spongework of trabeculae, arranged not haphazardly but in a very real pattem best adapted to resist the local strains and stresses. If for any reason there is an alteration in the strain to which cancellous bone is subjected there is a rearrangement of the trabeculae, The moulding of bone results from the resorption of existing bone by phagocytic osteaclasts and the deposition of new bone by osteoblasts. Cancellous bone is found im the interior of bones and at the articular ends of long bones. The organization of cancellous or trabecular bone is also basically lamellar but in the form of branching and anastomosing curved plates. Blood vessels do not usually lic within this bony tissue and osteocytes depend on diffusion from adjacent vedullary vessels.wo Abdul Wahab & Doctor patient report is maintained by? A asking open ended question B using pt language C using stressful environment D. Polite behaviour at bed site VVVv #Siyapaa4. Recirculation of bile acids to the liver The terminal ileum contains a Na‘-bile acid cotransporter, which is a secondary active transporter that recirculates bile acids to the liver. Because bile acids are not recirculated until they reach the terminal ileum, bile acids are present for maximal absorption of lipids throughout the upper small intestine.G Abdul Wahab Diff btw sarcoma and carcinoma a) site of origin WW VW b) inc vascularity #SiyapaaG Abdul Wahab & Which valve is affected more in Libmann sack endocarditis ? A. Mitral and tricuspid B. Aortic C. Mitral and aortic WWW D. Tricuspid and pulmonary #SiyapaaAbdul Wahab & Rbc swelling occur in which solution A. Mannitol B. Sodium 150mmol C. 100meq calcium chloride D. Urea 300 mm VW WV hypertonic sol causes shrinkg of rbcs In ref ucan see about manitol & 150mmcacl2 are hypertonic While150Mm isotonic ds wont distrb even #Brsphysio #Siyapaa isD (IBG Abdul Wahab & Which one of the following is most potent A.H202 VW Ww B. Superoxide Oh > h202 > superoxide #SiyapaaAbdul Wahab Patient diagnose with Ca gall bladder with cholelithiasis cause of his cancer is A.chronic irritation WW VW B.stones C.obstructive jaundice Go for phenomena #Robbins #Siyapaa Carcinoma of the Gallbladder Although uncommon, carcinoma of the gallbladder is the most frequent malignant tumor of the biliary tract. It is 2 to 6 times more common in women and occurs most fre- quently in the seventh decade of life. Carcinoma of the gallbladder is more frequent in the populations of Mexico and Chile, presumably due to the higher incidence of gall- stone disease in these regions. In the United States the incidence is highest in Hispanics and Native Americans Only rarely is it discovered at a resectable stage, and the mean 5-year survival rate is a dismal 5%. Gallstones are present in 60% to 90% of cases. In Asia, where pyogenic and parasitic diseases of the biliary tree are more common, gallstones are less important. Presumably, gallbladders containing stones or infectious agents develop cancer as a rSdilt OF Sacuzrent aiimaland ehvonis iaarhinadion. The role of carcinogenic derivatives of bile acids is unclear.Abdul Wahab & infectious mononucleosis shows T cells B cells atypical cellsW¥W VW W einfected T cell eaffected B cells #Robbins #Siyapaa The major alterations involve the blood, lymph nodes, spleen, liver, central nervous system, and occasionally other organs. There is peripheral blood leukocytosis; the whit: is usually between 12,000 and 18,000 cells/ 12 to 16 jum in diameter, with an oval, indented, or folded nucleus and abundant cytoplasm with a few azurophilic granules (Fig. | 1-12). These atypical lymphocytes, which are sufficiently distinctive to suggest the diagnosis, are mainly CD8+ T cells. c fi ( n i tl b a ( n w CS Abdul Wahab Syeda Zainab Kazmi Nasophayrnx = pseudostratified Oropharynx =stratified Epiglottis=stratified Subglottis = pseudostratified... Like Reply View 1 previous reply @® Feps Med i Abdul Wahab here D? Abdul Wahab Stratified squamous epithelium is present in?? a)Nasal cavity b) Subglottis c) Trachea d) Epithelium of parotid ducty W #SiyapaaAbdul Wahab Energy utilized during normal Quite breathing A.0.05% B.15% C.10% D.20% E.5%VW VW #Guyton #Siyapaa weal ree during heavy exercise, the amount of energy required can increase as much as 50-fold, especially if the person has any degree of increased airway resistance or decreased pulmo- nary compliance. Therefore, one of the major limitations on the intensity of exercise that can be performed is the person's ability to provide enough muscle energy for the respiratory process alone.S Abdul Wahab s 23 year old boy came with mild jaundice, HBsAg -ve, HBclIgM -ve, Anti-HBe +ve. 1) Acute hepatitis 2) Window period 3) Acute revolving phase VV VW 4) Chronic Hepatitis HBe shows chronic phase While igM shows acute phase #1staid #SiyapaaAbdul Wahab Which one is a branch of posterior division of sacral plexus ?? Confusion is among a Posterior cutaneous nerve of thigh b Perforating cutaneous nerve VVVV c Nerve to quadratus femoris B is pure from posterior Ais mixes Cis from ventral #Rjlast #Siyapaa Scretaberos ligament nd curves 10e Abdul Wahab ACTH and diurnal regulationof melatonin by a. suprachiasmatic nucleus VVV b. arcuate nucleus #1staid #Siyapaa ith 4 REM deep and delta wave sleep; ing by | N3.and REM sleeyAbdul Wahab The most characteristic feature of thalassemia trait A. Normal ferritin B. HbA2 greater than 3.5 Vv VW C. Slightly raised HbF #CMDT #Siyapaa 3. Beta-thalassemia minor—These patients have a modest anemia with hematocrit between 28% and 40%. The MCV ranges from 55 fL to 75 fL, and the red blood cell count is normal or increased. The reticulocyte count is normal or slightly elevated. The peripheral blood smear is mildly abnormal, with hypochromia, microcytosis, and target cells. In contrast to alpha-thalassemia, basophilic stipplin, and occasional elevations of hemoglobin F to 1-5%.or Abdul Wahab & 390. TUMOUR MOST COMMONLY OCCUR AFTER RADIATION?? MENINGIOMA or Acute Leukemiav VW Both B>A #Brspatho #SiyapaaS Abdul Wahab SK 7 controversies.... 1. Graves opthalmopathy A. Unilateral B. Bilateral WW VW C. Optic nerve compression D. Medial and lateral rectus involvement eAlways bilateral & cause optic nerve compression 2. Vibrio cholera A. Grows in acidic medium B. Grows in alkaline medium C. Resistant to acidic medium D. Resistant to alkaline mediumv V Vv edue to resistance to alkaline media itis able to grow in alkaline media so both are correct,dea would be never 2 option2. Vibrio cholera A. Grows in acidic medium B. Grows in alkaline medium C. Resistant to acidic medium D. Resistant to alkaline mediumv V Vv edue to resistance to alkaline media it is able to grow in alkaline media so both are correct,dea would be never 2 option 3. Lady came with loin pain increased urine frequency , Hb all right, WBC 21000 most important investigation A. Blood culture alone B. Urine culture VW VW W C. Blood and urine culture D. Ultrasound @Hx of fever Then go for C #SiyapaaAbdul Wahab Adamkiwez artery At5 to t9 Bti9totl2VvVVv Ct12 to L2 #Researchgate... The artery of Adamkiewicz (AKA), also known as the arteria radicularis magna, is the principal vessel that feeds the lower thoracic, lumbar, and sacral portions of the spinal cord. This vessel exhibits significant variability in its anatomy (e.g., branch point topography). It derives from a single poste: ercostal artery originating from the aorta between the levels of joracic vertebrae) 9 to L (lumbar vectetae) 5, most dripiasis between T9 and T12 [1-4]. Localizing thie waceal ie aecantial meine tn thaescia ancl abel! csmmesse Abdul Wahab a stab wound in chest starts at and including external intercostal muscle and (parietal pleura and pleural cavity as 2 layers). It will pierce how many layers? A.5 B.6 C.7 D.BWVV Vv #SiyapaaG Abdul Wahab Drug of choice for pseudomonas aeruginosa ? eCeftazidin eCiprofloxacin in UTI #SiyapaaG Abdul Wahab A young man suffers from injury to penile urethra.After perineum where else urine will b leaked. A..Ant abdominal wall VW VW Ww B.. Deep perineal pouch C..superficial perineal pouch D..pelvis #Siyapaawe Abdul Wahab What prevents complications regarding the intervention/ procedure? A.remains within the limits of professional competence B.informed consentv Vv W #SiyapaaG Abdul Wahab & Due to stress of surgery what will inc and cause vasoconstriction.. A.acth B.cotisol C.epinephv Vv vw #Siyapaae Abdul Wahab s& Increased Leukamoid Reaction 1) CML 2) Leukaemia 3) Non Hodgkin Lymphoma ANoneV V VW e@CML dec LAP reaction eBenign neutrophillia/ leukamoid reaction inc LAP #1staid #SiyapaaeG Abdul Wahab eTabes dorsalis atonic bladder elesion at sacral region atonic/ autonomic elesion above sacral region spastic/ autmatic epartial damag to sacral or at higher center damag Neurogenic #Kaplan #Guyton #SiyapaaG Abdul Wahab &» A person doing regular exercise.which factor in this condition increase his respiratory rate A.proprioceptorsVW VW W B.stretch receptor in lung C.baroreceptors D.chemoreceptors #Guyton #Brsphysio #Siyapaa ActuallAbdul Wahab Which of the following penicillin is active against pseudomonas: 1. penicillin G 2. cloxacilin 3. piperacillin VW VW #Levinson #SiyapaaAbdul Wahab Sperm lif in femal genital track 24-48 hours. VV VW 24-72 hrs #Guyton #Siyapaa wre Physiology of the Mature Sperm. The normal motile, fertile sperm are capable of flagellated movement through the fluid medium at velocities of 1 to 4 mm/min. The activ- ity of sperm is greatly enhanced in a neutral and slightly alkaline medium, as exists in the ejaculated semen, but it is greatly depressed in a mildly acidic medium. A strong acidic medium can cause rapid death of sperm. The activity of sperm increases markedly with increas- ing temperature, but so does the rate of metabolism, caus- ing the life of the sperm to be considerably shortened.QUESTION 18 out of 95 Basal metabolic rate is dependent on: A Body weight PS WSO LME-LeLel 1 c Amount of adipose tissue eae Le ccLM ele MLL) ane 2 falls}Abdul Wahab Thyroid gland medial relation:- A:-carotid sheath B:-Recurrent Laryngeal nerveYV V W C:-superior thyroid artery D :-sternothyroid muscle E:-parathyroid gland #Rjlast #siyapaa Each lateral lobe is pear-shaped with a narrow upper pole and a broader lower pole, and appears approximately triangular on cross-section with lateral, medial and posterior surfaces. The lateral (superficial) surface is under cover of sternothyroid and siernohyoid inst the lateral side of the larynx and upper trachea, with the lower pharynx and upper oesophagus immediately behind. This surface is related to the and the inferior constrictor of the pharynx, The posterior surface overlaps the medial part of the carotid sheath, ie. the part containing the common carotid artery; if enlarged, the lobe may extend across the more laterally placed internal jugular vein. The parathyroid glands usually lie in contact with this surface, between it and the fascial sheath. the nerves lie in or ~ front of the groove between the trachea and oesophagus. The left nerve, which recurves aroundAbdul Wahab Medial geniculate body lies on? Midbrain VW Vv Ww Or Thalamus #rjlast #Siyapaa The mass of grey matter making up the thalamus is roughly wedge-shaped. The medial walls of the two thalami lie parallel, near each other across the third ventricle, where in two-thirds of cases they are joined by the interthalamic adhesion, Behind this the medial surface diverges from the midline and expands into a large posterior convexity, the pulvinar; the lateral geniculate body (see p, 465) bulges down from its lateral part (Figs 7.4 and 7.20). [heiaedialigenieulate’bod), a thalamic nucleus which relays auditory impulses, is separated from the main mass of the thalamus and Hi@SUGillilie ‘IGLFAM. It receives fibres from the cochlear nerves by way of the nuclei of the nerves and the lateral lermiscus, and relays them through the sublentiform part of the internal capsule to the auditory cortex in the temporal lobe.Abdul Wahab When no specific factor 8 concentrate available,the next best sourceof factor 8 is. A. Albumin infusion B. Cryoprecipitatey VW W C. Packed cells D. Fresh whole blood. E. Platelet concentrate #CMDT #Siyapaa (Gryoprecipitate is made from fresh plasma by cooling the plasma to 4°C and collecting the precipitate. One unit of cryoprecipitate has a volume of approximately 15-20 mL and_ contains pe 250 ms of Beas and sen or in rare instances of congenital hypo- fibrinogenemia. One unit of cryoprecipitate will raise the fibrinogen level by about 8 mg/dL. (0.24 memol/L). Cryo- precipitate is sometimes used to temporarily correct the acquired qualitative platelet dysfunction associated with kidney diseaseAbdul Wahab 12. Regarding pia mater: a. Extends into sulci and fissures of brain tissuev V VW b. Exxtends into the posterior median sulcus of spinal cord c. Has openings at the medial/lateral ends of ventricles d. Extends into the ventricles e. Continues along with dura upto S2 level #Rjlast #Siyapaa bone. Like periosteum it tween pia mater and the lar fibrous tissue and can be stripped away from out over the cranial nerves and spinal nerve roots to fuse with their s. The ths of pia, surrounded by a narrow perivascular space containing the brain surface. It epineurium, and itis arteries lie loose in the cerebrospinal fluid. The region between the pia and the arachnoid is the subarachnoid space, filled with cerebrospinal fluidGS Abdul Wahab 1. Milk is notoriously deficient in A. Vitamin cW W B. Pantothenic acid Cpsp key b but otherwise A 2. Abundant Cholesterol A. LDL B. ChylomicronsVvW VW W 3.vitamin deficiency cause HomoCystinUria A. Vit B 12 B. But B6 Basically it is due to both of them There are two types congenitaly 1 from b6 other from b12 4. Dry heat kills bacteria by A. Coagulation of proteins B. OxidationYv VWG Abdul Wahab which open directly into heart espicially right atrium a.coronory sinus b.venae cordis minimi VW VW Vv v c.ant cardiac vein D. Superior vena cava #Rijlast #Siyapaa MVERTOCORMS MIAME are very smal! veins in the walls of all four chambers of the heart tn The lymphaties of the heart drain back along the coronary arteries, emerge from the fibrous pericardium along with the aorta and pulmonary trunk, and empty into the tracheobronchial and brachiocephalic lymph nodese Abdul Wahab s& Q81:-Tumor suppresing ant surface of sternocleidomastoid which vessel engorged ? A)external jugular vein’ VW Ww B)internal jugular vein C) Anterior jugular vein #Rijlast #Siyapaa deep cervical fascia, whien splits to surround it (Fig. 6.1). Theinmusclelis (crossed superficially by the great auricular nerve, the and the transverse cervical nerve, in that order from above downwards. Deep to the upper half of the muscle lies the cervical plexus; deep to its lower part lies the carotid sheath and its contents, overlying sealers anterior.Abdul Wahab w& Infarction of Apex of heart.artery involved aLADVV Vv b marginal br of RcA #Kaplan #Siyapaawe Abdul Wahab Milk is notoriously deficient in ? Vitamin c WW Ww Iron Riboflavin Pantathenoic acid VitA #Siyapaae Abdul Wahab & spleen antigen? white pulp red pulpv Vv Ww #SiyapaaAbdul Wahab & In CKD patients? a-inc PO2 b-fluid should be restricted to 0.5 litre per day WV VW c-Anemia is due to erythropoetin deficiency Both are fine enuf Could be so many causes of anemia so B more #Davidson #Siyapaa The inability of the failing kidney to excrete sodium and water loads commonly leads to their accumulation, which may manifest as oedema and may drive hypertension. . Diuretics are commonly required, and as renal function deteriorates, increasing doses of potent loop diuretics or synergistic combinations of loop, thiazide and potassium-sparing diuretics may be necessary. Occasionally, some patients with tubulo-interstitial disease can develop ‘salt-wasting’ disease and may require a high sodium and water intake, including supplements of sodium salts, to prevent fluid depletion and worsening of renal function.Abdul Wahab Hormone that converts norepinephrine to epinephrine? Ach Cortisol WW VW Dopamine #1staid #Siyapaa ine synthesis/tyrosine catabolism renin tet —— tr | | mn Fumarate 8 decarboxyiaseé 2 Catbidopa wana | apni Catechol-O-methyl transferase Norepinephrine ui sau |Phenylethanoamine-W- methyltransferase. |“ Gar Normetanephri Epinephrine + Metanephtine ————+ Vanilyimendelicwo Abdul Wahab = Transient adhesion due to A selectin’ Vv Ww B integrin C spectrin #Brspatho #SiyapaaAbdul Wahab Patient present with weight loss foul smelling bulky stool investigation done a.stool d/e WV Vv b.stool culture Stool examination to rule out so many things But culture only in case of bacterial infections #Siyapaa Astool analysis is a series of tests done ona stool (feces) sample to help diagnose certain conditions affecting the digestive tract. These conditions can include infection (such as from parasites, viruses, or bacteria), poor nutrient absorption, or cancer. Fora stool analysis, a stool sample is collected ina clean container and then sent to the laboratory. Laboratory analysis includes microscopic examination, chemical tests, and microbiologic tests. The stool will be checked for colour, consistency, amount, shape, odour, and the presence of mucus, The stool may be examined for hidden (occult) blood, fat, meat fibres, bile, white blood cells, and sugars called reducing substances. The pH of the stool also may be measured. A stool culture is done to find out if bacteria may be causing an infection.GS Abdul Wahab Brain can use ketons instead of glucose in starvation While RBc'S cant use ketons only use glucosevV V VW #1staid #Siyapaa Ketone bodies: acetone, acetoacetate, B-hydroxybutyrate Breath smells like acetone (fruity odor) Urine test for ketones can detect acetoacetate, but not B-hydroxybutyrate RBCs cannot utilize ketones; they strictly use glucose. HMG-C HMG. A lyase for ketone production. SoA reductase for cholesterol synthesis,e Abdul Wahab Q,A drug has sudden rise in blood levels after oral dose/increased dose response a.it has increased first pass metabolism b.small dose will cause high blood conc c.has maximum bioavailibity W d.urinary excretion will be high e.because it is more potent #Siyapaawo Abdul Wahab Most important for malignancy Increased N/C ratio Metastasis VW VW Ww Invasion #Siyapaae Abdul Wahab & Complete ventricular depolarization ??? A.QRS complex B.ST segment Vv Vv vw #Brsphysio #Siyapaa © isthe segment from the end of the S wave to the beginning of the T wave. © is isoelectric. ® Tepresents the period ijSHInE Men iniolesefStepolan2e0)Abdul Wahab & Dermatome below clavicle to sterna border A. C3-cA WV VW B.T1 C.T2 #Rjlast #Siyapaa i Nostinsupply (C2 Occipital region postevor neckand sHinover parotid (Go marabriontemal junction), shoalder and above seapalar spine (C5 [Lateral arm [C6 [eatera forearm and than [C7 [Midate tapers a ete i daa arm above and below elbow [T3_[Thorsx end occasional extension toaxila 14 [Nipple [17 [Subcostal angle IL Beprepubic and inguinal regions penis, eateror serotan( labia), wppor bubook [2 [Anirior thigh upper butiosk al thigh and Re media ane and side of Tot [5 [Lateral eg, dorsum of foot, medial sole [SI Lateral ankle lateral side of dorsum and sole 182 Pesterior leg, posterior thigh, buttock, penis [S3_[Siting rea of butock. poster scrotum aia) 7G Abdul Wahab Patient having hepatoma,dependent edema and diluted abdominal vein,cause is. Portal vein. VOW VV #Siyapaa.G Abdul Wahab there's deficeincy of aldosterone which of the following will be seen in blood ? a. increase ACTH in hypophyseal blood b. increase acth in blood leaving the hypothalamus c. increased acth in systemic arterial blood d. increase acth in venous blood leaving ant. pituitary Vv Ww #SiyapaaAbdul Wahab A labourer sweats 2L and drinks 2L pure water what will happen? A.inc ECF B.inc IcF vollW WW Inc icf vol > dec icf osmo > inc ecf vol Lines taken from brs physio beq explanation #Brsphysio #Siyapaa BD sveurwenad Muhammad Jalal Bashir Khan Warferin Toxicity Ventricle khan Soonh Sanaullah Explanation 1stlook whats happing During sweating dea is more logs of water than NA 80 itis ine ‘smo of ecf, to compensate inc cosmo of ecf fluid from ict will shift 0 ecf meanwhile icf osmo- is inc ‘So now whatis gonna happen next when a person crinks water Water is hypotonic solution end ‘twill affect 1stief..now due to rush of fluid toto icf tet thing would be ine vol of icf & ultimately dec in osmo of icf Only these 2 option are oriorty If ‘these are nt in option then last option would b inc ecf vol to chooseAbdul Wahab ss Which of the following will happen on the excitatory synapse? Cation influx on post.synaptic through ligand gated channels VVV Joining of synaptic vesicle on the presynaptic membrane #Brsphysio #Siyapaa 2. Excitatory postsynaptic potentials (EPSPs) are inputs that depolarize the postsynaptic cell, bringing it closer to threshold and closer to firing an action potential. similar to the ACh channels, The membrane potential depolarizes to a value halfway between the equi- librium potentials for Na’ and K* (approximately 0 mV). © Excitatory neurotransmitters include ACh, norepinephrine, epinephrine, dopamine, glutamate, and serotonin.S Abdul Wahab Q. A young man presented with absent stretch reflex, atrophy of calf muscles, loss of pain and temperature on the lateral aspect of leg and foot. The most likely lesion is A. Upper motor neuron lesion B. Lower motor neuron lesion with anterior horn damage VV W C. Lower motor neuron lesion D. Peripheral nerve lesion #Explanation LMN injury eLoss or reduces reflex pronounced wasting of muscles e Flacidity #AntHorn It should be anterolateral eloss pain e loss of temp #Siyapaawo Abdul Wahab which structure related to posterior ethmoidal sinus Optic nerve VV Vv Ophthalmic artery Cavernous sinus #Rijlast #Siyapaa The anterior and middle ethmoidal air cells, situated in front of the ground lamella, of the middle turbinate are considered to constitute an anterior ethmoidal system. At the back of the labyrinth the wall of the POS/@HOR@HMOIdaNGIME2USis completed by fusion of the orbital process of the palatine bone and the sphenoidal concha (Figs 6.25 and 6.26). The ostia of the posterior air cells open into the superior meatus its canal (a surgically important relationship).G Abdul Wahab True end arteries retinay W While others are in Spleen Heart Brain #Siyapaawe Abdul Wahab & Primary hypertension A. Cardiac output increase B. Cardiac work increase VW VW W C. Increase in oxygen demand B>c #SiyapaaAbdul Wahab & The function of femoral canal is: 1. lodge lymph nodes 2. space for femoral hernia 3. anatomic dead space 4. to provide space during straining VVV It cause draining of deep inguinal lymph nodea due to presence of lymphatic vessels so alone lodgng is not a Function While it has free space which allows distensn of adjacnt structre to cope with inc venous return & inc intraabdominal pressure #Siyapaa * Lymphatic vessels — draining the deep inguinal lymph nodes. * Deep lymph node - the lacunar node * Empty space. * Loose connective tissue. The empty space allows distension ofAbdul Wahab Root value of phrenic nerve largest contribution by C3 CAVVV C5 #Rijlast #Siyapaa with contributions from C3 and C5 and runs down. from lateral to medial vertically over the obliquity of the scalenus anterior muscle, pa: borders, beneath the prevertebral fascia, lateral to the ascendi thyroid artery. It passes behind the subclavian vein into the mediastinum (see p_195). It may be ‘oined below the vein bv a branch (the aecessorv ohrenic nerve) from the nerve to subelavius:Abdul Wahab Lower respiratory compnents sympathetic supply is via T3T4 T1 to T4 C.T2toT4VV Vv #Rjlast #Siyapaa Nerve supply Autonomic nerve fibres from the cardiac plexuses, and directly from the thoracic vagus and sympathetic chain, pass to the pulmonary plexuses, which are situated anterior and posterior to other hilar structures, the anterior plexus being much smaller than the posterior. From here nerve fibres pass into the lung with the bronchi and vessels. The parasympathetic (vagal) fibres are afferent (cell bodies in the inferior ganglion) and efferent (cell bodies in dorsal nucleus, with relay in the bronchial mucosa). They provide the afferent fibres for the cough reflex (see p. 395), important for clearing excess secretions and inhaled substances from the tracheobronchial tree; the receptors are unmyelinated endings in the epithelium. Included among the afferent fibres are those subserving pain. The vagal efferents are bronchoconstrictor, vasodilator and secretomotor to mxcous glands. TheAbdul Wahab & Which space is accessed after piercing the inter laminar ligament during LP? 1. Epidural space 2. Sub arachnoid space. Vv W #Kaplan #Siyapaa Squence wise epidural But for csf draining u have to go in subarchS Abdul Wahab Reticular connective tissue present in? Epidermis TonsilsVvV VW W True regarding stratified columnar is? Nuclei at same levelVW V VW All nuclei present at base What is true about pseudocolumnar epithelium? all cells at basevW VW all nuclei at same level #SiyapaaAbdul Wahab Osteoclast derived from? Monocytes VV VW Osteocytes #Medicalphysiology #Slyapaa 2 Bone is also being continually resorbed in the presence o. Ce eileen 1 PHYSIOLOGY percent of the bone surfaces of an adult. Later in the @ chapter we see that PTH controls the bone resorptive activity of osteoclasts, CreeAbdul Wahab Most common organism causing infection after blood transfusion A. CMV Vw B. hepatitis virus C. Herpes zoster D. None #SiyapaaAbdul Wahab & lymph drainage of upper one third of stomach a.sup gastric nodes b.celiac nodes c.pancreticosplenuc nodesV VV VW Go for 1st thing than ultimate thing #Rjlast #Siyapaa All lymph from the stomach eventually reaches coeliac nodes after passing through various outlying srope le 2A) lyoph vcnsaarmm holy fsck el, a ce we lvoe vessels that direct lymph in such a way that a line drawn parallel to the greater curvature and two- thirds of the way down the anterior surface indicates a ‘watershed’ (Fig_5.27B). From the largest Ses cle ond Wr cg SIE ns ics pcs lek sce vc mies slg taht right gastric arteries. From the upper left quadrant lymph flows via left gastrocpiploic nodes and Ponte reetie pr emenne epee of the stomach lymph reaches nodes along the right gastrocpiploic vessels, which drain to subpyloric nodes near the gastroduodenal artery. The pyloric part of the stomach drains to hepatic nodes in the porta hepatis and to subpyloric and right gasirie nodes. In cases of gastric carcinoma, the left Faecleteser aks acy plpalylvaed (Prete sg, esol by spend atog ts oracle deDe Abdul Wahab & Female sexual stimulation ? a.mucosal secretion b.parasympatheticy W #Robbins #Siyapaa CLILES LIUIIL LILE SACLaI PICAUS LU LILE CALELIAl PELIULdlld. a ings. This allows rapid accumulation of blood in the erec-Abdul Wahab Oral (buccopharyngeal) oropharyngeal membrane sperates A.oral cavity nasal cavity B.layrnx & phyrnx C.bucopharngeal memb from primitive gut D.none of above. VV v Actuall ans is Buccopharnygeal memberames separates stomodium from it VVV #Humananatomy #Siyapaa ae Sea Chapter 11). The foregut lies and the orophary Pees from the stomodeum (see Fig.Abdul Wahab Prevertebral fascia encloses A.sternocleidomastoid B.muscle of cervical vertebre VVV C.trechea & esophagus #rjlast #Siyapaa This is a firm, tough membrane that lies in front of the prevertebral muscles (Eig. 6.1). It extends from the base of the skull, in front of the longus capitis, rectus capitis lateralis and longus colli muscles, downwards to blend with the anterio ogitial ligament on the body of T4 vertebra. It extends sideways across the scalenus anterior, scalenus medius and levator scapulae muscles (Fig. 6.8). getting thinner further out and fading under cover of the anterior border of trapezius. it). The jes of the posterior triangle and the accessory nerve lic superficial to it. The third part of the subclavian artery lies deep to the fascia, which becomes prolonged over the artery and the brachial plexus below the clavicle as the axillary sheath to a varying extent in the axilla, It does not invest the subclavian or axillary vein; these lic in loose arcolar tissue anterior to it, free to dilate during times of increased venous return from the upper limb. The fasica is pierced by the four cutaneous branches of the cervical plexus (great auricular, lesser occipital, transverse cervical and supraclavicular nerves),Abdul Wahab which test will advise for pernicious anemia A.antiparietal cell antibodies B.anti intrinsic factor antibodiesv V V Anti parietal antibody are preaent in 90% cases but are also present in normly so these are not diagnostic So B best #davidson #siyapaa IY TIT of dietary vitamin B,, is absorbed, Pernicious anaemia has an incidence of 25/100 000 population over the age of 40 years in developed countries, but an average age of onset of 60 years. Itis more common in individuals with other autoimmune disease (Hashimoto's thyroiditis, Graves’ disease, vitligo or Addison's disease; Ch. 16) or a family history of these or pernicious angemia. . The Schiling test, involving measurement of absorption of radio-labelled By. after oral administration before and after replacement of intrinsic factor, has fallen out of favour with the availabilty of autoantibody tests, greater caution in the use of radicactive tracers, and limited availability of intrinsic factor.Abdul Wahab & Internal jugular vein is related Medial to carotid artery Lateral to carotid arteryyw VW #Rjlast #Siyapaa _aternat carotid artery “The inernal carotid artery arises atthe bifurcation of the common carotid (see p. 342) and continues upwards within the carotid sheath (see p_346). At its commencement it shows a slight bulge, the carotid sinus. Here the arterial wall is thin and its conined baroreceptors are supplied by the glossopharyngeal ard vagis nerves, which mediate blood pressure impulses to medullary centres ‘The carotid body is a small structure lying behind the bifurcation ofthe common carotid artery, oF its branches, from which it receives two or three very swall glomic arteries, ts cells are cprors concerned (like the aortic bodies, see p.192) with respira-tory reflenes, and are ‘by the glossopharyngeal and vagus nerves. Carotid body tumours form a swelling atthe anterior border of sternocieidomastoid atthe level ofthe carotid bifireation, and exhibit transmitted plsation from he arteries. ‘The interna carotid artry is lateral tothe external carotid at is origi, but soon passes up posteriorly to-a medial and deeper level. I has no branches and passes straight up in the carotid sheath, beside the pharynx, tothe carotid canal in the hase of the skal its intracranial cqurse is considered on pages 44S and 449 Behind the internal carotid artery in the neck isthe symmuthetic trunk (ouside the carotid sheath), pharyngeal veins and the superior laryracal branch of the vagus. The ascending pharyngeal arcry is ‘medial to it Thelinigrnalugularlveinsilaefal, with the vagus nerve deeply placed between artery and vein. Superficially near its origin its crossed by te Lingual and facial veins, the occipital artery and hypoglossal nerve. The superior root of the ansa cervicalis urs downwards along it, embedded in the carotid sheath. Ata higher level it is crossed by the posterior belly of digastric and siylohyoid ‘nd the posterior auricular artery, andl by the stractures that separate it fom the ext above).Abdul Wahab Auscultation of tricuspid valve best heart at Lower border of left sternumv VW Lower border of right sternum #Davidson #Siyapaa ® Auscultation of the heart © Use the diaphragm to examine at the coo, CHE ET TE area) and upper left (pulmonary area) and right (aortic area) stemal edges. Use the bell to examine low-pitched noises, particularly at the apex for the mid-diastolic murmur of mitral stenosis. Time the sounds and murmurs by feeling the carotid pulse; the first heart sound (S1) just precedes the upstroke of the pulse and the second heart sound (S2) is out of step with it. If present, a third heartG Abdul Wahab & In the presence of ADH, The distal nephron is least permeable to : a) water . b) ammonia . c) urea. VV VW d) sodium . e) carbon dioxide. #Brsphysio #Siyapaa A. Urea by simpl © ADH stimulates a facilitated diffusion transporter for urea (UT) in the inner medullary col- lecting ducts. Un reeyeling in the gradient on by diffusion, either simple or facilitated, simple diffusiAbdul Wahab following organisms are responsible for community acquired pneumonia; a.clostridium b.streptococcus pyogenes c.klebsella d.hemophillus influenza vWvW Ww #Robbins #Siyapaa Community-Acquired Acute Pneumonia Moraxella catarrhalis Staphylococcus aureus Legionella pneumophila Enterobacteriaceae (Klebsiella pneumoniae) and Pseudomonas spp.Abdul Wahab 2 year old patient has history of abdominal distention and massive splenomegaly cause?? A Infectious mono.. B. Ida C Myelofibrosis WW VW #Robbins #Siyapaa SPLENOMEGALY The spleen is frequently involved in a wide variety of ation of splenic enlargement is aided by recognition of the usual limits of splenomegaly produced by specific disor- Hert would encod fo atshate on enforgelepleen pushing into the pelvis to vitamin B, entertain a diagnosis of CML in the megaly following! ceof splenomegaly that th * Chronic lymphocytic leukemia and hairy cell leukemia + Lymphomas alaria jaucher disease + Primary tumors of the spleen (rare)G Abdul Wahab Which of the following is the most common tumor associated with type 1 neurofibromatosis A.optic nerve glioma Vv VW vW B.meningioma C.acoustic shwanoma D.low grade astrocytoma #1staid #Siyapaae Abdul Wahab an adult in sitting position resonance of the lungs can be auscalted from back of the chest till 6 rib 8 rib 10 ribVyW VW 11rib 12rib #Kaplan #Asimshoaib #SiyapaaDe Abdul Wahab & eDuring would healing #Type 3 collage eTensil or scar tissue strength #Type 1 #SiyapaaAbdul Wahab elnfectious mononucleus eActivated T cells e infected B cells #SiyapaaAbdul Wahab & Which nerve locally anesthesized for performing surgery of nose A. Maxillary nerve WV WV Vv B. Mandibular nerve C. Opthalmic nerve D. Ant ethmoidal nerve infrorbital branch of maxilary > Nasocilliary branch of opthalmic A>C #Siyapaa Because adrenaline is not used for the nasociliary block to prevent any risk of retinal artery spasm, this block wears off first. Thus, the mean duration of block represents the mean duration of anaesthesia in the area supplied by the nasociliary nerves. This could explain the short duration of if the short time taken to block the infraorbital nerve. The failure rate _ A>Abdul Wahab Lacunar ligamnt forming medial boundary fibres enrolled to form. a.Inguinal ligament b.Transverse ligament c pectineal ligament VV Vv Ww #Rjlast #Siyapaa Figure 5.3 Left superficial inguinal ring, after removal of the external spermatic fascia which is continuous with the margins of the ring, From the medial end of the inguinal ligament the triangular lacunar ligament (of Gimbernat) extends horizontally backwards to the pectineal line on the pubis (see Fig. 3.1. p. 112). The crescentic fice lateral edge of the lacunar ligament is the medial margin of the femoral ring (see p._L18)-Abdul Wahab Pt is AB postive blood, has to be given plt. Which will be given A. O-ive B. Ab -ive VV VW C. A-ive D. B-ive universal donor of plasma is AB group either positive or negative Here asking about transfusion of plasma cells so option B #1staid #Siyapaa A 8 AGB ee a @ a~@ gh Ale we NON ae xe VF igh 1M Igh, igAbdul Wahab s& Carotid sheath A.laterally prevertebral fascia B.extend up to adventia of aortic archV VV Insteat of word adrenalis word is adventitia thats typing mistake #B #Siyapaa #Rjlast Carotid sheath This is nota fascia in the sense of a demonstrable membranous layer, but consists of a feltwork of areolar tissue that surrounds the common and intemal carotid arteries, internal jugular vein, vagus nerve and some deep cervical lymph nodes (Eig. 6.1). Iti thin where it overlies the internal jugular vein, allowing the vein to dilate during increased blood flow. The sheath is attached to the base of the idomastoid. Where they lie alongside, the sheath blends the carotid sheath there is a minimum of reolar tissue ral fascia; the cervical sympathetic trunk lies here in front of the prevertebral fascia (Fig. 6.8). The carotid sheath is described further on page 366. 54m ‘Like Reply O00:Abdul Wahab Pregnant lady developed severe breathlessness. O/e pulse irregularly irregular... She had mild diastolic murmur. Appropriate investigation? A. Pmitrale on ECG B. Raised pressure gradient across mitral valve” VW vw #SiyapaaAbdul Wahab All are associated with Down's syndrome except A. Asd B. Alzheimer Cc. AML D. hypothyroid E. Horse shoe kidneyW V VW Rule of exclusion #Robbins #Siyapaa Cytogenesc Disorders RA, cushion, including SEHSIRGBEIMERSS, atrioventricular valve malformations, and ventricular septal defects (Chapter 10). Cardiac problems are responsible for a majority of the deaths in infancy and early childhood. Several other congenital malformations, includ sias of the esophagus and small bowel, als ve a10- to 20-fold + Children with trisomy 21 h risk of devel blastic leukemias and (Chapter 11), Viewally all patients with rsomy 21 older than age 40 develop neuropathologic changes characteristic of HRIRRRURIL, 9 degenerative disorder of the brain (Chapter 22), Patents with DISATARABAe demonstrate sbnormal immune responses that predispose them to serious infections, particularly of the lungs, and to AWOMMIMUMIEY (Chapter 19). Although several abnor- malities, affecting mainly T cell functions, have been reported, the basis for the immunologic disturbances is not clear.Abdul Wahab Energy utilized during normal Quite breathing A.0.05% B.15% C.10% D.20% E.5%VW VW #Guyton #Siyapaa wi eect ree during heavy exercise, the amount of energy required can increase as much as 50-fold, especially if the person has any degree of increased airway resistance or decreased pulmo- nary compliance. Therefore, one of the major limitations on the intensity of exercise that can be performed is the person's ability to provide enough muscle energy for the respiratory process alone.G Abdul Wahab Primary dehydration what occur? A. Inc icf osmolarity B. Inc ecf osmolarityYW VW WwW C.inc both icf ecf osmolarity #SiyapaaAbdul Wahab In dysplasia A.pleomorphism VW YW B.N/a ratio Both but pleomorphism is more considerable #Robbins #Siyapaa li Figure 5-6 Carcinoma in situ. A, Low-power view shows that the entire no orderly differentiation of squamous cells. The basement membrane is int of another region shows failure of normal differentiation, marked nuclear a the surface. The intact basement membrane (below) is not seen in this sect proliferation. Dysplasia is encountered principally in epi- thelial lesions. It nuclei that are abnormally large for the size of the cell. Mitotic figures are more abundant than usual and freauently annear in ahnarmal lacations within the enithe.G Abdul Wahab .. The following statements concerning chorda tympani nerve are true except that it A) Carries secretomotor fibers to the parotid gland ¥WW@ VV B ) Joins lingual nerve in infratemporal fossa C) Is a branch of facial nerve D) Contains preganglionic parasympathetic fibers #Rijlast #Siyapaa [he chorda tympani (from the ficial nerve, see p_417) emerges through the ympanic fissure (Fig. 6.35), grooves the acute angle (Eig, thirds of thewo Abdul Wahab & female lethargic hb 8.1 mcv 55 mchc 35 serum ferritin 1000 deferoxime VV VW folic acid ferrous sulphate zinc sulphate #SiyapaaAbdul Wahab Respiratory rate is controlled by ? A. Apneustic B. PneumotaxicY VW W C. Stretch receptors in lung D. Medulla E. Pons #Guyton #Siyapaa A Pneumotaxic Center Limits the Duration of Inspiration and increases the Respiratory Rate A pneumotasie center, located dors: the nucleus parabrachialis of the upper pon: ts signals to the inspiratory area ‘When the pneumotaxie signal is strong, inspi- ration might last for as little as 0.5 second, thus fi lungs only slightly; when the pneumotaxic signal inspiration might continue for 5 or more secon z the lungs with a = excess of air: GOR. A strong pneumotaxic signal can increase the rate of breathing to 30 to 40 breaths per minute, whereas a weak pneumotaxic signal may reduce the rate to only 3 to 5 breaths per minateAbdul Wahab Antibodies of importance in primary sclerosing cholangitis A. Anti mitochondrial antibodies B. Anti neutrophil cytoplasmic antibodiesV V VW #Davidson #Siyapaa Investigations Biochemical screening usually reveals a cholestatic pattern of LFTs but ALP and bilirubin levels may vary widely in individual patients during the course of the disease. For example, ALP and bilirubin values increase during acute cholangitis, decrease after therapy, and sometimes fluctuate for no apparent reason. Modest elevations in serum transaminases are usually seen, whereas hypoalbuminaemia and clotting abnormalities are found at a late stage only.G Abdul Wahab 1=Organism responsible for sudden death due to food poisoning Shigella S aurus Botlinuinvy VW Flacid paralysis && respiratory failure #SiyapaaGS Abdul Wahab A 50 year old ma was diagnosed as a case of myocardial infarction with an inferior infarct .he was advised angiography.onangiography which artery most likely to be infarcted? 1..RCA 1..right marginal artery WV WwW 2..left marginal artery 3..left diagonal artery 4..anterior ventricular branch of left coronary #Siyapaaw Abdul Wahab true about graves opthalmopathy? usually bilateraly WW optic nerve compression most commonly involve medial nd lateral rectus muscle #SiyapaaG Abdul Wahab Absence of cartilage in terminal bronchioles differentiate it from: A/ conducting bronchiolev Vv VW B/ respiratory bronchiole C/ alveoli D/ trachea Conduction zone not bronchiol #SiyapaaAbdul Wahab Drug of choice for treatment of Myesthenia Gravis?? Pyridostigmine WW VW W #Davidson #SiyapaaG Abdul Wahab postmenopausal women come to your clinic she has strong family h/o ihd . Her sister died in mi . What will you give to prevent her from post menopausal related osteoporesis Aca and vitd B raloxifen WV” VW C estrogen only #SiyapaaS Abdul Wahab & Onchocercosis causes which of following A)Intestinal nodules B)Corneal hemmaorrhages C)Eye and skin nodules WV W #1staid #Siyapaa Tissue Toxocara canis Visceral larva migrans—nematodes migrate to blood through intestinal wall — inflammation and damage. Often affects heart (myocarditis), liver, eyes (visual impairment, blindness), and CNS (seizures, coma) Onchocerca volvulus ble Loaloa Swelling in skin, worm in conjunctiva Wuchereria bancrofti Lymphatic filariasis (elephantiasis)—e Abdul Wahab i pt from hill station having labour pain hcg done. Fetus normal stll which anomally can be at greater risk. PdavV Vv Vsd Asd Prematurty due to low 02 level at higher place #SiyapaaAbdul Wahab Pterygomandibular raphe attachment? Superior constrictor Buccinator BothV VV Vv #rjlast #Siyapaa rom the tip of the hamulus the piemgomencibular raphe extends to the mandible just above th. posterior end of the mylohyoid line; between them the Lingual nerve is in contact with the mandible where the bone often thinned by a shallow groove (Fig. 6.22), TheUbuccinatortarisesmmonmtie r (sce p..383). The muscle converges on the modiolus, where its fibres of origin from the raphe decussate; the maxillary and mandibular fibres pass medially without decussation into the upper and lower lips respectively. The muscle is pierced by the parotid duct opposite the third upper molar tooth. The duct also passes through the buccal fat pad which lies on the outer surface of buccinator and is particularly prominent in infants, giving them their chubby checks. Beneath the fat tie a few small molar glands; their ducts pierce the muscle to open on the mucous membrane of the cheek, which lines the muscle's inner surface and to which muscle fibres are attached.Abdul Wahab Old man who was being treated by a GP for arthritis comes to you with complaints of Generalised weakness,pallor,easy bruising. Hb 5g/dl and dec RBC,WBC PLT. Retic count 0.1%. hypocellular bone marrow with adequate cells. a)Aplastic anemiav VW b)Myelofibrosi #Robbins #Siyapaa . The limited cellularity often consists only of lymphocytes and plasma cells. Anemia may cause fatty change in the liver. Thrombocytopenia and granulocytopenia may result in hemorrhages and bacterial infections, respectively. The requirement for transfusions may eventually lead to hemosiderosis.we Abdul Wahab & Low voltage QRS complex is seen in ?? a) old MIVW Ww b) Bundel branch block c)Hypertension d)IHD e)Pleuritis #Siyapaae Abdul Wahab & Virulence factor for strep pneumoniae A.Capsule VW V V B.ig A protease #Levinson #Siyapaa Justnow Like ReplyAbdul Wahab & Type of immoveable joint whr bones are held together by ligaments A. Skull suture. B.vertebral column C. Syndesmosisv Vv YW #rjlast #Siyapaa The inferior tibiofibular joint is a fibrous joint (Syndesmosis) between the convex medial surface of the distal end of the fibula and the concave fibular notch of the distal tibia, THENBGRESTarelheld whose fibres occupy the triangular area on cach bone at the lower end of the interosscous border (Fig. 3.54)ee Abdul Wahab Regarding syringomyelia which is correct: a- it has ependymal lining b-50% are due to csf blockage c- 20% have spinal cord expansion VVVv d- none #SiyapaaAbdul Wahab Patient not taking fruits and Vegetables has delayed healing due to? A.decrease collagen tensile strength B.no synthesis of collagen C.defective synthesis of collagenv VV vw #SiyapaaeS Abdul Wahab Referred pain to groin due to ureteric colic. Nerve responsible llioinguinal nerve vw VW Genitofemoral nerve. eLoin & Groin illiohypogastric & ilioinguinal eMedial Thigh & testes Genitofemoral nerve #Snell #SiyapaaAbdul Wahab s Stability of TM joint A/ capsule B/ stylomandibular ligament C/ temporomandibulary V W ligament D/ muscles #Snell #Rjlast #SiyapaaAbdul Wahab About pituitary gland a. Above diaphramatic sella b. Abnormality causes junctional scotoma VV V Vv c. Lateral to cavernous sinus pitutry lies over sella turica while diapharam sella lies over pituatry gland #rjlast #Siyapaa atuitary gland someone te gland Roe hs oper pad othe caverasugih THe fla tn crachnod bisa wih the capeul af be gland. Below We fosa les ty body of he spond bone containing the sphenoidal air sinuses. When small the sinuses lie anteroinferior to the fossa, but when ‘wrge one or both extend back beneath the fossa,Abdul Wahab Cardiac output measurd by A.cardio green VV VW B.cardiac blue #Guyton #Siyapaa Indicator Dilution Method for Measuring Cardiac Output This passes rapidly through the right side of the heart, then through the blood vessels of the lungs, through the left side of the heart, and, finally, into the systemic arterial system. The concentration of the dye is recorded as the dye passes through one of the peripheral arteries, giving a curve as shown in Figure 20-19. In each of these instances, 5 milligrams of Gardi6= in the top recording, into the arterial tree until about 3 fam est than thee a none of the dye pas: nannndaaw Abdul Wahab Q24 Which of the following most commonly causes bronchogenic carcinoma?? A- asbestosis B- silicosis C- brucellosis D- tobacco smoking WV W Tobaco smoke > Radon > asbestosis #1staid #SiyapaaAbdul Wahab & Erythroblastosis fetalus type of hypersensitivity Ige mediated Iga Cell mediatd Complement mediated cell response VVVV Cell mediated is type 4 not type 2 #Robbins #SiyapaaAbdul Wahab Cauda equina Anterior and posterior roots of spinal cord from L1 to LEW WV VW Ant n posterior roots of spinal cord from $1 to S2 #rjlast #Siyapaa Spinal nerve roots The anterior and posterior roots ofthe spinal nerves unite within the intervertebral foramina, Within the subarachnoid space the nerve roots are atached tothe spiral cord each by a series of rootlers Fach anterior root is formed by three or four rootlets which emerge irregularly along the anterolateral surface ofthe spinal cord. Each posterior root is formed by several rootlets, attached vertically to the posterolateral surface of the cord. A short distance from the cord the rootlets are combined into singe root (see Eig 6 ILL p_454). The anterior and posterior roots pass fiom the cord to appropriate irservertebral foramina, where each evaginaes the dura mater separately before unit to form the mixed spinal nerve. The ganglion on the posterior nerve root lies in the intervertebral foramen, witn the tubular evagination of dura and arachnoid immediately proximal to the point of Union of arterior and posterior nerve roots. However, the posterior root ganglia of cervical nerves lie partly lateral to the inervertebral foramina, behind and in contact with the vertebral artery (see Fis. {6.109 p_432), the ganglion of the frst cervical nerve, however, lies onthe posterior arch of the atlas For all levels from C1 to LL vertebrae the anterior and posterior nerve roots pass in fiort af and behind the dersiculte ligament respectively, and evaginate the dura mater between the deniculations (60¢ Eig 6 111 p_ 454). In conformity with the shortness of the spinal cord, the lower a norve reot the nore steeply it'slopes down tote intervertebral foramen. The upper cervical roots are horizontal, the upper thoracic roots first slope down to their point of evagination of the meninges orly w become inked upwards at an angle to seach te Fig 7.30). Below LI vertebra the roots pass almost vertically downwards through the ‘orming the eauda equina. ‘The filum ferminale (pia mater, see p_453) extends down | of the conus medullaris among the roots of the caudaS Abdul Wahab A lady drone in water. She was taken out and was resuscitated, develop ARDS. Mechanis, A. interstitial Oedema B. Hypoxia improves with Oxygen therapy VV Ww #Davidson #Siyapaa Management Initial aaa requires cardiopulmonary FESUSGHatORIWHAL (p. 456). It is important to clear the airway of foreign bodies and protest the conic) pine, aS SETTER . Prophylactic antibiotics are only required if exposure was to obviously contaminated water.Abdul Wahab & In mineralocorticoid secreting tumor A. Hypokalaemiav VW B. Hyponatremia #Davidson #Siyapaa Investigations Biochemical Routine blood tests may show a hypokalaemic alkalosis. Socium is usually at the upper end of the reference range in primary hyperaldosteronism, but is characteristically low in secondaryAbdul Wahab 26.Regarding trigeminal ganglion Bath in csf completely Completely coverd vid dura matter Present in mid cranial fossa alongside cavrnous sinus........ VVV Only posterior portion is bathed in csf #rjlast #Siyapaa ‘The trigeminal ganglion lies beneath the dura mater in the floor of the middle cranial fossa alongside ‘the cavernous sinus, and occupies the trigeminal impression, a srmall fossa on the front of the apex of ‘islpetousitemporal/bone posterolateral to the foramen laccrum (Figs G.LOL and 8.4, p. $29), The trigeminal nerve leaves the pons in the posterior fossa and runs forwards to cross the upper border of the petrous bone, upon which it leaves a shallow groove some 5 mm wide; itis accompanied by the small motor root, which lies below the sensory root. They pass beneath the superior petrosal sinus at this point (Fig. 6.105). As they do so, with their covering of pia, they evaginate a diverticulum of the inner layer of the dura and the ar the trigeminal eave (of Meckel), which passes forwards with them to lie in the trigeminal impression beneath the dural floor of the middle cranial fossa, the sensory root now enlarged to form the ganglion, with the motor root still below it. The evaginated inner layer of dura and the arachnoid fuse with we pia mater at the middle of te wigeminal ganglion, so the sensory and motor rools of the nerve and ‘cerebrospinal Muid (Fig. 6.104Abdul Wahab Metastatic calcification in a pt with bone pain occur bez of Paget diseasev V VW Hyperparathyridism #Robbins #Siyapaa Metastatic Calcification Metastatic calcification can occur in normal tissues when- ever there is hypercalcemia. The major causes of hypercal- cemia are (1 , immobilization, or tumors (increased bone catabolism associated with multiple myeloma, leukemia, or diffuse skeletal metastases); (3) vitamin D-related disorders including vitamin D intoxication and sarcoidosis (in which macrophages activate a vitamin D precursor); and (4) renal failure, in which phosphate reten- tion leads to secondary hyperparathyroidism.Abdul Wahab = Basophilic stippling A.lead poisoning B.myrloproliferative syndromes C.sideroblastic anaemia Dallw~vv #1staid #Siyapaa fad EXAMPLE ASSOCIATED PATHOLOGY Acanthocytes QB 7 (“spur cells”) EY a \#) BASOpRILIESEIPpIING [IAbdul Wahab &» A woman of 40 complains of weight gain her thyroid investigation shows T3-3 (normal 3-6) T4-8 (normla 8-12) and tsh( 0.2 to 2) what is cause of her symtom A.Hyperthyroidism B.hypothyroidismv VW C.overeating So it is posible despite of normal values #Davidson #Siyapaa ‘Symptoms of hypothyroidism with normal thyroid function tests The are a large number of wetsite ial serum TSH is rot a good measure of thyroid hormone: ty tests of thyod function of dubious sient val, inetusirg measurement of serum reverse T,, 24-hour urine T,, basal body temperature, skinAbdul Wahab & Water in the cell is present in the following concentration A. 45% to 55% B.56% to 57% C.58% to 59% D.60% to 70% E..71% to 80%” VW #Guyton #Siyapaa Water. The principal fluid medium of the cell is water, which is present in most cells, except for fat cells, inaleon- ERC, Many cellular chemicals are dissolved in the water. Others are suspended in the water as solid particulates. Chemical reactions take place among the dissolved chemicals or at the surfaces of the suspended particles or membranes. insu com to fc prov asele Abdul Wahab premignant lesion of oral cavity a) oral submucosal fibrosis b) erythroplakiav Vv VW #Areejkhannotes #Siyapaa Premalignant esionsGS Abdul Wahab & The clinical features of primary hypothyroidism include A. carpal tunnel syndrome and distal myopathy . B. cold sensitivity and amenhorhea C. Vertigo. D. puffy eyelids and malar flush WWW E. absent ankle tendon reflexes . Other features are proximal myopathy,menorrhagia, dec ankle tendon reflex #Davidson #Siyapaa sulphate, resulting in a low-pitched voice, poor hearing, slurred ‘speech due to a large tongue, and compression of the median nerve at the wrist (carpal tunnel syndrome). Infiltration of the dermis gives rise to non-pitting oedema (myxoedema), which is most marked in the skin of the hands, feet and eyelids. Most cases of hypothyroidism are not cinically obvious, however, and a high index of suspicion needs to be maintained so that the diagnosis is not overlooked in individuals complaining of non-specific symptoms such as tiredness, weight gain, depression or carpal tunnel syndrome.G Abdul Wahab & Anterior and posterior spinal arteries arise from a. Vertebral and PICA respectively VVV b. Vertebral and basilar arteries #SiyapaaAbdul Wahab Regarding coronary blood flow A.increases with increase in heart ratev VV B.decreases with increase in heart rate #Guyton #Siyapaa Abdul Wahab i #A As coronary Flow is mainly due to local metabolites during diasystol Inc in HR cause Inc in coronary flow Zaid Khan #Guyton #Siyapaa Control of Coronary Blood Flow Local Muscle Metabolism ls the Primary Controller ‘of Coronary Flow This local Mlentical body, espe coronary blood flow is almos ccurring in many other tissues of the the sheletal muscles,Abdul Wahab & #A As coronary Flow is mainly due to local metabolites during diasystol Inc in HR cause Inc in coronary flow Zaid Khan #Guyton #Siyapaa Control of Coronary Blood Flow Local Muscle Metabolism Is the Primary Controller of Coronary Flow nutritional needs of cardiac muscle. That is, This local regulation of coronary blood flow is almost identical to that occurring in many other tissues of the body, especially in the skeletal muscles.e Abdul Wahab 1 Not present in lung hamartoma? Coin lesionv Vv Ww Cartilage in lesion area 3 most radio sensitive Lymph nodev ~W Bone Brain #SiyapaaG Abdul Wahab & 1 what is seen in dysplasia A)pleomorphismv VW W B)inc nuclear to cytoplasm ratio 2- dysplasia is recognized by A)dyskeratosis B)loss of polaeity and architecturey VW C)pleomorphism 3)diagnostic criteria for premalignant condition... pleomorphism mitotic figures increse nuclear cytoplasmicV VW W ratio ~.G Abdul Wahab which of the following is not neoplasia A. Choriostoma VW VW W B. Leiomyoma #Robbins #Siyapaa eee Se ee ete eeeAbdul Wahab In a patient of drowning following will be found: A/ pulmonary edema B/ respiratory acidosis C/ respiratory alkalosis D/ metabolic acidosisv V W Hypoxemia is followed by pulmonary oedema #Davidson #Siyapaa Clinical features Acute lung injury usually resolves rapidly over 48 72 hours, unless infection occurs (Fig. 9.6). Gomplications include dehydration, hypotension, haemoptysis, rhabdomyolysis, renal failure and cardiac arrhythmias. A small number of patients, mainly the more severely ill, progress to develop the acute respiratory distress syndrome (ARDS; p. 198). Survival is possible after immersion for up to 30 minutes in very cold water, as the rapid development of hypothermia after immersion may be protective, particularly in children Long-term outcome depends on the severity of the cerebral hypoxic injury and is predicted by the duration of immersion, delay in resuscitation, intensity of acidosis and the presence of cardiac arrest.Abdul Wahab & One mcq says ..... Broder classification of tumor depends upon A. differentiation B. mitosis C. Grading on histopathologyYy VW W #Oxfordplasticsurgry #Siyapaa Broder's classification QUICK REFERENCE Histological grading of tumours: + Grade 1: well differentiated.» Grade 2: moderately differer + Grade 1: well differentiated * Grade 2: moderately differentiated.Abdul Wahab Patients with acute liver disease the best prognostic factor is Serum albumin Serum afp Serum bilirubin Factor V estimationy V Vv #Davidson #Siyapaa Investigations The patient should be investigated to determine the cause of the liver failure and the prognosis (Boxes 22.10 and 22.11). Hepatitis B core IgM antibody is the best screening test for acute hepatitis B infection, as liver damage is due to the immunological response to the virus, which has often been eliminated, and the test for hepatitis B surface antigen (HBsAg) may be negative. The PT rapidly becomes prolonged as coagulation factor synthesis fails; this is the laboratory test of greatest prognostic value and should be carried out at least twice daily.Abdul Wahab 65 years old patient comes with progressive memory loss ,His wife complains that he has creative stories about neighbours which cause problem what is most likely diagnosis A Alzheimer disease b Korsakoff psychosisW VW W #Davidson #Siyapaa This is a rare but important indirect complication of chronic alcohol misuse. It is an organic brain disorder resulting from damage to the mamillary bodies, dorsomedial nuclei of the thalamus and adjacent areas of periventricular grey matter caused by a deficiency of thiamin (vitamin B,). The syndrome most commonly results from long-standing heavy drinking and ‘an inadequate diet but can also arise from malabsorption or even protracted vomiting. Wernicke's encephalopathy (nystagmus or ophthalmoplegia with ataxia and delirium) often presents acutely and, without prompt treatment (see below), can progress and become irreversible. Kors )Abdul Wahab & glucose and aminoacid absorption in intestinal cells? ? facilitated diffusion Secondary active transportv Vv Ww #Guyton #SiyapaaGS Abdul Wahab Most imp enzyem secreted in gastric juice A.pepsin B.pepsinogen V Vv Ww #Guyton #Siyapaa PEP UC SO TCS COS OF IE BAST IS BATS, VEIT SU; aT the pepsinogens perform the same functions.Abdul Wahab s True about monocyte is: A. Contain granule in cytoplasm B. Arise from lymphoid tissue C. Inhibited by cytokines. D. Leaves blood to enter tissue and then re enter blood. VWW W #Siyapaa #Davidson Monocytes Monocytes are the largest of the white cells, with a diameter of 12-20 yum and an irregular nucleus in abundant pale blue cytoplasm containing occasional cytoplasmic vacuoles. where they become macrophages, Kupffer cells or antigen-presenting dendritic cells. The former phagocytose debris, apoptotic cells and microorganisms (see Box 4.1, p. 64).e Abdul Wahab TPN c/i ?? A. Liver failure vv Ww B.DM Uncompnstaed DM > Liver > DM #Siyapaa AA.Abdul Wahab The poaterior division of superior, middle& inferiro trunck give A.radia nerve WV VV B.ulner nerve c.median nerve D.axillary nerve A &D both are right but largest branch is radial #rjlast #Siyapaa ‘whole plemts. It crosses the lower border of the posterior axillary wall, lying on the glistening tendon of latissimus dorsi (Fig. 2.16). It passes out of sight through the triangular space below the lower border of this tendon as it lies in front of teres major, between the long head of triceps and the humerus (Figs 2.9 and 2,17). Before disappearing it gives nerves of supply to the long head of triceps and the medial head (a nerve which accompanies the ulnar nerve along the medial side of the arm) and a cutaneous branch which supplies the skin along the posterior surface of the arm (posterior cutaneous nerve of the arm).S Abdul Wahab & A patient has anemia, hyper- segmented Neutrophils on peripheral blood examination & neurological manifestations. Which type of anemia he is suffering from? A. Folic acid deficiency anemia B. Iron deficiency anemia C. Pernicious anemiaW VW VW 0. Thalasemia E. Autoimmune hemolytic anemia Neurological involment is in pernicious/b12 def anemia #Robbins #SiyapaaG Abdul Wahab Q.no.158: Immediate response of body to heat production by cold is ? a) Hunger b) Shivering c) Increased release of Catecholamines VV W #Guyton #Siyapaa Temperature-Increasing Mecharisms When the Body Is Too Cold w 3 “standing on pathetic simulation causes the arrector pliAbdul Wahab Medial geniculate body lies on? Midbrain VW Vv Ww Or Thalamus #rjlast #Siyapaa The mass of grey matter making up the thalamus is roughly wedge-shaped. The medial walls of the two thalami lie parallel, near each other across the third ventricle, where in two-thirds of cases they are joined by the interthalamic adhesion. Behind this the medial surface diverges from the midline and expands into a large posterior convexity, the pulvinar; the lateral geniculate body (see p, 465) bulges down from its lateral part (Figs 7.4 and 7.20). [heiedialigenieulate’body, a thalamic nucleus which relays auditory impulses, is separated from the main mass of the thalamus and Hi@SUGiilltlie IGLFAM. It receives fibres from the cochlear nerves by way of the nuclei of the nerves and the lateral lermiscus, and relays them through the sublentiform part of the internal capsule to the auditory cortex in the temporal lobe.Abdul Wahab Internal jugular vein when it passes from jugular foramen its imediate relation with A. Sternocledomastoid B.Trocher nerve C.Acessory nerve d internal carotid artery WW VW #rjlast #Siyapaa Internal jugular vein ‘The internal jugular vein emerges from the jugular bulb at the posterior ‘ramen (Eigs6:3S) Ahi eee CAAA i Lee on the transverse process ofthe ibeary, jut nus passing buck lateral or medial t the glossopharyngeal, agus soc accexsory nerves, The vein passce down gain fc Lateral side of Artie eral cared arery fae tha te Soman carotid anor, wit hs Toone lata part of he carol abet with ds ages rerve deeply placed between the sein and the aries. in he lower part of is course the vein is overlaid bythe sleping strmecleidomestoid. Deep cervical lymph nde within th sheath are closely pout tx cil fet i onaon. i yomecarsadlns loo Ge curveal ples ogc levator scapuiae and sealers medius, and the phrenic nerve on saletus antrir. The dracfe dact crosses behind te left vein at the level of C7 vertebra, The inferior root ofthe asa cervealis curs round its lateral border, to unite with the superior root (from the hypoglossal nerve) at a variable level in front of the Low down the tendon of omohyoid crosses the vein, providing a useful snide 1 its position The terminal part ofthe vein lies deep 19 the wiangular interval between the Stemal and clavicular heads of sormclsidomnstoid (Fig. 62). It joins the subclavian to form the “tachiovephalic vein behind he sera! ead of clavicleAbdul Wahab s Q:heart failure commonly associated wth or due to? 1.fibrinious pericarditis vWV W 2.hemopericardium 3.pericardial effusion #Robbins #Siyapaa * Pericarditis, Transmural Mis can elicit a fibrinohemor- (Fig. 10-14, D). Heralded by anterior chest pain and a pericardial fric- tion rub, pericarditis typically appears 2 to 3 days after infarction and then gradually resolves over the next few days. Extensive infarcts or severe pericardial inflamma- tion occasionally can lead to large effusions or can orga- nize to form de adhesions that eventually manifest as a constrictive lesion. om tome on en 1 6 gm,Abdul Wahab = The phrenic nerve mainly formed by A.C3 BC4AVVV C.C3 &c4 #Rijlast #Siyapaa verdcally over the obliguty of the scalemis tncior muscle, pasting ftom lntrl tral borders, beneath the prevertebral fascia, lateral to the ascending cervical branch of the inferior thyroid artery. It passes behind the subclavian vein into the mediastinum (see p_195). It may bee Abdul Wahab Anterior relation of right kidney A liver VV Vv B 2nd part of duodenum Major portion by liver #Siyapaa Renal Inferior Aorta Renal R L artery vena vein cava 'Abdul Wahab Acute endocarditis is caused by. S.Aureus. VW VW Viridins. #Davidson #Siyapaa Microbiology Over three-quarters of cases are caused by streptococci or staphylococci. endocarditis (Box 16.94). Other organisms, including Enterococcus faecalis, E. faecium and Strep. gallolyticus subsp. galiolyticus (previously known as Strep. bovis), may enter the blood from the bowelor urinary tract. Patients who are found to have endocarditis caused by Strep. gallolyticus should undergo colonoscopy, since this organism is associated with large-bowel malignancy. common cause of acute endocarditis. It originates from skine Abdul Wahab & Hartmann pouch feature? Present in pathologicaly VW Ww conditions of gal blader Most common site for perforation of gall bladder Common site of stone obstruction #rjlast #Siyapaa ariations are common). The wall of the neck where it joins the eystic duct may show a sma, associated with a pathological condition; it may be the site of impaction of a gallstone “he fundus and body of the gallbladder are usually firmly bound to the undersurface of the liverAbdul Wahab Which passes infront of flexor retinaculum A.ulnar arery VV VW B.radial artery C.brachial artery D.deep branch of median nerve #Rjlast #Siyap Figure 2.39 Left carpal tumel, looking distally towards the palm For clarity the terdons and median nerve have been separated fom each other, in life they are closely packed in the tunnel The synovial sheath of tx finger Mexors is open towards the radial side allowing the access of blood vessels to the tenons, "The ulnar nerve lies on the front of the retinaculum Jateral to the pisiform bone, with the ulnar artery lateral to the nerve. The ulnar artery and nerv her lender band of fascia, forming the canal of Guyon in which the nerve may essed. The tendon of palmaris Tongus is partly adherent to the anterior surfict jum, and thenar and hypotherar muscles arise partly from it.The retinaculum is also crossed superficially by the palmar cutaneous branches of the ulnar and median nerves lying medial and lateral, respectively, to the tendon, The superficial palmar branch ofthe radial artery lies on the retinaculum firther laterallyAbdul Wahab In new born there is regurgitation of milk and pouring of saliva.diagnosis is Dudenal atresia Pyloric stenosis Esophageal atresiaw Vv VW #1staid #Siyapaa Tracheoesophageal anomaliesAbdul Wahab Corpus striatum is A. Amygaloid nucleus + globos pallidus B. Amygaloid nucleus + lentiform C. Amygaloid nucleus + putamen D. Caudate nucleus + putamen E. Caudate nucleus + putamen+ Globos pallidus WV YW Cauduate + (putament + Globos pallidus = lentifrom) =corpus striatum #rjlast #Siyapaa of grey matter and also by cavities which contain the CSF. The largest such mass of cells is the thalamus; it belongs tothe diencephalon and is described on page 470. Other cell groups lie lateral to the thalamus within the cerebral hemisphere and some of them constitute the basal muclei (also called basal ganglia). They are usually classified anatomically as consisting of the eavdate nucleus, minginold boy and wustrum. The caudate nucleus and the Tentiform nucleus arc separated by the internal ci below). The caudate micleus and the putamen part of the Ieniiform nucleus are joined by ercomecting fibres, which pass through the anterior part of the intemal capsule, giving the area a stricted appearance. Theveatdateeniicteus corpus striatum,Abdul Wahab s Migratory thrombophelbitis seen in... Acute pancreatitis chronic pancreatits pancreatic tumor VV W gastric carcinoma #1staid #SiyapaaAbdul Wahab Superficial dorsal vein of penis drains into A. Great saphenous vein VW VW W B. Femoral vein #rjlast #Siyapaa Blood supply The penis receives three pairs of arteries which are branches of the internal pudendals (see p. 309) The artery to the bulb supplies the corpus spongiosum, including the glans, The deep artery of the penis supplies the corpus cavernosum. The dorsal artery supplies skin, fascia and glans, There is anastomosis, via the continuity of corpus spongiosum and glans, between the artery of the bulb and the dorsal artery, the deep arteries supply the corpora cavernosa only. The skin of the penis is also supplied by the superficial external pudendal branches of the femoral arteries. Venous return from the corpora is partly by way of veins that accompany the arteries and join the internal pudendal veins, but mostly by the deep dorsal vein which pierces the suspensory ligament, passes above the perineal membrane and enters the vesicoprastatic venous plexus. The superficial vein drains the dorsal skin of the penis and divides to join the superficial external pudendal ies of the great saphenous veitAbdul Wahab Itching in scabies is caused by A. Mites moving on surface of skin. B. Hypersensitivity reaction Ww VW C. Mites moving by shedding protein Hypersensitvty type 4 due to crwaling of mites at night & shedding of excreta I,l agree with you but only crawling wont make suffient effect Options are poor recall though #Harrison #SiyapaaAbdul Wahab Blood supply of parathyroid gland Inf thyroid artery WV” Ww Suptinf thyroid artery If there is option anstomosis between inf & sup thyroid artery click that #rjlast #Siyapaa Parathyroid glands The small parathyroid glands normally lie behind the lobes of the thyroid gland. There are usually four glands (in 90% of subjects), 1wo on each side, Each weighs about 50 mg. The superior gland is the more constant in position, itis usually within the thyroid’s pretracheal the of the back of the thyroid lobe, level with the first tracheal ring and ¥y. The inferior gland is less constant in position. It is ually within behind the lower pole: but it may be in the gland itself. or outside the able position in the neck, or in the superior or posterior mediastinum. The lands are not necessarily on the same level on each side. They are brownish-yellow, which helps to distinguish them from the deep red of the thyroid gland. They are easily subject to subcapsular haematoma formation on handling, food supply upper and lower parathyroids are usually supplied by the inferior thyroid artery, otherwise by an is between the superior and inferior arteries. Their minute veins join thyroid veins,Abdul Wahab & trachea begins at level of .. A.cricoid cartilagev VW Ww B.c4 vertebra Explnation C6/cricoid cartilage #rjlast #siyapaa The trachea (Fig 6.5) begins at the level of C6 vertebra in continuity with the larynx, being attached the lower margin of the cricoid cartilage by the cricotracheal ligament. Of the total length of 10 cm, em are in the neck from the cricoid cartilage to the jugular notch. From thi the trachea passes into the thorax. +n = 1Abdul Wahab In acanthosis, target layer is Basal Corneum Granulosum Spinosumv VV vw #1staid #Siyapaa Dermatologic microscopic terms TON GURACTRTS Dans Hyperkeratosis 1 thickness of stratum comeum Psoriasis, calluses Parakeratosis Retention of nuclei in stratum cormeum Psoriasis Hypergranulosis 1 thickness of stratum granulosim Lichen planus Spongiosis Epidermal accumulation of edematous fluid in Eczematous dermatitis Acantholysis m ‘Acanthosis Epidermal hyperplasia (t spinosum) NGHNTOR 1 gricas epidermal cells Pemphigus vulgarisAbdul Wahab Commonest cause of hospital acquired pneumonia Staph aureus (overall hospital aquired > pseudomonas (ds is mostly icu related & venttilator #Levinson #Siyapaa emer ater EET £ pneumon we PrarramB Not satisfactry though 1.plasma membrane blebs VW 2.mitochondrial swelling #Robbins #Siyapaa more pronounced with progression to necrosis (described further on). The intracellular changes associated with reversible inj (Fa. 1-6) nce () plas membrafe alerations sch a blebbing, blunting, or distortion of intercellular attachments; (2) d the appearance of phospholipid-rich amor- phous densities; (3) dilation of the ER with detachment of ribosomes and dissociation of polysomes; and (4) nuclear alterations, with clumping of chromatin. The cytoplasm may contain phospholipid masses, called myelin figures, which are derived from damaged cellular membranes.Abdul Wahab 10 yr old with neck rigidity and fever. 1- S pneumonia 2-N meningitis VW #Davidson #Siyapaa . 25.63 Bacterial causes of menit Neonate Gram-negative bacilli Listeria monocytogenes (Escherichia coli, Proteus) | Group Bstreptococci = B streptococci | Pre-school Haemophilus influenzae Mycobacterium ——| Haemophilus influenzae Mycobacterium child Neisseria meningitidis tuberculosis (subtypes B, C, Y, W) Streptococcus [peu | Older child WAm@ningiHGISTSUBWYBeS) L. monocytogenes | child L. monocytogenes and adult M. tuberculosis Staphylococcus aureus (Skull fracture) H. influenzaeAbdul Wahab & dysplasia is recognised by A dyskeratosis B Loss of polarity and architecture of cellV VV C Pleomorphism 1st thing should b def That is B Acco to robbin If asked comon presnting feature that is C #Robbins SSS Figure 5-6 no orderly difes ane of another region shows failure of normal differentiation, marked nuclear 2 the surface. The intact basement membrane (below) is not seen in this sect proliferation. Dysplasia is encountered principally in epi- thelial lesionsAbdul Wahab platelets are contraindicated in ITPWVV spleenomegaly #Medscape No evidence of pletelet transfusin in ITp in #davidson #Siyapaa Platelet transfusions in patients with autoimmune destruction of platelets such as ITP should not be transfused in the absence of bleeding because the transfused platelets will be quickly removed similarly to the patient’s own platelets without clinical benefit. an mateG Abdul Wahab Following is not a cause of DIC? a.pre eclampsia b.amniotic fluid embolism c.cervical carcinomav VV Vv d.abruptio placentae e.PPH #Davidson #Siyapaa ch 23.68 Disseminated intravascular coagulation (DIC) Underlying conditions Infection/sepsis © Trauma Obstetric, e.o. amniotic fluid embolism, placental abruption Severe liver failure Malignancy, €.g. solid tumours and leukaemias Tissue destruction, e.g. pancreatitis, burns Vascular abnormalities, e.g. vascular aneurysms, liver haemangiomas Toxic/immunological, e.g. ABO incompatibility, snake bites, recreational drugsAbdul Wahab Carcinoma of protate which lobe involved? Posterior VWWV V Lateral #1staid #SiyapaaAbdul Wahab mean arterial pressure below 60mmbhg activate? 1- baroreceptor 2- CNS ischemic responsev V V W #Guyton #Siyapaa Importance of the CNS Ischemic Response as a Regulator of Arterial Pressure. Despite the power- ful nature of the CNS ischemic response, it does not become significant and below, reachin; its greatest degree of stimulation ae Therefore, it is not one of the normal mecha- m: regulating arterial pressure. Instead, it oper- ate: ipally as rther able. the a on th thetic veins press muct becat cles t hypo etal ne Abdul Wahab lron deficiency anemia is best diagnosed by, A. Serum iron+ increase TIBC B. Serum ferritin’ VW WW #Davidson #Siyapaa Investigations Confirmation of iron deficiency ‘Serum ferritin is a measure of iron stores in tissues and is the Bestisingleltest\tolcontinnliron|dsticieney (Sox 23.0). It is ae Abdul Wahab Iron deficiency anemia is best diagnosed by, A. Serum iron+ increase TIBC B. Serum ferritin’ VW WW #Davidson #Siyapaa Investigations Confirmation of iron deficiency ‘Serum ferritin is a measure of iron stores in tissues and is the Bestisingleliest\tolcontinnliron|dsticieney (Sox 25.30). It is aG Abdul Wahab & Simple cuboidal epithelium is preseng kn a) ducts of salivary glands ¥vW Vv b) lining of git c) renal calyces d) none Intercalated dics of salivry glands have simpl cuboidal epi #Siyapaa Like ReplyG Abdul Wahab w Which of the following structure damaged in thyroidectomy A. Recurrent laryngeal nerveY V WV B. External laryngeal nerve A>B #Generalsurgry #Lippincott #Siyapaa Tubercle of Zuckerkandl Like Reply OO:Abdul Wahab = 1. Knee jerk loss due to lesion of A.L1 B.L2 C.1L3WVV Vv D.L4 E.L5 Alone L3 Combo L3,L4 #Rjlast #Siyapaa ‘powtsrior neckand slin over paretid Jar region (io mamabriosieral jmncvon),sboulder andabove Seapalar§ IMidale fingers (CR [Lite finger and dist medial forearm 12 |ewr abdomen, upper batock ILI [Suprapabic anf inguinal regions. pens, anerior scrotum (abla), upper butock terior thigh, une butock