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*Lipopolysacharides(Bacteria)

LPS bind to "Toll-like receptor"(TLR) (a single Transmembrane receptor)------> activation of

Inhibitory kappa B kinase (IKB kinase)-------> 

Note: NF-kB is a transcription Factor that exist in cytoplasm bound to Inhibitory kappa B (IKB)
protein in Inactive form [NF-kB=IKB]

so continuing the above sequence .. 

LPS----> TLR---->+IKB kinase----->phosphorylation of IKB of the complex[NF-kB=IKB] and now this

phosphorylated IKB get degraded and NF-kB is released----->NF-kB move to Nucleus where it
upregulate gene expression of TNF------>Sepsis 
The Eustachian tube (or auditory tube or pharyngotympanic tube) is a tube that links the
pharynx to the middle ear.

Normally, the Eustachian tube is closed, which helps prevent the inadvertent
contamination of the middle ear space by the normal secretions found in the back of the
nose.

A dysfunctional Eustachian tube that is always open is called a "patulous" Eustachian

tube. Patients with this rare condition are plagued by chronic ear infections. A much more
common problem is a failure of the Eustachian tube to effectively regulate air pressure.
Partial or complete blockage of the Eustachian tube can cause sensations of popping,
clicking, and ear fullness and occasionally moderate to severe ear pain. Young children
may describe the popping sensation as "a tickle in my ear.
Methylparaben
A derivative of PABA {para-aminobenzoic acid)
CCl4--->centrilobular necrosis, fatty chance in liver
the vaccin is produced by recombinant DNA technology,the gene
coding for the HBsag inserted into yeast cells,which then release
this molecule into the culture medium.the molecule is then
purefied and used as the immunogen in the vaccin.

HPV is also produced by recombinant DNA

Q19.B
Prevalance=incidence*disease duration
The most common sources of embolism are proximal leg deep venous thrombosis (DVTs) or pelvic vein thromboses.
Any risk factor for DVT also increases the risk that the venous clot will dislodge and migrate to the lung circulation,
which happens in up to 15% of all DVTs. The conditions are generally regarded as a continuum termed venous
thromboembolism (VTE).
The development of thrombosis is classically due to a group of causes named Virchow's triad (alterations in blood
flow, factors in the vessel wall and factors affecting the properties of the blood). Often, more than one risk factor is
present.
Alterations in blood flow: immobilization (after surgery, injury or long-distance air travel), pregnancy (also
procoagulant), obesity (also procoagulant), cancer (also procoagulant)
Factors in the vessel wall: of limited direct relevance in VTE
Factors affecting the properties of the blood (procoagulant state): 
Estrogen-containing hormonal contraception
Genetic thrombophilia (factor V Leiden, prothrombin mutation G20210A, protein C deficiency, protein S deficiency,
antithrombin deficiency, hyperhomocysteinemia and plasminogen/fibrinolysis disorders)
Acquired thrombophilia (antiphospholipid syndrome, nephrotic syndrome, paroxysmal nocturnal hemoglobinuria)
Cancer (due to secretion of pro-coagulants)

The main indication for thrombolysis is in submassive PE where right ventricular dysfunction can be demonstrated
on echocardiography, and the presence of visible thrombus in the atrium.
In the natural aging process, aortic stenosis often increases afterload
because the left ventricle must overcome the pressure gradient caused
by the calcified and stenotic aortic valve in addition to the blood
pressure in order to eject blood into the aorta
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case control study measures with Odds ratio........a/b/c/d=ad/bc
External Oblique 

The external obliques are also a superficial muscle that is found just
laterally to the rectus abdominus. They originate from the external
surfaces of the lower 8 ribs, and insert into the anterior half of the
outer lip of the iliac crest and the aponeurosis of the anterior
abdominal wall.

Its function includes flexing the trunk (in bilateral contraction),

posterior pelvic tilt, same side flexion, and rotation of the trunk to the
opposite side (during unilateral contraction). The external obliques are
the largest of the abdominal muscles.
Patient has myxoma- most common cardiac tumor in adults
- 90% of them occur in atrium(especially left one)
Myxoma
a neoplasm composed of stellate to plump cytologically bland
mesenchymal cells set in a myxoid stroma.
cytologically bland mesenchymal cells, so-called “myxoma” or “lepidic”
cells .
Myxoma cells are frequently stellate with eosinophilic cytoplasm and
indistinct cell borders. Their ovoid nuclei are typically pale with open
chromatin. Nucleoli may be prominent.
Renal infarct produces gross hematuria...
U can see peripheral wedge shaped infarct in the pic...
That caused her hematuria
Renal infarct is becoz of some embolus...
embolus later lodged in her brain and became cause of her death.
case fatality rate=fatal case/total number of people
with disease
Primary care physicians frequently encounter children with heart
murmurs.1 Most of these young patients do not have heart disease. 

Echocardiography is not always needed to diagnose pediatric murmurs.

direct referral for echocardiography was an expensive way to evaluate
children with heart murmurs. Pediatric cardiology consultation was
significantly less costly in that many innocent murmurs were diagnosed
without echocardiography.
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100% SPECIFICITY...E
100% SENSITIVITY...C
MOST ACCURATE......D
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h influenza chocolate agar with factor V [NAD] and X [hematin]
Rabis....enveloped RNA SS-

Dynein, a motor protein responsible for retrograde axonal

transport, carries vesicles and other cellular products toward the
cell bodies of neurons.
Pelvic inflammatory disease (PID) refers to infection of the uterus
(womb), fallopian tubes (tubes that carry eggs from the ovaries to the
uterus) and other reproductive organs that causes symptoms such as
lower abdominal pain. It is a serious complication of some sexually
transmitted diseases (STDs), especially chlamydia and gonorrhea. PID
can damage the fallopian tubes and tissues in and near the uterus and
ovaries. PID can lead to serious consequences including infertility,
ectopic pregnancy (a pregnancy in the fallopian tube or elsewhere
outside of the womb), abscess formation, and chronic pelvic pain
Probenecid is a uricosuric drug that increases uric acid excretion in the
urine. It is primarily used in treating gout and hyperuricemia.

Mechanism
In the kidneys probenecid is filtered at the glomerulus, secreted in the
proximal tubule and reabsorbed in the distal tubule.

Probenecid works by interfering with the kidney's organic anion

transporter (OAT), which reclaims uric acid from the urine and returns
it to the plasma[5]. If probenecid (an organic acid) is present, the OAT
binds preferentially to it (instead of to uric acid), preventing re-
absorption of the uric acid. Hence, the urine retains more uric acid,
lowering uric acid concentration in the plasma.
Horseshoe kidney, also known as renal fusion, is a congenital disorder affecting about 1
in 400 people
In patients with this condition, the central portion of the kidney may be found just
inferior to the inferior mesenteric artery because the normal embryologic ascent of the
kidneys is arrested by its presence in people with central fusion of the kidneys.

most cases of horseshoe kidneys are asymptomatic and discovered upon autopsy
Rheumatic fever is an inflammatory disease that occurs following a Group A
streptococcal infection, (such as strep throat or scarlet fever). Believed to be caused by
antibody cross-reactivity that can involve the heart, joints, skin, and brain, the illness
typically develops two to three weeks after a streptococcal infection.
Acute rheumatic fever commonly appears in children between the ages of 5 and 17,
with only 20% of first-time attacks occurring in adults.

Aschoff bodies are nodules found in the hearts of individuals with rheumatic
fever.Aschoff bodies are areas of inflammation of the connective tissue of the heart, or
focal interstitial inflammation.
In various situations such as infection, insulin demands rise but are
not matched by the failing pancreas. Blood sugars rise, dehydration
ensues, and resistance to the normal effects of insulin increases
further by way of a vicious circle.(A virtuous circle or a vicious circle is
a complex of events that reinforces itself through a feedback loop)
Cyclosporine is a polypeptide of 11 amino acids of fungal origin and is active against helper T cells,
preventing the production of IL-2 via calcineurin inhibition (binds to cyclophilin protein). This agent is used
for induction and maintenance immunosuppression.

Adverse effects include nephrotoxicity with 3 stages: 

(1) immediate, secondary to renal ischemia; 
(2) 2-3 weeks after transplantation, secondary to renal vasoconstriction; and 
(3) chronic, secondary to interstitial nephritis.

Other adverse effects include hyperkalemia, hypomagnesemia, nausea, vomiting, diarrhea, hypertrichosis,
hirsutism, gingival hyperplasia, hyperlipidemia, glucose intolerance, infection, malignancy, and
hyperuricemia. Hypertrichosis and hirsutism can be alleviated by switching from cyclosporine to tacrolimus,
provided the patient is carefully monitored. Multiple drug interactions are possible, primarily with agents
affecting the cytochrome P-450 system
serotonine syndrome with cheese and MAO inhibitors,

Serotonin syndrome most often occurs when two drugs that affect the body's level of serotonin
are taken together at the same time. The drugs cause too much serotonin to be released or to
remain in the brain area.

few eg-[other than stem]

you can develop this syndrome if you take migraine medicines called triptans together with
antidepressants called selective serotonin reuptake inhibitors (SSRIs) and selective
serotonin/norepinephrine reuptake inhibitors (SSNRIs)
).
Older antidepressants called monoamine oxidase inhibitors (MAOIs) can also cause serotonin
syndrome , as well as meperidine (Demerol, a painkiller) or dextromethorphan (cough medicine)

Drugs of abuse, such as ecstasy and LSD have also been associated with serotonin syndrome
lead poisoning 
lead inhibits delta aminolevulenic acid and ferrochelatase leading to
microcytic anemia
The most common foregut cysts, the bronchogenic cyst and the
esophageal duplication representing abnormal budding of the
vertebral and dorsal primitive foregut, respectively, indicating their
common origin from the primitive foregut and close embryologic
relationship