free medical notes !

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Its from my wast collection of notes!
To start with i will post some qns and ans with relevant explanations!

1. Q Usual site for TB bursitis is?
   1 Prepatellar
   2 subdeltoid
   3 trochanteric
   4 subpatellar

A bursa may get infected by a pyogenic or tubercular infection. It occurs commonly in trochanteric bursa or prepatellar bursa

2. Most common glial tumour

1. astrocytoma

2. medulloblastoma
3. neurofibroma
4. ependymoma

Astrocytoma is the commonest glial tumor

3. Measures of central tendency are all ,except

1.mean

2median

3 mode

4mean deviation

ans 4

4 . AFP surveillance include all ,except

1.polio

2.GBS

3.traumatic neuritis

4.spastic CP

ans 4 AFP include paralytic diseases / Flaccid = absence of spasticity!

5. most common site of otosclerosis

1.oval window

2. round wimdow

3.semicircular canals

4.promontry

ans.1 The most common site of involvement in otosclerosis is the anterior oval window near the fistula ante fenestrum

6. Optimum treatment in a patient with c/c hepatitis B whose serum AST are elevated

1. Lamivudine

2 Lamivudine+interferon

3 interferon

4 immunoglobulin

ans .(1) for c/c hepatitis B either Lamivudine / interferon …combination gives no added advantage.! Lamivudine BETTER TOLERATED.

For c/c hepatitis C ,Ribaverin+ Peginterferon [long acting interferon]

6. can be given in renal failure ,all except

1.tobramycin

2.erythromycin

3doxicyclin

4.penicillin G

ans. 4.penicillin G has very rapid RENAL EXCRETION,ie 10% glomerular filtration and remaining 90% by tubular secretion

Erythromycin excreted primarily in BILE .NOTE..renal excretion is only minor.

7.streptomycin NOT useful for ,

1.brucellosis

2.syphilis

3.tularemia

4.plague

ans.2. streptomycin SENSITIVE organisms,

1. H.ducreyi

2. Brucella

3.Yersinia pestis

4. Francisella tulerensis

5. Nocardia

6. Calym.granulomatis

7. M.tuberculosis

Terfenadine is a prodrug, generally completely metabolised to the active form fexofenadine by intestinal CYP3A4

Risk of cardiac arrhythmia caused by QT interval prolongation

8.Which of the following cause absorptive defect of iron

1.antacid

2.anticonvulsants

3.tetracyclins

4.neomycin

ans.1 and 3 !

Factors impending iron absorption

1. Phytate
2. Tannates
3. Phosphates(rich in egg yolk)
4. Tetracyclins

A,b,c,&d decrease absorption by forming COMPLEX with IRON

e. Antacids àrender iron INSOLUBLE and heb=nce decrease absorption.

9.following interfere with cellwall synthesis.,except

1.bacitracin

2.cycloserine

3.polymyxin B

4.cephalosporin

ans.3 Polypeptide antibioticsàPolymyxin B & Colistin àbactericidalà detergent like action on cell membrane

Cycloserineà antiT.Bà inhibit CELL WALL synthesis by inactivating the enzymes which recemize L-alanine & link two D- alanine residues.

Drug interactions of MAO inhibitors eg Moclobamide,Clorgiline.

1]Cold and cough remedies --contain ephedrine/other sympathomimetics-->risk of HYPERTENSIVE crisis

2]Reserpine,Guanethidine,TCA*(TriCyclic Antidepressent

--excitement,increase in B.p & body temperature

3]Levodopa

--excitement and hypertension

4]Anticholinergic- Antiparkinsonian drugs

--risk of hallucination

5]Antihistaminics,Barbiturates,Alcohol,Opioids

--action of these drugs PROLONGED,risk of respiratory depression. 6]Pethidine -- risk of high fever,sweating,excitment,delirium,convulsions,respiratory depression.(because MAO inhibitors retard metabolism of pethidine ,but NOT its demethylation,therefore excess Norpethidine formed)

10.ototoxicity caused by all ,except

1. ethacrinic acid

2. chloramphenicol

3. streptomycin

4. vancomycin

best ans here is [2],chloramphenicol

main side effects of ,chloramphenicol are,

1] bone marrow depression

2] hypersensitivity reactions

3] g.i symptoms

4] super infections

5] GREY BABY SYNDROME

Benzthine penicillinà longest acting penicilinà upto 2 to 4 weeks,there fore useful for prophylactic purposes,

Lupus like* / Rheumatoid arthritis like symptoms is a side effect of HYDRALAZINE(directly acting ARTERIOLAR Dilator)

--seen in prolonged use

--more common in women & slow acetylators

Pharmaco Kinetics of Ampicillin

--ACID STABLE**

--oral absorption NOT comlete, but ADEQUATE

--FOOD interfere with absorption

--partly excreated in Bile and Reabsorbedàenterohepatic circulation present

--BUT,primary channel for excretion is KIDNEY!

11. Narcotic overdose cause all;except

1.hypotension

2.depressed reflexes

3.coma

4.dilated pupils

ans.4

More-distinct symptoms of overdose from narcotics are:

• Cold, Clammy Skin
• Miosis ( d/to direct stimulation of Edinger Westphal nucleus;there fore no miosis if applied topically over eyes!)
• Labored Breathing
• Decreased Pulse( d/to stimulation of VAGUSà bradycardia)
• Low Blood Pressure
• Convulsions
• Increased Sweating
• Blisters
• Confusion
• Delirium
• Deep Sleep or Loss of Consciousness

Mech.of action of Valproic acid

1] phenytoin like actionàfrequency dependent prolongation of Na+ channel inactivation

2] ethosuximide like actionà attenuation of Ca++ mediated T current

3] augmentation of release of INHIBITORY transmitter GABA ( d/to inhibition of GABA transaminase and there preventing degradation of GABA)**

Most Ototoxic aminoglycoside(Cochleotoxic)**

Neomycin**: This agent is one of the most cochleotoxic aminoglycosides when administered orally and in high doses; therefore, systemic use generally is not recommended.

Kanamycin: Although less toxic than neomycin, kanamycin is quite ototoxic. Kanamycin has a propensity to cause profound cochlear hair cell damage, marked high-frequency hearing loss, and complete deafness. The damaging effect is primarily to the cochlea, while the vestibular system is usually spared injury

12] Pasturization is not effective to kill,

1. brucella

2. coxiella

3. mycobacterium

4. salmonella

ans .4 pasturization effectively kills 90% of bacteriae more ,including heat resistant mycobacterium & coxiella(Q fever)

NOT effective against thermoduric bacteriae and SPORES!

13] drug11] Drug of choice for allergic broncho -pulmonary aspergillosisaspergillosis is

1. prednisolone

2. ketoconazole

3. griseofulvin

4. fluconazole

ans; [1] prednisolone

Most common site of iron absorptionà duodenum

Most common site of vit B 12 absorption-à ileum

14] what is associated with tuberculosis

1. silicosis
2. asbestosis
3. bagassosis
4. bysinosis

ans ; [ 1 ] silicosis ( silico tuberculosis )

Sertoli cell tumourà defeminizing/ virilizing

Granulosa cell tumourrà main C/F due to estrogen

15] drug used for management of ECTOPIC pregnancy?

1. methotrexate

2. mifepristone

3. cytosine arabinoside

4. procarbazine

ans; [1] metotrexate N.B mifepristone also useful!!!

Complete breechà Flexed breechà m.c in Multipara

Incomplete breech (3 types 1]extended breech/ frank breechàm.c in primi

2] footling presentation

3] knee presentation

16] Bony ankylosis is seen in ,

1. TB arthritis

2. septic arthritis

3. psoriatic arthritis

4. rheumatoid arthritis

ans [2] septic arthritis

TB arthritis , mostly result in FIBROUS ANKYLOSIS,except in SPINE(bony ankylosis)

17] All the following complications of otitis media are extra cranial,except;

1. citelli’s abscess

2. bezold’

3. peri sinus

4. Luc’s

ans [3] perisinus

Otitis media, complications are two ;

[1] Intra temporal

a. mastiditis(N.B abscesses in relation to mastoid are ;Post –auricular =most coomon, Zygomatic , Bezold’s abscess= pus breaks through the tip of mastoid into the sheath of sternomastoid;swelling seen in upper part of neck, Citelli’s abscess= swelling in digastric triangle, Luc’s abscess = meatal abscess;swelling seen in deep part of bony meatus,abscess behind the mastoid)

b. petrositis

c. facial palsy

d. labyrinthitis

[2] intra cranial**

a.extra dural abscess

b.sub dural abscess

c. meningitis

d. brain abscess

e. lateral sinus thrombophlebitis

f. (otitis) hydricephalus

Mycotic-- corneal ulcer-à Feathery finger like extension

----------------------à sterile immune ring

----------------------à satellite lesions

----------------------à BIG hypopyon

Herpes simplex ---------------à Dendritic ulcer **

---------------à geographical ulcer

---------------à disciform keratitis

---------------à diffuse stromal necrotic keratitis

Mooran’s ulcer( C/c serpiginous ulcer/ Rodent ulcer)

-----------------. Two types; benign & virulent

----------------- exact etiology NOT known; autoimmune?

Ulcer serpens-------------------à Pneumococci

18] Phaco emulsification is done with

1. Laser

2. Ultra sound

3. cryo

4. UV

ans; 2] Ultrasound

Phacoemulsifier acts through a hollow 1 mm. titanium needle,which vibrates @ ultrasound speed of 40,000 times a second.

Trachoma

Conjunctival Follicles & Hebert’s follicle(corneal) + Hebert’s pits

Papillaà contain Leber’s cells = multinucleated cells

Pannus

Conjunctival scarring = Arlt’s line

Vernal Kerato Conjunctivitis

Cobble stone arrangement** of papilla

N.B NO follicles in V.K.C

Gelatinous Limbal membrane

Tantra spots

Dusky red triangular congestion

Maxwell Lyon sign -à stringy / ropy discharge

19] Drug which is topically useful in taeia cruis

1. Fluconazole

2. Griseofulvin

3. Terbinafin

4. Nystatin

ans; [3] Terbinafin

Terbinafin

New allyl amine class of antifungal

Both,orally and topically effective against,dermatophytes and candida

Incontrast to Azoles, which are FungiSTATIC;Terbinafin is FungiCIDAL

Mech Of Action; non competitive inhibitor of Squalene Epoxide:an early step enzyme in the biosynthesis of Ergosterol.Accumulation of Squalene,leads to fungicidal properties.

20] Fatal dose of radiation:

1. 1 rad

2. 5 rads

3. 50 rads

4. 500 rads

ans; [4] ie 500 rads

@ dose of > 100 Gy , death occur in 24 to 48 hrs , due to Neurologic and Cardiovascular failureà Cardio vascular syndrome

@ dose of 5 to 12 Gy , death may occur in a matter of days à G.I syndrome.

A/c pancreatitisà plain X- ray, shows -----localsed ileus of Jejunum**à Sentinal Loop

----- Colon Cut Off sign

chronic pancreatitis:

ERCP findings--.diffuse ductal dilatationà"chain-of-lakes"

Window period in hepatits B

Antibody??

Total anti-HBc antibodies. Anti-HBc antibodies are directed against a viral capsid epitope or core antigen. They appear early during infection and remain detectable for life, whatever the outcome of infection. They can be present in the absence of both HBsAg and anti-HBs antibodies, during the convalescent period following acute hepatitis B before the appearance of anti-HBs antibodies, or in patients who resolved infection but lost detectable anti-HBs antibodies. Anti-HBc is therefore detected in anyone who has been infected with HBV.

Atrial natriuretic peptide inhibits renin release from juxtaglomerular cells by a cGMP-mediated process.

types of thyroplasty:

I-Medialization
II-Lateralization
III-Shortening
IV-Lengthening

(M)”Men Like Short Ladies”

A distended, palpable but nontender gallbladder in a jaundiced patient (Courvoisier's sign) à C.A Pancrease(mainly)

N.B C/c cholecystitis,leads to fibrosis,so gall bladder NOT palpable!

Carvallo's sign

The increase in the intensity of the pansystolic murmur of tricuspid regurgitation during inspiration. This distinguishes tricuspid from mitral involvement.(RINàright sided murmers increase on inspiration)

21] Pheochromcytoma is associated with

1. Café au leit spot
2. Acanthosis nigricans
3. Ash green patches
4. junctional nevus

Ans. [1] Café au leit spots

Bcoz,pheochromocytoma is associated with, MEN 2 syndrome & hence to Von Rechling hausen syn (Neurofibromatosis type 1)

Acanthosis nigricans

“ velvety HYPERPIGMENTATION of Flexoral aspects .

(X’TRA POINT; in adults ,Atopic dermatitis ,also affect Flexoral aspects,in children only, face and extensor surfaces affected)

seen in1] marker of internal malignancy ,especially G.I.Tract.

2] insulin resistence,obesity,DM,Stein levinthal syn,acromegaly &

cushings’ syn.

22] Micro organism causing surgical wound sepsis

1. Staph. Aureus

2. Staph. Epidermidis

3. Streptococcus

4. H.influenza

Ans. [2] Staph. Epidermidis

Coagulase negative Staph,like ,Staph. Epidermidis; are important causes of infection of intravascular and prosthetic devices & wound infection following cardio- thoracic surgeries .

23] In Peutz Jegher’ s syn, skin lesions are,

1. Freckles

2. Lentigines

3. Café au leit

4. Shagreen patch

Ans . Lentigines

Prominent Lentigines ,can be a sign of Carney’s complex à atrial myxoma

à Schwanoma

à endocrine over - activity ie tumors of thyroid/gonads/adrenal nodular hyperplasia

Similar skin pigmentation is also seen in Peutz- Jeghers’ syn!

P-V loop / curve is applied to BOTH LUNG & HEART
When it comes to heart ,

qn P-V curve is shifted to left in
a] MR
b] MS
c] AR
d] AS

ans {d]

P-V curve when applied to heart,its to LEFT VENTRICLE

So Shift to LEFT--> AS
shift to RIGHT --> MR & c/c AR (no change in A/c AR )
In MS,less reliable,still may be shifted to LEFT
So best ans for the qn is AS
In short,PV curve of HEART,
shift to left -->decrease in Compliance
shift to right--> increase in Compliance

opposite is applicable to LUNGS
ie Shift to left --> increase in compliance eg Emphysema
Shift to right --. decrease in compliance eg Pul.fibrosis,Pul congestion