522. For a normal healthy person, the daily requirement of vitamin C is:

A.   10 to 50 mg                              B. 50 to 100 mg

C.   100 to 200 mg                          D. 200 to 300 mg

Which of the following are risk factors for deep venous thrombosis? 1. Duration of surgery more than 30 minutes 2. Prior history of venous thrombosis 3. Age less than forty years 4. Obesity Select the correct answer using the codes given below: Codes:

A.   1, 2 and 3  B. 1, 2 and 4  C. 2, 3 and 4  D. 1, 3 and 4

388.In myasthenia gravis, autoantibodies are directed against which of the following structures?

A.Sarcomere
B.Acetylcholine receptor C.Myocyte nucleus
D.Sarcolemmal membrane  

Ans-B.Acetylcholine receptor

387.Cerebral embolism occurring as a complication of myocardial infarction is MOST indicative of which of the following?

 A.Mural thrombosis
B.     Phlebothrombosis
C.Decreased stroke volume
D.     Lack of collateral circulation

Ans-a.Mural thrombosis

386. Excessive deposits of copper in liver cells, degenerative changes in the brain, and a greenish-brown ring at the outer margin of the cornea characterize which of the following?

 A Galactosemia
B.     Phenylketonuria
C. Wilson's disease
D.     Diabetes mellitus

Ans-c.wilson's disease

385.Which of the following conditions predisposes to lung cancer by causing squamous metaplasia of bronchial epithelium?

 ABronchiectasis
B.     Bronchial asthma
C.Chronic bronchitis
D.     Bronchial carcinoid

Ans-C.Chronic Bronchitis

50.In a obese person, BMI is :

a)>10 b)>20
c)>30 d)>40


ANS: C


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24.Heart failure cells are seen in the following condition

1. CVC lung b.CVC liver c.CVC spleen
   

Ans.(a): Refg. 185/2nd Harish mohan

-CVC of lung occurs in test heart failure especially in rheumatic mitral stenosis so that there is consequent rise in pulmonary venous pressure.

-Histologically the breakdown of erythrocytes liberates haemosiderin pigment which is taken up by alveolar macrophages, so called heart failure cells, present in the alveolar lumina.

-CVC of liver occurs in right heart failure

-cut surface shows “nutmeg liver”.

-microscopically centrilobular haemorrhagic necrosis may be seen.

-CVC of spleen seen in right heart failure

-microscopically gamna-gandy bodies (or) syderofibrotic nodules are seen.

Ref.286/harshamohan.

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18. A wound to the posterior left axillary line, between the ninth and tenth rib, and extending approximately 5 cm deep, will most likely damage

A. Ascending colon B. Duodenum

C. Left kidney D. Spleen

ANS. D.

The spleen follows the long axes of ribs 9 to 11 and lies mostly posterior to the stomach, above the colon, and partly anterior to the kidney. It is attached to the stomach by a broad mesenterial band, the gastrosplemic ligament. Therefore, it is the most likely organ of the group to be pierced by a sharp object penetrating just above rib 10 at the posterior axillary line. Note that the pleural cavity, and possibly the lower part of the inferior lobe of the lung, would be pierced before the spleen. The ascending colon (choice A) is on the wrong side (the right) to be penetrated by a sharp instrument piercing the left side. Most of the duodenum (choice B) is positioned too far to the right to be affected by this injury. Even the third part of the duodenum, which runs from right to left, would still be out of harm's way. In addition, the duodenum lies at about levels L1 to L3, placing it too low to be injured in this case. The superior pole of the left kidney (choice C) is bordered by the lower part of the spleen. However, it is crossed by rib 12 and usually does not extend above rib 11. It would probably be too low and medial to be injured in this case because this penetration is at the posterior axillary line.

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4.

4.Difference between acute pyelonephritis and Uncomplicated UTI are all except

a. Loss of Concentrating ability

b. Presence of White blood casts

c. Presence of Antibody against Tamm-Horsfall proteins of tubules

d. Bacterial colony Count more than 10⁸
---------------------------------------------------

Answer

d. Bacterial colony Count more than 10⁸

Reference:

Harrison 16^th Edition Page 1717

Journal reference :

a. P. LARSSON, A. FASTH, U. JODAL, A. SOHL ÅKERLUND, C. SVANBORG EDÉN (1978) : URINARY TRACT INFECTIONS CAUSED BY PROTEUS MIRABILIS IN CHILDREN The Antibody Response to O and H Antigens and Tamm-Horsfall Protein and Bacterial Adherence to Uro-epithelium . Acta Paediatrica 67 (5), 591–596. doi:10.1111/j.1651-2227.1978.tb17807.x

b. Kidney International (1976) 9, 23–29; doi:10.1038/ki.1976.3. Experimental pyelonephritis: The effect of chronic active pyelonephritis on renal function. Thomas E Miller1, David Layzell1 and Elaine Stewart1

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Discussion

Normal urine is sterile. UTI can therefore be diagnosed if a single viable gram negative bacterium inhabits the urinary tract (kidney, ureters, bladder). In reality, the bacteria causing UTI multiply in log phase growth in normal urine, and most people with urinary tract infection have 10⁴-10⁶ bacteria/ml. The acute number will depend on the urine flow rate, characteristics of the urine, the duration of infection, etc. The problem in diagnosis is that of contamination arising from voided specimens passing through the non-sterile distal urethra. For this reason, clinicians use the criteria of 10⁵ bacteria/ml of “clean catch” urine to diagnose UTI. At this level, < style=""> At counts of 1000-10,000/ml, there is a 50/50 chance the result represents contamination. Such a count may represent true infection, but to be sure a second culture showing the same organism might be more convincing. The second criteria for diagnosing UTI is the presence of pyuria (> 5 WBC/HPF) on the urinalysis.

Explanation

a. A severe loss of urine concentrating capacity was demonstrable when the maximum urinary osmolality of a group of cases with pyelonephritis was compared with controls. Concentrating capacity decreased sharply over the first month but further loss over an eight-month period was minimal.

b. Presence of White blood casts is Pathognomic for Pyelonephritis

c. Presence of Antibody against Tamm-Horsfall proteins of tubules . "An increase in antibody levels against O antigen and Tamm-Horsfall protein was noted only in patients with acute pyelonephritis indicating that antibody determinations can be useful in differentiating between upper and lower urinary tract infection caused by Proteus in similarity to those caused by E. coli"

d. Bacterial colony Count more than 10⁸

Comments : This is what the Journal Says : Sera from seven girls with acute symptomatic pyelonephritis and nine children with acute symptomatic cystitis caused by Proteus mirabilis were analysed for antibodies against the bacterial O and H1 antigens and the Tamm-Horsfall protein. An increase in antibody levels against O antigen and Tamm-Horsfall protein was noted only in patients with acute pyelonephritis indicating that antibody determinations can be useful in differentiating between upper and lower urinary tract infection caused by Proteus in similarity to those caused by E. coli. In contrast no difference in adhesive ability was noted comparing Proteus strains causing acute pyelonephritis or cystitis

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