Symptoms Of Parkinson's Disease - Tremors, Shaking, Stiffness

Symptoms of Parkinson's disease can vary in intensity from one person to the next. You may experience a very mild tremor while someone else may develop symptoms that interfere with his or her ability to walk, talk or complete normal everyday tasks.

Initially the symptoms of Parkinson's disease are mild in everyone stricken with the disease. The first sign may be barely perceptible other than to know something doesn't feel right. For instance, you may develop a small tremor in your little finger that comes and goes or is only noticeable at times

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Celiac Disease Symptoms, Causes, Diagnosis And Treatment

Celiac disease symptoms will vary from person to person and this article will help you sift through the confusing symptoms of celiac disease so you can better understand how to handle this condition. This is primarily a disorder of the small intestine which prevents the absorption of nutrients. With this condition the lining of the small intestine is irritated when an individual eats certain foods that contain ingredients such as gluten, wheat, barley or rye resulting in symptoms that can range from diarrhea to constipation.

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What are Different Types of Gait?

1. Cerebellar gait
The patient has a broad-based gait, reeling and lurching to one side.

2. Parkinsonian gait
The steps are small and shuffling, and the patient walks in haste (festinates). The entire body stoops forwards, knees bent, head hunched forward, and the feet must hurry to keep up with it as if trying to catch up with the centre of gravity. There is associated loss of arm swing and mask-like facies.

3. Hemiplegic gait
The gait is slow. spastic and shuffling. With each step the pelvis is tilted upwards on the involved side to aid in lifting the foot off the ground, and the entire affected limb is circumducted, rotated in a semicircle at the pelvis. The upper limb is flexed, adducted and does not swing, and the lower limb is extended.

4. Sensory ataxia
The feet stamp, the movement of the legs bearing no relation to the position of the legs in space since proprioception is impaired or absent. The patient has to look down at the ground to compensate for the loss of proprioception. The patient walks on a wide base; the feet are lifted too high off the ground and are brought down too vigorously.

5. High-stepping gait
This is usually unilateral and results from foot-drop. The patient has to lift the foot high in order to avoid dragging the forefoot.
It may be due to the following:

Lateral popliteal nerve palsy.
· Poliomyelitis.
· Charcot-Marie-Tooth disease.
· Lead or arsenic poisoning.

6. Scissor gait
This is seen in spastic paraplegia. The adductor spasm may be so severe as to lead to the legs crossing in front of one another. Short steps with the front of the feet clinging to the ground result in a wearing out of the toes of shoes.

7. Waddling gait
The legs are held wide apart and the patient shifts weight from one side to the other as he walks. Comment on the lumbar lordosis. It is seen in advanced pregnancy and proximal weakness (Cushing's syndrome, osteomalacia, thyrotoxicosis, poly-myositis, diabetes, hereditary muscular dystrophies).

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Perepheral Neuropathy Frequently Asked Questions

A few causes of thickened nerves?
· Amyloidosis.
· Charcot-Marie-Tooth disease.
· Leprosy.
· Refsum's disease (retinitis pigmentosa, deafness and cerebellar damage).
· D5j5rine-Sottas disease (hypertrophic peripheral neuropathy).

What are the causes of motor neuropathy?
· Guillain-Barrd syndrome.
· Peroneal muscular atrophy.
· Lead toxicity.
· Porphyria.
· Dapsone toxicity.
· Organophosphorous poisoning.

What are the causes of mononeuritis multiplex?
Mononeuritis multiplex is a neuropathy affecting several nerves; causes include:

· Wegener's granulomatosis.
· Amyloidosis.
· Rheumatoid arthritis.
· Diabetes mellitus.
· SLE.
· Polyarteritis nodosa.
· Leprosy.
· Carcinomatosis, Churg-Strauss syndrome. (Mnemonic: WARDS, PLC).

A few causes of predominantly sensory neuropathy?
· Diabetes mellitus.
· Alcoholism.
· Deficiency of vitamins Bi2 and Bi.
· Chronic renal failure.
· Leprosy.

What are the types of neuropathy described in diabetes mellitus?
· Symmetrical, mainly sensory, polyneuropathy.
· Asymmetrical, mainly motor, polyneuropathy (diabetic amyotrophy).
· Mononeuropathy.
· Autonomic neuropathy.

What the other effects of alcohol on the central nervous system?
· Wernicke's encephalopathy (ophthalmoplegia, nystagmus, confusion and neuropathy).
· Korsakoff's psychosis (recent memory loss and confabulation).
· Cerebellar degeneration.
· Marchiafava-Bignami disease (symmetrical demyelination of corpus callosum).
· Central pontine myelinolysis.
· Amblyopia.
· Epilepsy.
· Myopathy and rhabdomyolysis.

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Chickenpox Symptoms, Causes, Diagnosis And Treatment

Chickenpox symptoms typically present as hundreds of fluid-filled blisters that are very itchy and can appear anywhere on the body. Chickenpox (a.k.a.Varicella) is a highly contagious viral disease and though this has long been considered a childhood disease, the same virus (herpes zoster) can cause a condition called shingles in an adult.

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Cholecystitis Symptoms, Causes, Diagnosis And Treatment

Cholecystitis symptoms typically present as a severe pain felt in the upper right section of the abdomen. Cholecystitis is sometimes referred to as a gallbladder attack as it is due to an inflammation of the gallbladder. This article shares the medical symptoms associated with this condition, what causes it and what you must do to get relief from the pain and avoid serious health complications.

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How To Perform Fine Needle Aspiration of Thyroid

• Indications:
o Evaluation of palpable thyroid masses
o Differentiation of benign from malignant thyroid lesions.

• Contraindications:
None

• Anesthesia:
Anesthesia is not routinely used for FNA. However, if needed, a small amount of 1% lidocaine may be infiltrated locally, taking care not to distort the palpable lesion.

• Equipment:
o Alcohol prep
o 10-ml syringe
o 1/2-inch 25-gauge needle
o Syringe holder (optional)
o Glass microscope slides (two)
o Spray fixative, gauze
o In many situations, it may be preferable to have a cytopathologist present.

• Positioning:
The patient is placed in a supine position, and a roll is placed behind the shoulders to allow for neck extension and to bring the lesion closer to the surface.

• Technique:
o Prep the area for aspiration with an alcohol prep pad as if for phlebotomy.
o Palpate the lesion and immobilize the mass between the fingertips of the nondominant hand.
Using the dominant hand, advance a 25-gauge needle with an attached 10-ml syringe into the lesion. The needle should be directed medially, toward the trachea.
o Note the consistency of the mass upon entering it with the needle (firm, soft, rubbery, doughy, gritty).
o Once the lesion is entered, a full 10 ml of suction is applied to the syringe. In a variant of this procedure, the nonsuction technique, no negative pressure is applied to decrease local trauma and bleeding.
o While maintaining suction (if used), move the needle back and forth through the lesion several times in different directions.
o Release the syringe plunger and allow it to return to a neutral position prior to removing the needle from the lesion. In the nonsuction technique, the plunger will already be in neutral
position. At this point the specimen is within the needle and hub and should not be in the syringe.
o Remove the needle from the patient, and have the patient apply pressure to the puncture site with a gauze pad.
o Detach the needle from the syringe.
o Fill the syringe with air.
o Reattach the needle onto the syringe.
o Touch the needle tip to a glass microscope slide with the bevel at a 458–908 angle to the slide surface.
o Expel material within the needle onto the slide.
o Make a smear by using a second glass slide to gently press down and draw out the material to a feathered edge. If the material is more liquid, it is pulled in the same fashion as a blood smear, except that before the feathering process is completed, the spreading slide is raised, leaving a line of particles across the slide. The spreading slide is then turned and again pressed down against the line of particles and drawn out into a feathered edge.
o Air dry or apply cytological fixative to the slide per the protocol of the cytopathology laboratory that will be processing the specimen. (If a fixative is applied, it must be applied very quickly, usually within seconds of preparing the smear.)
o Most cytopathologists require 3–6 needle passes (samples) for an adequate pathological diagnosis.
o If a cyst is aspirated, the cyst fluid should be sent for cytology. The region of the cyst should then be re-examined; if a residual mass is felt, it should then undergo FNA.

• Complications and Management:
o Bleeding and hematomas
Thyroid punctures may produce significant hematomas and ecchymoses.
Apply firm direct pressure to puncture sites immediately following aspiration.
o Tracheal puncture
If the trachea is entered, the suction in the syringe will be lost, and the aspiration will need to be repeated.
Puncture is usually of no consequence due to the small gauge of the needle.
o Infection
Extremely rare in FNA but has been reported
Antibiotics as appropriate
Incision and drainage as necessary

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Environmental Benefits Of Smoking Electronic Cigarettes

The dangers of global warming and pollution need to be handled right now or it will soon be the Judgment Day for all. Electronic cigarette can be your own way of fighting environment pollution and contributing to the world. You might have read pieces of information where the benefits of electronic cigarette for your own health have been discussed in details. However, this one is about how you will be helping the environment as well as yourself if you shift from tobacco cigarette to electronic cigarette.

1) Save the Ozone Layer with Smoke-free Substance The trouble with the ozone layer has been that it is being continuously perforated with various kinds of smoke, pollutants, gases and other substances from the earth. Electronic cigarette is smoke free. The nicotine in the e-cig is dissolved in about four other liquids, which keeps it diluted. Thus, when you exhale the vapor, all you get is maximum 10% nicotine vapor and the rest 90% is pure water vapor. Smoke from tobacco cigarette goes up in the air, gets mixed in it, and strikes the ozone layer up above. This is not the risk that our environment suffers with when the vapor of electronic cigarette is exhaled by users.

2) Needs No Fire, Save Wood Tons of wood is wasted every year just for the sake of lighting cigarettes with matchsticks. Lighters too use Naphtha or other carcinogenic materials which are not just harmful to the health of the user. Naphtha is a petroleum product, the excessive use of which leads to the emptying of the limited resources of fuel under the earth. Electronic Cigarette requires no fire, no matchstick to light it. It works or rechargeable battery and sensors. You just hold it between the lips and inhale, the e-cig is lighted for the instant. You inhale and once you keep it unused for some moments, it ‘extinguishes' itself to save power.

3) No Garbage, Clean Earth The cartridge or refill of each electronic cigarette lasts up to the puffs you get for 3 cigarettes. This means, you need not keep an ash-tray with yourself wherever you go, or even pollute the surroundings. Each cartridge saves the garbage up to three times than that with tobacco cigarette. Then again, the cartridge is only the ‘filter' part that you need to dispose off as it empties itself. The battery or the white part remains and it is rechargeable. Electronic cigarette saves environment from garbage disposal pollution.

4) Save Money, Save Yourself From Getting Poor Electronic cigarette can help you save up to $1000 per year! Tobacco cigarettes cost $4-$5 per packet. While electronic cigarette costs you $1.5-$2.5 that will last to till the time that would a pack of tobacco cigarette do. It saves you from burning a big hole in your pocket. Electronic cigarette vapor is a safe and non-smelly exhaled vapor that is safe for passive smokers.

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Plaque and Calculus

Some people are scared of the dentist. They think that the only thing that the dentist does is bring bad news. The truth is that he will often bring bad news, but it really isn't his fault! He is simply trying to help you to have the best oral health that you possibly can. By learning what your dentist in Ogden Utah does for you will have a better understanding as to why it is so important to see him so often.

As people get older they tend to think that they have outgrown the dentist. They feel like it's been a long time since their teeth have been checked and they still look alright. These are the type of people that assume that just because they brush twice a day and floss regularly that they don't need to see a dentist in Ogden Utah. These people are often in for a surprise, because no matter how good you are with your oral hygiene, you will probably have some issues.

One of the most frequent issues that people come up against Is plaque buildup. This is not a new problem at all. Most plaque buildup is accumulated because of a lack of brushing or flossing, but there will be buildup that occurs in other areas because of hard to reach places. Even after brushing for a couple of minutes you will likely have some areas that were difficult to reach that have residual plaque. These areas will build up over time. By seeing a dentist in Ogden Utah regularly you can get rid of the plaque before it causes more problems.

One of the issues that a dentist can help out with is calculus. Calculus is the hardened version of plaque. This calculus hardens and becomes nearly impossible to remove without the help of a dentist. This is a big deal as the calculus and plaque left over can leave acid on the teeth. This acid eats away at the teeth and starts tooth decay. This tooth decay is the start of cavities and is the reason why people need to get fillings from their dentist in Ogden Utah. By seeing your dentist twice a year you can get rid of the plaque before any tooth decay begins. This way you will have fewer needs for fillings from your dentist. If you haven't seen your dentist in a while, it's probably time to get started now!

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Why women should take whey protein for weight loss

Are you concerned about taking care of your body before and after strenuous activities or workouts? Do you try to avoid supplements that contain additives and possible side effects? I am very particular about what I am putting into my body at all times. I hate the idea of eating or taking something that I am not sure about what it is suppose to do or what side effects may be caused.

If you are interested in better health and improved physical fitness you have surely heard that bodybuilders and other athletes are turning to a simple, natural supplement called whey protein. Whey is the only supplement I take besides my daily multivitamin that I feel safe taking. So lets cover a few questions or concerns many women have about taking protein.

WHY DO ATHLETES USE WHEY PROTEIN?

Protein levels are depleted through exercise. Muscles require amino acids to prevent deterioration, give endurance and build mass. Proteins supply these amino acids to the muscles which is why athletes use whey protein. If you want to gain muscle you have to make sure you have the building blocks for it. Women need protein the same ways that men do so do not be afraid of it.

WHAT IS WHEY PROTEIN?

Commercial whey protein comes from cow's milk. Whey is the by-product of making cheese and was usually thrown away as a waste product. Now researchers know that whey protein is high quality, natural protein that is rich with amino acids essential for good health and muscle building. It is naturally found in mother's milk and also used in baby formula. It is being considered for use as a fortifier of grain products because of its considerable health benefits and bland flavor.

Although protein is also found in other foods such as meat, soy and vegetables, whey protein is proven to have the highest absorption (digestion) levels in comparison to all others.

WHO SHOULD CONSIDER USING WHEY PROTEIN?

Whey protein has many health benefits including immune support, bone health, sports health, weight management and overall well being. And as women, we need all the help we can get to keep out bones strong and supportive. Plus overall health is not a bad thing either. The better nutrition you have in your life the less likely that the flu or other bugs will come knocking on your door.

Because amino acids are 'building blocks' for the human body it is sometimes used by patients to speed up the healing of wounds or burns.

The high quality protein that comes from whey makes it a recommended choice for those who need optimal benefits from restricted diets including diabetics, those on weight management diets and even ill patients not able to consume enough protein in their diet to assist with healing.

CAN WHEY PROTEIN BE DANGEROUS?

Whey protein is a food and so it does not have have the risks associated with other supplements. That said, too much of anything carries risks. Extremely high use of whey protein can overload the liver which can cause serious problems. Moderation is always recommended.

If you are lactose intolerant you might try whey protein isolate which has less than 1% lactose and should be tolerable for most users.

Whey protein is a natural and healthy way to bring protein into your diet and increase well being.

WILL WHEY BULK ME UP?

No, women lack the hormones that men have that allow them to get those large bulky muscles. Women will get an overall toned appearance without looking like the Hulk. Those women you see in body building competitions more often than not achieve their unusual frame by injecting additional hormones or supplements into their body. But no, with the use of whey you will not look like these women.

SOME TRICKS WITH WHEY

If you buy the powder you will be able to do a lot more than just simple shakes. But for shakes be create.
Mix the whey with milk and maybe add some strawberries or blueberries to make the best shakes around!
When you bake cookies scoop some whey in for a power cookie
If you drink coffee but some chocolate whey in to make a great mocha

The possibilities are endless, get your creative juices going!

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Hair Loss Procedure: Usually Asked Questions

Hair loss can occur on multiple areas of the body and for multiple reasons as well. Hair loss is an embarrassing problem and may even make individuals look older than they actually are. Thinning and balding of the crown and head is a more common area for both men and women. Hair loss may be associated with stress, genetics, aging, or a side effect of medication. With Hair Restoration San Diego patients now have options to reverse hair loss will multiple procedures designed to fulfill their needs and restore their feelings of confidence and self-esteem. For prospective hair restoration patients, a series of frequently asked questions often arise. Here are some of them—answered.

How does a hair transplant procedure work?
With a Hair Transplant San Diego resident patients transplant hair from a "donor" area of the body into the area to be treated. There are multiple types of procedure types such as the FUE (Follicular Unit Transplant) that extracts hair from the donor area one follicle at a time and provides the best results. The hair transplant technique may also vary depending on the area to be treated. Most commonly treated areas are the crown, eyebrows, and the face (facial hair).

How do I go about finding the right hair transplant surgeon?
Finding a hair transplant surgeon who can perform a hair transplant procedure safely and effectively is important for prospective patients. Some treatment centers may offer hair transplant procedures; however, with a Hair Surgeon San Diego residents can ensure they receive the best treatment. Hair surgeons have received specialized, extensive education and training regarding hair transplant procedures. Also, taking a look at the surgeon's before and after photos of previous individuals will give the best idea of the types of results you can achieve with this particular hair surgeon.

How much does a hair transplant procedure cost?
The cost of a hair transplant procedure is one of the main deciding factors for prospective patients. The Hair Transplant Cost San Diego hair restoration centers average about $5 per graft. Most hair restoration surgeons and centers also offer financing options that may even include 0% interest, eliminating cost as a major deciding factor for patients.

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How to Lose Weight Fast?

Losing weight does not necessarily mean that you only improve your overall appearance; you also improve your health. People are starting to think that reducing weight is only done to look good. Having your weight reduced not only benefits your look but it also provides health benefits to the body.

When you lose weight, you also improve your body. Having a healthy body also means, longer and happy living. Getting your desired weight can be done naturally. There are a couple of products saying that they can provide instant weight loss. You may experience bad effects to your body once you use them. If you want to lose weight naturally, here are some of the best weight loss protocolsthat you can consider.

The first thing that you need to look at is your eating habits. It is a lot better if you will check your daily food intake and try to take note of the food that you are eating for the past few days. Taking fatty foods can greatly contribute to increase your weight so you must be aware of this. Another thing is that people often eats 5 or more larger meals on a daily basis which is not a good thing. You can change your eating habit by considering fruits and vegetables and setting aside oily meals. If you insist that you want to eat more than 5 times, it is fine as long as you can lower the amount of the food that you eat.

Drinking water is also a good way to reduce weight. Water therapy is a good way to eliminate the toxins that affects the process of weight loss. Drinking water is also more effective when combined with exercising. Be consistent in drink 8 or more glasses of water and exercise every day for approximately 30 minutes.

A simple exercise can already be a big help in improving the metabolism of your body. If you are working in an office and you are staying long hours in front of the computer, take time to walk sometimes at least for 10 to 15 minutes. Always keep in mind that the body can accumulate fat if it is not active in different physical activities.

These tips cannot provide overnight results like others want. If you will do these tips, you need to be patient and be consistent because results are not instant.

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Rare Blood Types

Within the ABO/Rhesus Group systems which are used to classify most blood types, there are several rare blood types. The rarest is AB-, with less than one percent of the world's population having this blood type. B- and O- are also very rare, each accounting for less than 5% of the world's population. However, there are over 30 recognized blood typing systems beyond these basic two, creating a plethora of rare blood types, some of which appear only in a handful of people.

Blood type is determined by the presence of certain antigens in the blood. The A and B antigens are very common, making it easy to classify people by which antigen they have, while people with Type O blood have neither antigen. The negative or positive symbol after the blood type indicates the presence or lack thereof of the Rhesus Factor. However, other antigens beyond A and B can be present, and these antigens can react with blood from certain donors. Someone with a rare blood type might appear, for example, to be A+, but he or she might lack another antigen, which could cause a bad reaction with A+ donor blood which contained that antigen.

People in the Bombay Blood Group lack A and B antigens, which would normally place them in the O grouping, except that they lack H antigen, a substance present in people with Type O blood. This means that if they are infused with blood from an O donor, they can get sick. This blood type is also referred to as the “hh Blood Group,” and it is named for the region of India where it was discovered.

Some of the other antigens used in blood typing include: D Factor, C Factor, E Factor, M Factor, S Factor, Le(a) Factor, K Factor, Fy(a) Factor, Jk(b) Factor, and Fy(b) Factor, among others. This means that someone could have a blood type such as AB-: Fy(b)-, K-. If blood from an AB- negative donor which contained the K Factor was transfused, this person could experience a reaction. Sometimes, these factors are referred to with names, as in “Duffy Negative” for people who lack Fy(a) and Fy(b), referencing a specific patient who first exhibited the trait.

Blood type is an inherited trait, and many rare blood types are found in specific communities and ethnic groups. African-Americans, for example, are more at risk of being Duffy Negative. This is why it is important for people from all ethnic groups to donate blood, to increase the probability of finding a matching donor. When blood from more than 200 donors must be screened to find a match for a patient, that patient has a blood type which is considered rare, but some people with rare blood types would be lucky to find blood which matched theirs in one of 200 donations. Some people with rare blood types bank their own blood in advance of surgical procedures to ensure that blood is available to them.

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MBBS 2nd Year Sendup Papers Punjab Medical College (PMC), Faisalabad

Punjab Medical College (PMC), Faisalabad
Biochemistry

Q1. Name the adrenocortical hormones and mechanism of action of cortisol.
Q2.how saturated fatty acids are synthesized in the body.
Q3. Define gluconeogenisis. How can we convert alanine to glucose?
Q4. Enumerate the function of pentose phosphate pathway. What are the effects of g-6pd deficiency?
Q5.
a. Name the enzyme and co enzyme of respiratory chain
b. Describe the importance of restriction endo- nucleases
Q6.ammonia detoxification in liver
Q7.how new DNA is synthesized in eukaryotes
Q8short note on
a. Metabolic alkalosis
b. Purine metabolism
Q9.
a. Causes of negative nitrogen balance
b. Nutritional Marasmus
Q10.
a. Sodium balance
b. Factors regulating blood glucose level

Physiology

Thick ascending loop of henle
Accommodation reflex
Taste blindness
Cretinism
Male infertility
Compare & contrast upper & lower motor neuron lesion
Role of hypothalamus in control of high temperature
What are the mechanisms to manage low plasma calcium level
A young boy receive a bullet injury at level t12 as a result he lost all type of sensory & motor activity below that point
a. What happen to knee jerk after 3 week?
b. What will happen to bladder reflex?
c. Describe type of motor neuron lost at T-12

Anatomy

1. (a) Draw and label the histological structure of duodenum
(b) Tabulate the gradual histological changes that occur in conducting division of respiratory tract (Nose to Terminal bronchiole)
2. Write short notes on a) JG apparatus b) Seminiferous tubules
3. Describe development of pancreas and enumerate its developmental anomalies
4. Describe development of breast along with its congenital anomalies
5. Describe the venous drainage of thoracic wall
6. Write note on a) Epiploic Foramen b) relations of 3rd part of duodenum
7. Describe anal canal with special reference to blood supply, nerve supply and lymphatic drainage
8. Describe inguinal canal, tabulate the differences b/w direct and indirect inguinal hernias
9. Give attachments, nerve supply and actions of extra-occular muscles in tabulated form
10. Describe the boundaries and contents of posterior triangle of neck.

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MBBS 2nd Year Sendup Papers Nishter Medical College (NMC), Multan

Nishter Medical College (NMC), Multan
Physiology

1) What is metabolic acidosis, Its correction by kidneys
2) How urine is concentrated in different segments of Nephron
3) Enumerate part of limbic system, Role of thalamus in motor activity
4) enumerate receptors a ANS, what is alarm response
5) Draw Pyramidal tract and label it. and effects of its lesion
6) Draw visual pathway and effects produced by lesion in optic tract
7) Growth hormone effect on protein metabolism. note on acromegaly
8)Name hormones of adrenal cortex. role of cortisol in inflammation
9)wat are the hormones that take part in pregnancy. how lactation is initiated

Biochemistry

1) Where does glycolysis take place. enumerate its reversible steps and way of there reversal
2)Process of plaque formation by LDL
3) What is point mutation. Amino acid changes in sickle cell anemia.
4) Classify hormones. Metabolic effects of catecholamines

Anatomy

1) Development of vertebral column and anomalies
2) How coelomic cavity is divided. give anomalies in thoracoabdominal diaphragm
3) Describe partitioning of heart
4) Derivatives of urogenetial sinus development of prostate
5) Descent of testis and its congenital abnormalities
6) Classify cells of hypothesis describe epsilon acidophil
7) Describe olfactory mucosa
8) Classify glands of stomach and describe the cells lining those glands
9) Components of JuxtraGlomerular complex describe JuxtraGlomerular cells
10) Give layers of retina and describe ultra structure of cone cells.

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MBBS 2nd Year Sendup Papers Rawalpindi Medical College (RMC), Rawalpindi

Rawalpindi Medical College (RMC), Rawalpindi
Physiology

1. Write down composition of normal urine. Why don’t we pass albumin and glues in urine normally
2. Enumerate various causes of metabolic acid, how it is compensated?
3. give a brief account of motor and sensory loss in patient with hemi section of spinal cord, below the level of lesion
4. Write down the components of reflex arc. Describe briefly lengthening reaction
5. Define pain. How will you differentiate neospinothalamnic tract from paleospinothalamic tract?
6. What changes occur in the eyes upon focusing a near object?
7. write notes on:
a) attenuation reflex
b) wernicks aphasia
8. How aldosterone secretion is regulated? What are the features of conn`s syndrome?
9. give in tabulated form the effect of epinephrine and nor epinephrine on the following:
a) heart rate
b) systolic blood pressure
c) diastolic blood pressure
d) total peripheral resistance
e) skeletal muscle blood vessels
10. outline various hormonal factors which tend to increase uterine contractility at the time of parturition

Anatomy

1. enumerate ectodermal, endodermal, and mesodermal derivatives of 1st pharyngeal arch
2. Give brief description of developments of mesonephros
3. Draw and label histological details of pancreas, how it differs from salivary gland?
4. What are the components of blood air barrier, how it helps in gaseous exchange?
5. give boundaries and contents of superior mediastinum
6. boundaries, contents and clinical significance of inguinal canal
7. what are different parts and surfaces of uterus, name its supports
8. Relations and blood supply of thyroid gland. How nerves are protected during thyroidectomy?
9. What is the course of mandibular nerve? Name its branches.
10. Name intrinsic muscles of larynx. How they help in expiration and phonation.

Biochemistry

1. a) in a person after hyperventilation ionic calcium serum level fall, how the parathyroid hormone is released in the blood and how it stimulates the release of calcium from bones at cellular level?
b) What is mechanism of action of group 1 hormones?
2. A man of 45 year was trapped under the rubble during earthquake in azad Kashmir without food and water. On the 3rd day how the 2 fuel substances for brain were synthesized. Explain and enumerate the steps.
3. a) Enumerate and explain disorders of Galactose metabolism
b) Name the enzymes of urea cycle in sequence
c) What is importance of oxidation of fatty acids in peroxisomes?
4. a) which biochemical disorders lead to gout?
b) Briefly describe the replication of DNA
5. a) Describe different types of cytochromes in respiratory chain. Also mention their functions and enzyme inhibitors
b) Describe ketoacidosis
6. a) Name and explain the lipoproteins which are important in the lipid profile of a heart patient
b) A patient’s blood chemistry reveals his cholesterol level 310mg/dl which biochemical measures should be taken to reduce his cholesterol level?
7. a) Give the steps of protein synthesis in eukaryotes
b) Write a note on:
i). Transcription
ii). tRNA and rRNA.
8. a) Write short notes on:
i). Phenylketonuria
ii). Maple syrup urine disease
b) Describe main features of balanced diet.

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MBBS 2nd Year Sendup Papers Quaid-e-Azam Medical College(QMC), Bahawalpur

Quaid-e-Azam Medical College(QMC), Bahawalpur
Anatomy

From which and where the common carotid artery arises & where it divides? enumerate branches of external carotid artery and discuss the facial artery
Discuss the extent of cervical sympathetic ganglia
Describe muscles of mastication with their nerve supply
Define mediastinum, its divisions, name the structural contents of inferior mediastinum, discuss the blood supply of heart
Discuss rectus abdominis and rectus sheath
How and where portal vein is formed, give its names and tributaries
Discuss pelvic diaphragm and urogenetial diaphragm
write short notes on internal iliac artery and blood supply of ureter
give structural derivatives of 1st pharyngeal arch. a new born with cystic swelling in the neck was brought to surgical outdoor. explain its embryological causes
Describe microscopic appearance of Thyroid Gland

Physiology

Enumerate physiological actions of insulin on carbohydrate, fat and protein metabolism. write down four features of diabetes mellitus
What are the features of right sided hemi-section of the spinal cord
Which neurotransmitters are leased in the basal ganglia? enumerate features of the Parkinson's disease
enumerate the effects of the sympathetic stimulation through alpha adrenergic receptors and beta adrenergic receptors
What is the mechanism of determination of sound frequency
Define filtration coefficient and filtration fraction. enumerate factors which affect the GFR
What are the features, cause & compensatory mechanisms of metabolic acidosis
enumerate the physiological actions of Estrogen

Biochemistry

What is the biochemical importance of glycolytic reducing equivalent shifted to mitochondria
Describe metabolism of LDL by diagram. How is HDL beneficial
Briefly describe the formation of neurotransmitters from amino acids
write down the steps of purine degradation
draw an outline of cycloxygenase pathway. what is its biomedical importance
Name the four hormones which bind to intracellular receptors. Describe the hyperglycemic action of cortisol
Explain Na+ ,K+ as following a) normal value b) Deficiency s/s of hyponateremia
What are the causes of lactic acidosis. How hyperlactemia is compensated by the body
Draw balanced diet chart for a medical student
Define tumor marker. Write down the three names of clinical useful tumor markers.

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MBBS 2nd Year Sendup Papers Allama Iqbal Medical College(AIMC), Lahore

Allama Iqbal Medical College(AIMC), Lahore

Anatomy

1.Draw n label microscopic structure of
a) Uterine tubes
b) Nephron
c) Intestinal glands
2.a) Name the congenital anomalies of the face?
b) role of ox genes
c) extrophy of urinary bladder
3. a) Account of course of facial art. On face name de arteries having torturous course & advantage of torturous course?
b) Internal jugular vein formation tributaries & termination
c) Formation of ansa cervicalis distribution & branches
4. a) Left anterior descending artery
b) Clinical significance in 90% occlusion
c) Lymphatic drainage of tongue
d) Note on ovarian fossa draw n label
e) Posterior relations of left kidney
5. a) Contents of posterior mediastinum n account of esophagus relations
b) Pudendal canal
c) Relation of terminal one third part of ureter
6. a) Pterygopalatine ganglion
b) Draw lateral wall of nose showing meatuses and chonchae
c) Draw n label extra hepatic billiary apparatus
d) Anal canal internal structure draw n label
e) Fistula in ano n how it is treated

Physiology

1…Give significance of different somatosensory areas of cerebral cortex. what is de effect of removing the somatosensory association area?
2..What is referred pain how r de pain receptors r stimulated?
3…Give a brief description of accommodation reflex? what is presbyopia?
4…Write short notes on
Thalamic syndrome
Lengthening reflex
5…Briefly discuss de functions of caudate circuit of basal ganglia. enlist important features of parkinsonism
6..What are the principle affects of rennin angiotensin aldosterone system on renal function
7..Give the mechanism of attenuation of sound by the middle ear. why is it important
8..Enlist de function of hypothalamus n give its role in regulation of body temp.
9..Define GFR n give a brief account of auto regulation of GFR
10..Give the role ascending reticular activating system I n sleep n wakeful cycle
11..Effect of cortisol on protein metabolism, difference b/w Cushing disease n Cushing syndrome
12..Write short notes on
Simmons disease
Addison disease
13.Give the role paratharmone in ecf calcium ion regulation
14.Discribe ovarian cycle with special emphasis on LH surge
15.Give a brief account of regulation of renal tubular h ion secretion
16.Namme diabetogenic hormones give metabolic function of insulin
17.What is counter current mechanism how it works in formation of concentrated urine
18.Define puberty what triggers the onset of puberty

Biochemistry

Write down the irreversible reactions of the glycolytic pathway. What is the biochemical explanation for cataract formation, retinopathy and peripheral neuropathy associated with hyperglycemia in uncontrolled diabetes mellitus?
Describe the Cori's cycle and its importance. Name any four enzyme activities residing in fatty acid synthetase multi enzyme complex. Name the enzyme defects in maple syrup urine disease, albinism, phenylketonuria and alkaptonuria.
Describe ketogenesis in liver. How are ketone bodies utilized in extra hepatic tissues.
Write down the reactions catalyzed by alanine aminotransferase, arginase, creatine kinase, dopamine hydroxylase. Describe sources of ammonia in body
What is the genetic code and write down its characteristics. what is the basic function of type I DNA topoisomerase? Describe any two types of covalent modifications in protein molecules following their synthesis
How does parathyroid hormone tend to increase plasma calcium concentration? Name the second messengers of Atrial natriuretic peptide, ACTH. Write down the steps for the synthesis of catecholamines from tyrosine
What do you understand by balanced diet and basal energy expenditure? enumerate any six factors affecting basal energy expenditure? Describe the buffering action of phosphate buffer system in kidney
Describe any four inhibitors of oxidative phosphorylation with their specific mechanism and site of action. Enumerate the steps of PCR. write down the reactions of uric acid formation from Hypoxanthine.

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MBBS 2nd Year Sendup Papers Fatima Memorial Hospital College, Lahore(FMHC)

Fatima Memorial Hospital College, Lahore(FMHC)

Biochemistry

Q1) a) what is meant by oxidative phosphorylation? Name the un-couplers of o.phosphorylation [3+3]
b) What is G6PD deficiency?

Q2) a) How is galactose metabolized in the body?
b) What congenital condition results due to deficiency of different enzymes? [5+3]

Q3) Describe B-Oxidation reactions. [3+5]
Calculate energy in the form of ATP derived from complete oxidation of Stearic Acid to CO2 and H2O

Q4) Draw Urea Cycle. Give the sources of ammonia. [5+3]

Q5) a) How are purines catabolized in body. How are purine bases salvaged? [3+3]
b) Differentiate between Kwashiorkor and Marasmus [2]

Q6) a) What is point mutation? How does it occur? What is the amino acid change in Sickle Cell Anemia? [1,1,2]
b) Define replication. Give various types. Enumerate diff types of enzymes in replication. [1,1,2]

Q7) Give various steps of protein synthesis. Enumerate the post transitional modifications. How are defective proteins degraded? [4,3,1]

Q8) a) Give synthesis of catecholamines and briefly discuss the role of adrenaline in carb metabolism. [4]
b) What is pheochromocytoma? What lab tests u will perform to evaluate a case of pheochromocytoma?[2,2]

Physiology

Q1) Explain counter current mechanism in the kidney.
Q2) Briefly describe actions of testosterone.
Q3) Name the hormones regulating plasma Calcium levels. Briefly describe the mechanism by which each acts.
Q4) Explain signs and symptoms of Parkinsonism. Which part of central nervous system is involved and how?
Q5) Explain the mechanism by which Insulin lowers plasma glucose levels.
Q6) Describe GOLGI TENDON REFLEX.
Q7) Describe the formation, drainage and functions of Aqueous Humor. What is normal intra ocular pressure?
Q8) Draw and Label the auditory pathway. Enlist the functions of middle ear.
Q9) Describe the role of kidney in regulation of pH.

Anatomy

Q1) Name the components of JuxtraGlomerular Apparatus. Draw a Nephron.
Q2) Draw the Adrenal Cortex.
Q3) What are the embryological basis of Congenital Umbilical Hernia?
Q4) Enumerate the derivatives of Pharyngeal Pouches.
Q5) a) Enumerate the constituents of spermatic cord.
b) Trace the course of Ductus Deferens [Vas Deferens]
Q6) Differentiate between Anatomical and Functional lobes of liver. Give the clinical significance.
Q7) Write down the attachments of Investing Layer of Deep Cervical Fascia.
Q8) What are the anatomical parts of pharynx? Give their sensory nerve supply.
Q9) Write a note on Blood Supply of the Heart.

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Crohn's Disease Symptoms, Diet, Causes, Diagnosis, and Treatment

If you are asking the question, what is Crohn's disease, you may already be experiencing some undesirable symptoms such as abdominal pain and diarrhea. To fully determine what Crohn's disease is and if you have the disease, you will need to take a look at the bigger picture of Crohns.

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Parkinson's disease Frequently Asked Questions

What comprises Parkinson's disease?
Upper body dyskinesia
This must be present - it is a symptom complex containing many of the following features:
· Slowness of movement (bradykinesia).
· Poverty of movement (mask-like facies, diminished arm swing).
· Difficulty in initiating movement.
· Diminished amplitude of repetitive alternative movement.
· Inordinate difficulty in accomplishing some simultaneous or sequential motor acts.

Rigidity
This is usually but not always present:
· Leadpipe rigidity, where the increase in tone is equal in flexors and extensors of all four limbs but slightly more in flexors, resulting in a part flexed 'simian' posture.
· Cog-wheel rigidity is due to superimposed or underlying tremor. Postural instability Usually a late feature.

Tremor
Absent in about one third of patients with Parkinson's disease at presentation and throughout its course in some.
· Resting, 3-5 Hz pill, pronation and supination rolling tremor of the upper limb.
· Tremor is intermittent (can usually be brought about by getting the subject to count backwards with the eyes closed and hands dangling over the armrests of the seat).
· The tremor is intensified by emotion or stress and disappears during sleep.
· The legs, head and jaw may shake as well. Jaw tremor is rare but is most distressing; the teeth may pound together until they become unbearably painful.

What are the causes of Parkinson's disease?
· True parkinsonism:
-Idiopathic (due to degeneration of the substantia nigra) - also known as Parkinson's disease.
-Drug-induced (chlorpromazine, metaclopramide, prochlorperazine).
- Anoxic brain damage such as cardiac arrest, exposure to manganese and carbon monoxide.
-Postencephalitic - as a result of encephalitis lethargica or von Economo's disease.
- 1-Methyl-4-phenyl- 1,2,3,6-tetrahydropyridine toxicity - seen in drug abusers. -Multiple system atrophy. -Progressive supranuclear atrophy.
- Familial.
-Mutation of the alpha-synuclein gene or linkage to a region on chromosome 2.
· Pseudoparkinsonism:
-Essential tremor.
-Atherosclerotic (vascular) pseudoparkinsonism (mention that in the past atherosclerosis was thought to be a cause of Parkinson's disease but this is no longer accepted as a cause).
· Hemiparkinsonism (presenting feature of a progressive space-occupying lesion).

What are the pathological changes in Parkinson's disease?
The most typical pathological hallmarks of Parkinson's disease are:
· Neuronal loss with depigmentation of the substantia nigra.
· Lewy bodies, which are eosinophilic cytoplasmic inclusions in neurons con-sisting of aggregates of normal filaments.

What is the mental status of patients with Parkinson's disease?
· In the initial stages, intellect and senses are usually preserved. Many patients have some intellectual deterioration - a slowness of thought and of memory retrieval (bradyphrenia), and subtle personality changes.
· Global dementia may develop in one fifth of patients.
· Depression occurs in one third of patients.
· Acute confusion can be precipitated by drug therapy.

Note. Parkinson's disease must be kept in mind in elderly patients presenting with a history of frequent falls.

What is the difference between rigidity, spasticity and gegenhalten?
· Rigidity indicates increased tone affecting opposing muscle groups equally and is present throughout the range of passive movement. When smooth it is called 'leadpipe' rigidity, and when intermittent is termed 'cog-wheel' rigidity. It is common in extrapyramidal syndromes, Wilson's disease and Creutzfeld-Jakob disease.
· Spasticity of the clasp-knife type is characterized by increased tone which is maximal at the beginning of movement and suddenly decreases as passive move-ment is continued. It occurs chiefly in the flexors of the upper limb and extensors of the lower limb (antigravity muscles).
· Gegenhalten, or paratonia, is where the increased muscle tone varies and becomes worse the more the patient tries to relax.

What do you understand by the 'wheelchair sign' in Parkinson's disease?
Patients with advanced disease and 'on-off' motor fluctuations require a wheelchair when 'off' and when 'on' are seen to walk about (sometimes pushing the chair!). These patients are rarely permanently wheelchair-bound; in contrast, those who never leave their wheelchair usually do not have Parkinson's disease.

How is the severity of Parkinson's disease graded?
The Hoehn-Yahr staging grades Parkinson's disease into five stages:

· Newly diagnosed disease - Stage I.
· Moderately severe disease - Stages II and III.
· Advanced disease - Stages IV and V.

In which condition is L-dopa absolutely contraindicated?
Melanoma.

What are Parkinson plus syndromes?
Some patients have other neurological deficits in addition to Parkinson's disease. Examples of these so-called 'Parkinson plus
syndromes' are:
· Steele-Richardson-Olszewski disease (akinesia, axial rigidity of the neck, bradyphrenia, supranuclear palsy).
· Multiple system atrophy. Olivopontocerebellar degeneration. Strionigral degeneration.
Progressive autonomic failure (Shy Drager syndrome).
· Basal ganglia calcification.

What is tardive dyskinesia?
Tardive dyskinesia is seen in patients taking neuroleptics. Its manifestations are orofacial dyskinesia such as smacking, chewing lip movements, discrete dystonia or choreiform movements and, rarely, rocking movements. Withdrawal of the offendingdrug will improve these symptoms over a period of 3-4 years, except in a small minority of patients.

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Coarctation of Aorta Frequently Asked Questions

What are the types of aortic coarctation?
Common:

• Infantile or preductal where the aorta between the left subclavian artery and patent ductus arteriosus is narrowed. It manifests in infancy with heart failure. Associated lesions include patent ductus arteriosus, aortic arch anomalies, transposition of the great arteries, ventricular septal defect.

• Adult type: the coarctation in the descending aorta is juxtaductal or slightly postductal. It may be associated with biscuspid aortic valve or patent ductus arteriosus. It commonly presents between the ages of 15 and 30 years.
  

Rare:
· Localized juxtaductal coarctation.
· Coarctation of the ascending thoracic aort
· Coarctation of the distal descending thoracic aorta.
· Coarctation of the abdominal aorta.
· Pseudocoarctation is of no haemodynamic significance and is a 'kinked' appear-ance of the aorta in the juxtaductal region without stenosis.

Is aortic coarctation more common in men or women?
This condition is two to five times as frequent in men and boys as in women and girls.

What conditions are associated with coarctation of aorta?
It may occur in conjunction with gonadal dysgenesis (e.g. Turner's syndrome), bicuspid aortic valve, ventricular septal defect, patent ductus arteriosus, mitral stenosis or regurgitation, or aneurysms of the circle of Willis.

At what age does the condition manifest?
It is particularly likely to produce significant symptoms in early infancy (presenting as cardiac failure) or between the ages of 20 and 30 years.

What causes rib notching?
Collateral flow through dilated, tortuous and pulsatile posterior intercostal arteries typically causes notching on the undersurfaces of the posterior portions of the ribs. The anterior parts of the ribs are spared because the anterior intercostal arteries do not run in the costal grooves. Notching is seldom found above the third or below the ninth rib and rarely appears before the age of 6 years.

What are the complications of aortic coarctation?
· Severe hypertension and resulting complications:
· Stroke.
· Premature coronary artery disease.
· Left ventricular failure (two thirds of patients over the age of 40 years who have uncorrected aortic coarctatioh have symptoms of heart failure).
· Rupture of aorta.
· Infective endocarditis endarteritis (at the site of the coarctation or on a con-genitally bicuspid aortic valve).
· Intracranial haemorrhage (combination of hypertension and ruptured berry aneurysm).
· Three quarters die by the age of 50, and 90% by the age of 60

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Cholangitis Symptoms, Causes, Diagnosis And Treatment

Cholangitis symptoms present as pain in the right side or middle of the upper abdomen that may be sharp, crampy or dull in nature. Cholangitis is an inflammation of the Common Bile Duct, which is the duct that carries bile from the gallbladder and liver to the small intestine. This article shares the symptoms, causes, diagnosis and treatment for this gastrointestinal disorder.

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How To Grow Taller Naturally? - Growing Taller Secrets & Tips

Are you unhappy with your height? Many people are and, even if you have stopped growing, there are still ways to present yourself so that you appear to be taller than you actually are. For more information on how to make yourself look taller, read on and I will explain to you more about the growth process and how you can make the best of yourself and look after your body to ensure you remain healthy as you get older. There are many dubious claims of specific exercises being able to stretch and lengthen your bones. Buyers beware! You cannot stretch your bones, or lengthen them, regardless of how much you exercise.

What you can do, however, is to exercise regularly in order to strengthen the muscles that are attached to your bones by means of tendons and ligaments. Strong, healthy muscles will have more stamina amongst the muscle fibers to be able to hold your body far more erect and so give the appearance of being much taller - as the result of exercise alone. Not only that, but regular exercise is the trigger that actually releases the growth hormones and enables adequate growth to occur. Another warning: avoid claims about the efficacy of hormone supplements or vitamin supplements. Neither of these can make your bones longer nor make you look taller. They simply make you feel healthier.

During puberty maintain a good diet and exercise as regularly as you can. This will enable your bones to grow healthily. While you are still of an age to grow the ends of your bones consist of a spongy bone matrix which is very rich in blood vessels from which the bone obtains high levels of nutrient. All the time your bone ends are soft, your body is able to grow. However, once a change occurs and the spongy bone is converted into the denser, compact bone that is hardened with calcium deposits, no further growth can occur. During your growing years, while your bone is still developing and evolving, a healthy diet full of appropriate sources of nutrients is essential. Plenty of vitamins, minerals and trace elements will help your bone to mineralize properly and to become strong and healthy which, in turn, will minimize any chances of fractures occurring. This is what happens as we age: our bones weaken due to loss of mineralization and fractures occur much more easily.

An excellent diet coupled with regular exercise is the best way to ensure your bones grow healthy and remain strong. As calcium is such an important mineral, you need to ensure you are including calcium-rich foods [such as dairy products and many sources of fish] in your diet. Adequate sources of nutrition are just as necessary when you grow older and even the elderly need to include ample nutrients such as protein, carbohydrates, fats, vitamins, and minerals into their diets to maintain a healthy lifestyle. Other factors, of course, can also help to maximize your height - clothing, for instance, is an important addition to any wardrobe.

Pick the right clothes and you can make yourself instantly look taller. Similarly, short hair will give your neck a more swan-like appearance and help give the appearance of height. Good posture is another thing to consider but, when you think about it, this goes back to ensuring you take adequate exercise so that the muscles that are attached to your bones are as strong and as healthy as possible. Healthy muscles will almost always lead to improved posture and enable you to give the appearance of being taller.

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What To Eat While Pregnant | Pregnancy Diet Tips

If you are pregnant then not only medicine will improve your health, you also need love and care from your family. In early stage of pregnancy, the pregnant women suffer from vomiting and nausea problems and she have also problem to take foods. However, this is necessary that she must maintain balance diet and must take sufficient amount of vitamins. Your diet should be as much as enough to fulfilling your hunger and also keep your weight up to date. Here we outline the latest diet tips for pregnant to keep and maintain her diet plan and maintain her health during pregnancy.

1. This is necessary for pregnant that she should provides all kinds of nutrients to her body. The food which gives you best nutrients are includes grains, fruits, bread, dairy products, vegetables, poultry which is the best solution of protein and mea, nuts fish etc.

2. This is best advice for pregnant that she should take food in number of times due to tendency of vomiting during pregnancy.

3. Choose to eats rice, bread, whole gain, fruits and vegetable because these foods are high in fiber.

4. To ensure iron and calcium are present in your pregnant body, you must take dairy products as your daily pregnant diet. Moreover, you must include vitamins and minerals in good amount for your pregnancy diet.

5. According to the experts:- The pregnant ladies need 70Mg of vitamin C. The source of Vitamin C foods like honeydew, orange, grapefruits, cauliflower, papaya, strawberries, green paper, mustard green, and tomatoes should be taken in your routine diet.

6. At the last this is important to know about those foods which should be avoided during pregnancy. This should be in your knowledge that this is very much harmful to loss weight during pregnancy. As well as this is also necessary to know that dieting is also risky during pregnancy. Correct nutrients and vitamin is needed by your body as well as your baby. So this is best advice for you to take balanced diet for your and your baby’s health.

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Chronic Obstructive Pulmonary Disease (COPD) Symptoms, Causes, Diagnosis And Treatment

Chronic Obstructive Pulmonary Disease (COPD) Symptoms can make it very difficult to breath. COPD is one of the most common lung disorders and is primarily caused by smoking. This article takes a close look at the symptoms of chronic obstructive pulmonary disease and steps a person can take to control those symptoms.

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Cirrhosis Symptoms, Causes, Cirrhosis Diagnosis And Treatment

Cirrhosis symptoms may develop gradually and in some cases no symptoms will be noticed, but when symptoms of cirrhosis do occur they can include a range of health problems from indigestion to confusion and impotence. This article shares what cirrhosis is, what causes it and how you can treat the disease to prevent further health complications.

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Dextrocardia Frequently Asked Questions

What is Dextrocardia?
Dextrocardia is an abnormal congenital positioning of the heart. Instead of the heart forming in the fetus on the left side, it flips over and forms on the right side. There are several types of dextrocardia, also called looping defects. Dextrocardia is frequently diagnosed in a routine prenatal sonogram, although not every radiologist will catch it, particularly if there are no cardiac structural abnormalities.

What is Kartagener's syndrome?
A type of immotile cilia syndrome in which there is dextrocardia or situs inversus, bronchiectasis and dysplasia of the frontal sinuses.

Which other abnormality has been associated with dextrocardia?
Asplenia (blood smear may show Heinz bodies, Howell-Jolly bodies).

What do you understand by the term 'situs inversus'?
Right-sided cardiac apex, right stomach, right-sided descending aorta. The right atrium is on the left. The left lung has three lobes and the right lung has two.

What do you understand by the term 'dextroversion'?
Right-sided cardiac apex, left-sided stomach and left-sided descending aorta.

What do you understand by the term 'levoversion'?
Left-sided apex, right-sided stomach and right descending aorta.

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Acute Myocardial Infarction Frequently Asked Questions

What is a silent myocardial infarct?
A painless infarct, common in diabetics and the elderly; it may present with complications of myocardial infarction.

What is Levine's sign?
In acute myocardial infarction the patient often describes the pain by illustrating a clenched fist.

What are the major risk factors for an acute MI?
· Smoking.
· Hypercholesterolaemia.
· Diabetes.
· Hypertension.

What are the complications of myocardial infarction?
· Extension of infarct and post-infarct ischaemia.
· Rhythm disorders: tachycardia, bradycardia, ventricular ectopics, ventricular fibrillation, atrial fibrillation and tachycardia.
· Heart failure: acute puhnonary oedema.
· Circulatory failure: cardiogenic shock.
· Infarction of papillary muscle: mitral regurgitation and acute puhmmary oedema.
· Rupture of interventricular septum.
· Left ventricular aneurysm.
· Mural thrombus.
· Thromboembolism: cerebral or peripheral.
· Venous thrombosis.
· Pericarditis.
· Dressler's syndrome, characterized by persistent pyrexia, pericarditis, pleurisy.
What are TIMI grades?
Grades determined in the Thrombolysis in Myocardial Infarction trial (TIMI) that measure coronary blood flow and luminal narrowing:
· Grade 0: no flow of contrast beyond the point of occlusion.
· Grade I: penetration with minimal perfusion (contrast fails to opacify the entire coronary bed distal to the stenosis for the duration of investigation).
· Grade 2: partial perfusion (contrast opacities the entire distal coronary artery, but the rate of entry or clearance or both is slower in the previously blocked artery than in nearby normally perfused
vessels).
· Grade 3: Complete perfusion (contrast filling and clearance are as rapid in the previously blocked vessel as in normally pert'used vessels).

Why is the Asian population in Britain susceptible to premature myocardial infarction ?
Premature ischaemic heart disease in migrants from the Indian subcontinent is associated with insulin resistance. The site of this defective insulin action has been localized to the skeletal muscle by means of positron emission tomography (Baliga RR et al. Positron emission tomography localizes insulin resistance to skeletal muscle in premature coronary heart disease.

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Hypertension Frequently Asked Questions - All Explained

What is Hypertension?
Hypertension or high blood pressure is a condition in which the blood pressure in the arteries is chronically elevated. With every heart beat, the heart pumps blood through the arteries to the rest of the body. Blood pressure is the force of blood that is pushing up against the walls of the blood vessels. If the pressure is too high, the heart has to work harder to pump, and this could lead to organ damage and several illnesses such as heart attack, stroke, heart failure, aneurysm, or renal failure

How would you record the blood pressure?
· Using a device whose accuracy has been validated and one that has been recently calibrated.
· The patient should be seated with the arm at the level of the heart. The blood pressure cuff should be appropriate for the size of the arm and the cuff should be deflated at 2 mm/s and the diastolic blood pressure is measured to the nearest 2 mmHg. Diastolic blood pressure is recorded as disappearance of the sounds (phase V).
· At least two recordings of blood pressure should be made at each of the several visits to determine blood pressure thresholds.

What are the causes of blood pressure discrepancy between the arms or between the arms and legs?
· Coarctation of aorta.
· Patent ductus arteriosus.
· Dissecting aortic aneurysm.
· Arterial occlusion or stenosis of any cause.
· Supravalvular aortic stenosis.
· Thoracic outlet syndrome.

How would you investigate a patient with hypertension in outpatients?
· Full blood count (FBC).
· Urine for sugar, albumin and specific gravity.
· Urea, electrolytes and serum creatinine.
· Fasting lipids, fasting blood sugar, serum uric acid.
· Serum total:HDL cholesterol ratio.
· ECG.
· Chest radiograph.
· 24-hour urine collection to measure vanillylmandelic acid.

What are the indications for ambulatory blood pressure recording?
· When clinic blood pressure shows unusual variability.
· When hypertension is resistant to drug treatment with three or more agents.
· When symptoms suggest that the patient may have hypotension.
· To exclude 'white-coat hypertension'.

What are causes of hypertension?
· Unknown or idiopathic (in 90% of cases).
· Renal: glomemlonephritis, diabetic nephropathy, renal artery stenosis, pyelonephritis.
· Endocrine: Cushing's syndrome, steroid therapy, phaeochromocytoma.
· Others: coarctation of aorta, contraceptives, toxaemia of pregnancy.

What special investigations would you perform to screen for an underlying cause?
· Renal digital subtraction angiography.
· 24-hour urinary catecholamines - at least three samples (phaeochromocytoma).
· Overnight dexamethasone suppression test.

What is the purpose of treatment in hypertension?
The purpose is to reduce the risk of devastating hypertensive complications such as myocardial infarction, stroke and heart failure.

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Argyll Robertson pupil Frequently Asked Questions

What are the causes of Argyll Robertson pupil?
· Neurosyphilis - tabes dorsalis.
· Diabetes mellitus and other conditions with autonomic neuropathy.
· Pinealoma.
· Brainstem encephalitis.
· Multiple sclerosis.
· Lyme disease.
· Sarcoidosis.
· Syringobulbia.
· Tumours of the posterior portion of the third ventricle.

What do you know about the nerve pathways of the light reflex?
· The afferent is through the optic nerve and the efferent limb is through the third cranial nerve. The relevant optic nerve fibres responsible for the light reaction leave those responsible for the perception of light to terminate in the pretectal region of the midbrain, from whence a further relay passes to the Edinger-Westphal nucleus.
· Disturbances of the pupillary light reflex occur when there is involvement of the following:
- Superior colliculus.
- Decussation of Meynert.
- Edinger-Westphal nucleus (supplies the constrictor muscles of the iris).

Where is the lesion in Argyll Robertson pupil?
Damage to the pretectal region of the midbrain is believed to be responsible for the Argyll Robertson pupil of neurosyphilis . This, however, does not explain the small irregular pupils and it has been suggested that local involvement of the iris is a separate lesion.

Which muscle in the eye is responsible for the accommodation reflex?
Paralysis of accommodation occurs when the ciliary muscle is involved. Remember that accommodation is a much more potent stimulus for constriction of the pupils than light, as there are more nerve fibres mediating the accommodation reflex than the light reflex.

Mention a few causes of a small pupil?
· Senile miosis.
· Pilocarpine drops in the treatment of glaucoma.

What is 'reversed' Argyll Robertson pupil?
The pupils react to light but not to accommodation - seen in parkinsonism caused by encephalitis lethargica.

What do you understand by the term 'anisocoria'?
Anisocoria is gross inequality of the pupils. Causes include:
· About 20% of normal individuals.
· Third nerve palsy.
· lritis.
· Blindness or amblyopia in one eye (pupil larger in the affected eye).
· Cerebrovascular accidents.
· Severe head trauma.
· Hemianopia due to optic tract involvement.

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Human physiology: from cells to systems - All Explained

The body is composed of many trillions of cells. Each cell is a self-contained, living entity. With the exception of red blood cells, cells of the same type join together, using inter­-cellular substances to form tissues, such as muscle tissue. One, two, or more tissues combine in a particular way to form more complex structures, called organs. All organs contribute to nutritional health, and a person's overall nutritional state deter­mines how well each organ functions. At a still higher level of coordination, several organs can cooperate for a common purpose to form an organ system, such as the digestive system. Overall, the human body is an organism made up of a coordinated unit of many highly structured organ systems.

Chemical processes (reactions) occur constantly in every living cell: The production of new substances is balanced by the breaking down of older ones, as exemplified by the constant formation and degradation of bone. For this turnover of substances to occur, cells require a continuous supply of energy in the form of dietary carbohydrate, protein, and/or fat. Cells also need water and building supplies for the turnover to occur. Amino acids, minerals, chemical regulators, and vitamins are some examples of genetic material that need the materials to break down. All of these substances enable the tissues, constituted from individual cells, to function properly.

Getting an adequate supply of all nutrients to the body's cells begins with a health­ful diet. You must have a daily intake of grain, fruits, vegetables, meats, and dairy to keep your organs functioning properly. All of these food groups provide an important vitamin or nutritional benefit for your body. To see how much of each food group your body requires, make sure to check out the latest food pyramid. To assure optimal use of nutrients, the body's tissues, organs, and organ systems also must work efficiently.

This article covers subject material concerned with the anatomy and physiology of the cell and major organ systems, especially as they relate to the study of human nu­trition. After reading this article, you have a brief outline on the information that is most essential about human physiology. However, if you are really interested in learning more about this subject, then you are more than welcome to start looking some other sources of information, including medical journals and other medicine books. Be sure to try to relate the information you read to your daily habits involving nutrition so that you can be healthier.

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Iatrogenic Cushing Syndrome and Corticosteroid Use

Iatrogenic Cushing Syndrome is the most common form of this disorder. The term iatrogenic means that the disease is caused by medical treatment. In the case of Iatrogenic Cushing Syndrome, the disease is a result of overuse of corticosteroids prescribed by a medical physician to treat unrelated disorders.

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Mitral Stenosis Frequently Asked Question

What is the commonest cause of mitral stenosis?
Rheumatic heart disease.

What is the mechanism of tapping apex beat?
It is due to an accentuated first heart sound.

What does the opening snap indicate?
The opening snap is caused by the opening of the stenosed mitral valve and indicates that the leaflets are pliable. The opening snap is usually accompanied by a loud first heart sound. It is absent when the valve is diffusely calcified. When only the tips of the leaflets are calcified, the opening snap persists.

What is the mechanism of a loud first heart sound?
The loud first heart sound occurs when the valve leaflets are mobile. The valve is open during diastole and is suddenly slammed shut by ventficular contraction in systole.

What is the mechanism of presystolic accentuation of the murmur?
In sinus rhythm it is due to the atrial systole which increases flow across the stenotic valve from the left atrium to the left ventricle; this causes accentuation of the loudness of the murmur. This may also be seen in atrial fibrillation and is explained by the turbulent flow caused by the mitral valve starting to close with the onset of ventricular systole. This occurs before the first heart sound and gives the impression of falling in late diastole; it is, however, due to the start of ventricular systole.

What are the complications?
· Left atrial enlargement and atrial fibrillation.
· Systemic embolization, usually of the cerebral hemispheres.
· Pulmonary hypertension.
· Tricuspid regurgitation.
· Right heart failure.

What are some rarer causes of mitral stenosis?
· Calcification of mitral annulus and leatlets.
· Rheumatoid arthritis.
· Systemic lupus erythematosus.
· Malignant carcinoid.
· Congenital stenosis.

Which conditions simulate mitral stenosis?
· Left atrial myxoma.
· Ball valve thrombus in the left atrium.
· Cor triatriatum

Have you heard of Ortner's syndrome?
It refers to the hoarseness of voice caused by left vocal cord paralysis associated with enlarged left atrium in mitral stenosis.

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How is ovarian cancer staged?

Ovarian cancer is deemed to be the most deadly gynaecological cancer and is the fifth leading cause of cancer related deaths is the United States. Claiming close to some 15,000 lives each year, it is one form of cancer difficult to recognize because it displays no symptoms till it has advanced to a very high level. Ovarian cancer stages are dependent on the size and spread of the tumor inside the body. The further treatment of ovarian cancer is dependent on which stage it has progressed to.

To classify stages, doctors take help of a simple rating system from 1 to 4. Stage I is the lowest on scale whereas Stage IV is close to being fatal and is the highest on the scale. Other than that, there are also borderline tumors.

A borderline tumor consists of low grade cancerous cells which have just started growing and multiplying. These have not yet affected the ovary in any way by growing into or damaging the ovarian tissue around them. This is not considered to be a bonafide ovarian cancer stage but is still treated as one with surgery. Stage I of the disease means that it has spread to the ovaries. This may be limited to one ovary or could be present in both ovaries. A further form of stage I shows up if the cancer has spread to the surface of the ovary or found inside of the abdomen during surgery. For stage I of ovarian cancer, surgery is the most effective way to dealing with it and preventing any sort of recurrence.

Ovarian cancer stage II usually means that the cancerous cells have spread from the ovary to the fallopian tube and/or uterus. A further form of stage II occurs when the cancer moves on to the pelvic region and cancerous tissue is seen in the rectum and bladder of the body as well. After which we come to stage III, where the cancer has definitely spread from the ovary to the abdominal region and can also be seen in the lymph nodes around the womb, crotch region and the upper part of the abdomen. The growths start becoming larger in size, measuring close to 2 cm and above, present in the lining of the abdominal cavity and causing many abdominal problems. These two stages usually call for chemotherapy to supplement the surgery done to remove as much cancer as possible from the body.

At the top is the ovarian cancer stage IV. This is the last stage of growth and often fatal for the patient. Survival rates at this point of treatment are pretty low and life expectancy after recovery is not very high. The treatment itself for this stage can be quite risky, especially for elderly women. At this stage, the cancer has spread from the ovaries and the abdomen to other parts of the body like the liver and lungs. After reaching here, radiation therapy is the best treatment available for the patients but is very dangerous for the elderly. A combination of surgery, chemotherapy and radiation is used at this point, often enough effectively.

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Celiac Disease on the Rise in the U.S.

Complaints of celiac disease are on the rise in the United States, with more and more people growing ill from exposure to products containing gluten.

Nearly five times as many people have celiac disease today than did during the 1950s, according to one recent study. Another report found that the rate of celiac disease has doubled every 15 years since 1974 and is now believed to affect one in every 133 U.S. residents.

"It's quite widespread," said Dr. Alessio Fasano, director of the Center for Celiac Research and the Mucosal Biology Research Center at the University of Maryland School of Medicine. "We thought there were regional differences in the past, but now we know it's everywhere."

That increased incidence rate has left researchers scrambling to figure out why more people are developing the chronic digestive disorder. Doctors still can't explain the trend, but they are making some headway testing a number of hypotheses.

"There are many theories out there, not all independent of each other and not all of them true," Fasano said.

Celiac disease is an inherited autoimmune disorder that causes the body's immune system to attack the small intestine, according to the U.S. National Institutes of Health and the University of Chicago Celiac Disease Center. The attack is prompted by exposure to gluten, a protein found in such grains as wheat, rye and barley.

The disease interferes with proper digestion and, in children, prompts symptoms that include bloating, vomiting, diarrhea or constipation. Adults with celiac disease are less likely to show digestive symptoms but will develop problems such as anemia, fatigue, osteoporosis or arthritis as the disorder robs their bodies of vital nutrients.

Awareness of celiac disease has grown in recent years, evidenced by the growing number of gluten-free foods on the market. However, medical experts don't believe that the increase in celiac disease incidence can be chalked up simply to folks becoming more aware of the chronic digestive disorder or to improvements in diagnostic techniques.

Rather, the most popular potential explanations for the increase in celiac disease rates involve improvements in sanitation and hygiene in civilization overall, said Fasano and Carol McCarthy Shilson, executive director of the University of Chicago Celiac Disease Center.

According to the "hygiene hypothesis," Shilson said, people in industrialized countries are more at risk for celiac disease because their bodies have not had to fight off as many diseases.

"We're just too clean a society, so our immune systems aren't as developed as they should be," she said.

Another version of the hypothesis holds that the cleanliness of industrialized society has caused a fundamental change in the composition of the digestive bacteria contained within the gut, Fasano said.

"It's because this increase occurs primarily in industrialized countries, where things are cleaner," Fasano said. "We abuse antibiotics, we wash our hands too often, we are vaccinated more often."

Other potential explanations for the rise in celiac disease rates, according to Fasano, include:

An increase in the amount of gluten found in grains. "We eat grains that are much more rich in glutens than they were 70 or 80 years ago," he said.
Children being exposed to gluten from an early age. "We know for sure if we introduce grains too early, people at risk for developing celiac disease are more likely to contract it," he said.
Too few women breast-feeding their children. "There are theories out there that say breast-feeding will protect you, or prevent celiac disease," Fasano said.

It's possible, experts say, that each of these theories is correct to a degree and that a combination of factors will ultimately be found to contribute to celiac disease. "It may well be in one person, one plays a stronger role than another," Fasano said.

But while experts try to find a cause -- and then, they hope, a cure -- advocates urge people who are at risk for developing celiac disease to undergo screening for the disorder.

Researchers have shown a genetic predisposition for celiac disease, with about 30 percent of the population carrying genes that make them vulnerable, Shilson said.

But because adults with celiac disease often don't suffer the digestive symptoms associated with gluten intolerance, many people are unaware they have it or could pass it on. "About two-thirds of people with the active disease have no symptoms at all," Shilson said.

Studies also have found that the earlier people find out they have celiac disease, the better able they are to head off the disorder's more debilitating effects.

"There's not much you can do to prevent it, but you can be aware of it and catch it," Shilson said. "Early intervention is key."

However, people who suspect they have celiac disease should not go gluten-free before being tested. Doing that can interfere with the accuracy of the screening.

"It's very important that you don't change your diet before you are screened for celiac disease," Shilson said.

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