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A pregnant woman with Mitral stenosis is most likely to gastritis and ulcers cheap ranitidine express undergo failure in which period A gastritis diet purchase 150 mg ranitidine visa. If a patient comes with complaints of post dated pregnancy what is the first thing that you will do A gastritis diet order ranitidine without prescription. Which of the following is a characteristic radiological finding in neonatal necrotizing enterocolitis A gastritis diet xone buy cheap ranitidine 300 mg on line. A patient presenting with a fasting blood sugar of 180 and post prandial sugar of 260. In a patient with transplanted heart which of the following are reasons for increased cardiac output in him during exercise a. In a patient which of the following would cause rhabdomyolisis and myoglobulinuria a. In a patient with acute arsenic poisoning which of the following strictures would show accumulation of arsenic a. In those types causing urinary infections the organism attaches by pili antigen c. Abdominoperineal resection is preferred in colorectal cancer based on which of the following a. In comparison between restrictive cardiomyopathy and constrictive pericarditis they are differentiated as in constrictive pericarditis a. True regarding recurrent thrombophlebitis (migratory thrombophlebitis) is Incomplete Question. Which of the following investigations would U do for a case of strangulated hernia a. A lady with 4 months ammenorhea presents with pain abdomen, constipation, and vomiting. Which of the following drugs is associated with least causation of raised intraocular tension a. In the diagnosis of filariasis the blood sample collected for identification of microfilaria is stored in/as a. Volume of air taken in and given out during normal respiration is referred to as a. A patient was started on antihypertensive treatment develops renal insufficiency, the drug/drugs implicated are. Can lead to red degeneration in pregnancy for which immediate surgery is required d. The alpha subunit is specific 244 the antigen-binding region on the antibody is/are a. When acute appendicitis is suspected it blood sugar of 180 and post prandial can be confirmed by sugar of 260. In oculomotor nerve palsy, which of the glomerulus as it is a large the following causes can be implicated molecule a. Regarding acid secretion in the would cause rhabdomyolisis and stomach myoglobulinuria a. Restrictive Fragment Length in both strands Polymorphism is used in the diagnosis b. Has high propensity to spread investigations would U do for a case of to lymphnodes strangulated hernia d. Correction of volume for give rise to which of the following hypovolemia symptoms. Genetic abnormalities in the treatment of congestive heart failure fetus can be diagnosed by include a. Properties making cardioselective beta blockers desirable are Page 10 of 10 Aippg. A lady with 4 months following features in common with ammenorhea presents with pain depression abdomen, constipation, and vomiting. In patients with substance abuse be changed by for maintenance drugs used is/are a. Occurs due to accumulation of conjuctiva is caused by urea crystals in the joints a. Treatment of choice for a patient with inverted papilloma of right side of nasal cavity is 1. A child presenting with history of nasal obstruction since 5 years and with epistaxis since 1 year. A child presented with history of unilateral purulent nasal discharge with occasional bloody discharge from the same side. Tympanic membrane and ossicles efficiently transmit sound to the inner ear at which of the following frequencies 1. In a patient with trauma with middle cranial fossa fracture complains of loss of tear secretion. Superficial thyroid vein is closely related with external branch of superficial laryngeal nerve 17. Most common tumor to have metastatic involvement of upper deep cervical lymph nodes is 1. In a patient with cataract, capsulotomy with removal of lens nucleus followed by aspiration of cortical content is known as 1. A patient presented with unilateral ptosis and diplopia and on examination was found to have decreased movement of eyeball in all directions. Corneal involvement is always associated with tip of nasal involvement and ulcers 4. Punctate Keratitis may coalesce and unite to form dendritic ulcers which simulate Herpes simplex 30. All the following are true regarding acute anterior uveitis in Ankylosing spondylitis except 1. In a population to prevent coronary artery disease changing harmful lifestyles by education is referred to as 1. Which of the following helps in diagnosis, in biopsy of brain specimen in Rabies 1. In a splenectomized patient there is increased chances of infection by all the following organisms except 1. In India which of the following is true regarding the cause of travelers diarrhea 1. In adult rhabdomyosarcomas are resistant to radiotherapy and spread to lymphnodes Ans. Dermatofibrosarcoma protruberance is a malignant tumor and often presents with metastasis 4. On radiography widened duodenal C loop with irregular mucosa on hypotonic duodenography is due to 1. All the following complications are seen with use of oral contraceptives except 1. Insulin mediated glucose entry is most important in which of the following organs 1. Corticosteroids given to mother prevent all the following complications in the newborn except 1. Lowest dose of ethinyl estradiol used in combination contraceptive which has been shown to be effective is 1. Hoffmans mechanism of drug elimination is seen in which of the following drugs 1. Deficiency of which of the following factors does not cause an abnormality of the. In coronary artery disease the role of Beta blockers in decreasing the symptoms is by all the following mechanisms except 1. Which of the following muscles are used in the action involved in sucking of a straw 1. High fibre containing diet is associated with increased incidence of Diverticulosis 2. In India >20% of the population above the age of 40 years is affected by diverticulosis 4. The serosal lining of the rectum is tough and prevents spread of tumor to surrounding pelvis 145. It is difficult to treat Diaphyseal aclasis when it causes which of the following 1. Epiphysis is present at end of long bone and is made of spongy bone covered with a articular cartilage 4.
The declaration described for surrogate class ten gastritis diet questionnaire buy ranitidine 150mg lowest price, above gastritis diet order ranitidine without prescription, must be signed and dated under penalty of perjury and state: 1 gastritis tratamiento buy ranitidine online now. What is reasonable depends on many factors gastritis eating too much order genuine ranitidine line, including the exigency of the situation. What if a higher priority surrogate decision-maker doesnt want to make decisions If a higher priority surrogate declines to make decisions, you must turn to the next available priority surrogate. The Medical Director, Administrator-on-Call, and Risk Management are available to consult in these situations. There is no specific definition of recognized medical emergency in Washington law. The decision to proceed with emergent treatment is not to be considered informed consent. Only maternal emergencies are considered obstetric emergencies that invoke the implied consent provisions of the law. The typical question/scenario is whether to proceed with an emergency Caesarean section if the mother is unable to make her own decisions. If the indication is fetal, you may choose to proceed if there is no indication that the mother would have refused. This form is signed by the attending physician and a second physician to document clinical agreement that there is an emergent need to proceed with treatment. There is an exception if a recognized medical emergency occurs during the procedure; even in that case, if possible the legally authorized surrogate should be consulted, especially if the additional procedures are not life-preserving. This does not mean that if there are eight siblings and you have located only five, you need to delay treatment unduly while attempting to locate the other three siblings. If you are faced with a dispute between the members of the surrogate group, this can often be resolved by holding a family conference. What if the surrogate decision-maker is making decisions I believe are not good for the patient If you believe that a surrogate is not making appropriate decisions for the patient, you may consult Ethics or Risk Management. If there is a surrogate or other family available but a court order is nonetheless needed for some reason, it is preferable for the surrogate/family to file the petition and otherwise take responsibility for obtaining the court order. Whats the process for obtaining a court-appointed guardian to make health care decisions The process is initiated by filing a petition for guardianship with the local court. It can take up to 4-6 weeks before a guardian is appointed who can actually make health care decisions, so if you believe your patient may need a guardian, it is advisable to begin the process as soon as possible. If your patients need is more urgent, special counsel can often expedite the process. A guardian ad litem will be appointed initially when the petition is filed; it is his/her responsibility to prepare a report to the court, which will be considered at the guardianship hearing (up to approximately 4 weeks after filing). If you believe your patient needs interim treatment, you should specifically request that the special counsel seek such an order. A guardian is a person who has been appointed by the court to act as an incapacitated patients decision-maker. These treatment decisions should be handled as with other informed consent issues. The discussion should take place with the patient if possible, and/or with the surrogate decision maker. If the patient has decision-making capacity, he/she has the absolute right to request or refuse life-sustaining treatment, despite what may be contained in a living will or other advance directive. Page 25 of 40 Please refer to your entitys advance directive/withdrawal of life support policies to determine when withholding and withdrawing life-sustaining treatment is appropriate. A Living Will or Health Care Advance Directive is a document that expresses a patients specific wishes regarding whether the patient wants life-sustaining treatment withdrawn or withheld. Under Washington law, its use is limited to situations where the patient is terminally ill or in a vegetative state. There are certain statutory requirements for Advance Directives, including who may and may not witness the document. If the patient has an advance directive or living will, these documents can provide evidence of what the patient would have wanted. However, the documents are not consents in and of themselves except in limited circumstances. It also must clearly state either that the power of attorney shall not be affected by the incapacity of the principal, or that the power of attorney shall become effective upon the incapacity of the principal, or similar language. Legal requirements for validity of these 10 Terminal condition means an incurable and irreversible condition caused by injury, disease, or illness that, within reasonable medical judgment, will cause death within a reasonable period of time in accordance with accepted medical standards, and where the application of life-sustaining treatment serves only to prolong the process of dying. Documents executed in Washington after January 1, 2017, must be signed and either notarized by one person or witnessed by two people who are not caregivers for the patient or relatives of the patient. Surrogate decision-makers are prohibited by law from authorizing the following types of treatment (see 33 and 48): Sterilization Electroconvulsive treatment/ psychosurgery Involuntary mental health treatment/psychotropic drugssee 59, below. A court order may also be advisable when considering amputation or other highly disfiguring procedures in a patient who cannot consent for themself. If a parent does not have this decision-making authority, he/she may not make any decision for the child other than those relating to emergency care. If the parenting plan designates decision-making or custody to be mutual, or joint, the consent of either parent is sufficient. The health care provider need not obtain a copy of the parenting plan, but may rely upon the representation of a parent that he or she possesses the health care decision-making authority. The health care provider may rely on this representation so long as there is no actual notice of the falsity of the statements. This authority typically extends only to routine medical, dental, and psychological examination and care. The typical order also allows the agency or individual to authorize all necessary emergency care for a child. Page 28 of 40 examinations, hearing examinations and hearing aids, immunizations, treatments for illnesses and conditions, and routine follow-up care customarily provided by a health care provider in an outpatient setting, excluding elective surgeries. In the meantime, hospitals and physicians are specifically authorized by statute to detain a child without the consent of a person legally responsible for the child, if there is reasonable cause to believe that permitting the child to continue in his or her place of residence or in the care and custody of the parent, guardian, custodian or other person legally responsible for the childs care would present an imminent danger to that childs safety. The hospital administrator or physician detaining a child without consent under these circumstances must notify the appropriate law enforcement agency or child protective service as soon as possible, but in no case longer than 72 hours after the detention. Providers should seek legal advice on situations where court orders of Indian tribes may control the custodian who may give health care consent for an Indian child. Situations may include when the patient is the subject of dependency or parental termination proceedings, in the pre-adoption process, or in proceedings for non-parental custody. Also, payment obligations generally do not flow to a parent who is not involved in the consent; if you have specific questions in this area, a risk management or compliance consult is recommended. A copy of the court order is also appropriate documentation to place in the record. Note that the minimum age may be gauged against the statutory requirement, which is 16, such that a younger age may not be deemed to signify sufficient maturity. Minors also may consent to the following specific types of treatment at various ages: Sexually Transmitted Disease: Minors 14 or older who may have come in contact with any sexually transmitted disease or suspected sexually transmitted disease may consent to hospital, medical and surgical care related to the diagnosis or treatment of such disease without parental consent. Note that the actual route of transmission in a specific case is not necessarily required to be sexual. Use clinical judgment regarding whether to involve the parents of a very young sexually mature minor. Page 30 of 40 health care of their grandchild unless they have obtained a court order of custodianship or guardianship or qualify as appropriate surrogates representing themselves as the adult relatives responsible for the minors health. Washington state law deems anyone who operates a motor vehicle to have given implied consent to alcohol or drug testing in connection with operation of the motor vehicle. There are legal consequences with respect to criminal traffic proceedings for a person who refuses to have his or her blood drawn in these circumstances, but the refusal must be honored by a health care provider, except in the following limited circumstances, when the health care provider may draw blood at the request of law enforcement even though the patient refuses: If the police officer has obtained a search warrant from a judge ordering that the blood draw be made; If the accompanying police officer states that the patient is one of the following (this should be documented in the medical record along with the police officers name and badge number): o Under arrest for vehicular homicide, o Under arrest for vehicular assault, or Page 31 of 40 o Under arrest for driving under the influence of intoxicating liquor or drugs resulting in an accident in which there is a reasonable likelihood that another person may die of injuries. There should be a medical indication for any diagnostic test, including blood or urine drug screening. Be dated and signed by the patient or contain documentation that it was signed at the patients direction in the patients presence; 4. Designate whether the patient wishes to be able or unable to revoke the directive during any period of incapacity; and 5. Be witnessed in writing by at least two adults, containing a declaration by each that he or she personally knows the patient, was present when the patient dated and signed the directive, and that the patient did not appear to be incapacitated or acting under fraud, undue influence, or duress.
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The ma tion gastritis special diet purchase 150 mg ranitidine with mastercard, if the patient bears down somewhat gastritis how long 300mg ranitidine overnight delivery, polyps can pass the jority of these perforations occur after mucosectomy or poly anal canal without completely falling apart or moving back up pectomy of sessile polyps chronic gastritis frequently leads to ranitidine 300 mg without prescription. Polyp pieces lost during retrieval in the colon can be of peritoneal irritation are cause for immediate investigation sieved from fluid evacuated from the bowels (Fig gastritis diet quality proven ranitidine 150mg. There is no time to lose if the en ing the patient again with an enema or a bowel cleansing solu doscopist observed the perforation, for example, by visualiza tion can usually be avoided, sparing him additional discomfort. Based on available research, the presence of intraperitoneal or retroperitoneal free air without remarkable clinical signs (silent perforation) does not necessitate immediate surgical Possible complications related to polypectomy or mucosectomy intervention. The patient should initially be given intravenous include bleeding, perforation, and postpolypectomy syndrome. Bleeding can be Small leakages may close spontaneously without requiring spontaneous (18. Depending on vessel supply to the resected polyp, bleeding intensity ranges from minimal oozing to arte Postpolypectomy syndrome mani rial, pulsating spurting. Spontaneous bleeding occurs immedi fests with localized abdominal pain, brief periods of fever and ately after resection in 1. Caused by local peritoneal irritation from trans occurs in around 2% of polypectomies. In both cases, immediate mural thermal damage with irritation of the serosa, the syn hemostasis by the endoscopist is the therapy of choice. Even in drome occurs in 1% of all polypectomies with onset of symp cases of delayed hemorrhage, immediate hemostasis can be at toms between six hours and five days after polypectomy (8). Polypectomy five days, though antibiotics may be necessary depending on bleeding is treated with endoscopic hemostasis, blood transfu clinical course, fever, and laboratory tests for signs of inflamma sion, and close clinical surveillance. Perfora the greatest concern in terms of complications is hemorrhage, which can lead to abscess, peritonitis, and fistulization. Energy is emitted though a 2-mm-thick Teflon tube in which argon gas flows around an electrode. The ionized argon gas is aimed from the probe tip at the targeted tissue without contact between the probe and the tissue. Because the argon gas is illumi nated, it is possible to guide it over the coagulation surface. The operative distance to the tissue is 210 mm; at a greater distance, ion izationand thus coagulationdisappears. The main advantage over laser coagulation (laser carboni zation and vaporization) is low depth of penetration (23 mm) that reduces risk of perforation. Argon gas and visibility blocking coagulation vapor must be intermittently suc tioned (Fig. Further advantages include low equip ment cost and the potential for gas sterilization of the delivery catheter. Bowel distention can be prevented by intermittently suctioning the argon gas and coagu lation vapor. There are now a number of manufacturers of self-expanding metal stents for traversing colon stenoses caused by tumor growth. The most common are the Wallstent Enteral and the Ultraflex Precision (Boston Scientific), as well as the Z stent (WilsonCook), the latter of which is also available as a covered stent especially designed for traversing fistulas. There are two techniques for applying colorectal stents: radiologic positioning, endoscopic positioning. The advantage of endoscopic positioning is better fixation of the rectosigmoid colon with the endoscope, especially if the tumor is causing torsion of the bowel. Argonplasmakoagulation in der flexiblen tive chemoradiation therapy after placement of a self-expanding Endoskopie. Applicator Isolating layer of vapor Dispersion of the plasma jet Neutral electrode Desiccation zone Coagulation zone Devitalization zone Fig. When the tip of the applicator is protrud ing from the endoscope the clip is ad vanced. Preloaded disposable clip applica tors are also available (images provided courtesy of Olympus). The Endoloop can also be used for postpoly pectomy ligation of a bleeding stalk remnant (image based on illustra tion provided courtesy of Olympus). Inter pretation of a radiograph without use of a contrast agent is the rectum is generally empty at endoscopy and should be sometimes difficult. At the rectosigmoid junction or just beyond it there is a point where the lumen is ob Urgent surgical intervention is associated structed by torsion of the sigmoid colon (Figs. Endoscopic reversal of torsion and decompression of a doscopist should attempt to carefully pass this point, sigmoid volvulus has a success rate of 58100% (6, 16, 23). If the mucosa is ischemic, the scope should tunately, reversal of torsion is accompanied by a high rate of re never be advanced without visualization (Figs. Air should be intermittently insufflated to assist in for two to three days following successful therapy appears to be the reversal of the torsion. Attention should be paid at this point (as before) to possible bowel ischemia (Figs. The mucosa should be washed off and if it appears healthy, the scope can be advanced until reaching the colon segment before the D F E 160 94, 95, 96 9 96 19 97 98 see also 226, 227 225 182 149 127, 148, 149 173 182, 183, 184 38 12, 82 102103 115, 133134 160, 172 159 see 159 Yersinia enterocolitica 108, 97 127, 193, 147 100, see 98 15, 16 108, 109 see also 99 129. John of Jerusalem Honorary member, Italian Assoc for the Study of Glaucoma 1995 Senior Honor Award, American Academy of Ophthalmology 1995 Listed, 111 Best Ophthalmologists in America, Ophthalmology Times 1996 Ophthalmologist of the Year, Heed Ophthalmic Foundation 1996 Guest of Honor, New England Ophthalmologic Society 1997 Gold Medal of Merit and Honour of A. Trantas 1998 Greek Glaucoma Society Commander of Grace and Lieutenant Knight Hospitaller of the Sovereign Order of the Orthodox Knights Hospitaller 1998 of St. John of Jerusalem Ophthalmology Times Achievement in Ophthalmology Award 1998 1998 Louis Rudin Award for Research in Glaucoma 1999 Honoree, Helen Keller Foundation 2000 Man of the Year, the Glaucoma Foundation 2000 Jesse H. Neal Award for Editorial Achievement 2000 John Kearny Rodgers Physician of the Year Award 4 New York Eye and Ear Infirmary 2005 Albion O. Fellow, American Academy of Ophthalmology Chairman, Distribution Advisory Subcommittee, 2000-2004 Chairman, Education Distribution Task Force, 2004-2006 Member, Committee on International Ophthalmology, 2001-4 Member, International Assistance Steering Committee, 2004-2006 International O. Fellow, New York Academy of Medicine Chairman, Program Committee, Section on Ophthalmology,1991-92 President, Section on Ophthalmology, 1993-1994 6. Fellow, American Society for Laser in Surgery and Medicine Chairman, Ophthalmology section, 1991-1992 7. Ophthalmic Laser Surgical Society Co-Founder with Drs Francis LEsperance and Raymond Harrison, 1981 Secretary-Treasurer, 1982-1998 President, 1998-2000 8. New York Society for Clinical Ophthalmology Recording Secretary, 1988-1990 Chairman, Program Committee, 1990-1991 President, 1991-1992 Executive Board, 1988-1998 9. American Ophthalmological Society Program Committee, 2001-2004 Chairman, Program Committee, 2003-2004 25. World Glaucoma Association, 2002 Steering Committee Chairman, Patient Groups and Foundations Liaison Committee Co-Chair, World Glaucoma Day Committee, 2007-2009 Co-Chair, World Glaucoma Week Committee, 2010 World Glaucoma Projects Committee 31. International Council of Ophthalmology Advisory Committee to the Board of Directors, 2002-2009 Chairman, Advisory Committee to the Board of Directors, 2009 Subspecialty Membership Criteria Committee, 2004-2008 Clinical Guidelines Committee, 2005 Exploratory Task Force on Glaucoma, 2007 Fellowship Committee, 2008 Research Committee, 2009 Education Committee, 2009 Board of Directors, 2009 34. Southeast Asian Glaucoma Interest Group Glaucoma Guidelines International Review Committee 2008 37. Symposium on Ophthalmology, Brooklyn and Long Island Chapter of the American College of Surgeons, Mount Sinai School of Medicine, September 19, 1979 2. Laser Therapy of the Ciliary Body, International Society of Lasers in Medicine and Surgery, Detroit, Mich, Oct 7, 1983 3. Scientific Chairman, Internat Ophthalmic Laser Symposium, Jerusalem, Israel, June 18-22, 1984 4. Scientific Chairman, Bangkok Ophthalmologic Congress, Bangkok, Thailand, January 7, 1985 6. Organizing Chairman, 2d Bangkok Ophthalmologic Congress, Bangkok, Thailand, January 3, 1986 7. Organizing Chairman, 3d Bangkok Ophthalmologic Congress, Bangkok, Thailand, January 5, 1987 8. When to Intervene in Open-Angle Glaucoma, 60th Annual New York Eye and Ear Infirmary Clinical Conference, May 29, l987 10. Organizing Chairman, 4th Bangkok Ophthalmologic Congress, Bangkok, Thailand, January 6, 1988 11.
Answer is 4 Apley gastritis zucker buy cheap ranitidine 150mg line,s orthopedics 8th ed/ 230 Maheshwari essential orthopedics 2nd ed/51 (table 10 gastritis diet gastritis treatment buy ranitidine on line amex. Axonotmesis degeneration occurs distal to diet bei gastritis generic ranitidine 150 mg on line the lesion and for a few mm retrograde treating gastritis with diet purchase ranitidine amex. In fetal development degeneration is by mechanism of apoptosis In senescence nerve starts degenerate because of no use of nerve. Answer is 1 Harrison principle of internal medicine 15th Ed /134 Lower Motor Neuron Weakness Lesion of ant. Flaccid weakness of muscle Loss of deep tendon reflexes Fasciculation of muscle fibers Atrophy of muscle Lesion of the cell bodies of brainstem motor cranial nerve nuclei and the anterior horn of the spinal cord. Or from dysfunction of the axons of these neurons as they reaches to skeletal muscle. Spasticity Upper motor neuron disease Rigidity Extrapyramidal disorders Lead pipe" or "plastic" stiffness Red nucleus Cogwheel Parkinsons disease Paratonia (gegenhalten) Disease of the frontal lobes Flaccidity Lower motor neuron lesion Q. Examination reveals increased blood pressure, tremors, increased psychomotor activity, fearful affect, hallucinatory behavior, disorientation, impaired judgement and insight. Answer is 2 Harrison priciple of internal medicine 15th ed/2565 All India repeat Q of 2003 When a chronic alcoholic stops taking alcohol then withdrawal symptoms generally begin within 5 to 10 h of decreasing ethanol intake, peak in intensity on day 2 or 3, and improve by day 4 or 5. Features include tremor of the hands (shakes or jitters); agitation and anxiety; autonomic nervous system over activity. The characteristic clinical triad is that of ophthalmoplegia, ataxia, and global confusion. Ocular motor abnormalities include horizontal nystagmus on lateral gaze, lateral rectus palsy (usually bilateral), conjugate gaze palsies, and rarely ptosis. She reports these thoughts to be her own and distressing; but is not able to overcome them along with medications. Answer is 1 New oxford textbook of psychiatry 1st ed/827-828 Although it is a repeat question, many guides has been given the answer systemic desensitizationBut according to oxford the behavioral therapy is as effective as pharmacotherapy in O. Desensitization, thought stopping, flooding, implosion therapy and aversion conditioning have also been used in-patient with O. He described himself as feeling strange as if he is different from his normal self. Answer is 2 Neeraj ahuja psychiatry 5th ed/113 Charlis G Morris psychology 10th ed/522 Essential feature of depersonalization is that person suddenly feels changed or different in a strange way. A 20 yr old college student sought professional help experiencing episodes of feeling outside of himself for 2 yr. Delusion mood and autochthonous delusion are the false belief as per definition, but this boy doesnt have false belief Q. Essential of pharmacology p396 Atypical anti psychotic Clzapine Tardive dyskinesia rase Prolactin level Resperidone Tardive dyskinesia rase prolaction level Olanapine Tardive dyskinesia rase little in prolactin level So main difference between typical and atypical antipsychotic is lack of Tardive dyskinesia in atypical. Essential of pharmacology p410 Anticholinergic side effect of antidepressant leads to dry mouth in the patients on these drugs. Dry mouth is due to the Muscarinic acetylcholine receptor antagonism of these drugs. Answer is 1 Charlis G Morris psychology 10th ed/416 Adolescence is a period of storm and stress, fraught with suffering, passion, and rebellion against adult authority (so they may have frequent quarrels with his parents). Between 15-30% of adolescent student dropout of high school, many regularly abuse drugs. So it excludes depression Frequent quarrels and loss of interest in studies only, exclude Migraine. A thought is retained long after it has become inappropriate in the given context. Symptoms do not normally reflect understandable physiological or pathological mechanisms. So it is the investigation of choice in evaluation of suspected Perthes disease If Question were Next step in evaluation of patient, or what will be the first investigation of choice Answer is 3 Snells clinical anatomy 7th Ed, Pg-802 Harrison principle of internal medicine 15th Ed Cribriform plate of the ethmoid bone may be damaged in the fractures of ant. Persistent rhinorrhea and recurrent meningitis are indications for surgical repair of torn dura and underlying fracture. Those are one source of posttraumatic epilepsy that occurs after years of the head injury. Administration of prophylactic antibiotic in fracture base of skull gives no benefit. Answer is 1 Harrison principle of internal medicine 15th ed/2386 Intraparenchymal hemorrhage is most common type of intracranial hemorrhage. The most common sites of Intraparenchymal bleed are the basal ganglia (Putamen, thalamus, and adjacent deep white matter), deep cerebellum, and Pons. It is possible to opacity arteries in many areas of the body using a direct percutaneous needle puncture. The common carotid and vertebral arteries can be punctured in the neck using an anterior approach to obtain arteriograms of the carotid and vertebrobasilar systems; the subclavian, axillary or brachial arteries can be punctured for upper limb arteriography, the abdominal aorta (high or low) for lumbar, pelvic and leg arteriography; and the femoral artery for single leg studies. But now Percutaneous studies in the head and neck and upper limb have been largely supplanted by the transfemoral catheter method. Answer is 3 Harrison principle of internal medicine 15th ed/626 Sarcomas tend to metastasize through the blood rather than the lymphatic system; lymph node metastases occur in 5% of cases. Exceptions are Synovial and epithelioid sarcomas, Clear-cell sarcoma (melanoma of the soft parts), Angiosarcoma, and Rhabdomyosarcoma Where nodal spread may be seen in 17% the pulmonary parenchyma is the most common site of metastases in sarcomas. In the treatment of sarcomas Doxorubicin (Adriamycin is trade name) -based chemotherapy is favored (as in Leiomyosarcomas). Radionuclide Radiation emitted Half-life Radium-226 Gamma rays Gamma rays Caesium-137 Gamma rays 30 years Cobalt-60 Gamma rays 5. Answer is 3 Grainger and Allisons, diagnostic radiology 4th ed/143 Gated imaging When any motion of body produces disturbance and motion related artifact in images in Radiology or during radiotherapy, then gating is done to reduce the motion related artifacts. Answer is 3 Harrison principle of internal medicine 15th ed/501 Widespread screening for breast, cervical, and colon cancer is beneficial for certain age groups Breast Cancer Annual or biennial screening with Lung Cancer Screening chest radiographs and mammography or mammography plus clinical breast sputum cytology has been evaluated as examination in women over the age of 50 saves lives. No reduction in lung cancer mortality has been found Colorectal Cancer Annual fecal occult blood testing Cervical Cancer Screening with Papanicolaou smears using hydrated specimens could reduce colorectal cancer decreases cervical cancer mortality. Two case-control studies suggest recommend regular Pap testing for all women who are that regular screening of people over 50 with sexually active or have reached the age of 18. Answer is 2 Walter Miller, Textbook of Radiotherapy; Pg -112 Grainger and Allison diagnostic radiology 4th Ed/141 Gamma camera is the devices used to observe the distribution of an isotope in an organ, or in a part of the body. It receives the gamma ray photons from patient through a grid of thousands of holes drilled parallel to each other. Scintillators when these are struck by a photon of X-ray or gamma ray they scintillate (released as a flash of light). It dt = is from starting (dt = T2 T1) dt it T1 is 0 than dt = t When T1 is 0 it is called initial decay dN = is called initial decay rate. Answer is 2 Parson disease of eye 19th ed/16,407 Circulus Arteriosus major situated along the base of iris in the ciliary body. Circulus arteriosus minor along papillary margin A concussion injury to iris, especially angle resection leads to hemorrhage in the ant. Khurana ophthalmology 2nd ed/11 Optic atrophy Painless but gradual loss of vision Developmental cataract Painless but gradual loss of vision Acute attack of angle closure glaucoma Painful, sudden loss of vision Vitreous hemorrhage Painless, sudden onset fall in vision Q. On computed tomography scan of the orbit there is calcification seen within the globe. Answer is 2 Wolfgang Dahnert Radiology Review Manual 5th ed/345 Kanskis Clinical Ophthalmology Pg-338. Graysons Diseases of the Cornea, 4th Ed pg-50 Corneal nerves may be seen in normal eyes as fine branching white lines. That originates at the limbus in the mid stroma and become more anterior centrally. Answer is 2 Harrison principle of internal medicine 15th ed/176 Trochlear Nerve the fourth cranial nerve originates in the midbrain, just caudal to the oculomotor Nerve complex. Only nerve that exit the brainstem dorsally and cross to innervate the Contralateral superior oblique. Abducent is not the longest intracranial nerve but it is most common nerve involved in raised I. Answer is 4 Harrison principle of internal medicine 15th ed/1202 Free-living amebas are Acanthamoeba, Naegleria, and Balamuthia are distributed throughout the world and have been isolated from a wide variety of fresh and brackish water. Fluorescein-labeled antiserum is available for the detection of protozoa in biopsy specimens. Examination of the cerebrospinal fluid for trophozoites may be diagnostically helpful, but lumbar puncture may be contraindicated because of increased intracerebral pressure.