comedk 2011 medical clarification comedk keys 2011

8/10/2019 Comedk 2011 Medical Clarification ComedK Keys 2011

1/16

Answer should be Manipulation and casting(Ponseti method)

Ref

1. 5-Minute Orthopaedic Consult

2. Current diagnosis & treatment in orthopedics - 4th editionChapter 11. Pediatric Orthopedic Surgery -- Topic : Foot Disorders Congenital Clubfoot

Conservative Treatment - Clubfoot always requires treatment, which should begin at birth. The initialapproach is passive manipulation and positioning to the corrected position . In the United States, themajority of orthopedists use serial manipulation and casting, usually at 1-week intervals in the first month oflife, and at 1- to 2-week intervals thereafter. In other parts of the world, strapping (with adhesive tape) orsplinting with a variety of braces are popular methods (in addition to serial casting) for maintaining themanipulated correction. When casting is performed, there is agreement that specific techniques are more likelyto be successful (Ponseti method) . Even when the deformity responds to casting, there is usually sufficientAchilles tightness that a heel cord lengthening needs to be done at 4 weeks or later to facilitate cast correction.

3. Campbell's Operative Orthopaedics - 10th & 11th Ed

Volume 2 - Part VIII - C H A P T E R 26 - Congenital Anomalies of Lower Extremity -Clubfoot

NONOPERATIVE TREATMENT

The initial treatment of clubfoot is nonoperative. Various treatment regimens have been proposed, including theuse of corrective splinting, taping, and casting. Treatment consists of weekly serial manipulation and castingduring the first 6 weeks of life, followed by manipulation and casting every other week until the foot isclinically and roentgenographically corrected. With experience, the clinician is able to predict which feet will

respond to nonsurgical treatment. The more rigid the initial deformity, the more likely that surgical treatmentwill be required.


2/16

Answer should be 46 XX as in other option it was 45XX and 46XY,not 46XX and 46XY.

Ref1. Textbook of obstetrics -Author -Dutta - 6th Ed - Pg No 194

2. Willi ams Obstetr ics - 23rd edi tion - Chapter 11

Ploidy - The chromosomal composition of complete moles is usually diploid and of paternal origin. About 85percent are 46,XX with both sets of chromosomes paternal in origin (Wolf and Lage, 1995). Termedandrogenesis, the ovum is fertilized by a haploid sperm, which duplicates its own chromosomes after meiosis.The chromosomes of the ovum are either absent or inactivated. In other complete moles, the chromosomal

pattern may be 46,XY due to dispermic fertilization (Bagshawe and Lawler, 1982).


3/16

Answer should be medulla as Salivary center & nuclei located in medulla.

Ref 1. Gray's anatomy 39th Ed - Fig 19.1

2. Ganong physiology 23rd Ed - Fig 26.3

3. USMLE Road Map Physiology - By James N. Pasley - 2nd Ed - Page 117

http://books.google.com/books?id=uiKpBsFx0b8C&pg=PA117&dq=salivation+center&hl=en&ei=OidRTarzL8izrAfvtszICA&sa=X&oi=book_result&ct=result&resnum=3&ved=0CDsQ6AEwAg#v=onepage&q=salivation%20center&f=false

Excessive salivation occurs prior to vomiting. The medullary vomiting center andsali vation center are located close together in the medulla.

4. http://flipper.diff.org/app/items/info/367

The secretion of saliva is controlled by a salivary center composed of nuclei in the medulla

5 .http: //webcache.googleusercontent.com/search?q=cache:N15nL 4-e120J:www.human- nervous-system.com/human-brain- encephalon/+salivary+center+situ ated+in+medull a+hypothalamus& cd=3& hl =en& ct=cln k & gl=i n& source=www.google.co.in

(b) M edul la oblongata (Myelencephalon). I t is posterior most par t of brai n and is located beneath thecerebell um. I t is with a cavity called fourth ventr icle or myelocoel wh ich i s continuous with centr al canal ofspinal cord. Roof of medull a oblongata is thin, non-nervous and forms posteri or choroid pl exus.Functi ons: I t controls involu ntary f unctions of body through a number of centers li ke cardiac centers (heartbeat); respir atory centers (rate of r espir ation ); vasomotor centers (contracti on of bl ood vessels); sali varycenters (secretion of saliva) etc. I t also controls coughi ng, sneezing, vomiti ng, ur in ating, defecation , bloodpressur e, gut peri stal sis, swall owing of f ood, etc.

http://webcache.googleusercontent.com/search?q=cache:jU- I eV0NTVEJ:th alamu s.wustl .edu/cour se/hypoANS.html +sali vary+center+situ ated+in+med ul la+hypothalamus& cd=6& hl =en& ct=cln k& gl=in & source=www.google.co.in

Sali vatory nuclei - These nuclei in th e medul la send axons to the sali vary glands via th eVI I th and I Xth n erves.
http://books.google.com/books?id=uiKpBsFx0b8C&pg=PA117&dq=salivation+center&hl=en&ei=OidRTarzL8izrAfvtszICA&sa=X&oi=book_result&ct=result&resnum=3&ved=0CDsQ6AEwAg#v=onepage&q=salivation%20center&f=falsehttp://books.google.com/books?id=uiKpBsFx0b8C&pg=PA117&dq=salivation+center&hl=en&ei=OidRTarzL8izrAfvtszICA&sa=X&oi=book_result&ct=result&resnum=3&ved=0CDsQ6AEwAg#v=onepage&q=salivation%20center&f=falsehttp://books.google.com/books?id=uiKpBsFx0b8C&pg=PA117&dq=salivation+center&hl=en&ei=OidRTarzL8izrAfvtszICA&sa=X&oi=book_result&ct=result&resnum=3&ved=0CDsQ6AEwAg#v=onepage&q=salivation%20center&f=falsehttp://books.google.com/books?id=uiKpBsFx0b8C&pg=PA117&dq=salivation+center&hl=en&ei=OidRTarzL8izrAfvtszICA&sa=X&oi=book_result&ct=result&resnum=3&ved=0CDsQ6AEwAghttp://books.google.com/books?id=uiKpBsFx0b8C&pg=PA117&dq=salivation+center&hl=en&ei=OidRTarzL8izrAfvtszICA&sa=X&oi=book_result&ct=result&resnum=3&ved=0CDsQ6AEwAghttp://books.google.com/books?id=uiKpBsFx0b8C&pg=PA117&dq=salivation+center&hl=en&ei=OidRTarzL8izrAfvtszICA&sa=X&oi=book_result&ct=result&resnum=3&ved=0CDsQ6AEwAghttp://flipper.diff.org/app/items/info/367http://flipper.diff.org/app/items/info/367http://flipper.diff.org/app/items/info/367http://webcache.googleusercontent.com/search?q=cache:N15nL4-e120J:www.human-nervous-system.com/human-brain-encephalon/+salivary+center+situated+in+medulla+hypothalamus&cd=3&hl=en&ct=clnk&gl=in&source=www.google.co.inhttp://webcache.googleusercontent.com/search?q=cache:N15nL4-e120J:www.human-nervous-system.com/human-brain-encephalon/+salivary+center+situated+in+medulla+hypothalamus&cd=3&hl=en&ct=clnk&gl=in&source=www.google.co.inhttp://webcache.googleusercontent.com/search?q=cache:N15nL4-e120J:www.human-nervous-system.com/human-brain-encephalon/+salivary+center+situated+in+medulla+hypothalamus&cd=3&hl=en&ct=clnk&gl=in&source=www.google.co.inhttp://webcache.googleusercontent.com/search?q=cache:N15nL4-e120J:www.human-nervous-system.com/human-brain-encephalon/+salivary+center+situated+in+medulla+hypothalamus&cd=3&hl=en&ct=clnk&gl=in&source=www.google.co.inhttp://webcache.googleusercontent.com/search?q=cache:N15nL4-e120J:www.human-nervous-system.com/human-brain-encephalon/+salivary+center+situated+in+medulla+hypothalamus&cd=3&hl=en&ct=clnk&gl=in&source=www.google.co.inhttp://webcache.googleusercontent.com/search?q=cache:N15nL4-e120J:www.human-nervous-system.com/human-brain-encephalon/+salivary+center+situated+in+medulla+hypothalamus&cd=3&hl=en&ct=clnk&gl=in&source=www.google.co.inhttp://webcache.googleusercontent.com/search?q=cache:jU-IeV0NTVEJ:thalamus.wustl.edu/course/hypoANS.html+salivary+center+situated+in+medulla+hypothalamus&cd=6&hl=en&ct=clnk&gl=in&source=www.google.co.inhttp://webcache.googleusercontent.com/search?q=cache:jU-IeV0NTVEJ:thalamus.wustl.edu/course/hypoANS.html+salivary+center+situated+in+medulla+hypothalamus&cd=6&hl=en&ct=clnk&gl=in&source=www.google.co.inhttp://webcache.googleusercontent.com/search?q=cache:jU-IeV0NTVEJ:thalamus.wustl.edu/course/hypoANS.html+salivary+center+situated+in+medulla+hypothalamus&cd=6&hl=en&ct=clnk&gl=in&source=www.google.co.inhttp://webcache.googleusercontent.com/search?q=cache:jU-IeV0NTVEJ:thalamus.wustl.edu/course/hypoANS.html+salivary+center+situated+in+medulla+hypothalamus&cd=6&hl=en&ct=clnk&gl=in&source=www.google.co.inhttp://webcache.googleusercontent.com/search?q=cache:jU-IeV0NTVEJ:thalamus.wustl.edu/course/hypoANS.html+salivary+center+situated+in+medulla+hypothalamus&cd=6&hl=en&ct=clnk&gl=in&source=www.google.co.inhttp://webcache.googleusercontent.com/search?q=cache:jU-IeV0NTVEJ:thalamus.wustl.edu/course/hypoANS.html+salivary+center+situated+in+medulla+hypothalamus&cd=6&hl=en&ct=clnk&gl=in&source=www.google.co.inhttp://webcache.googleusercontent.com/search?q=cache:jU-IeV0NTVEJ:thalamus.wustl.edu/course/hypoANS.html+salivary+center+situated+in+medulla+hypothalamus&cd=6&hl=en&ct=clnk&gl=in&source=www.google.co.inhttp://webcache.googleusercontent.com/search?q=cache:N15nL4-e120J:www.human-nervous-system.com/human-brain-encephalon/+salivary+center+situated+in+medulla+hypothalamus&cd=3&hl=en&ct=clnk&gl=in&source=www.google.co.inhttp://webcache.googleusercontent.com/search?q=cache:N15nL4-e120J:www.human-nervous-system.com/human-brain-encephalon/+salivary+center+situated+in+medulla+hypothalamus&cd=3&hl=en&ct=clnk&gl=in&source=www.google.co.inhttp://webcache.googleusercontent.com/search?q=cache:N15nL4-e120J:www.human-nervous-system.com/human-brain-encephalon/+salivary+center+situated+in+medulla+hypothalamus&cd=3&hl=en&ct=clnk&gl=in&source=www.google.co.inhttp://webcache.googleusercontent.com/search?q=cache:N15nL4-e120J:www.human-nervous-system.com/human-brain-encephalon/+salivary+center+situated+in+medulla+hypothalamus&cd=3&hl=en&ct=clnk&gl=in&source=www.google.co.inhttp://flipper.diff.org/app/items/info/367http://books.google.com/books?id=uiKpBsFx0b8C&pg=PA117&dq=salivation+center&hl=en&ei=OidRTarzL8izrAfvtszICA&sa=X&oi=book_result&ct=result&resnum=3&ved=0CDsQ6AEwAghttp://books.google.com/books?id=uiKpBsFx0b8C&pg=PA117&dq=salivation+center&hl=en&ei=OidRTarzL8izrAfvtszICA&sa=X&oi=book_result&ct=result&resnum=3&ved=0CDsQ6AEwAg#v=onepage&q=salivation%20center&f=false


4/16

An swer shou ld be Staphyl ococcus Aureus.

Ref.

1 . Al l I ndia Ophthalmology Society (AI OS)Arti cle - AI I M S

http://www.aios.org/cmefiles/CME_11_1.pdf

"few bacteria namely Niesseria, Corynebactrium, Hemophilus and. Listeria can invade an in tact epitheli um"

2. MRCOPHTH (MRCOphth, ophthalmology examination in UK) http://www.mrcophth.com/MRCOphth/122.html

3. Parson 20th ed page 187 ,21st Ed -Pg No 194

4. Kanski - 6th ed page 254
http://www.aios.org/cmefiles/CME_11_1.pdfhttp://www.aios.org/cmefiles/CME_11_1.pdfhttp://www.aios.org/cmefiles/CME_11_1.pdfhttp://www.aios.org/cmefiles/CME_11_1.pdfhttp://www.aios.org/cmefiles/CME_11_1.pdfhttp://www.mrcophth.com/MRCOphth/122.htmlhttp://www.mrcophth.com/MRCOphth/122.htmlhttp://www.mrcophth.com/MRCOphth/122.htmlhttp://www.aios.org/cmefiles/CME_11_1.pdfhttp://www.aios.org/cmefiles/CME_11_1.pdf


5/16

An swer shoul d be height/age.

Ref

1. OPG 6th Ed- Pg No 101

2. Park 19th Ed- Pg No 434

3. Nelson 18e, Chap 14

"Weight for height below the 5th percentile remains the single best growth chart indicator of acute undernutrition. A BMI less than the 5th percentile also indicates that a child is underweight. Brief periods ofweight loss or poor weight gain are usually rapidly corrected and do not permanently affect size.Children who have been chronically malnourished may be short as well as thin, so that their weight-for-heightcurves may appear relatively normal. Chronic, severe undernutrition in infancy may depress head growth, anominous predictor of later cognitive disability."

4. http://www.adbi.org/discussion- paper/2005/01/14/869.malnutrition.poverty.indonesia/measuring.malnutrition/

Wasting (Weight f or H eigh t) i s a measur e of acute or short -term exposur e to a negative envi ronment. It is sensitive to changes in calorie intake or the effects of disease. Wasting can be calculated without knowing theage of a child. Weight for height (WFH) is a measure of current body mass. It is the best index to use to reflectwasting malnutrition, when it is difficult to determine the exact ages of the children being measured.

Stunting (Height for age) is a measure of linear growth. Stunting refers to shortness, and reflects linear growthachieved pre- and postnatal; with its deficits it is generally assumed to in dicate long-term, cumul ative effects

of i nadequate nutr iti on and poor health statu s. Height for age (HFA) is considered a measure of pastnutrition , because a child who is short today, maybe did not have adequate nutritional intake at so me pointin the past
http://www.adbi.org/discussion-paper/2005/01/14/869.malnutrition.poverty.indonesia/measuring.malnutrition/http://www.adbi.org/discussion-paper/2005/01/14/869.malnutrition.poverty.indonesia/measuring.malnutrition/http://www.adbi.org/discussion-paper/2005/01/14/869.malnutrition.poverty.indonesia/measuring.malnutrition/http://www.adbi.org/discussion-paper/2005/01/14/869.malnutrition.poverty.indonesia/measuring.malnutrition/http://www.adbi.org/discussion-paper/2005/01/14/869.malnutrition.poverty.indonesia/measuring.malnutrition/http://www.adbi.org/discussion-paper/2005/01/14/869.malnutrition.poverty.indonesia/measuring.malnutrition/


6/16

Answer should be vertebral body.

In children it's intervertebral disc but in adults it usually begins in cancellous bone of vertebral body nearthe disc(paradiscal) as disc is avascular.

Ref.

1.Campbell's Operative Orthopaedics - 10th & 11th Ed

*Volume 2 - Part XII - C H A P T E R 40 - Infections of Spine- Specific Infections Tuberculosis

In the spine the infection spares the intervertebral discs and spreads beneath the anterior and posteriorlongitudinal ligaments.

*Volume 2 - Part V - C H A P T E R 18 - Tuberculosis and Other Unusual Infections "A peridiscal presentation occurs in approximately 80% of patients, with the anterior vertebral bodyaffected and contiguous progression through subligamentous burrowing (anterior longitudinal ligament) andeventual extension to the adjacent vertebrae. Less frequently, lesions occur centrally in the vertebral body. "

2. eMedicine Specialties > Infectious Diseases > Bone and Joint Infections http://emedicine.medscape.com/article/226141-overview

The anterior aspect of the vertebral body adjacent to the subchondral plate is area usually affected. Tuberculosis may spread from that area to adjacent intervertebral disks. In adults, disk disease is secondary to the spreadof infection from the vertebral body. In children, because the disk is vascularized, it can be a primarysite. 3

3. Harrison s principles of internal medicine 17th Ed

Part-7 - Chapter 158 Pg No 1012 Topic Tuberculosis Skeletal Tuberculosis

SKELETAL TUBERCULOSISIn the United States, tuberculosis of the bones and joints is responsible for ~10% of extrapulmonary cases. Inbone and joint disease, pathogenesis is related to reactivation of hematogenous foci or to spread from adjacentparavertebral lymph nodes. Weight-bearing joints (the spine in 40% of cases, the hips in 13%, and the kneesin 10%) are most commonly affected. Spinal tuberculosis (Pott's disease or tuberculous spondylitis;Fig. 158-7) often involves two or more adjacent vertebral bodies. While the upper thoracic spine is themost common site of spinal tuberculosis in children, the lower thoracic and upper lumbar vertebrae are usuallyaffected in adults. From the anterior superior or inferior angle of the vertebral body, the lesion slowlyreaches the adjacent body, later affecting the intervertebral disk. With advanced disease, collapse ofvertebral bodies results in kyphosis ( gibbus ). A paravertebral "cold" abscess may also form. In the upper spine,this abscess may track to and penetrate the chest wall, presenting as a soft tissue mass; in the lower spine, itmay reach the inguinal ligaments or present as a psoas abscess. CT or MRI reveals the characteristic lesionand suggests its etiology. The differential diagnosis includes tumors and other infections. Pyogenic bacterialosteomyelitis, in particular, involves the disk very early and produces rapid sclerosis. Aspiration of the abscessor bone biopsy confirms the tuberculous etiology, as cultures are usually positive and histologic findings highlytypical. A catastrophic complication of Pott's disease is paraplegia, which is usually due to an abscess or alesion compressing the spinal cord. Paraparesis due to a large abscess is a medical emergency and requiresrapid drainage. Tuberculosis of the hip joints, usually involving the head of the femur, causes pain;tuberculosis of the knee produces pain and swelling. If the disease goes unrecognized, the joints may bedestroyed. Diagnosis requires examination of the synovial fluid, which is thick in appearance, with a highprotein concentration and a variable cell count. Although synovial fluid culture is positive in a high percentageof cases, synovial biopsy and tissue culture may be necessary to establish the diagnosis. Skeletal tuberculosisresponds to chemotherapy, but severe cases may require surgery.
http://emedicine.medscape.com/specialtieshttp://emedicine.medscape.com/specialtieshttp://emedicine.medscape.com/specialtieshttp://emedicine.medscape.com/infectious_diseaseshttp://emedicine.medscape.com/infectious_diseaseshttp://emedicine.medscape.com/infectious_diseaseshttp://emedicine.medscape.com/infectious_diseases#bonehttp://emedicine.medscape.com/infectious_diseases#bonehttp://emedicine.medscape.com/infectious_diseases#bonehttp://emedicine.medscape.com/article/226141-overviewhttp://emedicine.medscape.com/article/226141-overviewhttp://emedicine.medscape.com/article/230802-overviewhttp://emedicine.medscape.com/article/230802-overviewhttp://emedicine.medscape.com/article/230802-overviewhttp://emedicine.medscape.com/article/230802-overviewhttp://emedicine.medscape.com/article/226141-overviewhttp://emedicine.medscape.com/infectious_diseases#bonehttp://emedicine.medscape.com/infectious_diseaseshttp://emedicine.medscape.com/specialties


7/16

Answer should be Mebendazole.

All standard textbooks mention mebendazole / mebendazole/albendazole as DOC, no

standard book mention mebendazole as second choice, while many books mentionalbendazole as second choice.

Mebendazole is the drug of choice for patients of all ages over 2 years and is takenas a single dose, because reinfection is so common a second dose may be given after 2-3 weeks

Ref

1. Basic & Clinical Pharmacology - Katzung - 11th Edition - Chapter 51

Table 53 1 Drugs for the Treatment of Helminthic Infections. 1

Infecting Organism Drug of Choice Alternative Drugs

Roundworms (nematodes)

Ascaris lumbricoides (roundworm) Albendazole or pyrantel pamoateor mebendazole

Ivermectin, piperazine

Trichuris trichiura (whipworm) Mebendazole or albendazole Ivermectin

Necator americanus (hookworm); Ancylostomaduodenale (hookworm)

Albendazole or mebendazole or pyrantel pamoate

Strongyloides stercoralis (threadworm) Ivermectin Albendazole orthiabendazole

Enterobius vermi cular is (pinworm) Mebendazole or pyrantelpamoate

Albendazole

2.Lipp inco tt 's Il lustrated Reviews: Pharmacolo gy, 4th Edit ion

Unit VII - Chemotherapeutic Drugs > Chapter 37 - Anthelmintic Drugs

* Mebendazol e - Mebendazole [me-BEN-da-zole], a synthetic benzimidazole compound, is effectiveagainst a wide spectrum of nematodes. It is a drug of choice in the treatment of infections bywhipworm (Trichuris trichiura), pinworm (Enterobius vermicularis ), hookworms (Necator

americanus and Ancylostoma duodenale), and roundworm (Ascariasis lumbricoides).

3. AHFS Drug Information - http://www.medicinescomplete.com/mc/ahfs/current/a382315.htm

"Mebendazole is the d rug o f cho i ce and albendazole and ivermectin, are alternatives"
http://www.medicinescomplete.com/mc/ahfs/current/a382315.htmhttp://www.medicinescomplete.com/mc/ahfs/current/a382315.htmhttp://www.medicinescomplete.com/mc/ahfs/current/a382315.htmhttp://www.medicinescomplete.com/mc/ahfs/current/a382315.htmhttp://www.medicinescomplete.com/mc/ahfs/current/a382315.htmhttp://www.medicinescomplete.com/mc/ahfs/current/a382315.htmhttp://www.medicinescomplete.com/mc/ahfs/current/a382315.htmhttp://www.medicinescomplete.com/mc/ahfs/current/a382315.htm


8/16

Answer should be Africa.

Ref

1.Baily & Love short textbook of surgery 25 th ed

Pg No 1192Si gmoid vo lvu lu s

This is rare in Europe and the USA but more common inEastern Europe and Africa . Indeed, it is the most common causeof large bowel obstruction in the indigenous black African population.

2. eMedicine Specialties > General Surgery > Colorectal Volvulus, Sigmoid and Cecal - http://emedicine.medscape.com/article/197322-overview

In the volvulus belt of Africa and the Middle East, nearly 50% of large bowel obstructions are a result ofvolvulus, almost exclusively of the sigmoid colon.

3.GPNotebook - http://www.gpnotebook.co.uk/medwebpage.cfm?ID=315621401

This condition accounts for about 2% of intestinal obstructions in the UK. However, it is much morecommon in Russia and Central Africa.

4.Radiology secrets - By E. Scott Pretorius, Jeffrey A. Solomon, Douglas S. Katz

http://books.google.com/books?id=J5V9vW3lMhwC&pg=RA3-PA26&lpg=RA3-PA26&dq=sigmoid+volvulus+more+common+in+africa&source=bl&ots=7mbTSAJRCc&sig=rwzidNvlXugxmD0_GyVBPpe7wIk&hl=en&ei=P7RRTZfHF8O8rAec34CrCA&sa=X&oi=book_result&ct=result&resnum=6&ved=0CDIQ6AEwBT
http://emedicine.medscape.com/specialtieshttp://emedicine.medscape.com/specialtieshttp://emedicine.medscape.com/specialtieshttp://emedicine.medscape.com/general_surgeryhttp://emedicine.medscape.com/general_surgeryhttp://emedicine.medscape.com/general_surgeryhttp://emedicine.medscape.com/general_surgery#colorectalhttp://emedicine.medscape.com/general_surgery#colorectalhttp://emedicine.medscape.com/general_surgery#colorectalhttp://emedicine.medscape.com/article/197322-overviewhttp://emedicine.medscape.com/article/197322-overviewhttp://emedicine.medscape.com/article/197322-overviewhttp://emedicine.medscape.com/article/197322-overviewhttp://emedicine.medscape.com/article/197322-overviewhttp://www.gpnotebook.co.uk/medwebpage.cfm?ID=315621401http://www.gpnotebook.co.uk/medwebpage.cfm?ID=315621401http://www.gpnotebook.co.uk/medwebpage.cfm?ID=315621401http://www.gpnotebook.co.uk/medwebpage.cfm?ID=315621401http://www.gpnotebook.co.uk/medwebpage.cfm?ID=315621401http://www.gpnotebook.co.uk/medwebpage.cfm?ID=315621401http://books.google.com/books?id=J5V9vW3lMhwC&pg=RA3-PA26&lpg=RA3-PA26&dq=sigmoid+volvulus+more+common+in+africa&source=bl&ots=7mbTSAJRCc&sig=rwzidNvlXugxmD0_GyVBPpe7wIk&hl=en&ei=P7RRTZfHF8O8rAec34CrCA&sa=X&oi=book_result&ct=result&resnum=6&ved=0CDIQ6AEwBThttp://books.google.com/books?id=J5V9vW3lMhwC&pg=RA3-PA26&lpg=RA3-PA26&dq=sigmoid+volvulus+more+common+in+africa&source=bl&ots=7mbTSAJRCc&sig=rwzidNvlXugxmD0_GyVBPpe7wIk&hl=en&ei=P7RRTZfHF8O8rAec34CrCA&sa=X&oi=book_result&ct=result&resnum=6&ved=0CDIQ6AEwBThttp://books.google.com/books?id=J5V9vW3lMhwC&pg=RA3-PA26&lpg=RA3-PA26&dq=sigmoid+volvulus+more+common+in+africa&source=bl&ots=7mbTSAJRCc&sig=rwzidNvlXugxmD0_GyVBPpe7wIk&hl=en&ei=P7RRTZfHF8O8rAec34CrCA&sa=X&oi=book_result&ct=result&resnum=6&ved=0CDIQ6AEwBThttp://books.google.com/books?id=J5V9vW3lMhwC&pg=RA3-PA26&lpg=RA3-PA26&dq=sigmoid+volvulus+more+common+in+africa&source=bl&ots=7mbTSAJRCc&sig=rwzidNvlXugxmD0_GyVBPpe7wIk&hl=en&ei=P7RRTZfHF8O8rAec34CrCA&sa=X&oi=book_result&ct=result&resnum=6&ved=0CDIQ6AEwBThttp://books.google.com/books?id=J5V9vW3lMhwC&pg=RA3-PA26&lpg=RA3-PA26&dq=sigmoid+volvulus+more+common+in+africa&source=bl&ots=7mbTSAJRCc&sig=rwzidNvlXugxmD0_GyVBPpe7wIk&hl=en&ei=P7RRTZfHF8O8rAec34CrCA&sa=X&oi=book_result&ct=result&resnum=6&ved=0CDIQ6AEwBThttp://books.google.com/books?id=J5V9vW3lMhwC&pg=RA3-PA26&lpg=RA3-PA26&dq=sigmoid+volvulus+more+common+in+africa&source=bl&ots=7mbTSAJRCc&sig=rwzidNvlXugxmD0_GyVBPpe7wIk&hl=en&ei=P7RRTZfHF8O8rAec34CrCA&sa=X&oi=book_result&ct=result&resnum=6&ved=0CDIQ6AEwBThttp://books.google.com/books?id=J5V9vW3lMhwC&pg=RA3-PA26&lpg=RA3-PA26&dq=sigmoid+volvulus+more+common+in+africa&source=bl&ots=7mbTSAJRCc&sig=rwzidNvlXugxmD0_GyVBPpe7wIk&hl=en&ei=P7RRTZfHF8O8rAec34CrCA&sa=X&oi=book_result&ct=result&resnum=6&ved=0CDIQ6AEwBThttp://books.google.com/books?id=J5V9vW3lMhwC&pg=RA3-PA26&lpg=RA3-PA26&dq=sigmoid+volvulus+more+common+in+africa&source=bl&ots=7mbTSAJRCc&sig=rwzidNvlXugxmD0_GyVBPpe7wIk&hl=en&ei=P7RRTZfHF8O8rAec34CrCA&sa=X&oi=book_result&ct=result&resnum=6&ved=0CDIQ6AEwBThttp://books.google.com/books?id=J5V9vW3lMhwC&pg=RA3-PA26&lpg=RA3-PA26&dq=sigmoid+volvulus+more+common+in+africa&source=bl&ots=7mbTSAJRCc&sig=rwzidNvlXugxmD0_GyVBPpe7wIk&hl=en&ei=P7RRTZfHF8O8rAec34CrCA&sa=X&oi=book_result&ct=result&resnum=6&ved=0CDIQ6AEwBThttp://books.google.com/books?id=J5V9vW3lMhwC&pg=RA3-PA26&lpg=RA3-PA26&dq=sigmoid+volvulus+more+common+in+africa&source=bl&ots=7mbTSAJRCc&sig=rwzidNvlXugxmD0_GyVBPpe7wIk&hl=en&ei=P7RRTZfHF8O8rAec34CrCA&sa=X&oi=book_result&ct=result&resnum=6&ved=0CDIQ6AEwBThttp://books.google.com/books?id=J5V9vW3lMhwC&pg=RA3-PA26&lpg=RA3-PA26&dq=sigmoid+volvulus+more+common+in+africa&source=bl&ots=7mbTSAJRCc&sig=rwzidNvlXugxmD0_GyVBPpe7wIk&hl=en&ei=P7RRTZfHF8O8rAec34CrCA&sa=X&oi=book_result&ct=result&resnum=6&ved=0CDIQ6AEwBThttp://books.google.com/books?id=J5V9vW3lMhwC&pg=RA3-PA26&lpg=RA3-PA26&dq=sigmoid+volvulus+more+common+in+africa&source=bl&ots=7mbTSAJRCc&sig=rwzidNvlXugxmD0_GyVBPpe7wIk&hl=en&ei=P7RRTZfHF8O8rAec34CrCA&sa=X&oi=book_result&ct=result&resnum=6&ved=0CDIQ6AEwBThttp://books.google.com/books?id=J5V9vW3lMhwC&pg=RA3-PA26&lpg=RA3-PA26&dq=sigmoid+volvulus+more+common+in+africa&source=bl&ots=7mbTSAJRCc&sig=rwzidNvlXugxmD0_GyVBPpe7wIk&hl=en&ei=P7RRTZfHF8O8rAec34CrCA&sa=X&oi=book_result&ct=result&resnum=6&ved=0CDIQ6AEwBThttp://www.gpnotebook.co.uk/medwebpage.cfm?ID=315621401http://www.gpnotebook.co.uk/medwebpage.cfm?ID=315621401http://emedicine.medscape.com/article/197322-overviewhttp://emedicine.medscape.com/article/197322-overviewhttp://emedicine.medscape.com/general_surgery#colorectalhttp://emedicine.medscape.com/general_surgeryhttp://emedicine.medscape.com/specialties


9/16

Answer should be Chronic Renal Disease > Polycystic Kidney or both as inpolycystic kidney, its not contraindicated even if large cysts if well localized.

Ref

1.Oxford textbook of clinical nephrology, 3rd Ed- Volume 1 - By Alex M. Davison, J. StewartCameron, Jean Pierre Gruenfeld

http://books.google.com/books?id=kNDzFS1abRkC&pg=PA173&lpg=PA173&dq=contraindication+of +renal+biopsy&source=bl&ots=v2kkAzz2K2&sig=kZp_7P0PGdJ2Zu9XK1223xNC6TU&hl=en&ei=h5xRTeGyGYq3rAf80dypCA&sa=X&oi=book_result&ct=result&resnum=7&ved=0CD8Q6AEwBjgK#v=onepage&q=contraindication%20of%20renal%20biopsy&f=false

2. http://www.nephrologychannel.com/biopsy/index.shtml

The most common contraindication to kidney biopsy is disease:

Bleeding disorder (e.g., inability to coagulate, platelet abnormality) Hypertension Pyelonephritis (disease of the pelvis of the kidney) Shrunken kidney (i.e., as a result of disease) Tumor

3. http://www.patient.co.uk/doctor/Renal-Biopsy.htm Patients with chronic renal failure and bilaterally small, shrunken kidneys should not undergobiopsy . The technique is then very difficult and the biopsy appearances are very unlikely to provideany benefit for clinical management.

4. Critical care nephrology - By Claudio Ronco, Rinaldo Bellomo, John A. Kellum - Table 53.2

http://books.google.com/books?id=XkKn96HThzEC&pg=PA290&lpg=PA290&dq=contraindication+of +renal+biopsy&source=bl&ots=J7qkfTVTuh&sig=cF80G3Zejn9vqtw-

Cl2o3a64Okk&hl=en&ei=bp5RTZysI4fkrAedoeCfCA&sa=X&oi=book_result&ct=result&resnum=7&ved=0CDkQ6AEwBjgU#v=onepage&q=contraindication%20of%20renal%20biopsy&f=false
http://books.google.com/books?id=kNDzFS1abRkC&pg=PA173&lpg=PA173&dq=contraindication+of+renal+biopsy&source=bl&ots=v2kkAzz2K2&sig=kZp_7P0PGdJ2Zu9XK1223xNC6TU&hl=en&ei=h5xRTeGyGYq3rAf80dypCA&sa=X&oi=book_result&ct=result&resnum=7&ved=0CD8Q6AEwBjgK#v=onepage&q=contraindication%20of%20renal%20biopsy&f=falsehttp://books.google.com/books?id=kNDzFS1abRkC&pg=PA173&lpg=PA173&dq=contraindication+of+renal+biopsy&source=bl&ots=v2kkAzz2K2&sig=kZp_7P0PGdJ2Zu9XK1223xNC6TU&hl=en&ei=h5xRTeGyGYq3rAf80dypCA&sa=X&oi=book_result&ct=result&resnum=7&ved=0CD8Q6AEwBjgK#v=onepage&q=contraindication%20of%20renal%20biopsy&f=falsehttp://books.google.com/books?id=kNDzFS1abRkC&pg=PA173&lpg=PA173&dq=contraindication+of+renal+biopsy&source=bl&ots=v2kkAzz2K2&sig=kZp_7P0PGdJ2Zu9XK1223xNC6TU&hl=en&ei=h5xRTeGyGYq3rAf80dypCA&sa=X&oi=book_result&ct=result&resnum=7&ved=0CD8Q6AEwBjgK#v=onepage&q=contraindication%20of%20renal%20biopsy&f=falsehttp://books.google.com/books?id=kNDzFS1abRkC&pg=PA173&lpg=PA173&dq=contraindication+of+renal+biopsy&source=bl&ots=v2kkAzz2K2&sig=kZp_7P0PGdJ2Zu9XK1223xNC6TU&hl=en&ei=h5xRTeGyGYq3rAf80dypCA&sa=X&oi=book_result&ct=result&resnum=7&ved=0CD8Q6AEwBjgK#v=onepage&q=contraindication%20of%20renal%20biopsy&f=falsehttp://books.google.com/books?id=kNDzFS1abRkC&pg=PA173&lpg=PA173&dq=contraindication+of+renal+biopsy&source=bl&ots=v2kkAzz2K2&sig=kZp_7P0PGdJ2Zu9XK1223xNC6TU&hl=en&ei=h5xRTeGyGYq3rAf80dypCA&sa=X&oi=book_result&ct=result&resnum=7&ved=0CD8Q6AEwBjgK#v=onepage&q=contraindication%20of%20renal%20biopsy&f=falsehttp://books.google.com/books?id=kNDzFS1abRkC&pg=PA173&lpg=PA173&dq=contraindication+of+renal+biopsy&source=bl&ots=v2kkAzz2K2&sig=kZp_7P0PGdJ2Zu9XK1223xNC6TU&hl=en&ei=h5xRTeGyGYq3rAf80dypCA&sa=X&oi=book_result&ct=result&resnum=7&ved=0CD8Q6AEwBjgK#v=onepage&q=contraindication%20of%20renal%20biopsy&f=falsehttp://books.google.com/books?id=kNDzFS1abRkC&pg=PA173&lpg=PA173&dq=contraindication+of+renal+biopsy&source=bl&ots=v2kkAzz2K2&sig=kZp_7P0PGdJ2Zu9XK1223xNC6TU&hl=en&ei=h5xRTeGyGYq3rAf80dypCA&sa=X&oi=book_result&ct=result&resnum=7&ved=0CD8Q6AEwBjgK#v=onepage&q=contraindication%20of%20renal%20biopsy&f=falsehttp://books.google.com/books?id=kNDzFS1abRkC&pg=PA173&lpg=PA173&dq=contraindication+of+renal+biopsy&source=bl&ots=v2kkAzz2K2&sig=kZp_7P0PGdJ2Zu9XK1223xNC6TU&hl=en&ei=h5xRTeGyGYq3rAf80dypCA&sa=X&oi=book_result&ct=result&resnum=7&ved=0CD8Q6AEwBjgK#v=onepage&q=contraindication%20of%20renal%20biopsy&f=falsehttp://books.google.com/books?id=kNDzFS1abRkC&pg=PA173&lpg=PA173&dq=contraindication+of+renal+biopsy&source=bl&ots=v2kkAzz2K2&sig=kZp_7P0PGdJ2Zu9XK1223xNC6TU&hl=en&ei=h5xRTeGyGYq3rAf80dypCA&sa=X&oi=book_result&ct=result&resnum=7&ved=0CD8Q6AEwBjgK#v=onepage&q=contraindication%20of%20renal%20biopsy&f=falsehttp://www.nephrologychannel.com/biopsy/index.shtmlhttp://www.nephrologychannel.com/biopsy/index.shtmlhttp://www.nephrologychannel.com/biopsy/index.shtmlhttp://www.cardiologychannel.com/hypertension/index.shtmlhttp://www.cardiologychannel.com/hypertension/index.shtmlhttp://www.patient.co.uk/doctor/Renal-Biopsy.htmhttp://www.patient.co.uk/doctor/Renal-Biopsy.htmhttp://www.patient.co.uk/doctor/Renal-Biopsy.htmhttp://books.google.com/books?id=XkKn96HThzEC&pg=PA290&lpg=PA290&dq=contraindication+of+renal+biopsy&source=bl&ots=J7qkfTVTuh&sig=cF80G3Zejn9vqtw-Cl2o3a64Okk&hl=en&ei=bp5RTZysI4fkrAedoeCfCA&sa=X&oi=book_result&ct=result&resnum=7&ved=0CDkQ6AEwBjgU#v=onepage&q=contraindication%20of%20renal%20biopsy&f=falsehttp://books.google.com/books?id=XkKn96HThzEC&pg=PA290&lpg=PA290&dq=contraindication+of+renal+biopsy&source=bl&ots=J7qkfTVTuh&sig=cF80G3Zejn9vqtw-Cl2o3a64Okk&hl=en&ei=bp5RTZysI4fkrAedoeCfCA&sa=X&oi=book_result&ct=result&resnum=7&ved=0CDkQ6AEwBjgU#v=onepage&q=contraindication%20of%20renal%20biopsy&f=falsehttp://books.google.com/books?id=XkKn96HThzEC&pg=PA290&lpg=PA290&dq=contraindication+of+renal+biopsy&source=bl&ots=J7qkfTVTuh&sig=cF80G3Zejn9vqtw-Cl2o3a64Okk&hl=en&ei=bp5RTZysI4fkrAedoeCfCA&sa=X&oi=book_result&ct=result&resnum=7&ved=0CDkQ6AEwBjgU#v=onepage&q=contraindication%20of%20renal%20biopsy&f=falsehttp://books.google.com/books?id=XkKn96HThzEC&pg=PA290&lpg=PA290&dq=contraindication+of+renal+biopsy&source=bl&ots=J7qkfTVTuh&sig=cF80G3Zejn9vqtw-Cl2o3a64Okk&hl=en&ei=bp5RTZysI4fkrAedoeCfCA&sa=X&oi=book_result&ct=result&resnum=7&ved=0CDkQ6AEwBjgU#v=onepage&q=contraindication%20of%20renal%20biopsy&f=falsehttp://books.google.com/books?id=XkKn96HThzEC&pg=PA290&lpg=PA290&dq=contraindication+of+renal+biopsy&source=bl&ots=J7qkfTVTuh&sig=cF80G3Zejn9vqtw-Cl2o3a64Okk&hl=en&ei=bp5RTZysI4fkrAedoeCfCA&sa=X&oi=book_result&ct=result&resnum=7&ved=0CDkQ6AEwBjgU#v=onepage&q=contraindication%20of%20renal%20biopsy&f=falsehttp://books.google.com/books?id=XkKn96HThzEC&pg=PA290&lpg=PA290&dq=contraindication+of+renal+biopsy&source=bl&ots=J7qkfTVTuh&sig=cF80G3Zejn9vqtw-Cl2o3a64Okk&hl=en&ei=bp5RTZysI4fkrAedoeCfCA&sa=X&oi=book_result&ct=result&resnum=7&ved=0CDkQ6AEwBjgU#v=onepage&q=contraindication%20of%20renal%20biopsy&f=falsehttp://books.google.com/books?id=XkKn96HThzEC&pg=PA290&lpg=PA290&dq=contraindication+of+renal+biopsy&source=bl&ots=J7qkfTVTuh&sig=cF80G3Zejn9vqtw-Cl2o3a64Okk&hl=en&ei=bp5RTZysI4fkrAedoeCfCA&sa=X&oi=book_result&ct=result&resnum=7&ved=0CDkQ6AEwBjgU#v=onepage&q=contraindication%20of%20renal%20biopsy&f=falsehttp://books.google.com/books?id=XkKn96HThzEC&pg=PA290&lpg=PA290&dq=contraindication+of+renal+biopsy&source=bl&ots=J7qkfTVTuh&sig=cF80G3Zejn9vqtw-Cl2o3a64Okk&hl=en&ei=bp5RTZysI4fkrAedoeCfCA&sa=X&oi=book_result&ct=result&resnum=7&ved=0CDkQ6AEwBjgU#v=onepage&q=contraindication%20of%20renal%20biopsy&f=falsehttp://books.google.com/books?id=XkKn96HThzEC&pg=PA290&lpg=PA290&dq=contraindication+of+renal+biopsy&source=bl&ots=J7qkfTVTuh&sig=cF80G3Zejn9vqtw-Cl2o3a64Okk&hl=en&ei=bp5RTZysI4fkrAedoeCfCA&sa=X&oi=book_result&ct=result&resnum=7&ved=0CDkQ6AEwBjgU#v=onepage&q=contraindication%20of%20renal%20biopsy&f=falsehttp://books.google.com/books?id=XkKn96HThzEC&pg=PA290&lpg=PA290&dq=contraindication+of+renal+biopsy&source=bl&ots=J7qkfTVTuh&sig=cF80G3Zejn9vqtw-Cl2o3a64Okk&hl=en&ei=bp5RTZysI4fkrAedoeCfCA&sa=X&oi=book_result&ct=result&resnum=7&ved=0CDkQ6AEwBjgU#v=onepage&q=contraindication%20of%20renal%20biopsy&f=falsehttp://books.google.com/books?id=XkKn96HThzEC&pg=PA290&lpg=PA290&dq=contraindication+of+renal+biopsy&source=bl&ots=J7qkfTVTuh&sig=cF80G3Zejn9vqtw-Cl2o3a64Okk&hl=en&ei=bp5RTZysI4fkrAedoeCfCA&sa=X&oi=book_result&ct=result&resnum=7&ved=0CDkQ6AEwBjgU#v=onepage&q=contraindication%20of%20renal%20biopsy&f=falsehttp://books.google.com/books?id=XkKn96HThzEC&pg=PA290&lpg=PA290&dq=contraindication+of+renal+biopsy&source=bl&ots=J7qkfTVTuh&sig=cF80G3Zejn9vqtw-Cl2o3a64Okk&hl=en&ei=bp5RTZysI4fkrAedoeCfCA&sa=X&oi=book_result&ct=result&resnum=7&ved=0CDkQ6AEwBjgU#v=onepage&q=contraindication%20of%20renal%20biopsy&f=falsehttp://books.google.com/books?id=XkKn96HThzEC&pg=PA290&lpg=PA290&dq=contraindication+of+renal+biopsy&source=bl&ots=J7qkfTVTuh&sig=cF80G3Zejn9vqtw-Cl2o3a64Okk&hl=en&ei=bp5RTZysI4fkrAedoeCfCA&sa=X&oi=book_result&ct=result&resnum=7&ved=0CDkQ6AEwBjgU#v=onepage&q=contraindication%20of%20renal%20biopsy&f=falsehttp://www.patient.co.uk/doctor/Renal-Biopsy.htmhttp://www.cardiologychannel.com/hypertension/index.shtmlhttp://www.nephrologychannel.com/biopsy/index.shtmlhttp://books.google.com/books?id=kNDzFS1abRkC&pg=PA173&lpg=PA173&dq=contraindication+of+renal+biopsy&source=bl&ots=v2kkAzz2K2&sig=kZp_7P0PGdJ2Zu9XK1223xNC6TU&hl=en&ei=h5xRTeGyGYq3rAf80dypCA&sa=X&oi=book_result&ct=result&resnum=7&ved=0CD8Q6AEwBjgK#v=onepage&q=contraindication%20of%20renal%20biopsy&f=falsehttp://books.google.com/books?id=kNDzFS1abRkC&pg=PA173&lpg=PA173&dq=contraindication+of+renal+biopsy&source=bl&ots=v2kkAzz2K2&sig=kZp_7P0PGdJ2Zu9XK1223xNC6TU&hl=en&ei=h5xRTeGyGYq3rAf80dypCA&sa=X&oi=book_result&ct=result&resnum=7&ved=0CD8Q6AEwBjgK#v=onepage&q=contraindication%20of%20renal%20biopsy&f=falsehttp://books.google.com/books?id=kNDzFS1abRkC&pg=PA173&lpg=PA173&dq=contraindication+of+renal+biopsy&source=bl&ots=v2kkAzz2K2&sig=kZp_7P0PGdJ2Zu9XK1223xNC6TU&hl=en&ei=h5xRTeGyGYq3rAf80dypCA&sa=X&oi=book_result&ct=result&resnum=7&ved=0CD8Q6AEwBjgK#v=onepage&q=contraindication%20of%20renal%20biopsy&f=falsehttp://books.google.com/books?id=kNDzFS1abRkC&pg=PA173&lpg=PA173&dq=contraindication+of+renal+biopsy&source=bl&ots=v2kkAzz2K2&sig=kZp_7P0PGdJ2Zu9XK1223xNC6TU&hl=en&ei=h5xRTeGyGYq3rAf80dypCA&sa=X&oi=book_result&ct=result&resnum=7&ved=0CD8Q6AEwBjgK#v=onepage&q=contraindication%20of%20renal%20biopsy&f=falsehttp://books.google.com/books?id=kNDzFS1abRkC&pg=PA173&lpg=PA173&dq=contraindication+of+renal+biopsy&source=bl&ots=v2kkAzz2K2&sig=kZp_7P0PGdJ2Zu9XK1223xNC6TU&hl=en&ei=h5xRTeGyGYq3rAf80dypCA&sa=X&oi=book_result&ct=result&resnum=7&ved=0CD8Q6AEwBjgK#v=onepage&q=contraindication%20of%20renal%20biopsy&f=falsehttp://books.google.com/books?id=kNDzFS1abRkC&pg=PA173&lpg=PA173&dq=contraindication+of+renal+biopsy&source=bl&ots=v2kkAzz2K2&sig=kZp_7P0PGdJ2Zu9XK1223xNC6TU&hl=en&ei=h5xRTeGyGYq3rAf80dypCA&sa=X&oi=book_result&ct=result&resnum=7&ved=0CD8Q6AEwBjgK#v=onepage&q=contraindication%20of%20renal%20biopsy&f=false


10/16

Answer should be Blood Glucose as initial investigation was asked.

Ref :

1. Agency for Toxic Substances and Disease Registry - CDC

CME - Case Studies in Environmental Medicine (CSEM)

http://www.atsdr.cdc.gov/csem/egpg/laboratory_evaluation.html

Ethylene Glycol and Propylene Glycol Toxicity - All patients with known or suspected ethyleneglycol ingestion require the following tests

arterial blood gases blood glucose serum electrolytes blood ethanol

Other helpful laboratory tests may include

serum BUN and creatinine calcium and magnesium levels acetaminophen and aspirin levels liver function tests urinalysis (with special attention to crystalluria)

http://www.atsdr.cdc.gov/csem/egpg/posttest.html Useful laboratory tests for diagnosing ethylene glycol poisoning include which of thefollowing?

A. arterial blood gases (ABG)B. blood glucoseC. blood ethanolD. all of the above

2. Acute Poisoning Management Guidelines - AIIMS Article

http://medind.nic.in/jac/t00/i2/jact00i2p142.pdf

At present, it is recommended to check the blood sugar using a reliable bedside test andto administer dextrose only if the blood sugar is below 80 mg/dl. However, if the sticks arenot available, it is still advisable to administer dextrose to all patients with altered sensorium,including those with focal neurologic deficits 3,4

3. eMedicine Specialties > Emergency Medicine > Toxicology

Toxicity, Ethylene Glycol: Treatment & Medication

http://emedicine.medscape.com/article/814701-treatment

When administering ethanol, determine glucose levels by fingerstick collection at regular intervals andconfirm with laboratory analysis to detect the hypoglycemia occasionally associated with ethanol therapy.
http://www.atsdr.cdc.gov/csem/egpg/laboratory_evaluation.htmlhttp://www.atsdr.cdc.gov/csem/egpg/laboratory_evaluation.htmlhttp://www.atsdr.cdc.gov/csem/egpg/laboratory_evaluation.htmlhttp://www.atsdr.cdc.gov/csem/egpg/laboratory_evaluation.htmlhttp://www.atsdr.cdc.gov/csem/egpg/posttest.htmlhttp://www.atsdr.cdc.gov/csem/egpg/posttest.htmlhttp://medind.nic.in/jac/t00/i2/jact00i2p142.pdfhttp://medind.nic.in/jac/t00/i2/jact00i2p142.pdfhttp://medind.nic.in/jac/t00/i2/jact00i2p142.pdfhttp://medind.nic.in/jac/t00/i2/jact00i2p142.pdfhttp://medind.nic.in/jac/t00/i2/jact00i2p142.pdfhttp://medind.nic.in/jac/t00/i2/jact00i2p142.pdfhttp://medind.nic.in/jac/t00/i2/jact00i2p142.pdfhttp://emedicine.medscape.com/specialtieshttp://emedicine.medscape.com/specialtieshttp://emedicine.medscape.com/specialtieshttp://emedicine.medscape.com/emergency_medicinehttp://emedicine.medscape.com/emergency_medicinehttp://emedicine.medscape.com/emergency_medicinehttp://emedicine.medscape.com/emergency_medicine#toxicologyhttp://emedicine.medscape.com/emergency_medicine#toxicologyhttp://emedicine.medscape.com/emergency_medicine#toxicologyhttp://emedicine.medscape.com/article/814701-treatmenthttp://emedicine.medscape.com/article/814701-treatmenthttp://emedicine.medscape.com/article/814701-treatmenthttp://emedicine.medscape.com/article/814701-treatmenthttp://emedicine.medscape.com/article/814701-treatmenthttp://emedicine.medscape.com/article/814701-treatmenthttp://emedicine.medscape.com/emergency_medicine#toxicologyhttp://emedicine.medscape.com/emergency_medicinehttp://emedicine.medscape.com/specialtieshttp://medind.nic.in/jac/t00/i2/jact00i2p142.pdfhttp://medind.nic.in/jac/t00/i2/jact00i2p142.pdfhttp://www.atsdr.cdc.gov/csem/egpg/posttest.htmlhttp://www.atsdr.cdc.gov/csem/egpg/laboratory_evaluation.htmlhttp://www.atsdr.cdc.gov/csem/egpg/laboratory_evaluation.html


11/16

Answer should be none.

Ref

1. Illness in the academy: a collection of pathographies by academics

By Kimberly Rena Myers

http://books.google.com/books?id=f1QIpLhWGh0C&pg=PA145&dq=hypothyroidism+endometriosis&hl=en&ei=6-lQTYWFMYrlrAfJyITACA&sa=X&oi=book_result&ct=result&resnum=4&ved=0CEIQ6AEwAw#v=onepage&q=hypothyroidism%20endometriosis&f=false

Women with endometriosis may also have associated disorders related to autoimmunedysregulation or pain Compared with published rates in the general USA female population,women with endometriosis had higher rates of hypothyroidism

2. Endometriosis: the complete reference for taking charge of your health By Mary Lou Ballweg, Endometriosis Association http://books.google.com/books?id=9iYA38bG80AC& pg=PA159& dq=hypothyroidi sm+endometri osis& hl=en& ei=6- lQTYWF M Yrlr AfJ yIT ACA& sa=X& oi=book_result& ct=result& resnum=7& ved=0CFI Q6AEwBg#v=onepage & q=hypothyroidism%20endometri osis& f=f alse

Hypothyroidism was seven times more common. Fibromyalgia was twice as common. The autoimmuneinflammatory diseases, systemic lupus ... 'These findings suggest a strong association betweenendometriosis and autoimmune disorders 3.http://www.nih.gov/news/pr/sep2002/nichd-26.htm Hypothyroidism an underactive thyroid gland was seven times more common in the endometriosispatients. In many cases, hypothyroidism may also be an autoimmune disorder, resulting from an immunesystem attack on the thyroid gland.
https://mail.google.com/mail/html/compose/static_files/goog_1422636460https://mail.google.com/mail/html/compose/static_files/goog_1422636460https://mail.google.com/mail/html/compose/static_files/goog_1422636460http://books.google.com/books?id=f1QIpLhWGh0C&pg=PA145&dq=hypothyroidism+endometriosis&hl=en&ei=6-lQTYWFMYrlrAfJyITACA&sa=X&oi=book_result&ct=result&resnum=4&ved=0CEIQ6AEwAw#v=onepage&q=hypothyroidism%20endometriosis&f=falsehttp://books.google.com/books?id=f1QIpLhWGh0C&pg=PA145&dq=hypothyroidism+endometriosis&hl=en&ei=6-lQTYWFMYrlrAfJyITACA&sa=X&oi=book_result&ct=result&resnum=4&ved=0CEIQ6AEwAw#v=onepage&q=hypothyroidism%20endometriosis&f=falsehttp://books.google.com/books?id=f1QIpLhWGh0C&pg=PA145&dq=hypothyroidism+endometriosis&hl=en&ei=6-lQTYWFMYrlrAfJyITACA&sa=X&oi=book_result&ct=result&resnum=4&ved=0CEIQ6AEwAw#v=onepage&q=hypothyroidism%20endometriosis&f=falsehttp://books.google.com/books?id=f1QIpLhWGh0C&pg=PA145&dq=hypothyroidism+endometriosis&hl=en&ei=6-lQTYWFMYrlrAfJyITACA&sa=X&oi=book_result&ct=result&resnum=4&ved=0CEIQ6AEwAw#v=onepage&q=hypothyroidism%20endometriosis&f=falsehttp://books.google.com/books?id=f1QIpLhWGh0C&pg=PA145&dq=hypothyroidism+endometriosis&hl=en&ei=6-lQTYWFMYrlrAfJyITACA&sa=X&oi=book_result&ct=result&resnum=4&ved=0CEIQ6AEwAw#v=onepage&q=hypothyroidism%20endometriosis&f=falsehttp://books.google.com/books?id=f1QIpLhWGh0C&pg=PA145&dq=hypothyroidism+endometriosis&hl=en&ei=6-lQTYWFMYrlrAfJyITACA&sa=X&oi=book_result&ct=result&resnum=4&ved=0CEIQ6AEwAw#v=onepage&q=hypothyroidism%20endometriosis&f=falsehttp://books.google.com/books?id=f1QIpLhWGh0C&pg=PA145&dq=hypothyroidism+endometriosis&hl=en&ei=6-lQTYWFMYrlrAfJyITACA&sa=X&oi=book_result&ct=result&resnum=4&ved=0CEIQ6AEwAw#v=onepage&q=hypothyroidism%20endometriosis&f=falsehttps://mail.google.com/mail/html/compose/static_files/goog_1422636473https://mail.google.com/mail/html/compose/static_files/goog_1422636473http://books.google.com/books?id=9iYA38bG80AC&pg=PA159&dq=hypothyroidism+endometriosis&hl=en&ei=6-lQTYWFMYrlrAfJyITACA&sa=X&oi=book_result&ct=result&resnum=7&ved=0CFIQ6AEwBg#v=onepage&q=hypothyroidism%20endometriosis&f=falsehttp://books.google.com/books?id=9iYA38bG80AC&pg=PA159&dq=hypothyroidism+endometriosis&hl=en&ei=6-lQTYWFMYrlrAfJyITACA&sa=X&oi=book_result&ct=result&resnum=7&ved=0CFIQ6AEwBg#v=onepage&q=hypothyroidism%20endometriosis&f=falsehttp://books.google.com/books?id=9iYA38bG80AC&pg=PA159&dq=hypothyroidism+endometriosis&hl=en&ei=6-lQTYWFMYrlrAfJyITACA&sa=X&oi=book_result&ct=result&resnum=7&ved=0CFIQ6AEwBg#v=onepage&q=hypothyroidism%20endometriosis&f=falsehttp://books.google.com/books?id=9iYA38bG80AC&pg=PA159&dq=hypothyroidism+endometriosis&hl=en&ei=6-lQTYWFMYrlrAfJyITACA&sa=X&oi=book_result&ct=result&resnum=7&ved=0CFIQ6AEwBg#v=onepage&q=hypothyroidism%20endometriosis&f=falsehttp://books.google.com/books?id=9iYA38bG80AC&pg=PA159&dq=hypothyroidism+endometriosis&hl=en&ei=6-lQTYWFMYrlrAfJyITACA&sa=X&oi=book_result&ct=result&resnum=7&ved=0CFIQ6AEwBg#v=onepage&q=hypothyroidism%20endometriosis&f=falsehttp://books.google.com/books?id=9iYA38bG80AC&pg=PA159&dq=hypothyroidism+endometriosis&hl=en&ei=6-lQTYWFMYrlrAfJyITACA&sa=X&oi=book_result&ct=result&resnum=7&ved=0CFIQ6AEwBg#v=onepage&q=hypothyroidism%20endometriosis&f=falsehttp://www.nih.gov/news/pr/sep2002/nichd-26.htmhttp://www.nih.gov/news/pr/sep2002/nichd-26.htmhttp://www.nih.gov/news/pr/sep2002/nichd-26.htmhttp://www.nih.gov/news/pr/sep2002/nichd-26.htmhttp://books.google.com/books?id=9iYA38bG80AC&pg=PA159&dq=hypothyroidism+endometriosis&hl=en&ei=6-lQTYWFMYrlrAfJyITACA&sa=X&oi=book_result&ct=result&resnum=7&ved=0CFIQ6AEwBg#v=onepage&q=hypothyroidism%20endometriosis&f=falsehttp://books.google.com/books?id=9iYA38bG80AC&pg=PA159&dq=hypothyroidism+endometriosis&hl=en&ei=6-lQTYWFMYrlrAfJyITACA&sa=X&oi=book_result&ct=result&resnum=7&ved=0CFIQ6AEwBg#v=onepage&q=hypothyroidism%20endometriosis&f=falsehttp://books.google.com/books?id=9iYA38bG80AC&pg=PA159&dq=hypothyroidism+endometriosis&hl=en&ei=6-lQTYWFMYrlrAfJyITACA&sa=X&oi=book_result&ct=result&resnum=7&ved=0CFIQ6AEwBg#v=onepage&q=hypothyroidism%20endometriosis&f=falsehttp://books.google.com/books?id=9iYA38bG80AC&pg=PA159&dq=hypothyroidism+endometriosis&hl=en&ei=6-lQTYWFMYrlrAfJyITACA&sa=X&oi=book_result&ct=result&resnum=7&ved=0CFIQ6AEwBg#v=onepage&q=hypothyroidism%20endometriosis&f=falsehttp://books.google.com/books?id=9iYA38bG80AC&pg=PA159&dq=hypothyroidism+endometriosis&hl=en&ei=6-lQTYWFMYrlrAfJyITACA&sa=X&oi=book_result&ct=result&resnum=7&ved=0CFIQ6AEwBg#v=onepage&q=hypothyroidism%20endometriosis&f=falsehttps://mail.google.com/mail/html/compose/static_files/goog_1422636473http://books.google.com/books?id=f1QIpLhWGh0C&pg=PA145&dq=hypothyroidism+endometriosis&hl=en&ei=6-lQTYWFMYrlrAfJyITACA&sa=X&oi=book_result&ct=result&resnum=4&ved=0CEIQ6AEwAw#v=onepage&q=hypothyroidism%20endometriosis&f=falsehttp://books.google.com/books?id=f1QIpLhWGh0C&pg=PA145&dq=hypothyroidism+endometriosis&hl=en&ei=6-lQTYWFMYrlrAfJyITACA&sa=X&oi=book_result&ct=result&resnum=4&ved=0CEIQ6AEwAw#v=onepage&q=hypothyroidism%20endometriosis&f=falsehttp://books.google.com/books?id=f1QIpLhWGh0C&pg=PA145&dq=hypothyroidism+endometriosis&hl=en&ei=6-lQTYWFMYrlrAfJyITACA&sa=X&oi=book_result&ct=result&resnum=4&ved=0CEIQ6AEwAw#v=onepage&q=hypothyroidism%20endometriosis&f=falsehttp://books.google.com/books?id=f1QIpLhWGh0C&pg=PA145&dq=hypothyroidism+endometriosis&hl=en&ei=6-lQTYWFMYrlrAfJyITACA&sa=X&oi=book_result&ct=result&resnum=4&ved=0CEIQ6AEwAw#v=onepage&q=hypothyroidism%20endometriosis&f=falsehttp://books.google.com/books?id=f1QIpLhWGh0C&pg=PA145&dq=hypothyroidism+endometriosis&hl=en&ei=6-lQTYWFMYrlrAfJyITACA&sa=X&oi=book_result&ct=result&resnum=4&ved=0CEIQ6AEwAw#v=onepage&q=hypothyroidism%20endometriosis&f=falsehttps://mail.google.com/mail/html/compose/static_files/goog_1422636460


12/16

Hermansky-Pudlak syndrome 2 answers are correct - B,C

In Hermansky-Pudlak syndrome - Platlet counts are normal but platlet function is abnormal, so option B isalso wrong.

Ref

1.emedicine Dermatology & emedicine ophthalmology

http://emedicine.medscape.com/article/1069291-diagnosis http://emedicine.medscape.com/article/1200277-diagnosis

Standard blood tests (eg, prothrombin time [PT], activated partial thromboplastin time [aPTT], platelet count,bleeding time) do not identify the platelet defect in Hermansky-Pudlak syndrome.

Platelet studies: Patients with the syndrome have normal platelets counts . However, platelets in patients withthe syndrome show abnormal aggregation with collagen, thrombin, epinephrine, and ADP.

2.http://www.albinism.org/publications/HPS.html

Bleeding Problems

The bleeding problems of HPS result from a malfunction of platelets , the tiny blood cells that clump togetherto plug up damaged blood vessels in cuts, scrapes, and bruises. The platelets lack dense bodies, which are tinystorehouses of the chemicals which platelets need to stay clumped together.

The usual tests which physicians use to diagnose coagulation (clotting) problems usually will show normalresults in HPS. These tests which may be normal include the prothrombin time (PT), partialthromboplastin time (PTT), and platelet count.

3.Pulmonary Manifestations of Pediatric Diseases-By Nelson L. Turcios, Robert J. Fink http://books.google.com/books?id=wl_c5KJAB88C&pg=PA267&dq=Hermansky-Pudlak+syndrome+normal+platelet+count&hl=en&ei=ZhNRTbuDCZCGvgO21eGMCQ&sa=X&oi=book_result&ct=result&resnum=5&ved=0CEkQ6AEwBA#v=onepage&q=Hermansky-Pudlak%20syndrome%20normal%20platelet%20count&f=false

Clinical features and laboratory abnormalities including a prolonged bleeding time withnormal pl atelet count
http://emedicine.medscape.com/article/1069291-diagnosishttp://emedicine.medscape.com/article/1069291-diagnosishttp://emedicine.medscape.com/article/1069291-diagnosishttp://emedicine.medscape.com/article/1200277-diagnosishttp://emedicine.medscape.com/article/1200277-diagnosishttp://emedicine.medscape.com/article/1200277-diagnosishttp://emedicine.medscape.com/article/1069291-diagnosishttp://emedicine.medscape.com/article/1069291-diagnosishttp://emedicine.medscape.com/article/1200277-diagnosishttp://emedicine.medscape.com/article/1200277-diagnosishttp://www.albinism.org/publications/HPS.htmlhttp://www.albinism.org/publications/HPS.htmlhttp://books.google.com/books?id=wl_c5KJAB88C&pg=PA267&dq=Hermansky-Pudlak+syndrome+normal+platelet+count&hl=en&ei=ZhNRTbuDCZCGvgO21eGMCQ&sa=X&oi=book_result&ct=result&resnum=5&ved=0CEkQ6AEwBA#v=onepage&q=Hermansky-Pudlak%20syndrome%20normal%20platelet%20count&f=falsehttp://books.google.com/books?id=wl_c5KJAB88C&pg=PA267&dq=Hermansky-Pudlak+syndrome+normal+platelet+count&hl=en&ei=ZhNRTbuDCZCGvgO21eGMCQ&sa=X&oi=book_result&ct=result&resnum=5&ved=0CEkQ6AEwBA#v=onepage&q=Hermansky-Pudlak%20syndrome%20normal%20platelet%20count&f=falsehttp://books.google.com/books?id=wl_c5KJAB88C&pg=PA267&dq=Hermansky-Pudlak+syndrome+normal+platelet+count&hl=en&ei=ZhNRTbuDCZCGvgO21eGMCQ&sa=X&oi=book_result&ct=result&resnum=5&ved=0CEkQ6AEwBA#v=onepage&q=Hermansky-Pudlak%20syndrome%20normal%20platelet%20count&f=falsehttp://books.google.com/books?id=wl_c5KJAB88C&pg=PA267&dq=Hermansky-Pudlak+syndrome+normal+platelet+count&hl=en&ei=ZhNRTbuDCZCGvgO21eGMCQ&sa=X&oi=book_result&ct=result&resnum=5&ved=0CEkQ6AEwBA#v=onepage&q=Hermansky-Pudlak%20syndrome%20normal%20platelet%20count&f=falsehttp://books.google.com/books?id=wl_c5KJAB88C&pg=PA267&dq=Hermansky-Pudlak+syndrome+normal+platelet+count&hl=en&ei=ZhNRTbuDCZCGvgO21eGMCQ&sa=X&oi=book_result&ct=result&resnum=5&ved=0CEkQ6AEwBA#v=onepage&q=Hermansky-Pudlak%20syndrome%20normal%20platelet%20count&f=falsehttp://books.google.com/books?id=wl_c5KJAB88C&pg=PA267&dq=Hermansky-Pudlak+syndrome+normal+platelet+count&hl=en&ei=ZhNRTbuDCZCGvgO21eGMCQ&sa=X&oi=book_result&ct=result&resnum=5&ved=0CEkQ6AEwBA#v=onepage&q=Hermansky-Pudlak%20syndrome%20normal%20platelet%20count&f=falsehttp://books.google.com/books?id=wl_c5KJAB88C&pg=PA267&dq=Hermansky-Pudlak+syndrome+normal+platelet+count&hl=en&ei=ZhNRTbuDCZCGvgO21eGMCQ&sa=X&oi=book_result&ct=result&resnum=5&ved=0CEkQ6AEwBA#v=onepage&q=Hermansky-Pudlak%20syndrome%20normal%20platelet%20count&f=falsehttp://books.google.com/books?id=wl_c5KJAB88C&pg=PA267&dq=Hermansky-Pudlak+syndrome+normal+platelet+count&hl=en&ei=ZhNRTbuDCZCGvgO21eGMCQ&sa=X&oi=book_result&ct=result&resnum=5&ved=0CEkQ6AEwBA#v=onepage&q=Hermansky-Pudlak%20syndrome%20normal%20platelet%20count&f=falsehttp://books.google.com/books?id=wl_c5KJAB88C&pg=PA267&dq=Hermansky-Pudlak+syndrome+normal+platelet+count&hl=en&ei=ZhNRTbuDCZCGvgO21eGMCQ&sa=X&oi=book_result&ct=result&resnum=5&ved=0CEkQ6AEwBA#v=onepage&q=Hermansky-Pudlak%20syndrome%20normal%20platelet%20count&f=falsehttp://books.google.com/books?id=wl_c5KJAB88C&pg=PA267&dq=Hermansky-Pudlak+syndrome+normal+platelet+count&hl=en&ei=ZhNRTbuDCZCGvgO21eGMCQ&sa=X&oi=book_result&ct=result&resnum=5&ved=0CEkQ6AEwBA#v=onepage&q=Hermansky-Pudlak%20syndrome%20normal%20platelet%20count&f=falsehttp://books.google.com/books?id=wl_c5KJAB88C&pg=PA267&dq=Hermansky-Pudlak+syndrome+normal+platelet+count&hl=en&ei=ZhNRTbuDCZCGvgO21eGMCQ&sa=X&oi=book_result&ct=result&resnum=5&ved=0CEkQ6AEwBA#v=onepage&q=Hermansky-Pudlak%20syndrome%20normal%20platelet%20count&f=falsehttp://books.google.com/books?id=wl_c5KJAB88C&pg=PA267&dq=Hermansky-Pudlak+syndrome+normal+platelet+count&hl=en&ei=ZhNRTbuDCZCGvgO21eGMCQ&sa=X&oi=book_result&ct=result&resnum=5&ved=0CEkQ6AEwBA#v=onepage&q=Hermansky-Pudlak%20syndrome%20normal%20platelet%20count&f=falsehttp://www.albinism.org/publications/HPS.htmlhttp://emedicine.medscape.com/article/1200277-diagnosishttp://emedicine.medscape.com/article/1069291-diagnosishttp://emedicine.medscape.com/article/1200277-diagnosishttp://emedicine.medscape.com/article/1069291-diagnosis


13/16

DISASTER CYCLE PROGRESS FROM answer should bemitigation reconstruction as rehabilitation reconstruction are both part of recoveryphase and mentioned together in asia disaster management strategy.

Ref :

1. Park 19th Ed- Pg No - 651 Fig 1

Disaster cycle includes

1. Risk reduction cycle (mitigation & preparedness)

2. Recovery phase (impact-response-rehabilitation-reconstruction), so answer should be mitigation-->reconstruction

2. FOOD AND AGRICULTURE ORGANIZATION (FAO.ORG)

3. Asian Disaster Reduction Center

http://www.adrc.asia/publications/TDRM2005/TDRM_Good_Practices/PDF/PDF-2005e/Chapter2_2.2.pdf

Total Disaster Risk Management - Good Practices -. Chapter 2.
http://www.fao.org/docrep/MEETING/003/X9178e2.gifhttp://www.fao.org/docrep/MEETING/003/X9178e2.gifhttp://www.fao.org/docrep/MEETING/003/X9178e2.gifhttp://www.adrc.asia/publications/TDRM2005/TDRM_Good_Practices/PDF/PDF-2005e/Chapter2_2.2.pdfhttp://www.adrc.asia/publications/TDRM2005/TDRM_Good_Practices/PDF/PDF-2005e/Chapter2_2.2.pdfhttp://www.adrc.asia/publications/TDRM2005/TDRM_Good_Practices/PDF/PDF-2005e/Chapter2_2.2.pdfhttp://www.adrc.asia/publications/TDRM2005/TDRM_Good_Practices/PDF/PDF-2005e/Chapter2_2.2.pdfhttp://www.adrc.asia/publications/TDRM2005/TDRM_Good_Practices/PDF/PDF-2005e/Chapter2_2.2.pdfhttp://www.fao.org/docrep/MEETING/003/X9178e2.gif


14/16

In case of Diabetes, diagnosis can be type 3 hyperlipidemia too and we can considersyndrome X.

Ref

1. eMedicine Specialties > Endocrinology > Metabolic Disorders

Dysbetalipoproteinemia

http://emedicine.medscape.com/article/118466-overview

Examination may reveal palmar xanthomas on hands .

Orange-yellow discoloration of the palmar creases is present, and these creasesmay be raised in more severe cases.

2. emedicine Differential Diagnoses of Carotenemia

http://emedicine.medscape.com/article/1104368-diagnosis

Other Problems to Be Considered

JaundiceRiboflavinemiaYellow skin discoloration associated with use of the oral multitargeted tyrosine kinase inhibitor sorafenib fortreatment of metastatic renal cell carcinom a9

Lycopenemia appears as orange-yellow skin discoloration due to the ingestion of large amounts of tomatoes. Itusually results from excessive ingestion of lycopene in foods. Type III hyperlipoproteinemia, a rare form ofdyslipidemia, was described with lycopenemia, including orange discoloration of xanthomas, followingelevated serum lycopene unassociated with excessive dietary intake .10
http://emedicine.medscape.com/specialtieshttp://emedicine.medscape.com/specialtieshttp://emedicine.medscape.com/specialtieshttp://emedicine.medscape.com/endocrinologyhttp://emedicine.medscape.com/endocrinologyhttp://emedicine.medscape.com/endocrinologyhttp://emedicine.medscape.com/endocrinology#metabolichttp://emedicine.medscape.com/endocrinology#metabolichttp://emedicine.medscape.com/endocrinology#metabolichttp://emedicine.medscape.com/article/118466-overviewhttp://emedicine.medscape.com/article/118466-overviewhttp://emedicine.medscape.com/article/118466-overviewhttp://emedicine.medscape.com/article/118466-overviewhttp://emedicine.medscape.com/article/1104368-diagnosishttp://emedicine.medscape.com/article/1104368-diagnosishttp://emedicine.medscape.com/article/1104368-diagnosishttp://emedicine.medscape.com/article/1104368-diagnosishttp://emedicine.medscape.com/article/118466-overviewhttp://emedicine.medscape.com/article/118466-overviewhttp://emedicine.medscape.com/endocrinology#metabolichttp://emedicine.medscape.com/endocrinologyhttp://emedicine.medscape.com/specialties


15/16

Answer should be middle cardiac vein.

Ref

Grays anatomy 39 th Ed Section 6 Chapter 60 Topic Heart

CARDIAC VEINSThe heart is drained by the coronary sinus and its tributaries, the anterior cardiac veins and the smallcardiac veins. The coronary sinus and its tributaries return blood to the right atrium from the entireheart (including its septa) except for the anterior region of the right ventricle and small, variable partsof both atria and left ventricle. The anterior cardiac veins drain an anterior region of the right ventricleand a region around the right cardiac border when the right marginal vein joins this group, endingprincipally in the right atrium. The small cardiac veins (Thebesius' veins) open into the right atrium andventricle and, to a lesser extent, the left atrium and sometimes left ventricle.

Variation in cardiac veins

Attempts to categorize variations in cardiac venous circulation into 'types' have not produced anyaccepted pattern. There are major variations concerning the general directions of drainage. Thecoronary sinus may receive all the cardiac veins (except the small veins), including the anteriorcardiac veins (33%), which may be reduced by diversion of some into the small cardiac vein and thento the coronary sinus (28%). The remainder (39%) represent the 'normal' pattern, as described above.

CORONARY SINUS

The large majority of cardiac veins drain into the wide coronary sinus, c.2 or 3 cm long, lying in theposterior atrioventricular groove between the left atrium and ventricle ( Figs 60.2, 60.25 ). The sinusopens into the right atrium between the opening of the inferior vena cava and the right atrioventricularorifice; the opening is guarded by an endocardial fold (semilunar valve of the coronary sinus; Fig.60.7 ). Its tributaries are the great, small and middle cardiac veins, the posterior vein of the left

ventricle and the oblique vein of the left atrium; all except the last have valves at their orifices.Great cardiac vein

The great cardiac vein begins at the cardiac apex, ascends in the anterior interventricular groove tothe atrioventricular groove and follows this, passing to the left and posteriorly to enter the coronarysinus at its origin ( Fig. 60.25 ). It receives tributaries from the left atrium and both ventricles, includingthe large left marginal vein that ascends the left aspect ('obtuse border') of the heart.

Small cardiac vein

The small cardiac vein lies in the posterior atrioventricular groove between the right atrium andventricle and opens into the coronary sinus near its atrial end ( Fig. 60.25 ). It receives blood from theposterior part of the right atrium and ventricle. The right marginal vein passes right, along the inferiorcardiac margin ('acute border'). It may join the small cardiac vein in the atrioventricular groove, but

more often opens directly into the right atrium.Middle cardiac vein

The middle cardiac vein ( Fig. 60.25 ) begins at the cardiac apex, and runs back in the posteriorinterventricular groove to end in the coronary sinus near its atrial end.

Posterior vein of the left ventricle

The posterior vein of the left ventricle ( Fig. 60.25 ) is found on the diaphragmatic surface of the leftventricle a little to the left of the middle cardiac vein. It usually opens into the centre of the coronarysinus, but sometimes opens into the great cardiac vein.

Oblique vein of the left atrium

The small vessel that is the oblique vein of the left atrium ( Fig. 60.25 ) descends obliquely on the backof the left atrium to join the coronary sinus near its end. It is continuous above with the ligament of theleft vena cava. The two structures are remnants of the left common cardinal vein.


16/16

ANTERIOR CARDIAC VEINS

The anterior cardiac veins drain the anterior part of the right ventricle. Usually two or three,sometimes even five, they ascend in subepicardial tissue to cross the right part of the atrioventriculargroove, passing deep or superficial to the right coronary artery. They end in the right atrium, near thegroove, separately or in variable combinations. A subendocardial collecting channel, into which all

may open, has been described. The right marginal vein courses along the inferior ('acute') cardiacmargin, draining adjacent parts of the right ventricle, and usually opens separately into the rightatrium. It may join the anterior cardiac veins or, less often, the coronary sinus. Because it iscommonly independent, it is often grouped with the small cardiac veins, but it is larger in calibre,being comparable to the anterior cardiac veins or even wider.

SMALL CA RDIAC VEINS

The existence of small cardiac veins, opening into all cardiac cavities, has been confirmed, but theyare more difficult to demonstrate than larger cardiac vessels. Their numbers and size are highlyvariable: up to 2 mm in diameter opening into the right atrium and c.0.5 mm into the right ventricle.Numerous small cardiac veins have been identified in the right atrium and ventricle, but they are rarein the left atrium and left ventricle.

Massive hemoptysis - ans?

90. Retinitis pigmentosa - ans?

96. VVF - ans?

Ref : International Journal of Gynecology and Obstetrics (2005) 90, 146 147

Vesicovaginal fistulas are frequently associated with amenorrhea. The amenorrhea isattributed to chemical endometritis, anemia, endocrine upset,and chronic malnutrition [4].

http://www.fistulacare.org/pages/pdf/Partners/Virtual-Resource-Center/JournalNews/ClinicalInfo/ezegwui.pdf
http://www.fistulacare.org/pages/pdf/Partners/Virtual-Resource-Center/JournalNews/ClinicalInfo/ezegwui.pdfhttp://www.fistulacare.org/pages/pdf/Partners/Virtual-Resource-Center/JournalNews/ClinicalInfo/ezegwui.pdfhttp://www.fistulacare.org/pages/pdf/Partners/Virtual-Resource-Center/JournalNews/ClinicalInfo/ezegwui.pdfhttp://www.fistulacare.org/pages/pdf/Partners/Virtual-Resource-Center/JournalNews/ClinicalInfo/ezegwui.pdfhttp://www.fistulacare.org/pages/pdf/Partners/Virtual-Resource-Center/JournalNews/ClinicalInfo/ezegwui.pdfhttp://www.fistulacare.org/pages/pdf/Partners/Virtual-Resource-Center/JournalNews/ClinicalInfo/ezegwui.pdfhttp://www.fistulacare.org/pages/pdf/Partners/Virtual-Resource-Center/JournalNews/ClinicalInfo/ezegwui.pdfhttp://www.fistulacare.org/pages/pdf/Partners/Virtual-Resource-Center/JournalNews/ClinicalInfo/ezegwui.pdf

comedk 2011 medical clarification comedk keys 2011

Documents