Tag: medicoapps masterclass

Image Based Question – 65939

Question

Lungs histopathology condition as shown in the photomicrograph below is seen in cases of ?

A. Dry drowning.

B. Wet drowning.

C. Immersion syndrome.

D. Secondary drowning.

 

Show Answer

Correct Answer » B

Explanation

Ans:B. Wet Drowning.

‘Emphysema aquosum’ is the term used to describe hyperexpanded and ‘waterlogged’ lungs seen in cases of wet drowning.

TYPES OF DROWNING

Wet Drowning

  • In this the water is inhaled into lungs . This is of two types, i.e. Fresh water and Salt water drowning.

Haemodilatation (Fresh water drowning)

Haemoconcentration (Salt water drowning)

Dry Drowning

  • Water does not enter the lungs, but death results from immediate sustained laryngeal spasm due to inrush of water into the nasopharynx or larynx.

Secondary Drowning or Near Drowning/Postimmersion Syndrome

  • Near Drowning is defined as initial survival at least beyond 24 hours of an individual after suffocation due to submersion in fluid. It does not necessarily lead to long-term survival and is associated with secondary complications, which require further medical management.

Immersion Syndrome or Hydrocution

  • Hydrocution or immersion syndrome refers to sudden death in water due to vagal inhibition as a result of:

cold water stimulating the nerve endings of the surface of the body

horizontal entry into the water with a consequent strike on the epigastrium

cold water entering eardrums, nasal passage, and the pharynx and larynx which cause mucosal nerve ending stimulation.

Signs of Drowning

  • Fine copious frothy discharge from mouth and nose.
  • Water in stomach or intestines
  • Diatoms in Bone marrow :Diatoms are ‘unicellular algae’ suspended in water.The extracellular coat of diatoms contains silica.
  • Emphysema aquosum is seen in wet drowning
  • Edema aquosum is seen in drowning of unconscious.
  • Cutis anserinus or goose skin
  • Paultaf’s hemorrhages:subpleural hemorrhages as a result of alveolar wall rupture.
  • Weeds, mud, grass in tightly clutched hands.
  • Gettler test is done for drowning and estimates the chloride content of blood in both sides of heart.

Image Based Question – 65940

Question

Time taken by the dead body to mimic the condition as shown in the picture below in indian summers is ?

A. 6 hours.

B. 12 hours.

C. 24 hours.

D. 72 hours.

 

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Image Based Question – 65942

Question

In a condition as shown in the picture below, ligature marks are example of ?

A. Contussion.

B. Printed abrasion.

C. Laceration.

D. Bruise.

 

Show Answer

 

 

Image Based Question – 65943

Question

A dead person was presented with a “red arrow in the neck in the picture below.The underlying soft tissue of neck showed extravasation of blood.Identify the most probable cause.

A. Throttling.

B. Hanging.

C. Strangulation by ligature.

D. Chocking.

 

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Image Based Question – 66839

Question

The following two regions in the world are known for making an illegal drug.Identify this drug.

A. Marijuana

B. Cocaine

C. Alcohol

D. Opium

 

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Image Based Question – 65421

Question

A patient presented with fever, night sweats and weight loss. Clinical examination revealed painless lymphadenopathy. Microscopy shows these cells. Most likely condition is:

A. HIV

B. Chronic lymphocytic leukemia

C. Hodgkin’s lymphoma

D. Secondary TB

 

Show Answer

Streptococcus pyogenes

Streptococcus Pyogenes

 

Morphology

  • Group A streptococci
  • Gram-positive cocci
  • Arranged in chains.

Biochemical Characterstics

  • Senstivity to bacitracin. (Maxted’s observation).
  • Catalase negative (S aureus is Catalase Positive)
  • CAMP Negative (Group B Streptococci are CAMP Positive)
  • Not soluble in 10% bile.
  • Hydrolyse PYR (Used for Presumptive Diagnosis of S pyogenes)
  • Ferment trehalose but not ribose.

Cultural Characteristics

  • Virulent strains produce ‘matt’ (finely granular) colony
  • Avirulent strains produce ‘glossy’ colonies.
  • Capsulated strains produce mucoid colonies, corresponding in virulence to the matt type.

METHOD OF TRANSMISSION:

  • Respiratory droplets
  • Hand contact with nasal discharge and skin contact with impetigo lesions
  • Pathogen can also be found in its carrier state (anus, vagina, skin, pharynx)
  • Can spread from cattle to humans through raw milk and contaminated foods (salads, milk, eggs)

Antigenic Structure

  1. Polysacchaide capsule:
    1. Composed of hyaluronic acid.
    2. Protect from ingestion and killing by phagocytosis.
    3. Also helps in colonization in the pharynx by binding to CD44
  2. CellWall:
    1. Inner layer made of peptidoglycan.
    2. Middle layer made of carbohydrate (basis of Lancefielil classification).
    3. Outer layer made of protein and lipoteochoic acid. e.g. M Protein T, R.
    4. M protein is basis of Griffith Typing. Inhibit phagocytosis.
    5. Antibody to M is protective.
  3.  Hair-like pilli (fimbria): Important for attachment to epithelial cells.

Antigenic Similarity

  • Antigen of streptococci are similar to normal human cells
  • Streptococcal infection is associated with autoimmune disease like rheumatic fever.
    • Capsular hyaluronic acid —>Synovial fluid
    • Cell wall protein —>Myocardium
    • Group A carbohydrates —> Cardiac valves
    • Cytoplasmic membrane —>Vascular intima
    • Peptidoglycan (mucoprotein) —->Skin antigen

Toxins and Virulence Factors

  •  Hemolysin
    • Oxygen labile
    • Activity only on pour plate
    • Antigenic specific.
    • Cardiotoxic
  • Streptolysin
    • Oxygen stable and serum soluble]
    • Non antigenic
    • Hemolysis on surface
  • Pyrogenic Exotoxin = Erythrogenic = Dick = Scadatinal Toxin:
    • This is superantigen causing TSS.
    • Identify children susceptible to scarlet fever by intradermal injection (Dicktest) and Schultz Charlton Reaction.
    • .Three types : Types A (MC) and Type C are coded by bacteriophage while type B is chromosomal.
  • Streptokinase (Fibrinolysin): Facilitates spread of infection.
  • Spy Lep: A serine protease that cleaves and inactivate IL-8, thereby inhibiting neutrophil recruitment to the site of infections.
  • Deoxyribo nuclease (Streptodornase): Responsible for thin serous character of strep Exudates. Also called as DNAase.
  • Nicotinamide Adenine Dinucleotidase (NAD-ase).
  • Hyaluronidase: Favor spread of infection.
  • Serum opacity factor: Lipoproteinase.
  • Anti Streptolysin O titre used in retrospective diagnosis; > 200 units is significant .

 

Clinical Manifestations of Streptococcus pyogenes

Infections typically begin in the throat or skin. The most striking sign is a strawberry-like rash

  1. Pharyngitis (strep throat):
    1. Sore Throat is the M/C Streptococcal Infection
  2. Localized skin infection (impetigo)
  3. Erysipelas(Superficial + S/C Tissue) and cellulitis (superficial form of cellulitis)
  4. Necrotizing fasciitis
  5. Scarlet fever:Streptococcal Pharyngitis + Rash with Minute Papules (Sand Paper Skin),
    1.  Associated with Circumoral palor + Strawberry Tounge
  6. Streptococcal toxic shock syndrome
  7. Autoimmune-mediated complications(  rheumatic fever and acute postinfectious glomerulonephritis
  8. Genital Infections
    1. Anaerobic Streptococci are most important cause of puerperal sepsis
  9. Bacteremia
    1. Bacteremia , Pneumonia and Toxic Shock Syndrome
  10. Non Suppurative  Complications

 

Acute Rheumatic Fever Acute Glomerulonephritis
Post Throat Infection (Any Serotype) Skin / Throat Serotypes 49, 53-55, 59-64, 1 & 12
Repeated Attacks Common Not seen
Penicillin Prophylaxis Indicated Not indicated
Course – Progressive / Static Self limiting
ASO Titre Raised May or May not (Skin Infection) Raised
Marked Immune Response No Change in Complement Moderate Immune Response with ↓ Complement Level

Lab Diagnosis of Streptococcus pyogenes

  • Acute Pharyngitis – Swab Culture (Gold Standard)
  • Transport Media – Pike’s Media
  • Sheep Blood Agar recommended (As it is inhibitory to H. hemolyticus)
  • ARF and Ac GN retroscpective with ↑ ASO Titres ( ASO > 200)
  • In Ac GN & Pyoderma Anti DNAse and Antihyaluronidase  used for retrospective diagnosis
  • Streptozyme Test :- Passive Haemagglutination Test (Specific and Sensitive for all Streptococcal Infections)

Management of Streptococcus pyogenes

  • Penicillin :- Pharyngitis / Impetigo / Erypsipelas / Cellulitis
  • Penicillin + Empyema Drainage:-Empyema or Pnemonia
  • Penicillin + Clindamycin + Surgical Debridement :-Necrotizing Fascitis / Myositis
  • Penicillin + Clindamycin + i/v Ig :- Streptococcal TSS

For PDF Version of the Notes on

Streptococcus pyogenes  Click Below to Download

Practice Test

Testing Quiz

Description

This quiz consists of 10 multiple-choice questions. To be successful with the weekly quizzes, it’s important to thoroughly read chapter 5 in the textbook.  It will also be extremely useful to study the key terms at the end of the chapter and review the Test Your Knowledge activity at the end of the chapter. 


Instruction

This quiz consists of 10 multiple-choice questions. To be successful with the weekly quizzes, it’s important to thoroughly read chapter 5 in the textbook.  It will also be extremely useful to study the key terms at the end of the chapter and review the Test Your Knowledge activity at the end of the chapter. Keep the following in mind:

  • Multiple Attempts – You will have three attempts for this quiz with your highest score being recorded in the grade book.
  • Timing – You will need to complete each of your attempts in one sitting, as you are allotted 30 minutes to complete each attempt.
  • Answers – You may review your answer-choices and compare them to the correct answers after your final attempt.

To start, click the “Take the Quiz” button. When finished, click the “Submit Quiz” button.

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Q. 1

After how many days of ovulation embryo implan­tation occurs ?

 A

3 – 5 days

 B

7 – 9 days

 C

10 – 12 days

 D

13 – 15 days

Q. 1

After how many days of ovulation embryo implan­tation occurs ?

 A

3 – 5 days

 B

7 – 9 days

 C

10 – 12 days

 D

13 – 15 days

Ans. B

Explanation:

7 – 9 days

“From the time a fertilized ovum enters the uterine cavity from the fallopian tube (which occurs 3-4 days after ovulation) until the time ovum implants (7-9 days after ovulation) the uterine secretions called uterinemilk provide nutrition for the early dividing ovum

“At the time of implantation, on days 21-22 of menstrual cycle the predominant morphologic feature is edema of the endometrial stroma.”

Important facts :

  • Oogenesis begins in ovary at 6-8 weeks of gestation.°
  • Maximum number of oocytes (6-7 million) are attained at 20 weeks of gestation.°
  • All the primary oocytes in the ovary of a newborn are arrested In the late prophase (of meiosis) till puberty.°
  • At puberty as a result of mid cycle preovulatory surge, meiosis is resumed and compTetedjust prior to ovulation.°
  • Therefore first polar body is released just prior fo ovulation
  • The second division starts immediately after_ it and is arrested in metaphase.°
  • At the time of fertilization second division is completed which results in the release of oocyte and second polar body.
  • Therefore second polar body release occurs only at the time of fertilisation.°
  • LH surge preceedes ovulation by 34-36 hours.o
  • LH peak preceedes ovulation by 10-16 hours.o
  • Prior to ovulation :- Follicle reaches a size of 18-20mm.

                                    – Endometrium is 9-10 min trick.o

                                    – Endometrium show triple line on USG.o

  • Ovulation occurs 14 days before the next menstruation.°
  • Maximum action of corpus luteum is at 22 day of menstruation° (following which it starts regressing ~ 8 years after ovulation).°
  • In absence of fertilisation and implanation the corpus leteum persists for 12-14 days.o
  • Maximum growth of corpus lutem of pregnancy is at 8th week of gestation and degenerates at 6  months of gestation.o
  • Fertilisation occurs in the ampullary part of fallopian tube.°
  • Fertilised egg enters the uterus on day 18 – 19 of the cycle.°
Q. 2

In a young female ot reproductive age with regular menstrual cycles of 28 days, ovulation occurs around 14th day of periods. When is first polar body extruded ?

 A

24 hours prior to ovulation

 B

Accompanied by ovulation

 C

48 hours atter the ovulation

 D

At ths time of fertilization

Q. 2

In a young female ot reproductive age with regular menstrual cycles of 28 days, ovulation occurs around 14th day of periods. When is first polar body extruded ?

 A

24 hours prior to ovulation

 B

Accompanied by ovulation

 C

48 hours atter the ovulation

 D

At ths time of fertilization

Ans. B

Explanation:

Accompanied by ovulation

Q. 3

ln which of the following transmission, meiosis occurs :

 A

Primary to secondary spermatocyte

 B

Secondary spermatocyte to globular spermatid

 C

Germ cells to spermatogonium

 D

Spermatogonium to primary spermatocyte

Q. 3

ln which of the following transmission, meiosis occurs :

 A

Primary to secondary spermatocyte

 B

Secondary spermatocyte to globular spermatid

 C

Germ cells to spermatogonium

 D

Spermatogonium to primary spermatocyte

Ans. A

Explanation:

Primary to secondary spermatocyte

Q. 4

Primary oocyte :

 A

ls formed after single meiotic division

 B

Maximum in number in 5 month fetus

 C

ls in prophase arrest

 D

Option B and C both

Q. 4

Primary oocyte :

 A

ls formed after single meiotic division

 B

Maximum in number in 5 month fetus

 C

ls in prophase arrest

 D

Option B and C both

Ans. D

Explanation:

Ans. is b and c i.e. Maximum in number at 5th month of the fetus; and ls in the prophase arrest

The process involved in the development of mature ovum is called Oogenesis.
The primitive germ cells take their origin from the yolk sac at about the end of 3rd week and migrate to the developing gonadal ridge, at aboul the end ol 4th week.

Oogenesis :

Primordial

       

Enters the gonad of a genetic female & differentiate into

       

Oogonlum tl4 XX

       Mitosis (not meiosis, as given in option)

Primary Oocyte 44 xx

                                                    (At birth no more mitosis occur & all oogonium are replaced by primary oocyte)

Enters Ist meiotic division

   ↓

Anested in prophase

   ↓

Ist meiotic division is completed after puberty, just prior to ovulationo

                                            releasing

             ___________________________________________

    ↓                                   

Secondary Oocyte 22 X
First Polar Body 22 X

                 2nd meiotic oivision

Arrested in metaphase

      ↓ At the time of  Fertilisation

       _________________________________

  ↓                          

Ovum 22 X
2nd Polar Body 22 X

lmportant facts

  • Oogenesis begins in the ovary at 6-8 A weeks of gestationo
  • Maximum number of oocytes/oogonia are in the ovary at 5th month of ddvelopmento (20 weeks of gestation)o.
  • Al birth total content ol both ovaries is 2 million primary oocytes.o
  • At puberty is further decreased and is  ~ 300000 – 500000, of which only 500 are distined to mature during an individual’s life time.o
Q. 5

Normal pH ot cervix ls :

 A

2

 B

3

 C

8

 D

11

Q. 5

Normal pH ot cervix ls :

 A

2

 B

3

 C

8

 D

11

Ans. C

Explanation:

8

The secretion of cervix are akaline and has a pH of 7.8.

  • The glands of cervix are racemose in type and secrete mucus with a high content of fructose which renders it attractive to sperm.
Q. 6

From which of the following layers the regeneration of endometrium take place :

 A

Zona basalis

 B

Zona pellucidum

 C

Zona compacta

 D

Zona spongiosum

Q. 6

From which of the following layers the regeneration of endometrium take place :

 A

Zona basalis

 B

Zona pellucidum

 C

Zona compacta

 D

Zona spongiosum

Ans. A

Explanation:

Zona basalis

 

                                                                                                                                Endometrium
Superficial layer (2/3) Deep layer (1/3)

It consists of stratum compactum stratum spongiosum These Layers are supplied by sprial which undergo vasocostriction during secretory phase

                          

This causes necrosis or sloughing of these layers at the time of menstruation

Stratum basale (Zona basalis) it is supplied by basllar arteries

                                   

During secretory phase these basilar arteries remain straight, so the blood supply stratum basale remains intact. Therefore this layer is not shed and during secretory phase it causes the regeneration.

 

Q. 7

True about galactorrhoea :

 A

Found in pregnancy and lactation

 B

Always B/L

 C

Surgery done

 D

A/w adrenal gland tumor

Q. 7

True about galactorrhoea :

 A

Found in pregnancy and lactation

 B

Always B/L

 C

Surgery done

 D

A/w adrenal gland tumor

Ans. C

Explanation:

Surgery done

Galactorrhea refers to mammary secretion of milky fluid which is not physiological (not related to pregnancy or needs of child) and is persistent and sometimes excessive.

  • Colour of fluid : Usually white, but can be yellow/green (local breast disease).
  • Hormonally induced secretions come from multiple duct openings in contrast to pathological discharge that usually comes from a single duct.
  • lt can be bilateral or unilateral
  • Any galactorrhea demands evaluation in a multiparous woman and if atleast 12 months have elapsed since the last pregnancy or weaning in a parous woman.

Differential diagnosis of Galactorrhea :

The bastc mechanism ts tncteased release ol prolactin or depletion of dopamlne.

Due to Disordsrs Drug Induced
  • Pituitary tumorso : Micro / Macro adenoma
  • Hypothyroidism
  • Prolonged intensive suckling. Similar
  • effect is seen in : ThoracotomY scarso,
    Cervical spine lesiono, Herpes zoster, stresso
  • Hypothalamic lesions / stalko
  • lesions or compressions
  • Non pituitary sources like : Lung tumor’
  • Renal tumor, Uterine leiomyoma, Severe
    renal disease requiring hemodialysis
  • Drugs which inhibit hypothalamic dopamine viz
  • Phenothiazines
  • Reserpineo
  • Amphetamineo
  • Opiates
  • Diazepamo
  • Butyrophenoneo
  • α methyl dopa
  • Tricyclic antidepressanto
  • Excessive estrogen like OCP’s

Clinical problem of Galactorrhea :

The clinical problems related to galactorrhea are related to hyperprolactinemia like :

  • Menstrual cycle disturbanceso leading to oligo-ovulation, corpus luteum insufficiency and amenorrhea.
  • Mild hirsutism.o
  • HYPerinsulinemia.o

Treatment of Galactorrhea :

Ireatment of Choice / Drug of Chorbe : Dopamine agonists viz Bromocriptine / Pergolide / Cabergoline.

ln case of pituitary tumors : Treatment of Choice is medical management with dopamine agonist but in
case medical management tails, Transsphenoidat resection of tumor can be done which is more successful
in case of Microprolactinomas than larger tumors (Macro Protactinomas

Surgery is one of the treatment modalities but not the IoC and since no other option is conect so, for this
question it is our option of choice.

Q. 8

The ovarian cycle is initiated by :

 A

FSH

 B

Oestrogen

 C

LH

 D

Progesterone

Q. 8

The ovarian cycle is initiated by :

 A

FSH

 B

Oestrogen

 C

LH

 D

Progesterone

Ans. A

Explanation:

FSH

Initiated by the release of FSH (From Anterior pituitary)
FSH stimulates the Growth of Multiple Follicles (Folliculogenesis)

Selection of a dominant Follicle (Graffian Follicle), by day 5-7.
Graffian Follicle acquires FSH receptors on Granulosa cells and LH receptors on Theca cell.
Under the influence of FSH, Graffian follicle secretes 178 estradiol (Day 7)
178 estradiol causes

4,                                                                   i                                                                    4,

Proliferative changes              Negative feedback on FSH                    Positive feedback on LH therefore

in the endometrium                                                                                      LH increases in amount.

Decreased Amount of FSH                      Increased LH leads to :

 

 

Production of androgen from Theca cells

which is converted peripherally to estrogen therefore Estrogen peak occurs (48 hours before ovulation)

LH surge (32-36 hours before ovulation) & LH peak (10-16 hours before ovulation) 1

Ovulation Occurs (14 days prior to next cycle)

Formation of corpus luteum & 2nd phase of ovulatory cycle i.e. Luteal Phase begins.

Secretes Progesterone

 

Stimulates Endometrium to undergo secretory changes 1.

In absence of Fertilisation corpus luteum degenerates

 

Oestradiol                          Progesterone                         Inhibin

(inhibin      FSH production)

(Leads to menstruation in menstrual

cycle) & will release the negative                         Increased FSH as

feedback on GnRH, therefore                               compared to LH increases GnRH pulses

L

Another follicular phase begins

Q. 9

Narrowest part of Fallopian Tube is:

 A

Interstitial portion

 B

lsthmus

 C

lnfundibulum

 D

Ampulla

Q. 9

Narrowest part of Fallopian Tube is:

 A

Interstitial portion

 B

lsthmus

 C

lnfundibulum

 D

Ampulla

Ans. A

Explanation:

Interstitial portion

Important Facts about Fallopian Tube :

1. Length = 4 inches or 10 – 12 cms.

2. Parts are : a. Interstitium (Intramural) : 1.8 cm long and 1 mm diameter (narrowest part°). It has no longitudinal muscles, only circular muscles are present.°

  1. Isthmus 3.5cm long and 2mm in diameter.°
  2. Ampulla : widest° and longest part° 6-7.5cm and fertilization occurs here°
  3. Fimbria/infundibulum°

3. Blood supply – Tubal branch of ovarian and uterine artery.°

4. Lymphatics – Via ovarian vessels to para-aortic nodes and uterine vessels to internal iliac nodes.°

5. Histologically – Fallopian tubes have unique type of cells called as Peg cells° whose function is not known.°

Also know : Friends, some other measurements are commonly asked in PGME exams from female genital Tract. I am listing a few of them :

Structure                                                                            Measurement

  • Isthumus which forms Inwpr laprinp gpampnt       5-6mmt)
  • Female urethra                                                       35-40 mm°
  • Posterior vaginal wall                                            11.5 cms
  • Anterior vaginal wall                                              9 cms
  • Uterus(Nulliparous)                                               8 cm X 6 cm X 4 cm
  • Cervix                                                                     2.5- 3.5 cms
  • Ovary                                                                      3.5 cms length


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