Benzodiazipines
Diazepam poisoning is treated by:
| A | Flumazenil | |
| B |
Hemofiltration |
|
| C | Charcoal | |
| D |
Resins |
Diazepam poisoning is treated by:
| A | Flumazenil | |
| B |
Hemofiltration |
|
| C | Charcoal | |
| D |
Resins |
Flumazenil REF: Harrison’s 17th ed Table e 35-4
See APPENDIX-42 for list of “Antidotes”
“Specific antidote for benzodiazepine poisoning is flumazenil”
Benzodiazepine antagonist ?
| A |
Flumazenil |
|
| B |
Naloxone |
|
| C | Furazolidone | |
| D |
Naltrexone |
Benzodiazepine antagonist ?
| A |
Flumazenil |
|
| B |
Naloxone |
|
| C | Furazolidone | |
| D |
Naltrexone |
Flumazenil [Ref. K.D.T. 6thIe p399-400 5th/e p 362]
- Benzodiazepine acts by enhancing presynaptic/postsynaptic inhibition through a specific BZD receptor which is an integral part of the GABA receptor-CI— channel complex.
- Flumazenil is a BZD analogue which has little intrinsic activity, but it competes with BZD agonists as well as inverse agonists for the BZD receptor and reverses their depressant or stimulant effects respectively.
- Flumazenil is the drug of choice for benzodiazepene overdose. About other options:
- Naltrexone –> Opioid antagonist
- Butorphanol –> Agonist/antagonist at opioid receptors
- Pralidoxime –> Cholinesterase reactivator
The following are the benzodiazepines of choice in elderly and those with liver disease, EXCEPT:
| A |
Lorazepam |
|
| B |
Orazepam |
|
| C |
Temazepam |
|
| D |
Diazepam |
The following are the benzodiazepines of choice in elderly and those with liver disease, EXCEPT:
| A |
Lorazepam |
|
| B |
Orazepam |
|
| C |
Temazepam |
|
| D |
Diazepam |
Diazepam generates active metabolites, has slow elimination and tends to accumulate with regular use.
Lorazepam, Oxazepam and Temazepam do not produce active metabolites and are relatively safer in elderly patients and in those with liver disease.
These agents should be used in preference to diazepam.
Ref: Essentials of Pharmacology By K D Tripathi, 5th Edtion, Page 364.
Shortest acting benzodiazepine is‑
| A |
Flurazepam |
|
| B |
Alprazolam |
|
| C |
Triazolam |
|
| D |
Diazepam |
Shortest acting benzodiazepine is‑
| A |
Flurazepam |
|
| B |
Alprazolam |
|
| C |
Triazolam |
|
| D |
Diazepam |
Ans. is ‘c’ i.e., Triazolam
o Midazolam (slightly shorter acting than triazolam) and triazolam are shortest acting BZDs.
Benzodiazepine without anticonvulsant property is‑
| A |
Nitrazepam |
|
| B |
Diazepam |
|
| C |
Clonazepam |
|
| D |
Temazepam |
Benzodiazepine without anticonvulsant property is‑
| A |
Nitrazepam |
|
| B |
Diazepam |
|
| C |
Clonazepam |
|
| D |
Temazepam |
Ans. is ‘d’ i.e., Temazepam
BZDs with significant anticonvulsant property are diazepam, clonazepam, nitrazepam, lorazepam and flurazepam.
Antagonist of Benzodiazepine is ‑
| A |
Nalorphine |
|
| B |
Carbamazepine |
|
| C |
Naloxone |
|
| D |
Flumazenil |
Antagonist of Benzodiazepine is ‑
| A |
Nalorphine |
|
| B |
Carbamazepine |
|
| C |
Naloxone |
|
| D |
Flumazenil |
Ans. is ‘d’ i.e., Flumazenil
o Flumazenil is a benzodiazepene analogue which competes with BZD agonists as well as inverse agonists for the BZD receptor and reverses their depressant or stimulant effects respectively.
o It also antagonizes the action of Zolpidem, Zopiclone and Zopeplon as these drugs also act on BZD site.
Flumazenil is –
| A |
Diazepam inverse agonist |
|
| B |
Diazepam antagonist |
|
| C |
Opioid antagonist |
|
| D |
Opioid inverse agonist |
Flumazenil is –
| A |
Diazepam inverse agonist |
|
| B |
Diazepam antagonist |
|
| C |
Opioid antagonist |
|
| D |
Opioid inverse agonist |
Ans. is ‘b’ i.e., Diazepam antagonist
A 6 yr. old child with acute onset of fever of 104° F developed febrile seizures and was treated. To avoid future recurrence of seizure attacks what should be given –
| A |
Paracetamol 400 mg + Phenobarbitone daily |
|
| B |
Oral Diazepan 6 hourly |
|
| C |
Paracetamol 400 mg 6 hourly |
|
| D |
I.V. diazepam infusion over 12 hrs |
A 6 yr. old child with acute onset of fever of 104° F developed febrile seizures and was treated. To avoid future recurrence of seizure attacks what should be given –
| A |
Paracetamol 400 mg + Phenobarbitone daily |
|
| B |
Oral Diazepan 6 hourly |
|
| C |
Paracetamol 400 mg 6 hourly |
|
| D |
I.V. diazepam infusion over 12 hrs |
Ans. is ‘b’ i.e., Oral Diazepan 6 hrly
An anxiolytic benzodiazepine which is also antidepressant :
September 2007
| A |
Lorazepam |
|
| B |
Oxazepam |
|
| C |
Alprazolam |
|
| D |
Chlordiazepoxid |
An anxiolytic benzodiazepine which is also antidepressant :
September 2007
| A |
Lorazepam |
|
| B |
Oxazepam |
|
| C |
Alprazolam |
|
| D |
Chlordiazepoxid |
Ans. C: Alprazolam
Alprazolam is approved for the short-term treatment of panic disorder, with or without agoraphobia. Alprazolam is very effective in the short-term symptomatic relief of moderate to severe anxiety, essential tremor, and panic attacks.
Alprazolam is indicated for the management of anxiety disorders or the short-term relief of symptoms of anxiety. Alprazolam is recommended for the short-term treatment of severe acute anxiety.
Alprazolam is sometimes prescribed for anxiety with associated depression.
The antidepressant effects of alprazolam may be due to its effects on beta-adrenergic receptors. Other benzodiazepines are not known to have antidepressant activity.
Benzodiazepine overdose in a patient presenting with coma, is treated by:
March 2010
| A |
Protamine |
|
| B |
Flumazenil |
|
| C |
Coumarin |
|
| D |
Midazolam |
Benzodiazepine overdose in a patient presenting with coma, is treated by:
March 2010
| A |
Protamine |
|
| B |
Flumazenil |
|
| C |
Coumarin |
|
| D |
Midazolam |
Ans. B: Flumazenil
Decontamination
– Gastric lavage is not recommended but may be considered if the presence of a lethal co-ingestant is suspected and the patient presents within 1 hour of ingestion.
– Single-dose activated charcoal is recommended for GI decontamination in patients with protected airway who present within 4 hours of ingestion.
- Respiratory depression may be treated with assisted ventilation.
- Flumazenil
– Flumazenil is a competitive BZD receptor antagonist and should be used cautiously because it has potential to precipitate BZD withdrawal in chronic users, resulting in seizures.
– Flumazenil administration is contraindicated in mixed overdoses (e.g., TCAs) because BZD reversal can precipitate seizures and cardiac arrhythmias.
– Ideal indication for flumazenil use is isolated BZD overdose, particularly if overdose is iatrogenic in nature.
Antidote for benzodiazepine poisoning:
FMGE 10, 13; NEET 14
| A |
Naloxone |
|
| B |
Atropine |
|
| C |
Flumazenil |
|
| D |
N-acetyl-cysteine |
Antidote for benzodiazepine poisoning:
FMGE 10, 13; NEET 14
| A |
Naloxone |
|
| B |
Atropine |
|
| C |
Flumazenil |
|
| D |
N-acetyl-cysteine |
Ans. Flumazenil
IV diazepam has which of the following effect which is not seen by other routes ‑
| A |
Analgesia |
|
| B |
Sedation |
|
| C |
Hypotension |
|
| D |
Coronary dilatation |
IV diazepam has which of the following effect which is not seen by other routes ‑
| A |
Analgesia |
|
| B |
Sedation |
|
| C |
Hypotension |
|
| D |
Coronary dilatation |
Ans. is ‘d’ i.e., Coronary dilatation
Mechanism of action of benzodiazepines (BZDs)
- Benzodiazepines act preferentially on midbrain ascending reticular formation (which maintains wakefulness) and on limbic system (thought and mental function).
- Muscle relaxation is produced by action on medulla.
- Ataxia is due to action on cerebellum.
- BZDs acts on GABAA receptors.
- GABA,,, receptor has 5 subunits a / p, p, a / y.
- GABA binding site is on p. subunit, while BZDs binding site is on a / y subunit.
- BZDs receptor increase the conductance of Cl- channel.
- BZDs do not themselves increase Cl- conductance, i.e. they have only GABA facilitatory but no GABA mimetic action. (Barbiturates have both GABA facilitatory and GABA mimetic actions).
Effect on CNS
- In contrast to barbiturates, BZDs are not general depressant, but exert relatively selective anxiolytic, hypnotic, muscle relaxant and anticonvulsant effects.
- The antianxiety action of BZDs is not dependent on their sedative property —› with chronic administration relief of anxiety is maintained, but drowsiness wanes off due to development of tolerance.
- Stage 2 sleep is increased, while REM, Stage 3 & 4 sleep are decreased.
- Nitrazepam is the only benzodiazepine, which increases REM sleep.
- Clonazepan and diazepam have more marked muscle relaxant property.
- Clonazepam, diazepam, nitrazepam and flurazepam have more prominent anticonvulsant activity than other BZDs.
- Diazepam (but not other BZDs) has analgesic action.
- Diazepam produces short lasting coronary dilatation on i.v. injection.
- Diazepam decreases nocturnal gastric secretion and prevents stress ulcers.
Inverse agonist of benzodiazepine receptor is –
| A |
Phenobarbitone |
|
| B |
Flumazenil |
|
| C |
Beta carboline |
|
| D |
Gabapentin |
Inverse agonist of benzodiazepine receptor is –
| A |
Phenobarbitone |
|
| B |
Flumazenil |
|
| C |
Beta carboline |
|
| D |
Gabapentin |
Ans. is `c’ i.e., Beta carboline
Antidote true is all except‑
| A |
Deferoxamine – Iron |
|
| B |
Flumazenil – BZDs |
|
| C |
Dimercaprol – Arsenic |
|
| D |
Naloxone – Dhatura |
Antidote true is all except‑
| A |
Deferoxamine – Iron |
|
| B |
Flumazenil – BZDs |
|
| C |
Dimercaprol – Arsenic |
|
| D |
Naloxone – Dhatura |
Ans. is ‘d’ i.e., Naloxone-Dhatura
Midazolam causes all except:
| A |
Anterograde amnesia |
|
| B |
Retrograde amnesia |
|
| C |
Causes tachyphylaxis during high dose infusions |
|
| D |
Decreased cardiovascular effects as compared to propofol |
Midazolam causes all except:
| A |
Anterograde amnesia |
|
| B |
Retrograde amnesia |
|
| C |
Causes tachyphylaxis during high dose infusions |
|
| D |
Decreased cardiovascular effects as compared to propofol |
Ans. b. Retrograde amnesia
At the time of peak concentration in plasma, hypnotic doses of benzodiazepines (midazolam) can be expected to cause varying degrees of lightheadedness, lassitude, increased reaction time, motor incoordination, impairment of mental and motor functions, confusion, and anterograde amnesia.”
Midazolam:
- It causes anterograde amnesiaQ
- Tolerance and tachyphylaxis may occur, particularly with longer-term infusionsQ(Shafer A. Complications of sedation with midazolam in the intensive care unit and a comparison with other sedative regimens. Crit Care Med. 1998;26(5): 947-56)
- Benzodiazepine withdrawal syndrome has also been associated with high dose/ long-term midazolam infusionsQ
- Compared with propofol infusions, midazolam infusions have been associated with a decreased occurrence of hypotension° but a more variable time course for recovery of function after the cessation of the infusion.
Shortest acting Benzodiazepine ‑
| A |
Diazepam |
|
| B |
Midazolam |
|
| C |
Alprazolam |
|
| D |
Chlordiazepoxide |
Shortest acting Benzodiazepine ‑
| A |
Diazepam |
|
| B |
Midazolam |
|
| C |
Alprazolam |
|
| D |
Chlordiazepoxide |
Ans. is ‘b’ i.e., Midazolam
- Ajay Yadav 4th/e p. 85] o Midazolam is the shortest acting benzodiazipine.
- It is 3 times more potent than diazepam.
- Midazolam is now very commonly used BZD in intraoperative period.
- Advantages of midazolam over diazepam are :
- Water based preparation, so injection is painless.
- Elimination half life is 2-3 hours, so can be safely used for day care procedures.
- Reversal with flumezanil is complete (no resedation).
- Disadvantages are that decrease in BP and peripheral vascularresistance, respiratory depression and incidence of apnea are higher and more profound than diazepam
The antidote for benzodiazepine toxicity is-
| A |
Flumazenil |
|
| B |
Naloxone |
|
| C |
Naltrexone |
|
| D |
Dimercaprol |
The antidote for benzodiazepine toxicity is-
| A |
Flumazenil |
|
| B |
Naloxone |
|
| C |
Naltrexone |
|
| D |
Dimercaprol |
Ans. is ‘a’ i.e., Flumazenil
Benzodiazepine without anticonvulsant property is ‑
| A |
Nitrazepam |
|
| B |
Diazepam |
|
| C |
Clonazepam |
|
| D |
Temazepam |
Benzodiazepine without anticonvulsant property is ‑
| A |
Nitrazepam |
|
| B |
Diazepam |
|
| C |
Clonazepam |
|
| D |
Temazepam |
Ans. is ‘d’ i.e., Temazepam
- BZDs with significant anticonvulsant property are diazepam, clonazepam, nitrazepam, lorazepam and flurazepam.
Effects of benzodiazepines
- In contrast to barbiturates, BZDs are not general depressant, but exert relatively selective anxiolytic, hypnotic, muscle relaxant and anticonvulsant effects.
- The antianxiety action of BZDs is not dependent on their sedative property with chronic administration relief of anxiety is maintained, but drowsiness wanes off due to development of tolerance.
- Stage 2 sleep is increased, while REM, Stage 3 & 4 sleep are decreased.
- Nitrazepam is the only benzodiazepine, which increases REM sleep.
- Clonazepan and diazepam have more marked muscle relaxant property.
- Clonazepam, diazepam, nitrazepam and flurazepam have more prominent anticonvulsant activity than other BZDs.
- Diazepam (but not other BZDs) has analgesic action.
- Diazepam produces short lasting coronary dilatation on injection.
- Diazepam decreases nocturnal gastric secretion and prevents stress ulcers.
Shortest acting benzodiazepine is
| A |
Flurazepam |
|
| B |
Alprazolam |
|
| C |
Triazolam |
|
| D |
Diazepam |
Shortest acting benzodiazepine is
| A |
Flurazepam |
|
| B |
Alprazolam |
|
| C |
Triazolam |
|
| D |
Diazepam |
Ans. is ‘c’ i.e., Triazolam
PELVIS MUSCULATURE
Muscles that can cause external rotation of the hip include all of the following except:
| A |
Sartorius |
|
| B |
Obturator internus |
|
| C |
Obturator externus |
|
| D |
Gluteus minimus |
Muscles that can cause external rotation of the hip include all of the following except:
| A |
Sartorius |
|
| B |
Obturator internus |
|
| C |
Obturator externus |
|
| D |
Gluteus minimus |
Ans:D.)Gluteus Minimus.
Many of the muscles of the gluteal region are external rotators of the hip. These muscles include the gluteus maximus, piriformis, obturator internus, obturator externus, quadratus femoris, superior gemellus, and inferior gemellus. The sartorius is a flexor and external rotator of the hip. The gluteus minimus is an abductor and internal rotator of the hip.
All are sphincters of lower genito urinary tract of female except?
| A |
Pubovaginalis |
|
| B |
External urethral sphincter |
|
| C |
Internal urethral sphincter |
|
| D |
Bulbospongiosus |
All are sphincters of lower genito urinary tract of female except?
| A |
Pubovaginalis |
|
| B |
External urethral sphincter |
|
| C |
Internal urethral sphincter |
|
| D |
Bulbospongiosus |
Internal urethral sphincter
There is no ‘internal urethral sphincter’ in females. It is present in males at the bladder neck and proximal urethral. Its function is to prevent retrograde ejaculation of semen into the bladder during the time of ejaculation.
In males the detrusor muscle fibers of the bladder at the region of bladde neck and proximal urethra are organized into internal urethral sphincter which is under involuntary control.
External urethral sphincter is present in both males and females.
- Vaginal sphincter is formed by the fibres of pubococcygeus known as pubovaginalis.
- There are other muscles also which contribute in compressing the vaginal orifice.
Pelvic diaphragm is formed by the following muscles:
| A |
Pubococcygeus |
|
| B |
Iliococcygeus |
|
| C |
Pubovaginalis |
|
| D |
All of the above |
Pelvic diaphragm is formed by the following muscles:
| A |
Pubococcygeus |
|
| B |
Iliococcygeus |
|
| C |
Pubovaginalis |
|
| D |
All of the above |
The pelvic diaphragm forms a broad muscular sling and provides substantial support to the pelvic viscera.
This muscle group is comprised of the levator ani and the coccygeus muscle.
Urogenital Diaphragm is made up of all of the following, EXCEPT?
| A |
Colle’s fascia |
|
| B |
Sphincter urethrae |
|
| C |
Perineal membrane |
|
| D |
Deep transverse Perineal muscle |
Urogenital Diaphragm is made up of all of the following, EXCEPT?
| A |
Colle’s fascia |
|
| B |
Sphincter urethrae |
|
| C |
Perineal membrane |
|
| D |
Deep transverse Perineal muscle |
Urogenital diaphragm is a triangular musculofascial diaphragm situated in the anterior part of perineum, filling in the gap of the pubic arch. It is formed by the sphincter urethrae, deep transverse perineal muscles enclosed between superior and inferior layer of fascia of urogenital diaphragm. Inferior layer of fascia is called perineal membrane.
Superficial perineal muscles include‑
| A |
Iliococcygeus |
|
| B |
Ischiococcygeus |
|
| C |
Bulbospongiosus |
|
| D |
Levator ani |
Superficial perineal muscles include‑
| A |
Iliococcygeus |
|
| B |
Ischiococcygeus |
|
| C |
Bulbospongiosus |
|
| D |
Levator ani |
Superficial muscles of perineum (lie in superficial perineal pouch) are ischiocavernosus, bulbospongiosus and superficial transverse perinei.
Deep muscles (lie in deep perineal pouch) are splincter urethrae, deep transverse perinei, and in females, compression urethrae and sphincter urethravaginalis.
Lateral border of ischeorectal fossa is formed by‑
| A |
Gluteus maximus |
|
| B |
Perineal membrane |
|
| C |
Pelvic diaphram |
|
| D |
Obturator internus |
Lateral border of ischeorectal fossa is formed by‑
| A |
Gluteus maximus |
|
| B |
Perineal membrane |
|
| C |
Pelvic diaphram |
|
| D |
Obturator internus |
Ans. is ‘d’ i.e., Obturator internus
Boundries of ischeoanal (ischeorectal) fossa are :-
i) Anteriorly :- Posterior border of perineal membrane .
ii) Posteriorly :- Gluteus maximus muscle, sacrotuberous ligament.
iii) Laterally :- Ischial tuberosity and obturator internus.
iv) Medially :- Sphincter ani externus (external anal sphincter) and pelvic diaphragm (levator ani).
True statement about anatomy of an organ marked by a “red box” in the picture below is?
| A |
Puborectalis is essential to maintain continence. |
|
| B |
Internal sphincter is skeletal muscle. |
|
| C |
Internal sphincter remains in the state of tonic contraction. |
|
| D |
Both A and C. |
True statement about anatomy of an organ marked by a “red box” in the picture below is?
| A |
Puborectalis is essential to maintain continence. |
|
| B |
Internal sphincter is skeletal muscle. |
|
| C |
Internal sphincter remains in the state of tonic contraction. |
|
| D |
Both A and C. |
Ans;D)Both A and C.
The organ marked by a “red box” in the picture above represents the anal canal.
In the anal canal Puborectalis is essential to maintain continence and Internal sphincter remains in the state of tonic contraction.
Structures crossing dorsal surface of the given structure marked by a “red arrow” are ?
| A |
Internal pudendal vessel. |
|
| B |
Pudendal nerve. |
|
| C |
Obturator nerve. |
|
| D |
Nerve to obturator internus. |
Structures crossing dorsal surface of the given structure marked by a “red arrow” are ?
| A |
Internal pudendal vessel. |
|
| B |
Pudendal nerve. |
|
| C |
Obturator nerve. |
|
| D |
Nerve to obturator internus. |
Ans;C).Obturator nerve
The structure marked by a red arrow represents the ischial spine.
ISCHIAL SPINE–a thin pointed triangular eminence that projects from the dorsal border of the ischium and gives attachment to the gemellus superior on its external surface and to the coccygeus, levator ani, and pelvic fascia on its internal surface
- The structure crossing dorsal surface of ischial spine is the Obturator nerve.
- Psoas major, iliacus & pectineus muscles, femoral vessels and nerve, femoral branch of genitofemoral nerve, lateral cutaneous nerve of thigh and lymphatics pass below inguinal ligament.
- ‘PIN’ structures i.e. Pudendal nerve, Internal Pudendal vessels, Nerve to obturator internus come out of greater sciatic foramen, cross the dorsal surface of ischial spine & enter into lesser sciatic foramen.
- From the posterior border of the body of the Ischium there extends backward a thin and pointed triangular eminence, the ischial spine, more or less elongated in different subjects.
Surfaces
| external surface | gives attachment to the Gemellus superior |
| internal surface | gives attachment to the Coccygeus, Levator ani, and the pelvic fascia |
| pointed extremity | the sacrospinous ligament is attached. |
It can serve as a landmark in pudendal anesthesia.
All of the following structures forms the boundary of the triangle as shown in the picture below, EXCEPT ?
| A |
Pubic rami. |
|
| B |
Ischial tuberosity. |
|
| C |
Ischio cavernosus muscle. |
|
| D |
Superficial transverse perineal muscle. |
All of the following structures forms the boundary of the triangle as shown in the picture below, EXCEPT ?
| A |
Pubic rami. |
|
| B |
Ischial tuberosity. |
|
| C |
Ischio cavernosus muscle. |
|
| D |
Superficial transverse perineal muscle. |
The triangle shown in the picture above represents Urogenital triangle.
The perineum is divided by an arbitrary line joining the ischial tuberosities into urogenital triangle and anal triangle. The urogenital triangle is bounded by pubic rami superiorly, the ischial tuberosities laterally, and the superficial transverse perineal muscle posteriorly.
All of the following are true about sphincter urethrae except?
| A |
Voluntary |
|
| B |
Supplied by pudendal nerve |
|
| C |
Arises from ischiopubic ramus |
|
| D |
Located at bladder neck |
All of the following are true about sphincter urethrae except?
| A |
Voluntary |
|
| B |
Supplied by pudendal nerve |
|
| C |
Arises from ischiopubic ramus |
|
| D |
Located at bladder neck |
Ans. d. Located at bladder neck
Support of prostate is ‑
| A |
Pubococcygeus |
|
| B |
Ischiococcygeus |
|
| C |
Ilioccygeus |
|
| D |
None of the above |
Support of prostate is ‑
| A |
Pubococcygeus |
|
| B |
Ischiococcygeus |
|
| C |
Ilioccygeus |
|
| D |
None of the above |
Ans. is ‘a’ i.e., Pubococcygeus
- Levator ani muscle is divisible into following parts :1) Puboccygeus part
- Anterior fibers of this part closely surround the prostate, in males, to form, levator prostatae. In the female these fibres surround the vagina and form sphincter vaginae. In both cases these anterior fibres are inserted into the perineal body.
- Middle fibers constitute the puborectalis. They partly form a loop or sling around the anorectal junction; and are partly continuous with longitudinal muscle coat of the rectum.
- Posterior fibers are attached to anococcygeal ligament and tip of coccyx.
- Iliococcygeus part
- This is inserted to anococcygeal ligament and last two pieces of coccyx.
- Ischiococcygeus part (or coccygeus)
- It forms posterior part of pelvic floor.
Superficial perineal space contains ‑
| A |
Sphincter urethrae muscle |
|
| B |
Ischiocavernosus muscle |
|
| C |
Deep transverse perinei muscle |
|
| D |
Bulbourethral gland |
Superficial perineal space contains ‑
| A |
Sphincter urethrae muscle |
|
| B |
Ischiocavernosus muscle |
|
| C |
Deep transverse perinei muscle |
|
| D |
Bulbourethral gland |
Ans. is ‘b’ i.e., Ischiocavernosus muscle
TUBERCULOSIS OF SPINE (Pott’s disease)
Pott’s spine is commonest at which spine:
| A | Thoracolumbar | |
| B |
Sacral |
|
| C | Cervical | |
| D |
Lumbosacral |
Pott’s spine is commonest at which spine:
| A | Thoracolumbar | |
| B |
Sacral |
|
| C | Cervical | |
| D |
Lumbosacral |
Thoracolumbar REF: Apley 387-389, S M Tuli 3rd edition page 192
- Most common site of skeletal tuberculosis is spine followed by hip and knee
SPINE (50%) > HIP > KNEE
- Commonest spine involved in spine TB is Thoracolumbar/Dorsolumbar T12-L1 (Lower thoracic to be precise)
LOWER THORACIC > LUMBAR > UPPER THORACIC
- Paraplegia due to pott’s spine most commonly involves upper thoracic vertebrae as in upper thoracic vertebrae there is more acute kyphosis, spinal canal is narrow and spinal cord is relatively large.
- First symptom of TB spine is “Pain on movement”
- Commonest symptom of TB spine is “Back pain”
| A | Sacral | |
| B | Cervica l |
|
| C | Lumbosacral | |
| D | Thoracolumbar |
| A | Sacral | |
| B | Cervica l |
|
| C | Lumbosacral | |
| D | Thoracolumbar |
Thoracolumbar
Most common cause of cold abscess of chest wall is‑
| A |
Pott’s spine |
|
| B |
TB abscesses of chest wall |
|
| C |
TB of ribs |
|
| D |
Intercostal lymphadenitis |
Most common cause of cold abscess of chest wall is‑
| A |
Pott’s spine |
|
| B |
TB abscesses of chest wall |
|
| C |
TB of ribs |
|
| D |
Intercostal lymphadenitis |
Ans. is ‘a’ i.e., Pott’s spine
True statement about chronic retropharyngeal abscess:
| A |
Associated with tuberculosis of spine |
|
| B |
Causes psoas spasm |
|
| C |
Suppuration of Rouviere lymph node |
|
| D |
a and c |
True statement about chronic retropharyngeal abscess:
| A |
Associated with tuberculosis of spine |
|
| B |
Causes psoas spasm |
|
| C |
Suppuration of Rouviere lymph node |
|
| D |
a and c |
- Chronic retropharyngeal abscess is associated with caries of cervical spine or tuberculous infection of retropharyngeal lymph nodes secondary to tuberculosis of deep cervical nodes (i.e. suppuration of Rouviere nodes)
- It leads to discomfort in throat, dysphagia, fluctuant swelling of postpharyngeal wall.
- Retropharyngeal abscess does not lead to psoas spasm.
Treatment
- Incison and drainage of abscess
- Full course of ATT
Commonest presenting symptom of Pott’s spine is:
March 2007
| A |
Cold abscess |
|
| B |
Back pain |
|
| C |
Decreased spinal movements |
|
| D |
Collapse of spine |
Commonest presenting symptom of Pott’s spine is:
March 2007
| A |
Cold abscess |
|
| B |
Back pain |
|
| C |
Decreased spinal movements |
|
| D |
Collapse of spine |
Ans. B: Back Pain
Tuberculosis (TB) of the spine (Pott’s disease) is the most common site of bone infection in TB. The lower thoracic and upper lumbar vertebrae are the areas of the spine most often affected.
Pott’s disease results from haematogenous spread of tuberculosis from other sites, often pulmonary. The infection then spreads from two adjacent vertebrae into the adjoining disc space.
If only one vertebra is affected, the disc is normal, but if two are involved the intervertebral disc, which is avascular, cannot receive nutrients and collapses (seen as narrowing of intervertebral space on X-rays)
The disease progresses slowly. Signs and symptoms include:
- Localised back pain is the earliest and commonest complaint
- Paravertebral swelling may be seen
- Neurological signs may occur, leading to paraplegia.
- Stiffness
- Deformity
- Constitutional symptoms
Spinal X-ray may not show early disease as 50% of bone mass must be lost for changes to be visible on x-ray. However, plain radiographs can show vertebral destruction and narrowed disc space.
MRI is useful to demonstrate the extent of spinal compression and can show changes at an earlier stage than plain radiographs. Bone elements visible within the swelling, or abscesses, are strongly indicative of Pott’s disease as opposed to malignancy.
CT scans and nuclear bone scans can also be used.
Tuberculosis in Pott’s disease involves:
September 2010
| A |
Hip Joint |
|
| B |
Knee Joint |
|
| C |
Spine |
|
| D |
Wrist Joint |
Tuberculosis in Pott’s disease involves:
September 2010
| A |
Hip Joint |
|
| B |
Knee Joint |
|
| C |
Spine |
|
| D |
Wrist Joint |
Ans. C: Spine
Pott’s disease is a presentation of extrapulmonary tuberculosis that affects the spine, a kind of tuberculous arthritis of the intervertebral joints.
It is named after Percivall Pott.
The lower thoracic and upper lumbar vertebrae are the areas of the spine most often affected.
Scientifically, it is called tuberculous spondylitis and it is most commonly localized in the thoracic portion of the spine.
Pott’s disease results from haematogenous spread of tuberculosis from other sites, often pulmonary. The infection then spreads from two adjacent vertebrae into the adjoining intervertebral disc space.
Earliest sign in X-ray in TB spine is:
March 2011
| A |
Paravertebral shadow |
|
| B |
Narrowing of disc space |
|
| C |
Gibbus |
|
| D |
Straightening of spinal curves |
Earliest sign in X-ray in TB spine is:
March 2011
| A |
Paravertebral shadow |
|
| B |
Narrowing of disc space |
|
| C |
Gibbus |
|
| D |
Straightening of spinal curves |
Ans. B: Narrowing of disc space
Reduction of the disc space is the earliest sign in the commoner, paradiscal type of tuberculosis
Skeletal TB:
- Earliest symptom of spinal TB: Back pain
- Earliest sign in Pott’s disease: Narrowing of disc space
- MC vertebrae to be involved in TB spine: T9-T12
- TB spine starts in: Vertebral body (paradiscal)
- Spina ventosa: TB dactylitis
All of the following are radiological features of tuberculosis of spine except:
| A |
Large paravertebral abscess |
|
| B |
Marked osteoblastic response |
|
| C |
Marked collapse of vertebra |
|
| D |
Deceased joint space |
All of the following are radiological features of tuberculosis of spine except:
| A |
Large paravertebral abscess |
|
| B |
Marked osteoblastic response |
|
| C |
Marked collapse of vertebra |
|
| D |
Deceased joint space |
Ans. Marked osteoblastic response
Note a feature of TB spine‑
| A |
Back pain earliest symptom |
|
| B |
Stiffness of back |
|
| C |
Exagrated lumbar lordosis |
|
| D |
All |
Note a feature of TB spine‑
| A |
Back pain earliest symptom |
|
| B |
Stiffness of back |
|
| C |
Exagrated lumbar lordosis |
|
| D |
All |
Ans. is `c’ i.e., Exagrated lumbar lordosis
Clinical features of TB of spine
- The disease is commonest in young adults.
- The presenting complains are : –
- Back pain : Commonest and earliest symptom. Initially pain occurs on sudden movement of spine.
- Stiffness of back : Is also an early symptom and occur along with pain.
- Visible deformity : Gibbus or Kyphosis
- Localized swelling : Due to cold abscess
- Paraplagia : In neglected cases
- Constitutional symptoms : Evening fever, loss of appetite, night sweat, loss of weight.
- On examination, following findings may be seen : –
- Decreased range of motion.
- Local tenderness : Over the spinous process of affected vertebra.
- Deformity : –
- Cervical spine : – Straight neck with loss of cervical lordosis.
- Thoracic : – Gibbus/kyphosis
- Lumbar : – Loss of lumbar lordosis
- Para-vertebral swelling : – Cold abscess
Caesarean Section
A 37-year old second gravid, previous LSCS at 37 wks of pregnancy presents with blood pressure of 150/100, urine albumin++. On pelvic examination
cervix is found to be soft with 50% effacement, station is – 3, pelvis adequate and cervical os is closed. Most appropriate step at the moment would be
| A |
Antihypertensive regime and then induce labour |
|
| B |
Wait and watch for 10 days |
|
| C |
Induce labour spontaneously |
|
| D |
Do caesarean section |
A 37-year old second gravid, previous LSCS at 37 wks of pregnancy presents with blood pressure of 150/100, urine albumin++. On pelvic examination
cervix is found to be soft with 50% effacement, station is – 3, pelvis adequate and cervical os is closed. Most appropriate step at the moment would be
| A |
Antihypertensive regime and then induce labour |
|
| B |
Wait and watch for 10 days |
|
| C |
Induce labour spontaneously |
|
| D |
Do caesarean section |
Do cesarean section [Ref- Dutta 7/e p. 227-232, COGDT 10/e p. 32-25; Williams Ohs 23/e p. 729]
- This is case of preeclampsia at 37 weeks.
- For management purpose preeclampsia is divided into two categories i.e., mild preeclampsia and severe preeclampsia.
- Severe and mild preeclampsia are managed differently.
- But this categorization does not matter in this case because of the gestational age of the patient.
– “The gestational age of the patient is 37 weeks and any case of preeclampsia 37 weeks gestational age is delivered immediately irrespective of the severity of the preeclampsia”.
- The main concern here is the mode of delivery
-The patient presents with unfavourable cervix and a history of previous LS.C.S.
– The best mode of delivery in such a patient with mild preeclampsia is performing an L.S.C.S.
Indications for caesarean section in pregnancy are all except ‑
| A |
Eisenmenger syndrome |
|
| B |
Aortic stenosis |
|
| C |
M.R. |
|
| D |
Aortic regurgitaion |
Indications for caesarean section in pregnancy are all except ‑
| A |
Eisenmenger syndrome |
|
| B |
Aortic stenosis |
|
| C |
M.R. |
|
| D |
Aortic regurgitaion |
Eisenmenger syndrome Eisenmenger’s syndrome
- Maternal mortality rate in Eisenmenger’s syndrome is 30-40%
– Because of high maternal mortality rate patient should he counselled to avoid pregnancy and if pregnant consider termination of pregnancy.
– Because of high maternal mortality rate abortion is the t/t of choice.
If any pregnancy continues upto term in Eisenmenger’s syndrome, there is no evidence to support the choice of either vaginal or cesarean delivery.
- Maternal mortality rate with normal delivery is 34% and with cesarean section is 75%.
Mitral regurgitation
- Mitral regurgitation is usually tolerated well during pregnancy. The marked decrease in systemic vascular resistance that occurs during pregnancy alleviates the abnormal physiologic stress imposed by this lesion. Rarely, reactive pulmonary hypertension and severe right heart failure may ensue.
- There are no specific recommendations for the management of mitral regurgitation during labour and delivery. Prior to labour, symptoms may be managed with diuretics and vasodilators. During labour, regional anaesthesia is usually well tolerated. However, in complicated NYHA class 3-4 cases, cesarean section and general anaesthesia may be required.
Aortic stenosis
- In general the symptoms of aortic stenosis are masked by progressive left ventricular hypertrophy and are thus easily missed. Overall, patients who were asymptomatic prior to pregnancy usually tolerate pregnancy relatively uneventfully.
- Echocardiographic determination of valve area is the best guide to severity of aortic stenosis. The hyperdynamic circulation of pregnancy frequently leads to overestimation of the degree of stenosis.
- These patients tolerate tachycardia, hypovolaemia and systemic vasodilatation poorly, since coronary perfusion is critically dependent upon maintaining aortic diastolic pressure. General anaesthesia and caesarean section, with the aid of invasive haemodynamic monitoring, appears to be the safest means of successful delivery.
Aggressive maintenance of systemic blood pressure with vasopressors (e.g. phenylephrine), is paramount to the avoidance of severe hypotension, acute left ventricular failure and cardiac arrest.
- Spinal anaesthesia is generally contraindicated in these patients. There are reports of the successful management of vaginal delivery under carefully introduced and limited epidural analgesia, but this should be restricted to very experienced hands.
Aortic regurgitation
- Aortic regurgitation also reduces both cardiac output and coronary blood flow. Like M.R. it is well tolerated in pregnancy. The preferred mode of delivery in A.R. vaginal delivery unless obstetrical indications for cesarean exist. The crux is
i) Both Aortic regurgitation and mitral regurgitation are well tolerated during pregnancy. Vaginal delivery is the preferred mode of termination of pregnancy unless there are obstetrical indications for cesarean section.
ii) Aortic stenosis carries more risk than the above two disorders and the preferred mode of delivery is cesarean section.
iii) Eisenmenger syndrome carries great risk in pregnancy. The maternal mortality reaches 50%. So, ideally pregnancy should be terminated in patients with Eisenmenger syndrome.
We are not sure, if we have got the correct question.
A patient undergoing caesarean section following prolonged labour under subarachnoid block developed carpopedal spasm. Lignocain was used as anesthetic agent. The most likely diagnosis is:
| A |
Amniotic fluid embolism |
|
| B |
Lignocaine toxicity |
|
| C |
Hypocalcemia |
|
| D |
Hypokalemia |
A patient undergoing caesarean section following prolonged labour under subarachnoid block developed carpopedal spasm. Lignocain was used as anesthetic agent. The most likely diagnosis is:
| A |
Amniotic fluid embolism |
|
| B |
Lignocaine toxicity |
|
| C |
Hypocalcemia |
|
| D |
Hypokalemia |
Pain due to prolonged labour may lead to hyperventilation and resultant respiratory alkalosis.
This will cause a decrease in the level of free ionized calcium in the ECF,
resulting in hypocalcemia and precipitating carpopedal spasm.
Ref: Primer on The Metabolic Bone Diseases and Disorders of Mineral Metabolism Edited By Clifford J. Rosen, 7th Edition, Page 354 ; Nutrition Therapy and Pathophysiology By Marcia Nahikian Nelms, 2007, Page 196 ; Essentials of Medical Pharmacology By KD Tripathi, 5th Edition, Page 479
A Lower Segment Caesarean section (LSCS) can be carried out under all the following techniques of anaesthesia, EXCEPT:
| A |
General anaesthesia |
|
| B |
Spinal anaesthesia |
|
| C |
Caudal anaesthesia |
|
| D |
Combined Spinal Epidural anaesthesia |
A Lower Segment Caesarean section (LSCS) can be carried out under all the following techniques of anaesthesia, EXCEPT:
| A |
General anaesthesia |
|
| B |
Spinal anaesthesia |
|
| C |
Caudal anaesthesia |
|
| D |
Combined Spinal Epidural anaesthesia |
Caudal anaesthesia may be used for perenial operations.
It is not indicated in Lower segment caesarian section.
Further it is associated with potential risk of penetrating the fetal head in obstetric practice.
Ref:Textbook of Anaesthesia By Aitkinhead, 4th Edition, Pages 568, 641, 643
Absolute indication for caesarean section in pregnancy are all except?
| A |
Advanced Carcinoma Cervix |
|
| B |
Central Placenta Praevia |
|
| C |
Non reassuring FHR (Fetal distress) |
|
| D |
Contracted Pelvis |
Absolute indication for caesarean section in pregnancy are all except?
| A |
Advanced Carcinoma Cervix |
|
| B |
Central Placenta Praevia |
|
| C |
Non reassuring FHR (Fetal distress) |
|
| D |
Contracted Pelvis |
Non reassuring FHR is a Relative indication for C-section.
Which of the following is the contraindication for trial of normal labour after caesarean section?
| A |
History of previous classical CS |
|
| B |
History of previous CS due to CPD |
|
| C |
No history of prior vaginal delivery |
|
| D |
History of previous CS due to malpresentation |
Which of the following is the contraindication for trial of normal labour after caesarean section?
| A |
History of previous classical CS |
|
| B |
History of previous CS due to CPD |
|
| C |
No history of prior vaginal delivery |
|
| D |
History of previous CS due to malpresentation |
Prior classical or T-shaped uterine incisions are considered contraindications to labor.
The highest risks of uterine rupture are present with prior vertical incisions extending into the fundus such as the classical incision.
Women with a transverse scar confined to the lower uterine segment have the lowest risk of symptomatic scar separation during a subsequent pregnancy.
- One previous prior low-transverse cesarean delivery
- Clinically adequate pelvis
- No other uterine scars or previous rupture
- Physician immediately available throughout active labor capable of monitoring labor and performing an emergency cesarean delivery
- Availability of anesthesia and personnel for emergency cesarean delivery
A primigravida at 37 week of gestation reported to labour room with central placenta previa with heavy bleeding per vaginum. The fetal heart rate was normal at the time of examination. Which of the following is the best management option for her?
| A |
Caesarean section |
|
| B |
Expectant management |
|
| C |
Induction and vaginal delivery |
|
| D |
Induction and forceps delivery |
A primigravida at 37 week of gestation reported to labour room with central placenta previa with heavy bleeding per vaginum. The fetal heart rate was normal at the time of examination. Which of the following is the best management option for her?
| A |
Caesarean section |
|
| B |
Expectant management |
|
| C |
Induction and vaginal delivery |
|
| D |
Induction and forceps delivery |
- Severe degree placenta previa (type-II (marginal), type-III (incomplete or partial central), type-4 (central or total).
- Lesser degree of placenta previa where amniotomy fails to stop bleeding or fetal distress appears.
- Complicating factors associated with lesser degrees of placenta previa where vaginal delivery is unsafe.
Vaginal delivery usually is reserved for patients with a marginal implantation and a cephalic presentation. If vaginal delivery is elected, the membranes should be artificially ruptured prior to any attempt to stimulate labor (oxytocin given before amniotomy is likely will cause further bleeding).
Which of the following is an absolute indication for Caesarean section?
| A |
Placenta Previa |
|
| B |
CPD |
|
| C |
Previous Cesarean section |
|
| D |
Breech presentation |
Which of the following is an absolute indication for Caesarean section?
| A |
Placenta Previa |
|
| B |
CPD |
|
| C |
Previous Cesarean section |
|
| D |
Breech presentation |
Cephalopelvic disproportion is an absolute indication for Caesarean section. Other absolute indications includes central placenta praevia, pelvic mass causing obstruction (cervical or broad ligament fibroid), advanced cervical carcinoma and vaginal obstruction (as in atresia, stenosis).
- Previous caesarean delivery
- Non reassuring FHR
- Dystocia due to relatively large fetus, small pelvis or inefficient contractions
- Antepartum hemorrhage
- Malpresentation
- Failed surgical induction of labour, failure to progress in labour
- Bad obstetric history
- Hypertensive disorders
- Medical gynecological disorders
Which of the following is an indication of Caesarean section after a previous caesarean section?
| A |
Hypertension |
|
| B |
Type 1 placenta previa |
|
| C |
CPD |
|
| D |
Multigravida |
Which of the following is an indication of Caesarean section after a previous caesarean section?
| A |
Hypertension |
|
| B |
Type 1 placenta previa |
|
| C |
CPD |
|
| D |
Multigravida |
Indications of C section after a previous caesarean section includes: contracted pelvis, previous two casesarean sections, features of scar dehiscence and previous classical caesarean section.
In classical caesarean section more chances of rupture of uterus is in :
| A |
Upper uterine segment |
|
| B |
Lower uterine segment |
|
| C |
Utero cervical junction |
|
| D |
Posterior uterine segment |
In classical caesarean section more chances of rupture of uterus is in :
| A |
Upper uterine segment |
|
| B |
Lower uterine segment |
|
| C |
Utero cervical junction |
|
| D |
Posterior uterine segment |
Upper uterine segment
Best management in Mento-posterior presentation:
| A |
Vaginal delivery |
|
| B |
Forceps delivery |
|
| C |
Manual rotation |
|
| D |
Caesarean section |
Best management in Mento-posterior presentation:
| A |
Vaginal delivery |
|
| B |
Forceps delivery |
|
| C |
Manual rotation |
|
| D |
Caesarean section |
Caesarean section
Which of the following is an absolute indication for caesarean section in pregnancy associated with heart disease?
| A |
Pulmonary stenosis |
|
| B |
Coarctation of aorta |
|
| C |
Eisenmenger syndrome |
|
| D |
Ebstein’s anomaly |
Which of the following is an absolute indication for caesarean section in pregnancy associated with heart disease?
| A |
Pulmonary stenosis |
|
| B |
Coarctation of aorta |
|
| C |
Eisenmenger syndrome |
|
| D |
Ebstein’s anomaly |
Coarctation of aorta
True about transient tachypnoea of new born is ‑
| A |
Air bronchogram seen |
|
| B |
Common in preterm infants |
|
| C |
Interlobar fissure effusion |
|
| D |
Respiratory distress resolves in 6-10 days |
True about transient tachypnoea of new born is ‑
| A |
Air bronchogram seen |
|
| B |
Common in preterm infants |
|
| C |
Interlobar fissure effusion |
|
| D |
Respiratory distress resolves in 6-10 days |
Ans. is ‘c‘ i.e., Interlobar fissure effusion
A 26 year old third_gravida mother delivered a male baby weighing 4-2 kg at 37 weeks of gestation through an emergency caesarean section, for obstructed labour. The child developed respiratory distress one hour after birth. He was kept nil per orally (NPO) and given intravenous fluids. He maintained oxygen saturation on room air. No antibiotics were given. Chest radiograph revealed fluid in interlobar fissure. Respiratory distress settled by 24 hours of life. What is the most likely diagnosis ?
| A |
Transient tachypnea of the newborn |
|
| B |
Meconium aspiration syndrome |
|
| C |
Persistent fetal circulation |
|
| D |
Hyaline membrane disease |
A 26 year old third_gravida mother delivered a male baby weighing 4-2 kg at 37 weeks of gestation through an emergency caesarean section, for obstructed labour. The child developed respiratory distress one hour after birth. He was kept nil per orally (NPO) and given intravenous fluids. He maintained oxygen saturation on room air. No antibiotics were given. Chest radiograph revealed fluid in interlobar fissure. Respiratory distress settled by 24 hours of life. What is the most likely diagnosis ?
| A |
Transient tachypnea of the newborn |
|
| B |
Meconium aspiration syndrome |
|
| C |
Persistent fetal circulation |
|
| D |
Hyaline membrane disease |
Ans. is ‘a’ i.e., Transient tachypnea of newborn
o Respiratory distress, which resolves within 24 hours without any respiratory support and fluid in interlobar fissure on chest X-ray suggest the diagnosis of TTN.
A 21 year old lady with a history of hypersensitivity to neostigmine is posted for an elective caesarean section under general anesthesia. The best muscle relaxant of choice in this patient should be:
| A |
Pancuronium |
|
| B |
Atracurium |
|
| C |
Rocuronium |
|
| D |
Vecuronium |
A 21 year old lady with a history of hypersensitivity to neostigmine is posted for an elective caesarean section under general anesthesia. The best muscle relaxant of choice in this patient should be:
| A |
Pancuronium |
|
| B |
Atracurium |
|
| C |
Rocuronium |
|
| D |
Vecuronium |
B i.e. Atracurium
You might be thinking that this Q has never been asked, but think a while and try to understand that around which concept the Q is based. In other words, they are trying to ask that which muscle relaxant will not require reversal? I think now you need no explanation
– In pancuronium reversal is often required d/ t its longer duration of action
– Ve/Ro-curonium seldom require reversal unless repeated doses have been given
– In atracurium & cis-atracurium reversal is mostly not required due to its unique feature of spontaneous non eyzmatic degradation (Hoffmann elimination) Q.
A 30 year old woman with coarctation of aorta is admitted to the labour room for elective caesarean section. Which of the following is the anaesthesia technique of choice:
| A |
Spinal anaesthesia |
|
| B |
Epidural anaesthesia |
|
| C |
General anaesthesia |
|
| D |
Local anaesthesia with nerve block |
A 30 year old woman with coarctation of aorta is admitted to the labour room for elective caesarean section. Which of the following is the anaesthesia technique of choice:
| A |
Spinal anaesthesia |
|
| B |
Epidural anaesthesia |
|
| C |
General anaesthesia |
|
| D |
Local anaesthesia with nerve block |
C i.e. General anesthesia
In coarctation of aorta any decrease in cardiac output or cardiac return is deleterious to the fetus because the placental circulation is already comprised on account of coarctation. So any anesthetic procedure/drug which causes hypotension should be avoided.
Regional anaesthic procedure such as spinal anesthesia and epidural anesthesia should be avoidedQ in these patients because hypotension is the most common side effect of these procedure.
General anesthesia is technique of choiceQ for performing cesarian section in a patient with coarctation of aorta, as it has advantage of – rapid induction, better airway & ventilation and less hypotension.
A multigravida woman was posted for emergency caesarean section. Correct statements are all of the following except-
September 2006
| A |
Cricoid pressure is applied while intubating |
|
| B |
Isoflurane should not be used as it causes placental insufficiency |
|
| C |
CS is done to prevent fetal distress and meconiumm aspiration |
|
| D |
Cord clamping to be done after a few minutes |
A multigravida woman was posted for emergency caesarean section. Correct statements are all of the following except-
September 2006
| A |
Cricoid pressure is applied while intubating |
|
| B |
Isoflurane should not be used as it causes placental insufficiency |
|
| C |
CS is done to prevent fetal distress and meconiumm aspiration |
|
| D |
Cord clamping to be done after a few minutes |
Ans. B: Isoflurane should not be used as it causes placental insufficiency
General anaesthesia for CS:
It is given for fetal distress/if there is contraindication for spinal anaesthesia.
- Prophylaxis against aspiration should be taken.
- Intubation with Sellick’s manoeuvre (cricoid pressure)
- Give drugs in minimum doses
- Avoid premedication
- Induction by thiopentone in minimum doses
- All inhalational agent relax the uterus and cause post-partum hemorrhage in dose related manner.
- Isuflurane is the agent of choice as it maintains the cardiac output thus minimally compromising the fetal circulation.
Absolute indication for caesarean section is:
March 2013
| A |
Previous LSCS |
|
| B |
Type IV placenta previa |
|
| C |
Fetal distress |
|
| D |
Breech presentation |
Absolute indication for caesarean section is:
March 2013
| A |
Previous LSCS |
|
| B |
Type IV placenta previa |
|
| C |
Fetal distress |
|
| D |
Breech presentation |
Ans. B i.e. Type IV placenta previa
Caesarean section
Indications of classical caesarean section
- Previous classical cesarean section
- Neglected shoulder with anhydramnios
- Structural abnormality making approach to lower segment difficult
- Constriction ring due to neglected labor
- Fibroids in lower segment
- Anterior placenta accreta and praevia
- Very preterm fetus, where lower segment is poorly formed.
Ideal management of a 37 weeks pregnant elderly primigravida with placenta praevia and active bleeding:
September 2007
| A |
Labour induction |
|
| B |
Caesarean section |
|
| C |
Vaginal delivery |
|
| D |
Expectant treatment |
Ideal management of a 37 weeks pregnant elderly primigravida with placenta praevia and active bleeding:
September 2007
| A |
Labour induction |
|
| B |
Caesarean section |
|
| C |
Vaginal delivery |
|
| D |
Expectant treatment |
Ans. B: Caesarean Section
An initial assessment to determine the status of the mother and fetus is required.
It is now considered safe to treat placenta praevia on an outpatient basis if the fetus is at less than 30 weeks of gestation, and neither the mother nor the fetus are in distress.
Immediate delivery of the fetus may be indicated if the fetus is mature or if the fetus or mother are in distress. Blood volume replacement (to maintain blood pressure) and blood plasma replacement (to maintain fibrinogen levels) may be necessary.
In cases of fetal distress, associated complicating factors like malpresentation, elderly primigravidae, pregnancy with a previous caesarean section and contracted pelvis, a caesarean section is indicated.
Caesarean section is contraindicated in cases of disseminated intravascular coagulation.
Placenta praevia increases the risk of puerperal sepsis and postpartum haemorrhage because the lower segment to which the placenta was attached contracts less well post-delivery
Which of the following types of placenta complicates third stage of labour and is associated with a past history of caesarean section:
September 2011
| A |
Placenta succenturita |
|
| B |
Placenta extracholis |
|
| C |
Placenta membranecae |
|
| D |
Placenat accrete |
Which of the following types of placenta complicates third stage of labour and is associated with a past history of caesarean section:
September 2011
| A |
Placenta succenturita |
|
| B |
Placenta extracholis |
|
| C |
Placenta membranecae |
|
| D |
Placenat accrete |
Ans. D: Placenta accreta
Most important risk factors for placenta accreta are the placenta praevia and prior caesarean delivery It complicates 3rd stage of labour (haemorrhage, shock, infection and rarely inversion of the uterus) Other types of placenta:
- Biscoidal placenta: Placenta have 2 discs
- Lobed placenta: Placenta divided into lobes
- Placenta succenturita: Small part of placenta separated from the rest
- Febestrated: Placenta having a hole in centre
- Circumvallate: Edge of placenta is covered by circular fold of decidualis
Incidence of scar rupture in previous lower segment caesarean section:
March 2012
| A |
1% |
|
| B |
5% |
|
| C |
6% |
|
| D |
7% |
Incidence of scar rupture in previous lower segment caesarean section:
March 2012
| A |
1% |
|
| B |
5% |
|
| C |
6% |
|
| D |
7% |
Ans: A i.e. 1%
Incidence of scar rupture in lower segment CS is less (0.5-1.5%) whereas there is more risk of scar rupture in classical CS (4-9%).
Risk of rupture of uterus with previous classical caesarean section is:
March 2011
| A |
0.5-1.5% |
|
| B |
2-4% |
|
| C |
4-8% |
|
| D |
8-16% |
Risk of rupture of uterus with previous classical caesarean section is:
March 2011
| A |
0.5-1.5% |
|
| B |
2-4% |
|
| C |
4-8% |
|
| D |
8-16% |
Ans. C: 4-8%
Classical caesarean section carries more risk of scar rupture (4-8%) Scar rupture in lower segment CS is less (0.5-1.5%)
ENZYME INHIBTION
The presence of a noncompetitive inhibitor can be implicated in which of the outcome?
| A |
Leads to both an increase in the Vmax of a reaction and an increase in the Km |
|
| B |
Leads to a decrease in the observed Vmax |
|
| C |
Leads to a decrease in Km and Vmax |
|
| D |
Leads to an increase in Km without affecting Vmax |
The presence of a noncompetitive inhibitor can be implicated in which of the outcome?
| A |
Leads to both an increase in the Vmax of a reaction and an increase in the Km |
|
| B |
Leads to a decrease in the observed Vmax |
|
| C |
Leads to a decrease in Km and Vmax |
|
| D |
Leads to an increase in Km without affecting Vmax |
In the presence of a noncompetitive inhibitor, Vmax is decreased, whereas Km is unchanged. The steady-state concentration of ES is decreased.
A competitive inhibitor of an enzyme will?
| A |
Alter the Vmax of the reaction |
|
| B |
Bind to the same site as the substrate |
|
| C |
Decrease the apparent Km for the substrate |
|
| D |
Decrease the turnover number |
A competitive inhibitor of an enzyme will?
| A |
Alter the Vmax of the reaction |
|
| B |
Bind to the same site as the substrate |
|
| C |
Decrease the apparent Km for the substrate |
|
| D |
Decrease the turnover number |
Substances that reduce the activity of an enzyme are called inhibitors.
Reversible inhibitors bind to an enzyme but rapidly dissociate from it [in contrast to irreversible inhibitors , which bind tightly and dissociate very slowly from the enzyme].
There are several types of reversible inhibitors:
True about competitive inhibition of enzyme:
| A |
T Km |
|
| B |
Km |
|
| C |
T Vmax |
|
| D |
No change in Km and Vmax |
True about competitive inhibition of enzyme:
| A |
T Km |
|
| B |
Km |
|
| C |
T Vmax |
|
| D |
No change in Km and Vmax |
In noncompetitive antagonism, the true statement is:
| A |
Km value decrease; V max normal |
|
| B |
Km value decreased; V max decreased |
|
| C |
Km value normal; V max decreased |
|
| D |
Km value decreased; V max increased |
In noncompetitive antagonism, the true statement is:
| A |
Km value decrease; V max normal |
|
| B |
Km value decreased; V max decreased |
|
| C |
Km value normal; V max decreased |
|
| D |
Km value decreased; V max increased |
Non competitive inhibitor of carbonic anhydrase‑
| A |
Allopurinol |
|
| B |
Acetazolamide |
|
| C |
Bimatoprost |
|
| D |
Dipivefrine |
Non competitive inhibitor of carbonic anhydrase‑
| A |
Allopurinol |
|
| B |
Acetazolamide |
|
| C |
Bimatoprost |
|
| D |
Dipivefrine |
Ans. is ‘b’ i.e., Acetazolamide
o Acetazolamide is non-competitive , reversible inhibitor of carbonic anhydrase.
Which of the following is known as suicidal enzyme?
| A |
Lipoxygenase |
|
| B |
Cyclooxygenase |
|
| C |
Thromboxane synthatase |
|
| D |
5′ nucleotidase |
Which of the following is known as suicidal enzyme?
| A |
Lipoxygenase |
|
| B |
Cyclooxygenase |
|
| C |
Thromboxane synthatase |
|
| D |
5′ nucleotidase |
Suicidal enzyme is one, which undergoes self-destruction in order to terminate its own acitivity, e.g. Cyclooxygenase.
Suicidal Inhibition is conversion of a substrate by the enzyme into a metabolite, which is a potent inhibitor of the enzyme; example: Xanthine oxidase converts allopurinol to alloxanthine (oxypurinol), which is a more potent inhibitor of allopurinol.
Codons and genetic codes
A codon in the genetic code consists of:
| A |
One molecule of charged-tRNA |
|
| B |
A Shine-Dalgarno sequence |
|
| C |
Three consecutive nucleotides |
|
| D |
Two complementary base pairs |
A codon in the genetic code consists of:
| A |
One molecule of charged-tRNA |
|
| B |
A Shine-Dalgarno sequence |
|
| C |
Three consecutive nucleotides |
|
| D |
Two complementary base pairs |
A codon is a triplet sequence of bases. The tRNA molecule contains an anticodon.
The Shine-Dalgarno sequence is found in the 23S prokaryotic ribosomal RNA. A codon is on the same strand of DNA or mRNA.
Which of the following is the CORRECT explanation for ‘degeneracy of codon’?
| A |
More than one codon for a single amino acid |
|
| B |
More than one amino acid for a single codon |
|
| C |
No punctuation in codons |
|
| D |
Termination of protein synthesis |
Which of the following is the CORRECT explanation for ‘degeneracy of codon’?
| A |
More than one codon for a single amino acid |
|
| B |
More than one amino acid for a single codon |
|
| C |
No punctuation in codons |
|
| D |
Termination of protein synthesis |
Three of the 64 possible codons do not code for specific amino acids; these have been termed nonsense codons. These nonsense codons are utilized in the cell as termination signals; they specify where the polymerization of amino acids into a protein molecule is to stop. The remaining 61 codons code for the 20 naturally occurring amino acids. Thus, there is “degeneracy” in the genetic code—that is, multiple codons decode the same amino acid.
Amino acids not coded by triplet codon:
| A |
Lysine |
|
| B |
Hydroxyproline |
|
| C |
Selenocysteine |
|
| D |
Pyrrolysine |
Amino acids not coded by triplet codon:
| A |
Lysine |
|
| B |
Hydroxyproline |
|
| C |
Selenocysteine |
|
| D |
Pyrrolysine |
B i.e. Hydroxyproline
Stop codons are:
| A |
UAA |
|
| B |
UAG |
|
| C |
UGA |
|
| D |
All |
Stop codons are:
| A |
UAA |
|
| B |
UAG |
|
| C |
UGA |
|
| D |
All |
A, B, C i.e. UAA, UAG, UGA
If there are 4 nucleotides instead of 3 in codon, how many amino acids may be formed?
| A |
16 |
|
| B |
21 |
|
| C |
256 |
|
| D |
64 |
If there are 4 nucleotides instead of 3 in codon, how many amino acids may be formed?
| A |
16 |
|
| B |
21 |
|
| C |
256 |
|
| D |
64 |
C i.e. 256
Stop codon:
| A |
UAG |
|
| B |
UCA |
|
| C |
UAC |
|
| D |
AUG |
Stop codon:
| A |
UAG |
|
| B |
UCA |
|
| C |
UAC |
|
| D |
AUG |
A i.e. UAG
A codon consists of –
| A |
One molecule of amono acyl-t RNA |
|
| B |
Two complementary base pairs |
|
| C |
3 consecutive nucleotide units |
|
| D |
4 individual nucleotides |
A codon consists of –
| A |
One molecule of amono acyl-t RNA |
|
| B |
Two complementary base pairs |
|
| C |
3 consecutive nucleotide units |
|
| D |
4 individual nucleotides |
C i.e. 3 consecutive nucleotide units
Nonsense codons bring about-
| A |
Elongation of polypeptide chain |
|
| B |
Pre-translational modificastion of protein |
|
| C |
Initiation of protein synthesis |
|
| D |
Termination of protein synthesis |
Nonsense codons bring about-
| A |
Elongation of polypeptide chain |
|
| B |
Pre-translational modificastion of protein |
|
| C |
Initiation of protein synthesis |
|
| D |
Termination of protein synthesis |
D i.e. Termination of protein synthesis
Same aminoacid is coded by multiple codons d/t following :
| A |
Degeneracy |
|
| B |
Frame-shift mutation |
|
| C |
Transcription |
|
| D |
Mutation |
Same aminoacid is coded by multiple codons d/t following :
| A |
Degeneracy |
|
| B |
Frame-shift mutation |
|
| C |
Transcription |
|
| D |
Mutation |
A i.e. Degeneracy
The anticodon region is an important part of the
| A |
r-RNA |
|
| B |
m-RNa |
|
| C |
t-RNa |
|
| D |
hn-RNa |
The anticodon region is an important part of the
| A |
r-RNA |
|
| B |
m-RNa |
|
| C |
t-RNa |
|
| D |
hn-RNa |
C i.e. t – RNA
In transcription anticodon is seen in ‑
| A |
t-RNA |
|
| B |
m-RNA |
|
| C |
r-RNA |
|
| D |
None |
In transcription anticodon is seen in ‑
| A |
t-RNA |
|
| B |
m-RNA |
|
| C |
r-RNA |
|
| D |
None |
A i.e. t – RNA
Amber codon refers to
| A |
Mutant codon |
|
| B |
Stop codon |
|
| C |
Initiating codon |
|
| D |
Codon for more than one amino acids |
Amber codon refers to
| A |
Mutant codon |
|
| B |
Stop codon |
|
| C |
Initiating codon |
|
| D |
Codon for more than one amino acids |
B i.e Stop Codon
A mutation in the codon which causes a change in the coded amino acid, is known as:
| A |
Mitogenesis |
|
| B |
Somatic mutation |
|
| C |
Missense mutation |
|
| D |
Recombination |
A mutation in the codon which causes a change in the coded amino acid, is known as:
| A |
Mitogenesis |
|
| B |
Somatic mutation |
|
| C |
Missense mutation |
|
| D |
Recombination |
C i.e. Missense mutation
A codon codes for a single amino acid. This characteristic is called ‑
| A |
Non-overlapping |
|
| B |
Unambiguous |
|
| C |
Non-punctate |
|
| D |
Degeneracy |
A codon codes for a single amino acid. This characteristic is called ‑
| A |
Non-overlapping |
|
| B |
Unambiguous |
|
| C |
Non-punctate |
|
| D |
Degeneracy |
Ans. is ‘b’ i.e., Unambiguous
Characteristics of genetic codes
Genetic codes have following characteristics ‑
1) Universal :- Each codon specifically codes for same amino acid in all species, e.g. UCA codes for serine and CCA codes for proline in all organisms. That means specificity of codon has been conserved from very early stages of evolution. Exception to the universality of genetic coder are found in human mitochondria, where the code :-
α UGA codes for tryptophan instead of serving as a stop codon.
AUA codes for methionine instead of isoleucine.
CUA codes for threonine instead of leucine.
LI AGA and AGG serve as stop codon instead of coding for arginine.
2) Unambiguous/Specific :- A particular codon always codes for the same amino acid. For example CCU always codes for proline and UGG always codes for tryptophan.
3) Degeneracy/Redundancy :- A given amino acid may have more than one codon. For example, CCU, CCC, CCA and CCG all four codons code for proline. Therefore, there are 61 codons for 20 amino acids.
4) Stop or termination or nonsense codons:- Three of the 64 possible nucleotide triplets UAA (amber), UAG (Ochre) and UGA (opal) do not code for any amino acid. They are called nonsense codons that normally signal termination of polypeptide chains. Thus, though there are 64 possible triplet codons, only 61 codes for 20 amino acids (as remaining three are non-sense codons).
5) Non overlapping and nonpuntate (Comma less) :- During translation, the code is read sequentially, without spacer bases, from a fixed starting point, as a continuous sequence of bases, taken 3 at a time, e.g. AUGCUA GACUUU is read as AUG/CUA/GAC/UUU without “ponctation” (coma) between codons.
Multiple codons code for same amino acid ‑
| A |
Ambiguity |
|
| B |
Wobble phenomenon |
|
| C |
Degeneracy |
|
| D |
Mutation |
Multiple codons code for same amino acid ‑
| A |
Ambiguity |
|
| B |
Wobble phenomenon |
|
| C |
Degeneracy |
|
| D |
Mutation |
RNA which contains codon for speicific amino acid ‑
| A |
tRNA |
|
| B |
rRNA |
|
| C |
mRNA |
|
| D |
None |
RNA which contains codon for speicific amino acid ‑
| A |
tRNA |
|
| B |
rRNA |
|
| C |
mRNA |
|
| D |
None |
Ans. is ‘c’ i.e., m RNA
The m RNA carries genetic information in the form of codons.
- Codons are a group of three adjacent nucleotides that code for the amino acids of protein.
- Each mRNA molecule is a transcript of antisense or template strand of a particular gene.
- Its nucleotide sequence is complementary to that of antisense or template strand of the gene, i.e. adenine for thyamine, guanine for cytosine, uracil for adenine (as RNA does not contain thymine) and cytosine for guanine.
- For example, if antisense strand of DNA has a gene with sequence 5′-TTACGTAC-3′, its complementary RNA transcript will be 5 ‘-GUACGUAA-3’.
Total mubers of codons are ‑
| A |
60 |
|
| B |
61 |
|
| C |
62 |
|
| D |
64 |
Total mubers of codons are ‑
| A |
60 |
|
| B |
61 |
|
| C |
62 |
|
| D |
64 |
Ans. is ‘d’ i.e., 64
- The information needed to direct the synthesis of protein is contained in the mRNA in the form of a genetic code, which inturn is transcribed from template strand of DNA and is therefore complementary to it.
- The genetic code is the system of nucleotide sequences of mRNA that determines the sequence of amino acids in protein.
- Codon is a sequence of three adjacent bases that corresponds to one amino acid.
- There are 64 possible codom sequences.
- Because four nucleotide bases A,G, C and U are used to produce the three base codons, there are therefore 64(43) possible codon sequences.
Which is non-sense codon –
| A |
UGG |
|
| B |
AUG |
|
| C |
UGA |
|
| D |
CCA |
Which is non-sense codon –
| A |
UGG |
|
| B |
AUG |
|
| C |
UGA |
|
| D |
CCA |
Ans. is ‘c’ i.e., UGA
Stop codons or nonsense codons or termination codons
- Three of the 64 possible nucleotide triplets UAA (amber), UAG (Ochre) and UGA (opal) do not code for any amino acid.
- They are called nonsense codons that normally signal termination of polypeptide chains.
- Thus, though there are 64 possible triplet codons, only 61 codes for 20 amino acids (as remaining three are nonsense codons).
Phopholipids
| A | Phosphatidylethanolamine | |
| B | Cardiolipin | |
| C | Phosphatidylcholine | |
| D | Sphingomyelin |
| A | Phosphatidylethanolamine | |
| B | Cardiolipin | |
| C | Phosphatidylcholine | |
| D | Sphingomyelin |
Sphingomyelin = phosphorylcholine + ceramide
Ceramide = fatty acid + sphingosine
Sphingosine = condensing palmitic acid with a decarboxylated serine and then reducing the product
Glycerol never is involved in the structure of sphingomyelin. Phosphatidylethanolamine, cardiolipin, phosphatidylcholine, and phosphatidylinositol are synthesized using phosphatidic acid as the basic building block Phosphatic acid is diacylglycerol with a phosphate ester on carbon three; therefore, glycerol is the backbone of all of these compounds. FAQ Sphingomyelin :-
– Membranous myelin sheath that surrounds nerve cell axons.
– It is the only sphingolipid NOT derived from Glycerol.
– Associated with increased accumulation in Niemann-Pick Disease.
Function of phospholipid in cell membrance is:
| A |
Cell to cell variation |
|
| B |
Transduction of Signals |
|
| C |
Transmembrane preparation of protein |
|
| D |
DNA replication |
Function of phospholipid in cell membrance is:
| A |
Cell to cell variation |
|
| B |
Transduction of Signals |
|
| C |
Transmembrane preparation of protein |
|
| D |
DNA replication |
B i.e. Transduction of signals
Which of the following phospholipid has antigenic acitivity ‑
| A |
Plasmalogen |
|
| B |
Cardiolipin |
|
| C |
Phosphatidylcholine |
|
| D |
Sphingomyelin |
Which of the following phospholipid has antigenic acitivity ‑
| A |
Plasmalogen |
|
| B |
Cardiolipin |
|
| C |
Phosphatidylcholine |
|
| D |
Sphingomyelin |
Ans. is ‘b i.e., Cardiolipin
- Cardiolipin is the only human glycerophospholipid that possess antigenic properties”
- Cardiolipin is the major lipid of inner mitochondrial membrane.
Which of the following is not a phospholipid ‑
| A |
Lecithine |
|
| B |
Plasmalogen |
|
| C |
Cardiolipin |
|
| D |
Ganglioside |
Which of the following is not a phospholipid ‑
| A |
Lecithine |
|
| B |
Plasmalogen |
|
| C |
Cardiolipin |
|
| D |
Ganglioside |
Ans. is ‘d’ i.e., Ganglioside
Phospholipids are :
- Glycerophospholipids (glycerol containing) :- Phosphatidylcholine (lecithin), phosphatidylethanolamine (cephaline), phosphatidylserine, phosphatidylinositol, plasmalogens, lysophospholipids, cardiolipin.
- Sphingophospholipids (sphingosine containing) :- Sphingomyeline
Severe combined immunodeficiency
SCID which is true –
| A |
Adenosine deaminase deficiency |
|
| B |
Decreased circulating lymphocytes |
|
| C |
NADPH oxidase deficiency |
|
| D |
CI esterase dificiency |
SCID which is true –
| A |
Adenosine deaminase deficiency |
|
| B |
Decreased circulating lymphocytes |
|
| C |
NADPH oxidase deficiency |
|
| D |
CI esterase dificiency |
Ans. is ‘a’ i.e., Adenosine deaminase deficiency
Which of the following about SCID is false ‑
| A |
Failure of descent of thymus |
|
| B |
Peyer’s patches are present and normal |
|
| C |
X-linked type is the most common |
|
| D |
Gene therapy can be used |
Which of the following about SCID is false ‑
| A |
Failure of descent of thymus |
|
| B |
Peyer’s patches are present and normal |
|
| C |
X-linked type is the most common |
|
| D |
Gene therapy can be used |
Ans. is ‘b’ i.e., Peyer’s patches are present and normal
LESCH-NYHAN SYNDROME
Lesch Nyhan syndrome is associated with deficiency of?
| A |
HPRT(partial) |
|
| B |
HPRT(total) |
|
| C |
PRPP(partial) |
|
| D |
PRPP(total) |
Lesch Nyhan syndrome is associated with deficiency of?
| A |
HPRT(partial) |
|
| B |
HPRT(total) |
|
| C |
PRPP(partial) |
|
| D |
PRPP(total) |
A complete deficiency of HPRT, the Lesch-Nyhan syndrome, is characterized by hyperuricemia, self-mutilative behavior, choreoathetosis, spasticity, and mental retardation. A partial deficiency of HPRT, the Kelley-Seegmiller syndrome, is associated with hyperuricemia but no central nervous system manifestations. In both disorders, the hyperuricemia results from urate overproduction and can cause uric acid crystalluria, nephrolithiasis, obstructive uropathy, and gouty arthritis. Early diagnosis and appropriate therapy with allopurinol can prevent or eliminate all the problems attributable to hyperuricemia but have no effect on the behavioral or neurologic abnormalities.
Ref: Burns C.M., Wortmann R.L. (2012). Chapter 359. Disorders of Purine and Pyrimidine Metabolism. In D.L. Longo, A.S. Fauci, D.L. Kasper, S.L. Hauser, J.L. Jameson, J. Loscalzo (Eds), Harrison’s Principles of Internal Medicine, 18e.
Lesch Nyhan syndrome is due to deficiency of:
| A |
Hypoxanthine phosphoribosyl transferase |
|
| B |
Xanthine oxidase |
|
| C |
Purine phosphorylase |
|
| D |
Adenosine deaminase |
Lesch Nyhan syndrome is due to deficiency of:
| A |
Hypoxanthine phosphoribosyl transferase |
|
| B |
Xanthine oxidase |
|
| C |
Purine phosphorylase |
|
| D |
Adenosine deaminase |
A i.e. Hypoxanthine phosphoribosyl transferase
Metabolism of triacylglycerides
In the liver cells, triglycerides are formed primarily in the following organelle:
| A |
Rough endoplasmic reticulum |
|
| B |
Smooth endoplasmic reticulum |
|
| C |
Golgi apparatus |
|
| D |
Ribosomes |
In the liver cells, triglycerides are formed primarily in the following organelle:
| A |
Rough endoplasmic reticulum |
|
| B |
Smooth endoplasmic reticulum |
|
| C |
Golgi apparatus |
|
| D |
Ribosomes |
Synthesis of triacylglycerols mainly takes place on the smooth endoplasmic reticulum of the liver but can also be generated in adipose cells.
A 32-year-old woman who has been on oral contraceptive pills for 5 years, developed symptoms of depression, irritability, nervousness and mental confusion. Her hemoglobin level was 8g/dl. Biochemical investigations revealed that she was excreting highly elevated concentrations of xanthurenic acid in urine. She also showed high levels of triglycerides and cholesterol in serum. All of the above are most probably related to a vitamin B6 deficiency caused by prolonged oral contraceptive use except:
| A |
Increased urinary xanthurenic acid excretion |
|
| B |
Neurological symptoms by decreased synthesis of biogenic amines |
|
| C |
Decreased hemoglobin level |
|
| D |
Increased triglyceride and cholesterol levels |
A 32-year-old woman who has been on oral contraceptive pills for 5 years, developed symptoms of depression, irritability, nervousness and mental confusion. Her hemoglobin level was 8g/dl. Biochemical investigations revealed that she was excreting highly elevated concentrations of xanthurenic acid in urine. She also showed high levels of triglycerides and cholesterol in serum. All of the above are most probably related to a vitamin B6 deficiency caused by prolonged oral contraceptive use except:
| A |
Increased urinary xanthurenic acid excretion |
|
| B |
Neurological symptoms by decreased synthesis of biogenic amines |
|
| C |
Decreased hemoglobin level |
|
| D |
Increased triglyceride and cholesterol levels |
Pyridoxal phosphate is a coenzyme involved in the metabolism of protein, carbohydrates and fat. In protein metabolism, Vit B6 participates in the decarboxylation of amino acids and the conversion of tryptophan to niacin or serotonin.
Ref: Harper’s Biochemistry Pages 258, 491 ; Textbook of Therapeutics: Drug and Disease Management By Richard A. Helms, David J. Quan, 2006, Page 737 ; Psychology and Schizophrenia By Janet E. Pletson, 2007, Page 110
Not true about eukaryotic gene:
| A |
Polycistronic mRNA |
|
| B |
Noncoding intron |
|
| C |
Contain nuclear gene & pseudogene |
|
| D |
Modification of mRNA before transportation from nucleus |
Not true about eukaryotic gene:
| A |
Polycistronic mRNA |
|
| B |
Noncoding intron |
|
| C |
Contain nuclear gene & pseudogene |
|
| D |
Modification of mRNA before transportation from nucleus |
A i.e. Polycistronic mRNA
Triglycerides synthesis is increased by:
| A |
Growth hormone |
|
| B |
Insulin |
|
| C |
Cortisol |
|
| D |
Glucagons |
Triglycerides synthesis is increased by:
| A |
Growth hormone |
|
| B |
Insulin |
|
| C |
Cortisol |
|
| D |
Glucagons |
Where is the triglycerides stored in the human body?
| A |
Nerve cells |
|
| B |
Adipose tissues |
|
| C |
Both |
|
| D |
None |
Where is the triglycerides stored in the human body?
| A |
Nerve cells |
|
| B |
Adipose tissues |
|
| C |
Both |
|
| D |
None |
Triglycerides are stored in adipose tissues.
