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*Lipopolysacharides(Bacteria)
LPS bind to "Toll-like receptor"(TLR) (a single Transmembrane
receptor)------> activation of Inhibitory kappa B kinase (IKB
kinase)------->
Note: NF-kB is a transcription Factor that exist in cytoplasm bound to
Inhibitory kappa B (IKB) protein in Inactive form [NF-kB=IKB]
so continuing the above sequence ..
LPS----> TLR---->+IKB kinase----->phosphorylation of IKB of the
complex[NF-kB=IKB] and now this phosphorylated IKB get degraded
and NF-kB is released----->NF-kB move to Nucleus where it upregulate
gene expression of TNF------>Sepsis

The Eustachian tube (or auditory tube or pharyngotympanic tube)

is a tube that links the pharynx to the middle ear.
Normally, the Eustachian tube is closed, which helps prevent the
inadvertent contamination of the middle ear space by the normal
secretions found in the back of the nose.
A dysfunctional Eustachian tube that is always open is called a
"patulous" Eustachian tube. Patients with this rare condition are
plagued by chronic ear infections. A much more common problem
is a failure of the Eustachian tube to effectively regulate air
pressure. Partial or complete blockage of the Eustachian tube can
cause sensations of popping, clicking, and ear fullness and
occasionally moderate to severe ear pain. Young children may
describe the popping sensation as "a tickle in my ear.

Methylparaben
A derivative of PABA {paraaminobenzoic acid)

CCl4--->centrilobular necrosis, fatty chance in liver

the vaccin is produced by recombinant DNA

technology,the gene coding for the HBsag
inserted into yeast cells,which then release this
molecule into the culture medium.the molecule
is then purefied and used as the immunogen in
the vaccin.
HPV is also produced by recombinant DNA

Q19.B
Prevalance=incidence*disease duration

The most common sources of embolism are proximal leg deep venous thrombosis
(DVTs) or pelvic vein thromboses. Any risk factor for DVT also increases the risk that
the venous clot will dislodge and migrate to the lung circulation, which happens in
up to 15% of all DVTs. The conditions are generally regarded as a continuum termed
venous thromboembolism (VTE).
The development of thrombosis is classically due to a group of causes named
Virchow's triad (alterations in blood flow, factors in the vessel wall and factors
affecting the properties of the blood). Often, more than one risk factor is present.
Alterations in blood flow: immobilization (after surgery, injury or long-distance air
travel), pregnancy (also procoagulant), obesity (also procoagulant), cancer (also
procoagulant)
Factors in the vessel wall: of limited direct relevance in VTE
Factors affecting the properties of the blood (procoagulant state):
Estrogen-containing hormonal contraception
Genetic thrombophilia (factor V Leiden, prothrombin mutation G20210A, protein C
deficiency, protein S deficiency, antithrombin deficiency, hyperhomocysteinemia and
plasminogen/fibrinolysis disorders)
Acquired thrombophilia (antiphospholipid syndrome, nephrotic syndrome,
paroxysmal nocturnal hemoglobinuria)
Cancer (due to secretion of pro-coagulants)
The main indication for thrombolysis is in submassive PE where right ventricular
dysfunction can be demonstrated on echocardiography, and the presence of visible
thrombus in the atrium.

In the natural aging process, aortic stenosis often

increases afterload because the left ventricle must
overcome the pressure gradient caused by the
calcified and stenotic aortic valve in addition to the
blood pressure in order to eject blood into the aorta

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control study measures with Odds ratio........a/b/c/d=ad/bc

External Oblique
The external obliques are also a superficial muscle
that is found just laterally to the rectus abdominus.
They originate from the external surfaces of the
lower 8 ribs, and insert into the anterior half of the
outer lip of the iliac crest and the aponeurosis of
the anterior abdominal wall.
Its function includes flexing the trunk (in bilateral
contraction), posterior pelvic tilt, same side flexion,
and rotation of the trunk to the opposite side
(during unilateral contraction). The external
obliques are the largest of the abdominal muscles.

Patient has myxoma- most common cardiac tumor in

adults
- 90% of them occur in atrium(especially left one)
Myxoma
a neoplasm composed of stellate to plump
cytologically bland mesenchymal cells set in a
myxoid stroma.
cytologically bland mesenchymal cells, so-called
myxoma or lepidic cells .
Myxoma cells are frequently stellate with
eosinophilic cytoplasm and indistinct cell borders.
Their ovoid nuclei are typically pale with open
chromatin. Nucleoli may be prominent.

Renal infarct produces gross hematuria...

U can see peripheral wedge shaped infarct in the
pic...
That caused her hematuria
Renal infarct is becoz of some embolus...
embolus later lodged in her brain and became
cause of her death.

case fatality rate=fatal case/total

number of people with disease

Primary care physicians frequently encounter children

with heart murmurs.1 Most of these young patients do
not have heart disease.
Echocardiography is not always needed to diagnose
pediatric murmurs. direct referral for echocardiography
was an expensive way to evaluate children with heart
murmurs. Pediatric cardiology consultation was
significantly less costly in that many innocent murmurs
were diagnosed without echocardiography.

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100% SPECIFICITY...E
100% SENSITIVITY...C
MOST ACCURATE......D

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fluenza chocolate agar with factor V [NAD] and X [hematin]

Rabis....enveloped RNA SSDynein, a motor protein responsible for

retrograde axonal transport, carries vesicles
and other cellular products toward the cell
bodies of neurons.

Pelvic inflammatory disease (PID) refers to

infection of the uterus (womb), fallopian tubes
(tubes that carry eggs from the ovaries to the
uterus) and other reproductive organs that causes
symptoms such as lower abdominal pain. It is a
serious complication of some sexually transmitted
diseases (STDs), especially chlamydia and
gonorrhea. PID can damage the fallopian tubes and
tissues in and near the uterus and ovaries. PID can
lead to serious consequences including infertility,
ectopic pregnancy (a pregnancy in the fallopian
tube or elsewhere outside of the womb), abscess
formation, and chronic pelvic pain

Probenecid is a uricosuric drug that increases uric

acid excretion in the urine. It is primarily used in
treating gout and hyperuricemia.
Mechanism
In the kidneys probenecid is filtered at the
glomerulus, secreted in the proximal tubule and
reabsorbed in the distal tubule.
Probenecid works by interfering with the kidney's
organic anion transporter (OAT), which reclaims
uric acid from the urine and returns it to the
plasma[5]. If probenecid (an organic acid) is
present, the OAT binds preferentially to it (instead
of to uric acid), preventing re-absorption of the uric
acid. Hence, the urine retains more uric acid,

Horseshoe kidney, also known as renal fusion, is a congenital

disorder affecting about 1 in 400 people
In patients with this condition, the central portion of the kidney
may be found just inferior to the inferior mesenteric artery
because the normal embryologic ascent of the kidneys is
arrested by its presence in people with central fusion of the
kidneys.
most cases of horseshoe kidneys are asymptomatic and
discovered upon autopsy

Rheumatic fever is an inflammatory disease that occurs

following a Group A streptococcal infection, (such as strep
throat or scarlet fever). Believed to be caused by antibody
cross-reactivity that can involve the heart, joints, skin, and
brain, the illness typically develops two to three weeks after a
streptococcal infection.
Acute rheumatic fever commonly appears in children between
the ages of 5 and 17, with only 20% of first-time attacks
occurring in adults.
Aschoff bodies are nodules found in the hearts of individuals
with rheumatic fever.Aschoff bodies are areas of inflammation
of the connective tissue of the heart, or focal interstitial
inflammation.

In various situations such as infection, insulin

demands rise but are not matched by the failing
pancreas. Blood sugars rise, dehydration ensues,
and resistance to the normal effects of insulin
increases further by way of a vicious circle.(A
virtuous circle or a vicious circle is a complex of
events that reinforces itself through a feedback
loop)

Cyclosporine is a polypeptide of 11 amino acids of fungal origin and is active

against helper T cells, preventing the production of IL-2 via calcineurin
inhibition (binds to cyclophilin protein). This agent is used for induction and
maintenance immunosuppression.
Adverse effects include nephrotoxicity with 3 stages:
(1) immediate, secondary to renal ischemia;
(2) 2-3 weeks after transplantation, secondary to renal vasoconstriction; and
(3) chronic, secondary to interstitial nephritis.
Other adverse effects include hyperkalemia, hypomagnesemia, nausea,
vomiting, diarrhea, hypertrichosis, hirsutism, gingival hyperplasia,
hyperlipidemia, glucose intolerance, infection, malignancy, and hyperuricemia.
Hypertrichosis and hirsutism can be alleviated by switching from cyclosporine
to tacrolimus, provided the patient is carefully monitored. Multiple drug
interactions are possible, primarily with agents affecting the cytochrome P-450
system

serotonine syndrome with cheese and MAO inhibitors,

Serotonin syndrome most often occurs when two drugs that affect the
body's level of serotonin are taken together at the same time. The
drugs cause too much serotonin to be released or to remain in the
brain area.
few eg-[other than stem]
you can develop this syndrome if you take migraine medicines called
triptans together with antidepressants called selective serotonin
reuptake inhibitors (SSRIs) and selective serotonin/norepinephrine
reuptake inhibitors (SSNRIs)
).
Older antidepressants called monoamine oxidase inhibitors (MAOIs)
can also cause serotonin syndrome , as well as meperidine (Demerol,
a painkiller) or dextromethorphan (cough medicine)
Drugs of abuse, such as ecstasy and LSD have also been associated
with serotonin syndrome

lead poisoning
lead inhibits delta aminolevulenic acid and
ferrochelatase leading to microcytic anemia

The most common foregut cysts, the

bronchogenic cyst and the esophageal
duplication representing abnormal budding of
the vertebral and dorsal primitive foregut,
respectively, indicating their common origin from
the primitive foregut and close embryologic
relationship