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Answer2730. #EXPLANATION The patient's symptoms and behavior suggest a condition where the patient's belief in having a physical condition (in this case, a tumor in the brain) is not supported by any objective evidence. This condition is known as Hypochondriasis. #Highyield ⦁ Hypochondriasis is a psychological disorder characterized by a preoccupation with having a serious illness, despite the absence of any physical symptoms or medical evidence to support the belief. ⦁ Hypochondriasis may occur in an individual who had a childhood illness or had a sibling with a childhood illness. ⦁ May be related to another psychiatric disorder, such as anxiety or obsessive compulsive disorder. Symptoms: ⦁ Persistent belief in having a serious illness. ⦁ No physical symptoms or medical evidence to support the belief. ⦁ The belief is not related to the effects of a substance or another mental disorder. Diagnosis: ⦁ The diagnosis is based on the patient's insistence on having a serious illness despite the absence of any physical symptoms or medical evidence. ⦁ The condition is not related to the effects of a substance or another mental disorder. Other Options: ⦁ Option B. Somatization: A disorder where physical symptoms are believed to be caused by psychological factors, rather than by a physical condition. This does not fit the patient's scenario, as the patient is convinced of having a physical condition (a tumor) rather than experiencing physical symptoms that are believed to be psychological. ⦁ Option C. Somatoform Pain Disorder: A disorder characterized by pain that cannot be explained by a physical condition. This does not fit the patient's scenario, as the patient is not experiencing pain but is convinced of having a physical condition. ⦁ Option D. Obsessive-Compulsive Disorder (OCD): A disorder characterized by recurring, unwanted thoughts (obsessions) and behaviors (compulsions) that the person feels driven to perform. This does not fit the patient's scenario, as the patient's preoccupation is with having a physical condition rather than with obsessions and compulsions. Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th Edition, Page No.471,494. Ans. A. Hypochondriasis

Answer2729. #EXPLANATION Features suggestive of CREST syndrome aka Limited Scleroderma in the given question are: ⦁ Difficulty in swallowing can be attributed to Esophageal Dysmotility ⦁ Pain and bluish discoloration of fingers due to Secondary Raynaud’s phenomenon. ⦁ Anti-centromere antibody positive ⦁ Primary Pulmonary hypertension is a recognized complication of CREST syndrome. ⦁ Systemic sclerosis can lead to pulmonary arterial hypertension due to the progressive fibrosis and vascular changes that occur in the lungs, leading to increased resistance in the pulmonary arteries and eventually causing pulmonary hypertension. #Highyield Systemic sclerosis has triad of autoimmunity, noninflammatory vasculopathy, and collagen deposition with fibrosis. Clinical features ⦁ Commonly sclerosis of skin, manifesting as puffy, taut skin without wrinkles, fingertip pitting ⦁ Can involve other systems, eg, renal (scleroderma renal crisis; treat with ACE inhibitors), pulmonary ( pulmonary HTN, interstitial fibrosis,), gastrointestinal (esophageal dysmotility and reflux), cardiovascular. CREST syndrome is a variant of systemic sclerosis, also known as scleroderma. It is characterized by a constellation of symptoms including: ⦁ Calcinosis ⦁ Raynaud's phenomenon ⦁ Esophageal dysfunction ⦁ Sclerodactyly ⦁ Telangiectasia 2 major types: ⦁ Diffuse scleroderma ⦁ Limited scleroderma Other option: ⦁ Option A: The usual interstitial pneumonia (UIP) pattern of spatial/temporal heterogeneity of inflammation, fibrosis and fibrotic foci seen in idiopathic pulmonary fibrosis is less common in Limited Scleroderma and more common in diffuse scleroderma ⦁ Option. B: Pleural plaques are the most common lung manifestation in Asbestosis. ⦁ Option C: Hilar lymphadenopathy is seen classically in sarcoidosis. Reference: Harrison's Principles of Internal Medicine, 21st Edition, Page No. 2783 Ans. D. Pulmonary artery Hypertension

Answer2728. #EXPLANATION ⦁ Cephalins belong to glycerophosphatides class of phospholipids. ⦁ These contain fatty acids, glycerol as alcohol and ethanolamine as nitrogenous base . OTHER OPTIONS: ⦁ Option B- Cephalins contain glycerol as alcohol is a true statement. ⦁ Option C- Cephalins contain ethanolamine as nitrogenous base is a true statement. ⦁ Option D- Cephalins have role in the synthesis of very low density lipoproteins in the liver cells is a true statement. Reference- Harper’s Illustrated Biochemistry,31st Edition , Page No.200 Ans. A. Cephalins belong to phosphosphingosides class of phospholipids

Answer2726. #EXPLANATION ⦁ This large, ulcerated lesion with heaped-up margins is a malignant tumor of the esophageal mucosa. There are two main histologic types of esophageal carcinomas—squamous cell carcinoma and adenocarcinoma—with distinct risk factors. Smoking and alcoholism are the primary risk factors for esophageal squamous cell carcinoma. #HIGHYIELD: ⦁ Oesophageal cancer has poor prognosis and squamous cell carcinoma are found in upper and middle part of esophagus and of dysplastic type ⦁ Progressive dysphagia is most common symptom related to increasing luminal obstruction by cancer and if early symptoms are ignored , it will progress from dysphagia to solid , soft , eventually to liquid diet ⦁ Blood loss is less common in squamous cell carcinoma in comparison to adenocarcinoma ⦁ In case of squamous cell carcinoma and dysplasia , chromoendoscopy using Lugo iodine is useful adjunct and the normal squamous mucosa will be stained brown , while dysplastic and early cancer remains unstained OTHER OPTIONS: ⦁ Option A. Adenocarcinoma is most likely to arise in the lower third of the esophagus and to be associated with Barrett esophagus. Chronic inflammation may lead to stricture and not to a localized mass. ⦁ Option B. Dilated veins occur in esophageal varices; they do not produce an ulcerated mass. ⦁ Option C. Intranuclear inclusions suggest infection with herpes simplex virus or cytomegalovirus, both of which are more likely to produce ulceration without a mass; both occur in immunocompromised patients. Reference: Bailey & Love's Short Practice Of Surgery , 28th Edition , Page No. 1136 , 1137 , 1138 Ans. D. Squamous cell carcinoma

Answer2727. #EXPLANATION ⦁ Deficiency of glucose 6-phosphatase results impaired dephosphorylation of glucose 6-phosphate into glucose during the process of glycogenolysis. ⦁ As a result, excessive storage of glycogen occurs in the hepatocytes. ⦁ In healthy individuals during fasting state, glycogen undergoes glycogenolysis in liver to provide glucose and is essential to meet energy demand of body. ⦁ Deficiency of glucose 6-phosphatase inhibits the gluconeogenesis and thus, lactate cannot be utilized leading to its accumulation in body. OTHER OPTIONS: ⦁ Option B- Aldolase B deficiency results in accumulation of fructose 1-P in body and manifests as hereditary fructose intolerance. ⦁ Option C- Glucose 6-phosphate dehydrogenase deficiency results into hemolytic anemia after an intake of primaquine or sulfa drugs. ⦁ Option D- Fructokinase deficiency leads to accumulation of fructose in body and manifests as essential fructosuria. Reference- Harper’s Illustrated Biochemistry, 31st Edition, Page No. 167 Ans. A. Glucose 6-phosphatase deficiency

Q2729. A 27-year-old female patients visits the Rheumatology Clinic at PGI, Chandigarh after being referred by her family doctor with complaints of difficulty in swallowing, pain and bluish discoloration followed by ulcers on the fingers. Her blood work shows Anticentromere antibody positive. Which of the following is the most common cause of lung involvement the above described scenario? a. Usual Interstitial Pneumonia b. Pleural plaques c. Hilar Lymphadenopathy d. Pulmonary Artery Hypertension Comment your answer

Q2728. Cephalins are compound lipids that are abundantly found in the living cells. Cephalins constitute around 25% of all phospholipids in human tissues. These are abundant in the ⦁ white matter of ⦁ brain, nerves, neural tissue, and in ⦁ spinal cord, in which these make up 45% of all phospholipids. Select the incorrect statement? a. Cephalins belong to phosphosphingosides class of phospholipids b. Cephalins contain glycerol as alcohol c. Cephalins contain ethanolamine as nitrogenous base d. Cephalins have role in the synthesis of very low density lipoproteins in liver cells Comment your answer