NEET PG / FMGE /AIIMS /JIPMER

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A 60 year old male patient came with complaints of shortness of breath for 6months. On examination he has a hyperdynamic apical impulse with wide pulse pressure and a diastolic murmer in the second intercostal space on the left sternal border. The systolic blood pressure of the lower limb exceeds that of the upper limb by 24mm Hg. Which among the following is the above mentioned sign?

Answer2359. EXPLANATION ⦁ The duodenum receives blood from the gastroduodenal artery, a branch of the common hepatic artery. It also receives blood from the inferior pancreato duodenal artery, which is a branch of the superior mesenteric artery. ⦁ So, the duodenum is receiving blood from the common hepatic artery and the superior mesenteric artery, but it is not receiving any blood from the splenic artery. ⦁ The splenic artery supplies blood to the body of the pancreas with the dorsal and superior pancreatic arteries; it supplies blood to the tail of the pancreas with the caudal pancreatic artery. ⦁ The splenic artery supplies the fundus of the stomach with short gastric arteries and the left portion of the greater curvature with the left gastro omental artery. ⦁ The left gastro omental artery also supplies blood to the greater omentum through omental branches. All of these structures would be affected if the splenic artery was ligated. Ans. B. Duodenum

Answer2358. EXPLANATION ⦁ There is no evidence for involvement of the parasympathetic nervous system in the MMC. ⦁ Fasting, or the interdigestive state, is characterized by long periods of quiescence, with short periods of waves of contractions. ⦁ The contractions, called the migrating myoelectric complex (MMC), originate in the mid-stomach and continue to the terminal ileum during each cycle and serve to sweep the undigested material and bacteria out of the stomach and small intestine, into the colon. ⦁ This protects the delicate upper GI tract (small intestine) from damage and sequesters most of the bacteria in the colon, a drier environment less hospitable to bacteria. ⦁ There are four phases of the MMC that occur in 75- to 120- minute cycles during fasting, based on contractile activity. Phases I, II, and IV have little activity. Phase III is most important of the four, when the hormone motilin is released from Mo cells of the small intestine into the circulation. ⦁ Motilin stimulates strong sequential contractions, sweeping bacteria and undigested matter down the tract from MID stomach into the colon. Phase III lasts only 6 to 10 minutes in each cycle. ⦁ Motilin acts through the enteric and autonomic nerves to stimulate contractions, which proceed for a few feet abnormally, and then start up again slightly further down the intestine. ⦁ This pattern is repeated until the complex reaches the terminal ileum, and then a new complex is initiated in the stomach. These cycles begin about 3 hours after the last meal and repeat until ingestion of food. With ingestion, the normal propulsive patterns resume. Ans. B. The parasympathetic nervous system controls the MMC contractions.

Answer2357. EXPLANATION ⦁ The ejaculatory duct courses through the prostate gland and contains solely semen. Now it is extremely important to remember that semen is the combination of sperm from the ductus deferens, seminal fluid from the seminal vesicle, and secretions of the prostate gland. ⦁ The ejaculatory duct is formed by the union of the duct of the seminal vesicle and the ampulla of the ductus deferens, and it is the site where sperm and seminal fluid mix. ⦁ The prostatic urethra is also contained in the prostate gland, and it carries semen. But it also carries urine out of the bladder. ⦁ The membranous urethra is the continuation of the prostatic urethra outside of the prostate gland, and it carries both semen and urine as well. ⦁ The seminal vesicle is a structure on the posterior surface of the bladder that produces seminal fluid. ⦁ The ductus deferens is a passageway that carries sperm from the epididymis to the ejaculatory duct. Ans. B. Ejaculatory duct

Answer2354. EXPLANATION Among the most important physiological changes that occur during this acclimatization process are an approximately twofold increase in the maximum rate of sweating, an increase in plasma volume, and diminished loss of salt in the sweat and urine to almost none; the last two effects result from increased secretion of aldosterone by the adrenal glands. Ans. C. Sweating rate

Answer2360. EXPLANATION ⦁ Achalasia (literally, failure to relax) is a condition in which food accumulates in the esophagus and the organ becomes massively dilated. ⦁ It is due to increased resting LES tone and incomplete relaxation on swallowing. The myenteric plexus of the esophagus is deficient at the LES in this condition and the release of NO and VIP is defective. ⦁It can be treated by pneumatic dilation of the sphincter or incision of the esophageal muscle (myotomy). Inhibition of acetylcholine release by injection of botulinum toxin into the LES is also effective and produces relief that lasts for several months. Ans. D. Achalasia of the lower esophageal sphincter

Answer2355. EXPLANATION ⦁ Type O individuals are “universal donors” because they lack A and B antigens, and type O blood can be given to anyone without producing a transfusion reaction due to ABO incompatibility. ⦁ This does not mean, however, that blood should ever be transfused without being cross-matched except in the most extreme emergencies. Ans. C. O Negative RBC and colloids/crystalloid