DBMCI eGurukul OFFICIAL

Answer2725. #EXPLANATION The pressure gradient between regions of the cardiovascular system is directly proportional to the resistance of the intervening structures. During ventricular ejection, the aortic valves are open and do not offer any significant resistance to blood flow. Therefore, there is very little, if any, pressure difference between the left ventricle and the aorta . #HIGHYIELD ⦁ Ventricular ejection is the phase of the cardiac cycle during which the ventricles contract, forcing blood out of the heart into the pulmonary artery (right ventricle) and aorta (left ventricle). ⦁ Valvular Role: Semilunar valves (pulmonary and aortic valves) open during ventricular ejection to allow blood to be ejected into the pulmonary artery and aorta. ⦁ Pressure Differences During Ventricular Ejection: ⦁ Left Ventricle and Aorta: The pressure difference between the left ventricle and the aorta is significant during ventricular ejection. Blood is propelled from the left ventricle into the aorta to be distributed throughout the systemic circulation. Clinical Significance: ⦁ Coronary Artery Disease: Myocardial infarction (heart attack) can occur when blood flow to a part of the heart muscle is blocked, leading to damage and impaired cardiac function. ⦁ Diagnostic Procedures: Cardiac catheterization, including coronary angiography, is a diagnostic procedure used to visualize the coronary arteries and assess hemodynamics during the cardiac cycle. Other options: ⦁ Option: A. Because most of the resistance in the systemic vasculature occurs at the level of the arterioles, there is a large pressure gradient between the aorta and the capillaries . ⦁ Option: B. Because the mitral valve is closed during ventricular ejection, there is a pressure difference between the left ventricle and left atrium . ⦁ Option: D. Similarly, because the tricuspid valve is closed during ventricular ejection, there is an appreciable pressure difference between the right ventricle and the right atrium . Reference: Ganong's Review of Medical Physiology 26th Edition, Page No. 366 Ans. C. Left ventricle and aorta

Answer2724. #EXPLANATION ⦁ Routine examination of a 68-year-old woman complaining of fatigue, abdominal fullness, and bilateral axillary adenopathy, revealed marked leucocytosis constituting 99% of lymphocytes. Physical examination shows bilateral palpable axillary and cervical adenopathy and an enlarged spleen. ⦁ A peripheral smear shows intermediate sized lymphocytes with bland chromatin along with the presence of the smudge cells characteristic of chronic lymphocytic leukemia #HighYield ⦁ Chronic Lymphocytic Leukemia (CLL)/Small Lymphocytic Lymphoma (SLL) ⦁ Clinical criteria: ⦁ Absolute clonal lymphocytes >5000/uLQ ⦁ OMC leukemia of adults in the Western world. ⦁ Median age at diagnosis is 60 years; M:F = 2:1 ⦁ MC mutation-Del 13q. ⦁ Cell of origin-Naive B cell. ⦁ Peripheral Smear: ⦁ Small round lymphocytes with scant cytoplasm (CONVENT girl appearance)Q ⦁ Occasional cells have distorted outline called smudge cellsQ ⦁ Rarely Warm type AIHA may develop showing SpherocytesQ ⦁ Morphology of Lymph nodes: ⦁ Diffusely effacedQ by an infiltrate of predominantly small lymphocytes (6-12µm) between which lies larger activated lymphocytes proliferation centersQ (pathognomonic for CLL/SLL), which contain mitotically active cells. ⦁ Overall CLL has low mitotic rateQ exc in proliferative center ⦁ Diagnosis of choice ⦁ Immunophenotyping ⦁ Dim Surface Ig (usually IgM or IgM and IgD)Q ⦁ Pan B-cell markers CD19 + and CD20+Q ⦁ CD23+ and CD5+Q #OtherOptions: ⦁ Option A and B- Lymphoblast and myleoblast are not seen in the peripheral smear image, hence these are the incorrect options ⦁ Option D- Splenomegaly and malignant cells appear to have “hairy” projections that can be appreciated on the peripheral smear #Extraedge Transformations of CLL (poor prognosis): ⦁ Diffuse large B-cell lymphoma - Richter syndrome (5% - 10%)Q ⦁ Large-cell transformation to prolymphocytic leukemia (PLL)Q ⦁ Acute Leukemia Reference: Robbins & Cotran Pathologic Basis of Disease, 10th Edition, Page No. 597-598 Ans. C. Chronic lymphocytic lymphoma

Answer2723. #EXPLANATION ⦁ The gradual onset of her symptoms, together with the radiologic findings of diffuse interstitial infiltrates, suggests atypical pneumonia. ⦁ Atypical pneumonia is caused most commonly by Mycoplasma pneumoniae, Legionella pneumophila, Chlamydia pneumoniae, and viruses; however, IgM cold agglutinin production is seen only with Mycoplasma infection. #Otheriotions: ⦁ Option A. Culture on buffered charcoal yeast extract medium is performed to diagnose L pneumophila pneumonia. L pneumophila causes atypical pneumonia that is seen most commonly in older individuals who smoke and abuse alcohol. Although Legionella is transmitted through environmental water sources, infection does not imply aspiration. ⦁ Option C. Phyocyanins, a product of Pseudomonas aeruginosa, lead to the blue- green color of the organisms. Pseudomonas can cause pneumonia but typically in patients who have cystic fibrosis or are severely immuno- compromised. ⦁ Option D. Polysaccharide capsules are a characteristic of Streptococcus pneumoniae and other organisms including certain strains of Haemophilus influenzae, Neisseria meningitidis, and Escherichia coli. S pneumoniae is the cause of typical lobar pneumonia, which is characterized by sudden onset of fever, chills, cough, and pleuritic pain. X-ray of the chest usually shows focal lung consolidation rather than diffuse infiltrates, as seen in this case. Reference: Robbins & Cotran Pathologic Basis of Disease, 10th Edition, Page No. 649, 706-707 Ans. B. IgM cold agglutinins

Answer2722. #EXPLANATION ⦁ The gradual coarsening of facial features, progressive protrusion of the brows, and the need for larger shoes suggest acromegaly, a condition characterized by excess growth hormone (GH) secretion in adulthood. ⦁ Growth hormone synthesis is predominantly regulated by hypothalamic GHRH (growth hormone releasing hormone), and its pulsatile secretion is predominantly regulated by hypothalamic somatostatin. #HIGHYIELD ⦁ Acromegaly: Chronic disorder characterized by the excessive production of growth hormone (GH) in adulthood. ⦁ Most commonly caused by a benign pituitary adenoma (somatotroph cell adenoma) in the anterior pituitary. Clinical Features: ⦁ Gradual enlargement of bones and tissues, typically involving: ⦁ Head (enlarged hands, feet, and facial features). ⦁ Osteoarthritic changes. ⦁ Soft tissue hypertrophy (thickened skin, enlarged tongue). ⦁ Coarsened facial features. Systemic Effects: ⦁ Cardiovascular complications (hypertension, cardiomyopathy). ⦁ Metabolic changes (insulin resistance, diabetes mellitus). ⦁ Respiratory issues due to soft tissue hypertrophy. ⦁ Increased risk of certain cancers. ⦁ Endocrine Features: Elevated levels of insulin-like growth factor-1 (IGF-1) due to GH stimulation; Suppressed levels of insulin-like growth factor binding protein-3 (IGFBP-3). Diagnosis: ⦁ Measurement of IGF-1 levels. ⦁ Oral glucose tolerance test (failure to suppress GH secretion). ⦁ Imaging studies (MRI of the pituitary) to identify the adenoma. Treatment: ⦁ Surgical removal of the pituitary adenoma (transsphenoidal surgery). ⦁ Radiation therapy. ⦁ Somatostatin analogs (e.g., octreotide) to inhibit GH secretion. ⦁ Growth hormone receptor antagonists (e.g., pegvisomant). Other options: ⦁ Option A.Dopamine and norepinephrine are catecholamines that regulate smooth muscle tone and cardiac function. Excess of these hormones is seen in pheochromocytoma. ⦁ Option B.Luteinizing hormone (LH) regulates sex steroid hormone production by both testes and ovaries. Human chorionic gonadotropin (hCG) is produced by the placenta and has actions similar to LH. ⦁ Option C.Prolactin regulates menstruation and lactation. Follicle-stimulating hormone (FSH) regulates ovarian and testicular function. Reference: Ganong's Review of Medical Physiology 26th Edition, Page No-696 Ans. D. Somatostatin and GHRH

Answer2721. #EXPLANATION The history of the patient , points towards diagnosis of tension pneumothorax on right side and the immediate step should be to decompress right pleural space by doing needle thoracostomy #HIGHYIELD: ⦁ Tension pneumothorax , develops when a ‘ one - way valve ‘ air leaks either from lung or through chest wall ⦁ The affected lungs are collapsed and completely compressed as the air is sucked into the thoracic cavity and it cannot escape. The mediastinum is deviated to the opposite side and there is decrease in venous return and compressing of the opposite lung ⦁ Causes: ⦁ penetrating chest trauma ⦁ blunt chest trauma with parenchymal lung injury ⦁ air leak which do not resolve spontaneously ⦁ iatrogenic lung injury ⦁ mechanical positive pressure ventilation ⦁ Clinical features: It is a clinical diagnosis and treatment should never be delayed waiting for radiological confirmation ⦁ The patient appear restless with tachypnoea , dyspnoea and distended neck veins ⦁ Tracheal deviation is a late sign ⦁ Hyper resonance and decreased or absent breath sounds over affected hemithorax ⦁ Treatment: ⦁ immediate decompression by rapid insertion of large bore cannula into the second intercostal space in the mid - clavicular line of affected side ⦁ It is followed by insertion of chest tube through fifth intercostal space in the anterior axillary line Reference: Bailey And Love’s , Short Practice Of Surgery , 27th Edition , Page No.367 Ans. C. Decompress the right pleural space

Q2725. The spouse of a 55-year-old man calls Ambulance because her husband complains of chest pain radiating down his left arm. He is transported to the emergency department, where an ECG and cardiac enzymes indicate a recent myocardial infarction. The man undergoes cardiac catheterization, including coronary angiography and hemodynamic recordings throughout the cardiac cycle. No valvular defects were present. During ventricular ejection, the pressure difference smallest in magnitude is between which of the following? a. Aorta and capillaries b. Left atrium and left ventricle c. Left ventricle and aorta d. Right atrium and right ventricle Comment your answer

Q2724. During a routine visit, a 68-year-old woman complains of 3 months of fatigue, abdominal fullness, and bilateral axillary adenopathy. On physical examination, vital signs are normal, and she has bilateral palpable axillary and cervical adenopathy and an enlarged spleen. A complete blood count is notable for a white cell count of 88,000 with 99% lymphocytes. A peripheral smear is shown in Image. Which of the following is the most likely diagnosis? a. Acute lymphoblastic leukemia b. Acute myelogenous leukemia c. Chronic lymphocytic lymphoma d. Hairy cell leukemia Comment your answer

Q2723. A 30-year-old woman complains of a non-productive cough that has developed over the past 10 days. She reports feeling achy, and having a sore throat and headaches. X-ray of the chest demonstrates patchy bilateral interstitial infiltrates. After work-up, the patient is diagnosed with Mycoplasma pneumoniae pneumonia. Which of the following is associated with the causative organism? a. Growth on buffered charcoal yeast extract media b. IgM cold agglutinins c. Phycocyanin production d. Polysaccharide capsule Comment your answer

Q2722. A series of photographs taken of a middle-aged man over a period of 2 decades demonstrates gradual coarsening of facial features and progressive protrusion of the brows. Upon questioning, the patient reports having to wear larger shoes than he did as a young man. Which of the following pairs of hormones normally regulates the hormone responsible for these changes? a. Dopamine and norepinephrine b. LH and hCG c. Prolactin and FSH d. Somatostatin and GHRH Comment your answer