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www.AIM4PG.com A neonate was born with signs of encephalitis, chorioretinitis, hepatosplenomegaly, fever and jaundice. The mother gave a history of fever two to three times during pregnancy. History taking revealed that she has many cats as pets. On examination of the neonate, intracranial calcifications were found. IgM Ab titer was also raised. What is the most likely Microorganism responsible? fb.me/aim4pg A) Treponema pallidum B) Toxoplasma gondii C) Rubella virus D) Cytomegalovirus EXPLANATION Instagram.com/aim4pgmed The Correct Answer is B This is a typical case of congenital toxoplasmosis caused by organism Toxoplasma gondii. Primary mode of transmission includes: i) Cat feaces ii) Raw meat or insufficiently cooked meat iii) Unpasteurised milk Daily lectures YouTube.com/aim4pgmed

www.AIM4PG.com A 25 year female patient presents with progressive dysphagia to solids and liquids. So barium swallow was done. What are the investigations needed to come to a diagnosis? Fb.me/aim4pg a) Endoscopy + Esophageal manometry b) Endoscopy + 24 hr pH monitoring c) Endoscopy biopsy d) Endoscopy+ CT chest EXPLANATION Instagram.com/aim4pgmed The given clinical scenario and the image confirms Achalasia cardia. The barium swallow image given shows Bird Beak/Rat tail/Pencil tip appearance. IOC for Achalasia is Manometry. Other supportive investigations are Barium swallow and Endoscopy. 24 hr pH monitoring is IOC for GERD Ans: (A) Endoscopy + Esophageal manometry Study Group aim4pg.com/study-group Daily lecture YouTube.com/aim4pgmed

A 7-year-old boy with Down syndrome underwent surgery to repair a congenital ventricular septal defect. During this procedure, iatrogenic injury to the coronary artery supplying the conduction system of the heart, including the sinuatrial and atrioventricular nodes, occurred, resulting in a heart block. What artery in the given picture was most likely damaged by the surgeon? Fb.me/aim4pg (A) A (B) B (C) C (D) D EXPLANATION Instagram.com/aim4pgmed Answer: A. Right coronary artery. It gives off arterial branches that usually supply both the SA and AV nodes. The SA node is usually supplied by the SA nodal artery, which branches off the proximal aspect of the right coronary artery. The AV nodal branch, which usually branches off the posterior interventricular branch of the right coronary artery, supplies the AV node. latrogenic injury to the right coronary artery would compromise the conduction system of the heart and lead to a heart block, as seen in this patient. Daily lecture YouTube.com/aim4pgmed

A 27-year-old female with vulvovaginal candidiasis is given a one-time 100 mg dose of oral fluconazole. She has no other pertinent medical problems and takes no prescription medications. Administration of the medication results in a peak plasma concentration of 20 mg/mL. What is the apparant volume of drug distribution? A 0.5ml B 1ml C 5ml D 50ml facebook.com/aim4pg EXPLANATION The answer is C: 5 L. Instagram.com/aim4pgmed The volume of distribution is calculated by dividing the total amount of drug in the body by the plasma concentration of the drug. In this case, Vd= 100 mg fluconazole/20 mg/mL which is the peak plasma concentration. Thus, the volume of distribution of fluconazole is 5 L. Daily video lectures YouTube.com/aim4pgmed

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A 26-year-old female presents with intermittent symptoms of sweating, palpitations, and hunger. Her past medical history is non contributory and she is not taking any medications. On physical examination, the blood pressure is 110/70 mm Hg and the heart rate is 80/min. The thyroid examination is normal and there are no signs of hyperthyroidism. During one such episode, investigations reveal a glucose level of less than 40 mg/dL, with corresponding low serum insulin and high serum glucagon levels. Which of the following best describes the hormone function of glucagon? aim4pg.com/study-group A) Structure similar to Carbohydrate B) Antigenic similarity to Insulin C) Promotes Glycogenolysis & Gluconeogenesis D) Helps in reducing Blood Sugar facebook.com/aim4pg EXPLANATION Answer : C. Instagram.com/aim4pgmed Glucagon promotes glycogenolysis and gluconeogenesis to protect the blood glucose value when hypoglycemia develops. Daily lecture YouTube.com/aim4pgmed

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A 17-year-old student is brought to the emergency room, displaying vomiting, fever, and diarrhea. The patient reports that for a period of 24 hours prior to admission, he suffered from abdominal pain first centered around the navel and then moving inferiorly to the right. As the patient talks, you realize that he is gesturing toward McBurney's point. You tentatively diagnose acute appendicitis and request emergency surgery. Accurate visual identification of the appendix during surgery can be verified by using which of the following landmarks facebook.com/aim4pg A) Haustra B) Bifurcation of the Abdominal Aorta C) Epiploic Appendages D) Taeniae Coli EXPLANATION instagram.com/aim4pgmed Ans. D. Taeniae coli • The position of the appendix varies depending on the patient. The taeniae coli are three longitudinal bands of smooth muscle running the length of the colon. • Since the appendix is part of the colon, the taeniae coli can be accurately followed to this structure. Daily lecture YouTube.com/aim4pgmed

Facebook.com/aim4pg A 25-year-old black woman presents with a 3-month history of cough and shortness of breath on exertion. A chest X-ray reveals enlargement of hilar and mediastinal lymph nodes. Laboratory studies e show elevated serum levels of angiotensinconverting enzyme and an increase in 24-hour urine calcium excretion. An open-lung biopsy is shown in the image.Stains for microorganisms in the tissue are negative. www.AIM4PG.com What is the diagnosis? A) Silicosis B) Tuberculosis C) Sarcidosis D) Good Pasteur Syndrome EXPLANATION instagram.com/aim4pgmed Ans: C Sarcoidosis is a granulomatous disease, the lung is the most frequently involved organ, but the lymph nodes, skin, and eyes are also common targets. Angiotensin-converting enzyme (ACE) is produced by epithelioid macrophages and is elevated in the blood. Spontaneous regression of lesions is common, but in some cases, the disease causes pulmonary fibrosis and respiratory failure. YouTube.com/aim4pgmed

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A 15 year old female presented to the emergency department with history of recurrent epistaxis, hematuria and hematochezia. There was a history of profuse bleeding from umbilicus stump at birth. Previous investigations revealed normal prothrombin time, activated partial thromboplastin time, thrombin time and & fibrinogen levels. Her platelet counts as well as platelet function tests were normal but urea clot lysis test was positive. Which one of the following clotting factor is most likely to be deficient? (www.AIM4PG.com) A) Factor X B) Factor XI  C) Factor XII D) Factor XIII facebook.com/aim4pg EXPLANATION Ans. D. Factor XIII instagram.com/aim4pgmed Individuals with a positive bleeding history, particularly with features such as delayed bleeding, umbilical stump bleeding or miscarriages and in whom the initial panel of screening test is negative, should be tested for Factor XIII deficiency. Daily lecture YouTube.com/aim4pgmed

During an examination clinician ask the patient to raise the arm parallel to the ground and rotate them to full internal rotation (thumb down) as seen in given picture. Once rotated, the clinician pushes down on the wrists, and the patient is instructed to resist the downward pressure. The patient complains of both pain & weakness present during resistance. Given test is to test for... (facebook.com/aim4pg) (A) Supraspinatus tendonitis (B) Painful arc syndrome (C) Subacromial bursitis (D) Bicipital tendonitis EXPLANATION instagram.com/aim4pgmed Correct Answer is A. (Empty can test for supraspinatus tendon tear) EMPTY CAN TEST Purpose: Test supraspinatus muscle Position: Seated Technique: Elevate UE 30°-45° in plane of the scapula with IR, resist elevation Interpretation: + test = reproduction of pain &/or weakness Statistics: Pain: sensitivity = 44%-100% & specificity = 50%-99% Weakness: sensitivity = 77% & specificity = 68% Daily lecture YouTube.com/aim4pgmed www.AIM4PG.com

https://youtube.com/shorts/Xl55BSrlbmE?feature=share A female with the following symptoms of sudden high fever, associated with headache and vomiting along with nuchal rigidity, presented to the hospital. CSF analysis of this patient showed the growth of this organism a gram negative diplococci shown in the image,identify the organism: a) Neisseria meningitis b) Streptococcus pneumoniae c) Staphylococcus aureus d) Mycobacterium tuberculosis EXPLANATION instagram.com/aim4pgmed ANS: A. Neisseria meningitis: Gram negative cocci (catalase/oxidase positive) Ferments glucose and maltose( capsulated) Culture media : thayer martin media, muller hinton agar Transport media stuwart amile media Complications: water-house friderichsen syndrome( B/L adrenal haemorragic necrosis) Deficiency of C5-C9(MAC): Prone for neisserial infections. DOC: Ciprofloxacin( carrier), ceftrioxan (cases) www.AIM4PG.com

OBSTETRIC CASE DISCUSSION https://youtu.be/YPoftKXoLok Download this video lecture notes in AIM4PG PREMIUM Group only. https://bit.ly/AIM4PG INSTAGRAM https://instagram.com/aim4pgmed FACEBOOK https://facebook.com/aim4pg EVERY WEEK VIDEO/GUIDE TO USMLE/PLAB LECTURES WILL BE UPLOADED HERE https://YouTube.com/aim4pgmed www.AIM4PG.com

A 28-year-old man arrived to the clinic for regular check-up of his condition. He has these skin lesions shown in the figure for 10 years. Also there is continuous waxing and waning of the lesions. The scalp, lumbosacral region, and glans penis also are affected. For the past 2 years, he has had chronic arthritis in the hips and knees an he was taking medication for that. Which of the following physical findings would most likely be present in this patient? A. Friction rub B. Hyperreflexia C. Hypertension D. Nail changes www.AIM4PG.com Correct answer is D EXPLANATION: Diagnosis: Psoriasis Psoriasis is a chronic skin condition with marked epithelial hyperplasia and parakeratotic scaling. CD4 lymphocytes as part of a Th 17 and Th 1response, elaborate cytokines that promote cell proliferation, and CD8+ cells cause cellular damage. Nail changes, such as yellow-brown discoloration, pitting, dimpling, and separation of the mall plate from the nail bed (onycholysis), affect about one-third of patients.

A 57 year old man presents to the ER with a cough and progressively increasing shortness of breath. The patient has been a plumber for 20 yrs, and before that job he worked in a ship. High-resolution CT of thorax reveals area of pleural thickening with calcifed plaques in the lungs. A specially stained specimen from a patient with a similar condition is shown in the image. A. Compared to the general population, smoking would present an increased risk of lung cancer in this patient. B. Langs in this patient will have silicotic nodules. C. The findings are associated with exposure to air pollution. D. The parent does not have an increased risk of mesothelioma. EXPLANATION Answer is option A. EXPLANATION: The image shows the classic "barbell" ferruginous bodies seen in asbestosis. These bodies can only be seen when the slide is stained with Prussian blue. Asbestosis is most common in plumbers, construction workers, and shipbuilders. Pleural plaques are suggestive of asbestos exposure.

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