Anti Rejection drugs

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Q) Most nephrotoxic drug is 

A. Cyclosporine
B. Sirolimus
C. Azathioprine
D. Steroids

Answer

These are immunosuppressants used after solid organ transplants. These drugs have a lot of side effects.

Answer is here  

 

Parkland formula

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Q )  During fluid resuscitation in a burns patient using Parkland’s formula, volume of fluid given in first 8 hours is ?
A. 50%
B. 25 % 
C. 75 % 
D. 100 % 

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Ans a

The modified Parkland formula

TBSA% burn × weight (kg) × 4 = volume in mL
The first half is given in 8 hours and the second over 16 hours to complete the 24-hour resuscitation time frame.

Developed by Dr. Charles Baxter in the 1960s at the Parkland Memorial Hospital in Texas, this formula serves as a cornerstone in determining the initial fluid requirements to stabilize burn victims during the crucial early hours following injury.

Although the Parkland Formula offers a valuable framework for fluid resuscitation, it's important to note that individual patient variability, coexisting injuries, and evolving clinical conditions necessitate close monitoring and adjustment of the resuscitation plan. Over-resuscitation can lead to complications such as pulmonary edema, while under-resuscitation can result in inadequate tissue perfusion and organ failure.

Bailey 28th  671

Truncus arteriosus

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Q ) Which of the following statements about truncus  arteriosus is false?
A. Most infants do well without operations until late childhood.
B. Cyanosis is a late feature
C. Most infants present with congestive heart failure.
D. Repair requires a conduit from right ventricle to pulmonary arteries.

Answer 

In Truncus arteriosus there is a single arterial trunk arising from the ventricles, with single dysplastic valve with

semilunar leaflets and a subvalvular VSD..

Untreated, most infants  do not survive beyond 6 months. Cyanosis is usually not present early, because mixing
mainly occurs at VSD level and the arterial oxygen saturation is generally greater than  85%, but............Read on 

Diverticulitis

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Q ) Hincheys grade III Diverticulitis. Management most likely to follow more interventions after an index operation is

a) Laparoscopic irrigation and exploration

b) Sigmoid Colectomy+Hartman’s

c) Primary repair with omental patch and peritoneal toilette

d )Sigmoid Colectomy with colorectal anastomosis and diverting ileostomy

Grade III diverticulitis is generalized peritonitis.

Answer for premium Q 10 

Warfarin

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Q Warfarin sodium acts by
A. Inhibits carboxylation of  Factor VII, IX, X 
B. Factor X a inhibition
C. Thrombin inhibitor and X a inhibition
D. IX, XI, XII, factor and thrombin inhibition

Chronic pancreatitis enzymes

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Q . All are true regarding enzyme supplementation in chronic pancreatitis except 

a) Lipase to be given 30000U before or after meal

b) H2 blocker is mandatory with enteric coated tablets

c) Main cause of failure is inadequate dosage

d) In cases of failure of enzyme replacement feeding of medium chain Triglycerides are  helpful

Ans

Indications of enzyme supplementation are -

  1. Weight loss, steatorrhea (15g/day ) or both
  2. Dyspepsia, Diarrhoea, bloating, malabsorption of proteins  and carbohydrates
  3. Pain abdomen

Read on for ans Q 23 

Islet cells

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Q  Regarding islet cell of pancreas true is (AIIMS, JIPMER) 

a) Cells in descending order of frequency is B,D,A,F

b) B cells are more common in the periphery of islets

c ) Peri islet acinar cells same as acinar cells else where

d) Portal flow from islet to acinar cell helps to control secretions

Answer 

GCS

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Q. Best predictor in  Glascow coma scale (GCS) 

A. Eye opening
B. Motor response
C. Verbal response
D. All

Ans ) B, Motor response

In the Glasgow Coma Scale (GCS), motor response is considered the best predictor of patient outcomes, especially in assessing the severity of brain injury. This is because motor response correlates strongly with neurological function and brainstem activity, providing a more reliable indicator of the patient's level of consciousness and prognosis.

Why Other Choices Are Incorrect:

  1. A. Eye Opening:
    Eye opening is important but is less specific as a predictor because it can be influenced by factors like sedation, drugs, or environmental stimulation. It is useful for initial assessment but not as accurate in determining long-term outcomes.
  2. C. Verbal Response:
    Verbal response can be influenced by factors like intubation, sedation, or pre-existing conditions affecting speech. It is less reliable in predicting outcomes in patients with severe head injuries, especially when they are unable to speak due to other medical interventions.
  3. D. All:
    While all components of the GCS are valuable in assessing consciousness, motor response alone has been shown to be the strongest predictor of outcome, making it the primary focus when assessing prognosis in severe head injuries.

 

Pouch design

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Q. False statement about pouch design is-

a) S pouch is  preferred when length is  not available

b) J pouch is the  most preferred

c) W pouch has  more chances of diarrhoea than J pouch

d) Volume of the pouch is inverse proportional to the no. of bowel movements

Answer