Anatomy Revisited #1

Q. Which of the following is true of the anatomical position?

(A) The humerus is proximal to the scapula.

(B) The radius is medial to the ulna.

(C) The vertebral arch is ventral to the vertebral body.

(D) The femur is superior to the fi bula.

(E) The phalanges of the foot are cranial to the metatarsals

Ans: The answer is D:

The femur is superior to the fibula. In theanatomical position, a person is standing erect, facing anterior(forward), with the upper limbs by the sides, the palms facing anterior, the lower limbs placed together with the soles on the ground, and the toes pointing anterior. In this position, the thigh is superior to (above) the lower leg. Thus, the femur is superior to both the tibia and fi bula. Choice A (The humerus is proximal to the scapula) is incorrect. The humerus hangs from the lateral corner of the scapula; thus, it is lateral and inferior to the scapula. The humerus also may be described as distal to the scapula because it is further away from the attachment of the upper limb to the trunk. Choice B (Theradius is medial to the ulna) is incorrect. The radius is the bone in the forearm located further away from the midline. Therefore, the radius is located lateral to the ulna. Choice C (The vertebral arch is ventral to the vertebral body) is incorrect.

The vertebral arch, which is composed of the paired pedicles and laminae, is located dorsal (posterior; behind) to the body of the vertebra. Choice E (The phalanges of the foot are cranial to the metatarsals) is incorrect. The phalanges (toes) are positioned anterior to (or in front of) the metatarsals, which are located in the body of the foot. The phalanges also can be described as being distal to the metatarsals in that they are further away from the attachment/origin of the foot.

Q. A radiologist wishes to image the body in a plane parallel to both scapulae. Which of the following choices best describes the desired sectioning?

(A) Horizontal section

(B) Transverse section

(C) Frontal section

(D) Sagittal section

(E) Oblique section

The answer is C: Frontal section.

The scapulae (shoulder blades) lie across the back. An imaging plane passing parallel

to both these bones divides the body into anterior (front) and posterior (back) parts. A frontal (coronal) section divides the body into anterior (front) and posterior (back) portions.

It runs perpendicular to the median and horizontal planes. Choice A (Horizontal section) is incorrect. A horizontal section passes at right angles to both the median and coronal planes, dividing the body into superior (upper) and inferior (lower) parts. Choice B (Transverse section) is incorrect. A transverse section (cross section) passes perpendicular to the long axis of a structure. While often the same as a horizontal section, it is not always equivalent. For example, a transverse section through the foot is equivalent to a coronal (frontal) section, dividing the foot into anterior and posterior parts. However, a horizontal section of the foot divides it into superior and inferior parts, as shown in the given illustration. Choice D (Sagittal section) is incorrect. A sagittal section runs parallel to the median plane of the body, dividing it into unequal right and left parts. Choice E (Oblique section) is incorrect. Oblique sections run at offset angles from the median, coronal, and horizontal planes. Horizontal sections of the abdomen produce mostly oblique (not transverse) sections of the small intestine because of the coiled nature of the bowel.

Q.Screwing in movement of forearm is?

 (A) Flexion

(B) Abduction

(C) Pronation

(D) Adduction

(E) Supination

The answer is E: Supination.

The screw-home movement is the clockwise motion that drives a screw into its receptacle,

in this case the bulb into the socket. When using the right hand, the palm and forearm turn laterally and the palm moves from facing posterior to facing anterior, which is supination. Choice A (Flexion) is incorrect. Flexion is the action of decreasing the angle between parts while moving through the median or sagittal planes. Choice B (Abduction) is incorrect. Abduction refers to movements going away from the midline in the coronal plane. Choice C (Pronation) is incorrect. Pronation is the opposite of supination. When pronating the right hand, the palm and forearm turn medially so that the palm moves from facing anterior to facing posterior. In this case, right-handed pronation is a counter-clockwise movement that would unscrew the light bulb. However, when using the left hand, pronation produces the screw-home movement. Choice D (Adduction) is incorrect. Adduction refers to movements going toward the midline in the coronal plane.

Source: lipincotts illustrated anatomy and embryology

MIXED

MIXED



Q. What is the most effective screening technique for cervical cancer?
a. Fourier transform infrared
b. PCR assay
c. HPV DNA testing
d. Pap smear

Ans: d. The most effective screening technique remains the Papanicolaou test ("Pap
smear").Fourier transform infrared (FTIR) spectroscopy is a new tool for screening
cervical cancer and has a sensitivity of85% and a specificity of91 %. PCR DNA
techniques can be used to help detect concomitant HPV infection.


Q. Which of the following is a risk factor for breast cancer?
a. fibrocystic disease
b. first-degree relative with breast cancer
c. late menarche
d. multiple previous pregnancies

Ans: b. Nulliparity, early menarche, and history of a first-degree relative with breast
cancer are all risk factors for breast cancer. Fibrocystic disease is not a risk factor
for breast cancer


Q. Which of the following is associated with Lyme disease?
a. The infection is carried by mosquito larvae.
b. The infectious pathogen is Borrelia burgdorferi.
c. Nervous system involvement does not occur.
d. All patients present with a typical rash known as erythema chronicum migrans

 Ans: b. The infectious pathogen of Lyme disease is Borrelia burgdorferi. The carrier
is the Ixodes genus of tick. Many patients present with erythema chronicum
migrans but not all.

DERMA SPOTTER

Q. What is the diagnosis?( Clue: Xlinked dominant disease)
1) Becker disease
2) Incontinenta Pigmenti
3) Ichthyosis
4) Pemphigus vulgaris

Ans: 2) Incontinenta Pigmenti.

Incontinentia pigmenti is a complex developmental syndrome due to an X-linked dominant
trait that is usually lethal in males; 95% of cases are females.Vesicular, verrucous, and pigmented
skin lesions are usually seen.


Q). 34 years old female after sun exposure, what is the diagnosis?
1) Acne
2) Solar eczema
3) polymorphic light eruption
4) SLE

Ans: 3) Polymorphic light eruption.                                                                                                            
 This is a common intermittent skin reaction to UV exposure, which may represent a delayed type
hypersensitivity response to UV-induced cutaneous antigens. PLE presents with
an itchy, non-scarring, symmetrical papular rash
on light-exposed sites  within hours or days of significant sun exposure in young female usually below 30 years of age.
Large and small papules, papulopustules, and vesicles can occur. The eruption is transient, and resolves within several days, but it may persist if exposure continues.
Cutaneous lupus should be considered as differential diagnosis, and a minority of patients with PLE may subsequently develop lupus after several years .


Q). Skin eruption in a 26 year old male after scarlet fever.what is the diagnosis?
1) TSS
2)SSSS
3) Septic shock
4) Lyells syndrome

Ans: 1) TSS.


Scarlet fever (scarlatina) is an acute infection with a toxin-producing strain of Streptococcus pyogenes. Complications caused by the toxin or bacterial invasion include meningitis,
osteomyelitis, rheumatic fever, and glomerulonephritis.

HAEMATOLOGY QUESTIONS

Q. A 23-year-old woman is hospitalised with severe anorexia nervosa. Her FBC shows WBC 3.5 × 109/l, neutrophil count 1.1 × 109/l, Hb 100 g/l, MCV 104 fl and platelet count 70 × 109/l. Blood film shows occasional acanthocytes. Neutrophils show normal segmentation. Her prothrombin time (PT) is slightly increased.

The most likely diagnosis is:

a Aplastic anaemia

b Folic acid deficiency

c Haematological features of anorexia nervosa

d Hepatic steatosis

e Vitamin B12 deficiency

Ans: c. Haematological features of anorexia nervosa

The haematological abnormalities are all attributable to anorexia nervosa per se and can be related to bone marrow hypocellularity and gelatinous transformation

Q. A 23-year-old African man who presents with an epileptiform convulsion and fever is found to have a microangiopathic haemolytic anaemia, thrombocytopenia and acute kidney injury. The micro-organism you would test for is:

a Escherichia coli O104:H4

b Escherichia coli O157:H7

c Hepatitis B

d Human herpesvirus 8

e Human immunodeficiency virus

 Ans: e.Human immunodeficiency virus.

Escherichia coli O157:H7 is the usual cause of haemolytic uraemic syndrome while Escherichia coli O104:H4 was responsible for a German outbreak of this syndrome in 2011. However this patient has features suggesting a diagnosis of thrombotic thrombocytopenic purpura (TTP).1,2 It is important that all patients presenting with TTP are tested for human

immunodeficiency virus (HIV) since TTP may be the presenting feature of HIV infection. Some patients with HIV infection and TTP have a low ADAMTS13 and an ADAMTS13 antibody whereas others do not have an ADAMTS13 deficiency. Those who are deficient require plasma exchange as well as highly active anti-retroviral therapy.

Q. An 18-year-old medical student is permitted to perform an unsupervised venepuncture on a febrile Indian patient and suffers a needle prick injury. He is anxious that he may have contracted human immunodeficiency virus (HIV) infection. Assuming that the patient is infected, transmission is most likely for:

a Dengue fever

b Hepatitis B

c Hepatitis C

d Human immunodeficiency virus (HIV)

e Leishmaniasis

Ans. b Hepatitis B.

The infection most readily transmitted by needle prick injury is hepatitis B with reported transmission rates of 7−30%, followed by hepatitis C (reported rates 0−7%) then HIV (about 0.5%). Occasional examples of transmission of dengue fever have been reported.

Q. A 33-year-old woman with systemic lupus erythematosus who has developed livedo reticularis suffers an unprovoked deep vein thrombosisin her left leg. Her coagulation screen shows a PT of 16 s (12–14) and an APTT of 40 s (26–33.5). The test most strongly indicative of your suspected diagnosis would be:

a Anti-β2 glycoprotein 1 antibodies

b Antibodies to the phosphatidylserine–prothrombin complex

c Anti-cardiolipin antibodies

d Anti-prothrombin antibodies

e Lupus anticoagulant

Ans: e Lupus anticoagulant.

The clinical picture suggests the antiphospholipid syndrome. Livedo reticularisand venous thrombosis are among the more common features of this syndrome. Guidelines for diagnosis include, as laboratory criteria, the presence of anti-β2 glycoprotein 1 antibodies, anti-cardiolipin antibodies or the lupus anticoagulant, in each case the abnormality to be

demonstrated on at least two occasions, 12 weeks apart.1 Of these abnormalities, the lupus anticoagulant is the one that most strongly correlates with thrombosis and with fetal loss.

IMAGE DIAGNOSIS

Q). What is the diagnosis?


 

Ans: Psoriasis.



 Q.) What is the diagnosis?(Clue: Target Lesion)
 

Ans: Erythema Multiforme. 
Q). What is the diagnosis?

 

Ans: Mongolion Spot.


Q.) What is the diagnosis?

Ans: Necrobiosis lipoidica diabeticorum.

LEGIONELLA

LEGIONELLA

Q.Which of the following organisms, if found on a sputum culture, definitely indicates infection?
A. Chlamydia pneumoniae
B. Pneumococcus
C. Haemophilus influenzae
D. Legionella pneumophila
E. Moraxella

D. Legionella is not known to be a colonizer; if it is found on culture, it should be treated. While Mycoplasma and Chlamydia cultures are rarely sent, these organisms can be found in asymptomatic subjects, so their mere presence does not require treatment. Moraxella, Haemophilus, and Pneumococcus can also be colonizers in asymptomatic patients. However, they should be treated in a patient with clinical signs of pneumonia and one of these organisms predominating in a sputum Gram stain and culture.