question and answer

By Pratyush kumar

THESE ARE THE QUESTIONS ASKED IN OUR 1ST MEDICINE INTERNAL TEST.
Q.1 - Classify aneamia. megaloblastic anemia. {long question}
Q.2 - Metabolic syndrome
Q.3- Type 1 diabestese mellitus.

answer:-
1) def:- aneamia is defined as decrease in oxygen carrying capacity of blood , decrease number of red cell ,which varies according to age sex and altitude.

classification:-
aneamia is classified on the basis of reticulocyte index
1> reticulocyte index <2.5 {hypo proliferative aneamia}
   a> normocytic
   iron deficiency aneamia
   marrow supression
   aplastic aneamia
   b> microcytic
   iron deficiency aneamia
   thallasemia
   sideroblastic aneamia
2> reticulocyte index >2.5 {hyperproliferative aneamia}
   macrocytic:-
   megaloblastic aneamia
   blood loss

MEGALOBLASTIC ANEAMIA
aetiology:-

cobalamin deficiency:-

vegans

intrinsic factor deficiency

post gastrectomy

decrease intake

increased demand :- pregnancy, growth spurt

worm infestation :-diphylobrothum latum

folate deficiency:-

anti folate drugs:- methotrexate

increased demand

decrease absorption:- crohn disease, gluten sensitive enteropathy

increased metabiolism

pathogenesis:-

necessary for the synthesis of dna

disparity in the synthesis of nucleotides

helps in conversion of udp-->tdp

clinical features:-

symptoms:

anorexia

malaise

constipation

fever

weakness

decrease exercise tolerance

jaundice

neurological manifestation:-

demyelination of posterior cord pyramidal tract

bilateral neuropathy

muscle weakness

visual defect

sluggish reflex

investigation:-

blood picture:-

hypersegmented neutrophils

oval macrocytes

fragmented rbc

leukopenia

other test

schilling test

methyl malionic aciduria

serum cobalamin

serum folate

treatment

cobalamin -1000mcg for 7 days

folic acid - 5-15 mg for 7 days

before giving folic acid therapy cobalamin deficiency must be ruled out..otherwise it may cause cobalamin neuropathy

2) Metabolic syndrome:-

other names:-insulin resistance syndrme , syndrome X

defn:- seen as triad of hypertension, dyslipidemia, and hyperglyceamia

seen i type 2 diabetese mellitus

there are two of insulin resistance

TYPE A:- Seen in younger people

TYPE B:- Seen in older people.

investigation :-
bmi - >30
blood pressur ->140/90
cholestrol- elevated
hdl- decreased
ldl- elevated

treatment
ace inhibitors and thiazide diuretics are given

3) type 1 diabetese mellitus..
  defn:- it is a group of metabolic disorder sharing the phenotype of hyperglyceamia due to partial or complete
lack of insulin.{earlier it was called insulin dependant diabetese mellitus IDDM }
Aetiology:- autoimmune
   genetic:- mody 1 ,2,3.4.5
   endocrinopathies:- acromegaly, cushing syndrome ,
   infection:- congenital rubella syndrome
   tumour:- gulacagonoma ,
   *autoantibody to glyceamic acid decarboxylase (gad) is found
pathogenesis:-
   autoimmune mediated beta cell destruction
   insulinitis:- t cell mediated destruction
   infiltration of lymphocyte
   fibrous change
   genetic:- involvement of HLA-DR6 , CTLA - 4, on chromosome 6
   honeymoon phase:- this is the phase gyceamic control is attained with little or no insulin.
   symptom less period..due to compensation by remaining beta cell
   impaired glucose tolerance is seen
investigation:-
   fpg->126 mg/dl
   pp> 200 mg/dl
   presence of c peptide
   glucose tolerance test
   glycosylated hb:- helpful in prognosis of diabetese mellitus

treatment:-
   insulin infusion
   0.5-1 U/Kg.......50% must be given as basal dose
   various regimes are there:-
   continuous subcutaneous insulin infusion
   types :-
   regular , lispro, aspart
complication:-
   diabetic ketoacidosis:- due to lack of insulin

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orthopaedics viva

By Pratyush kumar

I am going to write about my ortho viva..it was very interesting one..
so questions were ranging from peripheral nerve injury to fracture dislocation and pathology of bone and joints.
WHILE answering any question REGARDING MANAGEMENT one should be very particular in mentioning
INVESTIGATIONS first and then TREATMENT..{examiners look for it}

my first question was on radial nerve injury , its course ..
injury at the origin of radial nerve will paralyse all the muscles
injury at the level of radial groove{Saturday night palsy} ,triceps muscle escapes..
radial nerve causes extension so injury to it causes wrist drop{ unable to extend at the level of wrist}
interossei are also supplied by ulnar nerve so it escapes..
brachioradialis is supplied by the nerve before it divides into superficial and deep branches so testing the muscle will tell the level of injury..
injury to posterior interosseous branch cause wrist drop.. but extensor carpi radialis longus may escape

then the next question was on ANGULAR DEFORMITY at the knee joint.
genu-knee , coxa -hip , cubitus -elbow
so genu valgum and genu varum are the angular deformity..to know the severity we can measure inter malleolar and inter condylar distance. Q angle is also diagnostic.