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q16- E
6 weeks after bone marrow transplant---acute reject -by cell mediated, cytotocxic T cell - type 4 hypersens. This is MC of rejects. due to host CD4 cell release cytokines----> activation of host macropgage& proliferation of CD8, destruction of Donor cell. will see extensive interstitial lymphocyte infiltrate in graft.
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q17- C-P50 ioncrease--- mean right shift
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shift right: mnemonic: increase up
Increase of P50, increase metabolic need, increase exercise( increase Pco2 and decrease O2 affinity) increase H, high attitude, increae2,3 DPG...
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q 17-- CC
Agree to sooner q actually asking about rt shift of curve ?
if we analyse other options
a--we are decreasing temp --cause left shift
b-decrease 2;3 DPG- left shift curve
d - increase ph means alkalosis- left shift
e-newborn blood fetal Hb again left shift
only option c has CO2 12% which itself is strong factor to shift curve to rt
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18.E
The decrease in deformability upon deoxygenation of sickle cells is due to increased intracellular viscoelasticity resulting from hemoglobin polymerization .
Thus, HbS polymerization contributes to microvascular occlusion characteristic of sickle cell disease .
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19.E I found this explantion in the forum,
yeabiruh - 08/24/10 20:02
hi there ...this is a case of congenital insensitivity to pain.....
---First we have to understand the pain pathway.....The first order neurons for pain pathway are slow diameter neurons of dorsal root ganglia...and the second Order neurons are in the spinothalamic TRACT ....and the third order neurons are found between THALAMUS AND PRIMARY SOMATOSENSORY CORTEX....
--The receptors for pain pathway are called NOCICEPTORS...and these are mainly free nerve endings and the cell bodies for these free nerve endings are found in the LATERAL part of the DORSAL ROOT GANGLIA or the TRIGEMINAL GANGLIA ....called FIRST ORDER NEURONS
There are two types of nociceptors based on the TYPE of the AXONS
1-A delta fiber =are thin but myelinated and can allow an action potential to travel at a rate of about 20 m/second towards the CNS....
2-C fiber axons=thin and unmyelinated only conduct at a speed of 2m/sec...slow compared to 1...
--And in the CONGENITAL ABSCENCE OF PAIN PERCEPTTION ...the problem is in the first order neurons Voltage Gated sodium Channel....Called Nav 1.7...
--these ION channel is usually expressed in NOCICEPTIVE FIRST ORDER NEURONS(small diameter neurons of DRG(PAIN TRANSMISSION) and the Sympathetic Ganglion of ANS(choice C...but as there is no mention about ANS dysregulation...C is out).....
hence the answer is EEEE
Choice A- is for touch sensation ...DORSAL COLUMN ...PATHWAY-fast ,myelinated ,thick A beta fibers....
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20.D
21.E
The ulnar nerve and its branches innervate the following muscles in the forearm and hand:
In the forearm, via the muscular branches of ulnar nerve:
Flexor carpi ulnaris
Flexor digitorum profundus (medial half)
In the hand, via the deep branch of ulnar nerve:
hypothenar muscles
Opponens digiti minimi
Abductor digiti minimi
Flexor digiti minimi
The third and fourth lumbrical muscles
Dorsal interossei
Palmar interossei
Adductor Pollicis
In the hand, via the superficial branch of ulnar nerve:
Palmaris brevis
[edit] CutaneousThe ulnar nerve also provides sensory innervation to the fifth digit and the medial half of the fourth digit, and the corresponding part of the palm:
Palmar branch of ulnar nerve - supplies cutaneous innervation to the anterior skin and nails
Dorsal branch of ulnar nerve - supplies cutaneous innervation to the posterior skin (except the nails)
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21.B
Chlamydia trachomatis, an obligate intracellular human pathogen.trachomatis is a Gram-negative bacteria,
can cause numerous disease states in both men and women Both sexes can display urethritis, proctitis (rectal disease and bleeding), trachoma, and infertility.
Trachoma is an infectious eye disease, and the leading cause of the world's infectious blindness.it is spread by direct contact with eye, nose, and throat secretions from affected individuals, or contact with objects, such as towels and/or washcloths, that have had similar contact with these secretions.
affected individual experiences symptoms of conjunctivitis, or irritation similar to "pink eye." Blinding endemic trachoma results from multiple episodes of reinfection that maintains the intense inflammation in the conjunctiva.
Antibiotics to treat active infection, using azithromycin
****Obligate intracellular parasites cannot reproduce outside their host cell, meaning that the parasite's reproduction is entirely reliant on intracellular resources.
Obligate intracellular parasites of humans include:
Viruses
Certain bacteria, including:
Chlamydia, and closely related species
Rickettsia
Coxiella
Certain species of Mycobacterium such as Mycobacterium leprae
Certain protozoa, including:
Plasmodia species
Leishmania spp.
Toxoplasma gondii
Trypanosoma cruzi
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22.D
Lenticulostriate Arteries
Small, deep penetrating arteries known as the lenticulostriate arteries branch from the middle cerebral artery Occlusions of these vessels or penetrating branches of the circle of Willis or vertebral or basilar arteries are referred to as lacunar strokes. About 20% of all stokes are lacunar
http://www.strokecenter.org/education/ai...050-lg.jpg
The cells distal to the occlusion die, but since these areas are very small Often only minor deficits are seen. When the infarction is critically located, however, more severe manifestations may develop, including paralysis and sensory loss.
Within a few months of the infarction, the necrotic brains cells are reabsorbed by macrophage activity, leaving a very small cavity a lake or lacune in French.
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21.E , 22.B, 23.D sorry for mixed up
24.A
"Cluster" refers to the tendency of these headaches to occur periodically, with active periods interrupted by spontaneous remissions.Cluster headaches are excruciating unilateral headaches] of extreme intensity, The duration of the common attack ranges from as short as 15 minutes to three hours or more.
The headache is accompanied by at least one of the following autonomic symptoms: ptosis (drooping eyelid), miosis (pupil constriction) conjunctival injection (redness of the conjunctiva), lacrimation (tearing), rhinorrhea (runny nose), and, less commonly, facial blushing, swelling, or sweating, all appearing on the same side of the head as the pain.
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