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Perception of bad smell Nasal cycle is the cyclical alternate nasal blockage occurring: a acne zones on face order tretinac pills in toronto. Every 12-24 hours Function of mucociliary action of upper respiratory tract is: a acne y embarazo buy tretinac australia. Used to visualize nasal cavity Nasal cavity skin care 20s order tretinac with american express, septum, floor of nose, inferior and middle turbinate, inferior and middle meatuses can be visualized by it. Posterior Rhinoscopy: y y y It consists of examining the nasopharynx and posterior part of nasal cavity by postnasal mirror Used to visualize posterior choanae and posterior end of inferior turbinates. Eustachian tube Middle meatus Posterior nares Anterior nasal cavity Which is not visualized on posterior rhinoscopy: b. Root of nose: the upper angle of the nose where it is continuous with forehead is called as root of the nose. The deepest point at the root of nose where the two nasal bones meet the frontal bone is called as nasion, i. If there is subjective improvement in nasal airway, the test is considered positive and indicats nasal valve compromise. Inferior turbinate is a separate bone, rest all are a part of ethmoidal labyrinth Ref. Also know-Sphenopalatine foramen is a route of communication between nasal cavity and pterygopalatine fossa. Nasolacrimal duct opens in inferior meatus, rest all structures open in middle meatus. Dhingra 6/e, p 141 Anterior and posterior ethmoidal arteries are branches of ophthalmic artery which is a branch of internal carotid artery. Dhingra 5/e, p 157, 6/e, p 142 Disorders of smell Anosmia: Total loss of sense of smell Hyposmia: Partial loss of sense of smell Parosmia: Perversion of smell (seen in recovery phase of post influenzal anosmia; intracranial tumors). Dhingra 6/e, p 141-142 Nasal mucosa contains goblet cells for secretion of mucus, which forms a mucus blanket. The inspired bacteria, viruses and dust particles are entrapped on this viscous mucus blanket. Mucociliary action As discussed in previous Question - movement of mucus in nose is mainly by mucociliary action. Olfactory epithelium Odor receptors are present in olfactory epithelium lining the olfactory region of nose. Tuli1/e, p 538, 2/e, p 503, Mohan Bansal p 281 Thudichum speculum or vienna type speculum is used to visualize anterior nasal cavity (examination is called anterior rhinoscopy). Veins not involved in spreading infection to cavernous sinus from danger area of face: a. Part of lateral nasal wall Inferior meatus Middle meatus Superior meatus Sphenoethmoidal recess Openings Nasolacrimal duct Frontal sinus, (which opens via fronto nasal duct), Maxillary sinus, Anterior ethmoidal sinus Posterior ethmoidal sinus Sphenoid sinus 8.

Placing the tunning fork on the vertex of the skull and determining the effect of gently occluding the audtitory canal on the thereshold of low frequencies c skin care event ideas purchase 30 mg tretinac amex. Placing the tuning fork on the mastoid process and comparing the bone conduction in the patient d acne under arms discount 5 mg tretinac with mastercard. Placing the tuning fork on the forehead and asking him to report in which ear he hears it better acne 4 dpo cheap tretinac 30 mg free shipping. Inconclusive test What should be the least hearing loss for Weber test to lateralize: [Rj 2004] a. The patient refused treatment, and returned to the emergency department after 2 weeks complaining of deafness in the affected ear. Low-compliance A young man presents with an accident leading to loss of hearing in right ear. On otoscopic examination, the tympanic membrane was intact pure tone audiometry that shows an airbone gap of 55 dB in the right with normal cochlear reserve. C type tympanogram Which is the best test for screening of the auditory func tion of neonates Outer hair cells are mainly responsible for cochlear microphonics and summation potential 61 19. A 35 years old pregnant female complaining of hearing loss, which aggravated during pregnancy, was sent for tympanometry. Tuli 1/e, p 28 Tuning fork tests can be done with tuning forks of different frequencies like 128, 256, 512, 1024, 2018 and 4096 Hz but most commonly used is 512 Hz because yy "Tests are done with various tuning forks, but 512 Hz is the most commonly used as it has longer tone decay and sound is quite distinct from ambient noise. Principle But if ossicular chain is fixed or disrupted, no such phenomenon occurs i. Dhingra 6/e, p 37; Tuli 1/e, p31 Malingering/Nonorganic hearing loss (also called pseudohypacusis) yy Ocassionally patients wilfully or subconsciously exaggerate their hearing loss. Significant differences between the threshold obtained using ascending and descending administration of test stimuli c. It is based on the concept that when both ears are stimulated simultaneously by a tone equal in frequency and phase, the auditory percept is lateralized to the ear with better hearing. Amongst the options given, only tympanosclerosis is a cause for conductive deafness. Placing the tuning fork on the forehead and asking him to report in which ear he hears better Ref. Webers is a very sensitive test and even less than 5 dB difference in 2 ears hearing level can be indicated. This means Rinne test should be negative on left side (as in conductive deafness - Rinne test is negative). In the question it is given hearing is normal on right side, so Rinne test will be positive on right side (because in case of normal hearing - Rinne test is positive). Dhingra, 6/e, p22 In the above question: Patient was suffering from suppurative labyrinthitis which was not treated and led to total loss of hearing i. Fistula Test the basis of this test is to induce nystagmus by producing pressure changes in the external canal which are then transmitted to the labyrinth. Positive Fistula Test is seen in: yy Erosion of horizontal semicircular canal (Cholesteatoma or fenestration operation) yy Abnormal opening in oval window (post stapedectomy fistula) or round window (rupture of round window). Method of doing the test and principle: A continuous tone of 5 dB above threshold in 500 Hz and 2000 Hz is given to the ear and person should be able to hear it for 60 sec. It consists of tympanometry and acoustic reflex Tympanometry is a measure of the condition of the middle ear at the level of tympanic membrane.

In woman with preclampsia levels of homocysteine are increased 3-4 fold times at midpregnancy skin care insurance purchase tretinac 40 mg with amex. Hyperuricemia is one of the earliest Manifestation of preeclampsia Plasma uric acid values > 5 acne home remedies cheap tretinac american express. Mean arterial Pressure in second trimester if mean arterial pressure is 90 mmHg in second trimester chances of developing preeclampsia increase acne questionnaire discount tretinac 5 mg online. Q yy Respiratory depression occurs with Mg concentration > 12 mEq / L and arrest when > 15 mEq/L. Patients with preeclampsia have elevated levels of plasma fibronectin, a glycoprotein. It measures angiotensin sensitivity in susceptibles when they lie supine the woman is turned from the left lateral to the supine position If there is an increase in the diastolic blood pressure by 20 mm or more, the test is considered positive m m m m eb oo Contd. And on pervaginal examination, cervix is 50% effaced station-3, os is closed and pelvis is adequate. Caesarean section co A 27 year primigravida presents with pregnancy induced hypertension with blood pressure of 150/100 mm of Hg at 32 weeks of gestation with no other complications. She was well-controlled on hydrochlorothiazide and lisinopril as an outpatient, but these drugs were discontinued when she found out that she was pregnant. Her blood pressure has been relatively well controlled in the 120-130 mm Hg systolic range without medication, and urinalysis has consistently. She reports an uneventful pregnancy other than early morning nausea and vomiting, which has subsided since her last visit. Her uterine size is consistent with her dates, and her physical examination is unremarkable. The patient is sent directly from the clinic for a nonstress test and an ultrasound. Shake test m co m co m eb oo ks A 25-Year-old female is 5 months pregnant and presents to her obstetrician along with her first child. She thinks she has gained adequate weight and her pregnancy has been uncomplicated till date. Her past medical history is notable for hypertension for which she is currently taking enalapril. Urinalysis reveals +1 glycosuria, +2 proteinuria and 24 hours urine collection shows 5 g protein. Initial inpatient evaluation followed by restricted activity and outpatient management. None of the above A 24-year-old woman with 36 weeks of pregnancy, suddenly complains of headache and blurring of vision. Cesarean delivery Which type of eclampsia has the worst prognosis: [New Pattern Question] a. Shock A pregnant woman in 3rd trimester has normal blood pressure when standing and sitting. Compression of internal iliac vessels the following are related to preeclampsia: [New Pattern Question] a. Placenta previa has also been reported to reduce the risk of hypertensive disorders in pregnancy. Note: A systolic rise of 30 mm Hg or a diastolic rise of 15 mm Hg is no longer a diagnostic criterion. Proteinuria: Irreversible excretion of 300 mg of protein in 24 hours urine collection or atleast 30 mg/dl or 1+dipstickinatleast2randomurinesamplescollectedatleast6hoursapartbutnomorethan7daysapartissignificant proteinuria.

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A 24-year-old woman presents with new onset right lower quadrant pain acne wont go away discount tretinac 40mg line, and you palpate an enlarged skin care line reviews tretinac 20mg with amex, tender right adnexa acne out active buy cheap tretinac line. Which of the following sonographic characteristics of the cyst in this patient suggests the need for surgical exploration now instead to observation for one menstrual cycle A 20-year-old young girl, presents with history of rapidly developing hirsutism and amenorrhea with change in voice. To establish a diagnosis you would like to proceed with which of the following tests in blood What is the stage of ovarian Ca with superficial liver metastasis with B/L ovarian mass Shaw 15th/ed pg -377 for option c, 379 for option d, 375 for option a, 374 for option b) 67. Laparotomy performed in a case of ovarian tumor revealed unilateral ovarian tumor with ascites positive for malignant cells and positive pelvic lymph nodes. Bilateral ovarian cancer with; capsule breached; ascites positive for malignant cells. A 55-year-old female patient has carcinoma ovary with bilateral involvement with ascitic fluid in the abdomen. Which of the following ovarian tumor is most prone to undergo torsion during pregnancy Stromal invasion is commonly present in ovarian tumours of borderline malignancy b. Presence of ascites and pleural effusion in Brenner tumour indicates poor prognosis d. Endometrioid carcinoma of the ovary may coexist with endometrial adenocarcinoma 78. A 52 years postmenopausal female presents unilocular with a ovarian cyst of 6 cms with normal Ca125 levels management is: a. Malignant transformation is frequent In para ovarian cysts-malignant transformation is rare. Prophylactic oophorectomy: "The only proven way to prevent ovarian cancer is surgical oophorectomy. As another possible site of disease among these high risk patients is fallopian tube therefore should be removed. In these patients, the procedure is approximately 90% effective in preventing epithelial ovarian cancer. Bailey & Love 24th/ed p 221 "Below the age of 20 years 60% of the tumours are of germ cell origin and in girls under the age of 10 years almost 85% are of germ cell origin and are invariably malignant. Novak 14th/ed p 1506 "Dysgerminomas are the most common malignant germ cell tumours of the ovary and have been considered the female equivalent of seminoma. Devita 7th/ed p 1391 Most common germ cell tumour of ovary is dermoid cyst (mature teratoma).