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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
                      

orthopaedics viva

 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.

gold medal for microbiology

receiving our chief guest

PRIZE for elocution on the topic doctor-2050

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