Investigation of choice (IOC)

INVESTIGATION OF CHOICE (IOC)

1) Acoustic neuroma-----------gadolinium DTPA enhanced MRI

2) Nasopharyngeal angiofibroma----------CECT scan

3) posterior fossa tumours------------MRI

4) DVT-----------venous USG

5) pulmonary embolism-----------CT chest with contrast

6) imaging of seminal vesicle and ejaculatory ducts---vasography >transrectal USG

7) extraintestinal amoebiasis-------ELISA

8) avascular necrosis--------------MRI

9) interstitial lung disease------HRCT scan

10) bronchiectasis------------HRCT scan

11) osteoporosis---------DEXA scan
(dual energy x-ray absorptiometry)

12) acute ureteric colic--------non contrast spiral CT scan abdomen

13) renal TB
early stage-----IVP
late stage------CTscan

14) localization of pheochromocytoma------MRI

15) acute dissection of aorta-----transoesophageal ECHO

16) chronic dissection of aorta(in stable patients)-----MRI

17) congenital hypertrophic pyloric stenosis------USG

18) extrahepatic biliary atresia-------peroperative cholangiogram

19) discrete swelling(solitary nodule) of thyroid-----FNAC

20) acute Subarachnoid haemorrhage(SAH)-----noncontrast CT HEAD

21) to localise site of bleed in SAH-----------4 vessel X-ray angiography

22) Single Bone Metastasis-------- CT

23) Multiple Bone Metastasis------- Bone scan

24) Spine Metastasis --------- MRI

25) Avascular necrosis-------- MRI

26) Bone Density/Osteoporosis-------- DEXA (Dual energy x ray absorptiometry)

27) Aneurysm/ AV Fistula-------Angiography

28) Dissecting Aneurysm (Stable)-------- MRI
      (Unstable)-------------Trans oesophageal USG

29) Pericardial Effusion--------- Echocardiography

30) Lobulated pericardial effusion------- MRI > CT

31) Minimum Pericardial Effusion------- Echocardiography

32) Ventricular Function-------- Echocardiography

33) Radiotherapy/ Chemotherapy induced cardiotoxicity------ Endomyocardial Biopsy

34) Pulmonary Embolism------- CECT> Pulmonary Angiography >V/Q Scan

35) Interstitial lung disease (Sarcoidosis)------ HRCT

36) Bronchiectasis-------- HRCT scan

37) Solitary Pulmonary Nodule------- High resolution CT (HRCT)

38) Posterior Mediastinal Tumor------- MRI

39) Pancoast Tumor (Superior Sulcus Tumor) ------ MRI

40) Minimum Ascites/ Pericardial effusion/Pleural effusion ------- USG

41) Traumatic Paraplegia------- MRI

42) Posterior Cranial Fossa ------- MRI

43) Acute Haemorrhage------- CT

44) Chronic Haemorrhage------- MRI

45) Intracranial Space Occupying Lesion------- MRI

46) Primary brain tumour------ contrast MRI
(Gold standard however remains to be biopsy)

47) Metastatic brain tumor------- (Gadolinium) contrast enhanced MRI

48) Temporal Bone---------CT

49) SAH Diagnosis-------- unenhanced CT

50) SAH aetiology------- 4 vessel MR Angiography > CT>Angiography > DSA

51) Obstetrics------- USG

52) Calcifications-------CT

53) Blunt abdominal Trauma------- CT

54) Acute Pancreatitis------ CT

55) GERD------ pH manometer > endoscopy

56) Dysphagia-------- Endoscopy

57) Congenital hypertrophic pyloric stenosis----- USG

58) Obstructive Jaundice/GB Stones------ USG
      Ureteric stone------- non contrast CT

59) Diverticulosis ------- barium enema

60) Diverticulitis ------- CT scan

61) Renal TB (early) ---- IVP
      (Late)------ CT

62) Posterior Urethral Valve----------- MCU

63) Renal Artery Stenosis-------- Percutaneous Angiography

64) Extraintestinal Amoebiasis--------- ELISA

65) Discrete swelling(solitary nodule) of thyroid-------- FNAC

Drugs causing SIADH

Drugs causing SIADH:---

C3b (B)  V.Imp for opsonization

C Carbamazepine
C Chlorpropamide
C Cyclophosphamide
B Barbiturates
V Vincristine
I Indomethacin

Bacterial Colonies

#Appearances of the colonies :-

Staphylococci -Oil paint appearance
(nutrient agar )

Pnumococci -Draughtmann/ carom coin appearance ( blood agar)

Corynebacterium -Chinese letter or
cuneiform arrangement

Bacillus
1) Bamboo stick appearance
2) Medusa head appearance( agar plates )
3) Inverted fir tree appearance( gelatin
stab culture)

Cl. perfringens
1) Stormy fermentation( litmus milk)
2) Target haemolysis(rabbit, sheep, human blood agar)

Cl. tetani -Drum stick appearance

Vibrio cholarae -Fish in stream appearance

Yersinia pestis
1) Safety pin appearance
2) Stalactite growth

H.influenzae -Satellitism

H. ducreyi -School of fish / rail road track appearance

Bordetella pertusis
1)Thumb print appearance
2)Bisected pearls / mercury drops(bordet- gengou medium)
3)Aluminium paint appearance

M. leprae -Cigar bundle appearance

Mycoplasma -Fried egg appearance

B.Anthrax

"IF MSC students Measures BP of B.Anthrax, they are utilizing energy to form AMP...."

B.Anthrax------
- Inverted fir tree appearance
- Frosted glass appearance
- Medusa head colony
- String of pearl's reaction
- Cut glass appearance in transmitted light
- Milzbrand-bazillus
- Bamboo stick appearance
- Polyglutamate capsule
- Ascoli's thermoprecipitin test
- M'Fadyean's reaction
- PLET Medium

Pulmonary anthrax----- by inhalation of wool----- so, "wool sorter's disease"

Cutaneous anthrax----- most common---painless ('hidden') charbon---- so, "hide porter's disease"

Amino acids facts

Glutathione are synthesised from----- glutamate, cysteine, glycine

Creatine & creatinine are synthesised from ----- glycine, Arginine, methionine (gam)

Carnitine are synthesised from ---- lysine, methionine (mlc)
(Or Car License Methia 6...)

Cysteine are synthesised from ---- methionine, serine
[Cysteine acts as direct precursor of Taurine...]

Bile salts are synthesized from ----- Glycine and Cysteine

Co-enzyme-A is synthesized from ---- beta Alanine

Nitric oxide is synthesized from ---- Arginine

--------------------------------------------------------

Cereals are deficient in---- lysine & threonine

Pulses are deficient in------ cysteine & methionine (both are sulfur containing amino acids)

Maize are deficient in------ tryptophan & lysine

(Cereals lysis through MeTaL PCM)

Synthetic analogue of nucleosides

Thymidine analogues :
- Idoxuridine (iodo deoxy uridine)
- Stavudine & Zidovudine
- Bromo deoxy uridine

Guanosine analogue :
- Abacavir

Deoxy-guanosine analogue :
- Acyclovir

Deoxy-cytidine analogue :
- Lamivudine
- Cytarabine

Purine analogue :
- Azathioprine
- Cladribine

Hypoxanthine analogue :
- Allopurinol

Immunodeficiency diseases

PRIMARY IMMUNODEFICIENCIES : (GENETIC)

1) B-cell defects
(Low levels of B cells & antibodies)
- agammaglobulinemia
- hypogammaglobulinemia
- selective immunoglobulin deficiency

2) T-cell defects
(Lack of all class of T cells)
- thymus aplasia (Di-george syndrome)
- chronic mucocutaneous candidiasis

3) Combined B cell & T cell defects
( lack or abnormal lymphoid stem cells)
- severe combined immune deficiency SCID
- X- SCIDI due to an interleukin defect
- adenosine deaminase deficiency (ADA def)
- ataxia telengectasia
- wiskott-aldrich syndrome

4) Phagocytes defects
- chediak-higashi disease
- chronic granulomatous disease of children
- lack of surface adhesion molecule

5) Complement defects
- one of C complement def
- hereditary angioedema
- associated with rheumatid disease

SECONDARY IMMUNODEFICIENCIES : (ACQUIRED)

1) Natural causes
- infection like AIDS
- cancer
- pregnancy
- aging
- stress
- nutrition deficiency

2) Immunosuppresive agents
- irradiation
- removal of spleen
- steroids
- severe burns
- drugs to treat graft rejection & cancers

Signs in Radiology - 2

73) Gastrointestinal string sign
Sign of Crohn disease.

74) Goblet sign
Sign of ureteral transitional cell carcinoma that may be seen on retrograde or intravenous urography (see also Bergman's coiled catheter
sign).

75) Gull wing appearance
Appearance of erosions that may occur in patients with erosive osteoarthritis.

76) H-shaped vertebral bodies
Shape of vertebral bodies that may be seen in patients with sickle cell disease. See also: Fish vertebrae.

77) Halo sign
Ground-glass attenuation surrounding a pulmonary nodule or mass on CT images. Represents hemorrhage and is highly suggestive of Aspergillus.

78) Hampton's hump
Triangular opacity secondary to infarction in the periphery of the lung distal to a pulmonary embolism.

79) Head cheese sign
Sign of subacute hypersensitivity pneumonitis.

80) Hidebound sign
On small bowel series, crowding of folds in dilated loops of small bowel may be seen in patients with scleroderma.

81) High-attenuating crescent sign
Sign of impending abdominal aortic aneurysm rupture.

82) Hole within a hole
Appearance that may be seen when
eosinophilic granuloma involves the skull.

83) Holly leaf appearance
Chest radiograph finding that may be seen with asbestos pleural plaques.

84) Honda sign
Sacral insufficiency fracture.

85) Hot cross bun sign
May be seen on axial T2 weighted images of the pons in multiple system atrophy.

86) Hot nose sign
Sign that may be observed on brain flow scans in patients with brain death.

87) Hourglass appearance
MRI appearance that may be seen with concentric cystic adventitial disease

88) Interstitial line sign
Sign that may be seen with an interstitial ectopic pregnancy.

89) Inverted Napoleon's hat sign
Sign of severe spondylolisthesis at the
lumbosacral junction.

90) Ivory vertebra sign
Increase in opacity of a vertebral body that retains its size and contours, with no change in the opacity and size of adjacent intervertebral discs.

91) Juxtaphrenic peak sign
Tenting of the diaphragm that may be seen with right upper lobe atelectasis.

92) Keyhole sign
US appearance that may be seen with posterior urethral valves.

93) Lace like Pattern that may be seen with sarcoid arthropathy.

94) Lace-like pattern
Ultrasound appearance of hemorrhagic ovarian cysts.

95) Lacunar skull
Appearance of skull that may be seen in infants with Chiari II malformation.

96) Lambda sign
On a Gallium-67 citrate scan, uptake in the hilar and paratracheal lymph nodes gives the appearance of a lambda. This is seen in sarcoidosis.

97) Lead pipe
Narrowing of colon with loss of haustra that may be seen in patients with ulcerative colitis.

98) Linguine sign
MRI sign that may be seen in patients with intracapsular breast implant rupture.

99) Lobster claw sign
Sign of papillary necrosis on IVU.

100) Lollipop
Appearance of diverticula that may been seen on HSG in patients with adenomyosis.

101) Luftsichel sign
"Air cresent". Sign that may be seen with left upper lobe atelectasis.

102) Mark Morton sign
Throckmorton's sign with a small penis.

103) Mercedes Benz sign
Appearance of gas within gallstones. (on xray )

104) Moulage sign
Effaced loop of bowel that may be seen on a small bowel series in sprue.

105) Molar tooth sign (GU)
Perivesicular extravasation of contrast on CT cystogram in a patient with extraperitoneal bladder rupture.

106) Molar tooth sign (Neuro)
Enlarged and horizontally directed tubular structure on each side of the midline emerging from the midbrain in patients with Joubert syndrome.

107) Monod sign
Air surrounding an aspergilloma (Also see air crescent sign).

108) Mount Fuji sign
CT sign of tension pneumocephalus.

109) Paintbrush appearance
Linear striations of contrast material opacifing collecting tubules that may be seen with medullary sponge kidney.

110) Panda sign
On a Gallium-67 citrate scan, uptake in the lacrimal and salivary glands gives the appearance of a panda. This is suggestive of sarcoidosis.

111) Parallel track sign
Pattern of uptake that may be seen on bone scan in patients with hypertrophic osteoarthropathy.

112) Pear-shaped bladder
Bladder assumes the shape of a pear when it undergoes extrinsic compression due to excess tissue in the pelvis.

113) Pearl necklace sign
MRI sign that may be seen with
adenomyomatosis.

114) Pencil in cup deformity
Erosion pattern of digits that may be seen in patients with psoriatic arthritis.

115) Picture frame vertebral body
Thicken cortex of vertebral bodies that may be seen in patients with Paget disease.

116) Picket fence
Appearance of bowel that may be seen on small bowel series with Whipple disease or gastrointestinal amyloidosis.

117) Pistol grip deformity
Appearance of the proximal femur that may be seen with cam type femoroacetabular impingement.

118) Playboy bunny sign
US sign of the appearance of the confluence of the hepatic veins with the IVC.

119) Polka-dot pattern
Appearance of thickening trabeculations seen in intraosseous hemangiomas of the spine. See
also Corduroy appearance.

120) Porcelain gallbladder
Calcification of the gallbladder wall.

121) Putty kidney
Appearance that may be seen with end-stage renal tuberculosis.

122) Reversal sign
CT sign of anoxic brain injury where gray matter is lower in attenuation than white matter (the opposite is normal).

123) Reversed halo sign
Relatively specific sign of pulmonary nodules in cryptogenic organizing pneumonia.

124)Ribbon bowel
Appearance of bowel that may be seen on barium studies in graft versus host disease.

125) Ribbon ribs
Appearance of ribs that may be seen with neurofibromatosis 1.

126) Rice kernel
CT appearance that may be seen with dacryolithiasis.

127) Rigler's sign
Sign of pneumoperitoneum where both sides of a loop of bowel are outlined by air.

128) Rim sign
On cholescintigraphy, increased uptake is seen in the region of the gallbladder fossa. Sign is specific for acute cholecystitis.

129) Ring of fire sign
US finding. Hypervascular ring in the adnexa that may be seen with either ectopic pregnancy or corpus luteum.

130) Ring sign
CT sign of epiploic appendagitis.

131) Rosary sign
CT sign that may be seen with
adenomyomatosis.

132) Rugger jersey spine sign
Appearance of spine that may be seen with hyperparathyroidism.

Signs in Radiology

Signs in Radiology

1) Accordion sign:
Appearance of bowel that may be seen with pseudomembranous colitis.

2) Air crescent sign:
Appearance of cavitation that may be seen with invasive apergillosis.

3) Anteater's nose sign:
Sign of calcaneonavicular tarsal coalition. (Coalition=Fusion)

4) Apple Core lesion;
Circumferential narrowing of the lumen secondary to colon

5) Ball on tee sign
Sign of papillary necrosis on IVU.

6) Banana sign
Seen on antenatal US and refers to a banana- shaped configuration of the cerebellum. Associated with neural tube defects.

7) Bat wing appearance (chest)
Classic chest radiography finding for
pulmonary edema.

8) Bat wing appearance (neuro)
Appearance of 4th ventricle that may be seen with Joubert syndrome.

9) Beak sign
Sigmoid volvulus.

10) Bergman's coiled catheter sign
Sign of ureteral transitional cell carcinoma when a catheter coils in region of neoplasm
(see also Goblet sign).

11) Bird's beak
Narrowing of the esophagus in achalasia.

12) Bird's beak
Narrowing of the colon in cecal volvulus.

13) Blade of grass
Paget disease.

14) Bone in bone sign
Appearance of spine that may be seen osteopetrosis.

15) Boot-shaped Heart
Appearance of heart that may be seen with tetralogy of Fallot.

16) Boxcar ventricles
Appearance of frontal horns that may be seen in Huntington's disease.

17) Breast in a breast
Term to describe Fibroadenolipomas.

18) Bulging fissure sign
Bulging of a pulmonary fissure. Most
commonly associated with Klebsiella
pneumonia.

19) Bullet carpal bones
Appearance of carpal bones that may be seen with mucopolysaccharidoses.

20) Butterfly vertebrae
Results from failure of fusion of the lateral halves of the vertebral body because of persistent notochordal tissue between them

21) C sign
Sign of talocalcaneal tarsal coalition.

22) Cake kidney
All renal tissue is fused into one pelvic mass and gives rise to two separate ureters which enter the bladder in normal relationship.

23) Canoe paddle ribs :
Appearance of ribs that may be seen with mucopolysaccharidoses.

24) Celery stalking
Irregular appearance of metaphyses in patients with rubella. Also used to describe metaphyses in patients with osteopathia striata.

25) Central dot sign -aiims nov 2008
Sign of Caroli's disease.

26) Champagne sign
Specific but not commonly seen ultrasound finding for emphysematous cholecystitis.

27) Cloverleaf skull
Appreance of the skull that may be seen with thanatophoric dysplasia.

28) Cluster of grapes
Appearance that may be seen with
pneumatosis cystoides coli.

29) Cobra head sign
Dilatation of the distal ureter which may be seen in patients with ureteroceles.

30) Coffee bean sign
Sigmoid volvulus.

31) Collar sign
Sign of diaphragmatic rupture.

32) Comet sign
Sign to differential a phlebolith from a ureteral stone. Calcified phlebolith represents the comet nucleus and the adjacent, tapering, noncalcified portion of the vein is the comet
tail (also see soft-tissue rim sign).

33) Comet tail sign
Produced by the distortion of vessels and bronchi that lead to an adjacent area of round atelectasis.

34) Cord sign
Sign of intracranial dural sinus thrombosis.
(Also empty delta sign)

35) Corkscrew collaterals
Appearance of collaterals that may be seen in patients with Buerger disease.

36) Corkscrew sign
Upper GI series sign of midgut volvulus.

37) Corduroy appearance
Appearance of thickening trabeculations seen in intraosseous hemangiomas of the spine. See
also polka-dot pattern.

38) Crazy-paving sign
Nonspecific appearance consisting of linear network or reticular pattern with areas of ground-glass opacification. Classically
associated with pulmonary alveolar
proteinosis.

39) Crossover sign
Anterior acetabular rim is projected laterally relative to the same point of the posterior rim in the superolateral aspect of the acetabulum. See with pincer type femoroacetabular impingement.

40) Cyclops lesion
May occur status post anterior cruciate ligament reconstruction.

41) David Letterman sign
Sign of scapholunate ligament disruption (also see Terry Thomas sign).

42) Dense vessel sign
Sign of cerebrovascular accident that represent thrombus in the middle cerebral artery.

43) Dependent viscera sign
Sign of diaphragmatic rupture (viscera falls to a dependent position).

44) Dot and dash pattern
Sacral insufficiency fracture.

45) Double bleb sign
Appearance of amnion and yolk sac at 5-6 weeks. Embryo lies between amnion and yolk sac

46) Double bubble sign
Sign of duodenal atresia and other forms of duodenal obstruction.

47) Double decidua sign
Sign of early normal intrauterine gestation.

48) Double density sign (cardiac)
Sign of left atrial enlargement when right side of the left atrium pushes into the adjacent lung.

49) Double density sign (Nucs)
Pattern of uptake that may be seen on bone scans in patients with osteoid osteomas.

50) Double duct sign
Simultaneous dilatation of the common bile duct and pancreatic ducts that is generally caused by a tumor in the pancreatic head.

51) Double PCL sign
MRI sign of a bucket-handle meniscal tear.

52) Double track sign
Appearance of hypertrophic pyloric stenosis that may be seen on upper GI series.

53) Draped aorta sign
Sign of contained rupture of an abdominal aortic aneurysm.

54) Drooping lily sign
Inferolateral displacement of the opacified lower pole moiety in a duplex kidney from an obstructed (unopacified) upper pole moeity.

55) Egg on a string
Appearance of the heart that may be seen with transposition of great arteries.

56) Empty delta sign
Sign of intracranial dural sinus thrombosis.
(Also cord sign)

57) Epicardial fat pad sign
Sign of a pericardial effusion.

58) Eye of the tiger sign
low signal intensity circumscribing the globus pallidus in patients with Hallervorden-Spatz syndrome.

59) Faceless kidney
Appearance of kidney secondary to any process that obliterates renal sinus (i.e. lymphoma, transitional cell carcinoma).

60) Fallen fragment sign
Sign of a pathologic fracture seen with unicameral bone cysts.

61) Feeding vessel sign
Sign of pulmonary septic emboli.

62) Flame shaped (Breast)
Gynecomastia.

63) Flame shaped (MSK)
Paget disease.

64) Fat halo sign
Seen in various diseases of the bowel in which fatty infiltration of the submucosa is present.

65) Fat ring sign
Preservation of the perivascular fat around the mesenteric vessels that may be seen with mesenteric panniculitis.

66) Flat tire sign
Sign of a ruptured globe.

67) Flat waist sign
Appearance of left heart border that may be seen with left lower lobe atelectasis.

68) Figure 3 sign
Appearance of the aorta that may be seen in patients with coarctation of the aorta.

69) Figure of eight
Appearance of the brain in pachygyria.

70) Finger in glove sign
Sign of mucous plugging seen with allergic bronchopulmonary aspergillosis.

71) Fish vertebrae.
Description of shape of vertebral bodies that may be seen in patients with sickle cell disease.
See also: H-shaped vertebral bodies.

72) Football sign
Sign of pneumoperitoneum seen on supine radiographs.

Signs in Radiology

Signs in Radiology

1) Accordion sign:
Appearance of bowel that may be seen with pseudomembranous colitis.

2) Air crescent sign:
Appearance of cavitation that may be seen with invasive apergillosis.

3) Anteater's nose sign:
Sign of calcaneonavicular tarsal coalition. (Coalition=Fusion)

4) Apple Core lesion;
Circumferential narrowing of the lumen secondary to colon

5) Ball on tee sign
Sign of papillary necrosis on IVU.

6) Banana sign
Seen on antenatal US and refers to a banana- shaped configuration of the cerebellum. Associated with neural tube defects.

7) Bat wing appearance (chest)
Classic chest radiography finding for
pulmonary edema.

8) Bat wing appearance (neuro)
Appearance of 4th ventricle that may be seen with Joubert syndrome.

9) Beak sign
Sigmoid volvulus.

10) Bergman's coiled catheter sign
Sign of ureteral transitional cell carcinoma when a catheter coils in region of neoplasm
(see also Goblet sign).

11) Bird's beak
Narrowing of the esophagus in achalasia.

12) Bird's beak
Narrowing of the colon in cecal volvulus.

13) Blade of grass
Paget disease.

14) Bone in bone sign
Appearance of spine that may be seen osteopetrosis.

15) Boot-shaped Heart
Appearance of heart that may be seen with tetralogy of Fallot.

16) Boxcar ventricles
Appearance of frontal horns that may be seen in Huntington's disease.

17) Breast in a breast
Term to describe Fibroadenolipomas.

18) Bulging fissure sign
Bulging of a pulmonary fissure. Most
commonly associated with Klebsiella
pneumonia.

19) Bullet carpal bones
Appearance of carpal bones that may be seen with mucopolysaccharidoses.

20) Butterfly vertebrae
Results from failure of fusion of the lateral halves of the vertebral body because of persistent notochordal tissue between them

21) C sign
Sign of talocalcaneal tarsal coalition.

22) Cake kidney
All renal tissue is fused into one pelvic mass and gives rise to two separate ureters which enter the bladder in normal relationship.

23) Canoe paddle ribs :
Appearance of ribs that may be seen with mucopolysaccharidoses.

24) Celery stalking
Irregular appearance of metaphyses in patients with rubella. Also used to describe metaphyses in patients with osteopathia striata.

25) Central dot sign -aiims nov 2008
Sign of Caroli's disease.

26) Champagne sign
Specific but not commonly seen ultrasound finding for emphysematous cholecystitis.

27) Cloverleaf skull
Appreance of the skull that may be seen with thanatophoric dysplasia.

28) Cluster of grapes
Appearance that may be seen with
pneumatosis cystoides coli.

29) Cobra head sign
Dilatation of the distal ureter which may be seen in patients with ureteroceles.

30) Coffee bean sign
Sigmoid volvulus.

31) Collar sign
Sign of diaphragmatic rupture.

32) Comet sign
Sign to differential a phlebolith from a ureteral stone. Calcified phlebolith represents the comet nucleus and the adjacent, tapering, noncalcified portion of the vein is the comet
tail (also see soft-tissue rim sign).

33) Comet tail sign
Produced by the distortion of vessels and bronchi that lead to an adjacent area of round atelectasis.

34) Cord sign
Sign of intracranial dural sinus thrombosis.
(Also empty delta sign)

35) Corkscrew collaterals
Appearance of collaterals that may be seen in patients with Buerger disease.

36) Corkscrew sign
Upper GI series sign of midgut volvulus.

37) Corduroy appearance
Appearance of thickening trabeculations seen in intraosseous hemangiomas of the spine. See
also polka-dot pattern.

38) Crazy-paving sign
Nonspecific appearance consisting of linear network or reticular pattern with areas of ground-glass opacification. Classically
associated with pulmonary alveolar
proteinosis.

39) Crossover sign
Anterior acetabular rim is projected laterally relative to the same point of the posterior rim in the superolateral aspect of the acetabulum. See with pincer type femoroacetabular impingement.

40) Cyclops lesion
May occur status post anterior cruciate ligament reconstruction.

41) David Letterman sign
Sign of scapholunate ligament disruption (also see Terry Thomas sign).

42) Dense vessel sign
Sign of cerebrovascular accident that represent thrombus in the middle cerebral artery.

43) Dependent viscera sign
Sign of diaphragmatic rupture (viscera falls to a dependent position).

44) Dot and dash pattern
Sacral insufficiency fracture.

45) Double bleb sign
Appearance of amnion and yolk sac at 5-6 weeks. Embryo lies between amnion and yolk sac

46) Double bubble sign
Sign of duodenal atresia and other forms of duodenal obstruction.

47) Double decidua sign
Sign of early normal intrauterine gestation.

48) Double density sign (cardiac)
Sign of left atrial enlargement when right side of the left atrium pushes into the adjacent lung.

49) Double density sign (Nucs)
Pattern of uptake that may be seen on bone scans in patients with osteoid osteomas.

50) Double duct sign
Simultaneous dilatation of the common bile duct and pancreatic ducts that is generally caused by a tumor in the pancreatic head.

51) Double PCL sign
MRI sign of a bucket-handle meniscal tear.

52) Double track sign
Appearance of hypertrophic pyloric stenosis that may be seen on upper GI series.

53) Draped aorta sign
Sign of contained rupture of an abdominal aortic aneurysm.

54) Drooping lily sign
Inferolateral displacement of the opacified lower pole moiety in a duplex kidney from an obstructed (unopacified) upper pole moeity.

55) Egg on a string
Appearance of the heart that may be seen with transposition of great arteries.

56) Empty delta sign
Sign of intracranial dural sinus thrombosis.
(Also cord sign)

57) Epicardial fat pad sign
Sign of a pericardial effusion.

58) Eye of the tiger sign
low signal intensity circumscribing the globus pallidus in patients with Hallervorden-Spatz syndrome.

59) Faceless kidney
Appearance of kidney secondary to any process that obliterates renal sinus (i.e. lymphoma, transitional cell carcinoma).

60) Fallen fragment sign
Sign of a pathologic fracture seen with unicameral bone cysts.

61) Feeding vessel sign
Sign of pulmonary septic emboli.

62) Flame shaped (Breast)
Gynecomastia.

63) Flame shaped (MSK)
Paget disease.

64) Fat halo sign
Seen in various diseases of the bowel in which fatty infiltration of the submucosa is present.

65) Fat ring sign
Preservation of the perivascular fat around the mesenteric vessels that may be seen with mesenteric panniculitis.

66) Flat tire sign
Sign of a ruptured globe.

67) Flat waist sign
Appearance of left heart border that may be seen with left lower lobe atelectasis.

68) Figure 3 sign
Appearance of the aorta that may be seen in patients with coarctation of the aorta.

69) Figure of eight
Appearance of the brain in pachygyria.

70) Finger in glove sign
Sign of mucous plugging seen with allergic bronchopulmonary aspergillosis.

71) Fish vertebrae.
Description of shape of vertebral bodies that may be seen in patients with sickle cell disease.
See also: H-shaped vertebral bodies.

72) Football sign
Sign of pneumoperitoneum seen on supine radiographs.

Signs in Radiology

Signs in Radiology

1) Accordion sign:
Appearance of bowel that may be seen with pseudomembranous colitis.

2) Air crescent sign:
Appearance of cavitation that may be seen with invasive apergillosis.

3) Anteater's nose sign:
Sign of calcaneonavicular tarsal coalition. (Coalition=Fusion)

4) Apple Core lesion;
Circumferential narrowing of the lumen secondary to colon

5) Ball on tee sign
Sign of papillary necrosis on IVU.

6) Banana sign
Seen on antenatal US and refers to a banana- shaped configuration of the cerebellum. Associated with neural tube defects.

7) Bat wing appearance (chest)
Classic chest radiography finding for
pulmonary edema.

8) Bat wing appearance (neuro)
Appearance of 4th ventricle that may be seen with Joubert syndrome.

9) Beak sign
Sigmoid volvulus.

10) Bergman's coiled catheter sign
Sign of ureteral transitional cell carcinoma when a catheter coils in region of neoplasm
(see also Goblet sign).

11) Bird's beak
Narrowing of the esophagus in achalasia.

12) Bird's beak
Narrowing of the colon in cecal volvulus.

13) Blade of grass
Paget disease.

14) Bone in bone sign
Appearance of spine that may be seen osteopetrosis.

15) Boot-shaped Heart
Appearance of heart that may be seen with tetralogy of Fallot.

16) Boxcar ventricles
Appearance of frontal horns that may be seen in Huntington's disease.

17) Breast in a breast
Term to describe Fibroadenolipomas.

18) Bulging fissure sign
Bulging of a pulmonary fissure. Most
commonly associated with Klebsiella
pneumonia.

19) Bullet carpal bones
Appearance of carpal bones that may be seen with mucopolysaccharidoses.

20) Butterfly vertebrae
Results from failure of fusion of the lateral halves of the vertebral body because of persistent notochordal tissue between them

21) C sign
Sign of talocalcaneal tarsal coalition.

22) Cake kidney
All renal tissue is fused into one pelvic mass and gives rise to two separate ureters which enter the bladder in normal relationship.

23) Canoe paddle ribs :
Appearance of ribs that may be seen with mucopolysaccharidoses.

24) Celery stalking
Irregular appearance of metaphyses in patients with rubella. Also used to describe metaphyses in patients with osteopathia striata.

25) Central dot sign -aiims nov 2008
Sign of Caroli's disease.

26) Champagne sign
Specific but not commonly seen ultrasound finding for emphysematous cholecystitis.

27) Cloverleaf skull
Appreance of the skull that may be seen with thanatophoric dysplasia.

28) Cluster of grapes
Appearance that may be seen with
pneumatosis cystoides coli.

29) Cobra head sign
Dilatation of the distal ureter which may be seen in patients with ureteroceles.

30) Coffee bean sign
Sigmoid volvulus.

31) Collar sign
Sign of diaphragmatic rupture.

32) Comet sign
Sign to differential a phlebolith from a ureteral stone. Calcified phlebolith represents the comet nucleus and the adjacent, tapering, noncalcified portion of the vein is the comet
tail (also see soft-tissue rim sign).

33) Comet tail sign
Produced by the distortion of vessels and bronchi that lead to an adjacent area of round atelectasis.

34) Cord sign
Sign of intracranial dural sinus thrombosis.
(Also empty delta sign)

35) Corkscrew collaterals
Appearance of collaterals that may be seen in patients with Buerger disease.

36) Corkscrew sign
Upper GI series sign of midgut volvulus.

37) Corduroy appearance
Appearance of thickening trabeculations seen in intraosseous hemangiomas of the spine. See
also polka-dot pattern.

38) Crazy-paving sign
Nonspecific appearance consisting of linear network or reticular pattern with areas of ground-glass opacification. Classically
associated with pulmonary alveolar
proteinosis.

39) Crossover sign
Anterior acetabular rim is projected laterally relative to the same point of the posterior rim in the superolateral aspect of the acetabulum. See with pincer type femoroacetabular impingement.

40) Cyclops lesion
May occur status post anterior cruciate ligament reconstruction.

41) David Letterman sign
Sign of scapholunate ligament disruption (also see Terry Thomas sign).

42) Dense vessel sign
Sign of cerebrovascular accident that represent thrombus in the middle cerebral artery.

43) Dependent viscera sign
Sign of diaphragmatic rupture (viscera falls to a dependent position).

44) Dot and dash pattern
Sacral insufficiency fracture.

45) Double bleb sign
Appearance of amnion and yolk sac at 5-6 weeks. Embryo lies between amnion and yolk sac

46) Double bubble sign
Sign of duodenal atresia and other forms of duodenal obstruction.

47) Double decidua sign
Sign of early normal intrauterine gestation.

48) Double density sign (cardiac)
Sign of left atrial enlargement when right side of the left atrium pushes into the adjacent lung.

49) Double density sign (Nucs)
Pattern of uptake that may be seen on bone scans in patients with osteoid osteomas.

50) Double duct sign
Simultaneous dilatation of the common bile duct and pancreatic ducts that is generally caused by a tumor in the pancreatic head.

51) Double PCL sign
MRI sign of a bucket-handle meniscal tear.

52) Double track sign
Appearance of hypertrophic pyloric stenosis that may be seen on upper GI series.

53) Draped aorta sign
Sign of contained rupture of an abdominal aortic aneurysm.

54) Drooping lily sign
Inferolateral displacement of the opacified lower pole moiety in a duplex kidney from an obstructed (unopacified) upper pole moeity.

55) Egg on a string
Appearance of the heart that may be seen with transposition of great arteries.

56) Empty delta sign
Sign of intracranial dural sinus thrombosis.
(Also cord sign)

57) Epicardial fat pad sign
Sign of a pericardial effusion.

58) Eye of the tiger sign
low signal intensity circumscribing the globus pallidus in patients with Hallervorden-Spatz syndrome.

59) Faceless kidney
Appearance of kidney secondary to any process that obliterates renal sinus (i.e. lymphoma, transitional cell carcinoma).

60) Fallen fragment sign
Sign of a pathologic fracture seen with unicameral bone cysts.

61) Feeding vessel sign
Sign of pulmonary septic emboli.

62) Flame shaped (Breast)
Gynecomastia.

63) Flame shaped (MSK)
Paget disease.

64) Fat halo sign
Seen in various diseases of the bowel in which fatty infiltration of the submucosa is present.

65) Fat ring sign
Preservation of the perivascular fat around the mesenteric vessels that may be seen with mesenteric panniculitis.

66) Flat tire sign
Sign of a ruptured globe.

67) Flat waist sign
Appearance of left heart border that may be seen with left lower lobe atelectasis.

68) Figure 3 sign
Appearance of the aorta that may be seen in patients with coarctation of the aorta.

69) Figure of eight
Appearance of the brain in pachygyria.

70) Finger in glove sign
Sign of mucous plugging seen with allergic bronchopulmonary aspergillosis.

71) Fish vertebrae.
Description of shape of vertebral bodies that may be seen in patients with sickle cell disease.
See also: H-shaped vertebral bodies.

72) Football sign
Sign of pneumoperitoneum seen on supine radiographs.

Signs in Radiology

Signs in Radiology

1) Accordion sign:
Appearance of bowel that may be seen with pseudomembranous colitis.

2) Air crescent sign:
Appearance of cavitation that may be seen with invasive apergillosis.

3) Anteater's nose sign:
Sign of calcaneonavicular tarsal coalition. (Coalition=Fusion)

4) Apple Core lesion;
Circumferential narrowing of the lumen secondary to colon

5) Ball on tee sign
Sign of papillary necrosis on IVU.

6) Banana sign
Seen on antenatal US and refers to a banana- shaped configuration of the cerebellum. Associated with neural tube defects.

7) Bat wing appearance (chest)
Classic chest radiography finding for
pulmonary edema.

8) Bat wing appearance (neuro)
Appearance of 4th ventricle that may be seen with Joubert syndrome.

9) Beak sign
Sigmoid volvulus.

10) Bergman's coiled catheter sign
Sign of ureteral transitional cell carcinoma when a catheter coils in region of neoplasm
(see also Goblet sign).

11) Bird's beak
Narrowing of the esophagus in achalasia.

12) Bird's beak
Narrowing of the colon in cecal volvulus.

13) Blade of grass
Paget disease.

14) Bone in bone sign
Appearance of spine that may be seen osteopetrosis.

15) Boot-shaped Heart
Appearance of heart that may be seen with tetralogy of Fallot.

16) Boxcar ventricles
Appearance of frontal horns that may be seen in Huntington's disease.

17) Breast in a breast
Term to describe Fibroadenolipomas.

18) Bulging fissure sign
Bulging of a pulmonary fissure. Most
commonly associated with Klebsiella
pneumonia.

19) Bullet carpal bones
Appearance of carpal bones that may be seen with mucopolysaccharidoses.

20) Butterfly vertebrae
Results from failure of fusion of the lateral halves of the vertebral body because of persistent notochordal tissue between them

21) C sign
Sign of talocalcaneal tarsal coalition.

22) Cake kidney
All renal tissue is fused into one pelvic mass and gives rise to two separate ureters which enter the bladder in normal relationship.

23) Canoe paddle ribs :
Appearance of ribs that may be seen with mucopolysaccharidoses.

24) Celery stalking
Irregular appearance of metaphyses in patients with rubella. Also used to describe metaphyses in patients with osteopathia striata.

25) Central dot sign -aiims nov 2008
Sign of Caroli's disease.

26) Champagne sign
Specific but not commonly seen ultrasound finding for emphysematous cholecystitis.

27) Cloverleaf skull
Appreance of the skull that may be seen with thanatophoric dysplasia.

28) Cluster of grapes
Appearance that may be seen with
pneumatosis cystoides coli.

29) Cobra head sign
Dilatation of the distal ureter which may be seen in patients with ureteroceles.

30) Coffee bean sign
Sigmoid volvulus.

31) Collar sign
Sign of diaphragmatic rupture.

32) Comet sign
Sign to differential a phlebolith from a ureteral stone. Calcified phlebolith represents the comet nucleus and the adjacent, tapering, noncalcified portion of the vein is the comet
tail (also see soft-tissue rim sign).

33) Comet tail sign
Produced by the distortion of vessels and bronchi that lead to an adjacent area of round atelectasis.

34) Cord sign
Sign of intracranial dural sinus thrombosis.
(Also empty delta sign)

35) Corkscrew collaterals
Appearance of collaterals that may be seen in patients with Buerger disease.

36) Corkscrew sign
Upper GI series sign of midgut volvulus.

37) Corduroy appearance
Appearance of thickening trabeculations seen in intraosseous hemangiomas of the spine. See
also polka-dot pattern.

38) Crazy-paving sign
Nonspecific appearance consisting of linear network or reticular pattern with areas of ground-glass opacification. Classically
associated with pulmonary alveolar
proteinosis.

39) Crossover sign
Anterior acetabular rim is projected laterally relative to the same point of the posterior rim in the superolateral aspect of the acetabulum. See with pincer type femoroacetabular impingement.

40) Cyclops lesion
May occur status post anterior cruciate ligament reconstruction.

41) David Letterman sign
Sign of scapholunate ligament disruption (also see Terry Thomas sign).

42) Dense vessel sign
Sign of cerebrovascular accident that represent thrombus in the middle cerebral artery.

43) Dependent viscera sign
Sign of diaphragmatic rupture (viscera falls to a dependent position).

44) Dot and dash pattern
Sacral insufficiency fracture.

45) Double bleb sign
Appearance of amnion and yolk sac at 5-6 weeks. Embryo lies between amnion and yolk sac

46) Double bubble sign
Sign of duodenal atresia and other forms of duodenal obstruction.

47) Double decidua sign
Sign of early normal intrauterine gestation.

48) Double density sign (cardiac)
Sign of left atrial enlargement when right side of the left atrium pushes into the adjacent lung.

49) Double density sign (Nucs)
Pattern of uptake that may be seen on bone scans in patients with osteoid osteomas.

50) Double duct sign
Simultaneous dilatation of the common bile duct and pancreatic ducts that is generally caused by a tumor in the pancreatic head.

51) Double PCL sign
MRI sign of a bucket-handle meniscal tear.

52) Double track sign
Appearance of hypertrophic pyloric stenosis that may be seen on upper GI series.

53) Draped aorta sign
Sign of contained rupture of an abdominal aortic aneurysm.

54) Drooping lily sign
Inferolateral displacement of the opacified lower pole moiety in a duplex kidney from an obstructed (unopacified) upper pole moeity.

55) Egg on a string
Appearance of the heart that may be seen with transposition of great arteries.

56) Empty delta sign
Sign of intracranial dural sinus thrombosis.
(Also cord sign)

57) Epicardial fat pad sign
Sign of a pericardial effusion.

58) Eye of the tiger sign
low signal intensity circumscribing the globus pallidus in patients with Hallervorden-Spatz syndrome.

59) Faceless kidney
Appearance of kidney secondary to any process that obliterates renal sinus (i.e. lymphoma, transitional cell carcinoma).

60) Fallen fragment sign
Sign of a pathologic fracture seen with unicameral bone cysts.

61) Feeding vessel sign
Sign of pulmonary septic emboli.

62) Flame shaped (Breast)
Gynecomastia.

63) Flame shaped (MSK)
Paget disease.

64) Fat halo sign
Seen in various diseases of the bowel in which fatty infiltration of the submucosa is present.

65) Fat ring sign
Preservation of the perivascular fat around the mesenteric vessels that may be seen with mesenteric panniculitis.

66) Flat tire sign
Sign of a ruptured globe.

67) Flat waist sign
Appearance of left heart border that may be seen with left lower lobe atelectasis.

68) Figure 3 sign
Appearance of the aorta that may be seen in patients with coarctation of the aorta.

69) Figure of eight
Appearance of the brain in pachygyria.

70) Finger in glove sign
Sign of mucous plugging seen with allergic bronchopulmonary aspergillosis.

71) Fish vertebrae.
Description of shape of vertebral bodies that may be seen in patients with sickle cell disease.
See also: H-shaped vertebral bodies.

72) Football sign
Sign of pneumoperitoneum seen on supine radiographs.

PSM MCQ - Part 1

1) WHO declared global eradication of small pox on-
A. 26th October 1997
B. 5th July 1975
C. 17th May 1975
D. 8th May 1980
Ans. :- (d) 8th May 1980 [Ref: 23rd /e p. 143]
Exp.: - The WHO declared on 8th may 1980 that smallpox had been eradicated.

2) The last case of small pox was reported in the world
A. 1997
B. 1978
C.1979
D. 1982
Ans. :- (a) 1997 [Ref: 23rd /e p. 143]
Exp.: - The world’s last case of smallpox occurred in Somalia on 26 October 1977 (Apart from laboratory accident in 1978).

3) Small pox eradication was successful because of all except-
A. Subclinical cases don’t transmit disease
B. Highly effective vaccine
C. Lifelong immunity
D. Cross resistance with animal pox
Ans.:- (d) Cross resistance with animal pox [Ref: 23rd /e p. 143]
Exp.:- Small pox eradication – Epidemiological basis
No known animal reservoir
No long – term carrier of the virus.
Life – long immunity after recovery from the disease.
The detection of cases comparatively simple because the rash was so characteristic and occurred in visible parts of the body.
Persons with sub-clinical infection did not transmit the disease.
Vaccine is highly effective; easily administered, heat stable and confers long – term protection.
International cooperation.

4) Which of the following factors helped in smallpox eradication?
A. Short incubation period of disease
B. Slow evolution of rashes over body
C. Long-term carrier stages in patients
D. Life-long immunity after disease
Ans.:- (d) Life-long immunity after disease [Ref: 23rd /e p. 142]

5) The infectivity of chicken pox lasts for-
A. Till the last scab falls off
B. 6 days after onset of rash
C. 3 days after onset of rash
D. Till the fever subsides
Ans.:- (b) 6 days after onset of rash [Ref: 23rd /e p. 144]
Exp.:- infectious period of chicken pox: - 2 days before and 5 days after the onset of rash.

6) Rash of chickenpox can be differentiated from the rash of small pox by the all except-
A. Pleomorphic
B. Centripetal
C. Deep-seated
D. Unilocular
Ans.:- (c) Deep- seated [Ref: 23rd /e p. 144]
Exp.:- Rash of chickenpox is superficial (not deep seated).
      :- Rash of chicken pox : Superficial, unilocular, centripetal, pleomorphic, symmetrical, affects         flexor surfaces and axilla, spares palms and sales, has inflammation around, rapid evolution and dew-drop on rose petal appearance.

7) All of the following are characteristics of the chicken pox rash except-
A. Rash occurs in crops
B. Pleomorphism is present
C. Is centripetal in distribution
D. Scab are infectious
Ans.:- (d) Scab are infectious [Ref: 23rd /e p. 144]
Exp.:- The fluid of vesicle of chickenpox contains virus during first 3 days of illness, but scab is non-infective.

8) Secondary attack rate of chicken pox is-
A. 60
B. 50
C. 90
D. 40
Ans.:- (c) 90 [Ref: 23rd /e p. 144]
Exp.:- Secondary attack rate of chicken pox is high, up-to 90 %.

9) Not true about varicella infection-
A. Secondary attack rate is 90%
B. Lesions occur on flexor surfaces
C. Only single stage of lesion is present at a time
D. Reactivation occur in 10-30% cases
Ans.: -(c) Only single stage of lesion is present at a time [Ref: 23rd /e p. 144]
Exp.:- The characteristic feature of chicken pox is “Pleomorphism”, that is, all stages of the rash (papules, vesicles and crusts) may be seen simultaneously at time in the same area.
      :-Chicken pox (varicella infection) is highly communicable by droplet infection with a secondary attack rate of approximately 90%.
      :-Rashes of chicken pox are symmetrical and occur mostly on flexor surface.
      :-Latent infection is established in cranial nerve, sensory ganglia and spinal dorsal root ganglia. The virus may reactivate in immunosuppressive conditions, resulting in herpes zoster in about 10-30% of persons.

10) Chicken pox vaccine is-
A. Live vaccine
B. Killed vaccine
C. Conjugated vaccine
D. None
Ans.: - (a) Live vaccine [Ref: 23rd /e p. 145]
Exp.:- Varicella vaccine is live attenuated vaccine and is recommended for children between 12-18 months of age.

11) Incubation period of measles-
A. 14 days
B. 1 Month
C. 3 Month
D. 5 Month
Ans.: - (a) 14 days [Ref: 23rd /e p. 145]
Exp.:- Incubation period of measles is 10-14 days.

12) Which of the following statements is true about the epidemiological determinants of measles-
A. Measles virus survives outside the human body for 5 days
B. Carriers are important sources of infection
C. Secondary attack is less than that of rubella
D. Incidence of measles is more in males than females
Ans.:- (c) Secondary attack is less than that of rubella [Ref: 23rd /e p. 147]
Exp.:- SAR of some important infectious diseases
         Measles       —80%
         Rubella         —90-95%
         Chicken pox — ~90%
         Pertussis       -- ~90%
         Mumps         -- ~86%
About other options
The measles virus cannot survive outside the human body for any length of time. But it retains infectivity when stored at sub – zero temperature.
The only source of infection is a case of measles, carriers are not known to occur.
Incidence of measles is same in males and females.

13) Measles is infectious during-
A. After 4 days of rash
B. 4 days before and 5 days after rash
C. Throughout disease
D. Only in incubation period
Ans.:- (b) 4 days before and 5 days after rash [Ref: 23rd /e p. 147]
Exp.:- the period of communicability for measles is 4 days before and 5 days after the appearance of rash.

14) Which of the following is the “Least common” complication of measles-
A. Diarrhea
B. Pneumonia
C. Otitis media
D. SSPE
Ans.:- (d) SSPE [Ref: 23rd /e p. 148]
Exp.:- Sub-acute sclerosing panencephalitis (SSPE) is a rare complication of measles, which develops many years after the initial infection.
         :- The most common complications are : measles – associated diarrhea, pneumonia and otitis media-

15) Most serious complication of measles is-
A. Koplik spots
B. Parotitis
C. Meningoencephalitis
D. Nephritis
Ans.:- (c) Meningoencephalitis[Ref: 23rd /e p. 148]
Exp.:- Neurological complications are more severe, e.g., febrile convulsions, encephalitis, and SSPE.

16) Reconstituted measles vaccine should be used with in-
A. 1 hour
B. 3 hour
C. 6 hour
D. 12 hour
Ans.:- (a) 1 hour [Ref: 23rd /e p. 148]
Exp.:- “The reconstituted vaccine should be kept on ice and used within one hour”.

17) India started 2-dose vaccination strategy for measles, in-
A. 2008
B. 2009
C. 2010
D. 2011
Ans. :- (c) 2010 [Ref: Park 20th /e 138]
Exp.:- In the 2010, the world’s two most populous countries made promising advancing measles control:-
China held the largest ever SIA, vaccinating more than 103 million children.
India started implementation of 2- dose vaccination strategy.

18) All the true about measles except –
A. Incubation period is 10-14 days
B. Secondary attack rate is 30-40%
C. Sub cutaneous vaccine is available
D. Vaccine is live attenuated
Ans.:- (b) Secondary attack rate is 30-40% [Ref: Park 23th /e 147]
Exp.:- SAR of measles is approximately 80%.

19) Definition of measles elimination-
    A. <1/1000
B. <1/10000
C. <1/100000
D. <1/100
Ans.:- (c) 1<100000 [Ref: Park 23th /e 150]
Exp.:-
WHO defines elimination of measles as the absence of endemic measles for a period of >_ 12 months in the presence of adequate surveillance.
One indicator of measles elimination is a sustained measles incidence < 1/100, 000 population.
In 2005, the World Health Assembly set a goal of achieving a 90% reduction in global measles mortality by 2010 as compared with level in 2000.

20) Measles vaccination compaign between 9-14 years age for elimination is-
A. Keep up
B. Follow up
C. Mop up 
D. Catch up
Ans.:- (d) Catch up [Ref: Park 23rd /e p. 149 & 22th /e p. 135-138]
Exp.:-
WHO’s measles elimination strategy comprises a three part vaccination strategy, i.e:-
Catch up one time, nationwide vaccination campaign targeting usually all children aged 9 months to 14 years regardless of history of measles disease or vaccination status.
Keep up routine service aimed at vaccinating more than 95% of each successive birth cohort
Follow-up subsequent nationwide vaccination campaign conducted every 2-4 years targeting usually all children born after catch up campaign.

21) Sub-acute sclerosing pan-encephalitis is associated with-
A. Mumps
B. Measles
C. Rubella
D. Typhoid
E. Diphtheria
Ans. :- (b) Measles [Ref: Park 23rd /e p. 148 & 22th /e p. 139]

22) All of following are true about measles except-
A. Maximum incidence in 6m-3  years age group
B. Best age for immunization is 9-12 months
C. Secondary attacks rate is 30%
D. I.P.= 7-14 days
Ans.:- (c) Secondary attacks rate is 30% [Ref: Park 23rd /e p. 147& 22th /e p. 138 & 139]

23) Measles vaccination is given at-
A. 9 months
B. At birth
C. 4 weeks
D. 8 weeks
E. Secondary attacks rate is 30%
Ans.:- (a) 9 months [Ref: Park 23rd /e p. 149 & 22th /e p. 140]
Exp.:-
The WHO expanded program on immunization recommends immunization at 9 months of age.
Now, second dose of measles is also given at 16-24 months in national immunization schedule.
 
24) In measles vaccine can be given within-
A. 3 months
B. 5 months
C. 7 months
D. 6 months
Ans.:- (d) 6 months [Ref: Park 23rd /e p. 149 & 22th /e p. 140]
Exp.:-
The best age for measles vaccination is 9 months.
It can be lowered to 6 months if there is measles outbreak in the community. For infants immunized between 6 months and 9 months of age, second dose should be administrated as soon as possible after child reaches the age of 9 months provided that at least for weeks have elapsed since the last dose.

25. To eradicate measles the percentage of population to be vaccinated is at least_________%-
A. 70
B. 80
C. 85
D. 95
Ans.:- (d) 95[Ref: Park 23rd /e p. 149]
Exp.:-
Epidemic of measles occur if proportion of susceptible children is >40%.
If measles is introduced in virgin community it infects >90% of children.
Eradication of measles require vaccine coverage >96%.

26. Measles epidemic can be anticipated when proportion of susceptible children in a community reaches-
A. 20%
B. 40%
C. 60%
D. 80%
Ans. :- (b) 40%
Exp.:-
Measles is endemic all over the world.
So if the proportion of susceptible in terms of unvaccinated children, new births or immigrants reaches 40% the protection afforded by herd immunity

27. Incubation period of rubella is-
A. 18-72 hours
B. 2-3 weeks
C. 1-3 months
D. >1 years
Ans.:- (b) 2-3 weeks [Ref: Park 23rd /e p. 150& 22th /e p. 142]
Exp.:-
Incubation period of rubella is 2-3 weeks.

28. Rubella virus was isolated in-
A. 1862
B. 1912
C. 1932
D. 1962
Ans. :- (d) 1962[Ref: Park 23rd /e p. 150& 22th /e p. 141]
Exp.:-
Rubella virus was isolated in 1962 and live attenuated vaccine was developed in 1967.

29. Under eradication of congenital rubella syndrome program the first priority group for rubella vaccination is-
A. All non-pregnant women of age 15 to 34
B. All adolescent non pregnant girls 15 to 24 years of age
C. All female children at one year
D. All non-pregnant women
Ans.:- (a) All non-pregnant women of age 15 to 34[Ref: Park 23rd /e p.151 & 22nd /e p. 142-143]

30. Rubella vaccine is given in which age –
A. 1-14 years
B. <5 years
C. >50 years
D. None
Ans.:- (a) 1-14 years [Ref: Park 23rd /e0 p. 151]

31. Risk of the damage of fetus by maternal rubella is maximum if mother gets infected in-
A. 6-12 weeks of pregnancy
B. 20-24 weeks of pregnancy
C. 21-25 weeks of pregnancy
D. 32-36 weeks of pregnancy
Ans.:- (a) 6-12 weeks of pregnancy [Ref: Park 23rd /e p.151 & 22nd /e p. 142]

32. Most common viral disease affecting parotid glands-
A. Mumps
B. Measles
C. Rubella
D. Varicella
Ans. :- (a) Mumps [Ref: Park 23rd /e p. 152 & 22nd /e p. 143]
Exp.:-
Among the given the options mumps affect salivary glands most commonly.

33. Commonest complication of mumps is –
A. Orchitis and oophritis
B. Encephalitis
C. Pneumonia
D. Myocarditis
Ans.:- (a) Orchitis and oophritis[Ref: Harrison 18th /e p. 1609 & 17th /e p. 1220]
Exp.:-
Orchitis is most common manifestation of mumps among sub-pubertal males.

34. With reference to mumps which of the following is true-
A. Meningoencephalitis can precede parotitis
B. Salivary gland involvement is limited to the parotid
C. The patient is not infectious prior to clinical parotid enlargement
D. Mumps orc Meningoencephalitis can precede parotitis
  Ans.:-(a) Meningoencephalitis can precede parotitis[Ref: Harrison 18th /e p. 1608& 1609 & 17th /e p. 1220]
  Exp.:-“Aseptic meningitis may develope before, during, after or in the absence of parotitis.”
Mainly parotid glands are involve, but sublingual and sub-maxillary glands may also be involved.
Patient is infectious 4-6 days before onset of swelling.
Sterility after mumps orchitis is rare.

35. Incubation period of Mumps-
A. 4-5 days
B. 7-15 days
C. 12-24 days
D. 50 days
Ans.:- (c) 12-24 days [Ref: Park 23rd /e p. 152 & 21st / e p. 137]

36. Incubation period of influenza –
A. 18 – 72 hours
B. 1 – 6 hours
C. 5 – 10 hours
D. <1 hours
Ans.:- (a) 18-72 hours [Ref: Park 23rd /e p. 154 & 22nd / e p. 146]
Exp.:-
Incubation period of influenza is 18-72 hours

37. Influenza pandemic is mainly caused by-
A. Type A
B. Type B
C. Type C
D. All
Ans.:- (a) Type A [Ref: Park 23rd /e p. 154 &22nd /e p. 145]
Exp.:-
Type A causes all pandemics and most of the epidemics.

38. Antigenic variation seen in which of the following –
A. Influenza virus
B. Hepatitis virus
C. Yellow fever virus
D. Leptospira
Ans.:- (a) influenza virus [Ref: Park 23rd /e p.145 & 22nd /e p. 144]
Exp.:-
Unique feature of influenza virus is its ability to undergo antigenic variation.
Antigenic variability is highest in influenza virus Type A, less in Type B, while it is not been demonstrated in Type C.

39. True regarding antigenic shift –
A. Gradual
B. Seen in influenza A & B
C. Due to genetic recombination
D. Due to point mutation
              Ans.:- (c) Due to genetic recombination [Ref: Park 23rd /e p. 154 & 20th /e p. 145]
               Exp.:-
               Antigenic drift
Antigenic change is gradual over a period of time.
New antigens though different from the previous antigens, are yet related to them.
Antigenic drift involves point mutation in the gene owing to selection pressure by immunity in the population.
Antigenic drift accounts for the periodic epidemics of influenza.
Occurs every 2-3 years in case of influenza A and every 4-7 years in case of influenza B.

Antigenic shift
And abrupt, drastic discontinuous variation in the antigenic structure.
Result from genetic recombination of human with animal or avian virus.
Accounts for major epidemics or pandemics.
Occurs every 10-15 years.
Occurs in influenza A only

40. False about antigen drift-
A. Causes pandemic
B. Occurs due to mutation
C. Occurs more frequently
D. Affected by previous antibodies
Ans.:- (a) Causes pandemic [Ref: 23rd /e p. 154 & Ananthanarayan 8th /e p.496]
Exp.:-
Antigenic shift is responsible for pandemic.
Antigenic drift occurs due to point mutation.
Antigenic drift occurs more frequently (2-3 years) then antigenic shift (10-15 years).
Antigenic drift is influenced by presence of antibody to the predecessor strains in the host population.

41. Not true regarding influenza virus is-
A.  All types exhibit antigenic shift
B. Only type A shows antigenic drift
C. Drift is accumulation of point mutations
D. None of the above
Ans.:-(a) All types exhibit antigenic shift & (b) Only type A shows antigenic drift[Ref: Park 23rd /e p.154 & 22nd /e p. 145]
Exp.:-
Antigenic shift is seen only in influenza A virus.
Antigenic drift is seen only in influenza A & b virus.
Antigenic drift involves point mutation in the gene owing to selection pressure by immunity in the host population.

42. True about epidemiology of influenza –
A. Asymptomatic seen rarely
B. Incubation period 10-12 hours
C. Pandemic rare
D. Extra human reservoir not seen
E. All  ages sex are equally affected
Ans.:- (e) all ages sex are equally affected [Ref: Park 23rd /e p.154 & 22nd /e p.145
Influenza affects all ages and both sexes
About other options
Most infections are subclinical.
Incubation period is 18-72 hrs.
Influenza causes pandemic every 10-15 years.
Major reservoir of influenza virus exist in animals and birds.

43. H5N1 is a strain of –
A. Avian flu
B. New vaccine against AIDS
C. Agent for Japanese encephalitis
D. Causes Chickengunya fevers
Ans.:- (a) Avian flu [Ref: Park 23rd /e p. 153& Harrison 18th /e p. 1494 & 17th /e p. 1127]
Exp.:-
In 1997, human cases of influenza caused by avian influenza viruses (A/H5N1) were detected in Hong-Kong during an extensive outbreak of influenza in poultry.
All these cases were associated with contact with infected poultry.

44. Which of the following lead to an outbreak of Influenza in China in 2013 –
A. H1N1
B. H3N2
C. H2N2
D. H7N9
E. H5N1
              Ans.:- (d) H7N9 [Ref: WHO H7N9 Avian influenza 2013 document]
             Exp.:-
In china, there was an outbreak of influenza caused by avian influenza H7N9 in 2013
It started in china and spread to Hong-Kong.
All these cases were associated with contact with infected poultry.

45. Pig in H1N1 influenza acts as?
A. Carrier
B. Amplifying host
C. Reservoir
D. Vector
Ans.:- (c) Reservoir [Ref: Park 23rd /e p. 154& www.fass.org]
Exp.:-
“Pig serve as major reservoir of H1N1 & H3N2 influenza viruses which are endemic in pig population worldwide and are responsible for one of the most prevalent respiratory diseases in pigs.”………..www.fass.org

46. Swine flu is caused most commonly by –
A. H1N1
B. H5N1
C. H3N2
D. B virus
             Ans.:- (a) H1N1 [Ref: Essentials of microbiology 701]
              Exp.:-
Swine flu is most commonly caused by H1N1 influenza 4
Other influenza virus causing swine flu occasionally are H1N2, H2N1, H3N2 & H

47. Incubation period of swine flu –
A. 1-3 days
B. 2-3 weeks
C. 10-15 days
D. 5 weeks
Ans.:- (a) 1-3 days [Ref: Essentials of Microbiology p. 701]
Exp.:-
Swine flu, also called swine influenza, pig influenza, is caused by influenza virus.
Incubation period is about 1-3 days and the symptoms of swine flu in humans are similar to most influenza infection, e.g., fever, cough, rhinorrhea, fatigue and headache.

48. Most common source of Diphtheria-
A. Case
B. Carrier
C. Both
D. None
Ans.:- (b) Carrier [Ref: Park 23rd /e p. 160]
Exp.:- Source of infection cases of carriers; carriers are common sources of infection, there ratio is estimated to be 95 carriers for clinical cases.

49. The infectivity of a patient with diphtheria is-
A. Till cough subsides
B. Till patient is febrile
C. Life long
D. For 15 days after infection
Ans.:- (d) For 15 days after infection [Ref: Park 23rd /e p. 161]
Exp.:-
The period of infectivity may vary from 14 to 28 days from the onset of the disease, but carriers may remain infective for much longer period.
A case or carrier may be considered non – communicable when at least to cultures properly obtain from nose and throat, 24 hours apart, are negative for diphtheria bacilli.

50. A herd immunity of over - % is considered necessary to prevent epidemic spread of diphtheria-
A. 50%
B. 55%
C. 60%
D. 70%
Ans.:- (d) 70% infection [Ref: Park 23rd /e p. 161]
Exp.:- A herd immunity of over 70% is considered necessary to prevent epidemic spread, but some believe that the critical level may be as high as 90%.

Metabolic pathways in cytosol & mitochondria

♦Metabolic pathways in cytosol :-
-Glycolysis
-Glycogenolysis
-HMP shunt
-Glycogenesis
-Fatty acid synthesis
-Cholesterol synthesis
-Bile acid - bile salts synthesis

♦Pathways in mitochondria :-
-Fatty acid oxidation (<20 C)
-ETC
-Krebs cycle
-Oxidative phosphorylation

♦Pathways initially in mitochondria followed by cytosol :-
-Urea synthesis
-Gluconeogenesis

Alien Hand Syndrome

Alien Hand Syndrome

The phrase, “the right hand doesn’t know what the left is doing” is actually literally true for some people. The condition involves a rogue hand that acts independently, grasping objects or moving in a way contrary to what the individual wishes to do..

Sometimes, a rare side effect to brain injuries or surgical severing of the corpus callosum, is the inability to control the actions of one hand. There is no cure for this condition, though the symptoms can be managed by making sure the hand is actively engaged in activity...

Immunoglobulin - The Ultimate Protector

***RAPID REVISION***

1- SMALLEST Ig-IgG
2- LARGEST Ig - Ig M
3- MAXIMUM SERUM CONCENTRATION Ig-Ig G
4- MINIMUM SERUMCONCENTRATION  Ig -IgE
5- HEAT LABILE Ig - IgE
6- EARLIEST TO BE SYNTHESISED (PRIMARY IMMUNE REAPONSE) Ig -IgM
7- SECONDARY IMMUNE RESPONSE Ig -IgG
8- CROSSES PLACENTA Ig - IgG
9- MINIMUM HALF LIFE Ig - IgE
10- MAXIMUM HALF LIFE Ig -IgG
11- PROTECTS SURFACES Ig - lgA
12- WARM ANTIBODIES Ig - IgG
13- COLD ANTIBODIES Ig - IgM
14- PRESENT IN MILK Ig - IgG & IgA
15- FIX COMPLEMENTS VIA CLASSICAL PATHWAY Ig - IgM & IgG
16- FIX COMPLEMENTS VIA ALTERNATIVE PATHWAY Ig - IgA & IgD
17- PRIMARY ALLERGIC RESPONSE Ig - IgE
18- MAXIMUM SEDIMENTATION COFFICIENT Ig - IgM
19- REAGIN ACTIVITY Ig - IgE
20- ANTIGEN RECOGNITION BY B CELLS Ig - IgD
21- PRAUSNITZ KUSTNER REACTION Ig - IgE
22- HOMOCYPTOTROPISM Ig - IgE
23- HIGHEST CARBOHYDRATE Ig - IgE
24- LOWEST CARBOHYDRATE Ig - IgG

“Stone Man Syndrome”

“Stone Man Syndrome”

Fibrodysplasia ossificans progressiva (FOP) is a progressive genetic disorder that turns soft tissues into bone over time. The ACVR1 gene found in bone, muscles, tendons, and ligaments regulates growth and development of those tissues, and is normally responsible for turning cartilage into bone as children develop. However, mutations of this gene can allow ossification to go unchecked throughout a sufferer's life, even turning skeletal muscle into bone and causing joints to fuse together.

This disorder occurs in about 1 in 2 million people, and there are currently no treatments or cures. Trauma exacerbates the condition, so attempts to remove bone surgically just results in the body producing even more bone in the area.

Vampire Syndrome

“Vampire Syndrome”

Humans need sunlight to synthesize vitamin-D, but too much exposure to the Sun’s UV rays can damage the skin. Approximately 1 in 1 million people have xeroderma pigmentosum and are extremely sensitive to UV rays..
These people must be completely
shielded from sunlight, or will experience extreme sunburns and breakdown of the skin. If someone with the condition isn’t careful, they could easily develop skin cancer.

Xeroderma pigmentosum is caused by a rare recessive mutation of the nucleotide excision repair enzymes. Functioning normally, these enzymes correct damaged DNA that can be caused by UV rays. For those with this condition, the enzymes do not work properly and DNA damage persists and accumulates. While there are some treatments available, the best
prevention from damage is merely
staying completely out of sunlight, just like a vampire...