All of the following are impulse control disorders except;

1. Pyromania.

2. Trichotillomania.

3. Kleptomania.

4. Capgras’ sydrome.

Answer4. Capgras’ sydrome.

Impulse control disorders are characterized by impulsive behaviour which the patient cannot resist or control. There may be a feeling of release of tension by doing the act and a feeling of guilt after the act is over

Explanation
1. Pyromania is an Impulse control disorder and is Pathological Fire setting.
2. Trichotillomania is an Impulse control disorder and is compulsive hair pulling.
3. Kleptomania is an Impulse control disorder and is pathological stealing.
4. Capgras’ sydrome is not an impulse control disorder.

Capgras Syndrome is a syndrome that is closely related to delusional disorders and it is characterized by a delusional conviction that the other persons in the environment are not their real selves but heir doubles. It is commonly seen in psychotic conditions with delusional symptomatology like Paranoid Schizophrenia (most frequently) Delusional Disorders and Organic Delusional disorder.

GRANULOMATOUS VASCULITIS

Wegeners and Churge Taken a Giant Cell.

W=Wegener's grenulomatosis

C=Chugg Straus's syndrome

T=Takayasu

G=Giant Cell Arteritis

MALLORY HYALINE BODY seen in --->

Rremember this by BHAI (W)

B===Billary cirrhosis ( Primary)

H===Hepatocellular Carcinoma(H.C.C.)

A===Alcoholic hepatitis ( M.C. CAUSE)

I====Indian childhood cirrhosis

W===Wilson's disease

A 55- year -old woman has recurrent urinary retention after a hysterectomy done for huge fibroid. The most likely cause is:
1. Atrophic and stenotic urethra.
2. Lumbar disc prolapse.
3. Injury to the bladder neck.
4. Injury to the hypogastric plexi.
Answer
4. Injury to the hypogastric plexi.


Explanation
1. Atrophic and stenotic urethra follows surgeries on the bladder neck for a fistula.
2. Lumbar disc prolapse is not related to this question.
3. Injury to the bladder neck is not common in Hysterectomy.
4. Injury to the hypogastric plexi.

A 20- year-old man has presented with increased alcohol consumption and sexual indulgence, irritability, lack of sleep, and not feeling fatigued even on prolonged periods of activity. All these changes have been present for 3 weeks. The most likely diagnosis is
1. Alcohol dependence
2. Schizophrenia.
3. Mania
4. Impulsive control disorder.

Ans-Mania

Explanation
1. Other than that he takes Alcohol, no other feature supports Alcohol dependence.2. Schizophrenia rarely presents like this.3. Mania is the correct diagnosis for this patient. We can see that all the features that are seen in this patient are the ones seen in Mania4. Impulsive control disorder does not present like this. Please look at the other question for Impulse control disorders

Honeycombimg of lung in C.X.R. is seen in :

R.A.
Scleroderma
Interstitial lung disease

A 2 year old boy suffering from leukaemia following are the x-ray finding :

Metaphysical osteoporosis
Periostial new bone formation
Transverse line of dark bands below the growth plate

(nuemonic-MTP)

Milliary shadows" on chest X-ray is seen in :

Tuberculosis
Rheumatoid Arthritis
Pneumoconiosis
Metastasis

"Milliary shadows" on chest X-ray is seen in :

Tuberculosis
Rheumatoid Arthritis
Pneumoconiosis
Metastasis

Tumors that are sensitive to chemotherapy :
Lymphoma
Germ cell tumor
Leukaemia

(CHoRiocarcinoma-CHemoResistant)

In a CT scan at the level of celiac trank, following structures will be seen :

Pancreas
Inferior vena cava
Portal vein

All isotopes are used for thyroid except :

I-131
I-123
I-125

Hypertranslucency of lung unilaterally is not seen in

Pulm art. obstruction

Which one of the following preservatives is used while packing catgut suture?
1. Isopropyl alcohol.
2. Colloidal iodine.
3. Glutaraldehyde.
4. Hydrogen peroxide.

• The suture is supplied sterile in "pre-cut" lengths or non-needled or attached to various needle types in one dozen boxes. • Suture is supplied with packing fluid o 90% Isopropyl Alcohol, o 0.5% Sodium Benzoate, o 0.5% Diethylethanolamine and o water q.s. ad 100%.
Explanation1.
Isopropyl alcohol is used while packing catguts. 2. Colloidal iodine is used as a skin disinfectant. 3. 2 % Glutaraldehyde is used for sterilizing Bronchoscope. (Asked in AIPGE 2003)4. Use of Hydrogen peroxide in Surgical Wards is a well known fact and needs no introduction to medical students .

A 20 year old woman gives a history of sharp pain in the lower abdomen for 2-3 days every month approximately 2 weeks before the menses. The most probable etiology for her pain is:
1. Endometriosis.
2. Dysmenorrhea.
3. Pelvic tuberculosis.
4. Mittelschmerz.
Answer
4. Mittelschmerz.

Discussion
Mittleschmerz is Painful Ovulation
· Pain associated with rupture of Ovarian Follicle at the Time of Ovulation
· Pain occurs at regular time in succeeding or intermittent cycles
· Usually at the time of cvulation
· Short Duration < 12 hours
· Slight Vaginal Bleeding may be present
· Treated with Analgesics and Assurance

Explanation
1. In Endometriosis pain is at the time of Menstraution.
2. In Dysmenorrhea. pain is at the time of Menstraution
3. In Pelvic tuberculosis pain is not cyclical.
4. Mittelschmerz classically presents as described above.

Comments
The only factor that created concern in this question is that OUR PATIENT experiences pain for 2 to 3 days, where as Shaw says that Mittelschmerz is usually of shorter duration

T cells express cell surface proteins, described by cluster determination (CD) numbers
TH cells express CD4 molecules on their cell surface

• Enables the lymphocyte to bind to a MHC class II molecule
• T cell receptor is unique in that it is only able to identify antigen when it is associated with a MHC molecule on the surface

Cytotoxic cells possess CD8 cell surface markers, which bind to antigenic peptides expressed on MHC class I molecules

T cells are divided into two distinct populations, which behave either as cytotoxic T cells or helper T cells (TH cells)
TH cells may be sub-divided into TH1 and TH2
TH1 are pro-inflammatory T cells and stimulate macrophages
TH2 orchestrate B cell differentiation and maturation and hence are involved in the production of humoral immunity (antibody mediated)

Thought disorders may be considered under the following headings:
form
content
flow
possession

There are three important disorders of the form of thought:
preoccupations:
these are thoughts or patterns of thinking which occur frequently but can be terminated if desired
one should always enquire about suicidal preoccupations in the depressed patient
preoccupations are a perpetuating factor in anxiety disorders e.g. thoughts about health in panic disorder
obsessive thoughts:
these are intrusive thoughts which are resisted by the patient
often the content of the thought is thought unacceptable
delusions:
in brief, a delusion is a false belief which is both culturally unconventional and held on inadequate grounds
delusions may be difficult to elicit as the patient either does not view them as unusual or is suspicious of the interviewer


Disorders of the content of thought include:
paranoid, including grandiose and persecutory thoughts
depressive, relating to the past, present or future
a depressed patient should always be asked about the suicidal content of their thoughts
other - e.g. obsessions, compulsions, hypochondriacal preoccupations

Disorders of the flow of thought fall into three categories:
flight of ideas
perseveration
loosening of associations
thought block

Disorders of the possession of thought include:
thought insertion
thought withdrawal
thought broadcasting



Many types of neurosis may be organised under three headings:
anxiety
obsessional disorder
somatoform (and dissociative) disorders

Neuroses are mental disorders without any demonstrable organic basis, in which the patient does not lose touch with external reality or experience psychotic symptoms. In general they represent exaggerated forms of the normal reactions to stressful events. Literally their name means a state of nerves.
Neuroses are characterised by:
the absence of symptoms such as hallucinations, delusions, thought disorder or intellectual impairment
anxiety is present
there is no change in personality
insight is preserved
Neuroses account for 20 to 25% of patients attending general practitioners