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NIMS(Nepal Index Of Medical Specialities) has been design to provide information on drugs that are marketed in Nepal by Pharma company from around the world .


NIMS(Nepal Index Of Medical Specialities) has been design to provide information on drugs that are marketed in Nepal by Pharma company from around the world .


NIMS(Nepal Index Of Medical Specialities) has been design to provide information on drugs that are marketed in Nepal by Pharma company from around the world .


NIMS(Nepal Index Of Medical Specialities) has been design to provide information on drugs that are marketed in Nepal by Pharma company from around the world .


NIMS(Nepal Index Of Medical Specialities) has been design to provide information on drugs that are marketed in Nepal by Pharma company from around the world .

Sunday, May 1, 2016

Every seizure are nor simple seizure neither epilepsy -DrSudeepKC

A 3-month-old boy exhibits nystagmus and limb tremors unassociated with seizures. Over the next few years, he develops optic atrophy, choreoathetotic limb movements, seizures, and gait ataxia. 

picture of 3 month boy having nystagmus and limb moments

He dies during status epilepticus and at autopsy is found to have widespread myelin breakdown with myelin preservation in islands about the blood vessels.

The pathologist diagnoses a sudanophilic leukodystrophy to describe the pattern of staining observed on slides prepared to look for myelin breakdown products.

a. Neuromyelitis optica (Devic’s disease)
b. Central pontine myelinolysis
c. Marchiafava-Bignami disease
d. Acute disseminated encephalomyelitis
e. Pelizaeus-Merzbacher disease

The answer is e. Pelizaeus-Merzbacher disease is a demyelinating disorder that belongs to a group of degenerative diseases known as sudanophilic leukodystrophies. 

Leukodystrophy refers to the disturbance of white matter, and sudanophilic refers to the Sudan staining
characteristics of the involved white matter. Children with PelizaeusMerzbacher disease typically become symptomatic during the first months of life, but survival may extend into the third decade of life. Most affected
persons are male.

Tuesday, April 26, 2016

57-year-old female presented

A 57-year-old female presented with a 3-month history of weight loss, lethargy, shortness of breath and pleuritic left-sided pain. She has never smoked. On examination, she was apyrexial, breathless and in pain.

1. What does the first CXR show?
2. What does the second CXR show?
3. What is the most likely diagnosis given the history and CXR appearances?

1. A large left-sided pleural effusion.
2. A trace of fl uid remains. In addition, there is extensive
consolidation of the basal segments of the left
upper lobe ( circle Image 3) partly obscuring the left
heart border.
3. Bronchioloalveolar cell carcinoma.

The relatively long history of lethargy and weight loss together with the lack of signs of sepsis suggest malignancy. This degree of consolidation if due to infection would be accompanied by a shorter history and the patient would be clinically septic. CT showed a rind of pleural thickening consistent with pleural metastases explaining her pleural effusion and pleuritic pain ( single arrows Images 4a, b).

This scan was performed following pleural drain insertion, hence the air within the soft tissues. Note the pleural thickening extends along the mediastinal contour ( double arrow Image 4a) and is associated with volume loss, both signs are highly suggestive of malignancy.
In addition, there is posterior bulging of the oblique fi ssure ( arrow Image 4c) which is in favour of
bronchioloalveolar cell carcinoma  . The incidence of bronchioloalveolar cell carcinoma
(a form of adenocarcinoma) is increasing particularly as the incidence of smoking is decreasing. It is the form of lung cancer most commonly seen in nonsmokers. 

Saturday, April 23, 2016

answer of MCQ

1.The following features are true for Tetralogy of Fallot, except:
a. Ventricular septal defect
b. Right ventricular hypertrophy
c. Atrial septal defect
d. Pulmonary stenosis.

2. The most common retrobulbar orbital mass in adults is:
a. Neurofibroma b. Meningioma
c. Cavernous haemangioma
d. Schwannoma

3. Expanisle type osseous metastases are characteristic of primary malignancy of:
a. Kidney b. Bronchus
c. Breast d. Prostate

4. Which is the objective sign of identifying pulmonary plethora in a chest radiograph?
a. Diameter of the main pulmonary/ artery> 16mm.
b. Diameter of the left pulmonary artery > 16mm
c. Diameter of the descending right pulmonary artery> 16mm
d. Diameter of the descending left pulmonary artery > 16 mm

5. The most accurate investigation for assessing ventricular function is:
a. Multislice CT
b. Echocardiography
c. Nuclear scan
d. MRI

6.The most important sign of significance of renal artery stenosis on an angiogram is:
a. A percentage diameter stenosis> 70%
b. Presence of collaterals
c. A systolic pressure gradient> 20 mm Hg across the lesion
d. Post stenotic dilatation of the renal artery

7. The MR imaging in multiple sclerosis will show lesion in:
a. White matter b. Grey matter c. Thalamus d. Basal ganglia

8. The most common location of hypertensive intracranial haemorrhage is:
a. Subarachnoid space
b. Basal ganglia
c. Cerebellum
d. Brainstem

9. Which of the following causes rib- notching on the chest radiography?
a. Bidirectional Glem shunt
b. Modified Blalock- Taussing shunt
c. IVC occlusion
d. Coarctation of aorta

10. The most sensitive imaging modality to detect early renal tuberculosis is:
a. Intravenous urography
b. Computed tomography
c. Ultrasound
d. Magnetic Resonance imaging

11. All of them use non- ionizing radiation, except:
a. Ultrasonography
b. Thermography
c. MRI
d. Radiography

12. The most radiosensitive tumor among the following is:
a. Bronchogenic carcinoma
b. Carcinoma parotid
c. Dysgerminoma
d. Osteogenic sarcoma

13. All of the following modalites can be used for in – situ ablation of liver secondaries, except:
a. Ultrasonic waves
b. Cryotherapy
c. Alcohol
d. Radiofrequency

14. All of the following radioisotopes are used as systemic radionucleide, except:
a. Phosphorus- 32 b. Strontium – 89
c. Iridium- 192 d. Samarium – 153

15. Phosphorous – 32 emits:
a. Beta particles b. Alfa particles
c. Neutrons d. X- rays

16. Which of the following is used in the treatment of differentiated thyroid cancer:
a. 131I b. 99mTc
c. 32P d. 131I-MIBG

17. Which one of the following imaging techniques gives maximum radiation exposure to the patient?
a. Chest X-ray b. MRI
c. CT scan d. Bone scan

18. Which one of the following has the maximum ionization potential ?
a. Electron b. Proton
c. Helium ion
d. Gamma (y)-Photon

19. Typically bilateral inferior lens subluxation of the lens is seen in:
a. Marfan’s syndrome
b. Homocystinuria
c. Hyperlysinaemia
d. Ocular trauma

20. The procedure of choice for the evaluation of an aneurysm is:
a. Ultrasonography
b. Computed tomography
c.Magnetic resonance imaging
d. Arteriography

21. The common cause of subarachnoid hemorrhage is:
a. Arterio- venous malformation
b. Cavenous angioma
c. Aneurysm
d. Hypertension

22. Spalding’s sign occurs after:
a. Birth of live foetus
b. Death of foetus in uterus
c. Rigor mortis of infant
d. Cadaveric spasm.

23. Renal artery stenosis may occur in all of the following, except:
a. Atherosclerosis
b. Fibromuscular dysplasia
c. Takayasu’s arteritis
d. Polyarteritis nodosa

24. Which one of the following congenital malformation of the fetus can be diagnosed in first trimester by ultrasound?
a. Anencephaly
b. Inencephaly
c. Microcephaly
d. Holoprosencephaly

25. Which of the following conditions is least likely to present as an acentric osteolytic lesion:
a. Aneurysmal bone cyst
b. Giant cell tumor
c. Fibrous cortical defect
d. Simple bone cyst

26. “Rugger Jersey Spine” is seen in :
a. Fluorosis
b. Achondroplasia
c. Renal Osteodytrophy
d. Marfan’s Syndrome

27. Brown tumours are seen in:
a. Hyperparathyroidism
b. Pigmented villonodular synovitis
c. Osteomalacia
d. Neurofibromatosis

28. Which of the following malignant tumours is radioresistant?
a. Ewing’s sarcoma
b. Retinoblastoma
c. Osteosarcoma
d. Neuroblastoma

Sunday, April 17, 2016

is a keratotic follicular eruption-DrSudeepKC

This disorder primarily involves the skin and eyes. Phrynoderma, the name applied to the cutaneous eruption of vitamin A deficiency, is a keratotic follicular eruption that initially appears on the proximal extremities. 
Phrynoderma (follicular hyperkeratosis)

It eventually extends to the trunk, back, abdomen, buttocks, and neck. Although phrynoderma is widely accepted as being specific for vitamin A deficiency, it has recently been suggested that it may be a manifestation of severe malnutrition associated with deficiencies of multiple critical vitamins and essential fatty acids. 

Facial lesions may resemble large comedones of acne. Eye symptoms include nyctalopia (delayed dark adaptation, the earliest finding), night blindness, and xerophthalmia.

Objective findings are Bitot’s spots, which are areas of shed corneal epithelium, and in severe disease, keratomalacia. Vitamin A deficiency is most commonly caused by malabsorption disorders.

Phrynoderma is a type of follicular hyperkeratosis located on the extensor surfaces of the extremities whose main cause is vitamin A deficiency. The simultaneous occurrence of phrynoderma and ocular symptoms secondary to hypovitaminosis A after bariatric surgery is exceptional.

Friday, April 15, 2016

The following antihypertensive combination is irrational, and therefore should not be used:

The following antihypertensive combination is irrational, and therefore should not be used:

A. Nifedipine + hydralazine
B. Amlodipine + atenolol
C. Enalapril + clonidine
D. Enalapril + hydrochlorothiazide

ANS IS : A. Nifedipine + hydralazine

Thursday, March 31, 2016

BP lowering in hypertensive urgency

ans is 
B. Inability to control the rate and extent of fall in BP
C. Reports of adverse/fatal outcome
D. Both 'B' and 'C'

thank you;

Wednesday, March 23, 2016

sore throat.-DrSudeepKC

A 22-year-old woman complains of a sore throat. On examination she has mild jaundice and an enlarged liver and spleen.
Examination of Throat

a. Anaerobic bacteria
b. Chlamydia psittaci
c. Corynebacterium diphtheriae
d. Epstein–Barr virus

D.Epstein–Barr virus right answer

EBV infects B cells of the immune system and epithelial cells. Once EBV's initial lytic infection is brought under control, EBV latency persists in the individual's B cells for the rest of the individual's life.

It is best known as the cause of infectious mononucleosis (glandular fever). It is also associated with particular forms of cancer, such as Hodgkin's lymphomaBurkitt's lymphomagastric cancer,nasopharyngeal carcinoma, and conditions associated with human immunodeficiency virus (HIV), such as hairy leukoplakia and central nervous system lymphomas.There is evidence that infection with EBV is associated with a higher risk of certain autoimmune diseases,especiallydermatomyositissystemic lupus erythematosusrheumatoid arthritisSjögren's syndrome,and multiple sclerosis.Some 200,000 cancer cases per year are thought to be attributable to EBV.

The infection develops slowly with such mild symptoms that it may initially be indistinguishable from a cold or the flu. As the condition progresses the symptoms may include:
  • sore throat that lasts two weeks or more
  • Swollen lymph nodes in the neck, armpits, and groin
  • A persistent fever (usually about 102 degrees F)
  • fatigue
  • malaise (a vague feeling of discomfort)
These symptoms can be mild or so severe that throat pain impedes swallowing and fever reaches 105 degrees F. Some people also experience a rash, eye painphotophobia (discomfort with bright light), a swollen spleen or liver infection.
Although the symptoms of infectious mononucleosis usually resolve in one or two months, the EBV remains dormant in cells in the throat and blood for the rest of the person's life. Periodically, the virus can reactivate and can be found in the saliva of infected persons. This reactivation usually occurs without symptoms of illness. EBV also establishes a lifelong dormant infection in some cells of the body's immune system.
Diagnosis is suggested on the basis of the clinical symptoms of fever, sore throat, swollen lymph glands and the age of the patient. A physical examination may reveal an enlarged liver and/or enlarged spleen. The liver and spleen may also be tender. Laboratory tests may be needed for confirmation.
Blood findings with infectious mononucleosis may include an elevated white blood cell count, an increased percentage of certain white blood cells and a positive reaction to a "monospot test." The monospot test relies on clumping of horse red blood cells by mononucleosis antibodies presumed to be in a person's serum.
antibody tests for EBV measure the presence and/or the concentration of specific EBV antibodies. Different laboratory tests can measure specific EBV antibodies. Some of these tests can be performed on a single sample of blood, while others compare different samples of blood over a period of time.
In most cases of mononucleosis, no specific treatment is necessary. The illness is usually self-limited. Since it is a viral infection and viruses do not respond to antibiotics, they are ineffective against mono. Doctors will recommend bedrest and drinking plenty of fluids.
When the patient's temperature returns to normal, he or she may gradually resume normal activities as strength returns. However, mono can be accompanied by a streptococcal infection of the throat, in which case an antibiotic will be prescribed to treat that condition.
In severe cases, corticosteroid drugs that reduce swelling are prescribed. If the spleen is swollen, the doctor may recommend avoiding strenuous activities, such as lifting and pushing, as well as any contact sports, which may cause sudden rupture of the spleen. Hospitalization is necessary if there is a serious complication, such as rupture of the spleen.