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MCQ

1.A 50-year-old woman who works as a secretary comes to the physician because of numbness and tingling in her hands. On examination, the patient is found to have decreased sensation in all of her fingers except her fifth digit. Which of the following muscles is most commonly weakened in patients with this condition?
(A) Adductor pollicis
(B) Dorsal interossei
(C) Lumbricals (3 and 4)
(D) Opponens digiti minimi
(E) Opponens pollicis

2.A 21-year-old woman with no family or personal history of breast cancer presents with a small, firm mass in the lower inner quadrant of her right breast that seems mobile when palpated. It is nontender. There are no overlying skin changes or nipple discharge. Which of the following would most likely be found on biopsy of this mass?

(A) Blue dome cysts and some atypical epithelial hyperplasia
(B) Cells in a single fi le formation
(C) Fibrosing stroma around normal-looking glands
(D) Large cells with clear “halos”
(E) Multicentric lobes with lymphocytic infiltrate

ANS:The correct answer is C. Fibroadenomas are the most common tumor in young women, presenting as small,firm, mobile masses. They are not associated with malignancy. On histology, fibrosing stroma is seen around normal duct and gland structures.

Answer A is incorrect. Blue dome cysts are seen in fibrocystic diseases of the breast. These lesions have associated risks of carcinoma with the presence of atypia.
Answer B is incorrect. Infiltrating lobular carcinomas are often multilocular and bilateral. These cells are found in clusters or in a linear formation.
Answer D is incorrect. Paget’s disease presents with eczematous skin fi ndings with underlying ductal carcinomas. Paget’s cells are large cells with halo-like clearings.
Answer E is incorrect. Any lymphocytic infiltrate suggests infl ammatory carcinoma with a poor prognosis.Answer B is incorrect. Infiltrating lobular carcinomas are often multilocular and bilateral. These cells are found in clusters or in a linear formation.Answer D is incorrect. Paget’s disease presents with eczematous skin fi ndings with underlying ductal carcinomas. Paget’s cells are large cells with halo-like clearings.Answer E is incorrect. Any lymphocytic infiltrate suggests infl ammatory carcinoma with a poor prognosis.Answer B is incorrect. Infiltrating lobular carcinomas are often multilocular and bilateral. These cells are found in clusters or in a linear formation.Answer D is incorrect. Paget’s disease presents with eczematous skin fi ndings with underlying ductal carcinomas. Paget’s cells are large cells with halo-like clearings.Answer E is incorrect. Any lymphocytic infiltrate suggests infl ammatory carcinoma with a poor prognosis.

3,A 39-year-old woman, gravida 3, para 2, at 20 weeks' gestation comes to the physician because of fevers, chills, and a cough for the past week. Her prenatal course had been otherwise unremarkable. Her temperature is 38.0 C (100.4 F), blood pressure is 100/60 mm Hg, pulse is 98/min, and respirations are 14/min. Examination demonstrates crackles and harsh breath sounds at the right lung base. The physician recommends a chest x-ray, but the patient is concerned about radiation exposure during pregnancy. Which of the following is the most appropriate response?

(A) Exposure from a chest x-ray does not cause harmful fetal effects
(B) Exposure from a chest x-ray leads to birth defects
(C) Exposure from a chest x-ray leads to spontaneous abortion
(D) When chest x-ray has occurred, fetal pneumonia is more common
(E) When chest x-ray has occurred, termination should be considered

ANS:The correct answer is A. Exposure to radiation, particularly in the form of an x-ray, is a major cause of anxiety for pregnant patients. There is a generally held belief that exposure to any radiation during pregnancy will lead to miscarriage or birth defects. There is no evidence, how ever, of any increase in spontaneous abortion or fetal anomalies at doses of radiation less than 5 rad. This dose is above the level of radiation exposure of diagnostic procedures. The fetal exposure from a chest x-ray with 2 views is approximately 0.05 mrad. This amount is several orders of magnitude below the 5 rad limit. Therefore, it is currendy believed that x-ray exposure from any single diagnostic procedure will not cause harm to the fetus. This patient has signs and symptoms consistent with pneumonia and could therefore benefit from a chest xray. She should be reassured that the exposure to the fetus from a chest x-ray is minimal and has not been shown to cause birth defects or fetal loss.

A chest x-ray exposes the fetus to minute amount of radiation compared with the amount needed to cause birth defects (choice B). 
There is no evidence that the exposure of 0.02 to 0.07 mrad of radiation caused by a chest x-ray leads to spontaneous abortion (choice C).
To state that when chest x-ray has occurred, fetal pneumonia is more common (choice D) is incorrect. The presence or absence of a fetal infection is not dependent on a chest x -ray being performed to evaluate for maternal pneumonia.
To state that when chest x-ray has occurred, termination should be considered (choice E) is incorrect.
Exposure to x-ray during pregnancy is not an indication for therapeutic abortion.

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NEPHROTIC AND NEPHRITIC SYNDROME

मधुमेहका रोगीले खानैपर्ने नौ खानेकुरा

रगतमा चिनीको मात्रा बढी हुने भएकाले मधुमेहका रोगीले जे पायो त्यही खानेकुरा खान हुँदैन । 

यो एक दीर्घ रोग भएकाले रोगीले खाना खाँदा निक्कै होस पुर्याएर खानुपर्छ । यसका साथै यस्ता

 रोगीले सीमित खानेकुराहरु नियमित र ठिक्क मात्रामा खान आवश्यक छ । यहाँ हामी तपाईलाई

 यस्ता खानेकुराको बारेमा जानकारी दिँदैछौं जुन मधुमेह नियन्त्रणका लागि खान आवश्यक छ ।

१.स्याउ : भनिन्छ दिनको एउटा स्याउले डाक्टरलाई टाढा राख्छ ; विशेषगरी कार्डियोलोजिष्ट ।

 सन २०१२ मा ओहियो स्टेट युनिभर्सिटीले प्रकाशित गरेको 

जर्नलमा चार हप्तासम्म् दिनमा एउटा स्याउ सेवन गर्नाले 

नराम्रो कोलेस्ट्रोललाई ४० प्रतिशतले घटाउने गर्छ । कोलेस्ट्रोल 

एउटा यस्तो तत्व हो जसले मुटु रोगलाई मद्दत गर्छ ।यसका

 साथै स्याउमा मधुमेह कम गर्ने तत्व पनि पाईन्छ । हाभार्ड 

स्कुल अफ पब्लिक हेल्थले दुई लाख मानिसहरुको स्वास्थ्यस्थिती जाँच गर्दा हप्तामा ५ वा सो 

भन्दा बढी स्याउ खाने मानिसमा मधुमेहको खतरा २३ प्रतिशतले कम हुने जनाएको छ

२. कुरिलो : स्वादका दृष्टिकोणले मात्र हेर्ने हो भने पनि कुरिलो धेरैजासो मानिसको मन 

पर्ने तरकारी हो । के तपाईलाई थाहा छ कुरिलोमा ५ ग्राम 

कार्बोहा८ड्रट, २० प्रतिशत क्यालोरी  र करिब २ ग्राम फाइृबर 

पाईन्छ । यसमा बिशेषगरी ग्लुताथायन नामक 

एन्टिअक्सिडेन्ट पाईने  भएकालदे यसले बुढ्यौलीको असरलाई 

फिक्का बनाउने गर्दछ भने विभिन्न रोगबाट मुक्त गराउँछ ।

 जस्तै मधुमेह, मुटुरोग र क्यान्सर ।सन २०१२ मा ब्रिटिश 

जर्नल अफ न्यूट्रिसनले गरेको एक अनुसन्धानका अनुसार कुरिलोले रगतमा चिनीको मात्रालाई राम्रो 

अवस्थामा राख्ने गर्दछ भने इन्सुलिनको मात्रालाई बढाउने काम गर्छ ।

३. एभोक्याडो :

 नास्पातीजस्तो देखिने फल एभोक्याडो स्वास्थ्यका दृष्टिले 

निक्कै राम्रो मानिन्छ । मधुमेह र एभोक्याडोबीच निक्कै 

सकारात्मक सम्बन्ध रहेको छ । सन २००८ मा अमेरिकन

 जर्नल अफ क्लिनिकल न्यूट्रिसनले प्रकाशित गरेको रिपोर्ट

 अनुसार एभोक्यार्डो खाने महिलाहरुमा दोस्रो प्रकारको  मधुमेह

 हुने खतरा २५ प्रतिशतले कम हुन्छ ।

४. सिमी

सिमीमा प्रचुर मात्रामा फाईबर पाइन्छ । साथै,यो प्रोटिनको राम्रो स्रोत मानिन्छ । जसका 

कारण मधुमेहका रोगीले यसलाई आफ्नो खानामा सामेल गराउनु आवश्यक छ । 

सन २०१२ मा गरिएकाखे उक अध््नुसन्धानका अनुसार टुसा उम्रिएको सिमीको

 तरकारी दिनमा एक कप खाने गर्नाले रगतमा चिनीको मात्रामा सन्तुलित हुन्छ भने 

ब्लड प्रेसर पनि कम गर्छ ।

५. ब्रोकाउली

ब्रोकाउलीमा बेटा क्यारोटिन नामक एीन्टअक्सिडेन्ट

 पाईन्छ । जसले मधुमेह रोगीलाई फाईदा पुर्याउँछ । 

यसमा भिटामीन ‘ए’ प्रचुर मात्रामा पाइने हुँदा दाँत

 हड्डी, छाला र आँखालाई फाईदा पुर्याउछ । यो फोलेट

 र फाइबरको खानी भएका कारण स्वास्थ्यका लाथि निक्कै

 लाभदायक मानिन्छ ।

६. गाजर :

गाजरलाई भिटामिन ‘ए’को खानीका रुपमा लिईन्छ । 

यो भिटामिन रोग प्रतिरोधात्मक क्षमता वृद्धिका लागि 

आवश्यक तत्व मानिन्छ । यसले मधुमेह रोगलाई राहत प्रदान

 गर्दछ भने केहि क्यान्सरबाट मक्ति दिने मायो  क्लिनिकलले

 बताएको छ ।

७. माछा :

सन २०१० को डायटरी गाइडलाइन फर अमेरिकाले हप्तामा 

दुईपटक माछा खान सुझाउको छ । माछामा ओमेगा ३ 

फ्याटी एसिड पाइने हुँदा यसले अरहाथमियास (असामान्य मुटुको धड्कन)

 को जोखिमलाई कम गर्ने गर्दछ । मधुमेहका रोगीले माछाको सेवन गर्नु लाभदायक मानिन्छ ।

८. लसुन :

खानालाई मिठो बनाउन हामिले प्रयोग गर्ने लसुनमा 

औषधीय गुणसमेत रहेको छ । यसले उच्च कोलेस्ट्रोल, मुटु 

रोग, उच्चरक्तचाप र क्यान्सरको खतरालाई टाढा राख्छ ।

९. प्याज: प्याजमा एन्टिअक्सिडेटको मात्रा बढी हुने भएकाले यसले मधुमेहका रोगीलाई फाइदा

 पुर्याउँछ ।प्याजमा मधुमेहका रोगीलाई फाईदा पुर्याउँने फाइबर,

पोटासिम र फोलेटजस्ता तत्व हुने भएकाले यसलाई खानामा

संलग्न गर्न अत्यावश्यक छ । सन २००२ मा अमेरिकन जर्नल

 अफ क्लिनिक न्युट्रिसनले गरेको अनुसन्धान अनुसार प्याजमा

 पाइने फ्लेभोननोइड क्वेरसेटिनले दीर्घ रोग लाग्नबाट बचाएँछ 

what a joke

DO U KNOW THISS

MATHS-mentally affected teachers harassing students.

GOD= generator, operator, destroyer

BIBLE- Basic Instruction Before Leaving Earth

Middle East respiratory syndrome coronavirus

The Middle East Respiratory Syndrome coronavirus, also termed EMC/2012, is positive-sense, single-stranded RNA novel species of the genus Betacoronavirus. 

Scientific name: Middle East respiratory syndrome coronavirus

Rank: Species

Higher classification: Betacoronavirus

Middle East Respiratory Syndrome (MERS) is an illness caused by a virus (more specifically, a coronavirus) called Middle East Respiratory Syndrome Coronavirus (MERS-CoV). MERS affects the respiratory system (lungs and breathing tubes). Most MERS patients developed severe acute respiratory illness with symptoms of fever, cough and shortness of breath. About 3-4 out of every 10 patients reported with MERS have died.

Health officials first reported the disease in Saudi Arabia in September 2012. Through retrospective investigations, health officials later identified that the first known cases of MERS occurred in Jordan in April 2012. So far, all cases of MERS have been linked to countries in and near the Arabian Peninsula.

MERS-CoV has spread from ill people to others through close contact, such as caring for or living with an infected person.MERS can affect anyone. MERS patients have ranged in age from younger than 1 to 99 years old.

Symptoms & Complications

Most people confirmed to have MERS-CoV infection have had severe acute respiratory illness with symptoms of:

fever

cough

shortness of breath

Some people also had gastrointestinal symptoms including diarrhea and nausea/vomiting. For many people with MERS,

 more severe complications followed, such as pneumonia and kidney failure. About 3-4 out of every 10 people reported with MERS have died. Most of the people who died had an underlying medical condition. Some infected people had mild symptoms (such as cold-like symptoms) or no symptoms at all; they recovered.

Based on what researchers know so far, people with pre-existing medical conditions (also called comorbidities) may be more likely to become infected with MERS-CoV, or have a severe case. Pre-existing conditions from reported cases for which we have information have included diabetes; cancer; and chronic lung, heart, and kidney disease. Individuals with weakened immune systems are also at higher risk for getting MERS or having a severe case.

Based on information we have to date, the incubation period for MERS (time between when a person is exposed to MERS-CoV and when they start to have symptoms) is usually about 5 or 6 days, but can range from 2-14 days

Clinical Presentation

A wide clinical spectrum of MERS-CoV infection has been reported ranging from asymptomatic infection to acute upper respiratory illness, and rapidly progressive pneumonitis, respiratory failure, septic shock and multi-organ failure resulting in death. Most MERS-CoV cases have been reported in adults (median age approximately 50 years, male predominance), although children and adults of all ages have been infected (range 0 to 99 years). Most hospitalized MERS-CoV patients have had chronic co-morbidities. Among confirmed MERS-CoV cases reported to date, the case fatality proportion is approximately 35%.

Limited clinical data for MERS-CoV patients are available; most published clinical information to date is from critically ill patients. At hospital admission, common signs and symptoms include fever, chills/rigors, headache, non-productive cough, dyspnea, and myalgia. Other symptoms can include sore throat, coryza, nausea and vomiting, dizziness, sputum production, diarrhea, vomiting, and abdominal pain. Atypical presentations including mild respiratory illness without fever and diarrheal illness preceding development of pneumonia have been reported. Patients who progress to requiring admission to an intensive care unit (ICU) often have a history of a febrile upper respiratory tract illness with rapid progression to pneumonia within a week of illness onset.

Clinical Course

The median incubation period for secondary cases associated with limited human-to-human transmission is approximately 5 days (range 2-14 days). In MERS-CoV patients, the median time from illness onset to hospitalization is approximately 4 days. In critically ill patients, the median time from onset to intensive care unit (ICU) admission is approximately 5 days, and median time from onset to death is approximately 12 days. In one series of 12 ICU patients, the median duration of mechanical ventilation was 16 days, and median ICU length of stay was 30 days, with 58% mortality at 90 days. Radiographic findings may include unilateral or bilateral patchy densities or opacities, interstitial infiltrates, consolidation, and pleural effusions. Rapid progression to acute respiratory failure, acute respiratory distress syndrome (ARDS), refractory hypoxemia, and extrapulmonary complications (acute kidney injury requiring renal replacement therapy, hypotension requiring vasopressors, hepatic inflammation, septic shock) has been reported.

Transmission

MERS-CoV, like other coronaviruses, is thought to spread from an infected person’s respiratory secretions, such as through coughing. However, the precise ways the virus spreads are not currently well understood.

Person-to-person spread of MERS-CoV, usually after close contact, such as caring for or living with an infected person, has been well documented. Infected people have spread MERS-CoV to others in healthcare settings, such as hospitals. Researchers studying MERS have not seen any ongoing spreading of MERS-CoV in the community.

All reported cases have been linked to countries in and near the Arabian Peninsula. Most infected people either lived in the Arabian Peninsula or recently traveled from the Arabian Peninsula before they became ill. A few people became infected with MERS-CoV after having close contact with an infected person who had recently traveled from the Arabian Peninsula.

Public health agencies continue to investigate clusters of cases in several countries to better understand how MERS-CoV spreads from person to person.

 Risk  factors for MERS

1) Recent Travelers from the Arabian Peninsula

If you develop a fever and symptoms of respiratory illness, such as cough or shortness of breath, within 14 days after traveling from countries in or near the Arabian Peninsula, you should call ahead to a healthcare provider and mention your recent travel. While sick, stay home from work or school and delay future travel to reduce the possibility of spreading illness to others.

2) Close Contacts of an Ill Traveler from the Arabian Peninsula

If you have had close contact with someone within 14 days after they traveled from a country in or near the Arabian Peninsula and the traveler has/had fever and symptoms of respiratory illness, such as cough or shortness of breath, you should monitor your health for 14 days, starting from the day you were last exposed to the ill person.

If you develop fever and symptoms of respiratory illness, such as cough or shortness of breath, you should call ahead to a healthcare provider and mention your recent contact with the traveler. While sick, stay home from work or school and delay future travel to reduce the possibility of spreading illness to others.

3) Close Contacts of a Confirmed Case of MERS

If you have had close contact with someone who has a confirmed MERS-CoV infection, you should contact a healthcare provider for an evaluation. Your healthcare provider may request laboratory testing and outline additional recommendations, depending on the findings of your evaluation and whether you have symptoms. You most likely will be asked to monitor your health for 14 days, starting from the day you were last exposed to the ill person. Watch for these symptoms:

Fever. Take your temperature twice a day.

Coughing

Shortness of breath

Other early symptoms to watch for are chills, body aches, sore throat, headache, diarrhea, nausea/vomiting, and runny nose.

If you develop symptoms, call ahead to your healthcare provider as soon as possible and tell him or her about your possible exposure to MERS-CoV so the office can take steps to keep other people from getting infected. Ask your healthcare provider to call the local or state health department.

4) Healthcare Personnel Not Using Recommended Infection-Control Precautions

Healthcare personnel should adhere to recommended infection control measures, including standard, contact, and airborne precautions, while managing symptomatic close contacts, patients under investigation, and patients who have probable or confirmed MERS-CoV infections. Recommended infection control precautions should also be utilized when collecting specimens.

Healthcare personnel who had close contact with a confirmed case of MERS while the case was ill, if not using recommended infection control precautions (e.g. appropriate use of personal protective equipment), are at increased risk of developing MERS-CoV infection and should be evaluated and monitored by a healthcare professional with a higher index of suspicion..

5) People with Exposure to Camels

MERS-CoV has been found in some camels, and some MERS patients have reported contact with camels. However, we do not know exactly how people become infected with MERS-CoV—many people with MERS have had close contact with a person sick with MERS.

The World Health Organization has posted a general precaution for anyone visiting farms, markets, barns, or other places where animals are present. Travelers should practice general hygiene measures, including regular handwashing before and after touching animals, and avoid contact with sick animals. Travelers should also avoid consumption of raw or undercooked animal products.The World Health Organization considers certain groups to be at high risk for severe MERS; these groups include people with diabetes, kidney failure, or chronic lung disease and people who have weakened immune systems. The World Health Organization recommends that these groups take
additional precautions:

1. Avoid contact with camels
2. Do not drink raw camel milk or raw camel urine
3. Do not eat undercooked meat, particularly camel meat

* Countries considered in the Arabian Peninsula and neighboring include: Bahrain; Iraq; Iran; Israel, the West Bank, and Gaza; Jordan; Kuwait; Lebanon; Oman; Qatar; Saudi Arabia; Syria; the United Arab Emirates (UAE); and Yemen.

** Close contact is defined as

•  being within approximately 6 feet (2 meters) or within the room or care area for a prolonged period of time (e.g., healthcare personnel, household members) while not wearing recommended personal protective equipment (i.e., gowns, gloves, respirator, eye protection) 

•  having direct contact with infectious secretions (e.g., being coughed on) while not wearing recommended personal protective equipment (i.e., gowns, gloves, respirator, eye protection.

Laboratory Findings

At admission may include leukopenia,lymphopenia,thrombocytopenia, and elevated lactate dehydrogenase levels. Co-infection with other respiratory viruses and a few cases of co-infection with community-acquired bacteria at admission has been reported; nosocomial bacterial and fungal infections have been reported in mechanically-ventilated patients. MERS-CoV virus can be detected with higher viral load and longer duration in the lower respiratory tract compared to the upper respiratory tract, and has been detected in feces, serum, and urine. However, very limited data are available on the duration of respiratory and extrapulmonary MERS-CoV shedding.

Prevention

Currently, there is no vaccine to prevent MERS-CoV infection. The U.S. National Institutes of Health is exploring the possibility of developing one.

CDC routinely advises that people help protect themselves from respiratory illnesses by taking everyday preventive actions:

1. Wash your hands often with soap and waterfor 20 seconds, and help young children do the same. If soap and water are not available, use an alcohol-based hand sanitizer.
   
2. Cover your nose and mouth with a tissue when you cough or sneeze, then throw the tissue in the trash.
3. Avoid touching your eyes, nose and mouth with unwashed hands.
4. Avoid personal contact, such as kissing, or sharing cups or eating utensils, with sick people.
5. Clean and disinfect frequently touched surfaces and objects, such as doorknobs.

Treatment

There is no specific antiviral treatment recommended for MERS-CoV infection. Individuals with MERS can seek medical care to help relieve symptoms. For severe cases, current treatment includes care to support vital organ functions.

REFRENCE

http://www.nbcnews.com/storyline/mers-mystery/what-mers-other-questions-about-mers-outbreak-n370531

http://www.cdc.gov/coronavirus/mers/hcp.html