Patch test phytodermatitis itchy erythematous papular lesions on face, neck, ‘V’ area of chest, dorsum of hands and forearms

069. A 45-year-old farmer has itchy erythematous papular lesions on face, neck, ‘V’ area of chest, dorsum of hands and forearms for 3 years. The lesions are more severe in summers and improve by 75% in winters. The most appropriate test to diagnose the condition would be:

1. Skin biopsy

2. Estimation of IgE levels in blood

3. Patch test

4. Intradermal prick test

Answer

3. Patch test

Reference

Rook Textbook of Dermatology Chapter 20

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Discussion

In phytodermatitis, the pattern of dermatitis varies depending on the source. Typically, it involves the hands, forearms, face and genitals. Often it is acute and vesicular. Involvement of the eyelids is common. Sometimes, the hands only are involved, with fissuring and hyperkeratosis of the fingertips and subungual hyperkeratosis (as with tulip bulbs, garlic, etc.). At other times the dermatitis may be of a volatile pattern and may present as a light-aggravated or 'exposed site' dermatitis (as with Compositae dermatitis). The principal types of phytodermatitis are:

1. irritant contact phytodermatitis-both chemical and physical
2. allergic contact phytodermatitis-both immediate and delayed;
3. phytophototoxic dermatitis;
4. pseudophytophotodermatitis, for example Ranunculaceae;
5. allergic contact phytodermatitis with secondary photo-sensitivity, for example Compositae, lichens, etc.

Explanation

The allergen may be localized anywhere in the plant, but usually the leaves are used for patch testing. Primin occurs in minute glandular hairs most closely set on the surface of small leaves A 1 cm piece of leaf can be used for patch testing, but false-negative reactions are common, and patch-test sensitization occurs in 0.8% of those tested. It is therefore preferable to test with a standardized extract of primin and Compositae.

Comments

Active sensitization is uncommon when such extracts are used. The risk of patch-test sensitization from plants other than Primula and poison ivy has not yet been systemically studied.

Tips

The condition is more common in men. Broad spectrum photoprotection and light avoidance are beneficial.

Barberio’s test is used to detect semen

074. Which of following tests is used to detect semen?

1. Phenolphthalein test

2. Reine’s test

3. Barberio’s test

4. Paraffin test

Answer

3. Barberio’s test

Reference

Parikh 6^th Edition Page 7.26

Apoorva Nandy 1^st Edition Page 128

Reddy 17^th Edition Page 328

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The tests used for Chemical Examination of seminal fluid are

Ä Florence test : dark brown crystals due to the formation of chlorine periodide

Ä Barberio’s test (Barbario) : tests spermine in semen, with picric acid

Ä Acid Phosphatase test : Quantitative test

Ä Test for Creatine Phosphokinase : Levels of more than 400 units/ml

Ä Choline and Spermine Test

Ä Gel Electrophoresis test :

Ä LDM Isoenzyme Method

Ä Acid Phosphatase Isoenzyme Test

Ä Ammonium Molybdate Test (Phosphorus)

Ä Semen Specific Glycoprotein (P30 ) Test

Ä Enzyme-linked immunosorbent assay (ELISA), the SEMA® assay, for a seminal vesicle-specific antigen (SVSA)

Explanation

1. Phenolphthalein test (Kastle Meyer test), Benzedine test, Leucomalachite green test, Orthotolidine (Blue or green) test (Kohn and O’kelly test) and Luminal test are used to detec blood

2. Reine’s test ??? - Rinne's test compares the patients ability to hear a tone conducted via air and bone - the mastoid process.

3. Barberio’s test is to detect semen.

4. Paraffin test (also known as the dermal nitrate test) uses the reagent diphenylamine to detect gun powder

Comments

Basis of Berberio’s Test: Detection of Spermine

Procedure: A few drops of Berberio’s reagent when added to spermatic fluid produces crystals of sperm in picrate (needle shaped, rhombic & of yellow colour).

For various valid reasons, like non-specificity and lack of reproducibility, the florence and berberio’s tests have not been accepted universally.

Tips

Semen consist of the following

1. Spermatozoa (10%)

2. Seminal Plasma (90%)

3. Epithelial Cell (<>

Scab or Crust of abrasion appears brown Between 2-3 days

073. Scab or Crust of abrasion appears brown:

1. Between 12-24 hours

2. Between 2-3 days

3. Between 4-5 days

4. Between 5-7 days

Answer

2. Between 2-3 days

Reference

Parikh 6^th Edition Page 4.3

Apoorva Nandy 1^st Edition Page 213

Reddy 17^th Edition Page 138

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From abrasions, the time of assault can be roughly assessed

Ä When fresh, an abrasion is red with evidence of oozing of serum and a little blood. There is no scab

Ä By 8 to 24 hours, there is a reddish scab formation

Ä By 2^nd and 3^rd day, the scab is reddish brown

Ä By 4^th and 5^th Day, it is dark brown

Ä By 6^th Day, it is blackish and it starts falling off from the margins. Epithelium grows underneath the scab

Ä After 7 Days, Scab dries, shrinks and falls off.

Ä By A big scab may take a few more days to fall off

Explanation

Self Explanatory

Comments

Except Apoorva Nandy, the other books do not talk about the 4^th and 5^th Day evolution of scab

Tips

Difference between antemortem and post mortem abrasion

Trait	Antemortem abrasion	Post mortem abrasion
Site	Anywhere on the body	Usually over bony prominences
Colour	Bright reddish brown	Yellowish, translucent and parchment like
Exudation	More; scab slightly raised	Less; Scab often lies slightly below the level of the skin
Microscopic feature	Intravital reaction and congestion seen	No intravital reaction and no congestion

Medical qualifications awarded by institutions out side India and recognized by MCI are registered in

072. Medical qualifications awarded by institutions out side India and recognized by MCI are registered in:

1. First schedule of Indian Medical Council Act 1956

2. Second schedule of Indian Medical Council Act 1956

3. Part I of third schedule of Indian Medical Council Act 1956

4. Part II of third schedule of Indian Medical Council Act 1956

Answer

4. Part II of third schedule of Indian Medical Council Act 1956

Reference

Parikh 6^th Edition Page 1.24

Apoorva Nandy 1^st Edition Page 18

Reddy 17^th Edition Page 21

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The Indian Medical Council maintains three schedules.

Ä The first schedule contains the list of different medical degrees offered by different Universities or Institutions inside India, which are recognized by the Council and Government of India

Ä The Second Schedule contains the list of medical degrees conferred outside India and are recognized by the Medical Council of India and Government of India

Ä The Third Schedule has two parts

o Part A of the third schedule contains the list of medical qualifications conferred by Indian Universities or Institutions but not yet included in the First Schedule.

o Part B of the third schedule includes the list of standard medical qualifications of foreign countries which are recognized when Indian citizens possess the qualifications

Explanation

Self Explanatory

Comments

If an Indian national obtains a foreign qualification which is not included in part II of THrid Schedule, he can apply to the Central government. The candidate is required to provide full information with regard to the course of study, syllabus, and duration of course etc. This is forwarded to IMC which has authority to enter into negotiations with any of the medical councils of the foreign countries and can recognize such foreign qualifications on reciprocal basis. The Central Government, may, by notification in the Official Gazette, amend the part II of the Third Schedule so as to include such qualification there in

Tips

Dr.B.C.Roy was the first Indian to be the president of MCI in 1939. Hope you all know about B.C.Roy. His birthday July 1^st is being observed as Doctors Day

Spalding’s sign occurs after Death of foetus in uterus

071. Spalding’s sign occurs after:

1. Birth of live foetus

2. Death of foetus in uterus

3. Rigor mortis of infant

4. Cadaveric spasm

Answer

2. Death of foetus in uterus

Reference

Parikh 6^th Edition Page 2.36, 5.75

Apoorva Nandy 1^st Edition Page 422

Reddy 17^th Edition Page 341

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In intrauterine maceration, the skull vault bones may partly overlap each other. This is called as Spalding’s sign and is also detectable by X Ray examination before the birth of the dead fetus

Explanation

Self Explanatory

Comments

Maceration is a process of aseptic autolysis of a fetus dead in utero. It occurs when the dead fetus remains in the utero for 3 to 4 days surrounded by liquor amnii but with exclusion of air. It does not occur if the dead fetus is born within 24 hours. It is characterized by softening and degeneration of tissues. The process is aseptic because the fetus being enclosed in the membranes is in a sterile condition.

Tips

Mummification results when death of a fetus occurs from deficient supply of blood or when liquor amnii is scanty and when no air has entered the uterus. In this condition the fetus is dried up and shriveled.

Finger Print Bureau was first established in Writer's Building at Calcutta in the year 1897

070. Finger Print Bureau was first established in:

1. England

2. China

3. India

4. Singapore

Answer

3. India

Reference

http://ncrb.nic.in/cfpb.htm

Parikh 6^th Edition Page 2.15

Apoorva Nandy 1^st Edition Page 92

Reddy 17^th Edition Page 67

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General Knowledge. A passing mention is given in textbooks. And this fact is NOT mentioned in Western Textbooks (please see below)

Discussion

The idea that fingerprints as a means of identification was first given by Sir Wiliam Herschelle, Distt. Magistrate of Hooghly District of Bengal province in 1858. Later Dr. Henry Faults gave the idea of tracing a criminal from the latent prints found at the scene of crime and came to the conclusion that no two fingerprints are alike. Based on the idea of Herschelle and Faults, Sir Francis Galton, the renowned English Scientist established scientifically the basic principles of uniqueness and permanency in fingerprints.

Explanation

It was then that Sir Edward Richard Henry, the IGP, Lower Bengal with the able assistance of two of his Indian officers viz. Khan Bahadur Azizul Haq and Rai Bahadur Hemchandra Bose developed a system of classification of fingerprints and thereby discarding the anthropometric system of identification. Thereafter the first ever Finger Print Bureau of the world was established at Writer's Building at Calcutta in the year 1897.

Comments

Key Dates in the History of Fingerprinting

Ä The distinctive nature of fingerprints has been known for centuries.

Ä The ancient Babylonians used fingerprint impressions to record business transactions and fingerprints were used on Chinese documents more than a thousand years ago. The scientific use of fingerprints to solve crime, however, started little more than a hundred years ago.

Ä 1858 Sir William Herschel, a British Administrator in Bengal, makes the first practical application of fingerprints for personal identification when he requires Indians to place their fingerprints as well as their signatures on contracts.

Ä 1880 Dr Henry Faulds, a doctor working in Tokyo, looks at the possibility of fingerprint science identifying criminals by the fingerprints left at the crime scene using printer's ink.

Ä 1892 Juan Vucetich, a police officer in Argentina, makes the first fingerprint identification from a crime scene, and opens the first fingerprint bureau in the world.

Ä 1892 English scientist Sir Francis Galton publishes an accurate and in-depth study of the fingerprint science, including an attempt at a system of fingerprint classification for large collections of fingerprints.

Ä 1897 Sir Edward Henry, Inspector General of Police in Bengal and later Commissioner of London's Metropolitan Police, with the assistance of two Bengali Police Officers, devises a simplified fingerprint classification system for police use and introduces it in India. The Henry system is the basis of most fingerprint systems in the English-speaking world.

Ä 1901 The Fingerprint Bureau is formed at New Scotland Yard.

Ä 1902 In Australia, Sam McCauley begins fingerprinting in NSW prisons and establishes a Fingerprint Bureau at Darlinghurst Gaol.

Ä 1903 NSW establishes the first State fingerprint bureau, followed by Victoria (1903), Queensland and South Australia (1904), Tasmania (1912), Western Australia (1928), the Northern Territory (1957) and the ACT (1967). In 1980 the Australian Federal Police incorporate the ACT fingerprint bureau.

Ä 1941 The NSW Fingerprint Bureau becomes the Central Fingerprint Bureau of Australia, a jointly-funded national fingerprint support service.

Ä 1957 The chemical Ninhydrin is used for the first time to develop fingerprints left on paper.

Ä 1986 The Central Fingerprint Bureau of Australia is replaced by the National Automated Fingerprint Identification System (NAFIS), a computerised national database based on scanning original ink fingerprints.

Ä 2001 Establishment of the new National Automated Fingerprint Identification System. The system commences operations with 2.4 million 'ten print' records, covering 24 million individual fingerprints and 4.8 million palm prints, and 180,000 latent prints from unsolved crime scenes.

Tips

It is disheartening to note that almost all the western source do not mention the name of the two Bengali Officers, nor do they mention that the first bureau was established in India. Western Bias ??!!

Isotretinoin - Multiple nodular, cystic, pustular and comadonic lesions on face, upper back and shoulders for 2 years.

068. A 24-year-old unmarried woman has multiple nodular, cystic, pustular and comadonic lesions on face, upper back and shoulders for 2 years. The drug of choice for her treatment would be:

1. Acitretin

2. Isotretinoin

3. Doxycycline

4. Azithromycin

Answer

2. Isotretinoin

Reference

Harrison 16^th Edition Page 295

Katzung 9^th Edition Page 1024

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Treatment of acne vulgaris is directed toward elimination of comedones by normalization of follicular keratinization, decreasing sebaceous gland activity, decreasing the population of lipophilic bacteria and yeast, and decreasing inflammation. Acne vulgaris may be treated with either local or systemic medications. Minimal to moderate, pauci-inflammatory disease may respond adequately to local therapy alone. Although areas affected with acne should be kept clean, there is little evidence to suggest that removal of surface oils plays an important role in therapy. Overly vigorous scrubbing may aggravate acne due to mechanical rupture of comedones. Topical agents such as retinoic acid, benzoyl peroxide, or salicylic acid may alter the pattern of epidermal desquamation, preventing the formation of comedones and aiding in the resolution of preexisting cysts. Topical antibacterial agents such as benzoyl peroxide, azelaic acid, topical erythromycin (with or without zinc), clindamycin, or tetracycline are also useful adjuncts to therapy.

Patients with moderate to severe acne with a prominent inflammatory component will benefit from the addition of systemic therapy. Oral tetracyclines or erythromycin in doses of 250 to 1000 mg/d will decrease follicular colonization with some of the lipophilic organisms. They also appear to have an anti-inflammatory effect independent of their antibacterial effect. Female patients who do not respond to oral antibiotics may benefit from hormonal therapy. Women placed on oral contraceptives containing ethinyl estradiol and norgestimate have demonstrated improvement in their acne when compared to a placebo control.

Explanation

Severe nodulocystic acne not responsive to oral antibiotics, hormonal therapy, or topical therapy may be treated with the synthetic retinoid isotretinoin.

Comments

Isotretinoin is used at doses of 0.5 to 2.0 mg/kg as a single daily dose for 15 to 20 weeks.

Tips

The use of this drug is limited by its teratogenicity, and female patients must be screened for pregnancy prior to initiating therapy, maintain a method of birth control during therapy, and be screened for pregnancy during treatment. Patients receiving this medication develop extremely dry skin and cheilitis and must be followed for development of hypertriglyceridemia.

Slit lamp examination of eye

067. A patient had seven irregular hyperpigmented macules on the trunk and multiple small hyperpigmented macules in the axillae and groins since early childhood. There were no other skin lesions. Which is the most likely investigation to support the diagnosis?

1. Slit lamp examination of eye

2. Measurement of intraocular tension

3. Examination of fundus

4. Retinal artery angiography

Answer

1. Slit lamp examination of eye

Reference

Harrison 16^th Edition Page 2457

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It is easy to arrive at an diagnosis. Axillary hyperpigmentations point to Neurofibromatosis. To confirm the diagnosis, we have to look for the Lisch nodules.

Explanation

1. Slit lamp examination of eye is done to diagnose Lisch nodules of Iris

2. Measurement of intraocular tension is also needed in Neurofibromatosis to rule out Congenital Glaucoma (often associated with the disease) but is not the most likely investigation to support the diagnosis

3. Examination of fundus is also done, but not for supporting the diagnosis

4. Retinal artery angiography will not help in supporting the diagnosis

Comments

Ocular manifestations of neurofibromatosis include

1. Plexiform tumours of lids with Ptosis
2. Thickened corneal nerves
3. Pulsating proptosis (due to transmitted cerebral pulsations through the defects in the orbital walls)
4. Glioma of optic nerve
5. Congenital Glaucoma

Tips

Mutation of the NF1 gene on chromosome 17 causes von Recklinghausen's disease. The NF1 gene is a tumor suppressor gene; it encodes a protein, neurofibromin, which modulates signal transduction through the ras GTPase pathway. Patients with NF1 are at increased risk of developing nervous system neoplasms, including plexiform neurofibromas, optic gliomas, ependymomas, meningiomas, astrocytomas, and pheochromocytomas. Neurofibromas may undergo secondary malignant degeneration and become sarcomas.

Transplantation of Human Organs Act - 1994

061. In which of the following year the Transplantation of Human Organs Act was passed by Government of India?

1. 1994

2. 1996

3. 2000

4. 2002

Answer

1. 1994

Reference

The Act itself

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Discussion

THE TRANSPLANTATION OF HUMAN ORGANS ACT, 1994

(Central Act 42 0f 1994)

Ä Bill No. LIX-F of 1992

Ä THE TRANSPLANTATION OF HUMAN ORGANS BILL, 1994

Ä As Passed by the Houses of Parliament

o Rajya Sabha on 5th May, 1993)

o Lok Sabha on 14th June 1994

Ä Amendments made by the Lok Sabha

o Agreed to by the Rajya Sabha on 15th June 1994)

Ä Assented to on 8-7-1994 Act No. 42 of 1994

Explanation

Self Explanatory

Comments

This fact is also given in our text books. So this is not exactly “out of syllabus”

Tips

Legal Information is also available with our affiliate sites like www.mcqsonline.com www.nellaimedicos.com and www.penandscale.com

Premium of the “Community based Universal Health Insurance Scheme” launched during 2003-04 - Rs.1 per day poor and individual to Rs.2 per day for a fa

060. The premium of the “Community based Universal Health Insurance Scheme” launched during 2003-04 ranges from

1. Rs.1 per day poor and individual to Rs.2 per day for a family of seven

2. Rs.1 per day poor and individual to Rs.3 per day for a family of seven

3. Rs.2 per day poor and individual to Rs.2 per day for a family of seven

4. Rs.1 per day poor and individual to Rs.7 per day for a family of seven

Answer

1. Rs.1 per day poor and individual to Rs.2 per day for a family of seven

Reference

http://www.niacl.com/social-universal.html

The New India Assurance

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Discussion and Explanation

Salient features of the Universal Health Insurance Scheme are given below

Benefits

Ä Medical Reimbursement

o The policy provides reimbursement of hospitalisation expenses upto Rs.30,000/- to an individual /family subject to the following sublimits:

o (i) Room, Boarding expenses upto Rs.150/- per day

o (ii) If admitted in ICU upto Rs.300/- per day

o Surgeon, Anaesthetist, Consultant, specialists fees, Nursing expenses upto Rs.4,500/- per illness/ injury

o Anaesthesia, Blood, Oxygen, OT charges, Medicines, Diagnostic material & X-Ray, Dialysis, Radiotherapy, Chemotherapy, Cost of pacemaker, Artificial limb, etc upto Rs. 4,500/- per illness/ injury

o Total expenses incurred for any one illness upto Rs. 15,000/-

Ä Personal Accident Cover

o Coverage for Death of the Earning Head of the family (as named in the schedule) due to accident: Rs. 25,000/-.

Ä Disability Cover

o If the earning head of the family is hospitalized due to an accident / illness a compensation of Rs.50/- per day will be paid per day of hospitalization up to a maximum of 15 days after a waiting period of 3 days.

Ä For purpose of this policy HOSPITAL means:

o Any Hospital/ Nursing home registered with the local authorities and under the supervision of a registered and qualified Medical practitioner.

o Hospital/ Nursing Home run by Government.

o Enlisted hospitals run by NGOS / Trusts / selected private hospitals with fixed schedule of charges.

o It should have minimum 15 beds (10 in case of class 'C' cities having a population lest than 5 lakhs) with fully equipped OT, fully qualified nursing staff round the clock and fully qualified doctor should be in charge round the clock.

o Hospitalization should be for a minimum period of 24 hrs. However this time limit is not applied to some specific treatments and also where due to technological advancement hospitalization for 24 hrs may not be required.

Premium

Ä For an individual

o Rs. 1.00 per day

o Rs. 365/- per annum

Ä For a family upto 5 (including the first3 children)

o Rs. 1.00 per day

o Rs. 548/- per annum

Ä For a family upto 7 (including the first 3 children and dependent parents)

o Rs. 2.00 per day

o Rs. 730/- per annum

Premium Subsidy For BPL Families

Ä For families below the poverty line the Government will provide a premium subsidy of Rs.100/- per family.

Main Exclusions

Ä All pre-existing diseases.

Ä All diseases contracted during the first 30 days from the Commencement date of the policy Provided that in the opinion of the panel doctor/s the insured person could not have known about the existence of disease or its symptoms at the time of making the proposal AND had not taken any consultation, treatment for the disease prior to taking the insurance.

Ä Some of the diseases such as Cataract, Benign Prismatic Hypertrophy, Hysterectomy, hernia, Hydrocele, Fistula in anus, piles, sinusitis, Congenital internal disease are not covered in the first year of the policy.

Ä Corrective, cosmetic or aesthetic dental surgery or treatment.

Ä Cost of spectacles, contact lens and hearing aid.

Ä Vaccination, inoculation, change of life or cosmetic treatment or surgery HIV, AIDS, Sterility, Venereal Disease, Intentional Self injury, use of Intoxicating Drugs/ Alcohol.

Ä Primarily diagnostic expenses not related to sickness/ injury.

Ä Treatment for Pregnancy, Childbirth, Miscarriage, abortion etc.

Claim Settlement

Ä Claim settlement to be done through TPAS mentioned in the schedule or by the insurance company. To be made cashless as far as possible through listed hospitals.

Other Features

Ä Any One Illness

o Will be deemed to mean continuous period of illness and it includes relapse within 60 days from the date of last consultation with the hospital.

Ä Age Limitations

o This Policy covers people between the age of 3 months to 65 years.

Ä Family

o Means earning head, spouse and up to maximum of three dependent children. Dependent parents can also be included.

Ä Floater Basis

o The benefit of family will operate on floater basis i.e. the total reimbursement of Rs.30,000/- can be availed of individually or collectively by members of the family.

Comments

Policy details given are indicative, not exhaustive. Please contact your nearest NIA office (www.niacl.com) for further details.

Tips

This scheme is also being offered by Oriental Insurance Company Ltd http://orientalinsurance.nic.in/