B. Peer. Cleary University.

Burr cell is seen in: (Jharkhand 2003) (d) Howell-Jolly bodies (a) Uremia (e) Cabot ring (b) Hepatocellular carcinoma (c) Gastric carcinoma 6 5 mg propecia for sale hair loss early pregnancy. Which of the following surface glycoproteins is most (d) Ovarian carcinoma often expressed in human hematopoietic stem cell? A 74 year-old female Lajo Devi with renal failure (a) Renal cell carcinoma presents for hemodialysis buy genuine propecia on-line hair loss in men 55. On further (c) High altitude investigations order propecia 5mg free shipping hair loss cure 7 jours, she is found to be anemic and is given a (d) Benign liver tumor dose of erythropoietin. Normal platelet count is found in: (a) Methyl violet (a) Wiskott Aldrich syndrome (b) Brilliant Cresyl blue (b) Henoch Schonlein purpura (c) Sudan black (c) Immune thrombocytopenia (d) Indigo carmine (d) Dengue fever 16. In an adult man, there is about how much grams of (c) Mild splenomegaly hemoglobin in the circulating blood? Hypersegmented neutrophils are present in which of (b) Myelodysplastic anemia the following anemia? All of the following can cause reticulocytosis except and ataxia is given radiolabeled cobalamin by mouth (a) Aplastic anemia followed by an intramuscular injection of unlabeled (b) Thalassemia cobalamin. The urine radioactivity level measured (c) Sickle cell anemia afterwards is determined to be normal. Which of the (d) Chronic blood loss following is the most likely cause of this patient’s 39. Upper gastrointestinal endoscopy is (a) Rubella (b) Human parvo virus B19 consistent with atrophic gastritis. Some blood parameter (c) Measles (d) Dengue virus changes after the frst dose of cyanocobalamin are shown in the graph on the left side of the page. A 60-year old male patient with history of rheumatoid (c) Haptoglobin (d) Gastrin arthritis presents with the following: Hb:4. A 13 yr girl with fatigue and weakness was found to be (a) Beta thalassemia trait having reduced hemoglobin. Schilling test is used for identifcation of which of the (d) Thalassemia major following? The condition which does not cause microcytic hypo- (b) Binding of lead to transferrin, inhibiting the trans- chromic anemia is: (Karnataka 2008) port of iron (a) Iron defciency (c) Binding of lead to cell membrane of erythroid pre- (b) Hookworm infestation cursors. Lead poisoning is associated with: (d) Thalassemia minor (a) Microcytic hypochromic anemia 47. Microspherocytes in peripheral blood smear are seen (d) Bone marrow hypoplasia in: (Karnataka 2005) (e) Iron defciency (a) Congenital spherocytosis 48. Anemia of chronic disease is characterized by of all (c) Anemia in chronic disease. A 30 years old female asymptomatic not requiring blood (a) Spectrin (b) Transferrin transfusion has Hb-13 gm%, HbF-95%, HbA2 1. Response of iron therapy in a patient with iron (b) Increased total iron binding capacity defciency anemia is denoted by: (c) Decreased serum ferritin (a) Restoration of enzymes (d) Increased mean corpuscular volume (b) Reticulocytosis 64. Sideroblastic anemia is seen in chronic poisoning with: (c) Serum ferritin (a) Lead (b) Arsenic (d) Serum transferin (c) Copper (d) Mercury 65. Rate of iron uptake is regulated by which one of the fol- (c) Iron defciency anemia lowing: (d) Pernicious anemia (a) Mucosal cell iron stores 69. A 68 year-old man Babu Rao Apte presents with skin (b) Route of administration pigmentation, cirrhosis and diabetes mellitus. A 23-year-old female presented with jaundice and (b) Erythropoetic porphyria pallor for 2 months. The most relevant (d) Cutaneous porphyria investigation to arrive at a diagnosis is which of the 69. An abnormal Ham test is most likely associated with against malaria except: which of the following? A 5 year old male child presents with episodic anemia (c) Sickle cell disease and jaundice since birth. In hereditary spherocytosis an inherited abnormality is (d) Conjugated bilirubin seen in which of the following red blood cell compo- 80. A young male photographer Alok Nath from Bangalore (c) Defective hemoglobin synthesis is evaluated for recurrent episodes of jaundice. Not seen in paroxysmal nocturnal hemoglobinuria is: insignifcant and the person is not on any medication. His blood pressure is 120/80 mmHg, pulse is (c) Decreased leukocyte alkaline phosphatase 72/mm, temperature is 36. A 20-year-old man John Abraham is transported to the emergency department within 20 minutes of sustain- release hemoglobin. If it is presumed that he may have (a) Cirrhosis and hepatocellular carcinoma lost about 1. A 16-year-old female Gitika notices that her urine (b) Decreased hematocrit becomes red after she is given sulfonamides for (c) Decreased blood pressure treatment of a urinary tract infection. Both urine and (d) Decreased red blood cell count serum test positive for free hemoglobin, and the urine 95. The dis- smear shows normocytic and normochromic red cells trict has high endemicity of malaria. Dubey gives him primaquine chemoprophylaxis following substances is most likely responsible for for Plasmodium vivax malaria. Singh develops anemia, (a) Alpha-chain of hemoglobin hemoglobinemia, and hemoglobinuria. Special studies (b) Beta-chain of hemoglobin will likely reveal an abnormality in which of the fol- lowing? An infant presents with mild anemia, jaundice, and (c) Intrinsic factor splenomegaly. A 38-year-old male Kritesh presents to his physician The parents state that several relatives have also with the complaints of sudden onset of fever, chills suffered from a similar illness. A 6yrs old child belonging to Punjabi family with past history of blood transfusions presented with (b) Acute myelomonocytic leukemia hemoglobin 3. A 14-year-old male Kaalu is brought to the emergency (b) One altered peptide of HbS migrates faster towards room with high grade fever, chest pain, and dyspnea. Evaluation today the polymer and cause sickling of the red blood cells reveals a hematocrit of 23% and reticulocyte count of (d) Lowering the concentration of deoxygenated HbS 9%. Several hours after being admitted, the patient dies can prevent sickling in the hospital. At autopsy, the patient’s spleen is frm and brown; this fnding is most likely related to: 111. The hemoglobin electrophoresis shows (e) Target cell are present the following: Hb A 60% and Hb S 40%. Sickle cell anemia is the clinical manifestation of sickle cell anemia and thalassemia major?

Many plasma-derived mediators are present as precursors and need enzymatic cleavage to become active cheap propecia 5 mg free shipping hair loss 40 year old woman. For example propecia 1mg with amex hair loss in men at 50, thrombin is necessary to transform soluble fibrinogen into insoluble fibrin for blood clots order propecia paypal hair loss diet. Inflammatory cytokine profiles provide a biomarker for the severity of inflammation. An important class of mediators is cytokines, which are cell products synthesized de novo in response to immune stimuli. Certain inflammatory diseases present with characteristic cytokine profiles; therefore, inhibition of proinflammatory cytokines may aid in the treatment of the diseases. It activates cells, increases adhesion molecule expression, and induces fever and the release of acute-phase proteins. In addition to B-cell differentiation, it promotes the production of acute- phase proteins and fever. It additionally stimulates angiogenesis and has other functions outside of inflammation. In inflammation, it activates phagocytes and enhances leukocyte–endothelial adherence. An important member is C-reactive protein, which is used to monitor the severity and progression of some cardiovascular diseases. Acute inflammation is a stereotypic, highly complex process that self- terminates. Modern molecular biology superimposes many additional layers of complexity onto the presented model of acute inflammation as a stereotypic process of the vascular system. For instance, it has been shown that factors independent of the vasculature can trigger and modulate aspects of both inflammation and repair. Vibration and hypoxia can lead to histamine release of mast cells (degranulation), hence initiating inflammatory events. Mechanical load on tendon fibroblasts can modulate their response during inflammation, promoting their destruction at high loads and protecting them from inflammatory apoptosis at low loads. Furthermore, proinflammatory molecules can be upregulated without any concomitant invasion and stimulation of inflammatory cells. Chemical mediators disappear either because of their short half-life or because they are enzymatically inactivated (e. Substrates are consumed, and the lymph flow carries the mediators away faster than they can be produced. Following inflammation, tissue that is capable of regeneration will be almost completely restored; otherwise, scar formation occurs. Chronic inflammation develops when neither agent nor host is strong enough to overwhelm the other (e. Chronic inflammation may last weeks, months, or years and leads to chronic wounds, which are composed of loosely arranged connective tissue (granulation tissue), infiltrated fibroblasts, and inflammatory cells. It is the only cell type present in the case of chronic inflammation resulting from a nonantigenic agent such as a suture thread. In the case that the injurious agents are also antigenic, other cell types appear, such as lymphocytes, plasma cells, and eosinophils. Chronic inflammation is characterized by ongoing tissue damage from reactive oxygen and nitrogen species and proteases that are secreted by inflammatory cells. Other products, such as arachidonic acid and proinflammatory cytokines, amplify as well as propagate the damage. This weakens the body and makes it even more susceptible to infection and further inflammation. Overwhelming inflammation combined with immune suppression can lead to systemic inflammatory response syndrome, which is called sepsis, or septicemia, when the inflammation is a result of infection. Chronic inflammatory diseases can affect every body part and are usually indicated by adding the suffix “itis. Another example is pneumonia, which is more commonly used than “pneumonitis” to name the chronic inflammatory infection of the lung. The role of inflammation in diseases that were not traditionally categorized as inflammatory diseases has been viewed with considerable interest. In fact, inflammation is now recognized to be a critical pathologic component underlying many illnesses, ranging from Alzheimer’s and Parkinson’s diseases to diabetes and certain types of cancer (e. Although the association between inflammation and disease has been recognized for a long time, inflammation was mainly considered a result, rather than a cause, of the illness. Studies clearly show that the destructive, self-promoting cycle between oxidative stress and resulting inflammation causes more oxidative stress and contributes to the development of chronic illnesses. This chain of events may initially occur at a low, asymptomatic level, which leads to the speculation that subacute chronic inflammation might be the cause of a number of illnesses. They inhibit the accumulation of neutrophils at sites of inflammation (see Neuroendoimmunology) but also have widespread effects on other inflammatory cells and processes. This is the reason for abundant side effects ranging from osteoporosis to disruption of the hypothalamic–hypophyseal axis. Alternative therapies include a wide variety of natural substances that have antioxidative and anti- inflammatory features but often have poorly understood mechanisms of action. These include nutrients such as vitamin E, herbs such as chamomile, and supplements such as glucosamines, to name a few. Because the side effects or uncertainties associated with many existing anti-inflammatory drugs often outweigh their benefits, a main focus of twenty-first century medical research is to develop novel anti- inflammatory strategies. Novel drugs generally aim to target specific pathways instead of general inflammatory processes. For instance, leukotriene modifiers, a relatively new class of anti-inflammatory medications for asthma patients, specifically block the products of arachidonic acid metabolism and can prevent an asthma episode before it even starts (Clinical Focus 10. Their children are more susceptible to allergies than they were when they were children. In the past 30 years, the prevalence of allergies has been greatly increasing in the United States and in the world, proportionally more so in more developed countries compared with developing countries and more so in urban areas compared with rural areas. One hypothesis, often referred to as the hygiene model, proposes that the children who are not exposed to enough antigens or innocuous microorganisms from soil or water early in their childhood do not adequately develop their T helper 1 cell response. This leads to an imbalance toward T helper 2 cell responses, which are present from birth. Even though this hypothesis is disputed as being grossly oversimplified, it is undisputed that the various manifestations of allergic inflammation are the result of wrongly activated T helper 2 cells. It belongs to type I hypersensitivity disorders and is characterized by airways that narrow excessively in response to many provoking stimuli. Typical allergens causing atopic (also called extrinsic or allergic) asthma are animal dander, dust mite excrement, grass pollen, and cockroach antigen. The symptoms of both asthma types are similar and include wheezing, breathlessness, chest tightness, and coughing. They are caused by chronic inflammation of the airways, which leads to their swelling. Bronchoconstriction, excess production of mucus, and increased collagen deposition further exacerbate the restriction of the airflow to and from the lungs.

Bright generic 1 mg propecia overnight delivery hair loss in men as they age, sharp and direct light produces glare such as a hotel or stadium should not rise above 10 which may cause eye strain discount 1mg propecia visa hair loss juice fast, fatigue and headache purchase propecia american express hair loss nioxin. Noise lighting may lead to accidents, hence highways, emerging from a private place at its periphery should gangways, hallways and machine rooms should be well not exceed 5 dB above the ambient noise level at the illuminated. Ten automatic noise monitoring stations in Indirect illumination by reflected light from a hidden certain cities would be installed that will record ambient source is comfortable and does not have a shadow noise levels 24 hours a day to create noise maps for producing effect. All efforts should be made to maximise the use of Radiant Energy natural sunlight. This can be done by providing plenty of windows and sky lights (glass area at least 20 percent It has various forms depending upon the wavelength of floor area) and by painting the walls white. The effects of various types of radiant rays have a wavelength of about 200 millimicrons. This explains why persons skiing over snow get severe sunburns even on the underside of nose These are used for wireless transmission. An indoor Microwaves source of ultraviolet radiation is the mercury vapour They are short waves used in radar communications on discharge tube, which is widely used for ultraviolet ships, aeroplanes, etc. Ultraviolet light is also emitted by carbon arcs, cataract may develop on excessive exposure. Outdoor exposure may occur in case of farmers and sailors who are exposed to too much sun. Blast furnace It does not penetrate more than a few millimeters and workers, blacksmiths, kiln and oven workers and stokers is almost entirely absorbed at the surface of the body. Intense exposure Effects on the skin include erythema, darkening of the to infrared rays leads to cataract. Prolonged exposure may result in squamous cell carcinoma or basal cell epithelioma Visible light may be in the form of natural sunlight or (rodent ulcer). Ordinary light from electric bulbs and Proper clothing is adequate to protect the skin against ultraviolet light. Light reflected from snow can cause the same Residential 55 45 lesion, sometimes referred to as snow blindness. Industrial 75 70 Special glasses that filter ultraviolet and infrared rays Commercial 65 60 85 should be worn to protect the eyes from radiation *Environment and Forest Ministry. Powel found increased incidence of leukemia and other neoplasma in children It is of two types-particulate radiation (alpha particles, followed upto ten years after their mothers received beta particles and neutrons) and electromagnetic radiation diagnostic X-rays during pregnancy. On entering the body, ionizing radiations damage the cells by causing ionization, Genetic effects: Genetic mutations are well known to particularly in the nucleus. The examples of occupational occur in experimental animals and to a certain extent, exposure to ionizing radiation are as follows: in man as well. Radiation mutation being recessive, the • Persons working in departments of radiology, radio- chance of its manifestation in future generations is small. In the remaining 5 percent, the • Painters of which radium dials are exposed as they mutation is mainly in chromosomes other than sex moisten the brush with the tongue. The extent of damage depends upon: a latent period of a week or two as erythema, edema, pruritus, blisters, sloughing of epidermis and ulceration. Delayed effects include hyperkeratosis, Highly sensitive cells are lymphocytes, bone marrow atrophy of sweat and sebaceous glands and, eventually, cells and gonadal cells. Type of Radiation Prevention of radiation hazards: Strict adoption of Both alpha and beta particles are harmful if injected or known preventive measures is essential in order to avoid inhaled. Protection against External Source Area of the Body Exposed Shielding: The source of X-rays, g-rays and particulate irradiation of large area of the body may lead to death radiation should be surrounded by radio protective in days to weeks because of bone marrow depression. Radiation dose is several million times the average daily Lead boxes are used to keep radium needles. Lead dose received from natural sources and occupational glasses are used in the window panes of diagnostic and or medical exposure. The cobalt unit used in the treatment of cancer is kept in thick concrete walled chambers. Acute Exposure Lead rubber aprons and lead rubber gloves should be used by X-ray technicians in radiology departments. Massive doses of penetrating radiation such as X-rays and γ-rays may cause death in a few hours or days. In less Distance: The intensity of exposure varies inversely severe cases, loss of appetite, nausea and vomiting occur with the square of the distance from the source. Symptoms may subside after one controls should be as distant as possible from the source day to two weeks, but reappear after a latent period in of radiation so that the operator is exposed to the the form of diarrhea, fever, bleeding and ulceration of minimum. Long forceps should be used to handle mucous membranes, fall in blood pressure, increased radium needles. The personnel employed Chronic Exposure should be adequate and they should be rotated in such Cancer: Various types of cancer may be induced, parti- a manner that no single person in exposed for a long time. Whenever an adverse Exposed part of body Occupationally Public at large effect is detected in a worker, he should be moved away exposed persons from the site of exposure. The presence of other physical factors such as heat, lighting and noise may adversely affect the likelihood of occurrence and the severity of such injuries. Study of accidents and their prevention is an that the degree of exposure may be continuously important subject for an industrial physician. Mainlining Maintenance of plants, equipment and shields: quarries, construction works, railway workshops and These should be checked regularly to detect any heavy industries such as steel are particularly known for leakage. Age, sex, habit, personality and physical and mental state of the worker play an important role in Protection against Entry (By Inhalation, Ingestion occurrence of accidents. An industrial health team or through Intact of Abraded Skin) consisting of an industrial physician, an engineer, nurse and social worker should study the cause of each and • Radio-contamination of air should be prevented by every accident and should try to prevent further enclosing or encasing the radiation generating plant occurrence. Preventive safety measures such as proper and walls should be wet mopped and not swept dry. Chemical Agents Radioactive dust cannot be let off into water or air, nor can it be burnt or chemically treated. Gaseous and air- Chemical agents responsible for occupational diseases borne radiation should be controlled by filtration and form a long list and their number is ever increasing. Liquid radioactive material should be may occur in the form of dusts, fumes, mists, vapors allowed to decay to the lowest possible level and then and gases produced during various industrial processes disposed of by filtration and dilution with water. Dusts Technical Supervision and M onitoring They are solid particles generated on handling, crushing These should be directed by a health physicist in atomic and grinding of rocks, owes, metals, coal, wood and energy establishments and by an industrial hygienist in grain, etc. The duties of the health physicist include designing plants and equipment, Fumes making frequent radiation surveys, providing and reading monitoring devices, imparting health education, They are solid particles generated on volatilization of undertaking research on safety measures and examining liquids. Mists M edical Supervision They are suspended liquid droplets produced by Medical check up and blood count should be done splashing, foaming or atomising. Examples are chromic before employment and at regular intervals after acid mists in electroplating industry and oil mist from 87 employment. Some gases are chemical asphyxiants such as carbon monoxide, hydrogen cyanide and hydrogen They arise in gaseous form from substances normally sulphide. The Bhopal gas tragedy occurred on Toxic agents or substances may be ingested with water December 3, 1984 because of accidental chemical and food.