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Monday, December 15, 2008

Which of the following is transmitted by soil Coccidiodomycosis Tetanus Anthrax.

Question 39
Which of the following is not transmitted by soil / not found in Soil
a.       Coccidiodomycosis
b.      Tetanus
c.       Brucella
d.      Anthrax.
Answer
c. Brucella
Reference
Harrison 15th Edition Chapter 222
Park 18th Edition Page 249
Ananthanarayanan 7th Edition Page 241, 345
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Discussion
Ä     Human disease may result from contaminated soil, due to unsanitary practices for disposal of excreta, improper or inadequate sewage treatment, or unfavourable climatic conditions.
Ä     Basically, the types of diseases emanating from soil contamination can be divided into three main categories.
o       Man-soil-man diseases result from contamination of soil by human excreta from which disease is contracted by either direct skin contact or consumption of food grown in such soil; examples include enteric bacteria and protozoa, and parasitic worms (helminths).
o       Animal-soil-man diseases result from contact with soil previously contaminated with excreta of animal carriers, cadavers, and any part of infected animal bodies. Among this latter category can be found anthrax, leptospirosis, and Q fever.
o       The third category of disease is a result of fertile climatic conditions inducing the proliferation of a pathogen from microorganisms growing in the soil. The mycoses, tetanus and botulism join this subdivision.
Explanation
a.       Coccidioidomycosis is transmitted by Soil (Harrison 15th Edition Chapter 222)
b.      Natural habitat of bacteria causing tetanus is soil and dust (Park 18th Page 249)
c.       Brucella are strict parasites of animals and may also infect humans (Ananthanarayanan 7th Edition Page 345)
d.      Anthrax is transmitted by soil (Ananthanarayanan 7th Edition Page 241)
Comments
C. immitis is a soil saprophyte found in certain arid regions of the United States, Mexico, Central America, and South America. Within the United States, most cases of infection with C. immitis are acquired in California, Arizona, and western Texas. A few cases are acquired by exposure to fomites from endemic areas (e.g., in cotton bales).
Infection in humans and animals results from inhalation of wind-borne arthrospores from soil sites. T
Tips
Ä     Many of the diseases result from inadequate pretreatment of soil reused as fertilizer, or waste water reclaimed for irrigation purposes. Conventional sewage treatment processes cannot remove all the pathogenic organisms, although success of removal generally parallels removal rates for coliform organisms.

Demarcation line in iceberg disease is between Apparent & inapparent cases

Question 38
Demarcation line in iceberg disease is between
a. Symptomatic & asymptomatic cases
b. Diagnosed & undiagnosed cases
c. Apparent & inapparent cases
d. Case and Carriers
Answer
c. Apparent & inapparent cases
Reference
Park 18th Edition Page 35
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A concept closely related to the spectrum of disease is the concept of the iceberg phenomenon of disease. According to this concept, disease in a community may be compared with an iceberg. The floating tip of the iceberg represents what the physician sees in the community. i.e clinical cases. The vast submerged portion of the iceberg represents the hidden mass of disease. ie latent, inapparent, presymtomatic and undiagnosed cases and carriers in the community.
Explanation
The waterline represents the demarcation between the apparent and inapparent disease.
Comments
Please note that at first look, this appears as a dummy question. But the answer is very clear if you refer Park.
Tips
The unknown morbidity (ie the submerged portion of the iceberg) far exceeds the known morbidity in diseases like Hypertension, Diabetes, Anemia, Malnutrition, Mental illness.

KAP studies were initially used for Family Planning

Question 37
KAP studies were initially used for
a. HIV
b. Family Planning
c. Malaria
d. Cancer Cervix
Answer
b. Family Planning
References
Park 18th page 358-359.
Specific References are given along with the Discussion
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Discussion and Explanation – KAP Studies on Family Planning
Ä     Family Planning Program in India: An Evaluation :
o       Roy C. Treadway, Jacqueline E. Forrest :
o       Studies in Family Planning, Vol. 4, No. 6 (Jun., 1973), pp. 149-156
o       doi:10.2307/1964798
o       The KAP study was done in 1968
Ä     Title: Family planning program in India: an evaluation.
o       POPLINE Document Number: 731143
o       Author(s): Treadway RC, Forrest JE
o       Source citation: Studies in Family Planning, June 1973;4(6):149-156.
o       Abstract: In 1968 and 1969 the Program Evaluation Organisation of the Planning Commission of India evaluated the Indian family planning program by conducting 2 separate studies. The first (September-December, 1968) consisted of 2 parts: 1) a sample of 69 rural clinics in 16 states and 1 Union Territory to study program accomplishments; 2) a sample of 6949 males (including 944 local leaders) to analyze knowledge, attitudes, and practice. Acceptance of contraceptive methods was analyzed in the second study (March-May 1969) which involved 5708 acceptors (3268 from villages, 854 from urban areas and 1586 from cities). The condom was the most widely used method (12 couples per 1000 population) followed by vasectomy (6.6 couples per 1000 population) and the IUD (5.6 couples per 1000 population). Awareness of methods in villages was most strongly influenced by the number of visits made by the family planning staff; the proportion of the population accepting a method was most strongly correlated with the holding of group meetings. Acceptance was also influenced by the availability and quality of facilities as evidenced by the higher acceptance rates in cities compared to towns and rural areas. Of the males interviewed, 49% of the general respondents and 31% of the local leaders wanted more children; these proportions decreased as the number of living sons increased. Local leaders favored longer spacing intervals. 77% of the general sample knew where to find family planning services compared to 93% of the leaders; those knowing about some method of contraception were 76% and 91% respectively. Vasectomy was the best known method (mentioned by 87% of the general respondents and 93% of the local leaders) followed by the IUD, condom, and tubectomy. Only 11% of the general respondents were using a method and only 21% of the local leaders were. Sterilization was generally favored but few supported its use before the third child. Abortion, still illegal at the time of the study, was approved by 1/8 of the general respondents and by 1/3 of the local leaders, mostly to avoid risk to mother's life. Of the acceptors (2882 vasectomy, 451 tubectomy, 2375 IUD) 2/3 were practicing family limitation. Rural acceptors were generally older and of higher parity than urban or city women. The family planning staff was an important source of information and influence on the particular method selected. Friends were more important in cities as a source of influence. Security and ease of pregnancy prevention were the reasons for adoption most often cited (by 54%, 69%, and 75% of the IUD, tubectomy and vasectomy acceptors respectively). To reach India's goal of a crude birth rate of 25 per 1000 by 1979, innovative programs may be required in addition to the continuation of present efforts.
Comments & Tips :
Other early studies on Family Planning
Ä     INDIA: UN Mission Evaluation of the Family Planning Program
o       Emil Sady, Basilio Aromin, William Seltzer, C. E. Gurr, Y. V. Lakshmana Rao
o       Studies in Family Planning, Vol. 1, No. 56 (Aug., 1970), pp. 4-18
o       doi:10.2307/1965084
Ä     Do incentives matter? – Evaluation of a family planning program in India
o       Authors: Sunil T.S.; Pillai V.K.; Pandey A.
o       Source: Population Research and Policy Review, Volume 18, Number 6, December 1999 , pp. 563-577(15)
o       Publisher: Springer
o       Abstract: Indian Family Planning programs in the past have introduced a number of approaches such as providing monetary benefits, and motivational programs to improve contraceptive use among rural illiterate women. Under the Ammanpettai family welfare program, the Melatur PHC administered three program types involving a combination of monetary and motivational approaches to improve contraceptive use in three treatment areas. The program was introduced during January 1989 and was simultaneously discontinued after a period of two years. The present evaluation was conducted in 1994. Data from a random sample of 933 non-sterilized women at the time of social survey using a questionnaire approach is used in this study. The implementation of incentive programs in a socio-economically homogenous population has resulted in an increase in the likelihood of current of contraceptive use. The results of this study suggest that motivational programs are more likely to improve long term use of temporary family planning methods than cash incentive programs. One implication of our finding is that motivational programs should provide peer based family planning education and training in community work to contact persons who make door to door visits to promote family planning programs.
o       Links for this article
§        http://www.ingentaconnect.com/klu/popu/1999/00000018/00000006/00241362
§        http://openurl.ingenta.com/content?genre=article&issn=0167-5923&volume=18&issue=6&spage

Equal Interview Time Eliminates Interviewers’ Bias

Question 36
Equal Interview Time Eliminates
a. Berkesonian bias
b. Recall bias
c. Selection bias
d. Interviewer’s Bias
Answer
d. Interviewers’ Bias
Reference
Park 18th Edition Page 67
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Discussion
Interviewer bias is the intentional or unintentional prompting by a marketing researcher, which affects the interviewee's response during oral surveys (e.g. personal, face-to-face or telephone interviews). This may lead to distorted results caused for example through (over-) politeness, social acceptability or conflict avoidance.
Explanation
Bias may also occur when interviewer knows the hypothesis and also knows who the cases are. This prior information may lead him to question the cases more thoroughly than controls regarding a positive history of the suspected causal factor. A useful check on this kind of bias can be made by noting the length of time taken to interview the average case and average control.
Comments
In statistics, the term bias is used for describing several different concepts:
Ä     A biased sample is one in which some members of the population are more likely to be included than others.
Ä     The bias of an estimator is the difference between an estimator's expectation and the true value of the parameter being estimated.
Ä     Systematic bias and systemic bias are external influences that may affect the accuracy of statistical measurements.
Tips
Interviewers bias can also be eliminated by double blinding

Active form of Calcium is Ionised Form

Question 35
Active form of Calcium is
a.       Ionised
b.      Albumin Bound
c.       Phos
d.      Protein
Answer
a. Ionised
Reference
Chaterjee 6th Edition Page 538
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The serum level of calcium is closely regulated with a normal total calcium of 2.2-2.6 mmol/L (9-10.5 mg/dL) and a normal ionized calcium of 1.1-1.4 mmol/L (4.5-5.6 mg/dL). The amount of total calcium varies with the level of serum albumin, a protein to which calcium is bound. The biologic effect of calcium is determined by the amount of ionized calcium, rather than the total calcium. Ionized calcium does not vary with the albumin level, and therefore it is useful to measure the ionized calcium level when the serum albumin is not within normal ranges, or when a calcium disorder is suspected despite a normal total calcium level.
Explanation
Ionised calcium is physiologically active form of calcium.
Comments
Calcium is the most abundant mineral in the human body. The average adult body contains in total approximately 1 kg, 99% in the skeleton in the form of calcium phosphate salts. The extracellular fluid (ECF) contains approximately 22.5 mmol, of which about 9 mmol is in the serum. Approximately 500 mmol of calcium is exchanged between bone and the ECF over a period of twenty-four hours
Tips
One can derive a corrected calcium level when the albumin is abnormal. This is to correct for the change in total calcium due to the change in albumin-bound calcium, and gives an estimate of what the calcium level would be if the albumin were within normal ranges.
    Corrected calcium (mg/dL) = measured total Ca (mg/dL) + 0.8 (4.0 - serum albumin [g/dL]), where 4.0 represents the average albumin level.
When there is hypoalbuminemia (a lower than normal albumin), the corrected calcium level is higher than the total calcium.

The following are trypsin inhibitors alpha - 1 Anti trypsin alpha-1-anti proteinase Egg-white

Question 34
The following are trypsin inhibitors except..
a.       alpha - 1 Anti trypsin
b.      alpha-1-anti proteinase
c.       Enterokinase
d.      Egg-white
Answer
c. ENterokinase
Reference:
Harper 27th Edition Page 597
Chaterjee 6th Edition Page 398
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Trypsin is a proteinase. And can hydrolyze a peptide bond formed by the carbonyl group of a lysine residue on trypsinogen, converting the latter to trypsin and inactive hexapeptide
Explanation
a.       alpha - 1 Anti trypsin is the principal serine protease inhibitor of human plasma. It inhibits trypsin, elastase and certain other proteases forming complexes with them.
b.      alpha-1-anti proteinase is the new name for alpha - 1 Anti trypsin
c.       Enterokinase activates trypsinogen into trypsin in the presence of Calcium
d.      Egg-white is a trypsin inhibitor
Comments
Other trypsin inhibitors are
·        Human and bovin Colostrum
·        Raw SOyabeans
·        DFP (Di Iso propyl fluoro phosphate
Tips
Trypsin can be activated (ie trypsinogen converted to trypsin) by
·        Enterokinase
·        Trypsin itself (Autocatalytically)

Proteins are sorted by Golgi bodies

Question 33
Proteins are sorted by
a.       Golgi Bodies
b.      Mitochondria
c.       Ribosomes
d.      Nuclear Membranse
Answer:
a. Golgi bodies
Reference:
Harper 27th Edition Page 506
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Proteins must travel from polyribosomes top many different sites in the cell to perform their particular functions. Some are destined to be components of specific organelles, others for the cytosol or for export and yet other will be located in the various cellular membranes. Thus there is considerable intracellular traffic of proteins. Many studies have shown that the Golgi apparatus plays a major role in sorting of proteins for their correct destination.
Explanation
Self Explanatory
Comments
The entire pathway of ERà Golfi apparatus à Plasma membrane is often called the secretory or exocytotic pathway. Secretory pathway involving transport vesicles is called “constitutive”
Tips
Other proteins destined for secretion are carried in secretory vesicles. These are prominent in pancreas and certain other glands. Their mobilization and discharge are regulated and often referred to as “regulated secretion”

Chaperones groups of proteins assist in the folding of other proteins

Question 32
Which of the following groups of proteins assist in the folding of other proteins?
1. Proteases.
2. Proteosomes.
3. Templates.
4. Chaperones
Answer
4. Chaperones
Reference
Harper 27th Edition Pages 37, 515,
Textbook of Medical Biochemistry 4th Edition Chaterjee and Shinde Page 225
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Discussion
The chaperones are proteins that play a role in the proper folding of other proteins without themselves being a compound of latter. They stabilize unfolded or partially folded intermediates, allowing them to fold properly and prevent inappropriate interactions. Few substances that can be called as chaperones include
a.       Calreticulin
b.      HSP 90A (Heat Shock Proteins)
c.       Synuclein alpha
d.      Lectin mannose binding 1
e.       DNA fragmentation factor 45
f.        Tubulin specific chaperone C
g.      Arylhydrocarbon-interacting receptor protein-like 1
h.      Tubulin specific chaperone D
i.        Unactive progesterone receptor 23KD (Yeah, That the name given - it is not printing mistake)
Explanation
1. Proteases are enzymes that hydrolyze proteins.
2. Proteosomes (especially the 26S component) help in degrading the proteins that are “marked” with Ubiquitin.
3. Template is involved in Synthesis of Nucleic Acids.
4. Chaperones are involved in Protein folding
Comments
Chaperonins are hsp60 family of chaperons
Tips
Few more points about Chaperones
1)      Present in many species
2)      Few are induced by conditions which cause unfolding of newly synthesized proteins
3)      Bind predominantly to Hydrophobic regions
4)      Act as Editing Mechanisms or Quality control
5)      Most have ATPase activity
6)      Found in
a)      Cytosol
b)     Mitochondria
c)      Lumen of Endoplasmic Reticulum

Okasaki Fragments are seen during the synthesis of ds DNA

Question 31
Okasaki Fragments are seen during the synthesis of
a.       ds DNA
b.      ss DNA
c.       m RNA
d.      t RNA
Answer
a. ds DNA
Reference:
Harper 26th Edition Page 328, 27.335
Lippincott 3rd Edition Page 403
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Discussion
An Okazaki fragment is a relatively short fragment of DNA (with an RNA primer at the 5' terminus) created on the lagging strand during DNA replication. It was originally discovered in 1968 by Reiji Okazaki, Tsuneko Okazaki, and their colleagues while studying replication of bacteriophage DNA in Escherichia coli.
The polymerase III holoenzyme (the dnaE gene product in E.Coli) binds to template DNA as part of a multiprotein complex that consists of several polymerase accessory factors (beta, gamma, delta, delta’ and theta). DNA polymerases only synthesize DNA in the 5’ to 3’ direction and only one of the several different types of polymerases is involved at the replication fork. Because the DNA Strands are antiparallel, the polymerase functions asymmetrically. On the leading (Forward) strand, the DNA is synthesized continuously.
Explanation
When the lagging strand is being replicated on the original strand, the 5'-3' pattern must be used; thus a small discontinuity occurs and an Okazaki Fragment forms. On the lagging (retrograde) strand, the DNA is systhesized in short (1-5kb) fragments, the so called Okazaki fragments. These fragments are processed by the replication machinery to produce a continuous strand of DNA and hence a complete daughter DNA helix.
Comments
Please note that synthesis of lagging strand involves DNA polymerase I, but the Okasaki fragments of the lagging strands are synthesized by DNA polymerase III
E.Coli
Mammalian
Function
I
a
Gap Filling and synthesis of lagging strand
II
e
DNA Proofreading and repair
b
DNA repair
g
Mitochondrial DNA synthesis
III
d
Processive leading strand synthesis
Tips
Reiji Okazaki  was a Japanese molecular biologist known for his research in DNA replication and especially for describing the role of so-called Okazaki fragments which he discovered working with his wife Tsuneko Okazaki in 1968.

Von Gierke disease - A child presents with Massive hepatomegaly, hypoglycemia, and there is no improvement with Glucagon.

Question 30
A child presents with Massive hepatomegaly, hypoglycemia, and there is no improvement with Glucagon. The probable diagnosis is
a.       Von Gierke disease
b.      Mcardle
c.       Cori
d.      Forbe
Answer
a) Von Gierke
Reference
Harper 27th Edition Pages 166, 308, table 19.2
Table 73.1 Nelson 15th Edition Table 350-1 Harrison 15th Edition
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Glycogen storage disease type I or von Gierke's disease, is the most common of the glycogen storage diseases. This genetic disease results from deficiency of the enzyme glucose-6-phosphatase. This deficiency impairs the ability of the liver to produce free glucose from glycogen and from gluconeogenesis. Since these are the two principal metabolic mechanisms by which the liver supplies glucose to the rest of the body during periods of fasting, it causes severe hypoglycemia. Reduced glycogen breakdown results in increased glycogen storage in liver and kidneys, causing enlargement of both. Both organs function normally in childhood but are susceptible to a variety of problems in the adult years. Other metabolic derangements include lactic acidosis and hyperlipidemia. Frequent or continuous feedings of cornstarch or other carbohydrates are the principal treatment. Other therapeutic measures may be needed for associated problems.
Explanation
Self Explanatory
Comments
GSD No
Name
Enzyme Affected
Tissue Distribution of
Excessive Glycogen and
Enzyme Deficiency
Clinical Symptoms
and Signs
Comments
GSD Ia
Von Gierke disease,
Glucose-6-phosphatase
Liver, kidney, intestine; frequent intranuclear glycogen seen in
  these organs not diagnostic; continuous nighttime feeding by
  tube and pump may alleviate clinical symptoms; portacaval
  shunt risky and clinically disappointing; treatment with
  phenytoin or phenobarbital ineffective
Enlarged liver and kidneys; "doll face," stunted growth,
  normal mental development; tendency to hypoglycemia, lactic
  acidosis, hyperlipidemia, hyperuric acidemia, gout, bleeding;
  IV* galactose or fructose not converted to glucose (caution:
  these tests may precipitate acidosis); abortive or no rise in
  blood glucose after SC† epinephrine or IV glucagon; normal
  urinary catecholamines; prognosis fair to good
hepatorenal glycogenosis; no
  involvement of skeletal or cardiac muscle, or of leukocytes or
  cultured skin fibroblasts (glucose-6-phosphatase not normally
  present in these tissues)
  GSD Ib
In vitro activity of glucose-6-phosphatase is
    normal, but translocase is deficient
 
Activity of glucose-6-phosphatase is normal in frozen liver
  homogenate but is not demonstrable in isotonic homogenate
  of fresh liver tissue that has never been frozen
Symptoms are as those of GSD Ia; in addition, frequent
  neutropenia
Transport defect for glucose-6-phosphate at microsomal
  membrane
GSD Ic
In vitro activity of glucose-6-phosphatase
    can be demonstrated
Activity of glucose-6-phosphatase is normal in frozen liver
  homogenate but is deficient in isotonic homogenate of fresh
  liver tissue that has never been frozen
The patient, an 11-yr–old girl, had hepatomegaly, brittle
  diabetes, frequent hypoglycemia
Transport defect for inorganic phosphate at microsomal
  membrane
Tips
The hypoglycemia of GSD I is termed "fasting", or "post-absorptive", meaning that it occurs after completion of digestion of a meal-- usually about 4 hours later. This inability to maintain adequate blood glucose levels during fasting results from the combined impairment of both glycogenolysis and gluconeogenesis. Fasting hypoglycemia is often the most significant problem in GSD I, and typically the problem that leads to the diagnosis. Chronic hypoglycemia produces secondary metabolic adaptations, including chronically low insulin levels and high levels of glucagon and cortisol.