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Trotter's Triad

# Trotter's triad is seen in:
a) Angiofibroma
b) Nasopharyngeal carcinoma
c) Laryngeal carcinoma
d) Growth in fossa of Rosenmuller



The correct answer is B. Nasopharyngeal carcinoma.

Trotter's triad:
1) Conductive deafness (Eustachian tube blockade)
2) lpsilateral temporoparietal neuralgia (Cranial Nerve V)
3) Palatal paralysis (Cranial Nerve X)

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Nasopharyngeal carcinoma virus

#The virus associated with nasopharyngeal carcinoma is:
a) Epstein Barr
b) Cytomegalo virus
c) Hepatitis
d) Herpes virus


The correct answer is A. Epstein Barr.

Nasopharyngeal carcinoma affects younger age group and half of the patients will present with secondaries in neck.

Epstein-Barr virus is also implicated as an etiological factor for Burkitts Lymphoma and infectious mononucleosis.

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Punched out edge of ulcer

# Punched out edge is characteristic of which type of ulcer?
a) Tuberculosis
b) Rodent
c) Syphilitic
d) Non specific


The correct answer is C. Syphilitic.


  •  Non-specific ulcer = Shelving edge
  • Tuberculous ulcer = Undermined edge
  • Rodent ulcer = Raised, pearly white and beaded 
  • Squamous cell carcinoma = Rolled out, everted 
  • Syphilitic = Punched out edge; Base covered with wash leather slough




Cellular response to Stress and Noxious Stimuli

Cellular responses to stress and noxious stimuli:
Normal cells handle normal physiologic demands, maintaining a steady state called homeostasis.

More severe physiologic stresses and some pathologic stimuli may bring about a number of physiologic and
morphologic cellular adaptations, during which new but altered steady states are achieved, preserving the viability of the cell.

The adaptive response may consist of an increase in the number of cells, called hyperplasia, increase in the
sizes of individual cells, called hypertrophy.

Conversely, Atrophy is an adaptive response in which there is a decrease in the size and function of cells.

Nature of the stimulus and Cell response/adaptation towards it
- Increased demand = Hyperplasia and hypertrophy
- Decreased nutrients and stimuli = Atrophy
- Chronic irritation = Metaplasia
- Reduced oxygen supply, chemical and microbial injury = Acute reversible injury
- Progressive damage including the DNA = Necrosis and Apoptosis
- Metabolic alterations = Intercellular accumulations and calcification

Mechanism of plasma membrane damage in ischemia

# The major mechanism of damage to plasma membrane in ischemia is:
A. Reduced intracellular pH
B. Increased intracellular accumulation of sodium
C. Increased Ca++ ions in the cytosol
D. Reduced aerobic respiration


The correct answer is C. Increased Ca++ ions in the cytosol.

The ion calcium is critical for cell damage. Influx of calcium acts as second messenger and activates wide spectrum of enzymes that destroy cellular organelles.

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Most reactive free radical

# Out of the various free radical species, the following radical is most reactive:
A. Super oxide (O2
B. Hydrogen peroxide (H2O2
C. Hydroxyl (OH-
D. Nitric oxide (NO)


The correct answer is C. Hydroxyl ion.

Important mechanism of cell injury is by damage to DNA, proteins, lipid membranes, and circulating lipids (LDL) by peroxidation caused by oxygen derived free radicals--super oxide anion (O2-), hydroxy radical (OH-), and hydrogen peroxide (H2O2). Hydroxyl ion is most reactive.

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Folic acid deficiency

# Folic acid deficiency is associated with administration of:
A. Phenytoin
B. Chloramphenicol
C. Isoniazide
D. Streptomycin


The correct answer is A. Phenytoin.

Folic acid deficiency can be caused by drugs that interfere with folate absorption or metabolism. Phenytoin, some other anticonvulsants, oral contraceptives, and isoniazide can cause Folic acid deficiency by interfering with Folic acid absorption. Other drugs such as methotrexate and, to a lesser extent, trimethoprim and pyrimethamine, inhibit dihydrofolate reductase and may result in a deficiency of folate cofactors and ultimately in megaloblastic anemia.

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